1.

Endocrine changes
Esrd also effect to endocrine system, including insulin utilization and
parathyroid function discussed previously. Pituitary hormones, such as growth
hormone and prolactin, may be increased in some clients. The levels of
luteinizing hormone and follicle-stimulating hormone very greatly from client
to client. Thyroid-stimulating hormone level is usually normal, but it may
show a blunted response to thyrotropin-releasing hormone; this commonly
results in hypothyroidism
2. Psychosocial changes
Psychosocial changes probably result from both the physiologic alterations
and the extreme stress experience by a client who has a chronic, lifethreatening disease. Common stressor includes feelings of powerlessness and
lack of control over the illness and treatment, intrusive therapy, restrictions
imposed by the medical regimen, changes the body images, and changes in
sexuality.
Clients commonly experience role reversal, loss of reduction of work, financial
strain, and many lifestyle changes. Scheduling dialysis can create many
difficulties. The clients self-concept and body image may be altered, leading
to further problems.
Clients cope with these stressors in various ways, and not all coping
strategies are positive. They can range from obtaining support from family
and friends and seeking more information about the condition to depression
and thought of suicide. Indeed, helping a client cope with psychosocial
changes can be very challenging.
3. Reproductive changes
Women commonly experience menstrual irregularities, particularly
amenorrhea (absence of menstrual periods), and infertility. However, some
women with esrd have conceived and had successful full-term pregnancies.
Men commonly report impotence of both physiologic and psychological
causes. They may also experience testicular atrophy, oligosppermia
(decreased sperm count), and reduced sperm motility. Both genders report
decreased libido, possibly from both physiologic and psychological.
4. Integumentary changes
Integument problems are particularly uncomfortable for some clients with
ESRD. The skin also often very dry because of atrophy of the sweat glands.
Severe
and
intractable
pruritus
may
result
from
secondary
hyperparathyroidism and calcium deposits in the skin, pruritus can lead to
excoriated skin caused by continued scratching.
Several color changes affecting the skin found in client with renal failure. A
bleeding tendency often results in increased bruising, petechiae, and
purpura. These do not usually cause problems themselves, but their presence
may be alarming to the client. The pallor of anemia is evident. Retained
urochrome pigments make the skin orange green or gray in color.
Hair is brittle and tends to fall out; nails are thin and brittle as well.
Characteristic are red bands that develop on the nails are called muehrckles

lines. Another line pattern that has been observed is half-and-half nail; with
the proximal half normally white and the distal portion brown.
5. Neurologic changes
Although dialysis has reduced the incidence of neurologic changes, some
clients experience these problems early in the disease process. Peripheral
neuropathy cause many manifestations, such us burning feet, inability to find
a comfortable position for the legs and feet (restless leg syndrome), gait
changes, foot drop, and paraplegia. These manifestations move up the legs
and may extend to include the arms. Initially, it is primarily a problem of the
sensory system; however, if left untreated, it may progress to the motor
system. Nerve conduction becomes slower, and deep tendon reflexes and
vibratory sense are diminished.
Central nervous system involvement is demonstrated through forgetfulness,
inability to concentrate, short attention span, impaired reasoning ability and
judgment, impaired cognitive functioning, increased nervous irritability,
nystagmus, twitching, dysarthria, seizures, central nervous system
depression, and coma. Involvement of the cranial nerves may alter any of the
senses. Hearing threshold level show a high-frequency deficit early in the
disease, and hearing progressively deteriorates. Uremic amaurosis is the
sudden onset of bilateral blindness, which seems to be reserved in hours to
days. These eyed often contain calcium salts, which give them an irritated
appearance.