Presented By:

Uremia

a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function.

The term uremia, literally means urine in the blood.

rank as the number 10 killer in the Philippines causing death to about 7,000 Filipinos every year.

The population of Filipinos aged 20 years and above in 2005 was 46,627,172.

A prevalence of 2.6% means that 1,212,306 adult Filipinos have CKD.

Normal Function of KidneyShape and Location

• Kidneys are bean-shaped organs, each about the size of your fist.

• Located near the middle of your back, just below the rib cage.

Function

The kidneys are sophisticated trash collectors.

For filtration.

It measure out chemicals.

Kidneys release three important hormones:

Erythropoietin

Renin

The active form of vitamin D.

Urine is formed through three processes that occur in the kidney:

Ultrafiltration

Reabsorption

Secretion

UREMIA Is a clinical syndrome associated with

fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function.

Uremia more commonly develops with chronic renal failure (CRF) or the later stages of chronickidneydisease (CKD)

Uremia usually develops only after the creatinineclearance falls to less than 10 mL/min, although some patients may be symptomatic at higher clearance levels, especially if renal failure acutely develops.

In Uremia stage, nitrogen metabolites and other toxic material cannot be discharged out of body, so they deposited and cause disorder of water, electrolyte and acid-base balance and pathological changes of many organs and systems.

Digestive system

Pathological changes to heart and lungs

Hemopoietic system

Skeletal system

Skin

The nervous system

Stages of Chronic Kidney Disease

APPEARANCE

Grooming: poor

Attire: Hospital gown

Personal Hygiene: poor hygiene

Gait: Slow in movement with assistance

Posture: Client was on bed

General Body Built: Small Build

• BEHAVIOR

• Level of Consciousness:

• ( / ) awake

• ( / ) alert

• ( / )aware & responsive to internal & external stimuli

• ( / ) lethargic

• Facial Expression: Weak looking

• Speech: Low voice

• Mood: Client was irritated, moody

• Affect: Respond according to move

SKIN

INSPECTION

Color:

(/ ) Flushed

( / ) Pale

Texture: dry

Tone: fair

Edema: ( / ) Present Site: lower extremities, , legs

• CARDIOVASCULAR

>BP: 160/100

• PSYCHOLOGICAL

>Calm:( / )Yes

>Anxious:(/ )Yes

>Angry: ( / ) Yes

>Withdrawn: (/) No

>Irritable: ( / ) Yes

>Fearful:( / ) Yes

>Feeling of Helplessness: ( / ) Yes

>Hopelessness:(/ ) Yes

>Powerlessness: ( / ) Yes

>Tobacco Use: ( / ) Yes

NUTRITION

Nausea: ( / ) Yes

Vomiting (/ ) Yes

Location of Pain: Chest

Frequency: when the patient fail to use her oxygen inhalation.

Intensity- Pain Scale (0 -10): 6

Onset: (When did your pain started?): 6 months ago when she was admitted with the same reason.

Alleviating Factors:_nasal inhalation

Precipitating Factors:she uses the nasal canula again._

Name: T.C.

Age: 48

Sex: Female

Date of Birth: May 20,1963

Status: Married

Ethnicity: Tausug

Religion: Muslim

Address: Mampang, Zamboanga City

Chief Complain: Difficulty of breathing

Clinical Impression: Uremia secondary to chronic kidney

disease in cresenticglomerulonephritis

Diagnosis: CKD stage 5 (Uremia)

Date Admitted: July 2. 2011

Discharge Date: July 10,2011

Attending Physician: Dr. AfdalKunting MD

Complete Blood CountExamination Actual Results Normal Value

HEMOGLOBIN 106 M 140-170 F120-150

HEMATOCRIT 0.3 M 0.42-0.52 F 0.37-0.47

RED BLOOD CELLS 3.65 4.0-5.2

WHITE BLOOD CELLS 8.32 5.0-10.0

SEGMENTERS 0.92 0.35-0.65

LYMPHOCYTES 0.05 0.23-0.35

EOSINOPHILS 0 0.02-0.06

BASOPHILS 0 0

MONOCYTES 0.03 0.01-0.02

BLOOD TYPING “A POS”

MCV 81.4 M 80-94 F 81-99

MCH 29 27.0-31.0

Complete Blood CountEXAMINATION ACTUAL RESULT NORMAL VALUE

HEMOGLOBIN 71 M 140-170 F 120-150

HEMATOCRIT 0.21 M 0.42-0.52 F 0.37-0.47

RED BLOOD CELLS 2.45 4.0-5.2

WHITE BLOOD CELLS 6.45 5.0-10.0

SEGMENTERS 0.84 0.35-0.65

LYMPHOCYTES 0.11 0.23-0.35

EOSINOPHILS 0 0.02-0.06

BASOPHILS 0 0-0.05

MONOCYTES 0.05 0.01-0.02

PLATELET 155 175-350

MCV 86.1 M 80-94 F 81-99

MCH 29 27.0-31.0

MCHC 33.6 33.0-37.0

URINALYSISEXAMINATION RESULT NORMAL

VALUECREATININE

CREATININE 11.43 0.6-1.2

SODIUM 140 136-145

POTASSIUM 3.8 3.6-5.1

NURSING CARE PLANS

1. Excess fluid volume related to decreased urine output.

2. Anxiety related to present condition (Chronic Kidney Disease)

3. Imbalanced Nutrition: Less then body requirements related to dietary restrictions.

4. Fatigue related to long hours of hemodialysisprocedure

5. Knowledge deficit R/T cognitive limitation of the disease process and its treatment.

DRUG STUDY1. Verapamil

(Antianginal)

For angina pectoris and hypertension

2. Amlodipine

( Antianginal)

For chronic stable angina and hypertension

3.Clyndamycin

( Anti-infectives)

For infections caused by streptococci, pneumococci, and staphylococci organisms.

4. Metaclopromide

(Antiemetics)

For prevention or reduction of nausea and vomiting.

5. Furosemide

(Diuretics)

For edema and hypertension.

6. Clonidine

(Antihypertensive)

For essential and renal hypertension.

7. Paracetamol

(Nonopiod analgesics and antipyretics)

For mild pain or fever.

8. Calcium Carbonate

(Antacids, adsorbents and antiflatulents)

For antacid and calcium supplement.

9. Sodium bicarbonate

(Acidifiers and alkalinizers)

For metabolic acidosis, systemic or urinary alkalization, and antacid.

10. Erythropoeitin

(Immunomodulationdrugs)

For anemia from reduced production of erythropoeitin caused by enstage renal disease.