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Chronic Kidney Disease
secondary toChronic
Glomerulonephritis
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PhysicalAssessment
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ASSESSMENT TECHNIQUE
USED
NORMAL FINDINGS ACTUAL
FINDINGS
SIGNIFICANCE
A. Skin
Skin color
Assess edema
Observe and
palpate skin
moisture
Skin turgor
Observe for
scratching
Inspection
Inspection
Inspection
Inspection
Inspection,
observation
and
palpation
Varies to light deep
brown
No edema
Moisture in skin folds
and the axilla
When pinched, skin
springs back to
Previous state
No pruritus
Pallor
With bipedal
Edema
(grade II)
Generalized
dryness of
the skin
Good skin
turgor noted
Pruritus
noted
Poor oxygenation of the
skin tissues
Due to water retention
and increase
permeability of
membrane that results
from shifting of fluids
Decreased activity of oil
glands and deposits of
nitrogenous waste.
Normal
Decreased activity of oil
glands and deposits of
nitrogenous waste.
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B. Nails
Nail bed color
TissuesSurrounding
nails
Allens test
Inspection
InspectionAnd
palpation
Inspection
Highly vascular,
pink
Intact epidermis
Prompt return
Pallor
Intactepidermis
Weak return
(5 sec)
Circulatory impairment
due to decreased
hemoglobin
Normal
Circulatory impairment
due to decreased
hemoglobin
C. Head
Size, shape
and
symmetry
Presence of
nodules,
masses
Hair
Inspection
and
Palpation
Inspection
and
Palpation
Inspection
Rounded,smooth
skull contour
Absence of
nodules
and masses
Even distribution
Silky and resilient
hair; No infectionor infestation
Rounded,
smooth skull
contour
Absence of nodules
And Masses Even
distribution
No infestation
Dry
Normal
Normal
Abnormal due to poor
hygiene
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D. Face Palpation
Inspection
Symmetric; no
involuntary muscle
movements
Symmetric; no
involuntary muscle
movements
Normal
E. Eyes
eyebrows
Sclera
Conjunctiva
Pupils
Inspection
Inspection
Inspection
Inspection
Hair evenly distributed;intact skin
White in color
Pinkish or red in color
equal size, normally 3 -
7mm in diameter, both
pupil equally reactive to
light and accomodation
Hair evenly distributed;intact skin
White in color
pale
equal size, about 2-3
mm; both pupil equally
reactive to light and
accomodation
Normal
Normal
Circulation
impairment
Normal
F. EarsAuricles
Clients
response to
normalvoice tones
Inspection
Inspection
Color same as facial skin;
symmetrical; aligned with
outer canthus of eye
Normal voice tone
audible
Color same as facial skin;
symmetrical; aligned with
outer canthus of eye
Normal voice tone
audible
Normal
Normal
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G. Nose
Deviations in
shape, size,
color and
presence offlaring/discharge
from nares
Presence of
tenderness,
masses and
Displacementsof bone and
cartilage
Patency of both
nasal cavities
Inspection
Palpation
Inspection
Symmetric,
Straight, no
discharge/flaring
Uniform color
Absence of
lesion/tenderness
Air moves freely
as the client
breathes
Symmetric,
straight, no
discharge/flaring;
Uniform color
Absence of
lesion/tenderness
Air moves freely
as the client
breathes
Normal
Normal
Normal
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H. Mouth
Lips
Teeth
Tongue
Gums
Inspection
Inspection
Inspection
Inspection
Uniform pink in color;
moist, smooth texture
Teeth is smooth, white in
color
Central position; no
lesion
Pinkish in color, no
bleeding
Pallor, dry
Teeth is smooth,
white in color
Central position; nolesion
Pale and Bleeding
Due to excessive
Dryness, poor
hydration and
Impairedcirculation
Normal
Normal
Due to poor
Circulation and
impaired platelet
function
I. Neck Palpation Muscle equal in size;
head centered; Lymph
node not palpable
Muscle equal in size;
head centered;
Lymph node not
Palpable; with
intrajugular catheter
At right intrajugular
vein, dry and intact
The catheter is a
temporary access
for hemodialysis
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J. Thorax
and Lungs
Breathing
patterns
Adventitious
Breath
Sounds
Auscultation
Auscultation
Full and symmetric chest
expansion, quiet, rhythmic
and effortless breathing
Absence of adventitious
sounds
Full and symmetric chest
expansion, quiet, rhythmic
and effortless breathing
Absence of adventitious
sounds
Normal
Normal
K. Heart Inspection
Auscultation
Auscultation
Palpation
No pulsation, lift and
heaves; symmetric pulse
volumes
No abnormal heart sounds
is heard
Cardiac rate ranges from
60 100 bpm.
Jugular vein is not visible
No pulsation, lift and
heaves; symmetric pulse
volumes
No abnormal heart sounds
is heard
94 bpm
Jugular vein is not visible
Normal
Normal
Normal
Normal
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L. Abdomen Inspection
and
Palpation
Palpation
Unblemished skin,
uniform in color, no
evidence of
enlargement of liver or
spleen, flat rounded or
scaphoid
Bladder not palpable
Unblemished skin,
uniform in color, no
evidence of
enlargement of liver
or spleen, the
abdomen isdestended
Bladder is not
palpable at time of
assessment
Increased serum
uremic toxins
Normal
M.Extremitie
s
Upper
Lower
Inspection
and
Palpation
Inspectionand
Palpation
Equal in size, no
deformities, no
tenderness, swelling
and
edema
Equal in size, nodeformities, no
tenderness,
swelling and edema
No tenderness,
swelling, edema
formation; no lesions;
equal in size. Dry
skin;
With bipedal edema(Grade II)
Pruritic
Dry skin is due
to deposits of
Nitrogenous
waste and poor
Hydration
Due to waterretention
and increase
permeability of
membrane that
Results
from shifting of
fluids
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Review
of
System
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Integumentary system
a. Pallor
b. Pruritus
c. Dry skin Gastrointestinal
a. Anorexia
b. Uremic fector
c. Bleeding gumsd. Nausea
e. Abdominal distention
f. ascites
Hematopoetica. Anemia
b. Defects in platelet function
c. Thrombocytopenia
Reproductive
a. decreased libido
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Neurologic
a. Confusion
b. Sleep disturbances
c. Muscle irritabilityGenitourinary
a. Decreased urine output
b. Protenuria
c. Damaged nephrons
d. Decreases urine sodiume. cast and cells in urine
Musculoskeletal
a. Decreased calcium absorption
b. Decreased phosphate excretion
c. Loss of muscle strenght
d. muscle cramps
Cardiovascular
a. hypertension
b. hypervolemia
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Anatomy
and
Physiology
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The Kidney
The kidneys are a pair of bean-shaped
organs located below the ribs near the middle of
the back. They are protected by three layers of
connective tissue: the renal fascia (fibrousmembrane) surrounds the kidney and binds the
organ to the abdominal wall; the adipose capsule
(layer of fat) cushions the kidney; and the renal
capsule (fibrous sac) surrounds the kidney and
protects it from trauma and infection.
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Parts of the Kidney
Renal Vein carries blood away from the kidney and
back to the right hand side of the heart.
Renal Artery supplies blood to the kidney from the
left hand side of the heart Pelvis is the region of the kidney where urine
collects
Ureter carries the urine down to the bladder
Medulla is the inside part of the kidney Cortex is the outer part of the kidney
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Urine formation
Regulation of electrolytes
Regulation of acid-base balance
Control of water balance
Renal clearance
Secretions of prostaglandins
Regulation of calcium and phosphorous balance
Activates growth hormone
Detoxify harmful substances (e.g., free radicals, drugs)
Increase the absorption of calcium by producing calcitriol(form of vitamin D)
Produce erythropoietin (hormone that stimulates red blood cellproduction in the bone marrow)
Secrete renin (hormone that regulates blood pressure andelectrolyte balance)
Functions of the Kidney
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The Nephrons
Functional and structural unit of the kidney
Each kidney has over one million nephrons
Two types of Nephron
1. Cortical Nephron (80-85%)
located at outermost part of cortex
2. Juxtamedullary Nephron
distinguished by long loops of henle
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Parts of the Nephron The afferent arteriole receives blood rich in oxygen from the
renal artery.
The glomerulus is a knotted up capillary that contains small
pores.
The efferent arteriole is smaller in diameter than the afferent
arteriole and increases the pressure in the glomerulus aiding
pressure filtration
Bowman's capsule collects the filtrate
Proximal Convoluted Tubule has a brush border with many
villi to increase the surface area for selective reabsorption.
Loop of Henle dips down into the hypertonic environment of
the kidney medulla and is responsible for the reabsorption of
water from the filtrate
Distal Convoluted Tubule is the site of tubular secretion
Peritubular Capillary Network acts as the blood supply to the
nephron.
Collecting duct receives filtrate from several nephrons.
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Functions of the Nephron
Filtration
Reabsorption
Secretion
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Pathophysiology
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BODY SYTEMS
MANIFESTATION
IN CHRONIC KIDNEYDISEASE
(CHRONIC RENAL
FAILURE)
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BODY
SYSTEM
CAUSES SIGNS AND SYMPTOMS ASSESSMENT
PARAMETERS
HEMATO-
POETIC
ySUPPRESSION OF RBC
PRODUCTION
yDECREASED SURVIVALTIME OF RBC.
yBLOOD LOSS THROUGH
BLEEDING AND DIALYSIS
yMILD
THROMBOCYTOPENIA
yDECREASED ACTIVITY
OF PLATELET
yANEMIA
yLEUKOCYTOSIS
yDEFECTS IN
PLATELET FUNCTION
yTROMBOCYTOPENIA
yHEMATOCRIT
yHEMOGLOBIN
yPLATELET COUNTyOBSERVE BRUISING,
AND OTHER SIGNS
AND SYMPTOMS OF
BLEEDING
CARDIO-
VASCULAR
yFLUID OVERLOAD
yRENIN-ANGIOTENSIN
MECHANISM
yANEMIA
y
CHRONICHYPERTENSION
yCALCIFICATION OF SOFT
TISSUES
yUREMIC TOXINS IN
PERICARDIAL FLUID
yFIBRIN FORMATION ON
EPICARDIUM
yHYPERVOLEMIA
yHYPERTENSION
yTACHYCARDIA
yARRYTHMIAS
y
CONGESTIVE HEARTFAILURE
yPERICARDITIS
yVITAL SIGNS
yBODY WEIGHT
yECG
yHEART SOUNDS
y
MONITORELECTROLYTES
yASSESS FOR PAIN
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GASTRO-
INTESTINAL
y CHANGES IN
PLATELET
ACTIVITY
y SERUM UREMIC
ACID
y ELECTROLYTE
IMBALANCE
y UREA COVERTED
TO AMMONIA BY
SALIVA
y ANOREXIA
y NAUSEAAND
VOMITING
y GASTROINTESTIN
AL BLEEDING
y ABDOMINAL
DISTENSION
y DIARRHEA
y CONSTIPATION
y UREMIC FECTOR
y MONITOR INTAKE
AND OUTPUT
y HEMATOCRIT
y HEMOGLOBIN
y GUALAC TEST FOR
STOOLS
y ASSESS THE
QUALITY OF
STOOLS
y ASSESS FOR
ABDOMINAL PAIN
NEUROLOGIC y UREMIC TOXINS
y ELECTROLYTE
IMBALANCES
y CEREBRAL
SWELLING
RESULTING FROMFLUID SHIFTING
y LETHARGY
y CONFUSION
y CONVULSION
y STUPOR
y COMA
y SLEEPDISTURBANCE
y UNUSUAL
BEHAVIOR
y ASTERIXIS
y MUSCLE
IRRITABILITY
y LEVEL OF
ORIENTATION
y LEVEL OF
CONSCIOUSNESS
y REFLEXES
y EEGy ELECTROLYTE
LEVEL
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MUSCULO-
SKELETAL
y UREMIC TOXINS
y DECREASED
CALCIUM
ABSORPTION
y DECREASED
PHOSPHATE
EXCRETION
y MUSCLE CRAMPS
y LOSS OF MUSCLE
STRENGTH
y RENAL
OSTEODYSTROPHY
y RENAL RICKETS
y BONE PAIN
y BONE FRACTURES
y ELECTROLYTE
LEVEL
y REFLEXES
y PAIN ASSESSMENT
SKIN y ANEMIA
y PIGMENT RETAINED
y DECREASED
ACTIVITY OF OIL
GLAND
y DECREASED SIZE OF
SWEAT GLAND
y PHOSPHATE
DEPOSIT
y PALLOR
y PIGMENTATION
y PRURITUS
y ECCYMOSIS
y EXCORIATION
y UREMIC FROST
y DRY SKIN
y OBSERVE FOR
BRUISING
y ASSESS SKIN
COLOR
y ASSESS SKIN
INTEGRITY
y OBSERVE FOR
SCRATCHING
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GENITO-
URINARY
yDAMAGED
NEPHRONS
yDECREASED URINE
OUTPUT
yDECREASED URINE
SPECIFIC GRAVITY
yPROTEINURIA
yCAST AND CELLS IN
URINE
yDECREASED URINE
SODIUM
yMONITOR INTAKE AND
OUTPUT
ySERUM CREATININE
yBUN
y
SERUMELECTROLYTES
yURINE SPECIFIC
GRAVITY
yURINE ELECTROLYTES
REPRODUCTIVE yHORMONAL
ABNORMALITIES
yANEMIA
yHYPERTENSION
yMALNUTRTITION
yMEDICATIONS
yINFERTILITY
yDECREASED LIBIDO
yIMPOTENCE
yAMENORRHEA
yDELAYED PUBERTY
yMONITOR INTAKE AND
OUTPUT
yMONITOR VITAL SIGNS
yHEMATOCRIT
yHEMOGLOBIN
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Laboratory
Results
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HematologyActual
Value
Normal Values Analysis
Hematocrit 0.16 0.42-0.52 % Result is below normal.
Hemoglobin 55 140-170 Result is below normal.
RBC 1.88 4.0-6.0 x 10 Result is below normal.
WBC 8.9 5.0-10.0 x 10 NormalPlatelet
count
142,000 150,000-350,000 Result is below normal.
Diferrentialcount
Neutrophils 0.85 0.55-0.65% Result is above normal.
Lympocytes 0.15 0.25-0.35% Result is below normal.
Eosinophils 0.00 0.02-0.04% Result is below normal.
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InterpretationThe kidney produce erythropoietin the stimulates
bone marrow to produce red blood cells that increasehemoglobin and hematocrit.
In chronic kidney disease, the production of
erythropoietin is impaired thus decreasing theability of the bone marrow to produce red blood
cells and decreasing the number of hemoglobin
and the hematocrit level resulting to anemia.
There was bone marrow suppression thereby
increasing the neutrophils while lympocytes and
eosinophils decrease because of anemia
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Blood Chemistry
TEST RESULT NORMAL RANGE Analysis
Creatinine 2,482.40 62.00-133.00 The result is above
normal.
Sodium 155.4 135-148 The result is abovenormal.
Potassium 5.93 3.5-5.5 The result is above
normal.
Phosphorous 10.8 2.5-4.5 The result is above
normal.
Calcium 1.08 1.12-1.32 The result is above
normal.
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Interpretation
Creatinine is a break-down product of creatine
phosphate and a nitrogenous waste.Creatinine is
excreted mainly in the urine.
In CKD, excretion of the nitrogenous wastes is
impaired thus resulting in an increase in level of
nitrogenous wastes like creatinine.
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Increased serum level of the sodium, phosphorousand potassium is caused by loss of excretory renal
function.
The impaired conversion of the vitamin d to itsactive form causes the decreased serum level of calcium
which then causes the increased serum level of
phosphorous.
Hyperparathyroidism also causes the decreased
level of the calcium.
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UrinalysisResult Analysis
Physical Color Light Yellow Normal
ph 5.0 ph Normal
Transparency Turbid The result is abnormal
Specific Gravity 1.020 Normal
Albumin +++ The result is abnormal.
Sugar Trace The result is abnormal.
Pus cells
RBC
Epithelial cells
Bacteria
4-6/hpf
0-2/hpf
Many
Few
The result is abnormal.
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Interpretation
The increased permeability of the capillary
causes the excessive passage of protein in the
urine.
The impaired tubular reabsorption of glucose
causes the traces of sugar in the urine.
The transparency of the urine is turbid. There
are many substances that causes the turbidity of
it.
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