Disorder of Kidney

Subject: Medical and Surgical Nursing I (Theory)

Overview

Renal function gradually declines over months or years in a chronic kidney illness. Renal function is deteriorating, but it is reversible. Its causes include Glomerulo nephritis, Hypertension, and Diabetic Nephropathy. Weakness, fatigue, confusion, difficulty focusing, disorientation, seizure, restlessness, etc. are some of its symptoms. Glomerular filtration rate, albumin levels, etc. are used to diagnose it. For its therapy, antihypertensive medications, erythropoietin, iron and calcium supplements, phosphate binding agents, antacids, etc. are employed. Check for jugular vein enlargement, listen for rales in the lungs, rigidly monitor I/O, keep track of weight every day, and carefully assess peripheral edema when evaluating hydration status. Strict aseptic technique: keep an eye out for infection indicators (fever, leukocytosis), and stay away from patients who are sick.

Acute and Chronic Renal Disease

Renal function gradually declines over months or years in a chronic kidney illness. Renal function is deteriorating, but it is reversible.

Causes

  • Diabetic nephropathy
  • Hypertension
  • Glomerulonephritis
  • Others
  • Obstructive urine flow
  • Enlarged prostate, kidney stone or tumor
  • Kidney artery stenosis
  • Fetal developmental problems
  • Malaria and yellow fever
  • Some medication overuse (for ex NSAIDS) such as aspirin or ibuprofen
  • Injury/sharp blow or physical injury to the kidneys.

Four stages of decreased renal function in CKD

  • Silent-GFR up to 50 ml/min.
  • Renal insufficiency –GFR 25 to 50 ml/min.
  • Renal failure –GFR 5 to25 ml/min.
  • End –stage renal failure- GFR less than 5 ml/min

Pathophysiology

  • Protein metabolism byproducts build up in the blood.
  • Every system is negatively impacted by uremia as it grows.
  • The symptoms are more severe the more waste items accumulate.
  • Development of the latter stages renal illnesses.
  • Hypertension is present.
  • The condition tends to worsen.

Signs and Symptoms

  • Neurological
    • Weakness
    • Fatigue
    • Confusion
    • Inability to concentrate
    • Disorientation
    • Seizure
    • Restlessness
    • Behavioral changes
    • Burning of sole and feet
  • Cardiovascular
    • HIN
    • Pitting edema
    • Pericardial effusion
    • Enlarged neck veins
    • Periorbital edema
    • Hyperlipidemia
  • Pulmonary
    • Crackles
    • Thick tenacious sputum
    • Decreased cough reflex
    • Tachypnea
    • Pleuritic pain
  • Gastro – intestinal
    • Metallic taste
    • Mouth ulceration
    • Anorexia
    • Nausea
    • Vomiting
    • Hiccups
    • Constipation
    • Diarrhea
    • GI bleeding due to uremia
  • Hematology
    • Anemia
    • Bleeding tendency
  • Reproductive
    • Amenorrhea
    • Testicular atrophy
    • Decreases Libido
    • Infertility
  • Musculoskeletal
    • Muscle cramps
    • Loss of muscle strength
    • Bone pain
  • Integumentary System
    • Purpura
    • Urea is excreted by sweating and crystallizes on skin

Diagnosis

  • History taking
  • Measurement of:
    • Glomerular filtration rate
    • Albumin levels
    • Acquisition of radiologic studies

Medical Management:

  • Pharmacological therapy:
    • Antihypertensive drugs, erythropoietin, iron supplement, calcium supplement, phosphate binding agents, antacids etc.
  • Nutritional therapy:
    • Proteins are only permitted if they have a high biologic value and offer the essential amino acids needed for development and repair.
  • Fluids:
    • >500-600 ml than previous day's 24-hour urine output.
  • Dialysis

Nursing management:

  • Examine your fluid levels, probable imbalance sources, vital signs, edema, and anemia.
  • Inform the patient and their family about ESRD, available treatments, and potential side effects.
  • Encourage vegetables that are leaching, high in calories, low in proteins, and sodium.
  • The same as in ARF for the treatment of hyperkalemia, hyperphosphatemia, and metabolic acidosis
  • Use side rails and have a suction machine available at bed level while carefully monitoring seizure activity, evaluating neurological condition, and looking for symptoms of hypocalcemia such as chvostek's and trousseau's.
  • Check for jugular vein enlargement, listen for heartbeats in the lungs, strictly monitor I/O, keep a daily weight log, and carefully assess peripheral edema when evaluating hydration status.
  • Observe issues with the bones and joints, prevent pathology, and give passive ROM exercises.
  • To avoid pulmonary problems, deep breathing and coughing exercises are recommended.
  • Strict aseptic technique: keep an eye out for infection indicators (fever, leukocytosis), and stay away from patients who are sick.
  • Brush your teeth with a gentle brush to practice good oral hygiene.
  • Watch for prolonged bleeding at the puncture site and at the vascular access site used for dialysis. Look for symptoms of bleeding (petechial, echymoisis).
  • Watch for pericardial friction and chest pain as pericarditis symptoms to report.
  • Advice on diet for acute renal failure.
  • Get the patient ready for hemodialysis.
  • Exercises for passive ROM are provided to treat diseased conditions.

References

bpac.org.nz/BPJ/2012/september/ckd.aspx 

emedicine.medscape.com/article/238798-overview

en.wikipedia.org/wiki/Kidney_failure

patient.info/doctor/acute-on-chronic-kidney-disease

Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
Things to remember
  • A chronic kidney diseases is a progressive loss of renal function over a period of months or years. 
  • Some medication over use (for ex NSAIDS) such as aspirin or ibruprofen 
  • Urea is excreted by sweating and crystalizes on skin 
  • Encourage high caloric, low proteins, low sodium, leaching vegetables.
  • Fluids >500-600 mls than previous day's 24 hour urine output. 
  • Assess fluid status, potential source of imbalance, I/O, vital sign, edema, and anemia 
  • Good skin care including pericare.
  • Good oral hygiene: brush the teeth with soft brush. 
  • Deep breathing and coughing exercise to prevent pulmonary complications. 
Questions and Answers

Sign and symptom

Neurological

  • Weakness
  • Fatigue
  • Confusion
  • Inability to pay attention
  • Disorientation
  • Seizure
  • Restlessness
  • Behavioral alterations
  • Feet and soles are burned

Cardiovascular

  • HIN
  • Pitting swelling
  • Cardiovascular effusion
  • Extravasated neck veins
  • Edema around the eyes
  • Hyperlipidemia

Pulmonary

  • Crackles
  • Strong, thick sputum
  • Reduced coughing reflex
  • Tachypnea
  • Pleural discomfort

Gastro – intestinal

  • Metal flavor
  • A mouth ulcer
  • Anorexia
  • Nausea
  • Vomiting
  • Hiccups
  • Constipation
  • Diarrhea
  • GI bleeding brought on by uremia

Hematology

  • Anemia
  • Bleeding tendency

Reproductive

  • Amenorrhea
  • Testicular atrophy
  • Decreases Libido
  • Infertility

Musculo Skeletal

  • Muscle pain
  • Muscle strength decline
  • A bone ache

Integumentary System

  • Purpura
  • Urea is excreted by sweating and crystalizes on skin

 

Nursing Management

  • Examine your fluid levels, probable imbalance sources, vital signs, edema, and anemia.
  • Inform the patient and their family about ESRD, available treatments, and potential side effects.
  • Encourage vegetables that are leaching, high in calories, low in proteins, and sodium.
  • The same as in ARF for the treatment of hyperkalemia, hyperphosphatamia, and metabolic acidosis
  • Hypocalcaemia should be treated similarly to ARF (carefully monitor seizure activity, evaluate neurological condition, and look for chvostek's and trousseau's signs, which indicate hypocalcaemia: use side rails, make suction machine available at bed level)
  • Check for jugular vein enlargement, listen for rales in the lungs, rigidly monitor I/O, keep track of weight every day, and carefully assess peripheral edema when evaluating hydration status.
  • Observe issues with the bones and joints, prevent pathology, and give passive ROM exercises.
  • To avoid pulmonary problems, deep breathing and coughing exercises are recommended.
  • Strict aseptic technique: keep an eye out for infection indicators (fever, leukocytosis), and stay away from patients who are sick.
  • The use of pericare in good skin care.
  • To maintain good oral hygiene, clean your teeth gently.
  • Watch for prolonged bleeding at the puncture site and at the vascular access site used for dialysis. Look out for symptoms of bleeding (petechial, echymoisis).
  • Watch for pericardial friction and chest pain as pericarditis symptoms to report.
  • Advice on diet for acute renal failure.
  • Prepare the patient for dialysis; subsequently we'll talk about care before, during, and after dialysis.

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