CHRONIC RENAL FAILURE

Chronic renal failure (CRF), also known as chronic kidney disease (CKD), is a progressive reduction
of functioning renal tissue such that the remaining kidney mass can no longer maintain the body's
internal environment. CRF can develop insidiously over many years or it may result from an
episode of a cure renal failure from which the client has not recovered.

Nursing Goal
The nursing goal for clients with CRF is to prevent further complications and supportive care.
Client education is also critical as this is a chronic disease and thus requires long-term treatment.
Fluid Volume Excess
The renal disorder impairs glomerular filtration that resulted in fluid overload. With fluid volume
excess, hydrostatic pressure is higher than usual, pushing excess fluids into the interstitial spaces.
Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system. It
stays in the interstitial spaces, leading the patient to have edema, weight gain, pulmonary
congestion, and HPN at the same time due to decreased GFR, nephron hypertrophied leading to
decreased ability of the kidney to concentrate urine and impaired excretion of fluid, thus leading
to oliguria/anuria.
Acute Pain
Pain is discomfort that is caused by the stimulation of nerve endings. Any trauma that the kidney
experience (by any causes or factors) perceives the body as a threat. The body releases cytokine
and prostaglandin, causing pain which the patient at his flank area feels.
Altered Renal Tissue Perfusion
For optimal cell functioning, the kidney excretes potentially harmful nitrogenous product-Urea,
Creatinine, Uric Acid. Because of the loss of kidney excretory functions, there is impaired
excretion of the nitrogenous waste product causing an increase in BUN, Creatinine, Uric Acid
Level.
Impaired Urinary Elimination
Renal failure is a problem which results to loss of kidney functions and as GFR decrease, the
kidney cannot excrete nitrogenous product and fluid causing impaired in Urinary elimination and
together with prolonged use of medications such as NSAIDs this will lead to further kidney
destruction which may thus be decreasing the glomerular filtration and destroying of the
remaining nephrons. This condition will result in the kidney's inability to concentrate urine, which
makes the patient have a nursing diagnosis of impaired urinary elimination.
Altered Nutrition: Less than Body Requirements
Due to restricted foods and prescribed dietary regimens, an individual experiencing renal
problems cannot maintain ideal body weight and sufficient nutrition. At the same time, patients
may experience anemia due to decreased erythropoietic factors that cause a decrease in RBC
production, causing anemia and fatigue.

Scenario
A 65-year-old patient is admitted with renal failure. The patient is alert and oriented times 3. The
patient reports he decided to go to his doctor's office because he has been unable to "pee" for
the past four days, and he was sent here to the ER. He states he has "may be peed three drops"
of urine over the past four days and that the "drops" were very dark brown. The patient also
states he has been forcing fluids because he thought maybe the patient was dehydrated but says
that the fluids seem to be going into his legs, and he has gained 12 lbs over the past three days.
He states he weighs typically 165 lbs. The nurse notes the patient has 4+ pitting edema in his legs
and fine crackles throughout his lungs. The patient's vital signs are BP 180/110, HR 85, oxygen
saturation 91%, Temp 37.6, and RR 19. The patient labs are Potassium 6.0, Hgb 8.0, HCT 29.3,
BUN 6.5, and Creatinine 52. The MD ordered the patient to have dialysis today.

Assignment:
1. Watch the video (link is provided) https://www.youtube.com/watch?v=YH-9iQKx5vQ
2. Based on the scenario, what are the possible nursing problems?

NOTE:
1. Please do the assignment in separate paper. Do not forget to put your name, class and student number
2. Upload your assignment in the drive (https://drive.google.com/drive/folders/1WpjZIpXyqB89peNRDooGbCz3D2qIqiTX?
usp=share_link) by 22 March 2023, 11.55 p.m