409 Final 4 (CKD) Flashcards
Prognosis of CKD
its progressive and they don’t recover
ESKD is when
the functioning is so low that it can’t sustain the patients life
The stages of CKD are based on
GFR, which declines in each stage
“Renal Reserve” means
the amount of extra work the kidneys can handle
a person in stage 1 could have normal GFR, but
their renal reserve is decreased so they can’t handle extra stress from infection etc
renal reserve is decreased because the nephrons are
over compensating just to reach the normal GFR
In mild CKD, you still won’t see much a____
azotemia
In mild CKD, you might have increased ___ of ___
output of urine
In mild CKD the urine may be decreased and also
dilute
By the following doctors orders (i.e. diet and BP medication) can
slow the progression of mild CKD
In moderate CKD, the nephrons can’t
handle the normal workload anymore.
Severe/ESKD: You can’t make ___ urine
dilute
Severe/ESKD: the urine osmolarity is
fixed
Severe/ESKD: output
decreased
EARLY in CKD, the patient could have decreased sodium because
the nephrons don’t work well enough to reabsorb Na, also Na is lost because of polyuria
LATE in CKD, they have increased sodium because now
urine output is decreased
acid base balance in Early CKD
it’s not affected
acid base balance in Late CKD
you get metabolic acidosis because you’re not getting rid of hydrogen ions (also you have less bicarb)
in Late CKD the meta acidosis causes this respiratory finding
kussmaul
In early CKD you have ___ phosphate and ___ calcium
increase phosphate, decreased calcium (this affects bone density)
CKD cardiac changes: common BP finding
htn
CKD cardiac changes: HF can occur when the heart can’t handle the
excess fluid volume
Pericarditis can occurs because
the uremic wastes infects the pericardial fluids
2 signs of tamponade
decreased pulse pressure
bradycardia
Anemia is common in ___ CKD
late
Food might
taste different
2 of the main diseases that cause CKD
DM and HTN
Teach people to manage these diseases, stay hydrated, don’t abuse NSAIDs because they
reduce kidney perfusion
Because of hematologic changes, they may report
bruising/bleeding
Encephalopathy can cause __ and __
sz and coma
Encephalopathy is treated with
dial
SOB with exertion or at night suggests
fluid overload
Thick sputum can indicate
uremic lung
Skin findings
color can change a little
itchy
In late CKD, if you don’t restrict protein,
the BUN can increase 10 or 20 times the normal amount
Imaging: if CKD progresses RAPIDLY you may want US or CT to rule out
obstruction
Diuretics can be used for managing fluid volume and BP. However,
by the time you’re in ESKD, you shouldn’t be using diuretics because they can harm the patient
remember the conversion from kg to L
1 to 1
Weigh after the pt
voided
Treat PE with highfowlers, O2, and
diuretics
During pulmonary edema, you may need to decrease heart O2 demand with
morphine
Nutrition: patients starting HD or PD need increased
protein
In patients on dial, how much Na can they have
2 to 4 grams
Digoxin range is
0.8 to 2.0
Aluminum-based phosphate binders can cause
neuro problems if taken for a long time
As CKD progresses, you may need to decrease insulin dose because
the kidneys aren’t excreting insulin as quickly as before
A drug that can help with fatigue
erythropoetin
Anticoagulants (like ___) are needed during dial
heparin
AV fistulas and grafts shouldn’t be used for
giving fluids
After HD, you would expect some degree of decrease weight and decrease BP. You might need to treat with
NS
After HD, slight temp is normal because
the machine warms the blood
HD: Neuro changes can indicate d____ ____
disequilibrium syndrome
HD: disequilibrium syndrome can be prevented by
starting dial slowing and gradually
PD is a better choice if the pt can’t tolerate
anticoagulants
PD: If the effluent is very cloudy it can indicate
peritonitis
PD: What should everyone wear
you should wear mask and sterile gloves
patient should wear mask
PD: you’re using ___ technique
aspetic
PD: In the beginning, it can cause pain; ____ing the solution can increase comfort
warming
