Hypertension Non-modifiable factors: Age greater than 60 years old Hereredofamilial disease (DM, HPN) Gender Race Increase

ease BP to kidneys

Obstruction

Modifiable factors: Hydronephrosis Increased protein and cholesterol intake Smoking Alcohol intake DM, HPN Recurrent infections Use of analgesics

Back-up of urine

Renal artery damaged/ weakened Injury to nephrons/ kidneys

Distend the ureters and might progress to the kidneys

Urine not able to drain out of kidneys

Too much pressure to the kidneys LEGEND: Pathophysiology Complications Nephrosclerosis Clinical Manifestations Lab results or diagnostic exam Nursing Diagnosis Destruction of glomerulus Fibrosis occurs Tissue Necrosis

Distention of the renal pelvis and its calyces

Atrophy of the Kidneys

Deterioration and destruction of kidney nephrons

CHRONIC RENAL FAILURE

Increase BUN Decrease Glomerular filtration rate Increase Serum Creatinine (6.65 g/dL) 37

Hypertrophy of remaining nephrons

Dehydration

Dilute Polyuria

Inability to concentrate urine

Loss of sodium in urine

Hyponatremia (123 mg/dL)

Hct= 30.4% WBC= 16.4 T/cumm Neutrophils= 90% Lymphocytes= 8%

further loss of nephron function Gram Staining Gram positive cocci in pairs are rare Loss of non-excretory function Cellulitis Delayed wound healing Decrease H+ excretion Decrease Potassium excretion Hyperkalemia Decrease Sodium reabsorption in tubules Decreased urine output, oliguria, 10cc Decrease Excretion of Nitrogenous waste Loss of excretory function

Dopamine side drip x 10cc for 1 hour Dobutamine side drip x 20cc for 1 hour

Disturbances in reproductive system Immune disturbances due to uremic toxins Decrease Lipoprotein lipase activities Impaired insulin action
3 1

Decreased libido and infertility Immunosuppression /leukocytes suppresion Accumulation of lipids in peripheral tissues Increase glucose level

Infection

Metabolic Acidosis

Decrease Phosphate excretion Hyperphosphatemia

Increase triglycerides Atherosclerosis Decrease Calcium absorption Hypocalcemia Release PTH Hyperparathyroidism

Hypergylcemia

Water retention

Failure to produce erythropoietin

Anemia

Palor, fatigue, pale palpebral conjunctiva Hct= 30.4% Osteodystrophy, hypocalcemia

Hgb= 10.2 mg% RBC= 3.4 T/cumm

Hypertension Heart Failure Pulmonary Edema, Peripheral Edema 38

Decrease activation of Vitamin D

Decrease calcium absorption in GIT

Infection r/t presence of wound on left foot as evidenced by redness and swelling Independent: Monitor vital signs Do proper wound care Do proper hand washing before and after handling the area Stress proper Maintain proper and adequate hydration and catheterize Collaborative: Monitor laboratory findings Cloxacillin 500 mg IVTT q 6O ANST
2

Increase BUN Increase uric acid, (9.8 mg/dL) Sepsis Proteinuria Trace, 5 mg/dL Increase Creatinine (6.65 mg/dL)

Uremia

Peripheral Nerve Changes

Pericarditis Continuous Multisystem affection CNS Changes Pruritus Multiple organ failure Uremic Encephalopathy

Bleeding
Altered Taste (Metallic)

Fluid Volume excess r/t water retention Independent: Monitor blood pressure Monitor intake and output Record occurrence of dyspnea Note presence of edema Observe and assess skin and mucous membrane Collaborative: Administer Lasix 20mg IV Dopamine side drip x 10cc for 1 hour

Ineffective Tissue Perfusion r/t decreased hemoglobin concentration in blood Independent: Monitor vital signs Assess for signs of changes in mentation Assess capillary refill Monitor GCS Collaborative: Administer O2 therapy Administer: Salbutamol nebulization q 80 Trombocil 50 mg 1 tab BID

DEATH

39