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Yes.

Okay.

So for this power point presentation um we're going to

be discussing preventing injuries and patient with chronic kidney disease.

Um

Of course my name is Megan

and this is for adult health nursing too.

So the first thing I want to discuss um is the learning objectives.

There are three learning objectives that you should get from this course.

Um the first one is to identify three symptoms of chronic kidney disease.

Also number two is identify three signs of gait impairment

and three is identify evidence.

Three evidence based interventions to prevent

falls in patients with kidney disease.

So the first thing we'll discuss briefly is

the path of physiology of chronic kidney disease.

Um It's a very complicated process but essentially chronic kidney

disease develops after prolonged acute inflammation from the kidneys.

Um Often there's no symptoms early

in the early stages.

Um And this is where most of the significant damage to

the kidneys actually occurs but often times the patients are not aware

There are five stages of kidney disease and the 5th stage

is in stage kidney disease.

Um Listed to the right, there are several causes. Number one is diabetes.

That's the that's the majority of chronic kidney disease results from diabetes.

However, hypertension, um glow mary, Ellen nephritis.

Um All these other issues can also

lead to

chronic kidney disease as well.

Um And some of the symptoms would like to discuss here.

Um The diagnostic factor for chronic kidney disease is your G fr

So when you have a decreased glamorous hello

filtration rate for three months or more.

That indicates that you have chronic kidney disease and it

is based off of the level of the G.

F. R. Of what stage you are in.

You also will see elevated serum creatinine levels.

Um And these actually are what cause the symptoms that people start to develop

in sort of the later stages.

Um You also, your patients with kidney disease will have anemia

metabolic acidosis. They'll have abnormal electrolyte levels,

hypertension which will be pretty difficult to treat.

Often require um multiple medications for this.

Keep in mind you want to keep um medications on

board that are not um harmful to the renal system.

You're gonna see patients with adama

and fluid retention and also heart failure is very common

and chronic kidney disease um Often they have generalized pain.

Um So that needs to be addressed flu like symptoms.

Just general aches and pains,

neuropathy that type of thing often develops with chronic kidney disease as well.

And for the purposes of this teaching, we're going to be discussing

more in depth specifically the gate changes

that occur during chronic kidney disease.

He,

so the rationale for this capstone project um

you know chronic kidney disease is very common.

You're gonna see this in a lot of your patients.

Um Older adults often have chronic kidney disease as well as other comorbidities.

Um And and one thing to keep in mind when you're treating these patients.

Not all but many have gate changes

and so that makes them very high risk for falls.

And as a result, they're very high risk for injuries.

Um And so there are evidence based interventions that

can be implemented to prevent falls and injuries.

Um So that's what we're going to discuss

and and basically, since

the renal system and and renal dysfunction

can affect the physical balance and their gate performance, then um you know,

you need to keep that in mind with patients

and um be aware that falls and other injuries are

are high risk for these patients.

So this slide is just an overview of the stages of chronic kidney disease.

Um like I said before, there are five stages

And just something to think about what stage do you think

poses the most risk for falls out of the stages 1-5.

But really just reviewing this, each stage,

being familiar with each stage of it and the symptoms

and the level of care that these patients will need.

Um As I discussed before, the G. F. R.

Declines as the stages go up. So the lower the G fr the higher the stage.

So, to answer the question, the last slide,

Um Stage five, which is in stage renal disease,

um or kidney failure,

uh That is the stage

in which patients are most at risk for falls from gate changes.

And in stage kidney disease affects

every single body system

and you're gonna

you're gonna see many, many changes in each body system when you do your assessment

and this slide is just some general overview.

Um You're going to see the abnormal labs like we discussed. The G. F. R.

Will be very low.

You're going to see elevated, creating elevated B. U. N.

Um neurological changes. Often they can be disoriented.

They'll have tremors. Um Or as um neuropathy in the feet is also very common.

Can even lead to seizures,

integer commentary system.

This is often time you're going to see their skin is very very dry. They itch.

Um They can even see you can even uh form your E.

Mc Frost which is is basically the your your E. MiA

is leaching out of their skin.

That doesn't happen often. But it can

um You're gonna see this thinning hair, thin brittle nails, that type of thing.

Cardiovascular changes. They're gonna see, you're gonna see that hypertension.

Like we talked about

often the edema, edema of the face.

You're going to see edema of the hands, feet and sacrum.

You might hear some abnormal heart sounds.

Um That type of thing,

pulmonary changes

crackles the same the same thing.

You're gonna see these fluid overload type symptoms.

Um Just from the kidneys not being able to process

all the water out of the system.

Um So shortness of breath. Just some tech apnea, spewed um

crackles that type of thing.

Gastro

intestinal changes as well.

Um You may see some nausea, vomiting often they lose their appetite.

Um Or they have severe constipation.

Often they'll have alterations in their mouth with, with some bleeding,

so that will make it difficult for them to eat as well.

Um and like we discussed, the humor to logic changes. Anemia. Also thrombosis.

Dapena is a big one there. Plate platelets

will be low as well.

So when you're doing a focused patient assessment on someone

In stage five,

this is where assessing for their gait abnormalities really comes into play here.

So,

You know, your patient is probably going to be in stage five at this point.

Um you wanna do your, whatever fall risk assessment your facility uses.

That is an excellent tool to assess fall risk

uh

in the elderly for any patient,

but especially with those with chronic kidney disease.

And then you're just gonna kind of ask yourself these, these questions here.

Does this patient have gate changes? Not all

end stage kidney disease patients will have gate changes, but some do

um you're going to assess what is their normal gait pattern, Has it changed?

Has it declined?

Do they have a history of falls?

If so, um when have they fallen? How have they fallen? How often have they fallen?

Those type of things are excellent questions to assess.

And when you see the red arrows? Those are the key

sort of alarm bells that you want to monitor.

These patients are going to be very high risk for falls. Um So if you see these,

these few things here,

you know, this patient is really going to be high risk. So keep that in mind,

muscle weakness, that's a big one.

They're gonna have weakness just from impaired cardiac output. Dizziness.

That type of thing.

Their mobility is is going to be impaired. For the most part,

dizziness is a big one as well.

Um for the same reasons, often they're undergoing hemodialysis.

So, you know, you can potentially see some major fluid shifts, electrolyte changes

and that makes them high risk as well.

Commonly.

You will see a shuffling gait in these patients

very similar to a Pakistani in type shuffling gait.

Um but it is not

Parkinson's related.

Um also the decreased step length with the research that was done often,

this was the single um the single finding that

the researchers discovered was basically the step length of

of the patient had decreased significantly.

Also, if they have a history of fractures, your your you know,

that potentially they're at risk for another fracture.

And of course, as we talked about chronic kidney disease,

affects every body system.

So you're going to have impaired impaired bone growth and impaired bone regrowth.

So you're potentially

they're high risk for falls just from that as well.

So also if your patients already using a wheelchair or a walker,

um these things indicate that, you know,

they're already having difficulty walking.

So these are, that's one of the main um components that you want to assess for

cognitive impairment can be very common in these patients as mentioned before.

They can be very confused.

Also impaired balance from dizziness changes in blood pressure,

Ortho static hypertension,

that type of thing makes them very high risk for falls.

And you also want to make sure that they have proper shoes on.

Yeah, you want to avoid slip on shoes or slippers, that type of thing.

You want a really good shoe with a good um nonslip sole.

So here's some potential nursing diagnosis is for these patients,

of course your main one would be this patient is high risk for falls

and these risk factors would include gate changes,

um bone mineral density changes,

say they have neuropathy or generalized muscle weakness.

Those type of things make them um

are are the risk factors for the risk for falls and

because the risk for falls are also risk for injury.

Um

And and and the risk factors are essentially the same for that

and activity intolerance there, they're going to be fatigued very easily.

Their body is not functioning at its peak.

And so you know,

you're gonna wear these people out really fast if you try to overwork them.

Um And then also fatigue very similar.

Um You know these these patients need a lot of

time to rest in between activities before meals before showers,

that type of thing.

So take that into consideration. Don't try to rush them plan their day um to allow

periods of rest.

And just this little comic here thought it was cute where uh you know,

they're trying to prevent falls and this lady has

her own idea of how to prevent falls.

She can just lay there on the ground and she'll never fall.

So planning

the primary goal of nursing management for chronic kidney disease

patients um that's to maintain the kidney function and

their homeostasis for as long as you can.

Um That can be difficult.

These patients are sickly and you know,

their their kidney function can decline very rapidly.

So you want to maintain that as long as you can.

Of course the secondary goal then is to prevent injury

from falls for these patients that do have gait changes.

Um and and also some other

goals would be to maintain their current level of physical

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