Chronic Kidney Disease

Solution

Chronic Kidney Disease

1. When performing an initial assessment, which body systems does the nurse recognize are impacted by chronic kidney disease (CKD)? List 3 body systems and explain how CKD impacts each.

Body systems that are impacted by CKD include the cardiovascular system, hematologic and immune system, and gastrointestinal system.

Many patients with CKD have heart damage and enlargement due to long term hypertension. Hypertension can be either the cause or the result of CKD. CKD elevates the patient’s blood pressure by causing fluid and sodium overload and dysfunction of the renin-angiotensin-aldosterone system (RAAS). Severe hypertension typically occurs with CKD patients and it is difficult to manage, it eventually worsens the patient’s kidney function.  Heart failure may also occur in patients with CKD due to the increased workload on the heart as a result of hypertension and fluid overload. Pericarditis can also occur in patient’s with CKD.

Hematologic and immunity changes can also occur. Anemia is common with patients that are in the later stage of CKD and worsens the symptoms of CKD. The cause of anemia in CKD patients is the decreased erythropoietin level with a reduced red blood cell production and survival time of the red blood cells from uremia and iron and folic acid deficiencies. These changes can cause the patient to have increased bleeding or bruising due to impaired platelet function. CKD causes a decreased immunity in patients which increases the risk for infection.

Lastly, uremia affects the GI system. A change is caused in the flora with uremia. Anorexia, nausea, and hiccups are common in patients with uremia. The cause of these problems can be related to a high BUN and creatinine levels as well as acidosis.

2. Upon intake assessment, the nurse notes that Mrs. Nygyen has very dry skin and mucous membranes, mild ecchymosis to the lower extremities, and lung crackles bilaterally. Vital signs include blood pressure of 160/90, pulse 90, respirations 22, and temperature 99.0° F.

• What assessment data collected by the nurse would indicate that Mrs. Nygyen’s neurological system has been impacted by chronic kidney disease? Please list specific assessment findings likely to be identified.

The patient’s lung crackles and changes in vital signs indicate fluid overload. Fluid overload can cause changes in the neurological system. Neurologic symptoms include lethargy, seizures or coma. The crackles in the lungs may indicate uremic encephalopathy. Fluid overload can cause changes in cognition.  If uremic encephalopathy is left untreated, it can lead to seizures and coma.

3. The following day, the nurse performs another assessment. At that time, Mrs. Nygyen’s skin assessment includes yellowish discoloration, mild ecchymosis to the lower extremities, urea crystals on eyebrows, dryness, decreased turgor, and rash to the groin area.

• Which finding(s) alerts the nurse to the development of advanced uremic syndrome? Please explain why your finding(s) has or have occurred.

yellowish discoloration, urea crystals on eyebrows, and rash to the groin area are signs of advanced uremic syndrome. Uremic syndrome typically occurs when waste products such as urea build up in the body due to the kidneys being unable to function properly. Because of this the patient will present with urea crystals on eyebrows, yellow discoloration and a rash to the groin area.

4. Please name 5 interprofessional team members that should be considered as part of Mrs. Nygyen’s plan of care? Please explain how each member can be a beneficial member in assisting the patient.

The physician should be about of Mrs. Nygyen’s care because the physician is the one who creates the patient’s plan of care and provides medication in order to assist the patient on her road to recovery. The nurse should be considered in the plan of care because the nurse is with the patient for the majority of the time and does the patient’s assessments to report to the physicians and notices any changes. The nurse also administers the patient’s medications. A dietician will also be a part of the patients plan of care because the patient will require a specific type of diet for this type of patient. The dietician will calculate the protein, calorie and fluid needs for the patient. Nephrology services will be required for the patient to monitor her kidney function. The patient’s family or close friends should also be a part of the team for support and comfort.