Williams Sneak Preview

UNIT NINE

712

Understanding the Urinary System

Table 37.8 Effects of Chronic Kidney Disease on Body Systems

Body System Disease Process Cardiovascular

Angina due to coronary artery disease, anemia Arrhythmias due to electrolyte imbalance, coronary artery disease Edema due to fluid overload and a decrease in osmotic pressure Heart failure due to fluid overload, left ventricular failure Hypertension due to fluid overload and accelerated arteriosclerosis Pericarditis due to presence of waste products in the pericardial sac

Gastrointestinal

Stomatitis due to fluid restriction, presence of waste products in the mouth, secondary infections Anorexia, nausea, vomiting due to uremia Gastritis/gastrointestinal bleeding due to urea decomposition in gastrointestinal tract releasing ammonia that irritates and ulcerates the stomach or bowel; patient is also under stress, increasing ulcer formation, and may have platelet dysfunction Constipation due to electrolyte imbalances, decrease in fluid intake, decrease in activity, phosphate binders Diarrhea, hypermotility due to electrolyte imbalance Anemia due to impaired synthesis of erythropoietin, a substance needed by the bone marrow to stimulate formation of red blood cells (RBCs); also due to decreased life span of RBCs from uremia and interference in folic acid action Bleeding tendency due to abnormal platelet function from effects of uremia Prone to infection due to a decrease in immune system function from uremia; renal patients can rapidly become septic and die from septic shock Dry, itchy, inflamed skin due to calcium-phosphate deposits in the skin Pale yellow skin color due to urobilins, which give urine its yellow color Skin will have an odor of urine because skin is an organ of excretion and the body attempts to remove toxins Decreased function of oil and sweat glands Confusion due to uremic encephalopathy from increased urea and metabolic acids Peripheral neuropathy due to effects of waste products on neurologic system Cerebrovascular accidents due to accelerated atherosclerosis Pleurisy/pleural effusion due to waste products in the pleural space, causing inflammation with pleurisy pain and collection of fluid resulting in effusion

Hematopoietic

Integumentary

Neurologic

Pulmonary

Reproductive

Loss of libido, impotence, amenorrhea, infertility due to a decrease in hormone production

Skeletal

Bone and mineral disease due to hyperphosphatemia and hypocalcemia

Disturbance in Electrolyte Balance As kidney function decreases, the kidneys lose their ability to absorb and excrete electrolytes. If the kidneys are unable to maintain normal amounts of electrolytes in the blood, these substances can accumulate at high levels and become life threatening. When the kidneys are unable to regulate sodium levels ade- quately, the patient may show signs of hypernatremia (excessive sodium in the blood), which causes water retention, edema, and hypertension. Hyponatremia (too little sodium) may result if too much sodium is lost. This can occur when the patient has experienced prolonged episodes of vomiting or diarrhea or is

urinating large amounts of diluted urine. Patients with hypo- natremia may show signs of confusion. Sodium levels may be normal, or they may be low due to dilution from excess fluid. Hyperkalemia (adult potassium level greater than 5.3 mEq/L) can be life threatening if the level goes above 6.5 mEq/L (Earl, 2020). The patient may experience arrhyth- mias or cardiac arrest. Patients with hyperkalemia report muscle weakness, abdominal cramping, and diarrhea. They may be confused or disinterested in care. Patients with hyperkalemia should be placed on a cardiac monitor and observed for cardiac arrhythmias during treatment to reduce the potassium level.

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