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Medical Surgical Nursing 2

Conference Paper · April 2016

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Subject Code: HN 242.

Subject Name: Medical Surgical Nursing 2.

Lecturer: Mr Lester Asugeni.

Assignment Number: One (1).

Assignment Title: Kidney disease.

Due date: 17/04/2015.

Student (write full name): Jonah Anzo.

I hereby certify that this assignment is my own work; based on my personal

study and/or research, and that I have acknowledged all material and sources
used in the preparation of this assignment. I also certify that the assignment has
not previously been submitted for assessment and that I have not copied in part
or whole or otherwise plagiarised the work of other students or other persons.

Signature:

Date of submission: 21/04/15.

Medical Surgical Nursing 2 Page 1

 Pacific Adventist University

KIDNEY DISEASE

“Chronic Renal Failure”

A research paper

presented in partial fulfillment

of the requirements of degree

BACHELOR IN NURSING

By

Jonah Anzo

April 2015

Medical Surgical Nursing 2 Page 2

 Introduction

Kidney failure or renal failure is a complete loss of kidney functioning and is the

destruction of the glomerular that are responsible for the filtration of the fluids in the body. It

is a major health problem that affects most people and it comes in two forms, the acute are

partially reversible whereas chronic is irreversible and leads to progressive renal tissue

destruction and loss of functioning ( Teixeira Lima, Morais, Coelho, Oliveira Neves, Melo,

& Barbosa, 2012). It is also a public health problem (Gerogianni & Babatsikou, 2014) that

tends to take dimensions of epidemic and has serious impact on the quality of life of patients

undergoing haemodialysis, the social spiritual mental and physical life of a person. According

to (Brunner & Suddarth, 1988), renal failure is the result whit it fails to renew the body

metabolic waste or perform their regulatory functions. The substances normally eliminated in

the urine accumulate in the body as a result of impaired renal excretion and leads to a

disruption in endocrine and metabolic functions as well as fluid, electrolyte, and acid base

disturbance (p.1033).

Chronic renal failure exists when the kidney are no longer capable of maintaining an

internal environment that is consistent with life and damage to the kidney irreversible. It is

different from acute renal failure and it is progressive and irreversible damage to the kidney.

This essay will highlight on kidney (Renal) failure specifically the chronic renal failure. It

will cover the pathophysiology, clinical manifestation, and the complications together with

medical, surgical and nursing care given to a patient considering their cultural, ethical, legal

and professional aspect of care given to them. Not only needs that but also considering their

social, emotional and spiritual.

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 Body

Chronic renal failure is different from acute renal failure and it is advanced and

irreversible kidney damage. According to (Bartuuct, 1995), progression of the disorder is

essentially through four stages, the diminished renal reserve, renal deficiency and renal

failure. The specific pathophysiologic mechanism depends on the causal disease causing the

destruction to the kidney. During chronic renal failure, some of the nephrons including the

glomeruli and tubules are thought to remain intact while others are devastated (p.1665). As

renal function declines, the end products of protein metabolism, which it plays, are role of

excreting it in urine that is accumulated in the blood. When this occurs it imbalances the body

chemistry and chances the systems of the body like cardiovascular, hematologic,

gastrointestinal, neurologic, and skeletal system. In the research of (Brunner & Suddarth,

1988) they said that the patient with chronic renal failure tents to retain salt and water in the

body were it then leads to oedema formation, congestive heart failure, and hypertension

(p.1037)..

Patients with chronic renal failure may develop more of signs and symptoms at time and it

all begins with one or more symptoms like fatigue and lethargy, headache, general weakness,

gestational symptoms, especially anorexia, vomiting, diarrhoea, the bleeding tendencies, and

mental confusion. There is also decreased salivary flow, thirst, a metallic taste in mouth, loss

of smell and taste, and parotitis or stomatitis. Bartuuct (1995), states that if active treatment is

begun early, the symptoms may dissappear. Otherwise, these symptoms become more

marked, and others appear as the metabolic abnormallities of uremia affect virtually every

body system. The chronic renal failure patient will gradually become more and more drowsy,

the respiration becomes Kussmaul in character, and a deep coma develops, often with

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convulsions, which becomes as muscles twitching or severe spams. Unless it is treated, or

else death will follow soon. The other signs and symptoms include, anaemia, hypertension of

160/100, loss of appetite, nausea and often vomiting with no good reason, wasting of muscles

and breath that smells like urine.

The patient with chronic renal failure may encounter some complications where it varies

according to the selected type of therapy. Patients on haemodialysis often experience

hypotensive episodes, muscular cramps, itching, arrhythmias, and anaphylactic responses

during the sessions. They also often develop infections and bacteraemia due to various

interventions and associated immunosuppression. Finally, a high percentage of hospital

admissions occur due to vascular access dysfunction.1 Patients on peritoneal dialysis often

experience episodes of peritonitis that may lead to dysfunction of the peritoneal membrane

and eventually transfer of the patient to haemodialysis.8-12 On the other hand, transplanted

patients may face rejection episodes and increased rate of infections and cancers ( Tzanakaki

, Boudouri, Stavropoulou, Stylianou, Rovithis, & Zidianakis, 2014).

According to (LeMore & Burke, 2008) they said that the aim of management is to help the

diseased kidney to maintain homeostasis for as long as possible. All factors that are

contributing to this problem should be identified and treated, especially the irreversible ones

(p.887). In medical care according to (Bartuuct, 1995), drugs are given to firstly to reduce

and keep the blood pressure down to at least 140/90. Diuretic drugs like frusemide are given

to reduce extra cellular and oedema. Some of the important drugs are given to control the

concentration of sodium and potassium in serum and urine. Aluminium hydroxide antacids

Medical Surgical Nursing 2 Page 5

are given because they bind phosphorous in the intestinal tract. Vitamin supplementation is

necessary, since, since a protein-restricted diet does not give the necessary complement of

vitamins. For hypertension, it is managed by intravascular volume control and a variety of

antihypertensive medication. In addition, chronic renal failure patient should be restricted

from taking protein diets because unlike carbohydrate and fats, which body can store, excess

protein are then excreted by the kidney through metabolism and becomes nitrogenous waste

in the kidney.

In surgical care of the Chronic renal failure patient, because the kidney is totally destroyed

and cannot function any more, most of the patient are undergone the process of

haemodialysis or peritoneal dialysis and mostly are kidney transplant were it involves

transplanting a kidney from a donor or human cadaver to a recipient who has end-stage renal

disease. Most patients are on dialysis for months and years prior to transplant. Bartuuct

(1995), transplantation provides the patient with more normal life styleand is less expencive

than dialysis (p.1038). The pateint with kidney malfunctioning may or may not be removed,

and dialysis is instituded untill a kidney from a suitable donor is obtained. The available

treatments for CRF are continuous outpatient peritoneal dialysis, automated peritoneal

dialysis, intermittent peritoneal dialysis, hemodialysis and renal transplantation. Currently,

technological and therapeutic advances in dialysis are contributing to a greater survival rate

of patients with chronic renal diseases, since these treatments alleviate symptoms of disease,

preserve life and partially replace the renal function, however they do not promote disease

healing. Despite the great scientific advances before the dialysis therapies, the patients with

chronic renal failure have limitations in their daily lives, since they experience multiple

losses, which generates conflicts, feelings of guilt, frustrations and depression, both in the

Medical Surgical Nursing 2 Page 6

individual in situation of chronic illness and in its family members ( Souza Araujo, Silva,

Bezerra, Onofre, Araujo, & Silva, 2014). Hemodialysis cleans and filters your blood using a

machine to temporarily rid your body of harmful wastes, extra salt, and extra water

Hemodialysis helps control blood pressure and helps your body keep the proper balance of

important chemicals such as potassium, sodium, calcium, and bicarbonate

Dialysis can replace part of the function of your kidneys. Diet, medications, and fluid

limits are often needed as well. Your diet, fluids, and the number of medications you need

will depend on which treatment you choose (National Institute Of Health [NIOH] , 2007).

The patient with chronic renal failure requires astute nursing care to avoid the

complications of reduced renal function and the stresses and anxieties of dealing with a life

threatening ilness. According to (LeMore & Burke, 2008), potential nursing diagnosis for this

patient include alterations in fluid and electrolyte balance related to decreased urine output

and dietary and fluid restriction, alteration in nutrition, lessn then body reqiurements, related

to anorexia, gestational dicomfort, and dietary restrictions, activity intolerance related to

fatigue and altered self-care related to dependency and role changes. Nursing care is directed

at assessing fluid and elctrolyte status and identifying potencial sources of fluid imbalance,

implementing a dietary programe to ensure proper nutritional intake within the limits of the

treatment regimen, providing explaination and informations to the patient family concerning

the renal failure. In the first state of examination, the nursing care is mostly to assess fluid

and elctrolye status on serum electtrolyte, daily weight changes, intake and output balance,

skin tugor and presence of edema, distention of neck veins, bllod pressure and puls rhythm,

signs of calcium imbalnce and repiratory rate effort (p.1038).

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 When the patient who is suffering from chronic renal failure, and they undergo

haemodialysis, it may affects their quiality of life, especially their spiritual, emotional and

social life. According to (Bartuuct, 1995) “the provision of social support to patients with

chronic renal failure is associated with reduction in depressive symptoms, positive perception

of their illness and their general satisfaction with life”. For patients with chronic diseases,

daily activities and social support are of great importance for maintaining a satisfactory

quality of life. Social support and integration in the community are important factors, which

help patients to be adjusted to a chronic illness. should be noted that support by the family,

friends and caregivers to patients with renal disease plays a very important role, since it helps

patients to have an increased compliance to the treatment regimen. They can not even involve

them selves in any social activivties when they undergone haemodialysis. Most of the patient

with chronic renal failure may not enjoys rest of their life with social eactivities.

In the spiritual need of the patient with chronic renal failure, they really need spiritual

need to enhance them and give the hope to complete their treatment. According to (Ferrer, et

al., 2012), Spiritual well-being was significantly associated with various quality of life

variables, health status, personal happiness, or religiosity in patients on dialysis. There was

no relationship between spirituality scores and comorbidity, haemodialysis duration, gender,

or age. Spiritual well-being is relatively low in dialysis patients. Spirituality may play an

important role on psychological well-being, quality of life, and selfrated health for patients on

haemodialysis. Several different studies have demonstrated that spirituality is a fundamental

need in these patients. Spirituality provides the means through which patients can question

the meaning, significance, purpose, and direction of his/her life, disease, or suffering. In some

cases, spirituality becomes one of the primary resources available to the patient for dealing

Medical Surgical Nursing 2 Page 8

with suffering, disease progression, and its consequences. Many researchers and doctors

believe that, in any case, evaluating and prioritising spirituality are essential components of

integrated, holistic therapy for patients with severe health problems or end of life situations.

In many cases, patients on haemodialysis and their families turn to spirituality or religion as a

fundamental resource for maintaining an optimistic outlook in these situations. In this

context, it has been shown that spiritual well-being is related in a systematic and significant

manner with quality of life, social support, level of satisfaction, decreased symptoms of

depression, improved satisfaction with nephrological treatment, and higher survival rates.

These patients enjoy spiritual well-being when they have a sense of purpose, coherence, and

personal fulfilment in life, and when they retain the belief that life has value. In this sense,

health professionals must recognise the existence of spiritual needs in their patients when

applying high-quality, integrated health care, and should evaluate patient spiritual well-being

to the extent possible.

In chronic renal failure patient, they also are in great emotion about their own life and

what they gone achieve in life. All of their emotions are in that state of haemodialysis and

they may expect more of emotional support from their guardian and the family members. A

research study of (Gerogianni & Babatsikou, 2014) reached to the same conclusion, since

married family life is a major contributor of wellness, self-esteem and self-confidence for

patients with chronic renal failure. At the same time, data collection of another research study

about patients’ family satisfaction in the context of chronic renal disease and their spouses

showed that patients were consistently more satisfied with their marriages than their

husbands. Consequently, marital life is very important for patients who are forced to abstain

from social relationships and activities (p.740).

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 Conclusion

Chronic renal failure is the progressive and irreversible loss of the kidney functions that

can start with an acute clinical picture, in a slow and gradual manner. This consists of the

final stage of evolution of many kidney diseases and, in some cases, it is identified. Most of

these case are irreversible and it is life threatening. This particular disease mostly affects the

nephrons and glomerulus of the kidney; for that’s where most of the filtration is done, and

when they are destroyed, kidney can no longer function well to filter out the waste from the

body. Chronic renal failure is mainly caused by some of these factors like diabetic

nephropathy, hypertension, glomerulonephritis, cystic kidney disease and others.

There are few of the signs and symptoms of chronic renal failure can be detected earlier

such as severe anaemia, hypertension of 160/100, nausea and vomiting, loss of appetite,

wasting for no reason, urine like breath smell and bleeding in the skin. Patient with renal

failure are may go through some complication as they are on haemodialysis, often experience

hypotensive episodes, muscular cramps, itching, arrhythmias, and anaphylactic responses

during the sessions. They also often develop infections and bacteraemia due to various

interventions and associated immunosuppression. Most cases of chronic renal failure is

managed through investigation by performing urinalysis, urine culture, blood urine nitrogen,

creatinine, complete blood count, renal ultrasonography, and kidney biopsy were it is done to

identify underlying disease. There are some medications given to chronic renal failure firstly

to reduce the blood pressure to at least 140/90, diuretics like frusemide are given to reduce

extracellular fluids and oedema with good diet control of carbohydrate and fats and enough

protein and more, and no intake of salt in the diet.

Most of the patients are gone through kidney transplant were they replace their kidney

with the kidney form healthy human being, and most of the patient are successfully treated

Medical Surgical Nursing 2 Page 10

and help from chronic renal failure. Some are under gone haemodialysis and peritoneal

dialysis. In this case nursing care is highly appreciated to avoid further complications, and

nursing care is to monitor the patient condition and diagnosing them and providing

appropriate nursing care to them.

When the chronic renal failure is undergoing haemodialysis or peritoneal dialysis they

may not enjoy some aspects of life, there spiritual aspects of life may be in greater need and

they need spiritual care to have hope in them self, their guardian and the health workers. They

also need social support from the family members and friends to ensure they are in this

quality of life and may enjoy his or her life. Social need of the patient undergoing

haemodialysis may be affected. However, their emotional need is really important and they

may emotionally affect and may lead to further complication. Therefore, all patients who are

having chronic renal failure must have met all the quality aspects of life.

Medical Surgical Nursing 2 Page 11

 Referencing List

Bartuuct, M. R. (1995). Managemet of Person with Renal Failure. In V. L. Cassmeyer, J. K.

Sands, W. J. Phipps, & M. S. Ledbetter (Ed.), Medical Surgical Nursing (5th ed., pp.
1665-1673). St. Louise, United State of America.

Brunner, L. S., & Suddarth, D. S. (1988). Renal & Urinary Problem. In L. S. Brunner, & D.
S. Suddarth, Text book of Medical -Surgial Nursing (6th ed., pp. 1033-1044). U.S.A:
J.B. Lippincott Company Ltd.

Ferrer, A. R., Arenas, D., Cascales, R. F., Pascual, F. F., Blazquez, N. A., Gil, T., et al. (2012,
April). Evaluation of spiritual well-being in haemodialysis patients. 32(6), 731-742.

Gerogianni, S. K., & Babatsikou, F. P. (2014, September-December). Social Aspects of

Chronic Renal Failure in Patients Undergoing. International Journal of Caring
Sciences, 7(3), 740.

(2008). Nursing care of Client with Kidney dissorder. In P. LeMore, & K. Burke, Medical
Surgical Nursing (4th ed., pp. 882-915). New Jersey, Upper Saddle River: Pearson
Education Inc.

NATIONAL INSTITUTES OF HEALTH National Kidney and Urologic Diseases

Information Clearinghouse. (2007). CHOOSING A TREATMENT THAT’S RIGHT
FOR YOU.

Souza Araujo, R. C., Silva, R. R., Bezerra, M. X., Onofre, M. S., Araujo, A. V., & Silva, K.
P. (2014, June). Therapeutic itinerary of patients with chronic renal failure under
dialytic treatment. Journal of Research Fundermental Care online, 6(2).

Teixeira Lima, F. E., Morais, V. S., Coelho, E. L., Oliveira Neves, F. M., Melo, E. M., &
Barbosa, I. V. (2012, September). IMPLEMENTATION OF NURSING PROCESS
TO PATIENTS WITH CHRONIC RENAL. Journal of Nursing, 9(6), 2167-76.

Tzanakaki , E., Boudouri, V., Stavropoulou, A., Stylianou, K., Rovithis, M., & Zidianakis, Z.
(2014). Causes and complications ofchronic kidney disease inpatients on dialysis.
HEALTH SCIENCE JOURNAL, 8(3).

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