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Repeated infections result in adhesions and interfere with dialysis requiredhemodialysis Treatment: antibioticsNursing Diagnoses (pg. 804-805)oAltered fluid and electrolyte balance related to kidney not functioningoImbalance nutrition less than body requirements related to anorexia and nauseaoKnowledge deficit (in diagnosis, lab studies, treatment) Chronic Kidney DiseaseKidney damage with resulting dysfunctionoGFR < 60 mL/ minuteoPersists more than 3 monthsKidney failure or ESRD kidney results when kidneys are unable to excrete metabolic wastes OR regulate fluid and electrolytesUremia: urine in the blood oRefer to multisystem effects (pg. 810) Fluids and ElectrolytesoProteinuriaoHematuriaoDecrease urine concentration abilityoSalt and water poorly conserved (dehydration)oPolyuriaoNocturia
oFixed specific gravity (1.008-1.012) oHyperkalemiaoHyperphosphatemiaoHypocalcemiaoHypermagnesemia oMetabolic Acidosis Cardiovascular effectsoLeading cause of deathoAccelerated atherosclerosisoHypertensionExcess fluid volumeIncreased renin angiotensin activityoHyperlipidemiaoHeart FailureoPulmonary EdemaoIrritation or Pericardial SacoCardiac tamponade Hematologic EffectsoAnemiaoErythropoietin production declinesoRetained metabolic toxins suppress RBC productionoNutritional deficiencies oEffects of anemia (fatigue, weakness, depression, impaired cognition)oImpaired platelet function (epistasis, GI bleeding)Immune effectsoRisk for infectionoUrea and retained metabolic wastes impairs inflammationoWBC declines oHumoral and cell mediated immunity impairedoPhagocyte function is defectiveGI effectsoAnorexiaoN/VoHiccups occuroGastroenteritis oUlcerationsoPeptic Ulcers common Neurologic effectsoCNS changes in mentationoDifficulty concentrationoFatigueoInsomniaoPsychotic symptoms
oSeizuresoComaoPeripheral neuropathyoRestless leg syndromeoStocking GloveMS effectsoBone resorption and remodelingoRenal osteodystrophy “Renal Rickets” Decreased calcium absorptionOsteomalacia: soft bonesOsteoporosis: decreased bone massSigns: bone tenderness, pain, and muscle weaknessoRisk for spontaneous fracturesEndocrine effectsoIncreased creatinineoIncreased BUNoIncreased Uric Acid LevelsRisk of goutoGlucose IntoleranceoHigh triglycerides oLow HDLDermatologic EffectsoPalloroYellowish HueoDry skinoPoor turgor from dehydrationoSweat gland atrophy oItchingoPruritis oUremic Frost from high levels of urea in sweat CKD DiagnosisoUrinalysisoUrine cultureoBUN and serum creatinineoeGFRoSerum electrolytesoCBCoRenal ultrasonography- kidney sizeoKidney biopsy CKD MedicationsoACEI and ARBsoDiureticsoCCB
oStatinsoSodium BicarbonateoCalcium CarbonateoOral Phosphate BindingoIncreased Potassium bicarbonate, insulin, glucose, Kayexalate (oral or rectal) oErythropoietin: Epogen, Procrit Nutrition and Fluid ManagementoDietary modifications can slow the progression of nephron destruction, reduce