How does cognitive function and renal functional influence pressure ulcers?

rn/writer, RN · Sep 25, 2010

We are happy to help students where they are stuck, but first we like to see what you have come up with on your own. This is not a site where we will do people's homework for them as it robs them (and their future patients) of the knowledge that comes from searching for answers on your own.

What I suggest is that you tell us what you are thinking and why you are thinking along those lines. Show us your train of thought and then we'll know better how to assist you.

To get you started, what kinds of things--both external and internal--can cause pressure ulcers?

How might a cognitively impaired person behave in ways that could cause their skin to break down?

And what are some of the restrictions and signs and symptoms of chronic renal failure.

You can Google some of this information. Then tell us where those answers lead you and we'll let you know if you're on the right track.

Best wishes.

swansonplace · Sep 25, 2010

I have done my homework but did not see the connection.

Chronic kidney disease: slow loss of kidney function over time.

- kidneys main function is to remove wastes and excess water from the body

- bone pain

- build up of calcium

Did not get the connection with pressure sores from kidney disease? Did not see how bone pain would cause a person to be immobile.

Loss of cognitive ability does not make sense on how that would stop a person from moving. Even though a person is not thinking as well, they still have the ability to move.

bdanders · Sep 25, 2010

I have done my homework but did not see the connection.
Chronic kidney disease: slow loss of kidney function over time.
- kidneys main function is to remove wastes and excess water from the body
- bone pain
- build up of calcium
Did not get the connection with pressure sores from kidney disease? Did not see how bone pain would cause a person to be immobile.
Loss of cognitive ability does not make sense on how that would stop a person from moving. Even though a person is not thinking as well, they still have the ability to move.

While a person with loss of cognitive ability may be able to move, they may have limited sensory perception, which is one factor analyzed in the Braden Risk Assessment Scale. In otherwords, they may have the physical ability to move, but the signal that says "hey, I can' t feel my sacrum, time to switch positions" may not be functioning.

As for bone pain causing immobility, when something hurts, we avoid the stimulus that causes the pain. If bone pain is bad enough a person may avoid movement to the point of becoming immobile.

tencat · Sep 25, 2010

What about nutrition? How does nutrition play a factor in renal disease and in declined cognitive functioning? No one system is totally independent from another, so look at how one can influence the other. If one is not able to function cognitively, what might that do to their ability to take in nutrients? How about their ability to follow a renal diet?

swansonplace · Sep 25, 2010

The skin needs protein to stay intact. So if a person cannot eat enough protein, his skin will break down faster. So if the person does not know he is hungry, and does not eat then the skin could break down. Just seems far fetched though. Can a person be so sick cognitively that he does not know that he/she is hungry?

swansonplace · Sep 25, 2010

The body is absolutely incredible. Loosing ones senses or the ability to think cognitively sure does affect ones basic functioning alot. Incredible. We just started clinicals so for now everything is theory.

starmickey03, MSN, RN · Sep 25, 2010

The skin needs protein to stay intact. So if a person cannot eat enough protein, his skin will break down faster. So if the person does not know he is hungry, and does not eat then the skin could break down. Just seems far fetched though. Can a person be so sick cognitively that he does not know that he/she is hungry?

Protein is composed of Carbon, hydrogen, oxygen and nitrogen. Nitrogen is excreted by the kidneys, so a person who has chronic renal failure cannot have a lot of protein in their diet if any because their kidneys cannot handle excreting the nitrogen.

Maybe that will help you out some.

swansonplace · Sep 25, 2010

The kidney information with nitrogen does help out. It becomes a catch 22. The skin needs the protein to keep it intact, but the kidneys cannot remove the nitrogen from the system. I guess the kidneys have priority over the skin.

GeauxNursing · Sep 26, 2010

Dialysis nurse here. not entirely true re: protein. We fully encourage our pts to eat, eat, eat protein! Eat some protein with every meal to help with osmotic pressure to reduce edema. Protein helps healing, as well. I'd say that although protein is very important to all pts, even renal ones, it is hard to get protein into a diet with every meal. It is filling, which means they might not eat enough. Not to mention some pts, esp. renal ones, can be on so many meds that they suffer from many side effects, including nausea, anorexia, diarrhea, dry mouth or bad taste. This makes one not want to eat.

And yes, ppl can be so cognitively deteriorated that they no longer recognize pain or hunger. They have to be reminded, and sometimes helped, to eat and turn themselves to relieve pressure on the bony prominences.

Dialysis pts have a daily battle with controlling their phosphorus. High levels of PO4 lead to Ca leaving the bones, which leads to brittle fragile skeleton, which leads to discomfort and increased r/f breakage.

Isn't it cool learning how all the body systems work together?

starmickey03, MSN, RN · Sep 26, 2010

Dialysis nurse here. not entirely true re: protein. We fully encourage our pts to eat, eat, eat protein! Eat some protein with every meal to help with osmotic pressure to reduce edema. Protein helps healing, as well. I'd say that although protein is very important to all pts, even renal ones, it is hard to get protein into a diet with every meal. It is filling, which means they might not eat enough. Not to mention some pts, esp. renal ones, can be on so many meds that they suffer from many side effects, including nausea, anorexia, diarrhea, dry mouth or bad taste. This makes one not want to eat.
And yes, ppl can be so cognitively deteriorated that they no longer recognize pain or hunger. They have to be reminded, and sometimes helped, to eat and turn themselves to relieve pressure on the bony prominences.
Dialysis pts have a daily battle with controlling their phosphorus. High levels of PO4 lead to Ca leaving the bones, which leads to brittle fragile skeleton, which leads to discomfort and increased r/f breakage.
Isn't it cool learning how all the body systems work together?

YES! Lol...I took Pathophys over the summer and was really interested in how EVERY system related to another in some type of way. Too bad I couldnt retain all the info I learned though:crying2:

swansonplace · Sep 26, 2010

It is so cool to start to get an inkling of how the body systems affect a person. Thank you.