Renal failure and Dialysis

Dr. Wafaa Ramadan

Definitions:
 Renal failure is severe impairment and total lack of

kidney function, in which there is an inability to

excrete metabolic waste products and water.
Types of renal failure:
 1- Acute renal failure
 2- Chronic renal failure
 Chronic Renal Failure

 Definition:
 progressive, irreversible destruction of the nephrons in both kidneys.
 Causes of chronic renal failure:
 Glomerulonephritis and chronic pyelonephritis.
 Diabetic nephropathy.
 Hypertensive nephrosclerosis.
 Sickle cell anemia.
 Systemic lupus erythematosus.
 HIV- associated nephropathy.
 Prostatic and bladder tumors.
 Ureter obstruction.
 Calculi.
 Poly cystic kidney disease.
 Renal infarction.
 Signs and symptoms of chronic
renal failure
Neurologic:
 Weakness and fatigue; confusion; inability to

concentrate; disorientation; tremors; seizures;

asterixis; restlessness of legs; burning of soles of feet;
behavior changes
Integumentary:
 Gray-bronze skin color; dry, flaky skin; pruritus;

ecchymosis; purpura; thin, brittle nails; coarse,

thinning hair
Cardiovascular:
 Hypertension; pitting edema (feet, hands, sacrum);

periorbital edema; pericardial friction rub; engorged

neck veins; endocarditis; pericardial effusion;
pericardial tamponade; hyperkalemia; hyperlipidemia
Pulmonary:
 Crackles; thick, tenacious sputum; depressed cough reflex;

pleuritic pain; shortness of breath; tachypnea; Kussmaul-type

respirations; uremic pneumonitis; “uremic lung”
Gastrointestinal:
 Ammonia odor to breath (“uremic fetor”); metallic taste;

mouth ulcerations and bleeding; anorexia, nausea, and

vomiting; hiccups; constipation or diarrhea; bleeding from
gastrointestinal tract
Hematologic:
 Anemia; thrombocytopenia

Reproductive:
 Amenorrhea, testicular atrophy, infertility

Musculoskeletal:
 Muscle cramps; loss of muscle strength; renal osteodystrophy;

bone pain; bone fractures; foot drop.

 Complications:
Potential complications of chronic renal failure

◦ Hyperkalemia
◦ Pericarditis,
◦ Hypertension
◦ Anemia
◦ Bone disease and metastatic calcifications
:Potential nursing diagnoses for these patients

 Excess fluid volume related to decreased urine output,

dietary excesses, and retention of sodium and water
 Imbalanced nutrition: less than body requirements related
to anorexia, nausea and vomiting, dietary restrictions,
and altered oral mucous membranes
 Deficient knowledge regarding condition and treatment
regimen
 Activity intolerance related to fatigue, anemia, retention
of waste products, and dialysis procedure
 Low self-esteem related to dependency, role changes,
changes in body image, and sexual dysfunction
 Dialysis

Definition:
 Dialysis occurs with the movement of fluid and

particles across a semipermeable membrane.

Goals of dialysis therapy:
 Removal of metabolic waste products.
 Maintenance of safe concentration of electrolytes.
 Correction of acid base imbalance.
 Removal of excess fluid.
 Physiologic principles of dialysis:
 1- Diffusion:
 Involve the movements of particles from area of greater
concentration to an area of less concentration. Diffusion
results in the movements of urea, creatinine and uric acid from
the patient's blood into the dialysate solution.
 2-Osmosis:
 Involve movement of water excess across a semipermeable
membrane from an area of lesser concentration to an area of
greater concentration of particles.
 3-Ultra filtration:
 Involve the movement of fluid access of semipermeable
membrane as a result of an artificially created pressure
gradient.
 Types of dialysis:
 Peritoneal dialysis.
 Hemodialysis.
 Hemodialysis

 Definition:
 It is the process of removing metabolic waste and water from blood
by use of a semipermeable membrane of on artificial kidney
 Vascular Access
 Access to the patient’s vascular system must be established to
allow blood to be removed, cleansed, and returned to the patient’s
vascular system at rates between 200 and 800 mL/minute.
 Types of access:
 Subclavian
 Internal Jugular
 Femoral Catheters
:Fistula

 A more permanent access, known as a fistula, is

created surgically (usually in the forearm) by joining
(anastomosing) an artery to a vein, either side to side
or end to side (Fig. 16). The fistula takes 4 to 6 weeks
to mature before it is ready for use. This gives time
for healing. The patient is encouraged to perform
exercises to increase the size of these vessels (eg,
squeezing a rubber ball for forearm fistulas).
:Graft
An arteriovenous graft. Usually, a graft is created when the
patient’s vessels are
 not suitable for a fistula. Patients with compromised vascular

systems (eg, from diabetes) often need to have a graft to

undergo hemodialysis. Grafts are usually placed in the
forearm, upper arm, or upper thigh. Infection and thrombosis
are the most common complications of arteriovenous grafts.
Dialysis solution
Dialysis Process
 Indications of hemodialysis:
 May be used in the treatment of both acute and chronic

renal failure.
 The procedure is usually carried out three time / week
 Uncontrolled hyperkalemia.
 Fluid over load.
 Peritonitis.
 Sever acidosis.
 Contraindications:
 Sever homodynamic instability.
 Acute and sever bleeding.
 Intolerance to systemic heparinization.
 Advantages:
 More efficient, faster process.
 Can be used for temporary or permanent dialysis.
 Shorter time for treatment needed (3 – 4 h, 3-4 time per

week).
 Disadvantages:
 Required trained personnel and sophisticated

equipment.
 Requires heparinization.
 Require maintenance of vascular access.
 Expensive to maintain.
Complications of hemodialysis

 Hypotension
 Painful muscle cramping
 Exsanguination
 Dysrhythmias
 Air embolism
 Chest pain
 Dialysis disequilibrium results from cerebral fluid shifts. Signs
and symptoms include headache, nausea and vomiting,
restlessness, decreased level of consciousness, and seizures. It is
more likely to occur in acute renal failure or when blood urea
nitrogen levels are very high (exceeding 150 mg/dL).
Nursing diagnosis

Nursing diagnosis (1): Risk for fluid excess or deficit

related to renal failure or fluid over load.
Nursing diagnosis (2): Risk for infection related to
.vascular access
Nursing diagnosis (3): Ineffective coping related to
.effect of long term hemodialysis