Chronic Renal Failure: Pathophysiology Assignment Paper 1 Analysis

This assignment is a comprehensive analysis of chronic renal failure, focusing on a 55-year-old patient, Melanie Johnson. The paper begins with an overview of renal anatomy and physiology, followed by an in-depth exploration of the pathophysiology of chronic renal failure, including risk factors like age, hypertension, and anemia, as well as potential complications and treatment options. The assignment differentiates between acute and chronic renal failure and discusses renal replacement therapy, specifically hemodialysis, including the creation of an AV fistula. Furthermore, it examines two medications, Valsartan and Eprex, detailing their uses, side effects, and crucial nursing considerations for Melanie. The paper also explains the significance of GFR and Hb blood tests in diagnosing and monitoring the condition, concluding with a discussion on the teach-back method for patient education, particularly regarding dietary fluid management.

Running head: PATHOPHYSIOLOGY ASSIGNMENT PAPER 1
Pathophysiology Assignment Paper
Student’s Name
Institutional Affiliation

PATHOPHYSIOLOGY ASSIGNMENT PAPER 2
Introduction
This paper will majorly focus on Melanie Johnson, who is 55 years old. It is stated that
Melanie visited her General Practitioner and discovered her blood pressure was 190/110mm Hg
despite having hypertension. She was referred to a nephrologist, where she was diagnosed with
chronic renal failure. In that case, the essay will explain the renal anatomy in conjunction with
the 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 relevant to
Melanie. The paper will conclude by explaining the GFR and Hb blood tests that were performed
and the tech-back technique.
Part One
1.1 Renal anatomy and physiology
The kidneys are usually the primary functional organ of the renal system. As an
illustration, the kidney is surrounded by renal fascia, which is a thin layer of thick connective
tissue that holds the renal to its surroundings. Accordingly, the adipose capsule is a fatty layer
that shields the renal from trauma and helps to cushion them. The renal capsule layer is an even
transparent sheet of dense connective tissue which gives the renal its typical structure (Bylsma et
al., 2017). The asymmetry in the abdominal cavity caused by the liver usually results in the right
kidney slightly lower than the left. Accordingly, the right kidney sits below the diaphragm.
Kidneys can be described as bean-shaped retroperitoneal organs which alter the blood
elements and excrete urine. In the middle of every kidney, there is an indentation that conforms

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to 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.
The renal cortex is split into an outer cortical zone and an inner juxtamedullary zone, and
it has segments called renal columns that stretch down into the medulla cutting the renal
pyramids from each other. 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 heads out of
the renal via the ureter.
Melanie’s Chronic Renal failure pathophysiology, risk factors, complications and
treatments
As kidney tissue loses performance, there are some detectable malformations since the
remaining tissue elevates its performance which is called renal functional adaptation. Initially,
chronic kidney injury is defined as a declined renal reserve of inadequacy that may advance to
kidney failure. 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
(Chalmers, 2019). When kidney disease has progressed, the ability to effectively intensify or
liquefy urine is lost.
Some of the Factors that put Melanie at risk of chronic renal failure progression include
age, anemia, and uncontrolled high blood pressure. 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. Anemia is
regarded as a separate risk factor for the advancement of chronic kidney disease (Dhayef, Manuti

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& Abutabiekh, 2017). 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. 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 (Scott, Andrews,
Bulla & Loerzel, 2019).
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 (Schulman et al., 2018). Anemia is also an impediment of chronic kidney disease,
and it is proportional to the Glomerular Filtration Rate. It is because of the declined production
of erythropoietin by the kidneys, iron deficiency and reduced red blood cell survival along with
mineral bone disease which is a result of disturbed calcium, phosphate and vitamin D (Malek &
Nematbakhsh, 2015).
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. Furthermore, medications like
angiotensin-converting enzyme (ACE) inhibitors are used to control related issues like high
blood pressure. Dialysis is another treatment option that replicates some of the renal functions

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that may be necessary for advanced chronic renal failure. Also, for an advanced chronic renal
failure kidney transplant may be necessary (Gounden & Jialal, 2018).
Chronic and Acute Renal Failure
ARF (Acute renal failure) 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. Moreover, ARF is caused by an event while a long-term disease causes
CRF. 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 (Kalantar-Zadeh & Fouque, 2017).
1.4 Renal replacement therapy (hemodialysis)
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. In renal replacement therapy
blood is transported out of the body via tubes and cleaned in a machine by use of dialysis fluid.
The AV fistula is considered the prime type of permanent access. However, Melanie is
advised to undergo hemodialysis after an arteriovenous (AV) fistula is created. 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. 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

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high flow of blood so that the highest blood amount can go via the dialyzer (Gilbert, Lovibond,
Mooney & Dudley, 2018).
Part Two
The two medications used for Melanie, with rationale and clear links to her case. The four
major side effects and four nursing considerations
The Valsartan contains valsartan as an active ingredient that forms a part of drugs called
angiotensin II receptor antagonists that assist in controlling high blood pressure. Accordingly, the
Angiotensin II is a substance in the body that makes vessels tightens, leading to a rise in blood
pressure. This drug functions by hindering the impact of angiotensin II, and as a result, the blood
vessels relax, 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 causes side effects, although not everyone gets them.
After taking the medication, 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. 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.
On the other side, Eprex incorporates the vital ingredient epoetin alfa, a protein that
triggers the bone marrow to generate more red blood cells. Due to kidney failure, the decreased

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production of erythropoietin hormone by kidneys may cause anemia. Therefore, the drug
prompts the bone marrow to generate more red blood cells assisting in 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 (Michalatou et al., 2018).
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 after that. 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 (Shi et al., 2015). 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.
Glomerular Filtration Rate and Hemoglobin blood test performed
The Glomerular Filtration Rate (GFR) happens to be the best overall indicator of the
glomerular function. As an illustration, 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.

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Melanie’s GFR of 10 ml/min/1.72 m2 indicates that her CRF is at stage 5, which is the end-stage
renal disease. Also, it shows that it is incompatible with life without transplantation or dialysis
(Collins, Foley, Gilbertson & Chen, 2015).
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 more significant than 130g/L
(Ferenbach & Bonventre, 2016). This indicates that Melanie has anemia as a consequence of the
diminished generation of erythropoietin hormone by kidneys.
Part Three
Teach-back method
Show me approach is the other name for teach-back method 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. When 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 (Bernal et al.,. 2015).
Moreover, it is a communication approach to improve health literacy.
Discussion on how to educate Melanie to manage her fluid with diet using Teach back
method
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 relies on the cohesion of the

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suggested healthful regime. However, non-adherence to the recommended regime results in a
rapid worsening of the medical condition (D'Apolito, 2015).
For you to delay the progression of your condition, you have to limit your dietary sodium
by avoiding the addition of salt to your food at the table or when cooking. Furthermore, you can
avoid pickled foods like pickles and olives, along with processed meats like sausage, lunch
meats, and bacon. Salt substitutes are generally rich in potassium, and you need to avoid them
by using medications that block the renin-angiotensin-aldosterone system such as angiotensin-
converting enzyme inhibitors and angiotensin-receptor blockers.
Moreover, when you are on dialysis, fluid may build up in your body amidst therapies,
and the extra fluid can build up around the lungs resulting in shortness of breath. Therefore, you
need to limit your fluid intake by cutting back how much fluid you take. Also, you need 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 you are limiting your fluid, and you feel thirsty, try to quench your thirst
by chewing gum, sucking on a reusable ice cube, rinsing your mouth without swallowing and
sucking a piece of ice (Dinh, Bonner, Clark, Ramsbotham & Hines, 2016).
I will explain things to Melanie in s more straightforward way that she can understand. In
that case, I will ensure that the guidelines on how to manage her fluid intake in relation to her
diet are self-explanatory. I will also ask Melanie if she can tell me in her own words how she will
manage her condition of fluid intake as per her diet. If Melanie will be in a position to explain
back correctly, then it will imply she understood the procedure of managing her condition, and I
will also be willing to repeat if I realize she did not understand.

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