Chronic Renal Failure

medical surgical, med surg, renal

Video Transcript 

Hi friends in this video, we're going to talk about chronic renal failure. And if you like this video, make sure to give it a thumbs up and subscribe below to my channel. I create new nursing content for pre-nursing students, nursing students and nurses, and we have new videos every week, but let's get into it.

So chronic renal failure. It's the end result of a gradual progressive loss of kidney function causes include chronic infections, vascular disease, such as hypertension, obstructive processes, such as renal, calculi, collagen diseases, such as systemic lupus, neuro nephrotoxic agents like different drugs and endocrine diseases such as diabetes or hyperparathyroid.

It's generally progressive and produces major changes in all of the body systems. And the final stage of renal dysfunction and stage renal disease is demonstrated by a glow meal filtration rate of 15% to 20% of normal or less and renal failure results. When the kidneys cannot remove the body's metabolic waste or perform regulatory functions.

So substances that are normally eliminated in the urine, accumulate in the body as a result of impaired renal excretion, affecting endocrine and metabolic functions, as well as fluid electrolyte and acid-base balance. Accumulation as renal function, declines the end products of protein metabolism, which are normally excluded in the urine accumulate in the blood adverse effects.

We'll see our uremia, which develops and adversely affects every system of the body. The disease tends to progress more rapidly and patients with significant amounts of protein or have elevated blood pressure, then those who do not. So the pathophysiology of chronic renal failure includes pathologic features such as fibrosis loss of renal cells, infiltration of renal tissues by monocytes or macro phases.

We can see. proteinurea hypoxia, extensive angiotensin to production, all contribute to the pathophysiology and an attempt to maintain the global filtration rate, the glomerular hyperfiltration which results in endothelial injury. you'll see proteinurea results from increased glomerular, permeability and increased capillary pressure.

And hypoxia also contributes to disease progression angiotensin two increases glow meal, hypertension, which further damages the kidneys. So this is a nice chart overview of that path of physiology. You can see the hyperfiltration of the glomerular it's going to in crease, the glomerular permeability, which increases the filtration of proteins.

And. Macromolecules, which leads to nefrotoxic inflammation or remodeling or protein, urea and dyslipidemia. Or I will see an increase in RAAS which will lead to nephrotoxic inflammation. And remodeling. So both of them lead to that. And once this happens, you'll see that Tubulointerstitial , fibrosis, and you'll see the decreased glomerular filtration rate, decreased urine output and systemic complications.

So predisposing factors for chronic renal failure include diabetes being aged sixty or older kidney disease present at birth, a family history of kidney disease, an autoimmune disorder, a bladder outlet obstruction. And there are differences when it comes to race as well. Precipitating factors. So occupational hazards such as overexposure to toxins and some medications.

A sedentary lifestyle, which increases hypertension and atherosclerosis and a diet.

So clinical manifestations, we may see peripheral neuropathy. This is a disorder of the peripheral nervous system that is present in some patients they'll have like pins and needles in their fingers or their feet. Severe pain and discomfort. They may have restless leg syndrome and burning.

They may report burning feet can occur in the early stages and that's due to the peripheral neuropathy. So different complications of chronic renal failure include hyperkalemia due to decreased excretion, metabolic acidosis. And excessive intake such as diet medications, or different fluids pericarditis due to retention of uremic waste products and inadequate dialysis, hypertension due to sodium and water retention and the malfunction of the renin angiotensin aldosterone system anemia due to decrease Erythropoietin production, decreased red blood cell lifespan.

Bleeding in the gastrointestinal track from irritating toxins and ulcer formation and blood loss during hemo dialysis and also bone disease and metastatic and vascular calcifications due to retention of phosphorus, low sodium calcium levels, normal vitamin D metabolism and elevated aluminum levels.

So assessment and diagnostic findings. So the filtration rate in creatinine clearance decreases while serum creatine, which is a more sensitive indicator of renal function and bun levels increase. Sodium and water retention. Some patients retain sodium and water increasing the risk of edema heart failure and hypertension, acidosis metabolic acidosis occurs in end stage renal disease because the kidneys are unable to excrete increased loads of.

And anemia and end stage renal disease cause of Erythropoietin and production decreases and profound anemia results, producing fatigue angina and shortness of breath.

So we can also look at the urine. So usually in the stage of olguria, we'll see 400 milliliters in 24 hours. Or urine may be absent, which is anuria. The color may be abnormally, cloudy, and may be caused by pus bacteria, fat, different particles, phosphates, or urates. It could be dirty and brown and have sediment such as red blood cells, hemoglobin myoglobin.

Specific gravity is usually less than 1.015. And if it's less than 1.010, it reflects severe renal damage and osmolality less than 350 is indicative of tubular damage. And you're in certain ratios. Usually one-to-one. Creatinine clearance may be significantly decreased less than 80 milliliters per minute in early failure, but less than 10 liters per minute in end stage renal disease sodium more than 40, because kidney is not able to reabsorb the sodium and protein high grade protein.

Urea strongly indicates colonial damage when red blood cells and casts are also present.

So we can also look at the blood. We will usually see a bun or creating an elevated, usually in proportion, creatinine level of 12 suggests end stage renal disease. A bun of less than 25 is indicative of renal damage. If we look at a CBC the hemoglobin decreases because of anemia, usually less than seven or eight.

Red blood cells, lifespan decreases because of Erythropoietin and deficiency. We can look at ABGs. The pH will be decreased metabolic acidosis if less than 7.2. This occurs because of the loss of the renal ability to excrete, hydrogen and ammonia, or end products of protein catabolism by carboning and P C O two.

Is decreased serum. Sodium may be low if kidney wastes, sodium or normal reflecting dilution, state up hypernatremia and potassium may be elevated related to retention and cellular shifts in acidosis or tissue release red blood cell hemolysis and end stage renal disease. We can see ECG changes.

If potassium is 6.5 or higher potassium may also be decreased in patients on potassium sparing diuretics, or when patients are receiving dialysis, magnesium and phosphorus are usually elevated and calcium to phosphorus could be decreased.

All right. So assessment and diagnostic findings. So proteins, usually albumin is decreased. Serum levels may reflect protein loss via urine fluid shifts, decrease intake, or decreased synthesis because of the lack of essential amino acids serum osmolarity is usually higher than 285 K U B. X-rays demonstrates the size of the kidney ureters bladder in presence of obstruction or stones.

Retrograde pyelogram outlines the abnormalities of the renal pelvis and the ureters renal arteriogram assesses, renal circulation, and identifies vascularity is masses. Avoiding cystourethrogram. She has bladder size reflects into ureters and retention. Renal ultrasound determines the kidney size and presence of masses, cysts obstructions in the upper urinary tract.

A renal biopsy may be done endoscopically to examine tissue cells for histological diagnoses, renal and disc. Or an nephroscope is done to examine the renal pelvis and flush out calculi hematuria and remove selected tumors. And ECG may be abnormal reflecting electrolyte and acid-base amounts is, and we can also do x-rays of the.

Or skull or spine enhanced reveal, any calcifications or demineralization resulting from electrolyte shifts?

Sorry. Okay, here we go. So medical management, the goal of. Management is to maintain kidney function or homeostasis as long as possible. So pharmacological therapy includes calcium and phosphorus binders, which will treat hyperphosphatemia and hypocalcemia. We can use antihypertensive and cardiovascular agents such as digoxin or dobutamine mean to manage hypertension.

We can use anti-seizure agents such as. Phenotyping or IV Ativan are used for seizures. erythropoietin used to treat anemia associated with end stage renal disease, nutritional therapy. So dietary interventions include carefully regulating the protein intake fluid intake to balance fluid loss, sodium intake to balance sodium loss and some restrictions on potassium.

Also dialysis is usually initiated. If the patient cannot maintain a reasonable lifestyle without a consecutive treatments.

So nursing assessment, we want to assess fluid intake and fluid status, assess nutritional dietary patterns, nutritional state, understanding of the cause of renal failure and its consequences and his treatment assessing. The patient and family's response to restrictions that because of treatments and the illness and assess for signs of hyperkalemia.

These are just some different nursing diagnoses that we could use with these patients. So excessive fluid volume related to decreased urine output, dietary, excess, and retention of sodium and water. Imbalanced nutrition, less than bodies requirements related to anorexia nausea, vomiting, dietary restrictions, and altered oral mucous membranes, activity, and tolerance related to fatigue, anemia, retention of waste products in dialysis procedures.

And risk for situational low self-esteem related to dependency. Role change changes in body image and changes in sexual function. So planning and goals for these patients are to maintain an ideal body weight without excessive fluid maintenance of adequate nutritional intake participation in activity within tolerance and improved.

Self-esteem. Nursing priorities include maintaining homeostasis, preventing complications, providing information about the disease process and prognosis and treatment needs and support adjustments to lifestyle changes. So our nursing interventions can include assessing the fluid status and identifying potential sources of imbalance.

Implemented dietary program to ensure proper nutritional intake within the limits of treatment regimen, promote a positive feeling by encouraging increased self-care and greater independence and promote intake of high biologic value, protein foods, such as eggs, dairy products and meats, and after scheduled of medications so that they are not given immediately before.

And rest, encourage alternating activity with rest. So our evaluation of these interventions will include maintained ideal body weight without excessive fluid maintained, adequate nutritional intake participated in activity and within times and improved self-esteem. And again, these are just some examples because this is going to be based on how your individual patient responded to the interventions.

And discharge in home care guidelines. So the patient should be taught how to check the vascular access device for patency and provide appropriate precautions, such as avoiding venipuncture and blood pressure measurements on the arm with the access device. So this is for a patient who has dialysis. If they have a vascular access device.

This is usually in their arm and we want to teach them how to care for it. So problems to report the patient and the family need to know what problems to report nausea, vomiting changes in usual urine output ammonia odor on breath, muscle weakness, diarrhea, abdominal cramps, a clotted, fistula, or graft and signs of infection.

We also want to provide follow-up exams and. Treatment is stressed to be patient and stresses to the patient and family because changing physical status and renal function and dialysis requirements are all things that need to be monitored and home care referrals. So referral to any home care, to help assess the patient in any of their changing statuses.

And documentation guidelines. We want to make sure to document on existing conditions that contribute to and degree of fluid retention, I and O, and fluid balance results of lab tests, calorie intake, individual cultural, or religious restrictions and personal preferences, level of activity, plan of care, and teaching plan responses to interventions and teaching actions performed attainment of progress towards goals and outcomes.

Modifications to the plan of care and a longterm eats. All right. And that is the end of chronic renal failure. If you guys liked this video, make sure to subscribe and check out down below. I have a lot of free resources on my website, as well as an NCLEX study guide. I have a free pharmacology notebook.

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