Pathophysiology Of Chronic Renal Failure Essay 2022

need 10 references not older than 2014

Running head: NURSING 1
Nursing
Student’s Name
Institutional Affiliation

NURSING 2
Introduction
The essay focuses on a 55-year old patient, Melanie Johnson who visited her GP and
found that her blood pressure was 190/110mm Hg although she was diagnosed with
hypertension. Melanie was then referred to a nephrologist and was diagnosed with chronic renal
failure. The essay explains the renal anatomy and physiology, the pathophysiology of chronic
renal failure alongside its risk factors, possible complications and treatment options. It identifies
the differences amidst acute and chronic renal failure and describes renal replacement therapy.
Furthermore, the essay discusses two medications for Melanie alongside their side effects and
nursing considerations pertinent to Melanie. Lastly, it explains the GFR and Hb blood tests
carried out for Melanie and discusses the teach-back technique.
PART 1
Renal anatomy and physiology
Kidneys are bean-shaped retroperitoneal organs which alter the blood elements and
excrete urine. In the middle of every kidney, there is an indentation which conforms the renal
hilum which is the entrance and exit point for the renal artery and vein, lymphatics, ureter, and
nerves go in and come out of the renal (Chalmers, 2019). The kidney is surrounded by kidney
fascia which is a thin layer of thick connective tissue which holds the renal to its surroundings.
The adipose capsule is a fatty layer which shields the renal from trauma. Lastly, the renal capsule
layer is an even transparent sheet of dense connective tissue that gives the renal its typical
structure.
Moreover, the kidney has two main parts which are renal medulla and renal cortex. In the
renal medulla, renal papilla project into minor calyces that align to generate major calyces that
funnel into the renal pelvis. In the renal pelvis, urine collects and head out of the renal via the

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ureter (Chalmers, 2019). The renal cortex is split into an outer cortical zone and an inner
juxtamedullary zone and it has segments called renal columns which stretch down into the
medulla splitting the renal pyramids from each other.
The pathophysiology of chronic renal failure in Melanie, including her risk factor(s),
possible complications and treatment options
Initially, chronic kidney injury is defined as a declined renal reserve of inadequacy that
may advance to kidney failure. As kidney tissue loses performance, there are some detectable
malformations since the remaining tissue elevates its performance which is called renal
functional adaptation (Malek & Nematbakhsh, 2015). The diminished kidney function then alters
the ability of the kidney to control fluid and electrolyte homeostasis. Furthermore the potentiality
to concentrate urine reduces early and is followed by a decline in the capability to excrete excess
potassium, acid, and phosphate. When kidney disease has progressed, the ability to effectively
intensify or liquefy urine is lost (Malek & Nematbakhsh, 2015).
Factors which put Melanie at risk of chronic renal failure progression include age, anemia
and uncontrolled high blood pressure (Schulman et al., 2018). Kidney function decreases with
age in both males and females. According to statistics from the U.S. Renal Data System
(USRDS), around 83 % of chronic kidney injury diagnoses occur in people of 45 years and
above (Collins, Foley, Gilbertson & Chen, 2015). Anemia is regarded as a separate risk factor for
advancement of chronic kidney disease.
Moreover, although Melanie has not been diagnosed with hypertension, after examination
her blood pressure reads 190/110 mmHg which is very high hence putting her at risk. Systemic
high blood pressure is contracted to intraglomerular capillary pressure causing
glomerulosclerosis along with the renal function loss (Aryan, Singh, Patel, Malaviya & Kausar,

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2018). Hypertension may cause less blood to reach her kidneys leading to fewer functioning
nephrons and as the damage elevates the kidneys will be unable to produce aldosterone hormone
that regulates blood pressure (Schulman et al., 2018).
A uremic symptom is a possible complication of chronic renal failure which encompasses
various symptoms like increasing tiredness, nausea, and general pruritus. Furthermore, high
blood pressure is one of the most damaging complications of chronic renal failure and is believed
to contribute to the acceleration of a progressive decrease in renal performance. Anemia is also
an impediment of chronic kidney (Dhayef, Manuti & Abutabiekh, 2017) disease and it is
proportional to the Glomerular Filtration Rate. It is because of the declined production of
erythropoietin by the kidneys, the iron deficiency and reduced red blood cell survival along with
mineral bone disease which is as a result of disturbed calcium, phosphate and vitamin D
(Webster, Nagler, Morton & Masson, 2017).
Although chronic renal failure cannot be treated, some options can help its accelerated
progression. Lifestyle change is a treatment that makes sure one remains as healthy as possible.
It encompasses eating a healthy balanced diet and avoiding over the counter NSAIDs like
ibuprofen that Melanie is using as it damages the kidneys (Webster, Nagler, Morton & Masson,
2017). Furthermore, medications like angiotensin-converting enzyme (ACE) inhibitors are
utilized in controlling related issues like high blood pressure. Dialysis is another treatment
option which replicates some of the renal functions that may be necessary for advanced chronic
renal failure. Also, for an advanced chronic renal failure kidney transplant may be necessary
(Webster et al., 2017).
Differences between Acute and Chronic renal failure

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Acute renal failure (ARF) is an immediate decline in kidney performance while chronic
renal failure (CRF) is declined kidney function from damaged through mild, moderate and severe
CRF. ARF happens suddenly while CRF develops over a long time. ARF is reversible while
CRF irreversible (Ferenbach & Bonventre, 2016). Moreover, ARF is caused by an event while
CRF is caused by a long-term disease. Patients with ARF are placed on temporary dialysis while
those with CRF on permanent dialysis. People with ARF might not notice any symptoms at first
but with CRF, early symptoms include frequent urination and hypertension.
Renal replacement therapy (hemodialysis)
In renal replacement therapy blood is transported out of the body via tubes and cleaned in
a machine by use of dialysis fluid (Gilbert, Lovibond, Mooney & Dudley, 2018). Hemodialysis
helps in maintaining correct chemical balance like chloride, sodium, and potassium and keeps
the blood pressure under control. Before starting hemodialysis, one must have vascular access
through which one connects to the dialyzer.
Melanie is advised to undergo hemodialysis after an arteriovenous (AV) fistula is created.
The AV fistula is considered the prime type of permanent access. To create it, the vascular
surgeon usually links an artery to a vein. An artery is a blood vessel that transports blood away
from the heart while a vein is a blood vessel that transports blood back to the heart. When the
vascular surgeon links the artery to the vein, the vein becomes thicker and broader making it
easier to place the needles for dialysis (Bylsma, Gage, Reichert, Dahl & Lawson, 2017).
Moreover, the larger diameter of the AV fistula makes it possible for blood to flow out and back
to the body swiftly. The target is to enable a high flow of blood so that the highest blood amount
can go via the dialyzer.
PART 2

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Discuss the two medications used for Melanie, with rationale and clear links to her case.
Include 4 major side effects and 4 nursing considerations relevant to Melanie for each
drug.
Valsartan contains valsartan as an active ingredient which forms to a part of drugs called
angiotensin II receptor antagonists that assist in controlling high blood pressure (Michalatou et
al., 2018). Angiotensin II is a element in the body which makes vessels tightens leading to a rise
in blood pressure. This drug functions by hindering the impact of angiotensin II and
correspondingly, the blood vessels repose and blood pressure lowers. Reducing blood pressure
assists in avoiding kidney issues, heart attacks, and stroke. With Melanie’s case, her blood
pressure reading 190/ 110 mmHg is very high which needs to be regulated by this drug. Therapy
with this drug enables patients to resume many of their normal operations and treats the anemia
without the need for blood transfusion.
Like all other drugs, valsartan cause side effects although not everyone gets them. After
taking the drug, Melanie may experience symptoms of angioedema like itching and hives,
swollen throat, face, tongue and lips along with difficulty in swallowing or breathing. When
administering valsartan, nurses should consider the administration time since it causes dizziness
(Zappe, Crikelair, Kandra & Palatini, 2015). Also, nurses should consider lower listed initial
dose in patients with decreased renal function. Furthermore, they should monitor electrolyte
levels, blood pressure, and kidney performance before administering (Michalatou et al., 2018).
On the other side, Eprex incorporates the vital ingredient epoetin alfa, a protein that
triggers the bone marrow to generate more red blood cells (Dhayef et al., 2017). Due to kidney
failure, the decreased production of erythropoietin hormone by kidneys may cause anemia.
Therefore, the drug prompts the bone marrow to generate more red blood cells assisting in

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treating anemia related to renal failure. Where intravenous access is routinely accessible in
patients with chronic renal failure, Eprex administration via the intravenous route is preferable.
In patients on hemodialysis, the drug must always be given after completion of the dialysis. As
seen from Melanie’s blood results, her hemoglobin is very low and this drug will be useful to her
to increase her red blood cell count to treat the anemia.
Similar to valsartan, the side effects of Eprex are not experienced by everybody who
takes it. Melanie may experience clotting of the vascular access site she was on hemodialysis,
inflammation around the injection site, and a conventional feeling of fatigue or frailty along with
an increase in headaches (Dhayef et al., 2017).
When administering this drug, health professionals should consider Melanie's
hemoglobin concentration. The hemoglobin concentration should be measured regularly until a
stable level is reached and periodically thereafter. Furthermore, they should consider her blood
pressure since it should be controlled adequately before the treatment is initiated. Also, since
anemia is also caused by iron deficiency, nurses should evaluate iron supplementation and treat
the deficiency before starting the Eprex therapy. Lastly, serum electrolytes should be monitored
since if increased serum potassium is detected then consideration should be given to ceasing the
administration of Eprex until the serum level is corrected.
The GFR and Hb blood test performed for Melanie and what the GFR and Hb results
indicate
Glomerular Filtration Rate (GFR) is the best overall index of the glomerular performance
(Gounden & Jialal, 2018). It is the rate in milliliters per minute at which plasma substances are
filtered through the glomerulus or the clearance of substances from the blood. Melanie’s GFR of
10 ml/min/1.72 m2 indicates that her CRF is at stage 5 which is the end-stage kidney failure

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(Gounden & Jialal, 2018). Also, it shows that it is incompatible with life without transplantation
or dialysis.
Hemoglobin (Hb) is a protein in the red blood cells which transport oxygen to the rest of
the body. The hemoglobin test measures the hemoglobin amount in the blood and is done to
monitor the general health or diagnose a medical disorder. Melanie’s hemoglobin of 95g/L is
lower than the normal hemoglobin concentration of females of greater than 130g/L. This
indicates that Melanie has anemia as a consequence of diminished generation of erythropoietin
hormone by kidneys.
PART 3
The teach-back method is?
The teach-back technique is also called the show-me approach which is an approach used
by a health professional to affirm that he has clarified to the patient what is essential and in a
way that the patient understands (Dinh, Bonner, Clark, Ramsbotham & Hines, 2016). Whenever
the patient understands what is being explained to them and explains accurately in their own
words then the patient’s apprehension is validated. This technique helps the professional to
identify and elucidate clarifications and communication approaches which are most regularly
misunderstood by the patients. Moreover, it is a communication approach to improve health
literacy.
Using the teach-back method, discuss how you would educate Melanie to manage her fluid
intake in relation to her diet.
When one has chronic renal failure, one needs to adjust her lifestyle primarily focusing
on fluid uptake as well as diet as the diagnosis of the patient rely on the cohesion to the

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suggested healthful regime. However, the non-adherence to the recommended regime results in
rapid worsening of the medical condition (Beerendrakumar, Ramamoorthy & Haridasan, 2018).
For a person to delay the progression of her condition, she has to limit her dietary sodium
by avoiding the addition of salt to her food at the table or when cooking. Furthermore, the person
can avoid pickled foods like pickles and olives along with processed meats like sausage, lunch
meats and bacon. Salt substitutes are normally rich in potassium and one need to avoid them by
using medications that halt the renin-angiotensin-aldosterone system such as angiotensin-
converting enzyme inhibitors and angiotensin-receptor blockers.
Moreover, when the individual is on dialysis, fluid may build up in her body amidst
therapies and the extra fluid can build up around the lungs resulting in shortness of breath.
Therefore, one needs to limit her fluid intake by cutting back how much fluid she takes. Also, the
person needs to limit the foods which contain a lot of water along with foods and soups that melt
like ice cream, gelatin and ice. In case the person is limiting her fluid and feels thirsty, she
should try to quench her thirst by chewing gum, sucking on a reusable ice cube, rinsing her
mouth without swallowing and sucking a piece of ice
"Melanie, as your nurse, one of my top priorities is to make sure I am explaining things
in the manner that you understand. I want to make sure my instructions on how to manage your
fluid intake with your diet are clear. Would you mind telling me in your own words how you will
manage your condition in terms of fluid uptake and diet?” At this point, if Melanie explains back
correctly that means that she understood how to manage her condition and if not I will explain
again until she gets it.

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References
Aryan, S., Singh, O. P., Patel, S., Malaviya, P., & Kausar, G. (2018). Prevalence and risk factors
of chronic kidney disease: a single day screening on World kidney day for four
consecutive years in Varanasi. Urol Nephrol Open Access J, 6(6), 167-171.
Beerendrakumar, N., Ramamoorthy, L., & Haridasan, S. (2018). Dietary and fluid regime
adherence in chronic kidney disease patients. Journal of caring sciences, 7(1), 17.
Bylsma, L. C., Gage, S. M., Reichert, H., Dahl, S. L. M., & Lawson, J. H. (2017). Arteriovenous
fistulae for hemodialysis: a systematic review and meta-analysis of efficacy and safety
outcomes. European Journal of Vascular and Endovascular Surgery, 54(4), 513-522.
Chalmers, C. (2019). Applied anatomy and physiology and the renal disease process. Renal
Nursing: Care and Management of People with Kidney Disease, 21-58.
Collins, A. J., Foley, R. N., Gilbertson, D. T., & Chen, S. C. (2015). The United States Renal
Data System public health surveillance of chronic kidney disease and end-stage renal
disease. Kidney international supplements, 5(1), 2-7.
Dhayef, A. K., Manuti, J. K., & Abutabiekh, A. S. (2017). Anemia response to Methoxy
Polyethylene Glycol-Epoetin Beta (Mircera) versus Epoetin Alfa (Eprex) in patients with
Chronic Kidney disease on Hemodialysis. Methods, 17, 19.
Dinh, T. T. H., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of
the teach-back method on adherence and self-management in health education for people
with chronic disease: a systematic review. JBI database of systematic reviews and
implementation reports, 14(1), 210-247.

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Ferenbach, D. A., & Bonventre, J. V. (2016). Acute kidney injury and chronic kidney disease:
From the laboratory to the clinic. Nephrologie & therapeutique, 12, S41-S48.
Gilbert, J., Lovibond, K., Mooney, A., & Dudley, J. (2018). Renal replacement therapy:
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Gounden, V., & Jialal, I. (2018). Renal function tests. In StatPearls [Internet]. StatPearls
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