Question

Chronic kidney disease is a progressive loss of renal function. All organ systems are affected by chronic renal failure. Discuss the causes of anemia, or cardiovascular diseas, bone changes, or neurological changes associated with chronic renal failure. Discuss how this knowledge will guide your bedside nursing care.

Discuss anticipatory, safe, and deliberate nursing care for the situation presented?

Answer 1

CHRONIC KIDNEY DISEASE (CKD)

Cause of anaemia in ckd :

• Erythropoietin is secreted only in kidney
• Erythropoietin stimulates rbc production,, thus in ckd erythropoietin is not produced leading to anaemia .
• Anaemia manifest with fatigue , tiredness, impaired cognitive functions, palpitations and dyspnea.

Causes of heart diseases in ckd :

• In ckd there will be incresed sodium level in the blood which leads to increased water retention, which causes edema and volume overload finally heart failure  
• increased potassium level ,hyperkalemia  causes cardiac arrhythmia  
• Damaged kidney produces too much renin which causes high blood pressure finally cardiac failure
• homocysteine level is increased which leads to coronary artery disease which percipitate heart attacks.
• During dialysis of chronic renal failure patients cardiac failure is a major threat .

Cause of bone changes in ckd :

• Acidosis due to ckd leads to increased destruction of bones
• Calcitriol which helps in calcium absorption is not produced in ckd ,,, this causes increased secretion of parathormone which causes demineralization or increased bone destruction , which further leads to increased calcium levels in blood
• Phosphorus is not excreted due to ckd which also increases bone destruction
• Thus ckd causes osteodystrophy.

Neurologic changes in ckd :

• Increased levels of urea in the blood due to ckd leads to encephalopathy,, which causes loss of memory, depression, delusions, lethargy, psychosis, stupor .
• In patients undergoing long term dialysis aluminium toxicity occurs which causes dialysis dementia
• These neurological manifestations are due to imbalance in excitatory and inhibitory neurotransmitters due to accumulation of uremic metabolites.

The above given details will help in monitoring the patient and provide suitable care and treatment in cases of emergency .

Educating patients regarding maintaining their blood pressure, a proper glycemic control , a healthy diet and exercise will help in good prognosis of the disease

Nursing care for ckd patients:

• Routine blood and urine analysis must be taken to monitor the patient
• Clinical manifestations such as anaemia must be corrected
• Patient is advised less fluid intake due to sodium retention
• Diuretics , anti hypertensive drugs are prescribed
• Drugs which precipitate hyperkalemia like spiranolactone and ace inhibitors must be used appropriately .
• Calcium supplements can be given to improve bone metabolism
• Dialysis is performed for patients presenting with uremic syndrome
• Metabolic acidosis treated with oral alkali supplements
• Salt restriction advised.