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GROUP VI
1. Definition
Chronic renal failure is the end
stage of progressive destruction of
the kidneys and cannot be reversed.
2. Etiology
Diabetes is the leading cause of
chronic renal failure, followed by
hypertension, glomerulonephritis,
cystic kidney disease, and all the
other causes.
3. Pathophysiologi
The Pathophysiology of CFR involves a
gradual loss of entire nephron units. In the
early stages, as nephrons are destroyed,
remaining functional nephrons
hypertrophy. Glomerular capillary flow and
pressure increase in these nephrons, and
more solute particles are filtered to
compensate for lost renal mass. This
increased deman predisposs the remaining
nephrons to glomerular sclerosis (scarring),
resulting in their eventual destruction. This
4. Cllinical Manifestation
Chronic renal failure often is not identified
until its final, uremic stage is reached. Uremia,
which literally means “urine in the blood”,refers to
syndrome or group of symptoms associated with
ESRD. Uremia, fluid and electrolyte balance is
altered, the regulatory and endocrine functions of
the kidney are impaired, and accumulated
metabolic waste products affect essentially every
other organ system (kasper et al.,2005;Porth,2005).
5. Diagnostic Test
- Urinalysis
- Urine culture
6. Medications
Chronic renal failure affects both the
pharmacokinetic and pharmacodynamic effects
of drug therapy. Most medications are excreted
primarily by the kidney. The half-life and plasma
levels of many drugs increase in chronic renal
failure. Drug absorption may be decreased when
phosphate-binding agents are administered
concureently. Proteinuria can significantly reduce
plasma protein levels, leading to manifestations
of toxicity when highly protein-bound drugs are
given. In addition any potentially nephrotoxic
agents is avoided or used with extreme caution.
7. Therapeutic Management
Nutrition and Fluid Management
As renal function declines, the elimination of
water, solutes, and metabolic wastes is impaired.
Accumulation of these wastes in the body leads
to uremic symptoms. Instituted early in the
course of CRF, dietary modifications can slow the
progress of nephron destruction, reduce uremic
symptoms, and help prevent complications.
8. Complications
- Fluid and Electrolyte Effects
.
- Cardiovascular Effects
1. Assessment
Both subjective and objective data are used to
assess the client with CRF:
 Health history: Complaints of anorexia,
nausea, weight gain, or edema; current
treatment (if any), including type and
frequency af dialysis or previous kidney
transplant; chronic disease such as diabetes,
heart failure, or kidney disease.
 Physical examination: Mental status; vital
signs including temperatur, heart and lung
sounds, and peripheral pulses; urine output (if
any); weight; skin color, moisture, condition;
 Ineffective Tissue Perfusion:
Renal
 Imbalanced Nutrition: Less Than
Body Requirements
 Risk for Infection
 Disturbed Body Image
 Ineffective Tissue Perfusion: Renal
 Monitor intake and output, vital signs
including orthostatic blood pressure, and
weight.
 Restrict fluids as ordered.
 Monitor respiratory status, including lung
sounds, every 4 to 8 hours.
 Imbalanced Nutrition: Less than Body
Requirements
 Monitor food and nutrient intake as well as
episodes of vomiting.
 Weigh daily before breakfast.
 Riskfor Infection
 Use standart precautions and good hand
washing technique at all times.
 Monitor temperature and vital signs at least
every 4 hours.
 Monitor WBC count and differential.
 Disturbed Body Image
 Involve the client in care, including meal
planning, dialysis, and catheter, port, or
incision care to the extent possible.
 Encourage expression of feelings and
concerns, accepting perceptions and feelings

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