ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City

NCM 112 (RLE)

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC
Question and Answers:
CHRONIC RENAL FAILURE

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)

PRESENTED BY:

Camarista, Coleen Mae C.

(BSN III-G GROUP 1)

OCTOBER 18, 2021

BACHELOR OF SCIENCE IN NURSING
ILOILO DOCTOR’S COLLEGE
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

Questions:

1. Differentiate between acute and chronic renal failure.

Chronic renal disease is an umbrella term that describes kidney damage or a
decrease in the glomerular filtration rate (GFR) lasting for 3 or more months. CKD is
associated with decreased quality of life, increased health care expenditures, and
premature death. Untreated CRD can result in end-stage kidney disease (ESKD), which is
the final stage of CRD ESKD results in retention of uremic waste products and the need
for renal replacement therapies, dialysis, or kidney transplantation. Risk factors include
cardiovascular disease, diabetes, hypertension, and obesity. Recent research reported
that 10% of the U.S. population aged 20 years and older has CKD (Centers for Disease
Control and Prevention [CDC], 2014).

Acute renal injury (AKI) is a rapid loss of renal function due to damage to the
kidneys. Depending on the duration and severity of AKI, a wide range of potentially life-
threatening metabolic complications can occur, including metabolic acidosis as well as
fluid and electrolyte imbalances (Vritis, 2013). Treatment is aimed at replacing renal
function temporarily to minimize potentially lethal complications and reduce potential
causes of increased kidney injury with the goal of minimizing long-term loss of renal
function. AKI is a problem seen in patients who are hospitalized and those in outpatient
settings. A widely accepted criterion for AKI is a 50% or greater increase in serum
creatinine above baseline (normal creatinine is less than 1 mg/dL) (Vritis, 2013). Urine
volume may be normal, or changes may occur. Possible changes include nonoliguria
(greater than 800 mL/day), oliguria (less than 0.5 mL/kg/hr), or anuria (less than 50
mL/day) (Vritis, 2013).

2. Differentiate AV fistula and a shunt

Arteriovenous Fistula
The preferred method
of permanent vascular
access for dialysis is an
arteriovenous fistula (AVF)
that is created surgically
(usually in the forearm) by
joining (anastomosing) an
artery to a vein, either
side to side or end to side.
Needles are inserted into
the vessel to obtain blood
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

flow adequate to pass through the dialyzer. The arterial segment of the fistula is used
for arterial flow to the dialyzer and the venous segment for reinfusion of the dialyzed
blood. This access will need time (2 to 3 months) to “mature” before it can be used. As
the AVF matures, the venous segment dilates due to the increased blood flow coming
directly from the artery. Once sufficiently dilated, it will then accommodate two large-
bore (14-, 15-, or 16-gauge) needles that are inserted for each dialysis treatment.

Arteriovenous Graft or shunt

An arteriovenous graft can be created by subcutaneously interposing a biologic,
semibiologic, or synthetic graft material between an artery and vein. Usually, a graft is
created when the patient’s vessels are not suitable for creation of an AVF. Patients with
compromised vascular systems (e.g., from diabetes) often require a graft because their
native vessels may not be suitable for creation of an AVF. Grafts are usually placed in the
arm but may be placed in the thigh or chest wall. Stenosis, infection, and thrombosis are
the most common complications of this access.

3. What is the uses during an emergency dialysis?

Acute or urgent dialysis is indicated when there is a high and increasing level of
serum potassium, fluid overload, or impending pulmonary edema; increasing acidosis;
pericarditis; and advanced uremia (Grossman & Porth, 2014). It may also be used to
remove medications or toxins (poisoning or medication overdose) from the blood or for
edema that does not respond to other treatment, hepatic coma, hyperkalemia,
hypercalcemia, hypertension, and uremia.

4. Discuss the complication that can arise if chronic renal failure is not treated

Anemia, due to decreased erythropoietin production by the kidney, metabolic acidosis,

and abnormalities in calcium and phosphorus herald the development of CKD (Taal,
2013).
Fluid retention, evidenced by both edema and congestive heart failure, develops.
As the disease progresses, abnormalities in electrolytes occur, heart failure worsens,
and hypertension becomes more difficult to control.
Some of the common complications of CKD include bone disease.

5. Enumerate appropriate discharge plan and health teaching for the patient.
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

The management of patients with CKD includes treatment of the underlying causes:
Regular clinical and laboratory assessment is important to keep the blood pressure
below 130/80 mmHg (Klein-Kauric, 2015).

Medical management also includes early referral for initiation of renal replacement
therapies as indicated by the patient’s renal status:
 Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your

kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your

blood.

 Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into

your body. Transplanted kidneys can come from deceased or living donors.

Medicine Treatment:
 High blood pressure medications. People with kidney disease can have worsening high blood

pressure.

 Medications to relieve swelling. People with chronic kidney disease often retain fluids. This can

lead to swelling in the legs as well as high blood pressure. Medications called diuretics can help

maintain the balance of fluids in your body.

 Medications to treat anemia. Supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin),

sometimes with added iron, help produce more red blood cells. This might relieve fatigue and

weakness associated with anemia.

 Medications to lower cholesterol levels. Your doctor might recommend medications called statins

to lower your cholesterol. People with chronic kidney disease often have high levels of bad

cholesterol, which can increase the risk of heart disease.

 Medications to protect your bones. Calcium and vitamin D supplements can help prevent weak

bones and lower your risk of fracture.

 A lower protein diet to minimize waste products in your blood. As your body processes protein

from foods, it creates waste products that your kidneys must filter from your blood..

Prevention of complications is accomplished by controlling cardiovascular risk factors:

treating hyperglycemia;
 managing anemia;
 smoking cessation,
 weight loss and exercise programs as needed;
 reduction in salt and alcohol intake.

6. Research on reading or journal of current issues related to the case mentioned and
provide your reflection.
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

International:

The Agreement between Fasting Glucose and Markers Of Chronic Glycaemic

Exposure In Individuals With And Without Chronic Kidney Disease: A Cross-
Sectional Study

Abstract

Background: To assess whether the agreement between fasting glucose and glycated proteins
is affected by chronic kidney disease (CKD) in a community-based sample of 1621 mixed-
ancestry South Africans.

Methods: CKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m 2.

Fasting plasma glucose and haemoglobin A1c (HbA1c) concentrations were measured by
enzymatic hexokinase method and high-performance liquid chromatography, respectively, with
fructosamine and glycated albumin measured by immunoturbidimetry and enzymatic method,
respectively.

Results: Of those with CKD (n = 96), 79, 16 and 5% where in stages 3, 4 and 5, respectively.
Those with CKD had higher levels of HbA1c (6.2 vs. 5.7%; p < 0.0001), glycated albumin (15.0 vs.
13.0%; p < 0.0001) and fructosamine levels (269.7 vs. 236.4 μmol/l; p < 0.0001), compared to
those without CKD. Higher fasting glucose levels were associated with higher HbA1c, glycated
albumin and fructosamine, independent of age, gender, and CKD. However, the association with
HbA1c and glycated albumin differed by CKD status, at the upper concentrations of the
respective markers (interaction term for both: p ≤ 0.095).

Conclusion: Our results suggest that although HbA1c and glycated albumin perform acceptably
under conditions of normoglycaemia, these markers correlate less well with blood glucose levels
in people with CKD who are not on dialysis.

Keywords: Chronic kidney disease; Fructosamine; Glucose tolerance; Glycated albumin;

Haemoglobin A1c.

Reference:

George, C., Matsha, T. E., Korf, M., Zemlin, A. E., Erasmus, R. T., & Kengne, A. P. (2020). The agreement between fasting glucose and
markers of chronic glycaemic exposure in individuals with and without chronic kidney disease: a cross-sectional study. BMC
nephrology, 21(1), 32. https://doi.org/10.1186/s12882-020-1697-z

National:
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

Clinical Characteristics and Short-Term Outcomes of Chronic Dialysis Patients

Admitted for COVID-19 in Metro Manila, Philippines

Abstract
Aim: Data published on COVID-19 in the Filipino population, particularly those with end stage kidney
disease (ESKD) are still lacking.

Methods: We performed a retrospective, observational study of 68 ESKD patients admitted with COVID-
19 infection at a tertiary hospital in Metro Manila, Philippines from April 1, 2020 to July 31, 2020. We
compared the clinical features, baseline laboratory data, treatment strategies and short-term outcomes
between those who survived and those who died. We also determined the risk factors associated with
mortality from COVID-19.

Results: Mean age was 54.5 years old, 66% were male. All patients admitted were on maintenance
hemodialysis (HD). The most common presenting symptoms were dyspnea (57%), fever (47%) and cough
(38%). There was an equal number of patients on high flow nasal cannula (17.7%) and invasive mechanical
ventilation (17.7%). ICU admission was required in 17.7% of the cohort. In-hospital death occurred in 25%
of the patients. Admission PaO2/FiO2 (PF) ratios (162 ± 134 versus 356 ± 181; p=0.0009) were lower, and
procalcitonin (6.07 ± 10.5ng/mL versus 0.73 ± 3.61 ng/mL; p=0.02), lactate dehydrogenase (396 ± 274U/L
versus 282 ± 148 U/L; p=0.03), and white blood cell counts (10 ± 7.3 x 10 9/L versus 6.3 ± 4.2 x 109/L; p=
0.0039) were significantly higher among those who died compared to those who survived. After adjusting
for confounders, only low PF ratio (HR 1.01 for every unit decrease, 95% CI 1-1.01) and need for
ventilation (HR 6.45, 95% CI 1.16-35.97) conferred a significant risk for in-hospital mortality.

Conclusion: Short-term, in-hospital mortality is high among patients on chronic hemodialysis admitted

for COVID-19 infection. They present similarly with the general population. Low PF ratio on admission and
need for ventilation are independent risk factors for in-hospital mortality.

Keywords: COVID-19; coronavirus; dialysis; hemodialysis; kidney failure.

Reference:

Tomacruz, I. D., So, P. N., Pasilan, R. M., Camenforte, J. K., & Duavit, M. I. (2021). Clinical Characteristics and Short-Term Outcomes of
Chronic Dialysis Patients Admitted for COVID-19 in Metro Manila, Philippines. International journal of nephrology and renovascular
disease, 14, 41–51. https://doi.org/10.2147/IJNRD.S287455