Theory-ATI-CKD - A system disorder sheet focused on risk factors, s/s, nursing treatment/care, PDF

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Summary

A system disorder sheet focused on risk factors, s/s, nursing treatment/care, diagnosis, and patient education....

Description

Chronic Renal Failure Description: CKD is a progressive, irreversible kidney disease. Because the kidneys are highly adaptive, CKD is not often recognized until there has been considerable loss of nephrons. Individuals w kidney disease are frequently asymptomatic, resulting in CKD being underdiagnosed and untreated.

Risk Factors - CKD has many leading causes; the leading causes are diabetes (50%) and HTN (25%). - Less common include glomerulonephritis, cystic diseases, and urological diseases. - HTN, especially in African Americans - Chronic glomerulonephritis - Polycystic kidney disease/Cystic diseases - Acute kidney injury - Nephrotoxic medications (gentamicin, NSAIDs) or chemicals - Autoimmune disorders (systemic lupus erythematosus) - Pyelonephrosis - Renal artery stenosis - Recurrent severe infections - Obesity - Older clients are at increased risk for CKD related to aging process (decreased number of functioning of nephrons, decreased GFR) Symptoms/Manifestations Pt. 1:

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Urinary System o Early stages of CKD, no change in urine output. o Since Diabetes is the main cause of CKD, polyuria may be present o As CKD progresses, fluid retention will occur, and diuretic therapy is needed. o After dialysis, anuria may occur. Metabolic Disturbances o Waste Product Accumulation: as GFR decreases, BUN and creatinine levels increase. Polyuria may be present and as CKD progresses fluid retention may occur. Anuria may occur post dialysis. o Altered Carb Metabolism: mild to moderate hyperglycemia and hyperinsulinemia may occur. o Elevated Triglycerides: increased VLDLs, increased HDLs. Most CKD pts die from CV disease. Electrolyte and Acid-Base Imbalances o Potassium: hyperkalemia due to decreased excretion of potassium by the kidneys o Sodium: diluted hyponatremia occurs when large amounts of water is retained o Calcium and Phosphate: o Magnesium: hypermagnesemia (generally not a problem unless pt is consuming magnesium) and manifestation can include absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure. o Metabolic Acidosis: average adult produces 80-

Symptoms/Manifestations: - All body systems are affected as kidney functions deteriorates. - Clinical manifestations are a result of retained urea, creatinine, phenols, hormones, electrolytes, and water. - Client with CKD can be free from manifestation except during periods of stress (infections, stress, trauma) Stages of Chronic Kidney Disease - Stage 1: kidney damage with normal or increase GFR o >/= 90 o Diagnosis and treatment, CVD risk reduction, slow progression - Stage 2: kidney damage with mild decrease GFR o GFR 60-89 o Estimation of progress - Stage 3A: Moderate decrease in GFR o GFR 45-59 o Evaluation and treatment of complications - Stage 3B: Moderate decrease in GFR o GFR 30-44 o More aggressive treatment of complications - Stage 4: Severe decrease in GFR o GFR 15-29 o Preparation for renal replacement therapy (dialysis, kidney transplant) - Stage 5: End Stage Kidney Failure (ESRD – End Stage Renal Disease) o GFR 4 lbs (2 kg) o increasing BP o shortness of breath o edema o increasing fatigue or weakness o confusion or lethargy  need for support and encouragement. Share concerns about lifestyle changes, living with chronic illness, and decision about type of dialysis or transplantation....