what is chronic renal failure (CRF) or chronic renal disease (CRD)?
body fails to maintain the fluid and electrolyte balance
CRF cardiac assessment findings
engorged neck veins
CRF dermatological assessment findings
CRF GI assessment findings
CRF neurological assessment findings
inability to concentrate
what is asterixis?
flapping of hands
patient teaching considerations in CRF
give information in writing
teach in small increments due to inability to concentrate
make sure family present
CRF pulmonary assessment findings
thick tenacious sputum
CRF musculoskeletal assessment findings
CRF emotional assessment findings
grieving stages (anger, depressed)
stages of CRF
stage 1 of CRF
*GFR > or = to 90 mL/min
higher than normal levels of creatinine or urea in the blood
blood or protein in urine
evidence of kidney damage in an MRI, CT, US, contrast XR
stage 2 of CRF
*GFR is = to 60-89 mL/min
care is viligant o reduce risk factors for kidney disease
stage 3 of CRF
*GFR is 30-59 mL/min
moderate, chronic kidney disease
care is focused to slow progression of disease through diet and increased vigilance to avoid hypoperfusion, toxins, and other risk factors
*start having s/s
*should start seeing nephrologist
stage 4 of CRF
*GFR is 15-29 mL/min
likely to develop complications of kidney disease such as HTN, anemia, bone disease, heart disease, and other CV diseases
*s/s: nausea, taste changes, uremic breath, loss of appetite, difficulty in concentrating, nerve problems
*will probably begin thinking about dialysis, probably get dialysis access so it has time to heal
dialysis and kidney transplants
treatment, NOT A CURE!
stage 5 of CRF
s/s: loss of appetite, N/V, HA, being tired, being unable to concentrate, itching, making little or no urine, swelling (especially around the eyes and ankles), muscle cramps, tingling in hands or feet, changes in skin colo, increased skin pigmentation
*have to intervene or pt will die
FYI: may be referred to as ESRD
ARF vs CRF
survival is fluid electrolyte monitoring
may be caused by meds, trauma, MI, HF, renal obstruction
survivial means lifetime dialysis or transplant
may be caused by
what is calciphylaxis?
progressive cutaneous necrosis that often occurs in about 1% of CKD/ESRD
happens distally in toes, fingers, glans penis, abd, trunk, buttocks
calcium deposits line the vessels (like having rocks in the blood)
rare, often fatal (80%)
medical management of CRF
goal: maintain kidney function for as long as possible by treating underlying conditions
dialysis *treatment, NOT A CURE!
kidney transplant *treatment, NOT A CURE!
what meds might a renal pt take to increase calcium level?
what med might a renal pt take to increase red blood cell production?
can take 3 wks - 1 mth to start working
what med might help a renal and/or diabetic pt w/ gastric emptying?
what meds might be held when a pt is going to hemodialysis?