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What is Chronic Renal Failure? (CRF)
Progressive, irreversible deterioration of renal function
What happens in (ESRD) End Stage Renal Disease?
-Kidneys are unable to excrete wastes and adequately regulatefluid and electrolyte balance
-results in uremia or azotemia
What is uremia?
accumulation in the blood of constituents normally eliminated in the urine that produces a severe toxic condition and usually occurs in severe kidney disease
What is azotemia?
an excess of urea and other nitrogenous wastes in the blood as a result of kidney insufficiency
What is the incidence of CRF?
-Increasing in all age groups by 8% per year in the last 5 years
-mortality rate >infants/children than in adults
What is the Etiology/Causes of CRF?
-Systemic Diseases (DM, HTN)
-Renal Disease (chronic GN, Pyelonephritis)
-Polycystic Kidney Disease (congenital disorder)
-Congenital renal/urinary tract malformations
-Envorinmental and occupational agents (lead, cadmium, mercury, chromium)
What is the pathophysiology of CRF?
-Dufuse BIL disease with progressive destruction and scarring of the nephrons
-Decline in function occurs over many months or years
-As renal function declines nitrogenous wastes accumulate in blood resulting in azotemia and uremia.
What are the 3 stages of CRF?
1)Reduced Renal Reserve (40-75% loss of nephron function)
2)Renal insufficiency (75-90% nephron function loss)
3)ESRD (final Stage-less than 10% nephron function)
What is the first stage of renal function and what are the symptoms?
-Reduced Renal Reserve (40-75% loss of nephron function)
-Usually no symptoms-other nephrons compensate for loss
What is the Second stage of renal function and what are the symptoms?
-Renal insufficiency (75-90% nephron function lost)
-Serum BUN and Creatinine RISE, loses ability to concentrate urine, anemia develops
-May develop polyuria and nocturia
What is the THIRD stage of renal function and what are the symptoms?
ESRD End Stage Renal Disease (final stage-less than 10% nephron function)
-impaired kidney processes (regulation, excretory, hormonal)
-Elevated Serum BUN/Cr, Electrolyte imbalances
-Dialysis indicated
What does a urinalysis in ESRD look like?
-Oliguria or Anuria
-Fixed specific gravity (1.010)
-Protenuria
-Hematuria
What other diagnostics and labs are indicated for ESRD?
-Sreum BUN/Creatinine levels elevated
-24-Hour urine for creatinine clearance
-ABG-Metabolic Acidosis-dt inability to rid acid and reabsorb bicard
-CBC-anemia dt decreased production of rbc, shortened lifespan of RBC, nutritional and bleeding
-Serum Ca decreases/Phosphorus increases/ K+ increases
-Renal US-Decreased kidney size
What are the results of the 24 hour urine for creatinine clearance like in ESRD?
-GFR declines dt damaged glomeruli
-Creatinine clearance value decreases
What are the neurological clinical manifestations of CRF?
Altered LOC, confusion, muscle twitching, restlessness in legs, seizures
What are the respiratory clinical manifestations of CRF?
congestion, RAPID-DEEP RR, SOB
What are the CVS clinical manifestations of CRF?
HTN, Tachycardia, JVD
What are the GI clinical manifestations of CRF?
anorexia, N&V, ulcers, UREMIC FECTOR BREATH, diarrhea
What are the muskuloskeletal clinical manifestations of CRF?
weakness, muscle cramps, bone pain, bone demineralization
What are the skin clinical manifestations of CRF?
Gray-Bronzing color, dry, pruritis, UREMIC FROST, BURNING SOLES OF FEET
What is uremic frost?
Powdery deposits of urea and uric acid salts on the skin, especially the face, usually the result of severe uremia
What are other clinical manifestations of CRF?
dental defects (kids), endocrine, reproductive, amenorrhea, decreased libido, infertility, -Immune system, decreased response
What is the GOAL for medical managment of CHF?
Thhe goal is to maintain remaining kidney function and homeostasis and prevent complications
Erythropoietin
(Epogen SC or IV 3 times week)
Phosphate Binders
(Antacids)
Calcium Carbonate Supplements
Sodium Bicarbonate
Acidosis
Antihypertensives/Diuretics
Digoxin / dobutamine
heart failure
Vitamin and iron supplements (water soluble)
Vitamin D
to increase Ca absorption
Human growth hormone for children
What is the diet/fluid managment for ADULTS in CRF?
-Fluids, Previous days urine output + 500 cc 
-Adequate calories and protein restriction (limit to high biologic value) (less resticted when pt starts dialysis)
-Restricted K+, Na+, (Na+ less restricted when pt starts dialysis.
What is the diet/fluid managment for CHILDREN with CRF?
-Fluids previous day output + 500 cc
-Adequate calories and protein restrictions (limit to high biologic value) but NEVER below RDA for child's age
-Na+ and K+ restrictions not usual
Treatments for CRF
-Dialysis
-Transplantation
Main goal for CRF
Avoid complications and promote well being that requires astute nursing care
How to monitor fluid managment in CRF
-Monitor VS, neck veins
-weigh daily, monitor for edema
-strict intake and output
-maintain fluid restrictions
What nutritional managment should be done during CRF?
-Arrange dietary consult
-Assess usual dietary patterns/preferences
-Encourage protein of high biologic value
-Provide or encourage frequent oral care
-Explain rationale for diet restrictions to pt and individual who buys and prepares food
What foods have high biologic value of protein?
High biological value proteins are provided by animal sources of protein, such as meat, poultry, fish, eggs, milk, cheese and yogurt.  
What foods have low biologic value of protein?
Low biological value proteins are found in plants, legumes, grains, nuts, seeds and vegetables.
Family Education and support
-Disease and treatment option
-Diet and fluid options
-medications
-suppoert groups
-S&S to report to MD
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