Chronic Kidney Disease：慢性肾脏疾病.ppt

Chronic Kidney Disease (Chapter 47, “Nursing Management: Cronic Kidney Disease,” in the Lewis textbook-Modified by L. Copenhaver) Chronic Kidney Disease (CKD) Involves progressive, irreversible loss of kidney function Defined as either presence of Kidney damage Pathological abnormalities Glomerular filtration rate (GFR) 60 ml/min for 3 months or longer Chronic Kidney Disease Disease staging based on decrease in GFR What is the normal GFR? What diagnostic test reflects GFR? Last stage of kidney failure End-stage renal disease (ESRD) occurs when GFR 15 ml/min Chronic Kidney Disease Leading causes of ESRD Diabetes Hypertension Chronic Kidney DiseaseClinical Manifestations Uremia Syndrome that incorporates all signs and symptoms seen in various systems throughout the body Manifestations of Chronic Uremia Chronic Kidney DiseaseClinical Manifestations Urinary system Polyuria Results from inability of kidneys to concentrate urine Occurs most often at night Specific gravity fixed around 1.010 Chronic Kidney DiseaseClinical Manifestations Urinary system Oliguria Occurs as CKD worsens Anuria Urine output 40 ml per 24 hours Chronic Kidney DiseaseClinical Manifestations Metabolic disturbances Waste product accumulation As GFR ↓, BUN ↑ and serum creatinine levels ↑ BUN ↑ Not only by kidney failure but by protein intake, fever, corticosteroids, and catabolism N/V, lethargy, fatigue, impaired thought processes, and headaches occur Chronic Kidney DiseaseClinical Manifestations Electrolyte/acid–base imbalances Potassium Hyperkalemia Most serious electrolyte disorder in kidney disease Fatal dysrhythmias Chronic Kidney DiseaseClinical Manifestations Electrolyte/acid–base imbalances Sodium May be normal or low Because of impaired excretion, sodium is retained Water is retained Edema Hypertension CHF Chronic Kidney DiseaseClinical Manifestations Electrolyte/acid–base imbalances Calcium and phosphate alterations Magnesium alterations Metabolic acidosis Results