Chronic

kidney
Disease
Presented by
M A Naleef
DGN/DNA BNS(OUM)

UGS0019676
 Introduction
• Chronic kidney disease is a worldwide public
health problem. In the Asian countries, there is a
rising incidence and prevalence of kidney failure,
with poor outcomes and high cost.
• Chronic kidney disease (CKD) is characterized by
progressive destruction of renal mass with
irreversible sclerosis and loss of nephrons over a
period of months to years, depending on the
underlying etiology.
 CASE STUDY

• Mr. K A Nihal 45 yrs male

patient.
• Complain of DIB, vomiting,
poor oral intake and
weakness
In ETU
• Temperature: 37.1 Celsius

• Blood pressure: 102/49mmHg

• Heart rate: 51 beats per minute

• Respiratory rate: 35 per minute

• SPO2: 95%
• Dyspnea
• Lung crepts
• Lethargic
• Pale
• Bilateral pedal edema
• Disorientated to time,
place and people
• CKD since 2010 with HD
• DM and HPT for more than
10 years on OHD &
Antihypertensive.
• PSHx: Open
Appendicectomy 25yrs
before
 • Blood Test (Package B)
Potassium: 6.0mmol/L
Urea: 64.9mmol/L
Creatinine: 6.2 mmol/L

• ABG: (with
oxygen5L/min)
pH 7.173
• Patient admitted to ICU
PCO2 25.9 mmHg
for further
PO2 81.7mmHg
management
HCO3- 12.8mmol/L
On Examination

• Patient vital signs HR110/bpm, RR28/bpm, BP

140/88mmHg, Tem 100’F
• Patient in defaulting breathing with 15l oxygen
via face mask.
• Abdomen was distended feeling discomfort.
• Lower limb swelling with low urine out put
 Chronic Kidney Disease
Definition:

• CKD is a slowly worsening loss of ability of the

kidneys to remove wastes, concentrate urine,
and conserve electrolyte.
 Causes
• Diabetic
• Hypertension
• Chronic glomerulonephritis
• Polycystic kidney disease
• Others :
Pyelonephritis
Infection
Medication
Toxins
Functions of Kidney (A WET BED)

• Regulation of Acid base balance

• Regulation of Water
• Regulation of Electrolyte
• Remove Toxins substance
• Regulation of BP
• Production of Erythropoietin
• Metabolism of vitamin D
 Clinical Manifestations
• Fatigue, Nausea, vomiting, Headache, pruritus, &
ill feeling, unintentional weight loss.
• High BP, LOA, white nail syndrome, paleness,
Excessive thirst, agitation, uremic smell.
• Decreased alertness, confusion, drowsy, altered
UOP.
• Seizure, decreased sensation, muscle twitching,
cramps.
 Investigations
• Blood Tests
– Serum Creatinine, BUN, Creatinine clearance
– Serum potassium, calcium, Urea, Uric acid
– ABG , FBC, EGFR
• Urine tests
– UFR, 24h hours urine collection, Cultures,
• Radiological tests
– X-ray kidneys and abdomen
– Abdominal ultra sound scanning
 Treatment Option
• Dialysis :
– Hemodialysis
– Peritoneal dialysis

• Transplantation
 Haemodialysis
• Haemodialysis is the most common method used
to treat kidney failure.
• The haemodialysis is still considered as a
complicated and inconvenient therapy, because
it requires a coordinated effort from patients and
the health care team whom including
nephrologists, dialysis nurse, dialysis technician,
dietitian, and social workers.
• The principal of haemodialysis is diffusion and
ultra filtration.
 Hemodialysis

• Each treatment takes about 4 hours and is

done 2 times each week.
 Complication of Haemodialysis

• Hypotension
• Cramp
• Air embolism
• Clotting of blood
• Blood leak
• Haemolysis
 Nursing Care Plan
• Excess fluid volume related to failure of kidneys to
eliminate excess body fluid as evidenced by lower
limb oedema.
• Risk for infection related to impaired immune
function as evidenced by elevation of inflammatory
maker (CRP 84mg/dl).
• Disturbed thought process related to physiological
changes evidenced by changes in behaviours.
• Risk for impaired skin integrity due to accumulation
of the toxins in the skin as evidenced by complain of
itching
• Imbalanced nutrition less than body requirement
related to nausea vomiting as evidenced by
inadequate food intake.
• Impaired physical mobility lengthy dialysis
procedure as evidenced by impaired coordination.
• Anxiety due to threat of death as evidenced by
apprehension.
• Deficient knowledge regarding disease condition as
evidenced by request for information.
• Risk for constipation due to decreased fluid intake
as evidenced by patient verbalized.
 Nursing Interventions
• Provide emotional support to the client and
family.
• Provide high carbohydrate and moderate fat
content in the client’s diet.
• Restrict the client’s intake of fluids (based on
urinary output).
• Control protein intake based on the client’s stage
of renal failure and type of dialysis.
• Balance the client’s activity and rest.
• Prepare the client for haemodialysis.
• Provide skin care to client to increase comfort
and prevent breakdown.
• Encourage the client to ask questions and discuss
fears.
• Encourage the client to diet, exercise, and take
medication to control HPL,HTN,DM.
• Administer medications as prescribed (Folic acid,
Antihypertensives, Iron supplements, Alkalizers,
Erythropoietin, Diuretics, Stool softeners,
Aluminum hydroxide).
• Restrict the client’s dietary sodium, potassium,
phosphorous, and magnesium.
• Refer the client to a community resource or
support group.
• Teach the client how to measure blood pressure
and weight at home.
• Teach the client to avoid antacids containing
magnesium.
• Teach the client about the signs and symptoms
that require immediate reporting.
• Monitor for and plan interventions for life-
threatening complications
 Health Education
• Teach about medications and
lab results.

• Self-monitoring BP and
blood glucose levels.

• Interaction with members of the interdisciplinary

team, eg. Dietician, social worker for financial
information and support.

• Educate in care of AV fistula and dialysis.

 Conclusion
• Chronic kidney disease, if not managed carefully,
can become progressive; therefore it is up to
health care professionals to ensure that all is
realistically done to slow down the process.
• Effective monitoring according to disease stage,
health education and appropriate timely referral
to specialist services, can benefit individuals with
CKD in terms of improving long-term outcomes.
Thank You