18018276 Pa Tho Physiology

8/8/2019 18018276 Pa Tho Physiology

1/39

Chronic Kidney Disease

secondary toChronic

Glomerulonephritis


2/39

PhysicalAssessment


3/39

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.


4/39

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


5/39

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


6/39

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


7/39

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


8/39

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


9/39

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


10/39

Review

of

System


11/39

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


12/39

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


13/39

Anatomy

and

Physiology


14/39

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.


15/39

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


16/39


17/39

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


18/39

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


19/39

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.


20/39


21/39

Functions of the Nephron

Filtration

Reabsorption

Secretion


22/39


23/39

Pathophysiology


24/39


25/39


26/39

BODY SYTEMS

MANIFESTATION

IN CHRONIC KIDNEYDISEASE

(CHRONIC RENAL

FAILURE)


27/39

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


28/39

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


29/39

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


30/39

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


31/39

Laboratory

Results


32/39

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.


33/39

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


34/39

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.


35/39

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.


36/39

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.


37/39

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.


38/39

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.


39/39

Documents

18018276 Pa Tho Physiology