University of Muthanna

College of nursing

Nusing assessment guide

Kidney failure ( CKD )
Area : CCU

Preparation : Noor Raad Majeed

Administered : Raad Khudhair

Second Stage
Group : A
Demographical data

 Name : Fadela Jabeer

 Age : 75
 Gender : Female
 Marital status: Married
 Children Number: three kids
 Educational status: Unable to read and write
 Profession: House wife
 Smoking: Cigarette
 Alcohol consumption: No

Patient medical diagnosis

1. Hypertension
2. Diabetes mellitus
3. Chest pain
4. Abdominal pain

Chief complaint
Shoetness of breath(SOB)
Patinents surgical history
The patient didn’t undergo any surgery.

Patient medical history

 Precious diseases: hypertension.
 Injuries and accsidents: you haven’t had any injury or
accidents.
 Allergies and immunization: Negative
 Medicaltions: furosemide

Family history
Her family they do not have a genetic disease or chronic.

Cardiovascular system assessment

 Pulse: 100 beats /mint
 Rhythm: Regular
 Heard sound: Normal
 Blood pressure:170/100mmHg
 Temperature: 36.5C // Normal
Respiratory system
 Rate: 10 breath/mint
 Cough
 Dyspnea

Nutritional status
Loss of appetite

Gastrointestinal system
 Nausea
 Vomiting
 Dysphagia
 Hearburn
 Abdominal pain

Musculoskeletal system
 Pain or discomfort
 Weakness
Urinary system
 feeling of pain
 Decrease Urine Output

Pain Assessment
 Location : pain in abdominal.
 Quality : very strong pain.
 Triggers : Suddenly.
 Patient's perception of this problem : nephritis.

Medical diagnosis
Kidney failure(CKD)

Definition of medical diagnosis

 Chronic kidney disease: is a condition in which the
kidneys are damaged due to the accumulation of
nitrogen products in the blood A bullion in the blood.
And also happens result Many other possible causes.
This leads to a gradual and permanent loss of kidney
function over time.
 The main causes of CKD are diabetes, hypertension
(high blood pressure) and obesity.
Pathophysiology
 Although the pathogenesis of ARF and oliguria is not
always known, many times there is a specific
underlying problem.
 Underlying problems. There are underlying problems
that cause the development of ARF such as
hypovolemia, hypotension, reduced cardiac output
and failure, and obstruction of the kidney.
 Blood flow. As these underlying problems affect the
body, the blood flow to the kidneys reduces.
 Decreased kidney function. With inadequate blood
flow to the kidney, there is impaired kidney function.
 Failure. If the underlying conditions are not treated
and corrected, they can lead to permanent damage
of the kidneys.

Signs and symptoms

 Decreased urine output
 Acute kidney injury symptoms appear
 rapidly
 Fatigue
 Nausea and vomiting
 Shortness of breath
 Platelet dysfunction
Causes of disease
The most common causes of disease include.
1. Retention of fluids: which leads to swelling of the
arms or legs, or the collection of question in the lungs
(pulmonary edema).
2. High blood pressure: which causes hardening of the
kidneys glomerulonephritis and autoimmune
diseases.
3. Sudden rise in potassium levels (hyperkalemia):
which leads to a weakening of the heart's ability to
work and this may be life-threatening.
4. Diabetes: which leads to chronic diabetic
nephropathy.

Clinical manifestation
Almost every system of the body is affected by the failure
of the normal renal regulatory mechanisms.
1. Lethargy. Since waste products cannot be filtered, it
slowly accumulates in the different parts of the body.
2. Dryness. The skin and mucous membrane are dry
from dehydration.
3. Central nervous system symptoms. This include
drowsiness, headache, muscle twitching, and
seizures.
4. Increased creatinine. All phases of ARF exhibit an
increase in creatinine.
Prevention
 Hydration. Provide adequate hydration to patients at
risk for dehydration.
 Shock. Prevent and treat shock promptly with blood
and fluid replacement.
 Close monitoring. Monitor central venous and arterial
pressures and hourly urine output of critically ill
patients to detect the onset of renal failure as early
as possible.
 Blood administration. Take precautions to ensure that
the appropriate blood is administered to the correct
patient in order to avoid severe transfusion reactions.
 Infections. Prevent and treat infections promptly
because they can produce progressive renal
damage.
 Toxic drug effects. To prevent toxic drug effects,
closely monitor dosage, duration of use, and blood
levels of all medications metabolized or excreted by
the kidneys.

Complications
 Accelerated atherosclerosis
 Anemia
 Anorexia, nausea, and vomiting
  Dry itchy skin, ecchymosis, and subcutaneous
bruises
 Headache
 Heart failure
 Hypertension
 Heart failure
 Hypertension
 Impotence
 Osteomalacia
 Osteoporosis
 Pulmonary edema
 Uremic encephalopathy—lethargy.

Diagnosis test
1. Urine tests
 Urinalysis: Analysis of the urine affords enormous
insight into the function of the kidneys.
 Twenty–four–hour urine tests: This test requires you
to collect all of your urine for 24 consecutive hours.
The urine may be analyzed for protein and waste
products (urea nitrogen and creatinine). The
presence of protein in the urine indicates kidney
damage. The amount of creatinine and urea excreted
in the urine can be used to calculate the level of
 kidney function and the glomerular filtration rate
(GFR).
 Glomerular filtration rate (GFR): The GFR is a
standard means of expressing overall kidney
function. As kidney disease progresses, GFR falls.
The normal GFR is about 100–140 mL/min in men
and 85–115 mL/min in women. It decreases in most
people with age. The GFR may be calculated from
the amount of waste products in the 24–hour urine or
by using special markers administered intravenously.
Patients are divided into five stages of chronic kidney
disease based on their GFR.
 Urine Specific Gravity: This is a measure of how
concentrated a urine sample is. A concentrated urine
sample would have a specific gravity over 1.030 or
1.040.

2. Blood tests
 Creatinine and urea (BUN) in the blood: Blood urea
nitrogen and serum creatinine are the most
commonly used blood tests to screen for, and
monitor renal disease.
 Creatinine is a breakdown product of normal muscle
breakdown.
 Urea is the waste product of breakdown of protein.
 The level of these substances rises in the blood as
kidney function worsens.
 Electrolyte levels and acid–base balance: Kidney
dysfunction causes imbalances in electrolytes,
especially potassium, phosphorus, and calcium.
 High potassium (hyperkalemia) is a particular
concern.
 The acid–base balance of the blood is usually
disrupted as well.
 Decreased production of the active form of vitamin D
can cause low levels of calcium in the blood. Inability
to excrete phosphorus by failing kidneys causes its
levels in the blood to rise.
 Blood cell counts: Because kidney disease disrupts
blood cell production and shortens the survival of red
cells, the red blood cell count and hemoglobin may
be low (anemia). Some patients may also have iron
deficiency due to blood loss in their gastrointestinal
system. Other nutritional deficiencies may also impair
the production of red cells.

3. Other tests
 Ultrasound: Ultrasound is often used in the diagnosis
of kidney disease. An ultrasound is a noninvasive
type of test.
  In general, kidneys are shrunken in size in chronic
kidney disease, although they may be normal or even
large in size in cases caused by adult polycystic
kidney disease, diabetic nephropathy, and
amyloidosis.
 Biopsy: A sample of the kidney tissue (biopsy) is
sometimes required in cases in which the cause of
the kidney disease is unclear. Usually, a biopsy can
be collected with local anesthesia only by introducing
a needle through the skin into the kidney.

Nursing Interventions
Nursing interventions are aimed at restoring renal function
and reducing potential causes of increased renal injury.
 Monitor fluid and electrolyte balance. The nurse
monitors the patient’s fluid and electrolyte levels and
physical indicators of potential complications during
all phases pf the disorder.
 Reducing metabolic rate. Bed rest is encouraged and
fever and infection are prevented or treated promptly.
 Promoting pulmonary function. The patient is
assisted to turn, cough, and take deep breaths
frequently to prevent atelectasis and respiratory tract
infection.
  Provide safety measures. Patient with CNS
involvement may be dizzy or confused.
 Preventing infection. Asepsis is essential with
invasive lines and catheters to minimize the risk of
infection and increased metabolism.
 Providing skin care. Bathing the patient with cool
water, frequent turning, and keeping the skin clean
and well moisturized and keeping the fingernails
trimmed to avoid excoriation are often comforting and
prevent skin breakdown

Medication
1. Omeprazole.
 Generic name: Omeprazole
 Trade name: Oprazole
 Action: Omeprazole is used to treat cases in which
excessive amounts of acid are secreted in the
stomach. It inhibits the action of some enzymes
responsible for acid secretion, thus preventing acid
production.
 Number of doses: Once a day.
 Dosage: The dose ranges from 20-40 milligrams per
day.
 Route of administration: I. V. INFUSION
 Side effects: headache ،nausea, rash, aheat,
Diarrhea, hair loss and enzyme defects.

2. lasix
 Generic name: Furosemide
 Trade name: Lasix40mg
 Action: It is a diuretic treatment, so it works to rid the
body of water and excess fluid, which reduces
swelling of the feet and the occurrence of edema. It is
used to treat high blood pressure and congestive
heart failure.
 Dose: 20-40 mg per dose.
 Maximum dose: 200 mg per dose.
 Route of administration: I. V.
 Side effects: It causes many symptoms including
Hyperuricemia 40%, Hypokalemia 14-60%,
Squeamishness, Anemia, Anorexia diarrhea,
Vertigo, Glucose intolerance, urine sugar, Etc.

3. Ca glucaur
 Generic name: Metformin
 Trade name: Glucaure
 Action: The sugar regulator metformin is used alone
or with other medications to treat type 2 diabetes (a
condition in which the body does not use insulin
normally and therefore cannot control the amount of
 sugar in the blood). Metformin also helps control the
amount of glucose in the blood; it reduces the
amount of glucose absorbed by the body from food in
addition to decreasing the manufacture of glucose by
the liver. Metformin also increases the body’s
response to insulin.
 Dose: The oral solution is usually taken with meals
once or twice a day.
 Route of administration: I. V. INFUSION
 Side effects: Diarrhea, flatulence and gas, stomach
pain, Indigestion, holding, Feeling of a metallic taste
in the mouth, heartburn, Headache,redness of the
skin, muscle pain, Changes in the nails, pain in chest
and rash.

Reference
Williams, L.S And Hopper, P.D (2015) medical surgical
nursing_F.A. Davis Company
(1915) Arch Street
Philadelphia, PA 19103.
Pp(893-897)