Case study: End stage renal failure
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Case study: End stage renal failure
- 1. End Stage Renal Failure Presented by Jacynta F. Pepin (RN)
- 2. CASE STUDY • Madam O, 78 years old, Chinese • history of dyspnea and lethargy
- 3. TRIAGE • Temperature: 37.1 Celsius • Blood pressure: 102/49mmHg • Heart rate: 51 beats per minute • Respiratory rate: 35 per minute • SPO2: 95%
- 4. • Dyspnea • Lung crepts • Lethargic • Pale • Bilateral pedal edema • Disorientated to time, place and people
- 5. • DM and HPT for more than 10 years • Hemoglucose: 20.3mmol/L
- 6. • Ultrasound abdo: chronic renal parenchymal disease • CXR: suspected basal pneumonia with pulmonary congestion
- 7. • Blood Test (Package B) Potassium: 6.0mmol/L Urea: 64.9mmol/L Creatinine: 924µmol/L • ABG: (with oxygen5L/min) pH 7.173 PCO2 25.9 mmHg PO2 81.7mmHg HCO3- 12.8mmol/L
- 8. End Stage Renal Failure Definition: • The final stage of CKF when kidneys are unable to excrete metabolic wastes and regulate fluid and electrolyte balance adequately .
- 9. Causes • Diabetic • Hypertension • Chronic glomerulonephritis • Polycystic kidney disease • Others : Pyelonephritis Infection Medication Toxins
- 10. • Filtration • Reabsorbtion • Secretion
- 11. Pathophysiology
- 12. GFR equation • formula to calculate GFR: = 186 × (serum creatinine[mg/dL])-1.154 × (age [years])-0.203× 0.742 (if female) × 1.210 (if African-American)
- 14. Alteration and Manifestation • NEUROLOGICAL SYSTEM
- 18. RENAL SYSTEM
- 19. Treatment and Medicine • IV NaHCO3 8.4% (1 mEq/ml) in 50 ml • 1 ampoule of calcium gluconate 0.7 g in 10 ml • Actrapid subcutaneous injection TDS • Flagyl 500mg TDS and Meropenem 500mg TDS • IV Atropine 0.5mg (PRN)
- 20. Treatment Option • Dialysis : Hemodialysis Peritoneal dialysis • Transplantation
- 21. • Double lumen • Right jugular vessels • The tip should lie in the superior vena cava just above the right atrium
- 22. Hemodialysis • Each treatment takes about 4 hours and is done 3 times each week.
- 23. Management • 3hours,ultrafitration of 1000mL • 2unit of plasma transfusion • oxygen via nasal cannula at 4L/min, • cardiac monitoring • insertion of a peripheral intravenous catheter and an indwelling Foley catheter • 1000 mL fluid restriction • low protein diet
- 24. Nursing Care Plan • Excess fluid volume related to failure of kidneys to eliminate excess body fluid and risk of volume deficit related to extraction from dialysis. • Risk for infection related to invasive catheters and impaired immune function.
- 25. Excess fluid volume related to failure of kidneys to eliminate excess body fluid and risk of volume deficit related to extraction from dialysis. Goal: maintain hydration • Assess skin characteristic, signs of bleeding respiratory efforts and vital signs. • Daily weight, I&O • Diuretics and antihypertensive medicines are withheld during dialysis • Verify continuity of shunt and dialysis circuit • Assess for oozing or frank bleeding • Administer IV solution eg. Normal saline or volume expander eg. Albumin. • Monitor serum sodium level and restrict sodium intake • Restrict fluid intake
- 26. Risk for infection related to invasive catheters and impaired immune function. Goal: Prevent infection • Assess for signs and symptoms of infection. • Maintain asepsis with the catheter during dialysis. • Avoid usage catheter for any purpose but hemodialysis.
- 27. 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 preparation of AV fistula and dialysis.
- 28. Outcome • transferred out from ICU • VS improved but she require a permanent dialysis access ; arteriovenous fistula • refuse dialysis • dialysis treatment was abandoned • DIL, AMA
- 29. • On the fourth day, dyspnea ,wheezing , restless and drowsy • chest X-ray obtained shows worsening of congestive cardiac failure • condition deteriorating with falling blood pressure and heart rate • unconscious and severe dyspnea • no urine output after 80mg of IV Lasix • confirmed death with caused of death of Cardiac Failure
- 30. Conclusion • Assessment of all body systems is essential. • Education of patients about the management of ESRF. • It is not easy to prepare patient for dialysis. • Early prevention
- 31. Thank You