CRF.ppt
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Transcript of CRF.ppt
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CHRONIC RENAL FAILURE
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Chronic renal failure involves progressive, irreversible destruction of the nephrons. The end result is a systemic disease that affects every body organ…...
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ESRD Fact
• African Americans and Native Americans have highest incidence of ESRD.
• African Americans more likely to develop ESRD from hypertension
• Native Americans more likely to develop ESRD from Diabetes.
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Stages of Chronic Renal Failure
• Diminished Renal Reserve
• Renal Insufficiency
• End-stage Renal Disease (ESRD)
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Body System Effects
Neurologic System
• Depression of CNS – lethargy– apathy– decreased ability to concentrate– altered mental ability
• Peripheral neuropathy
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Body System Effects
Fluids, Electrolytes, Acid-base
• Hyperkalemia
• Calcium
• Magnesium
• Sodium
• Metabolic acidosis
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Body System Effects
Cardiovascular System
• hypertension
• edema
• acceleration of atherosclerotic vascular disease
• CHF
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Body System Effects
Respiratory System
• dyspnea
• pulmonary edema (from CHF)
• uremic lung
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Body System Effects
Hematologic System
• Anemia
• Bleeding Tendencies
• Infection
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Body System Effects
Urinary System
• Early sign is polyuria and specific gravity decreases due to inability to concentrate urine.
• Later signs - oliguria and/or anuria
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Body System Effects
Gastrointestinal System
• Inflammation of the GI tract
• Ulcers
• Anorexia, nausea
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Body System Effects
Musculoskeletal System
• Renal Osteodystrophy– osteomalacia– Osteitis fibrosa– metastatic calcification
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Body System Effects
Integument System
• yellowish discoloration to skin
• pruritis
• uremic frost
• ecchymosis
• dry & brittle hair
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Body System Effects
Reproductive System
• decreased libido
• decreased sexual function
• females: anovulation/menstrual changes
• males: decreased testosterone
• improved with dialysis
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Psychologic Effects
• Personality & Behavior changes
• Withdrawal
• Depression
• Body Image
• Dull affect
• Grief
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Collaborative Treatment - CRF
• PC: Fluid Management
• PC: Electrolyte Imbalances
• PC: Hypertension
• PC: Anemia
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PC: Fluid Imbalances
• Fluid restriction
• Dialysis
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PC: Electrolyte Imbalances
• Hyperkalemia
• Hypocalcemia
• Phosphate excess
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PC: Hypertension
• Antihypertensive agent most commonly used are: – calcium channel blockers – ACE inhibitors
• Be cautious about causing hypotension
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PC: Anemia
Anemia due to decreased production of erythropoietin.
• Administration of Erythropoietin - IV or SQ
• Monitor hemoglobin & hematocrit
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Nursing Diagnoses
• Impaired skin integrity
• Risk for injury
• Activity intolerance
• Risk for infection
• Anticipatory Grieving
• Self-esteem disturbances
• Risk for sexual dysfunction
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Altered Nutrition
• Special Dietary Needs– fluid restriction– protein restriction– sodium restriction– potassium restriction
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Dialysis
• Treatment to correct fluid and electrolyte imbalances and remove waste products in renal failure.– Peritoneal Dialysis (PD)– Hemodialysis Dialysis (HD)
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General Principles of Dialysis
Solutes and water move across the membrane from the blood to the dialysate– Diffusion– Osmosis
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Peritoneal Dialysis
• Peritoneum acts as semi-permeable membrane for exchange
• Different PD systems APD & CAPD
• Dialysis Exchange– infusion– dwell– drain
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Problems with Peritoneal Dialysis
• Infection, Infection, Infection• (Did someone say infection?)
• mechanical problems
• abdominal discomfort
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Hemodialysis
Vascular Access– Shunts– AV Fistula’s and
Grafts– Vascular access
catheters
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Dialysis Procedure
• Take blood out of arterial side - send to dialysis unit.
• Blood enters unit, filtered with dialysate, and returned to vein.
• Process takes 3-4 hours.
• Unit removes various amount of fluid - usually no more than 1.0-1.5 kg wt.
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Complications HD
• Hypotension
• Hepatitis
• Sepsis
• Blood loss
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Renal Failure Summary • ARF can lead to :
– Death
– Normal recovery ( may take 12 months)
– Chronic Renal Failure
• CRF treated by – PD, CAPD
– HD
– Transplantation
• EVERY BODY SYSTEM AFFECTED