CHRONIC RENAL FAILURE IN ENGLISH

                                           

                          CHRONIC RENAL FAILURE IN ENGLISH

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CRF-

Ø  When a patient has sustained enough kidney damage to require renal replacement therapy (dialysis) on a permanent basis and   changes are irreversible, it is known as chronic renal failure. ARF may convert into CRF if left untreated or complications occur. It is also known as end stage renal (kidney) disease.

 

CAUSES-

Ø  Causative factors of CRF includes all factors which We have discussed in ARF. If underlying causes of ARF are not managed than it may turn into CRF.

Ø  The rate of decline in renal function and progression of ESRD is related to the underlying disorder, the urinary excretion of protein, and the presence of hypertension

CLINICAL MANIFESTATIONS-

Ø  Almost every body system is affected in ESRD, patients exhibit a number of signs and symptoms such as-

Ø  Patients complain of severe body pain and discomfort.

Ø  Restless leg syndrome and burning feet can occur in the early stage of uremic peripheral neuropathy

Ø  Neurologic symptoms of CRF of includes-

Ø  Confusion

Ø   Inability to concentrate

Ø   Disorientation

Ø   Tremors

Ø   Seizures

Ø  Cardiologic  symptoms of CRF of includes-

Ø   Hypertension

Ø   Pitting edema (feet, hands, sacrum)

Ø   Periorbital edema

Ø   Engorged neck veins

Ø   Pericarditis

Ø  Pulmonary& GIT symptoms of CRF of includes-

Ø   Ammonia odor to breath

Ø   Metallic taste

Ø   Mouth ulcerations and bleeding

Ø   Anorexia, nausea, and vomiting

Ø   Constipation or diarrhea

Ø  Musculo-skeletal symptoms of CRF of includes-

Ø   Muscle cramps

Ø   Loss of muscle strength

Ø   Bone pain

Ø   Bone fractures

Ø   Foot drop

Ø  Integumentary symptoms of CRF of includes-

Ø   Gray-bronze skin color

Ø   Dry, flaky skin

Ø   Pruritus

Ø   Ecchymosis

Ø   Thin, brittle nails

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of CRF)

Ø  Urine output details.

Ø  Ultra sonography.

Ø  Urine specific gravity.

Ø  S. electrolytes and CBC.

Ø  S. urea and creatinine.

TREATMENT-

Ø  The goal of management of CRF is to maintain kidney function and homeostasis for as long as possible.

Ø  Medical Management is done with medications and diet therapy, although dialysis may also be needed to  decrease the level of uremic waste products in the blood and to control electrolyte balance.

Ø  Hyperphosphatemia and hypocalcemia are treated with binders such as calcium carbonate or calcium acetate.

Ø  Hypertension is managed by   a variety of antihypertensive agents.

Ø  Heart failure and pulmonary edema may also require treatment with fluid restriction, low-sodium diets, diuretic agents, inotropic agents such as digoxin  or dobutamine

Ø  Anti seizure medicines such as IV diazepam or phenytoin  is usually administered to control seizures.

Ø  Anemia associated with ESRD is treated with recombinant human erythropoietin

Ø  Management involves adjustment of heparin to prevent clotting of the lines during hemodialysis treatments

Ø  Diet management is very important in management of CRF. Dietary intervention is necessary with deterioration of renal function and includes careful regulation of protein intake, fluid intake to balance fluid losses, sodium intake to balance sodium losses, and some restriction of potassium. At the same time, adequate caloric intake and vitamin supplementation must be ensured.

Ø  As a last effort the patient with increasing symptoms of CRF is referred to a dialysis (Renal replacement therapy) and kidney transplantation center. Dialysis is usually initiated when the patient cannot maintain a reasonable lifestyle with conservative treatment and to wait for kidney donor.

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances.

Ø  The nurse monitors intake and output and record in the intake output chart.

Ø  The nurse assesses the patient’s progress and response to treatment, and provides physical and emotional support.

Ø  The nurse prepare for IV fluid therapy as per prescription along with electrolyte replacement.

Ø  The nurse keeps family members informed about the patient’s condition, helps them understand the treatments, and provides psychological support.

Ø  It is extremely important to provide explanations and information to the patient and family concerning ESRD, treatment options, and potential complications.

Ø  Fever and infection, both of which increase the metabolic rate and catabolism, are prevented or treated promptly.

Ø  The Nurse monitors pulmonary functions, and the patient is assisted to turn, cough, and take deep breaths frequently to prevent atelectasis and respiratory tract infection.

Ø  The skin may be dry or susceptible to breakdown as a result of edema; therefore, proper skin care is important, such as bathing the patient with cool water, frequent turning, and keeping the skin clean and well moisturized .

Ø  The Nurse monitors cardiac functions, specially for hypertension, Medicines are given on time to control the BP

Ø  The Nurse provides health education regarding diet therapy as prescribed

Ø  Provide health education and reinforcement while monitoring the patient’s progress and compliance with the treatment regimen and home care.

Ø  During discharge planning the patient and family should be explained about danger signs of Worsening signs and symptoms of CRF to report to the health care provider such as nausea, vomiting, change in usual urine output and ammonia odor on breath, muscle weakness, diarrhea, abdominal cramps, clotted fistula or graft, infection etc.