Buy a Nursing essay from

Left your Nursing Assignment to the last minute? Let a qualified expert do your Nursing essay for you and deliver it before your deadline!

Buy Nursing essay Papers
Calculate your paper price
Pages (550 words)
Approximate price: -

Chronic Renal Failure

Fran has been diagnosed with acute renal failure in the early months of the year. She is a spinster living alone in the city. She did not mind the physician’s instructions regarding her fluid intake, her diet, her level of activity, and her medications. As months passed, Fran started to notice that she is experiencing severe pain on her flank area. She cannot stand and move about for as long as she did in the past months. She tires easily and experiences shortness of breath. She went back to her physician and he told her that her ARF has already progressed to chronic renal failure (CRF) or end-stage renal disease (ESRD).


When the patient has sustained enough kidney damage to require renal replacement therapy on a permanent basis, the patient has moved into the fifth or final stage of CKD, also referred to as chronic renal failure.
  • Chronic renal failure (CRF) is the end result of a gradual, progressive loss of kidney function.
  • Causes include chronic infections (glomerulonephritis, pyelonephritis), vascular diseases (hypertension, nephrosclerosis), obstructive processes (renal calculi), collagen diseases (systemic lupus), nephrotoxic agents (drugs, such as aminoglycosides), and endocrine diseases (diabetes, hyperparathyroidism).
  • This syndrome is generally progressive and produces major changes in all body systems.
  • The final stage of renal dysfunction, end-stage renal disease (ESRD), is demonstrated by a glomerular filtration rate (GFR) of 15%–20% of normal or less.
  • Renal failure results when the kidneys cannot remove the body’s metabolic wastes or perform their regulatory functions.
  • The substances normally eliminated in the urine accumulate in the body fluids as a result of impaired renal excretion, affecting endocrine and metabolic functions as well as fluid, electrolyte, and acid-base disturbances.
  • Renal failure is a systemic disease and is a final common pathway of many different kidney and urinary tract diseases.
  • Accumulation. As renal function declines, the end products of protein metabolism (normally excreted in urine) accumulate in the blood.
  • Adverse effects. Uremia develops and adversely affects every system in the body.
  • Progression. The disease tends to progress more rapidly in patients who excrete significant amounts of protein or have elevated blood pressure than those without these conditions


There are many diseases that cause chronic renal disease; each has its own pathophysiology. However, there are common mechanisms for disease progression.
  1. Pathologic features include fibrosis, loss of renal cells, and infiltration of renal tissue by monocytes and macrophages.
  2. Proteinuria, hypoxia, and extensive angiotensin II production all contribute to the pathophysiology. In an attempt to maintain GFR, the glomerular hyperfiltration; this results in endothelial injury.
  3. Proteinuria results from increased glomerular permeability and increased capillary pressure.
  4. Hypoxia also contributes to disease progression. Angiotensin II increases glomerular hypertension, which further damages the kidney.
Predisposing Factors
  • Diabetes, which is the most common risk factor for chronic kidney failure in the United States
  • Age 60 or older
  • Kidney disease present at birth (congenital)
  • Family history of kidney disease
  • Autoimmune Disorder (Lupus erythematosus)
  • Bladder outlet obstruction (BPH and Prostatitis)
  • Race (Sickle cell disease)
Precipitating Factors Schematic Diagram Here’s a schematic diagram or concept map for Chronic Kidney Disease:

Clinical Manifestations

Because virtually every body system is affected in ESRD, patients exhibit a number of signs and symptoms.
  • Peripheral neuropathy. Peripheral neuropathy, a disorder of the peripheral nervous system, is present in some patients.
  • Severe pain. Patients complain of severe pain and discomfort.
  • Restless leg syndrome. Restless leg syndrome and burning feet can occur in the early stage of uremic peripheral neuropathy.


Potential complications of chronic renal failure that concern the nurse and necessitate a collaborative approach to care include the following:
  • Hyperkalemia. Hyperkalemia due to decreased excretion, metabolic acidosis, catabolism, and excessive intake (diet, medications, fluids).
  • Pericarditis. Pericarditis due to retention of uremic waste products and inadequate dialysis.
  • Hypertension. Hypertension due to sodium and water retention and the malfunction of the renin-angiotensin-aldosterone system.
  • Anemia. Anemia due to decreased erythropoietin production decreased RBC lifespan, bleeding in the GI tract from irritating toxins and ulcer formation, and blood loss during hemodialysis.
  • Bone disease. Bone disease and metastatic and vascular calcifications due to retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism, and elevated aluminum levels.

Assessment and Diagnostic Findings

Laboratory studies required to establish the diagnosis of CRF include:
  • Glomerular filtration rate. GFR and creatinine clearance decrease while serum creatinine (more sensitive indicator of renal function) and BUN levels increase.
  • Sodium and water retention. Some patients retain sodium and water, increasing the risk for edema, heart failure, and hypertension.
  • Acidosis. Metabolic acidosis occurs in ESRD because the kidneys are unable to excrete increased loads of acid.
  • Anemia. In ESRD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.
  • Urine
    • Volume: Usually less than 400 mL/24 hr (oliguria) or urine is absent (anuria).
    • Color: Abnormally cloudy urine may be caused by pus, bacteria, fat, colloidal particles, phosphates, or urates. Dirty, brown sediment indicates presence of RBCs, hemoglobin, myoglobin, porphyrins.
    • Specific gravity: Less than 1.015 (fixed at 1.010 reflects severe renal damage).
    • Osmolality: Less than 350 mOsm/kg is indicative of tubular damage, and urine/serum ratio is often 1:1.
    • Creatinine clearance: May be significantly decreased (less than 80 mL/min in early failure; less than 10 mL/min in ESRD).
    • Sodium: More than 40 mEq/L because kidney is not able to reabsorb sodium.
    • Protein: High-grade proteinuria (3–4+) strongly indicates glomerular damage when RBCs and casts are also present.
  • Blood
    • BUN/Cr: Elevated, usually in proportion. Creatinine level of 12 mg/dL suggests ESRD. A BUN of >25 mg/dL is indicative of renal damage.
    • CBC: Hb decreased because of anemia, usually less than 7–8 g/dL.
    • RBCs: Life span decreased because of erythropoietin deficiency, and azotemia.
    • ABGs: pH decreased. Metabolic acidosis (less than 7.2) occurs because of loss of renal ability to excrete hydrogen and ammonia or end products of protein catabolism. Bicarbonate and PCO2 Decreased.
    • Serum sodium: May be low (if kidney “wastes sodium”) or normal (reflecting dilutional state of hypernatremia).
    • Potassium: Elevated related to retention and cellular shifts (acidosis) or tissue release (RBC hemolysis). In ESRD, ECG changes may not occur until potassium is 6.5 mEq or higher. Potassium may also be decreased if patient is on potassium-wasting diuretics or when patient is receiving dialysis treatment.
    • Magnesium, phosphorus: Elevated.
    • Calcium/phosphorus: Decreased.
  • Proteins (especially albumin): Decreased serum level may reflect protein loss via urine, fluid shifts, decreased intake, or decreased synthesis because of lack of essential amino acids.
  • Serum osmolality: Higher than 285 mOsm/kg; often equal to urine.
  • KUB x-rays: Demonstrates size of kidneys/ureters/bladder and presence of obstruction (stones).
  • Retrograde pyelogram: Outlines abnormalities of renal pelvis and ureters.
  • Renal arteriogram: Assesses renal circulation and identifies extravascularities, masses.
  • Voiding cystourethrogram: Shows bladder size, reflux into ureters, retention.
  • Renal ultrasound: Determines kidney size and presence of masses, cysts, obstruction in upper urinary tract.
  • Renal biopsy: May be done endoscopically to examine tissue cells for histological diagnosis.
  • Renal endoscopy, nephroscopy: Done to examine renal pelvis; flush out calculi, hematuria; and remove selected tumors.
  • ECG: May be abnormal, reflecting electrolyte and acid-base imbalances.
  • X-ray of feet, skull, spinal column, and hands: May reveal demineralization/calcifications resulting from electrolyte shifts associated with CRF.

Medical Management

The goal of management is to maintain kidney function and homeostasis for as long as possible.
  • Pharmacologic therapy: 
    • Calcium and phosphorus binders treat hyperphosphatemia and hypocalcemia;
    • Antihypertensive and cardiovascular agents (digoxin and dobutamine) manage hypertension;
    • Anti-seizure agents (IV diazepam or phenytoin) are used for seizures, and;
    • Erythropoietin (Epogen) is used to treat anemia associated ESRD.
  • Nutritional therapy. Dietary intervention includes careful regulation of protein intake, fluid intake to balance fluid losses, sodium intake to balance sodium losses, and some restriction of potassium.
  • Dialysis. Dialysis is usually initiated if the patient cannot maintain a reasonable lifestyle with conservative treatment.

Nursing Management

The patient with ESRD requires astute nursing care to avoid the complications of reduced renal function and the stresses and anxieties of dealing with a life-threatening illness.

Nursing Assessment

Assessment of a patient with ESRD includes the following:
  • Assess fluid status (daily weight, intake and output, skin turgor, distention of neck veins, vital signs, and respiratory effort).
  • Assess nutritional dietary patterns (diet history, food preference, and calorie counts).
  • Assess nutritional status (weight changes, laboratory values).
  • Assess understanding of cause of renal failure, its consequences and its treatment.
  • Assess patient’s and family’s responses and reactions to illness and treatment.
  • Assess for signs of hyperkalemia.


Based on the assessment data, the following nursing diagnoses for a patient with chronic renal failure were developed:
  • Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water.
  • Imbalanced nutrition less than body requirements related to anorexia, nausea, vomiting, dietary restrictions, and altered oral mucous membranes.
  • Activity intolerance related to fatigue, anemia, retention of waste products, and dialysis procedure.
  • Risk for situational low self-esteem related to dependency, role changes, changes in body image, and change in sexual function.

Planning & Goals

Main Article: 6 Chronic Renal Failure Nursing Care Plans

The goals for a patient with chronic renal failure include:
  • Maintenance of ideal body weight without excess fluid.
  • Maintenance of adequate nutritional intake.
  • Participation in activity within tolerance.
  • Improve self-esteem.

Nursing Priorities

  1. Maintain homeostasis.
  2. Prevent complications.
  3. Provide information about disease process/prognosis and treatment needs.
  4. Support adjustment to lifestyle changes.

Nursing Interventions

Nursing care is directed towards the following:
  • Fluid status. Assess fluid status and identify potential sources of imbalance.
  • Nutritional intake. Implement a dietary program to ensure proper nutritional intake within the limits of the treatment regimen.
  • Independence. Promote positive feelings by encouraging increased self-care and greater independence.
  • Protein. Promote intake of high-biologic –value protein foods: eggs, dairy products, meats.
  • Medications. Alter schedule of medications so that they are not given immediately before meals.
  • Rest. Encourage alternating activity with rest.


A successful nursing care plan has achieved the following:
  • Maintained ideal body weight without excess fluid.
  • Maintained adequate nutritional intake.
  • Participated in activity within tolerance.
  • Improved self-esteem.

Discharge and Home Care Guidelines

The nurse should promote home and self-care to increase the esteem of the patient.
  • Vascular access care. The patient should be taught how to check the vascular access device for patency and appropriate precautions, such as avoiding venipuncture and blood pressure measurements on the arm with the access device.
  • Problems to report. The patient and the family need to know what problems to report: nausea, vomiting, change in usual urine output, ammonia odor on breath, muscle weakness, diarrhea, abdominal cramps, clotted fistula or graft, and signs of infection.
  • Follow-up. The importance of follow-up examinations and treatment is stressed to the patient and family because of changing physical status, renal function, and dialysis requirements.
  • Home care referral. Referral for home care gives the nurse an opportunity to assess the patient’s environment and emotional status and the coping strategies used by the patient and family.

Documentation Guidelines

The documentation in a patient with chronic renal failure should focus on the following:
  • Existing conditions contributing to and degree of fluid retention.
  • I&O and fluid balance.
  • Results of laboratory tests.
  • Caloric intake.
  • Individual cultural or religious restrictions and personal preferences.
  • Level of activity.
  • Plan of care.
  • Teaching plan.
  • Response to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcomes.
  • Modifications to plan of care.
  • Long term needs.

Practice Quiz: Chronic Renal Failure

Here’s a 5-item practice quiz for this Chronic Renal Failure Study Guide:

Exam Mode

In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.

Practice Quiz: Chronic Renal Failure

Congratulations - you have completed Practice Quiz: Chronic Renal Failure. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Practice Mode

Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Chronic Renal Failure

Congratulations - you have completed Practice Quiz: Chronic Renal Failure. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Text Mode

1. A major sensitive indicator of kidney disease is: A. BUN level. B. Creatinine clearance level. C. Serum potassium level. D. Uric acid level. 2. Significant nursing assessment data relevant to renal function should include information about: A. Any voiding disorders. B. The patient’s occupation. C. The presence of hypertension or diabetes. D. All of the above. 3. Decreased levels of erythropoietin, a substance normally secreted by the kidneys, leads to which serious complication of chronic renal failure? A. Anemia. B. Acidosis. C. Hyperkalemia. D. Pericarditis. 4. Dietary intervention for renal deterioration includes limiting the intake of: A. Fluid. B. Protein. C. Sodium and potassium. D. All of the above. 5. In chronic renal failure (end-stage renal disease), decreased glomerular filtration leads to: A. Increased pH. B. Decreased creatinine clearance. C. Increased BUN. D. All of the above. Answers and Rationale 1. Answer: B. Creatinine clearance level.
  • B: Creatinine clearance is a major sensitive indicator of kidney disease.
  • A: BUN level could also detect kidney disease but it is not as sensitive as creatinine clearance.
  • C: Serum potassium level may indicate presence of kidney disease.
  • D: Uric acid level may indicate presence of kidney disease.
2. Answer: D. All of the above.
  • D: All of the answers listed above are relevant data to renal function.
  • A: Voiding disorders are signs of impending or presence of kidney disease.
  • B: The patient’s occupation could predispose him or her to kidney disease.
  • C: The presence of hypertension or diabetes could predispose the patient to kidney disease.
3. Answer: A. Anemia.
  • A: Anemia due to decreased erythropoietin production could occur in patients with chronic renal failure.
  • B: Metabolic acidosis occurs in ESRD because the kidneys are unable to excrete increased loads of acid.
  • C: Hyperkalemia occurs due to decreased excretion, metabolic acidosis, catabolism, and excessive intake (diet, medications, fluids).
  • D: Pericarditis occurs due to retention of uremic waste products and inadequate dialysis.
4. Answer: D. All of the above.
  • D: All of those mentioned above should be restricted in patients with chronic renal failure.
  • A: Fluid should be restricted because the patient may result to excess fluid volume.
  • B: Protein is restricted because its end products may accumulate in the blood stream.
  • C: Sodium and potassium is restricted because they can aggravate the disease.
5. Answer: D. All of the above.
  • D: The above mentioned laboratory results occur in patients with decreased GFR.
  • A: Increased pH occurs due to decreased GFR.
  • B: Decreased creatinine clearance occurs due to decreased GFR.
  • C: Increased BUN occurs due to decreased GFR.
Posts related to Chronic Renal Failure:


Ask our team

Want to contact us directly? No problem. We are always here for you.

Frequently Asked Buy a Nursing essay Questions

See all
Is your service confidential?

When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.

Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.

Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.

We also use a secure encrypted connection and do not store your private data if we do not need it anymore. For more details about how we ensure your confidentiality, check our Privacy Policy, which completely complies with the GDPR.

We offer original model papers that can be used legally in a number of ways if properly referenced:

  • As a source of arguments or ideas for your own research
  • As a source of additional understanding of the subject
  • Direct citing

Nonetheless, check your college’s/university’s policies, including their definition of plagiarism and paraphrasing before using our services. Make conscious decisions in regards to your education.

How do I order a paper from essaypapers?

We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.

Let’s have a closer look at the simple steps you need to go through for submitting your order:

Fill in the order form.

Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.

Proceed with the payment.

After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.

A personal writer is assigned to your order.

Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.

Your paper is completed and delivered to your personal order page.

When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).

You can check how easy the process is by going to the order page and submitting your paper details right now.

Is there a money-back guarantee? If yes, how can I receive a refund?

You can get more details about possible types and terms of refunds on our official money-back guarantee page.

How will I receive a completed paper?

You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.

If there happen to be any problems with downloading your paper, please contact our support team.

What if I’m not satisfied with my order?

If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.

After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.

If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.

If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.

How do I request a refund?

You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.

When the paper is delivered, the “Refund” button on your personal order page becomes clickable.

On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.

Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.

Order your essay today and save 15% with the discount code NURSINGHELP