Chronic Renal Failure, nursing diagnoses and interventions
Istanbul University, Turkey.EDTNA/ERCA journal (English ed.) 01/2002; 28(1):13-5, 20. DOI: 10.1111/j.1755-6686.2002.tb00190.x
Chronic renal failure (CRF) is a clinical condition resulting from a multitude of pathologic processes which lead to derangement and insufficiency of renal excretory and regulatory functions (uraemia). There are normally two million glomeruli in both the kidneys of an adult, which filter an average amount of 120 ml of blood per minute. This filtration is called glomerular filtration rate (GFR). In the case of damaged parenchyma tissues due to renal disease, the filtration rate goes down to 20-30 ml per minute. This is when findings and symptoms of renal failure come about. In the case of a filtration rate less than 10 ml (GFR< 10 ml/min), a patient is understood to have reached the final stage of renal failure. At this stage, fluid and electrolyte balance is disturbed, azotemia increases and systemic manifestations (uraemia) occur (1,2). Renal failure is a condition in which the kidneys cannot fulfil their function of discharging metabolic waste and of maintaining the fluid and electrolyte balance. It can be divided into two groups: acute and chronic. This paper discusses the etiology, pathophysiology and signs and symptoms f CRF as well as the diagnosis and interventions required by nurses. Deficit, nursing priority and intervention are discussed in relation to patient problems.
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ABSTRACT: The aim of this study was to examine the content of nursing documentation with a focus on professional support for next of kin (NoK) of patients receiving chronic haemodialysis treatment. Professional support in nursing focuses on promotion, maintenance and restoration of health and prevention of illness. The study had a descriptive design and qualitative content analysis was used to search for themes based on descriptions contained in the collected nursing documentation. The total number of nursing records of patients receiving chronic haemodialysis treatment (n = 50) for the 5-year period 1998-2002 was included. All nursing documentation was systematic in accordance with the VIPS-documentation model. The professional support could be described within the framework of three themes: to explore NoK's supportive resources, to enable NoK' readiness in caring for the patient and to co-operate with NoK in the care of the patient in the home, captured by the core theme which described the professional support as a continuous process. Next of kin are a supportive resource in the nursing care of patients receiving chronic haemodialysis treatment and professional support for NoK focuses on planning their participation in the care of patients in the home. Professional support for NoK should be documented in family focused nursing diagnoses, which would make it possible to search for different types of support. Future research might explore nurses' or NoK's views on carer support.
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ABSTRACT: Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18-80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.
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