Resource Unit for Renal Failure

8/8/2019 Resource Unit for Renal Failure

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COLLEGE OF NURSINGSilliman UniversityDumaguete City

RESOURCE UNIT ON THE CARE OF PATIENT WITH RENAL FAILURE AND HEPATIC ENCEPHALOPATHY Time Allotment: 1 hourTopic Description: This topi !eals "ith the are o# patient "ith renal #ailure$ The !isussion ontains on the anatomy an! physiology o# urinary systemtypes o# renal #ailure% pathophysiology o# eah type% its linial mani#estations% an! nursing management #or spei' type o# renal #ailure% me!ial managappropriate #or the on!ition an! preventions o# prevalene o# renal #ailure an! hepati enephalopathy$Central O!ecti"e: (t the en! o# our 1 hour !isussion% the learners shall gain su)ient *no"le!ge at +,- level o# ompeteny% strengthen &eginning mani#est !esire! attitu!e in aring patients "ith renal #ailure an! hepati enepthalopathy$

SPECIFICO#$ECTI%ES

CONTENT TA T&LACTI%ITIES

RESOURCES E

Given theresoures% thestu!entsshall.

1$ Utili/eprevious

learning#rom 0IO inthe!isussiono# theanatomyan!physiology

$ Enumeratethe t"otypes o#renal #ailure

2$ E3plain

I' Pra(er

II' Intro)*ction: Re"ie+ o, Anatom( an) P-(siolo.(/i)ne(s

These small% !ar* re! organs "ith a *i!ney4&ean shape lie against the!orsal &o!y "all in a retroperitoneal position 5&eneath the parietal peritoneum6in the superior lum&ar region$ The *i!neys e3ten! #rom the T1 to the L2

verte&ra7 thus they reeive some protetion #rom the lo"er part o# the ri& age$0eause it is ro"!e! &y the liver% the right *i!ney is positione! slightly lo"erthan the le#t$ (n a!ult *i!ney is a&out 1 m long% 8 m 5$9 inhes6 "i!e% an!2 m 51 inh6 thi*% a&out the si/e o# a large &ar o# soap$ It is onve3 laterallyan! has a me!ial in!entation alle! the renal hilus$ Several strutures%inlu!ing the ureters% the renal &loo! vessels% an! nerves% enter or e3it the*i!ney at the hilus$ (top eah *i!ney is an a!renal glan!% "hih is a part o# theen!orine system an! is !istintly separate organ #untionally$Nep-ron

The nephron is the #untional unit o# the *i!ney$ (ppro3imately 1$million nephrons are ontaine! in eah *i!ney$ The nephron is tu&ular struture"ith su&units that inlu!e the renal orpusle% pro3imal onvolute! tu&ule% loopo# :enle% !istal onvolute! tu&ule% an! olleting !ut% all o# "hih ontri&uteto the #ormation o# 'nal urine$ The !i;erent strutures o# the epithelial ells

lining various segments o# the tu&ule #ailitate the speial #untion o# seretion

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1min Game.RN$

Leture4!isussion"ithpresentationo# theoneptmap

0la*% ?$@$:a"*s% ?$:$

5,,96$Medical-SurgicalNursing:ClinicalManagementfor PositiveOutcomes.Ath e! $ 5vol 16$ StLouis% @issouri.Elsevier In$pp$+,+4+2A

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a


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"ith theiro"n "or!sthepathophysiology o#renal #ailure#or at least+,-aurately

$ >rovi!e a&rie#overvie" onhepatienephalopathy

9$ Correlateproperly thelinialmani#estations inma*ing theplan o# areto patient"ithpossi&lerenal or"ith renal#ailure$

8$ Demonstrate thepropernursing an!

me!ial

an! rea&sorption$ The *i!ney has t"o *in!s o# nephrons. ortial nephrons% "hih e3ten!

only partially into the me!ulla% an! u3tame!ullary nephrons% "hih lie lose ttoan! e3ten! !eep into the me!ulla an! are important #or the onentration o# urine$ The glomerulus is a tu#t o# apillaries% the glomerular apillaries% thatloop into a irular apsule% alle! 0o"mans apsule% li*e 'ngers pushe! into&rea! !ough$ Together% the glomerulus an! 0o"mans apsule are alle! therenal orpusle$ @esangial ells an! some marophages lie &et"een an!support the apillaries$ The spae insi!e o# 0o"mans apsule is alle!0o"mans spae$Ureters

The ureters are slen!er tu&es eah 9 to 2, m long an! 8 mm in!iameter$ Eah ureter runs &ehin! the peritoneum #rom the renal hilus to theposterior aspet o# the &la!!er% "hih it enters at a slight angle$ The superioren! o# eah ureter is ontinuous "ith the pelvis o# the *i!ney% an! its muosallining is ontinuous "ith that lining the renal pelvis an! the &la!!er &elo"$

Essentially% the ureters are passage"ays that arry urine #rom the*i!neys to the &la!!er$ (lthough it might appear that urine oul! simply !rainto the &la!!er &elo" &y gravity% the ureters !o play an ative role in urinetransport$ Smooth musle layers in their "alls ontrat to propel urine into the&la!!er &y peristalsis$ One urine has entere! the &la!!er% it is prevente! #romlo"ing &a* into the ureters &y small valveli*e #ol!s o# &la!!er muosa thatap over the ureter openings$Urinar( #la))er

The urinary &la!!er is a smooth% ollapsi&le% musular sa that storesurine temporarily$ It is loate! retroperitoneally in the pelvis ust posterior tothe pu&i symphysis$ I# the interior o# the &la!!er is sanne!% three openingsare seen the t"o ureter openings 5ureteral ori'es6 an! the single opening o# the urethra 5the internal urethral ori'e6% "hih !rains the &la!!er$ The smoothtriangular region o# the &la!!er &ase outline! &y these three openings is alle!the trigone$ The trigone is important linially &eause in#etions ten! topersist in this region$ In males% the prostate glan! surroun!s the ne* o# the&la!!er "here it empties into the urethra$Uret-ra

The urethra is a thin4"alle! tu&e that arries urine &y peristalsis #rom the

&la!!er to the outsi!e o# the &o!y$ (t the 0la!!er4urethra untion% a thi*ening

Smelt/er% S$C$Het$al$ 5,,6$Brunner &Suddarthstetbook ofMedical-SurgicalNursing. 1th e!$>hila!elphia.Lippinottilliam Hil*ins$pp$12,412+

0la*% ?$ @$ H@atassar% E$51JJA6$Medical-surgical

nursing:clinicalmanagementfor continuit! of care$ 9th e!$>hila!elphia.$0$ Saun!ersCompany$ ppAJ84AJA

Le"is% S$L$ et$al$5,,A6$Medical-surgicalnursing:

assessment &


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managementapplia&leto lients"ith renal#ailure an!hepatienephalop

athy$

A$ (pply theproperpreventivemeasurestopre!ispose!lientorretly$

o# the smooth musle #orms the internal urethral sphinter% an involuntarysphinter that *eeps the urethra lose! "hen urine is not &eing passe!$ (seon! sphinter% the e3ternal urethral sphinter% is #ashione! &y s*eletalmusle as the urethra passes through the pelvi oor$ This sphinter isvoluntarily ontrolle!$

The length an! relative #untion o# the urethra !i;er in the t"o se3es$ In#emales% it is a&out 2 to m long% an! its e3ternal ori'e% or opening% liesanteriorly to the vaginal opening$ Its #untion is to on!ut urine to the &o!y

e3terior$In males% the urethra is appro3imately , m long an! has three name!

regions% the prostati% mem&ranous% an! spongy urethra$ It opens at the tip o# the penis a#ter traveling !o"n its length$ The urethra o# the male has a !ou&le#untion$ It arries urine out o# the &o!y% an! it provi!es the passage"aythrough "hih sperm is eete! #rom the &o!y$ Thus% in males% the urethra ispart o# &oth the urinary an! repro!utive systems$#rain

The &rain provi!es #or voluntary movements% interpretation an!integration o# sensation% onsiousness% an! ognitive #untion$ The &rain!evelops #rom the rostral portion o# the em&ryoni neural tu&e$ Early &rain!evelopment yiel!s the three primary &rain vesiles. the prosenephalon5ere&ral hemispheres an! !ienephalon6% mesenephalon 5mi!&rain6% an!rhom&enephalon 5pons% me!ulla% an! ere&ellum6$ Cephali/ation results in theenvelopment o# the !ienephalon an! superior &rain stem &y the ere&ralhemispheres$ In a "i!ely use! system% the a!ult &rain is !ivi!e! into theere&ral hemispheres% !ienephalon% &rain stem% an! ere&ellum$ The ere&ralhemispheres an! ere&ellum have gray matter nulei surroun!e! &y "hitematter an! an outer orte3 o# gray matter$ The !ienephalon an! &rain stemla* a orte3$ The &rain ontains #our ventriles 'lle! "ith ere&rospinal ui!$

The lateral ventriles are in the ere&ral hemispheres7 the thir! ventrile is inthe !ienephalon7 the #ourth ventrile is in the &rain stem an! onnets "iththe entral anal o# the spinal or!$Li"er

The liver an! gall&la!!er are aessory organs assoiate! "ith the smallintestine$ The liver% one o# the &o!ys most important organs% has manymeta&oli an! regulatory roles$ :o"ever% its !igestive #untion is to pro!ue

&ile #or e3port to the !uo!enum$ 0ile is a #at emulsi'er7 that is% it &rea*s up

&23min

management of clinical

"roblems$ Ath e!$ China.@os&yElsevier$pp$11JA4112$

@Cane% K$5,,+6$#nderstanding

"atho"h!siolog ! $ 5th e!$6$China. @os&yElsevier$ pp$AJJ4+,8$

@onahan% F$% et$al$5,,A6$ Phi""$sMedical %surgicalnursing: eathand illness

"ers"ective$ St$Louis% @issouri.@os&y Elsevier%In$ pp$ 1,,241,1


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#ats into tiny partiles so that they are more aessi&le to !igestive en/ymes$e "ill !esri&e &ile an! the emulsi'ation proess "hen "e !isuss the!igestion an! a&sorption o# #ats later in the hapter$ (lthough the liver alsoproesses nutrient4la!en venous &loo! !elivere! to it !iretly #rom the!igestive organs% this is a meta&oli rather than a !igestive role$ Thegall&la!!er is hiey a storage organ #or &ile$

III' C-ronic Renal Fail*re4 C-ronic /i)ne( Disease

Is irreversi&le an! progressive re!ution o# #untioning renal tissue$hen the remaining *i!ney mass an no longer maintain the &o!ys internalenvironment% renal #ailure is the result$ This s la&ele! stage 9 CKD an! is alsoalle! ESRD$ CKD an !evelop insi!iously over many years% or it may result#rom an episo!e o# (RF #rom "hih the lient has not reovere!$

A' Sta.es o, C-ronic /i)ne( Disease• Sta.e 2&Ki!neys !amage "ith normal glomerular 'ltration rate

• Sta.e 0&Ki!ney !amage "ith mil! !erease in GFR

• Sta.e 5&@o!erate !erease in GFR

• Sta.e 6&Severe !erease in GFR

• Sta.e 3&Ki!ney #ailure

#' Pat-op-(siolo.( o, C-ronic /i)ne( Disease (s renal #untion !elines% the en! pro!uts o# protein meta&olism5normally e3rete! in urine6 aumulate in the &loo!$ Uremia !evelops an!a!versely a;ets every system more pronoune! the symptoms are$ The rateo# !eline in renal #untion an! progression o# ESRD is relate! to the un!erlying!isor!er% the urinary e3retion o# protein% an! the presene o# hypertension$

The !isease ten!s to progress more rapi!ly in patients "ho e3rete signi'antamounts o# protein or have elevate! &loo! pressure than in those "ithoutthese on!itions$

C' Clinical 7ani,estations0eause o# virtually every &o!y system is a;ete! in ESRD% patients e3hi&it anum&er o# signs an! symptoms$ The severity o# these signs an! symptoms!epen!s in part on the !egree o# renal impairment$ Other un!erlying


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on!itions% an! the pre!ominant ause o# !eath in patients "ith ESRD$>eripheral neuropathy% a !isor!er o# the peripheral nervous system% is presentin some patients$ >atients omplain o# severe pain an! !isom#ort$ Restless legsyn!rome an! &urning #eet an our in the early stage o# uremi peripheralneuropathy$ The preise mehanisms #or many o# these systemi signs an!symptoms have not &een i!enti'e!$ :o"ever% it is generally thought that theaumulation o# uremi "aste pro!uts is the pro&a&le ause$

D' N*rsin. 7ana.ement 'ssessment and (iagnostic )ndings

a' 8lomer*lar Filtration Rate 98FR(s the GFR !ereases 5!ue to non#untioning glomeruli6% the reatininelearane !ereases% "hile the serum reatinine an! 0UN inrease$ Serumreatinine is a more sensitive in!iator o# renal #untion than 0UN$ The 0UN isa;ete! not only &y renal !isease &ut also &y protein inta*e in the !iet%ata&olism 5tissue an! R0C &rea*!o"n6% parenteral nutrition% an! me!iationssuh as ortiosteroi!s$

' So)i*m an) +ater retention The *i!ney annot onentrate or !ilute urine normally in ESRD$ (ppropriateresponses &y the *i!ney to hanges in the !aily inta*e o# "ater an!eletrolytes% there#ore% !o not our$ Some patients retain so!ium an! "ater%inreasing the ris* #ro e!ema% heart #ailure% an! hypertension$ :ypertensionmay also result #rom ativation o# the renin4angiotensin4al!soterone a3is an!the onomitant inrease! al!osterone seretion$ Other patients have theten!eny to lose so!ium an! run the ris* o# !eveloping hypotension an!:ypovolemia$ omiting an! !iarrhea may ause so!ium an! "ater !epletion%"hih "orsens the uremi state$

c' Aci)osis@eta&oli ai!osis ours in ESRD &eause the *i!neys are una&le to e3reteinrease! loa!s o# ai!$ Derease! ai! seretion results #rom the ina&ility o# the *i!ney tu&ules to e3rete ammonia an! to rea&sor& so!ium &iar&onate$

There is also !erease! e3retion o# phosphates an! other organi ai!s$)' Anemia

(nemia !evelops as a result i# ina!eBuate erythropoietin pro!ution% theshortene! li#espan o# R0Cs% nutritional !e'ienies% an! the patients ten!eny

to &lee!% partiularly #rom the GI trat$ Eryhtropoietin% a su&stane normally


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pro!ue! &y the *i!neys% stimulates &one marro" to pro!ue R0Cs$ In ESRD%erythropoietin pro!ution !ereases an! pro#oun! anemia results% pro!uing#atigue% angina% an! shortness o# &reath$

e' Calci*m an) P-osp-or*s Imalance(nother a&normality seen ESRD is a !isor!er in alium an! phosphorusmeta&olism$ Serum alium phosphate levels have reiproal relationships inthe &o!y$ (s one inreases% the other !ereases$ ith a !erease in 'ltrationthrough the glomerulus o# the *i!ney% there is an inrease in the serum

phosphate level an! reiproal or orrespon!ing !erease in the serum aliumlevel$ The !erease! serum alium level auses inrease! seretion o# parathormone #rom the parathyroi! glan!s$ :o"ever in renal #ailure% the &o!y!oes not respon! normally to the inrease! seretion o# parathormone as aresult% alium leaves the &one% o#ten pro!uing &one hanges an! &one!isease as "ell as ali'ation o# maor &loo! vessels in the &o!y$ In a!!ition%the ative meta&olite o# vitamin D 51%94!ihy!roholeali#erol6 normallymanu#ature! &y the *i!ney !erease as result #ailure progresses$ Uremi &one!isease% o#ten alle! renal osteo!ystrophy% !evelops #rom the omple3 hangesin alium% phosphate% an! parathormone &alane$ There is also evi!ene o# ali'ation o# &loo! vessels$

E' 7e)ical 7ana.ement The goal o# management is to maintain *i!ney #untion an! homeostasis #or aslong as possi&le$ (ll #ators that ontri&ute to ESRD an! all #ators that arereversi&le are i!enti'e! an! treate!$ @anagement is aomplishe! primarily"ith me!iations an! !iet therapy% although !ialysis may also &e nee!e! to!erease the level o# uremi "aste pro!uts in the &loo! an! to ontroleletrolyte &alane$P-armacolo.ic T-erap(

a' Calci*m an) P-osp-ate #in)ers:yperphosphatemia an! hypoalemia are treate! "ith me!iations that &in!!ietary phosphorus in the GI trat$ 0in!ers suh as alium ar&onate oralium aetate 5>hosLo6 are presri&e!% &ut there is a ris* o# hyperalemia$ I# alium is high or the alium4phosphorus pro!ut e3ee!s 99 mgM!l% apolymeri phosphate &in!er suh as sevelamer hy!rohlori!e 5Renagel6 may&e presri&e!$ These me!iations &in! !ietary phosphorus in the intestinal

trat$ (ll &in!ing agents must &e a!ministere! "ith #oo! to &e e;etive$


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@agnesium4&ase! antai!s are avoi!e! to prevent magnesium to3iity$' Anti-(pertensi"e an) Car)io"asc*lar a.ents

:ypertension is manage! &y intravasular volume ontrol an! a variety o# antihypertensive agents$ :eart #ailure an! pulmonary e!ema may also reBuiretreatment "ith ui! restrition% lo"4so!ium !iets% !iureti agents% an! !ialysis$

The meta&oli ai!osis o# ESRD usually pro!ues no symptoms an! reBuires notreatment ho"ever so!ium &iar&onate supplements or !ialysis may &enee!e! to orret the ai!osis i# it auses symptoms$

c' Antisei;*re A.entsNeurologi a&normalities may our% so the patient must &e o&serve! #or earlyevi!ene o# slight t"ithing% hea!ahe% !elirium% or sei/ure ativity$ I# sei/ureour% the onset o# the sei/ure is reor!e! along "ith the type% !uration% an!general e;et on the patient$ The physiian is noti'e! imme!iately$ I!ia/epam or phenytoin is usually a!ministere! to ontrol sei/ures$ The si!erails o# the &e! shoul! &e raise! an! pa!!e! to protet the patient$

)' Er(t-ropoietin(nemia assoiate! "ith ESRD is treate! "ith reom&inant humanerythropoietin 5Epogen6$ >atients "ith anemia 5hematorit less than 2,-6present "ith nonspei' symptoms% suh as malaise% general #atiga&ility% an!!erease! ativity tolerane$ Erythropoietin therapt is initiate! to ahieve ahematorit o# 22- to 2+- an! a target hemoglo&in og 1 gM!l% "hih generallyalleviates the symptoms o# anemia$ Erythropoietin is a!ministere!intravenously or su&utaneously three times a "ee* in ESRD$ It may ta*e to 8"ee*s #or the hematorit to inrease7 there#ore% the me!iation is not in!iate!#or patients "ho nee! imme!iate orretion o# severe anemia$ @anagementinvolves a!ustment o# heparin to prevent lotting o# the lines !uringhemo!ialysis treatment% #reBuent monitoring o# hemoglo&in an! hematoritan! perio!i assessment o# serum iron an! trans#erring levels$ 0eausea!eBuate stores o# iron are neessary #or an a!eBuate response toerythropoietin% supplementary iron may &e presri&e!$

e' N*tritional T-erap(Dietary intervention is neessary "ith !eterioration o# renal #untion an!inlu!es are#ul regulation o# protein inta*e% ui! inta*e to &alane ui! losses%so!ium inta*e to &alane so!ium losses% an! some restrition o# potassium$ (tthe same time% a!eBuate alori inta*e an! vitamin supplementation must &eensure!$ >rotein is restrite! &eause urea% uri ai! an! organi ai!s4the

&23min'


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&rea*!o"n pro!uts !ietary an! tissue proteins4aumulate rapi!ly in the&loo! "hen there is impaire! renal learane$ Usually% the ui! allo"ane per!ay is 9,, ml to 8,, ml more than the previous !ays hour urine output$Calories are supplie! &y ar&ohy!rates an! #at to prevent "asting$ itaminsupplementation is neessary &eause a protein4restrite! !iet !oes notprovi!e the neessary omplement o# vitamins$

I%' Hepatic Encep-alopat-(:epati enephalopathy 5:E6 is a &rain !isor!er ause! &y hroni liver

#ailure% partiularly in aloholis "ith irrhosis% "hih results in ognitive%psyhiatri% an! motor impairments$ In these patients% the num&er o# #untionalliver ells is re!ue!% an! some &loo! is !iverte! aroun! the liver &e#ore to3insare remove!$ (s a result% to3ins suh as ammonia an! manganese anaumulate in the &loo! an! enter the &rain% "here they an !amage nerveells an! supporting ells alle! astroytes$ >ositron emission tomographyanalyses have !etermine! that ammonia levels are elevate! in the &rains o# :Epatients7 ammonia aumulation an alter the e3pression o# various important&rain genes$ @agneti resonane images sho" that manganese is !eposite! ina &rain area alle! the glo&us palli!us7 manganese !eposits may &e responsi&le#or strutural hanges in the astroytes that are harateristi o# :E$ Treatmento# patients "ith :E involves measures to lo"er ammonia levels in the &loo!%

me!iations to ounterat ammonias e;ets on &rain ell #untion% !evies toompensate #or liver !ys#untion% an! liver transplantation.

A'Ca*ses< inci)ence< an) ris= ,actors:epati enephalopathy is ause! &y !isor!ers that a;et the liver$

These inlu!e !isor!ers that re!ue liver #untion 5suh as irrhosis orhepatitis6 an! on!itions in "hih &loo! irulation !oes not enter the liver$ Thee3at ause o# hepati enephalopathy is un*no"n$(n important o& o# the liver is to hange to3i su&stanes that are either ma!e&y the &o!y or ta*en into the &o!y 5suh as me!iines6 an! ma*e them

http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000255/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001154/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000255/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001154/


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harmless$ :o"ever% "hen the liver is !amage!% these poisons may &uil! upin the &loo!stream$ (mmonia% "hih is pro!ue! &y the &o!y "hen proteinsare !igeste!% is one o# the harm#ul su&stanes that is normally ma!e harmless&y the liver$ @any other su&stanes may also &uil! up in the &o!y i# the liver isnot "or*ing "ell$ They an ause !amage to the nervous system$ :epatienephalopathy may our su!!enly in people "ho previously ha! no liverpro&lems "hen !amage ours to the liver$ @ore o#ten% the on!ition is seen inpeople "ith hroni liver !isease$

:epati enephalopathy may &e triggere! &y.• Dehy!ration

• Eating too muh protein

• Eletrolyte a&normalities 5espeially a !erease in potassium6 #romvomiting% or #rom treatments suh as paraentesis or ta*ing !iuretis5"ater pills6

• 0lee!ing #rom the intestines% stomah% or esophagus

• In#etions

• Ki!ney pro&lems

• Lo" o3ygen levels in the &o!y

• Shunt plaement or ompliations 5See. Transugular intrahepatiportosystemi shunt 6

• Surgery

• Use o# me!iations that suppress the entral nervous system 5suh as&ar&iturates or &en/o!ia/epine tranBuili/ers6

Disor!ers that an mimi or mas* symptoms o# hepati enephalopathyinlu!e.• (lohol into3iation

• Compliate! alohol "ith!ra"al

• @eningitis

• @eta&oli a&normalities suh as lo" &loo! gluose

• Se!ative over!ose

• Su&!ural hematoma 5&lee!ing un!er the s*ull6

• erni*e4Korsa*o; syn!rome

:epati enephalopathy may our as an aute% potentially reversi&le !isor!er$

http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000982/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002350/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000089/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003896/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A007210/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A007210/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000944/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000764/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000680/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000386/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000713/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000771/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002215/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000982/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002350/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000089/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003896/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A007210/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A007210/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000944/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000764/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000680/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000386/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000713/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000771/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002215/


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Or it may our as a hroni% progressive !isor!er that is assoiate! "ithhroni liver !isease$

#'Si.ns an) s(mptoms

Symptoms many &egin slo"ly an! gra!ually "orsen% or they may &eginsu!!enly an! &e severe #rom the start$

Symptoms may &e mil! at 'rst$ Family mem&ers or aregivers may notie thatthe patient has.• 0reath "ith a musty or s"eet o!or

• Change in sleep patterns

• Changes in thin*ing

• Con#usion that is mil!

• Forget#ulness

• @ental #ogginess

• >ersonality or moo! hanges

• >oor onentration

• >oor u!gment

•

orsening o# han!"riting or loss o# other small han! movements@ore severe symptoms may inlu!e.• (&normal movements or sha*ing o# han!s or arms

• (gitation% e3itement% or sei/ures 5our rarely6

• Disorientation

• Dro"siness or on#usion

• Inappropriate &ehavior or severe personality hanges

• Slurre! speeh

• Slo"e! or sluggish movement

>atients "ith hepati enephalopathy an &eome unonsious% unresponsive%an! possi&ly enter a oma$>atients "ith hepati enephalopathy are o#ten nota&le to are #or themselves &eause o# these symptoms$

&23min'

(pa

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C'Dia.nostic e>aminationsNervous system signs may hange$ Signs inlu!e.• Coarse% apping sha*ing o# the han!s "hen attempting to hol! the arms

out in #ront o# the &o!y an! li#t the han!s• (&normal mental status% partiularly ognitive 5thin*ing6 tas*s suh as

onneting num&ers "ith lines• Signs o# liver !isease% suh as yello" s*in an! eyes 5aun!ie6 an! ui!

olletion in the a&!omen 5asites6% an! oasionally a musty o!or to the&reath an! urine

Tests may inlu!e.• Complete &loo! ount or hematorit to he* #or anemia

• CT san o# the hea! or @RI

• EEG

• Liver #untion tests

• >rothrom&in time

• Serum ammonia levels

• So!ium level in the &loo!

• >otassium level in the &loo!

•

0UN an! reatinine to see ho" the *i!neys are "or*ing

D'Treatment:epati enephalopathy may &eome a me!ial emergeny$ :ospitali/ation isreBuire!$

The 'rst step is to i!enti#y an! treat any #ators that may have ause! hepatienephalopathy$Gastrointestinal &lee!ing must &e stoppe!$ The intestines must &e emptie! o#&loo!$ In#etions% *i!ney #ailure% an! eletrolyte a&normalities 5espeiallypotassium6 nee! to &e treate!$Li#e support may &e neessary to help "ith &reathing or &loo! irulation%partiularly i# the person is in a oma$ The &rain may s"ell% "hih an &e li#e4threatening$>atients "ith severe% repeate! ases o# enephalopathy may &e tol! to re!ue

protein in the !iet to lo"er ammonia pro!ution$ :o"ever% !ietary ounseling

"iBu

http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000205/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000286/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003786/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003791/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003931/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003436/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003652/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003481/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003484/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003474/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003475/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000089/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000205/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000286/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003786/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003791/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003931/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003436/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003652/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003481/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003484/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003474/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003475/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000089/


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is important% &eause too little protein in the !iet may ause malnutrition$Critially ill patients may nee! speially #ormulate! intravenous or tu&e#ee!ings$Latulose may &e given to prevent intestinal &ateria #rom reating ammonia%an! as a la3ative to remove &loo! #rom the intestines$ Neomyin may also &euse! to re!ue ammonia pro!ution &y intestinal &ateria$ Ri#a3imin% a ne"anti&ioti% is also e;etive in hepati enephalopathy$Se!atives% tranBuili/ers% an! any other me!iations that are &ro*en !o"n &y

the liver shoul! &e avoi!e! i# possi&le$ @e!iations ontaining ammonium5inlu!ing ertain antai!s6 shoul! also &e avoi!e!$ Other me!iations an!treatments may &e reommen!e!$ They may have varying results$

E'Pre"ention Treating liver !isor!ers may prevent some ases o# hepati

enephalopathy$ (voi!ing heavy !rin*ing an! intravenous !rug use anprevent many liver !isor!ers$ I# there are any nervous system symptoms in aperson "ith *no"n or suspete! liver !isease% all #or imme!iate me!ialattention$

Open For*m

Re#erenes

0la*% ?$@$ :a"*s% ?$:$5,,96$ Medical-Surgical Nursing: Clinical Management for Positive Outcomes.Ath e! $ 5vol 16$ St Louis% @issouri. Elsevier +2A

Smelt/er% S$C$H et$al$ 5,,6$ Brunner & Suddarths tetbook of Medical-Surgical Nursing. 1th e!$ >hila!elphia. Lippinott illiam H il*ins$pp$12

0la*% ?$ @$ H @atassar% E$ 51JJA6$ Medical-surgical nursing:clinical management for continuit! of care $ 9th e!$ >hila!elphia. $0$ Saun!ers CompaAJA

Le"is% S$L$ et$al$ 5,,A6$ Medical-surgical nursing: assessment & management of clinical "roblems $ Ath e!$ China. @os&y Elsevier$pp$11JA4112$

@Cane% K$ 5,,+6$ #nderstanding "atho"h!siolog! $ 5th e!$6$ China. @os&y Elsevier$ pp$ AJJ4+,8$

http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000404/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002383/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000654/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000271/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000404/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002383/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000654/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000271/


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@onahan% F$% et$al$ 5,,A6$ Phi""$s Medical % surgical nursing: eath and illness "ers"ective $ St$ Louis% @issouri. @os&y Elsevier% In$ pp$ 1,,241,

%ISION

( lea!ing Christian institution ommitte! to total human !evelopment#or the "ell4&eing o# soiety an! environment$

7ISSION

1$In#use into the aa!emi learning the Christian #aith anhore! on the gospel o# ?esus

Christ7 provi!e an environment "here Christian #ello"ship an! relationship an &e nuan! promote!$

$>rovi!e opportunities #or gro"th an! e3ellene in every !imension o# the Universityor!er to strengthen harater% ompetene an! #aith$

2$Instill in all mem&ers o# the University ommunity an enlightene! soial onsiousnea !eep sense o# ustie an! ompassion$

$>romote unity among peoples an! ontri&ute to national !evelopment$


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COLLEGE OF NURSING

Silliman UniversityDumaguete City

RESOURCE UNIT ON THE CARE OF PATIENT WITH CHRONIC RENAL FAILAND HEPATIC ENCEPHALOPATHY

Su&mitte! to.@aam Cora/on S$ Or!oe/


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Su&mitte! &y.

0agani Ca&rera

Resource Unit for Renal Failure

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Transcript of Resource Unit for Renal Failure