NCP Chronic Renal Failure

NCP Chronic Renal Failure - RENAL FAILURE: CHRONIC Chronic...

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RENAL FAILURE: CHRONIC Chronic renal failure ( CRF ) is the end result of a gradual, progressive loss of kidney function. Causes include chronic infections (glomerulonephritis, pyelonephritis), vascular diseases (hypertension, nephrosclerosis), obstructive processes (renal calculi), collagen diseases (systemic lupus), nephrotoxic agents (drugs, such as aminoglycosides), and endocrine diseases (diabetes, hyperparathyroidism). This syndrome is generally progressive and produces major changes in all body systems. The final stage of renal dysfunction, end-stage renal disease (ESRD), is demonstrated by a glomeruler filtration rate (GFR) of 15%–20% of normal or less. CARE SETTING Primary focus is at the community level, although inpatient acute hospitalization may be required for life-threatening complications. RELATED CONCERNS Anemias (iron deficiency, pernicious, aplastic, hemolytic) Fluid and electrolyte imbalances Heart failure: chronic Hypertension: severe Metabolic acidosis (primary base bicarbonate deficiency) Psychosocial aspects of care Upper gastrointestinal/esophageal bleeding Additional associated nursing diagnoses are found in: Renal dialysis Renal failure: acute Seizure disorders/epilepsy Patient Assessment Database ACTIVITY/REST May report: Extreme fatigue, weakness, malaise Sleep disturbances (insomnia/restlessness or somnolence) May exhibit: Muscle weakness, loss of tone, decreased range of motion (ROM) CIRCULATION May report: History of prolonged or severe hypertension Palpitations; chest pain (angina) May exhibit: Hypertension; JVD, full/bounding pulses; generalized tissue and pitting edema of feet, legs, hands Cardiac dysrhythmias, distant heart sounds Weak thready pulses, orthostatic hypotension reflects hypovolemia (rare in end-stage disease) Pericardial friction rub Pallor; bronze-gray, yellow skin Bleeding tendencies EGO INTEGRITY May report: Stress factors, e.g., financial, relationship, and so on Feelings of helplessness, hopelessness, powerlessness May exhibit: Denial, anxiety, fear, anger, irritability, personality changes ELIMINATION May report: Decreased urinary frequency; oliguria, anuria (advanced failure) Abdominal bloating, diarrhea, or constipation May exhibit: Change in urine color, e.g., deep yellow, red, brown, cloudy
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Oliguria, may become anuric FOOD/FLUID May report: Rapid weight gain (edema), weight loss (malnutrition) Anorexia, heartburn, nausea/vomiting; unpleasant metallic taste in the mouth (ammonia breath) Use of diuretics May exhibit: Abdominal distension/ascites, liver enlargement (end-stage) Changes in skin turgor/moisture Edema (generalized, dependent) Gum ulcerations, bleeding of gums/tongue Muscle wasting, decreased subcutaneous fat, debilitated appearance HYGIENE May report: Difficulty performing activities of daily living (ADLs) NEUROSENSORY May report: Headache, blurred vision Muscle cramps/twitching, “restless leg” syndrome; burning numbness of soles of feet Numbness/tingling and weakness, especially of lower extremities (peripheral neuropathy)
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NCP Chronic Renal Failure - RENAL FAILURE: CHRONIC Chronic...

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