CHRONIC RENAL FAILURE A blood urea nitrogen (BUN) test measures how interference with the system of the

much nitrogen from the waste product urea is in renin-angiotensin-aldosterone system

Chronic kidney disease, also called chronic kidney your blood. BUN level rises when the kidneys (caused by renal dysfunction).
failure, describes the gradual loss of kidney function. aren't working well enough to remove urea from
the blood. 3 Investigate complaints of chest
Signs & Symptoms pain, note the location, radiation,
Nausea A fasting blood glucose test is done to measure severity (0-10 scale).
Vomiting R: HT and CRF can cause pain.
your blood sugar. High blood sugar
Loss of appetite levels damage blood vessels in the kidneys.
4 Assess activity level, response to
Fatigue and weakness
activity.
Sleep problems Blood tests measure levels of waste products R: Fatigue can also accompany
Changes in how much you urinate and electrolytes in your blood that should be CRF anemia.
Decreased mental sharpness removed by your kidneys. 2. Fluid and Electrolyte
Muscle twitches and cramps imbalances related
Swelling of feet and ankles Urinalysis (UA) and a urine test for micro to secondary edema (fluid volume
Persistent itching albumin, or other urine tests, can measure unbalanced because of the
Chest pain, if fluid builds up around the lining protein in your urine. Normally there is little or retention of Na and H2O).
no protein in urine Interventions:
of the heart
1 Assess fluid status with daily weigh,
Shortness of breath, if fluid builds up in the
balance input and output, skin turgor,
lungs Perform an ultrasound or CT scan to get a
vital signs.
High blood pressure (hypertension) that's picture of your kidneys and urinary tract.
difficult to control 2 Limit your fluid intake.
Etiology Perform a kidney biopsy, which is done in R: fluid restriction akn determine ideal
Type 1 or type 2 diabetes some cases to check for a specific type of body weight, urine output, and response
High blood pressure kidney disease, see how much kidney damage to therapy.
Glomerulonephritis an inflammation of the has occurred and help plan treatment
kidney's filtering units (glomeruli) Medications 3 Explain to the patient and family about
Interstitial nephritis an inflammation of the ACE inhibitors. high blood pressure the liquid restrictions.
kidney's tubules and surrounding structures Angiotensin II receptor blockers (ARBs). R: Understanding to increase cooperation
Polycystic kidney disease Beta-blockers. of patients and families in the fluid
Calcium channel blockers. restriction.
Prolonged obstruction of the urinary tract,
from conditions such as enlarged prostate, Direct renin inhibitors.
4. Instruct the patient / teach the patient to
kidney stones and some cancers Diuretics. For edema record the use of fluid intake and output
Vesicoureteral reflux, a condition that causes Vasodilators mainly.
urine to back up into your kidneys Nursing Diagnosis R: To determine the balance of inputs and
Recurrent kidney infection, also called 1. Decreased Cardiac Output related outputs.
pyelonephritis to increased cardiac load.
Labs and diagnostic test Interventions: 3. Imbalanced Nutrition, Less Than
A blood creatinine test helps to estimate 1 Auscultation of heart and lung Body Requirements related to
the glomerular filtration rate (GFR) by sounds. anorexia, nausea, vomiting.
measuring the level of creatinine in your blood. R: The presence of tachycardia, Interventions
The doctor can use the GFR to regularly check irregular heart rate. 1 Monitor the consumption of foods /
how well the kidneys are working and liquids.
to stage your kidney disease. 2 Assess for hypertension. R: Identifying nutritional deficiencies.
R: Hypertension may occur due to
2 Notice of nausea and vomiting. presence of redness. medulla is triangular regions with a striped appearance,
R: Symptoms that accompany R: Indicates area of poor circulation
the medullary pyramids.
the accumulation of endogenous toxins or damage that may lead to the
that can alter or lower income and require formation of pressure sores /
intervention. infections. The broader base of each pyramid faces
toward the inner region of the kidney. The pyramids are
3 Give food a little but often. 2 Monitor fluid intake
R: The portion of a smaller can increase and hydration of the skin and mucous separated by extensions of cortex-like tissue, the renal
food intake. membranes. columns. Medial to the hilus is a flat, basinlike cavity,
R: Detecting the presence of
4 Increase visits by people nearby during dehydration or overhydration the renal pelvis. The pelvis is continuous with the
meals. affecting circulation and tissue ureter leaving the hilus. Extensions of the pelvis,
R: Provides transfer and improve the integrity.
social aspects. 3 Inspection of the area depends on calyces, form cup-shaped areas that enclose the tips of
edema the pyramid. The calyces collect urine, which
5. Provide frequent mouth care. R: Tissue edema is more likely to be
R: Lowering stomatitis oral discomfort damaged / torn. continuously drains from the tips of the pyramids into
and unwelcome taste in the mouth that 4 Change positions as often as the renal pelvis. Urine then flows from the pelvis into
can affect food intake. possible.
4. Ineffective Breathing R: Reduce pressure on edema, poorly te ureter, which transports it to the bladder.
Pattern related to perfused tissue to reduce ischemia.
hyperventilation secondary: Blood supply
compensation via respiratory 5. Give skin care.
alkalosis. R: Reduce drying, skin tears. The kidneys continuously cleanse the blood
Interventions
1 Auscultation of breath sounds, note the and adjust its composition, so it is not surprising that
presence of crakles. Anatomy and Physiology kidney have a very rich blood supply. Approximately
R: To declare the existence of the Kidneys
collection of secretions. one-quarter of the total blood supply of the body passes
Kidneys are located in the lower back, this is through the kidneys each minute. The arterial supply of
2 Teach patient effective coughing and
deep breathing. not their location. Instead, these small, dark red organs each kidney is the renal artery. As the renal artery
R: Cleaning the airway and facilitate the with a kidney-bean shaped lie against the dorsal body approaches the hilus, it divides into segmental arteries.
flow O2.
wall in a retroperitoneal position in the superior lumbar Once inside the pelvis, the segmental artery break up
3 Adjust the position as comfortable as region. The kidneys extend from the T12 to L3 into lobar arteries, each of which gives off several
possible.
R: Preventing the occurrence of shortness veterbrae thus they receive some protection from the branches called interlobar arteries. At the medulla-
of breath. lower part of the rib cage. cortex junction, interlobar arteries give off the acuate

4 Limit to move. arteries, which curve over the medullary pyramids.

R: Reduce workload and prevent
tightness or hypoxia.
5. Impaired Skin Integrity related to
pruritis
Interventions
1. Inspection of the skin to change
color, turgor, vascular, note the
When a kidney is cut lengthwise, three distinct
regions become apparent. The outer region which is
light in color, is the renal cortex. Deep to the cortex is a
darker reddish-brown area, the renal medulla. The
Venous blood draining from the kidney flows
through veins that trace the pathway of the arterial
blood supply but in reverse direction interlobular
veins to arcuate veins to interlobar veins to the renal
vein, which emerges from the kidney hilus.
Nephrons and Urine Formation
Nephrons
Each kidney contains over a million tiny
structures called nephrons. Nephrons are the structural
and functional units of the kidneys and as such they are
responsible for forming the urine product. Each
nephron consist of two main structures: a glomerulus,
which is a knot of capillaries, and a renal tubule.
Bowmans capsule a cup-shaped and completely
surrounds the glomerulus. The inner layer of the
capsule is made up of higly modified octopus like cells
called podocytes. Podocytes have long branching
processes called pedicels that interwine with one
another and cling to the glomerulus.
The different tubules have specific names: Urine Formation
proximal convoluted tubule (PCT), loop of henle, and
Urine formation is a result of three processes
the distal convoluted tubule (DCT)
filtration, reabsorption, and secretion.
Most nephrons are called cortical nephrons
1.) Glomerular filtration creates a plasmalike
because they are located almost entirely within the
filtrate of the blood
cortex. In a few cases, the nephrons are called 2.) Tubular reabsorption removes useful solutes
juxtamedullary nephrons because they are situated from the filtrate, returns them to the blood
close to the cortex-medulla junction. The collecting 3.) Tubular secretion removes additional wastes
ducts, each of which receives urine from many from the blood and adds them to the filtrate
4.) Water conservation removes water from the
nephrons, run downward through the medullary
urine and returns it to the blood, concentrates
pyramids, delivering the final urine product into
wastes
calyces and renal pelvis.
The glomerulus is both fed and drained by
arterioles. The afferent arteriole, which arises from an
interlobular artery. The efferent arteriole receives blood
that has passed through the glomerulus.