1. The client/caregiver has a basic under- standing of the anatomy and physiology of the renal system.
   1. The kidneys are two bean-shaped organs. They are located on each side of the vertebral column at the 12th thoracic vertebrae at the posterior abdominal wall.
   2. Each kidney has a ureter about 25 to 30 centimeters long that connects to the bladder.
   3. The function of the kidneys is to remove waste materials from blood, balance body fluids, and form urine.
2. The client/caregiver can define chronic renal failure.
   1. It is the irreversible deterioration of renal function.
   2. Symptoms may occur very rapidly or very slowly over years.
   3. Uremia, an excess of urea and other nitrogenous wastes, occurs.
   4. Progression may continue to end-stage renal disease.
3. The client/caregiver can list factors that increase risk of chronic renal failure.
   1. Obstruction of the urinary tract
   2. Toxic agents
   3. Uncontrolled high blood pressure
   4. Diabetes mellitus
   5. Kidney diseases
   6. Recurrent infections
4. The client/caregiver can recognize signs and symptoms of chronic renal failure.
   1. Initial symptoms of chronic renal failure are
      • Loss of appetite
      • Unintentional loss of weight
      • Fatigue, apathy, and weakness
      • Nausea or vomiting
      • Frequent hiccups
      • Generalized itching
   2. Later symptoms may include
      • Increased or decreased urine output
      • Easy bruising or prolonged bleeding
      • Decreased alertness, confusion, and coma
      • Muscle twitching or cramps
      • Seizures
      • Decreased sensation in hands and feet
      • Uremic frost (deposits of white crystal in and on the skin)
   3. Late symptoms may be
      • Excessive nighttime urination
      • Excessive thirst
      • Abnormally dark skin or paleness
      • Nail abnormalities
      • Breath odor
      • High blood pressure
      • Loss of appetite
      • Agitation
5. The client/caregiver can list measures to manage chronic renal failure.
   1. Follow prescribed diet closely
      • High in carbohydrates
      • Low in protein
      • Low in sodium
      • Low in potassium
   2. Take vitamin and mineral supplements as ordered.
   3. Avoid infections or obtain prompt treatment for infections.
   4. Follow activity as instructed, with frequent rest periods.
   5. Avoid stress, which can aggravate symptoms.
   6. Monitor blood pressure closely.
   7. Monitor fluid status closely.
      1. Weigh daily (same time, same scale, and same amount of clothing).
      2. Measure intake and output.
      3. Restrict fluids as instructed.
   8. Provide skin care and oral hygiene.
      1. Keep fingernails short and avoid scratching.
      2. Use lotions to moisturize skin and decrease itchiness.
      3. Use soft-bristled toothbrush and mouthwash.
      4. Use medications and ointments as ordered to decrease itchiness.
      5. Obtain regular dental checkups.
   9. Prevent constipation with regular exercise and increased fiber.
   10. Keep follow-up appointments with physician and for laboratory tests.
   11. Take medications as ordered.
   12. Monitor and report to physician signs of bleeding, mental status changes, edema, elevated blood pressure, loss of appetite, weight loss or rapid weight gain, and skin breakdown.
   13. Wear Medic Alert bracelet.
6. The client/caregiver can list possible complications.
   1. End-stage renal disease
   2. Congestive heart failure
   3. Hypertension
   4. A loss of blood from the gastrointestinal tract
   5. Hemorrhage
   6. Increased incidence of infection
   7. Hepatitis B, hepatitis C, liver failure
   8. Seizures
   9. Dementia
   10. Fractures and joint disorders
   11. Changes in glucose metabolism
   12. Electrolyte imbalance
   13. Decreased libido, impotence
   14. Menstrual problems and infertility
   15. Dry, itchy skin with probable skin infections

Resources

National Kidney Foundation
www.kidney.org

National Kidney and Urologic Diseases Information
Clearinghouse
http://kidney.niddk.nih.gov/about/index.htm

Support groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com