NURBN2016 Assignment 2: Chronic Renal Failure Case Study Evaluation

This case study presents a comprehensive analysis of a 55-year-old woman, Melanie Johnson, diagnosed with chronic renal failure (CRF). The study delves into the pathophysiology of CRF, including the role of GFR, risk factors such as long-term NSAID use, and the implications of hypertension and anemia. It outlines the differences between acute and chronic renal failure, and explores treatment options, including haemodialysis, medication management (Valsartan and Eprex), and conservative approaches. The study also emphasizes nursing considerations, patient education using the teach-back method, and the importance of monitoring lab values such as GFR and Hb levels. Overall, the case study offers insights into the diagnosis, treatment, and management of CRF, highlighting the need for comprehensive patient care and education.

CASE STUDY ON CHRONIC RENAL FAILURE
CASE STUDY ON CHRONIC RENAL FAILURE
Name of the Student
Name of the University
Authors Note

CASE STUDY ON CHRONIC RENAL FAILURE
Part 1
Response to 1.1
The kidney is a bean-shaped paired organ. Kidneys are found in the abdominal cavity
along the posterior muscular wall behind the peritoneum, and the perirenal fats act as
protective padding. Kidneys have one concave side consisting an indentation called renal
hilus. The organs are surrounded by a renal capsule, which has seven cone-shaped renal
pyramids. The pyramids have a renal cortex and renal medulla. The pyramids have an apex,
and each of these is centred towards the renal pelvis. The apex connects to the minor calyx,
and minor calyces are merged to form major calyx (Bernhard et al.,2016). Major calyces
form renal pelvis, which opens to renal hilus, which connects the kidney to ureter.
Primary units of the kidney are nephron, and each nephron has glomerulus, which
filters the unused products out of the blood and excretes the products to urine. Urea in the
blood helps to distillate more wastes to maintain the balance between blood and urine. The
adequate amount of plasma and blood flow maintenance is another function of the kidney.
The kidney regulates extracellular fluid, ion concentration and pH in the body. The kidney
can produce hormones such as erythropoietin and renin, and blood plasma calcium and
glucose level are also controlled. It filters the body toxins and water-soluble waste products
by urine.
Response to 1.2
GFR (Glomerulus Filtration Rate) is one of the most significant factors in the
pathophysiology of Chronic Renal Failure as the rate can detect the level of damage is caused
in the kidney. According to the rate of GFR in the discussed case study, Melanie suffered

CASE STUDY ON CHRONIC RENAL FAILURE
from kidney failure GFR is less than 15 ml/minute /1.73m2, which interrupts the dilution and
concentration of urine. Low GFR induces the level of creatinine and urea, which gives rise to
the condition of uremia. The kidney also controls the potassium level, and as per the reports,
the serum potassium level is a little higher than the normal level, which specifies that excess
potassium becomes hard to remove. Normal rage of urea in a human is 2.7-7.8 mmol /L, but
Melanie’s report shows that she has a low level of urea and that can be caused by the high
GFR rate or any dysfunction related to liver or low protein diet. The reports do not provide
any evidence of liver dysfunction.the report shows that Melanie has high blood pressure
which can be a side effect of CRF (Chronic Renal Failure).
The risk factors of Chronic Renal Failure are cardiovascular disease, recurrent urinary
tract infections, chronic glomerulonephritis, and atherosclerosis. There are some other risk
factors associated with chronic renal failure are the genetic tendency, ethnicity and age. Other
risks factors are obesity, low birth rate or less number of the nephron, acute renal injury and
socio-economic condition. It has been shown by a study that renal failure or kidney disease-
prone in families with low income. Hypertension is one of the major factors in CRF, and
according to a study 28% of patients suffering from CRF and hypertension has gone thorough
hemodyliasis, but the Melanie is not a patient of hypertension as per the report. Hypertension
can cause glomerular capillary pressure to glomerulosclerosis and dysfunctions in the kidney.
The most important factor for CRF, in this case, is the usage of NSAIDs(Non-Steroidal Anti
Inflammatory Drugs) such as Naproxen and Ibuprofen.
The possible complication of chronic renal failure is oedema, hyperkalaemia,
cardiovascular disorder, anaemia, dispute immune response, acute damage in the kidney.
Retention of fluid can cause swelling in arms and legs, high blood pressure and pulmonary
oedema or fluid accumulation in the lung. The increasing level of potassium in the blood can
cause hyperkalaemia, and this can be harmful to the human heart. Hypertension or high blood

CASE STUDY ON CHRONIC RENAL FAILURE
pressure can harm the cardiovascular system of a human. Renal failure can cause sudden
neurological issues such as delirium and seizures.
Treatment of CRF is different as per the variable causes; in this case study, It is found
that the condition is neither a result of hypertension nor diabetes. The rate of GFR is very
low, and the serum potassium is slightly higher so it can be stated that blood transfusion, fluid
intake restriction, restriction in dietary protein and kidney dialysis or transplant are the
possible treatments. The report suggests that usage of NSAIDS drugs over a long time can
cause harm to human kidney and Melanie has consumed the drugs without any professional
advises so as the treatment of renal failure the drugs should be avoided.
Response to 1.3
Acute Renal Failure Chronic Renal Failure
Causes Myocardial infarction, rhabdomyolysis,
decreased blood flow, uremic syndrome,
Glomerulonephrities.
Chronic infection, diabetes,
hypertension, nephrosclereosis,
inherited disorders, polycystic
kidney disease, interstitial nephritis,
exposure to toxin and drugs.
classification Pre-renal failure, Intra-renal failure,
Post-renal failure
According to GFR ;CRF can be
classified in Diminished renal
reserve, renal failure, renal
insufficiency, end stage renal
disease
Clinical
Symptoms
Decreased kidney function, blockage in
urinary tracts, dehydration, reduced urine
Anaemia, nausea, fatigue, malaise,
pain in bone and in this case kidney

CASE STUDY ON CHRONIC RENAL FAILURE
output, reduced appetite function remain active until any
acute condition arrives.
Physical signs Imbalance in blood pressure and volume Bone weakness, loss of tubular
functions, metabolic acidosis and
activation of rennin
Effect Cardiac arrhythmias, muscle weakness,
paralysis, depressed mental state,
uraemia, reducing hepatic blood flow,
haemodynamic instability and fluid
overload
Issues in nervous system, gout,
cardiovascular disease, high
potassium in blood, excessive
production of fluid in body
Treatment Less protein intake, maintain the blood
pressure, balance of electrolytes
Dialysis, Kidney transplant,
erythropoietin recombination, uses
of diuretic
Response to 1.4
Haemodialysis is applied to patients with renal failure, and this process uses the
dialysis machine as an artificial kidney. The renal failure slows down or disrupts the kidney
function with various effects on the body. The case study shows that Melanie is suffering
from chronic renal failure, and some patients have opted for only medication therapy instead
of complicated dialysis. The process is called conservative management, but Melanie’s
condition needs dialysis. The dialysis process can be two types in centre dialysis and daily
haemodialysis. The haemodialysis process has three types of accesses; such as arteriovenous
fistula, AV graft and central venous catheter. According to the report, Melanie’s

CASE STUDY ON CHRONIC RENAL FAILURE
nephrologists opts AV fistula access for the process (Hill et al. ,2019). A vein and an artery
are connected in this process, and it is considered as the safest and most effective way. The
connection between vein and artery is called fistula, and at the connecting point, two needles
with consecutive pipes from the dialysis machine are attached. Through one channel or pipe,
blood from the body comes out to the dialyzer for filtration, and with another tube, filtered
blood passes to the body. This process needs doctor’s observation as some symptoms such as
abdominal cramps and nausea can arise.

CASE STUDY ON CHRONIC RENAL FAILURE
Part 2
Response to 2.1
Valsartan 80 mg od tablet is used for reducing pressure in blood vessels so that blood
can pass more easily. The medication is used for preventing cardiac arrest, stroke and renal
problems. The reports show that the blood pressure of the patient is extremely high, and
during the dialysis, some problems due to hypertension can occur (Wang et al.,2017). This
tablet acts as the angiotensin II receptor antagonists in the conditions of high blood pressure,
proteinuria and renal failure.
Side effects of Valsartan are dizziness, headache, stomach pain and flu-like symptoms
such as fever and body pain (Imbrici et al., 2017). There are other side effects also such as
swelling in feet, hand and unexpected weight gain. The discussed symptoms are observed
when patients are suffering from chronic failure.
Nursing considerations for Valsartan are observation, scheduling, monitor lab test and
analysis. The tablets should be given in an empty stomach. The observation of blood pressure
is the most important responsibility of a nurse. The scheduling of the dosage is also very
crucial as the overdose or inadequate dosage should be observed. Monitoring the lab tests is
another important aspect as liver test, BUN and creatinine test, serum potassium level are the
base of diagnosis (Banerjee,2018). Analysing the condition and taking appropriate decisions
are also comes under the nursing regulation.

CASE STUDY ON CHRONIC RENAL FAILURE
Eprex injection is used for the anaemic patients suffering from renal failures, as the
kidney is the producer of erythropoietin. The dose used primarily in intravenous access for
the dialysis patients and works as the stimulator of erythropoietin, which produces red blood
cells. Hb or haemoglobin report of the patient is showing the anaemic tendency of the patient.
The injection is used to control anaemia and cases of blood transfusion (Cheng et al.,2017).
The rationale of the needle is to increase the red blood cell with increasing level of
erythropoietin.
Side effects of Eprex are dizziness, clotting in the intravascular access, oedema,
muscle pain and headache. There are other side effects such as cough, fever, diarrhoea,
shortness of breath, blood clots, and allergic reactions (Beiraghdar et al.,2016). The side
effects can cause harm to the patient’s health. Some side effects are related to deficiency
vitamin B12 and folic acid, infection, inflammation and an excessive amount of aluminium in
blood.
The nursing implications for Eprex are controlling the BP, monitoring the condition
of the body. Control Blood Pressure sufficiently before the instigation of treatment and
carefully monitor. Hypertension must be observed.
Hypertensive encephalopathy in patients during higher Hct conditions must be monitored.
Neurological symptoms should be observed minutely as the possibilities of seizures can arise.
Nurses supervise blood clotting or thrombotic events. Patients may need extra heparin
through dialysis to stop clotting of the vascular contact or artificial kidney (Polgreen et
al.,2015). Control Hct two times weekly until it stabilises in the mark range (30–33%) and the
maintenance amount of epoetin alfa is another prime concern. Monitor CBC with difference
and platelet amount regularly for tracking the phosphorus, potassium, creatinine and BUN.

CASE STUDY ON CHRONIC RENAL FAILURE
Response to 2.2
GFR is extremely low in Melanie’s report as it is less than 15ml/min, which indicates
that the patient is in stage 5 or the end stage of chronic renal failure. The Hb report is also
deficient, so it can be said that the patient is anaemic. The level of the Haemoglobin is 95g/L,
which indicates the low amount of the red blood cell. Low GFR signifies renal or kidney
failure in a patient’s body. The kidney produces Erythropoietin which stimulates the bone
marrows and RBC; as a result, the rate of haemoglobin increases (Kajimoto et al.,2016). Here
the condition of the patient shows that the renal damage is affecting the production of
Erythropoietin. Poor nutrition can reduce the level of EPO hormone. Low level of
Haemoglobin can cause fatigue, weakness, dizziness, muscle pain. The given case study has
shown that patient consumes pain killers and the fatigue is a constant symptom in her body.
Part 3
Teach back method is a method to make the patients aware of their health condition.
The process is also recognised as the “show-me” method. This affirmative conversation can
lead to the patient to a healthier and better lifestyle. The teach-back method presented
positive outcomes in a wide range of medical industry results, although the method was not
always statistically significant (Dinh et al.,2016). Observations related to these type of
systematic interviews improve outcomes in disease-specific knowledge, adherence, self-
efficacy and the inhaler technique for the patients. The health illiteracy is one of the most
significant problems faced by patients. The health illiteracy causes some anxiety and
misconception about the health condition and can make them depressed.

CASE STUDY ON CHRONIC RENAL FAILURE
The teach-back method is not a test for the patient as a nurse; I would like to
recommend her some effective interventions and describe her the current scenario of her
health. CKD is one of the emerging diseases across the world, and I will ask her about the
conceptions related to CKD. I will also ask her how she would like to resolve her health-
related problem. I would recommend her some effective diet suggested by doctor and
exercise to control her weight and to increase her haemoglobin I will suggest her to resolve
malnutrition. I will also support her that she cannot face depression again. The mental health
is essential for the betterment of the patient, so I will try to motivate her and make her feel
confident about the diagnosis.

CASE STUDY ON CHRONIC RENAL FAILURE
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CASE STUDY ON CHRONIC RENAL FAILURE
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