Uremia. DAWFPIGZ

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1. CHRONIC KIDNEY DISEASE: Stage 5 UREMIA

2. Presented By: Alamares , Faye Russeth A. Dela Cruz, Alyssa Mae C. Enriquez, Wilson T. Idris , Paulo C. Jairulla , Zharima A. Larracochea , Georvi P. Saclolo , Kenneth Ivan P. Serabani , Dharmina S.

3. INTRODUCTION

4. Uremia a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function. The term uremia, literally means urine in the blood.

5. rank as the number 10 killer in the Philippines causing death to about 7,000 Filipinos every year. The population of Filipinos aged 20 years and above in 2005 was 46,627,172. A prevalence of 2.6% means that 1,212,306 adult Filipinos have CKD.

6. Normal Function of Kidney Shape and Location Kidneys are bean-shaped organs, each about the size of your fist. Located near the middle of your back, just below the rib cage.

7. Function The kidneys are sophisticated trash collectors. For filtration. It measure out chemicals.

8. Kidneys release three important hormones: Erythropoietin Renin The active form of vitamin D.

9. Urine is formed through three processes that occur in the kidney:  Ultrafiltration Reabsorption Secretion

10. PATHOPYSIOLOGY

11. UREMIA Is a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function. Uremia more commonly develops with chronic renal failure (CRF) or the later stages of chronic kidney disease  (CKD) Uremia usually develops only after the creatinine clearance falls to less than 10 mL /min, although some patients may be symptomatic at higher clearance levels, especially if renal failure acutely develops.

12. In   Uremia   stage, nitrogen metabolites and other toxic material cannot be discharged out of body, so they deposited and cause disorder of water, electrolyte and acid-base balance and pathological changes of many organs and systems. Digestive system Pathological changes to heart and lungs Hemopoietic system Skeletal system Skin The nervous system

13. Stages of Chronic Kidney Disease

14. ASSESSMENTS

15. APPEARANCE Grooming: poor Attire: Hospital gown Personal Hygiene: poor hygiene Gait: Slow in movement with assistance Posture: Client was on bed General Body Built: Small Build

16. BEHAVIOR Level of Consciousness: ( / ) awake ( / ) alert ( / )aware & responsive to internal & external stimuli ( / ) lethargic Facial Expression: Weak looking Speech: Low voice Mood: Client was irritated, moody Affect: Respond according to move

17. SKIN INSPECTION Color: (/ ) Flushed ( / ) Pale Texture: dry Tone: fair Edema: ( / ) Present Site : lower extremities, , legs

18. CARDIOVASCULAR >BP: 160/100 PSYCHOLOGICAL >Calm:( / )Yes >Anxious:(/ )Yes >Angry: ( / ) Yes >Withdrawn: (/) No >Irritable: ( / ) Yes >Fearful:( / ) Yes

19. >Feeling of Helplessness: ( / ) Yes >Hopelessness:(/ ) Yes >Powerlessness: ( / ) Yes >Tobacco Use: ( / ) Yes NUTRITION Nausea: ( / ) Yes Vomiting (/ ) Yes

20. Location of Pain: Chest Frequency: when the patient fail to use her oxygen inhalation. Intensity- Pain Scale (0 -10): 6 Onset: (When did your pain started?): 6 months ago when she was admitted with the same reason. Alleviating Factors: _nasal inhalation Precipitating Factors: she uses the nasal canula again._

21. Patient’s Personal Data

22. Name: T.C. Age: 48 Sex: Female Date of Birth: May 20,1963 Status: Married Ethnicity: Tausug Religion: Muslim Address: Mampang , Zamboanga City Chief Complain: Difficulty of breathing Clinical Impression: Uremia secondary to chronic kidney disease in cresenticglomerulonephritis Diagnosis: CKD stage 5 (Uremia) Date Admitted: July 2. 2011 Discharge Date: July 10,2011 Attending Physician: Dr. AfdalKunting MD

23. Gordon’s 11 Functional Health Patterns

24. I. Health Perception and Management

25. II. Nutritional Metabolic

26. III. Elimination Pattern

27. IV. Activity and Exercise

28. V. Sleep and Rest

29. VI. Cognitive Perceptual

30. VII. Self-Perception

31. VIII. ROLE Relationship

32. IX. Sexual Productive

33. X. Coping and Stress Tolerance

34. XI. Value Belief Pattern

35. Laboratory Results

36. Complete Blood Count Examination Actual Results Normal Value HEMOGLOBIN 106 M 140-170 F120-150 HEMATOCRIT 0.3 M 0.42-0.52 F 0.37-0.47 RED BLOOD CELLS 3.65 4.0-5.2 WHITE BLOOD CELLS 8.32 5.0-10.0 SEGMENTERS 0.92 0.35-0.65 LYMPHOCYTES 0.05 0.23-0.35 EOSINOPHILS 0.02-0.06 BASOPHILS MONOCYTES 0.03 0.01-0.02 BLOOD TYPING “A POS” MCV 81.4 M 80-94 F 81-99 MCH 29 27.0-31.0 MCHC 35.7 33.0-37.0

37. Complete Blood Count EXAMINATION ACTUAL RESULT NORMAL VALUE HEMOGLOBIN 71 M 140-170 F 120-150 HEMATOCRIT 0.21 M 0.42-0.52 F 0.37-0.47 RED BLOOD CELLS 2.45 4.0-5.2 WHITE BLOOD CELLS 6.45 5.0-10.0 SEGMENTERS 0.84 0.35-0.65 LYMPHOCYTES 0.11 0.23-0.35 EOSINOPHILS 0.02-0.06 BASOPHILS 0-0.05 MONOCYTES 0.05 0.01-0.02 PLATELET 155 175-350 MCV 86.1 M 80-94 F 81-99 MCH 29 27.0-31.0 MCHC 33.6 33.0-37.0

38. URINALYSIS EXAMINATION RESULT NORMAL VALUECREATININE CREATININE 11.43 0.6-1.2 SODIUM 140 136-145 POTASSIUM 3.8 3.6-5.1

39. NURSING CARE PLANS Excess fluid volume related to decreased urine output. Anxiety related to present condition (Chronic Kidney Disease) Imbalanced Nutrition: Less then body requirements related to dietary restrictions. Fatigue related to long hours of hemodialysis procedure Knowledge deficit R/T cognitive limitation of the disease process and its treatment.

40. DRUG STUDY Verapamil ( Antianginal ) For angina pectoris and hypertension 2. Amlodipine ( Antianginal ) For chronic stable angina and hypertension

41. 3.Clyndamycin ( Anti- infectives ) For infections caused by streptococci, pneumococci , and staphylococci organisms. 4. Metaclopromide ( Antiemetics ) For prevention or reduction of nausea and vomiting.

42. 5. Furosemide (Diuretics) For edema and hypertension. 6. Clonidine (Antihypertensive) For essential and renal hypertension.

43. 7. Paracetamol ( Nonopiod analgesics and antipyretics) For mild pain or fever. 8. Calcium Carbonate (Antacids, adsorbents and antiflatulents ) For antacid and calcium supplement.

44. 9. Sodium bicarbonate (Acidifiers and alkalinizers ) For metabolic acidosis, systemic or urinary alkalization, and antacid. 10. Erythropoeitin ( Immunomodulation drugs) For anemia from reduced production of erythropoeitin caused by enstage renal disease.

45. EVALUATION

46. THANK YOU! 