Problems Caused by Kidney Failure - s3. · PDF fileSleep or sexual problems. 9. Pain around the kidneys. Discuss ... • Rinse back much of the patient’s blood as you can at each

Problems Caused by Kidney Failure Hemodialysis Course

UREMIA • Build up of wastes in the blood.

• Symptoms

1. Swelling in feet, hands and face.

2. Trouble breathing.

3. Making more or less urine and nocturia.

4. Foamy and bubbly urine.

5. Severe itching.

6. Ammonia Breath, metal taste, nausea, avoidance of protein foods.

7. Yellow skin.

8. Sleep or sexual problems.

9. Pain around the kidneys.

Discuss - Page 25.

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Your role in Uremia •Dialysis can help with uremia.

•Standard in-center hemodialysis replaces 12-15% of normal

Kidney failure only.

Ask patients

if they have

symptoms.

Learn the

symptoms

of Uremia.



What can you do? Report

symptoms

to the

Nurse.

SYMPTOMS

• Fatigue

• Weakness

• Feeling cold

• Mental confusion

• Pail skin, gums, and fingernail beds

Also linked with Left Ventricular Hypertrophy (LVH).

(Enlarged heart’s left ventricle)

Anemia Shortage of red blood cells, low hemoglobin.

Less or no

erythropoietin



Epogen®

(EPOETIN ALFA)

• Is human erythropoietin

produced in cell culture

using recombinant DNA

technology.

• Very expensive.

• Called “Liquid Gold”.

• Box of 10 vials of 20,000u

vials = $3,123.75.

1 vial 20,000u = $312.37

Anemia Anemia management plan.



Your role in Anemia Management



• Rinse back much of the patient’s blood as you can at each treatment.

• Report to the nurse any unusual bleeding.

• Report to the nurse ant signs of infection. (Epo dose might be increased)

•Use pediatric lab tubes if accepted.

•Reuse dialyzer – report if they do not pass test.

•Urge patients to come for each treatment and stay for the full time.

Secondary Hyperparathyroidism (HPTH) Parathyroid glands make too much parathyroid hormone.

Parathyroid are glands located on the Thyroid gland.

They are located in the neck area of the body.

Calcitriol is a hormone created by the kidneys.

It is a messenger.

It lets the gut absorb calcium from food.



CALCITRIOL

No Symptoms or

-Joint pain

-Bone pain

-Muscle pain and/or weakness that

causes trouble walking.

High PTH Levels Renal Osteodystrophy – bone disease.



•Calcium deposits on the heart

and blood vessels.

•Risk for Heart attack or stroke.

•Calcium deposits can also be in the skin

and other organs.

Your role in Secondary Hyperparathyroidism

•Listen to your patient and report all of their symptoms to

the nurse.

•Reinforce what the doctor, nurses, and dietitians teach

patients.

•Urge patients to take their medications and adhere to

renal diet.



• 84% of the patients affected.

•Tend to affect both sides of the body in the same spots.

•Can disrupt sleep and reduce quality of life.

Causes:

1. Hyperparathyroidism.

2. High phosphorus.

3. Allergy (hives present).

- Contact dermatitis.

- Laundry soap or bleach used for

chair.

- Drugs (pork or beef heparin).

- Chemicals used to sterilize a

dialyzer.

Pruritis Itching



Your role in Pruritis Management

•Ask the nurse if oatmeal baths or Aveeno® soap are okay.

•Ask the nurse and dietitian if you should urge the patient

to take phosphate binders.

•Urge patients to come for each treatment and stay the

whole time.

Phosphorus

Binders help

reduce

phosphorus

levels in blood.



Causes in CKD patients: - Poor dialysis - Virus

Pericarditis Swelling of the sac around the heart.



Symptoms:

•Pain in the center of the chest. Sharp

and stabbing.

•Fever.

•Dry cough.

•Fatigue.

•Low blood pressure.

•Irregular heartbeat.

Your role in Pericarditis Management

•Report any chest pain right away!

•If chest pain is present, do not start dialysis and report.

•If a patient starts to have chest pain during dialysis tell the

nurse right away.

•Be sure patients receive their full treatment.



• Healthy kidneys remove excess proteins. • When kidneys fail protein enters tissues where it does not belong. Can cause: Carpal tunnel syndrome. Joint pain. Bone cysts and fractures.

•Longer or more frequent hemodialysis can

help with this condition.

Amyloidosis Waxy protein build up in soft tissues, bones and joints.



(Peripheral neuropathy)

Neuropathy (Nerve Damage)

“Pins &

needle”

feeling

Burning

hands &

feet

Muscle

weakness



Erectile dysfunction

Trouble walking

-Cause unknown.

-Most common when GFR

is below 12%.

- Vit B can help.

Patients can develop, (specially diabetic), nerve damage in hands & feet.

Sleeping Problems

Common in

people with

kidney failure

Trouble

falling

asleep

Sleep

Apnea

Trouble

staying

asleep



• Throat narrows.

•Melatonin (sleeping hormone) levels may drop.

Bleeding Problems

Your role

Easy bruising, gastrointestinal (GI) bleeding, blood in stool and nosebleeds.

Report excess clotting in patient’s dialyzer.

If bleeding occurs, ask the nurse for heparin reduction.

Always be sure dose of heparin is right.

Ask the patient if they have had bleeding between treatments.



Sodium (Water balance, nerve signals)

• Hypernatremia: intense thirst, flushed skin, fever, seizures and death.

•Hyponatremia: low blood pressure, muscle cramps, restlessness, anxiety, access pain, headache and nausea.

Electrolyte Imbalances



Potassium (Nerves, muscles, water balance and use of glucose)

• Hyperkalemia: changes in rhythm of heart. Weak muscles, belly cramps,

skipped heart beats, heart may stop.

•Hypokalemia: fatigue, weak muscles, changes in heart rhythms.



Calcium (Controls blood clotting, enzymes, hormones, nerves and muscles)

•Hypercalcemia

Vomiting, weakness, confusion and coma.

• Hypocalcemia

Numbness, seizures and tetany (tremors, facial twitches, muscles

spasms and muscle pain).



Phosphorus (Body’s use of energy)

• Hyperphosphatemia

Severe itching, bone disease, calcium and phosphorus bond and sharp

crystals can form in skin, eyes, lungs, heart, joints and can block vessels.

Binders help lower phosphorus.

• Hypophosphatemia

Poor diet or taking too many binders.

Muscle weakness, paralysis, problems with red blood cells function.



• Never start treatments until water system check is done.

•Make sure the right dialysate is given to the patient.

•When mixing dialysate have another staff check after you.

•Urge patients to follow their prescribed meal plans and fluid limits.

•Report all symptoms to the nurse.

Your role in Electrolyte Management





Questions?

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Problems Caused by Kidney Failure - s3. · PDF fileSleep or sexual problems. 9. Pain around the kidneys. Discuss ... • Rinse back much of the patient’s blood as you can at each