Nursing care of patients with chronic kidney failure

2021-07-09 11:30 AM

Most chronic kidney diseases, whether the onset is glomerular, tubular, or vascular disease, can lead to chronic renal failure.

Chronic renal failure is the result of chronic kidney diseases that cause a gradual decrease in the number of nephrons in terms of function, which gradually reduces the glomerular filtration rate. When the glomerular filtration rate falls below 50% (60 ml/min) of the normal range (120 ml/min), chronic renal failure is considered.

Chronic renal failure is a syndrome that develops in stages: in the early stages, there are only a few very subtle symptoms, whereas, in the late stages, it manifests itself with high uremia syndrome. The course of chronic kidney failure can last from months to years.

Reason

Most chronic kidney diseases whether the onset is a glomerular disease, tubulointerstitial disease, or renal vascular disease can lead to chronic renal failure.

Chronic glomerulonephritis

The most common, accounting for 40%. Chronic glomerulonephritis here can be primary or secondary to systemic diseases: systemic lupus erythematosus, diabetes, Scholein Henon.

Chronic pyelonephritis

accounted for about 30%. In which, chronic pyelonephritis in patients with urinary stones is a common cause in Vietnam.

Interstitial nephritis

Usually due to long-term pain medication (Phenylbutazone), hyperuricemia, hypercalcemia.

Renal vascular disease

Benign or malignant renal sclerosis.

Renal microvascular thrombosis.

Nodular periarteritis.

Renal vein occlusion.

Congenital kidney disease hereditary or non-inherited

Polycystic kidney.

Renal dysplasia.

Alport syndrome.

Metabolic nephropathy (Cystinose, Oxalose).

Systemic, metabolic disease

Diabetes.

Colloidal diseases: Lupus.

Currently, the main cause of chronic kidney failure in developed countries is mainly metabolic and renal vascular diseases (diabetes, renal vascular disease) while in developing countries the group of causes is caused by bacteria. still predominate with a high rate.

Clinical symptoms

Edema: depending on the cause of chronic kidney failure, the patient may have edema, in many cases the edema is very large and life-threatening.

Anemia is common, anemia is mild or severe depending on the stage. In chronic glomerulonephritis, anemia is obvious.

Hypertension in about 80% of patients, need to be aware of cases of malignant hypertension.

Heart failure is usually at a late stage and the patient is very sick.

Clinical uremia syndrome

Gastrointestinal symptoms, usually anorexia, vomiting and nausea, diarrhea...

Neurological signs such as headache, insomnia, agitation or coma depending on the stage.

Respiratory symptoms are usually dyspnea and dyspnea.

Cardiovascular signs: tachycardia, increased blood pressure in the early stages, may have pericardial rub or arrhythmia.

Skin itching.

Cramp.

Signs of bleeding can be seen on the skin or internal organs.

Subclinical

Blood count showed anemia.

Urea, blood creatinine increased.

Electrolyte and acid-base disturbances.

Proteinuria is positive.

In addition, some other tests can find the cause of chronic kidney failure: ultrasound, unprepared abdominal X-ray, abdominal CT-scan...

Internally medical treatment

Eat lightly when there is edema and high blood pressure.

Avoid foods high in potassium.

Limit meat and fish depending on the state of uremia.

Water intake is about 300-500 ml plus urine output in a day.

Use antihypertensive drugs when blood pressure is elevated.

Antibiotics are used in cases of infection, but with caution with regard to nephrotoxic antibiotics, the dose should be reduced when antibiotics are used in these patients.

Other treatments

Extrarenal dialysis: peritoneal dialysis, cycle kidney.

Kidney transplant.

Progression and prognosis

Patients with chronic progressive renal failure get worse regardless of the cause.

The disease can lead to death if dialysis or kidney transplantation is not performed in time.

Assess the situation

Assess by asking the patient

Has the patient ever had edema?

Have you ever had urinary problems?

Is there a history of high blood pressure?

Do you have a digestive disorder?

Do you have a headache or dizziness?

Is your health worse than before?

Previous treatment and care for kidney disease, if any.

The medical condition of the patient's family.

Judging by observation

Assess the patient's mental status, general condition of the patient.

Is there nausea and vomiting?

What is the patient's respiratory and breathing status?

What are the signs of skin and mucous membranes?

The patient's bowel movements and stool characteristics.

Color and quantity of urine.

Visiting patients

Check vital signs.

Measure urine output.

Examination of organs:

Abdomen: effusion, are the kidneys large, sore spots...

Respiration: breathing rate, breathing pattern, smell...

Cardiovascular: heart rate, abnormal heart sounds...

Receive information

Acquired through the patient's family.

Through records, treatment, and care slips.

Nursing diagnosis

Through the above comments, the nurse has some diagnoses in patients with chronic kidney failure as follows:

Headache, insomnia due to increased blood urea.

Anorexia, nausea due to increased blood urea.

Increased extracellular fluid volume due to water and salt retention.

Decreased urine output due to decreased glomerular filtration.

Risk of infection due to reduced resistance.

Care planning

The nurse analyzes, synthesizes, and summarizes the data to determine the patient's needs, thereby creating a care plan. Care planning must take into account the patient's overall health, recommending priorities, and deciding which issues to do first and which to do later.

Basic care

Let the patient rest, with the head elevated.

Explain to patient and family about a medical condition.

Eat full energy.

Daily cleaning.

Executing the medical orders

Administer medication to the patient and administer medication as directed.

Do basic tests.

Follow up

If there is any abnormality in pulse, temperature, blood pressure, breathing rate, you must notify your doctor immediately.

Amount and color of urine.

Monitor some tests such as urea and blood creatinine, proteinuria, blood count, if there is any abnormality, notify the doctor immediately.

Monitor for complications of the disease.

Health education

Patients and families need to know about the causes, how to detect the disease, how to prevent it, and how to treat and care for patients with chronic kidney failure.

Implement a care plan

The characteristics of patients with chronic renal failure are uremia, water and electrolyte disturbances as well as other complications caused by chronic renal failure. Patients can die from complications of the disease.

Perform basic care

Place the patient in a supine position with the head elevated.

Encourage and reassure the patient.

Always keep the patient's body warm.

Observe and monitor vital signs.

Diet:

Drinking water: it should be based on the patient's condition, blood pressure, and urine output. Water intake including eating and drinking is about 300 ml plus urine output during the day.

Diet for patients with chronic renal failure should ensure the patient an adequate number of calories. Patients with severe kidney failure need more calories to reduce the body's breakdown. at least 35 kcal/kg body weight/24 hours.

Eat light, easy-to-digest foods, ensure energy, and many vitamins (for anuria patients, it is necessary to limit fruits with a lot of K + such as bananas, oranges, tangerines, ...). Protein intake should also be based on the patient's blood urea status.

Blood urea less than 0.5g/l can give patients a lot of vegetable protein, little animal protein, the amount of protein put in a day is about 0.25g/kg body weight.

Blood urea from 0.5 to 1g/l, should use vegetable protein, not animal protein and the amount of protein included in the day is less than 0.25g/kg weight

Blood urea on 1g/l diet is mainly glucid and some essential amino acids.

Daily hygiene for patients: daily cleaning of teeth and skin to avoid foci of infection, early detection of infection foci to guide patient treatment. Clothes, pants, linens, and other items must always be kept clean.

Executing the medical orders

Fully comply with medical orders when taking drugs, such as: injections, oral drugs. In the process of taking the drug, if there is any abnormality, you must notify the doctor.

Perform tests:

Blood tests such as complete blood count, urea, creatinine, electrolytes, and alkaline reserve.

Ultrasound and electrocardiogram tests.

Urine tests: daily must carefully monitor the amount and color of urine. The tests to do are: protein, urea, creatinine and cells, bacteria.

Follow up

Vital signs: pulse, temperature, blood pressure, the breathing rate of the patient.

Clinical signs of uremia.

Patient weight, signs of edema.

Amount and color of urine.

Monitor kidney functions through tests of urea, blood and urine creatinine, creatinine clearance.

Monitor clinical signs and laboratory tests to detect fluid, electrolyte, acid-base disturbances.

Monitor for clinical and electrocardiographic signs of hyperkalemia.

Monitor for signs of hypocalcemia.

Health education

Patients and families need to know about the causes, how to detect the disease, how to prevent it, and how to treat and care for patients with chronic kidney failure.

The nurse must guide the patient and the patient's family with the necessary diet for people with kidney failure and how to monitor the diet in accordance with regulations.

Patients and their families should be aware of the need for cyclic hemodialysis in patients with end-stage chronic renal failure.

Care Reviews

The patient's condition after following the medical order and implementing the care plan compared to the initial time of the newly admitted patient to assess the disease situation:

Does observing respiratory status improve?

Observe the amount and color of urine compared to the original.

The patient's neurological and gastrointestinal status.

Are the vital signs abnormal or better?

Is the primary nursing care assessment performed and responsive to the patient's needs?

Errors or omissions need to be added to the care and treatment plan to be implemented.

Complications appear.