A Case Study

On

CHRONIC RENAL FAILURE

In Partial Fulfillment of
The Requirements
In Nursing Care
Management
102

Submitted to:

Mrs. Analiza Casalta, RN

Submitted by:
Haspe, Maria Flor
Kalaw, Herniňo C.
Lanchita, Jovelle Ann
Maynopas, Glaiza
Mendoza, karen
Nidwelan, Arbert

Date of Submission:

July 18, 2009

 Table of Contents

Contents Pages
Acknowledgement
Introduction
Objectives of the Study
A. General Objectives
B. Specific Objectives
Identification of the Case
Background and family History
Socioeconomic Status
Medical Health History
A. Past Illness
B. Present Illness
Developmental Task
Definition of terms
Anatomy and Physiology,
Pathophysiology of the disease
Symptoms
A. Present or Absent
Schematic Diagram
Medical Management
A. Ideal
B. Actual
Nursing Theories
Lab Findings
Drug Study
Nursing Assessment
A. General Survey
B. Vital Signs
C. Skin
D. Hair
E. Nails
F. Skull and Face
G. Mouth
H. Neck
I. Chest
J. Upper and Lower Extremities
K. Elimination
L. Urinary
Nursing Care Plans
Discharge Plan Method
A. Medication
B. Exercise
C. Treatment
D. Health teaching to the Family
E. Out-patient follow up
F. Diet
Journals
Reactions
Prognosis and Results
Ideal Prognosis
Summary
Evaluation
Nursing Implications
Acknowledgement
The proponents of this case study would like to express their sincerest appreciation
and gratitude to the following persons who in one way or another exerted their effort in
making this study possible.

To our clinical instructor, Mrs. Analiza Duhig- Casalta for providing us with significant
inputs in constructing this case study.

To our patient, for allotting his time with us during our data gathering for the
completion of this study.

To the staff of Medicine Ward of Davao Medical Center for allowing us to scan our
patient’s laboratory results, to the different authors of books, internet and journals
which helped in the contribution to materialized our research.

To our parents and guardians, for the interminable financial and moral support that
they’ve extended.

To our friends, classmates and group mates for allocating their resources, time and
venture to make this study attainable.

And most of all to our Almighty Father, the source of our faith, for the strength that had
sustained the advocates of this case study in constructing this complex endeavor
easily.
OBJECTIVES
A. General Objective:

This case study aims to provide the future researchers and students a broader
knowledge on Chronic Renal Failure

B .Specific Objectives:

Specifically study intends to;

 Present the personal data, medical and health history and developmental
background of Mr. X

 Define terms related to the case.

 Discuss the Normal anatomy and physiology related to the disease process

 Explain the pathophysiology and the disease process.

 Elaborate Nursing Theories applicable to our case.

 Enumerate the actual and ideal medical management.

 Enumerate and discuss the drugs and its pharmacologic effects.

 Formulate and prioritize nursing care plan applicable to the identified

problems.

 Identify the necessary health teachings and recommendations.

 Formulate the health maintenance and home care discharge plan.

 Identify prognosis of the case.

 Provide a Journal update related to the case.

 Explain the health implication of the study in terms of nursing practice,

education and research.
 IV. Identification of the Case
Patient’s Code Name: Mr. u-bob
Hospital: Davao Medical Center (Medicine
Ward, IMCU)
Case Number: 2080067
Address: Poblacion, Matalam Cotabato
Occupation: Motorcycle driver
Gender: Male
Age: 60
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Date of Admission: July 06, 2009 @ 8:56pm

Admitting Diagnosis: To consider chronic renal failure

secondary to hypertensive neuropathy

Final Diagnosis: CRF secondary to hypertensive

neuropathy

Chief Complaints: painful urination, flank pain

Attending physician: DR. Dharyl P. Guillermo

Date Study Begun: July 10, 2009

Date Study Ended: July 16, 2009
Time spent in actual care to patient: 6 days
Sources of Information/ Informants:
Primary Source Patient
His Wife
BACKGROUND AND FAMILY HISTORY

Our patient Mr. X is the eldest among the six children of Mr. and Mrs. Smith, 34
y.old, born on October 5, 1974.

His wife Mrs. Frail is a housewife; she spent her time taking good care of their
two children.

They are currently residing at Bato-Bato, San Isidro Davao Oriental and living
with his two children namely; Jing and Jong.

He had his elementary education at Bato-Bato elementary school and took his
secondary education at San Isidro National High School located at San Isidro Davao
Oriental. He did not finish his tertiary education due to financial constraints.

With regards to heredofamilial diseases, his mother side has a Diabetes

Mellitus while his father is none.

Socioeconomic Status
MEDICAL HEALTH HISTORY

History of Past Illnesses

Childhood Illness/ es: Measles at the age of 7
Chicken pox at the age of 9
Accidents or injuries: none
Chronic Illness/es: Nephrolithiasis
Hospitalization:
Operations: Removal of stone in the kidney

Immunizations: OPV

Last Examination Date:

Allergies: none
Taken Medications:
Past Illness; Nephrolithiasis

Present Illness; Chronic renal Failure

Secondary to obstructive uropathy

Arthritis
Developmental Task
Definition of Terms

Nephrolithiasis
Uropathy
Arthritis
Bloodstream
Erythropoietin
gluconeogenesis
bilirubin
calyces
microvilli
juxtaglomerular
Oliguria
Anuria
Pruritus
Renal osteodystrophy
Creatinine
Pericarditis
Anatomy and Physiology

Anatomy of the Kidneys and Urinary System

I.
A. Components of the urinary system

 two kidneys
 two ureters
 one urinary bladder
 one urethra

      B. Kidney process blood and form urine

 filter blood plasma (filtration)

 return most of the water and solutes to the bloodstream (reabsorption)
 the remaining water and solutes constitute urine
o passes through ureters
o stored in the urinary bladder
o excreted from the body through the urethra

       C. Functions of the urinary system

 the kidneys
 -regulate blood volume and composition
               -help regulate blood pressure
               -synthesize glucose
               -release erythropoietin
               -participate in vitamin D synthesis
               -excrete wastes in the urine
 the ureters transport urine from the kidneys to the urinary bladder
 the urinary bladder stores urine
  the urethra discharges urine from the body

 II. Overview of Kidney Functions

      A. Kidneys- do the major work of the urinary system

B. The remaining parts of the urinary system- passageways and storage areas

     Functions of the kidneys

          1. Regulation of blood ionic composition

 the kidneys help regulate the blood levels of Na +, K+, Ca2+, Cl-, and
HPO42-

         2.  Regulation of blood pH

 the kidneys excrete H+ into urine

 bicarbonate ions (HCO3-) are conserved- an important buffer of H+ in the blood

        3.  Regulation of blood volume

 the kidneys conserve or eliminate water in the urine

o b. an increase in blood volume increases blood pressure; a decrease in
blood volume decreases blood pressure

        4. Regulation of blood pressure

 the kidneys secrete the enzyme renin

 renin activates the renin-angiotensin-aldosterone pathway
 increased renin causes an increase in blood pressure

       5. Maintenance of blood osmolarity

 the kidneys maintain a relatively constant blood osmolarity (about 300

milliosmoles per liter)
 they do this by regulating the loss of water and solutes in the urine

      6. Production of hormones

         a. the kidneys produce two hormones

            (1) Calcitriol

                -The active form of vitamin D

                -helps regulate calcium homeostasis
            (2) erythropoietin- stimulates production of RBCs

      7. Regulation of blood glucose level

 like the liver, the kidneys can use the amino acid glutamine in gluconeogenesis
 gluconeogenesis is the synthesis of new glucose molecules
 can release glucose into blood to maintain normal blood glucose level

     8.  Excretion of wastes and foreign substances

         a. excrete wastes by forming urine

         b. examples of metabolic wastes

 -ammonia and urea from the deamination of amino acids

             -bilirubin from the catabolism of hemoglobin
             -creatinine from the breakdown of  creatin phosphate in
muscle fibers
             -uric acid from the catabolsim of nucleic acids

         c. examples of other wastes (foreign subsances from the diet)

 -drugs
-environmental toxins

      D. internal anatomy of the kidneys

          1. Two regions

              a. the renal cortex

                  -Superficial
                  -smooth-textured reddish area

             b. the renal medulla

                 -deep
                 -reddish-brown inner region
                 -consists of 8 to 18 cone-shaped renal pyramids

          2. Renal pyramids

              -the base faces the renal cortex

              -the apex (renal papilla) points toward the renal hilum
          3. Renal columns- portions of the renal cortex that extend between renal
pyramids

          4. Renal lobe- a renal pyramind + its overlying area of renal cortex + 1/2 of
each
                               adjacent renal column

5. The parenchyma- the functional portion of the kidney

                                      - consists of the renal cortex and renal pyramids of the
renal medulla
                                      - contains about 1 million microscopic structures called
nephrons

          6. Nephrons are the functional units of the kidney

          7. Urine formed by the nephrons drains into large papillary ducts- extend
through
              the renal papillae

          8. Papillary ducts drain into cuplike structures called minor and major calyces
(singular, calyx)

          9. From the major calyces, urine drains into a large cavity called the renal pelvis

         10. Urine leaves the renal pelvis through the ureter

         11. Ureters convey urine to the urinary bladder

         12. Flow of urine:

               Nephron-->collecting duct---> papillary duct---> minor calyx---> major calyx---

>
               renal pelvis--->ureter----> urinary bladder----> urethra

   Blood Supply of the Kidneys

        A. the kidneys are abundantly supplied with blood vessels- they process blood

        B. the kidneys receive 20 - 25% of the resting cardiac output via the right and left
renal arteries

        C. In adults, blood flow through both kidneys (renal blood flow) is about 1200 ml
per minute
        D. Blood supply of the kidneys
 

  V. The Nephron

       Parts of a nephron

           1. Two parts

               a. renal corpuscle- where blood plasma is filtered

               b. renal tubule- into which filtered fluid passes

          2. renal corpuscle-lies within the renal cortex

                                      -consists of two components

a. Glomerulus- a capillary network

b. the glomerular (Bowman's) capsule- a double-walled epithelial cup that
surrounds the glomerulus

      Parts of a renal tubule

A. proximal convoluted tubule- lies within the renal cortex

a. b. loop of Henle (nephron loop)- extends into the renal medulla, makes a
hairpin turn, and returns to the renal cortex
B. distal convoluted tubule- lies within the renal cortex  

C. the distal convoluted tubules of several nephrons empty into a single collecting
duct

       D. the loop of Henle

            1. The ascending limb- the first part of the loop of Henle
                                           - dips into the renal medulla

            2. The ascending limb- returns to the renal cortex

       E. cortical nephrons- 80-85% of nephrons

                                     - have short loops of Henle that lie mainly in the cortex /
penetrate only the outer region of the  renal medulla

 F. juxtamedullary nephrons- 15- 20% of nephrons

                                               - have renal corpuscles that lie deep in the cortex,
near the medulla
                                               - have a long loop of Henle that extemnds into the
deepest regions of
                                                  the medulla
                                               - the ascending limb of the loop of Henle consists
of two portions

1. A thin ascending limb (absent in cortical or short loop nephrons)

2. A thick ascending limb

-these nephrons enable the kidneys to excrete very dilute

                                                 or very concentrated urine

  
 
 
Symptomatology

Symptoms Present Absent Rationale

Neurologic manifestations
Lethargy √ Due to anemia
related to decrease
erythropoietic
production there is
manifestation of
weakness. (Jack
DeRuiter, Phd)
Day time √ Due to insomia (Jack
drowsiness DeRuiter, Phd)
Seizure √ Due to severe
Hyperthermia related
to accumulation of
urea and nitrogenous
products in the blood
serum. (Jack
DeRuiter, Phd)
Coma √ Due to brain tissue
damage related to
elevated levels of
urea and nitrogenous
product (Udan, MAN-
Medursg 2009)
Inability to √ Hypocalcemia
concentrate increases
neuromuscular
irritability which
impaired
concentration (Udan,
MAN- Medursg
2009)
Slurred speech √ Due to severe brain
damage (Udan,
MAN- Medursg
2009)
Tremors X Due to increase
neuromuscular
irritability (Udan,
MAN- Medursg
2009)
Cardio Manifestations
Hypertension √ Due to
vasoconstriction of
 peripheral nervous
system (Udan, MAN-
Medsurg 2009)
Peripheral Edema √ There is diminished
ability to excrete salt
and water resulting
to fluid retention.
(Porth, et.al)
CHF √ Due to Pericarditis
related to uremic
toxin infection (Jack
DeRuiter, Phd)
Respiratory Manifestations
Kassmaul √ Fluid overload
associated with
pulmonary edema
and acidosis leading
to Kassmaul
respiration.
(McCance
et.al,1994)
Shortness of √ Due to circulatory
breath overload (Udan,
MAN- Medsurg
2009)
Pulmonary Edema √ Presence of
Crackles upon
auscultation (Udan,
MAN- Medsurg
2009)
Crackles √ Due to circulatory
overload (Udan,
MAN- Medsurg
2009)
Hematologic manifestations
Anemia √ Decreased
production of
erythropoietin which
is normally secreted
by the kidney. (Udan,
MAN- Medsurg
2009)
Abnormal √ Due to abnormal
bleeding bleeding time and
abnormal platelet
aggregation (Jack
 DeRuiter, Phd)
Bruising √ Due to abnormal
bleeding time and
abnormal platelet
aggregation (Jack
DeRuiter, Phd)
G.I Manifestations
Nausea & √ Decomposition of
Vomiting urea by intestinal
flora, resulting in a
high concentration of
ammonia
Change in taste X
Diarrhea √ Due to Hypokalemia.
(Udan, MAN-
Medsurg 2009)
Stomatitis and GI √ Due to conversion of
bleeding urea back into
ammonia. Ammonia
irritates mucous
membrane including
the GI tract. (Udan,
MAN- Medsurg
2009)
Urinary Manifestations
Polyuria, Nocturia X It occurs at the early
(early) stage of renal failure.
(Udan, MAN-
Medsurg 2009)
Oliguria, Anuria √ Decreased function
(later) of the kidney in the
later stage. (Jack
DeRuiter, Phd)
Proteinuria √ Decreased
reabsorption of
protein due to
decrease glomerular
filtration rate (GFR)
Hematuria X
Integumentary Manifestations
Decrease skin X
turgor
Yellow-gray pallor; √ Retention of
hyperpigmentation urochromes,
of the skin contributing to
sallow, yellow color.
 (McCance
et.al,1994)
Dry skin √ Caused by reduction
in perspiration owing
to decreased size of
sweat glands &
diminished activity of
oil glands.
Pruritus √ Increase serum level
of phosphate in the
blood. (Udan, MAN-
Medsurg 2009)
Musculoskeletal Manifestations
Muscle weakness √ Due to hypocalcemia
and cramping and also common
symptoms of tetany.
(Udan, MAN-
Medsurg 2009)
Renal √ This is due to
osteodystrophy hypocalcemia. The
and bone pain bones become weak
and brittle. Increases
risk for fracture.
(Udan, MAN-
Medsurg 2009)

Etiology

Predisposing Rationale
Gender According to Ignatavicius and
Workman. Overall incidence is higher
in men.
Age According to Ignatavicius and
Workman. The incidence of stone
disease in the adult population is
relatively high. About 12% of adult will
have at least one episode of renal
stone disease.

Precipitating
Diet Increase sodium in diet
Urinary Retention (job) According to Ignatavicius and
Workman. Taking for granted the urge
to urinate will contribute to the
 formation or renal calculi.
Vices Increase alcohol/ liquor’s on his young
age (Udan, MAN- Medsurg 2009)
Pathophysiology

Predisposing Precipitating
 Gender ● Diet
 Age ● Vices
● Urinary retention
(job)

↓
Supersaturation of the urine
↓

↓ Of Glomerular Filtration Rate → (alteration of H 2O, acid-base

balance
(Alteration in renal tubular cell membrane integrity and tubular lumen obstruction)
↓
A progressive ↑ of the serum BUN and creatinine
↓
Renal failure
↓
Stage I diminished renal reserve → no symptoms are evident
(Renal function is reduced, but accumulation of metabolic wastes occurs)
↓
The healthier kidney compensate for the diseased kidney
↓
Ability to concentrate urine is decreased resulting to Nocturia and Polyuria
↓
Stage II Renal Insufficiency → (anemia & hypertension)
(Metabolic waste begin to accumulate in the blood because the unaffected nephron
can no longer compensate)
↓
Responsiveness to diuretic is ↓ resulting to Oliguria and edema
↓
Stage III: End stage Renal Disease → anemia, discomfort of skin
changes
↓
Excessive amounts of metabolic wastes accumulate in the blood-
↓
The kidneys are unable to maintain homeostasis
↓
 If treated: if untreated:
 Hemodialysis ● Increased infections
 Medication ● ↓ functioning of white blood cells
 Dietary Management ● Weakening of the bones
 Renal replacement therapy ● Liver inflammation
● Platelet dysfunction
● Pericarditis
● Peripheral neuropathy
↓
Death
Medical Management

IDEAL

Exams and Tests

There may be mild to severe high blood pressure. A neurologic examination may
show polyneuropathy. Abnormal heart or lung sounds may be heard with a
stethoscope.
A urinalysis may show protein or other abnormalities. An abnormal urinalysis may
occur 6 months to 10 or more years before symptoms appear.
Creatinine levels progressively increase.
BUN is progressively increased.
Creatinine clearance progressively decreases.
Potassium test may show elevated levels.
Arterial blood gas and blood chemistry analysis may show metabolic acidosis.
Signs of chronic renal failure, including both kidneys being smaller than normal, may
be seen on:
 Abdominal CT scan
 Abdominal MRI
 Abdominal ultrasound
 X-rays of the kidneys and abdomen
This disease may also alter the results of the following tests:
 Erythropoietin
 PTH
 Renal scan
 Serum magnesium - test
 Urinary casts
If your doctor suspects chronic kidney failure, he or she is likely to order urine and
blood tests to check for increased levels of waste products, such as urea and
creatinine. You also may have a chest X-ray to check for fluid retained in your lungs
(pulmonary edema) as well as tests to rule out other possible causes for your signs
and symptoms.
To help confirm a diagnosis of kidney failure, you may have the following tests:
M.Ultrasound imaging. This test uses high-frequency sound waves and
computer technology to generate images of your kidneys. Ultrasound images
can indicate the shape and structure of your kidneys and reveal obstructions
contributing to the problem.
N. Computerized tomography (CT) scans. This test uses computers to create
more detailed images of your internal organs — including your kidneys — than
conventional X-rays do.
O. Magnetic resonance imaging (MRI). Instead of X-rays, this test uses a
 magnetic field and radio waves to generate cross-sectional pictures of your
body.
P. Kidney biopsy. Sometimes your doctor may remove a small sample of kidney
tissue to be examined microscopically. Kidney tissue analysis permits a more
specific diagnosis of the kidney disease.
Your doctor confirms a diagnosis of end-stage kidney disease when blood tests
consistently show very high levels of urea and creatinine — a sign that kidney function
has been severely and permanently damaged.

Diagnosis
G. Electrolytes, BUN, creatinine, phosphate, Ca, CBC, urinalysis (including urinary
sediment examination)
H. Ultrasonography
I. Sometimes, renal biopsy
ACTUAL

02/ 15/09
9AM

Dx. Ff-up HBSag USD of KUB ; prostate

Anti-HCV
Still secure materials for hemodialysis
Pls. secure consent for shunt insertion
Sub. Refusal to GS for shunt insertion with materials and consent\
IVF: D5 0.3 Na Cl + 2 vials NaHCo3 @ 15 cc /hour to follow as mainline
Refer

Aida P. Maraman, Internal Med

License # 106260

02/ 16/ 09

Dx. Ff-up hepatitis profile S/F HBSag anti HCV

Pls provide request
IVF to heplock
Still to secure IJ shunt
Inform MROD once available materials
Refer
Clinical Microscopy URINE EXAM

Date: February 2, 2009

A. Color: light yellow
Appearance: slightly cloudy
Reaction : 6.0
Specific gravity 1.075

B. Chemical Exam

Sugar:( -)
pH:

C. Microscopic Exam
Epithelial Cells: +1
Squamous
Puss Cells: > 100 hpf
RBC 2-4 hpf
Bacteria
Yeast Cells
Oil Globules
Spermatozoa
Nursing Theories
Lab Findings

A. Clinical Microscopy URINE EXAM

Date: February 2, 2009 Reference

A. Color: light yellow
Appearance: slightly cloudy
Reaction: 6.0
Specific gravity 1.075

B. Chemical Exam
Na 136.00 136-155.00
K 3.7 3.5-5.5
Crea 2134.60 53.00-115.00

C. Microscopic Exam
IPP
Squamous
Puss Cells: > 100
hpf
RBC 2-4

hpf
Bacteria
Yeast Cells
Oil Globules
Spermatozoa
Drug Study
Nursing Assessment

Integument
Skin
Inspection: presence of rash
Palpation: presence of edema, dry, warm to touch

Nails
Inspection: brittle
Palpation: capillary refill of <5 secs

Hair
Palpation: brittle texture

Conjunctiva and sclera

Inspection: pale conjunctiva; icteric sclera

Mouth and Throat

Lips
Inspection: pale in color
Gums/Buccal mucosa
Inspection: pale in color

Neck
Palpation: no jugular vein distention
Chest
Posterior
Inspection: use of accessory muscle
Palpation: alteration in regular rhythm and depth, symmetric chest expansion,
Auscultation: crackles noted.

Heart
Auscultation: apical heart rate – 92 bpm

Abdomen
Inspection: bloated abdomen

Extremities
Inspection: presence of rashes.
Palpation: presence of edema
Nursing Care Plans

NCP Actual
Cues and Nursing Objectives Implementatio Rationale Goals
evidences’ diagnosis n

s/o Fatigue Within 8 hrs >monitoring of >for Goal met

>pale related to nsg.care, v/s baseline Pt. was
conjunctiva decrease pt. will be data able to:
> with hemoglobin able to:
daytime level >regulating of >to >identify
drowsiness secondary to >improve ivf at the maintain the
>generalize anemia strength as desired rate proper causativ
d edema evidence by hydration e factors
> inability to Rationale; a. affecting
concentrate, Due to verbalizatio >ascertain >for the
look irritable decrease n previous comparison voiding
> lethargic, erythrophoieti b. perform pattern of with current process
look weak n secretion in light bed elimination situation
reduces red activities
blood cell >discuss Na >there will
production by restriction be more
the bone water
marrow retention
(Udan, MAN-
Medsurg >assess >to reduce
2009) frequently for risk of
bladder infection
distention and other
complicatio
n
>emphasize
importance of >to reduce
keeping the risk of more
area dry and infection
clean and other
complicatio
n
NCP Potential
Cues and Nursing Objectives Implementatio Rationale Goals
evidences diagnosis n
s/o Risk for Within 8 hrs > v/s >for Goal met
infection nsg.care, monitoring baseline Pt.was able
>generalized r/t urinary pt.will be data to:
edema retention able to;
secondary >Identify
> + oliguria to CRF >Identify >regulating of >to intervention
intervention ivf at the maintain s to prevent
>+ecchymosi Definition s to prevent desired rate proper or reduce
s or reduce hydration risk for
An risk for infection
increased infection >instruct in >prevention
risk for techniques to of the
being protect the spread of
invaded integrity of the infection
by skin
pathogeni
c or >stress proper >to prevent
organisms hand washing spread of
infection

>discuss Na >there will

restriction be more
fluid
retention
that will
>emphasize promote
importance of urinary
keeping the retention
area dry and
clean >to reduce
risk of more
infection and
>promote other
hygienic complication
measures

>to facilitate
less
occurrence
of
complication
s
Discharge Plan Method
Journals
Prognosis and Results

Actual Prognosis

GOOD FAIR POOR RATIONALE

(3) (2) (1)
GENETIC Ö Chronic Renal
failure is not
genetically
acquired.
AGE Ö Chronic renal
Failure affects
ages mid 30’s
and above.

NUTRITION/DIET Ö Patient
usually
consumed
unhealthy
foods that are
high in sodium
and fats..

REACTION TO Ö Refuse to
MEDICAL have
MANAGEMENT Hemodialysis.
FAMILY SUPPORT Ö Home Against
Medical
Advice.

LEGEND: RATINGS:
GOOD = 2.4 - 3.0 GOOD: 1X3 = 3
FAIR = 1.7 - 2.3 FAIR: 1X2 2
POOR = 1.0 -1.6 POOR: 3X1 =3
TOTAL: 8/5 = 1.6
 The result of 1.6 signals a POOR PROGNOSIS. Wherein, out of the result, 1
criteria is graded as good, 2 are fair and 3 are poor. Therefore, our client and also his
family need to be provided with information on ways to promote health Treatment,
lifestyle modification and the clients Treatment compliance. Our client has poor
prognosis because of Home Against Medical Advice (HAMA). Patient also refuses
hemodialysis.
Ideal Prognosis

There is no cure for chronic renal failure. Untreated, it usually progresses to

end-stage renal disease. Lifelong treatment may control the symptoms of chronic
renal failure. Lifelong treatment may control the symptoms of chronic renal failure.
CRF is often slow in its onset and progression. The rate of progression is variable but
usually renal function steadily declines resulting in End Stage Renal Disease (ESRD).
Once ESRD is reached, the patient requires renal replacement treatment in form of
dialysis or kidney transplant. If this is not provided, the patient’s life is endangered due
to fluid overload and accumulation of toxins in the blood.
Summary
Evaluation
Nursing Implications