Chronic Renal Failure (End-stage Renal Failure)-is the progressive loss of renal function over

a period of months or years in which there is less than 10% of remaining

renal function and dialysis or kidney transplant is required to sustained life.
PATHOPHYSIOLOGY
Predisposing Factors: Precipitating Factors:
-Genetics -diabetic nephropathy
-Age -hypertensive nephrosclerosis

EMERGENCY CARE MANAGEMENT:

 Careful monitor of serum level to detect hyperkalemia
 Emergency treatment is Dialysis Therapy
 Administration of 50% hypertonic glucose I.V, regular insulin, calcium glocunate
I.V, sodium bicarbonate I.V and cation exchange resins such as sodium
polystyrene sulfate.
Cardiac tamponade resulting from pericardial effusion may result require
emergency pericardial tap or surgery.
Diagnostic Test:
 Elevated BUN, serum Creatinine, sodium and potassium level
 Decreased arterial pH and bicarbonate levels
 Low Hct and Hgb
 Increased blood glucose level
 ABG analysis
 X-RAY
 Kidney-ureter-bladder radiography
 Excretory urography
 Nephrotomography
 Renal scan
 Renal arteriography show reduced kidney size
 Abdominal X-RAY
 Abdominal CT Scan
 MRI
 Ultrasonography
 Renal biopsy
 EEG
Treatment and drugs:
 Low-protein diet
 High-calorie diet prevents Ketoacidosis
 Restrict sodium, phosphorus and potassium
 Maintaining fluid balance
 Monitoring vital signs, weight changes and urine volume
 Loop diuretic (furosemide)
 Cardiac glycosides in small amount does used to mobilize the fluids causing the
edema
 Antihypertensive
 Antiemetics given before meals
 Cimitidine, omreprazole or ranitidine may decrease gastric irritation
 Methylcellulose or docusate can help prevent constipation
 Folate supplements
 Severe anemia requires infusion of fresh frozen packed cells or washed packed
cells
 Synthethic erythropoietin (epoietin alfa)
 Antipruritic, such as trimeprazine or diphenydramine, can relieve itching,
 Aluminum hydroxide gel can lower serum phosphate levels
 Supplementary vitamins and essential amino acids
 Calcium and phosphorus imbalance may be treated with phosphate binding
agents, calcium supplements and reduction of phosphorus in the diet
 Hemodialysis or peritoneal dialysis
 Kidney transplantation best choice of treatment
NURSING MAMNGEMENT:
 Provide good skin care, bath patient daily
 Provide good oral hygiene
 Offer small, palatable, nutritious meal
 Monitor patients hyperkalemia, watch for cramping of the legs and abdomen and
for diarrhea
 Carefully assess the patient’s hydration status
 Monitor for bone or joint complications
 Encourage the patient to perform deep-breathing and coughing exercise to
prevent pulmonary congestion
 Maintain aseptic technique
 Carefully observe and document seizure activity
 Observe for sings of bleeding
 Schedule medication administration carefully
 If patient requires dialysis, check the vascular access every 2 hours for patency
and the arm used for adequate blood supply and intact nerve function
 Withhold the morning dose of antihypertensive on the day of dialysis, check for
disequilibrium syndrome.