chronic kidney failure.pptx .

M jyothi
2nd year bsc nursing
BBC college of nursing
Gangavathi

1. CHRONIC KIDNEY FAILURE Presented by, Ms m.jyothi 2 nd year Bsc Nursing BBC College of Nursing Gangavathi. Supervised by, Mr George D Honnalli Dept.of Medical Surgical Nursing BBC College of Nursing Gangavathi.

2. Introduction -Chronic kidney failure also called as chronic renal failure -Is a long term condition characterized by the gradual loss of kidney function over time.

3. Definition Ckf defend as a rapidly progressive deterioration or a loss of renal function in which the bodies ability to maintain metabolic , fluid , electrolyte balance fails, resulting in uremia and azote mia over a period of months or years this is characterised by a slow , insidious , ir reversible impairment of renal function

4. Causes and risk factors Family history of kidney disease Chronic glomerulonephritis Diabetes mellitus Hypertension Chronic Pyelonephritis Polycystic kidney disease Renal failure Autoimmune disorder Recurrent UTI infections Drug toxicity Reflux nephropathy

5. Pathophysiology Due to etiological factors renal function declines ⬇️ Nephron damage is progressive, damaged nephron cannot function ⬇️ Decreased glomerular filtration rate ⬇️ Remaining nephrons undergo changes to compensate for those damaged nephrons ⬇️ Compensatory excretion continues as GFR diminished ⬇️

6. Filtration of more concentrated blood by the remaining nephrons ⬇️ Damage of nephrons results in hypertrophy ⬇️ Urine may contain abnormal amount of protein, RBC, WBC ⬇️ Increased serum creatinine, BUN level, retention of urea ⬇️ Further 80 to 90% nephrons damage occur and GFR 10 to 20% ⬇️ CHRONIC RENAL FAILURE

7. ■"reduced renal reserve" : refers to the early stage of kidney damage where the kidneys have lost some functional capacity but are still able to maintain normal levels of function. At this stage, patients may not show any symptoms, but the kidneys are working harder to compensate for the loss of function. ■ Renal insufficiency: it occurs when the patient lost 75% of nephrons function and signs of mild renal failure are present, BUN and creatinine levels increased. ■ End stage renal disease: 90 % of nephrons are lost, dialysis and kidney transplant is required, uremia is present.

8. STAGES OF CHRONIC KIDNEY FAILURE

9. Clinical manifestations ■Chronic renal failure usually produces symptoms when renal function, which is measured as the GFR falls <30ml/min ■When GFR slows to below 30ml/min,signs of uremia may become noticeable. ■Uremic symptoms can affect every organ system.

10. Neurological system: Cognitive impairment,Inability to concentrate, Seizures, Confusion,Disorientation GI system: Nausea and vomiting, Mouth ulceration and bleeding, Anorexia,Ammonia odour to breath, constipation & diarrhoea Blood forming system: Anemia due to Erytropoiten deficiency, easy bruising, bleeding due to abnormal platelets Respiratory system : Fluid in the lungs,breathing difficulty, thick sputum,uremic pneumonitis,tachypnea Cardiovascular symptom: Chest pain due to pericarditis, pericardial effusion, hypertension, pitting edema, hyperkalemia,hyperlipidemia Integumentary system: Pruritis,dry flaky skin, thin hair,Ecchymosis, purpura, brittle nails.

11. Other symptoms:

12. Diagnostic evaluation: ■laboratory test: Serum creatinine Estimated GFR BUN Urinalysis Electrolytes & acid-base balance CBC: haemoglobin level ■ other tests: PTH test

13. Imageing studies: ■CT Scan

14. ■ ultrasound

15. ■kidney biopsy:

16. Management: Goal: the main goal of the treatment should be to reduce the progression of the Gfr further. ■ PHARMACOLOGICAL MANAGEMENT: >diuretic: furosemide >phosphate binders: calcium carbonate and calcium acetate >synthesis Erytropoiten is used to stimulate the bone marrow to produce RBC. >antihypertensive drugs(ACE inhibitors): lisinopril >iron & folic acid supplements >antipruritics: Trimeprazine or diphenhydramine >calcium &VIT-D supplements >methylcellulose to reduce constipation

17. Other therapies include: Emergency pericardiocentesis Thoracentesis Peritoneal or hemodialysis may be performed to control ESRD.

18. Non pharmacological management: Low protein diet ( to limit the accumulation of end product of protein metabolism that the kidney cannot excrete For patient on continuous peritoneal dialysis however a high protein diet is recommended A high calorie diet that used to prevent ketoacidosis and tissue atrophy Sodium, potassium, phosphate restriction diet like Banana, orange, Potato, spinach, salt, beans, nuts.

19. Surgical management Kidney transplant

20. Nursing management: Monitor vital signs Monitor intake and output chart Monitor weight daily at same time Assess for breath sounds Assess skin, face and dependent areas for edema Encourage high calorie, low protein, low sodium and low potassium diet

21. NURSING DIAGNOSIS ■Ineffective renal perfusion related to hypertension as evidenced by oliguria. ■Imbalanced nutritional status less than the body requirement related to restriction of protein diet as evidenced by monitoring body weight ■fluid volume excess related to renal dysfunction as evidenced by edema

22. THANK YOU