3. • CKI is a progressive, irreversible kidney
injury and kidney function doesnot
recover.
• When kidney function is too poor to
sustain life, CKD becomes End Stage
Kidney Disease (ESKD/ ESRD)
4. • Progressive, irreversible deterioration in
renal function in which the body’s ability
to maintain metabolic and fluid and
electrolyte balance fails resulting in
Uremia or Azotemia
5. INCIDENCE
• The incidence of end stage renal disease in
men (239/million) is much greater than in
women (162/million). It is much higher in
African-Americans (595/million) than Asians
(205/million) or Caucasians (150/million).
• More in men than women
• More seen at 65 years of age and older.
8. MORPHOLOGIC
a) Glomerular disease
Glomerulonephritis
Basement membrane disease
Goodpasture’s disease
b) Tubular disease
Chronic hypercalcemia
Chronic potassium depletion
Heavy metal poisoining
9. c) Vascular disease of the Kidney
Ischemic disease of the Kidney
Bilateral renal artery stenosis
Nephrosclerosis
Hyperparathyroidism
d) Urinary Tract Disease
Obstructive uropathy
12. d) Connective tissue disease
Progressive systemic sclerosis ( a systemic
connective tissue disease leading to collagen
accumulation in the kidney)
SLE
Polyarteritis (vasculitis: arteries damaged or
swollen)
14. • Stage 1: Kidney damage with normal or
increased GFR (>90 mL/min)
• Stage 2: Mild reduction in
GFR (60-89 mL/min)
• Stage 3: Moderate reduction in
GFR (30-59 mL/min)
• Stage 4: Severe reduction in
GFR (15-29 mL/min)
• Stage 5: ESRD
GFR <15 mL/min
16. CONSEQUENCES OF
DECRESED RENAL
FUNCTION
• Retension of Na and water-edema, CHF,
hypertension, ascites.
• Decreased GFR- stimulation of renin
angiotensin axis and increased aldosterone
secretion –increased BP
• Kidneys inability to excrete hydrogen ions ,
produce ammonia and conserve bicarbonates-
metabolic acidosis
• Decreased GFR –increased P-decrease in
serum calcium-bone reabsorption of calcium
23. MEDICAL
MANAGEMENT
• Detection and treatment of reversible causes of
renal failure
• Dietary regulation
• Correction of anemia, acidosis, hyperkalemia,
fluid retention
45. A) CALCIUM CHANNEL BLOCKERS
Nifedipine (Adalat, Procardia)
Adult
10-30 mg orally tid; not to exceed 120-180 mg/d
30-60 mg orally qid; not to exceed 90-120 mg/d
Pediatric
0.25-0.5 mg/kg tid/qid
Effects are believed to be mediated through
vasodilation , relaxes smooth muscle and produces
vasodilation, which, in turn, improves blood flow
and oxygen delivery.
46. B) BETA BLOCKERS/ BETA RECEPTOR
ANTAGONIST( BLOCKERS)
Atenolol
10 – 40 mg/ day
Action
It blocks the beta receptors thereby
causes vasodilation and bronchodilation
47. C) SYNTHETIC ERYTHROPOIETIN
• Epoetin Alfa
50 – 100 Units/ kg Subq or IV three times a
week for patient on dialysis.
It stimulate RBC growth and maturation in the
bone marrow
49. NURSING
MANAGEMENT
• Fluid volume excess related to decreased
GFR and sodium retension
– Monitor sign and symptoms of hypovolemia or
hypervolemia
– Monitor urinary output and urine specific
gravity
– Monitor serum and urine electrolyte
concentrations
– Weigh the patient daily
50. NURSING MANAGEMENT
CONT…..
–Adjust fluid intake to avoid fluid overload
and dehydration
–Measure blood pressure regularly
–Auscultate lung fields for rales
–Inspect neck veins for engorgement and
extremities, abdomen, sacrum and eyelids
for edema
–Evaluate for sign and symptoms of
hyperkalemia and monitor serum K levels
51. NURSING MANAGEMENT
CONT……..
–Administer sodium bicarbonate or glucose
and insulin to shift potassium into the cells
–Administer cation exchange resin to correct
hyperkalemia
–Watch for cardiac arrythmia and CHF
–Have resuscitation equipments in hands in
case of cardiac arrest
–Advice patient to avoid foods high in
potassium
52. NURSING MANAGEMENT
CONT…..
–Prepare for dialysis when rapid lowering of
potassium is needed
–Administer blood transfusions during
dialysis to prevent hyperkalemia from stored
blood
–Monitor acid base balance
53. NURSING MANAGEMENT
CONT….
• Risk for infection related to alterations in
the immune system and host defenses
–Monitor for all signs of infection
–Remove bladder catheter as soon as possible
–Monitor for UTI
–Use intensive pulmonary hygiene
–Carry out meticulous wound care
–If antibiotics are administered care must be
taken to adjust the dosage
54. NURSING MANAGEMENT
CONT….
• Altered nutrition less than body
requirements related to catabolic state,
anorexia and malnutrition
–Regulate protein intake
–Offer high carbohydrate feedings
–Weigh daily
–Restrict food and fluids containing large
amounts of Na, K ,P
–Prepare for hyperalimentation
55. NURSING MANAGEMENT
CONT….
• Risk for injury related to GI bleeding
–Examine all stools and emesis for gross
and occult blood
–Administer H2 receptor antagonist and
antacids for gastric stress ulcers
–Prepare for endoscopy
56. NURSING MANAGEMENT
CONT…..
• Altered thought processes related to
uremic toxins on CNS
–Speak to the patient in simple orienting
statements ,using repetitions when
necessary
–Maintain predictable routine and keep
change to a minimum
–Watch for and report changes in mental
status and seizure precautions
57. NURSING MANAGEMENT
CONT….
–Encourage and assist patient to turn and
move because drowsiness and lethargy may
prevent activity
–Use music tape to promote relaxation
–Prepare for dialysis which may help
prevent neurologic complications
58. NURSING MANAGEMENT
CONT…..
• Constipation related to fluid restriction
and ingestion of phosphate binding agents
• Encourage high fibre diet
• Use stool softners as prescribed
• Avoid laxatives and cathartics that cause
electrolyte toxicities
• Increase activity as tolerated
59. NURSING MANAGEMENT
CONT…..
• Impaired skin integrity related to uremic
frost and changes in oil and sweat gland
–Keep skin clean while relieving itching and
dryness
–Apply oilments and creams for comfort and
to relieve itching
–Keep nails short to prevent excoriation
–Keep hair clean and moisturised
60. NUSING MANAGEMENT
CONT…
• RISK FOR INJURY WHILE AMBULATING
RELATED TOPOTENTIAL FRACTURES AND
MUSCLE CRAMPSDUE TO CALCIUM
DEFICIENCY
• Monitor serum ca and p levels
• Inspect pts gait , range of motion and muscle strength
• Monitor x rays and bone scans for fractures ,
demineralization and joint deposits
• Increase activity as tolerated
• Administer ca supplements , vitamin d, phosphate
binding agents
61. NURSING MANAGEMENT
CONT…
• NONCOMPLIANCE WITH THE THERAPUETIC
REGIMEN RELATED
TORESTRICTIONS IMPOSED BY C R F AND
ITS TREATMENT
• prepare pt for DIALYSIS or K T P
• Assess pts understanding of treatment regimen
• Explore alternatives that may reduce or eliminate
side effects of treatment
• Encourage strengthening of social support system
and coping mechanisms
• Supportive psychotherapy for depression
• Refer to renal support agencies and self help
groups
62. NURSING MANAGEMENT
CONT….
• Knowledge defecit related to disease
condition
– Explain about residual defects in kidney
function
– Encourage routine follow up
– Advice avoidance of any other medications
unless prescribed
– Encourage resuming activity gradually
– Weigh daily
– Fluid restriction
