4092 2 Chronic Renal failure Flashcards
CRF Causes
- Diabetic Nephropathy
- High Blood Pressure
- Glomerular Diseases
- Inherited and Congenital Kidney Diseases (Polycystic kidney disease)
- Poisons
- Trauma
CRF: Stage 1
- Signs of mild kidney disease but with normal or better GFR (greater than 90% kidney function)
- Usually few or no physical symptoms
CRF: Stage 2
- Signs of mild kidney disease with reduced GFR (indicating 60% to 89% kidney function).
- Usually few or no physical symptoms
CRF: Stage 3
Signs of moderate chronic renal insufficiency (where the GFR indicates 40% to 59% kidney function)
CRF: Stage 3 symptoms
- High Serum creatinine.
- Tiredness
- Edema (puffiness)
- Back pain
- Appetite/sense of taste changes
- Urine changes
- HTN
- Poor digestion
CRF symptoms: puffiness is first noted around the
eyes
CRF: in stage 3, why might the urine be exceptionally clear
because the kidneys aren’t filtering anything. This is also why proteinuria etc can “improve” at this point
CRF: stage 4 symptoms
same as stage 3
CRF: stage 4
Signs of severe chronic renal insufficiency (where the GFR indicates 15% to 29% kidney function)
CRF: stage 5
Signs of end stage renal failure (where the GFR indicates less than 15% kidney function).
CRF: stage 5 symptoms
- Anemia
- Easy bleeding and bruising
- Headache
- Fatigue
- Mental symptoms
- N/V/D
- Thirst
- Muscle cramps/twitching
- Nocturia
- Itchy skin, itchy eyes
- Skin color changes
- Difficulty breathing
- Decreased sexual interest
- Changes in menstrual cycle (and difficulty getting pregnant)
- Decreased urine output
Medication that can cause HTN to occur in the early stages of CRF (HTN normally doesn’t occur until later stages)
IgAN
Even in ESRD some patients might have clear urine because
the kidneys get rid of water but not wastes
CRF: Investigate reports of chest pain and whether or not it is intensified by deep inspiration and supine position. What’s the rationale?
half of CRF patients on dialysis develop pericarditis, potentiating risk of pericardial effusion or tamponade.
CRF: Presence of sudden hypotension, paradoxic pulse, narrow pulse pressure, diminished or absent peripheral pulses, marked jugular distension, pallor, and a rapid mental deterioration indicate
tamponade (which is an emergency)
CRF: a dx test that is useful in identifying developing cardiac failure or soft-tissue calcification.
chest x ray
CRF: You may need to decrease the accumulation of fluid within pericardial sac with this procedure:
pericardiocentesis
CRF: 2 meds that prevent having to strain to defecate
Stool softener
Bulk laxative
azotemia
high build up of wastes (e.g. urea, creatinine)
Why might change in LOC indicate the need for dialysis
LOC can mean azotemia (build of waste)
CRF: Provide skin care. Restrict use of
soaps
___ ___, ___ baths decrease itching
Baking soda, cornstarch
_____ and _____ may be desired to relieve dry, cracked skin
Lotions and ointments
rather than scratching pruritic areas
Recommend patient use cool, moist compresses to apply pressure
To prevent scratching skin with fingernails encourage use of
gloves during sleep if needed
CRF patient should wear
loose-fitting cotton garments
The mattress should be
foam or flotation
Nursing Dx for a patient that has chemical irritation, conversion of urea in saliva to ammonia
Risk for Impaired Oral Mucous Membrane
Offer frequent mouth care and rinse with 0.25% ____ ____ solution
acetic acid
dental hygiene: avoid 3 things
- dental floss
- lemon or glycerine products
- mouthwash containing alcohol
Administer medications as indicated such as antihistamines: cyproheptadine (Periactin). What is the purpose?
Itch relief
Home Dialysis – Peritoneal. What are the benefits
- Fewer diet and fluid restrictions
- Portable for ease of travel
- Needle-free treatments
- Dialyze while you sleep
- Fewer peaks and valleys
- Doctor visits and labs performed once a month at a clinic
Home Dialysis – Peritoneal. What are the drawbacks
- Increased risk of peritonitis (abdominal infection)
- Requires space for supplies
- Potential weight gain
- Plastic tube from abdomen may be hindrance
the 2 types of Peritoneal dialysis
Continuous Ambulatory Continuous Cycling (this one involves a machine)
Home Dialysis – Hemodialysis. What are the benefits
- Flexible treatment time
- Doctor visits and labs only once a month
- Nocturnal allows dialysis while you sleep
Home Dialysis – Hemodialysis. What are the drawbacks
- Requires modifications to home electrical and plumbing
- Care partner required for needle insertion
- Must order and have room for supplies
- May have problems with fistula, AV graft not working
In Center Hemodialysis- Benefits
- Dialysis centers are found all over the country
- Skilled health care providers with you at all times
- Don’t have to put in own needle
- Get to know other dialysis patients
- Immediate access to emergency care if needed
- Do not need to store supplies in your home
- Frequent access to your health care team
- Nocturnal dialysis allows more time for activities
In Center Hemodialysis- Drawbacks
- Fistula or AV graft surgically inserted
- Must travel to a center
- Disrupts work schedule due to fixed schedule
- Less privacy (Sleep with other patients for nocturnal)
- More ups and downs in how you feel
- Must maintain a strict diet and fluid restriction
- Must follow centers rules regarding food, visitors, cell phones etc.
Compatible Living Related Donor
Kidney Transplant. Benefits
- May be able to be transplanted prior to start of dialysis
- Shorter wait time for transplant
- Better genetic match lessens risk of rejection
- Transplant takes place at a convenient time for both donor and recipient
- Kidney usually functions immediately
- Improved health with more active lifestyle
Compatible Living Related Donor
Kidney Transplant. Drawbacks
- Psychological stress of having a family member involved
- Time involved for evaluation and testing process
- May be responsible for travel expenses, wages lost
Compatible Deceased Donor
Kidney Transplant. Benefits
- No longer need dialysis
* Improved health with more active lifestyle
Compatible Deceased Donor
Kidney Transplant. Drawbacks
- Wait time for kidney may be years
- Kidney may not function immediately
- Rejection rate higher
- May be responsible for travel expenses, wages lost
Compatible Living Paired Donation Kidney Transplant. Benefits
- You receive a compatible kidney from a living donor other than a family member
- Kidney usually functions immediately
- May find a younger donor or a perfect 6-antigen match
- Multiple recipients can benefit with NEAD (Never Ending Altruistic Donation) paired transplant
- Shortens time on dialysis
- More recipients transplanted, less on waiting list
- Improved health with more active lifestyle
Compatible Living Paired Donation Kidney Transplant. Drawbacks
- Your family can donate, but not directly for you
- Will need to wait on dialysis while finding a match
- Not all transplant centers can handle multiple simultaneous transplants
- Complicated process
Incompatible Blood or Tissue Type Kidney Transplant. Benefits
- Positive cross matched patients are now able to receive a transplant
- Improved health with more active lifestyle
- Shortens time on dialysis
Incompatible Blood or Tissue Type Kidney Transplant. Drawbacks
- Not all transplant centers will accept highly sensitized patients
- More procedures (plasmapheresis, immune globulin therapy) are needed
Which stage: kidney damage with normal or increased GFR
1
Which stage: kidney damage with mild or decreased GFR
2
Which stage: moderate decrease in GRF
3
Which stage: severe decrease in GRF
4
Which stage: kidney failure
5
Goal: Preserve renal function and delay d____
dialysis
dialysis complication: something to do with the heart
Cardiac dysrhythmias
dialysis complications of the GI system
Hemorrhage and gastric ulcers
dialysis complications of the musculoskeletal system
Restless legs syndrome and muscle cramps
3 things to give for constipation
Bran
bulk laxative
stool softener
3 interventions for the dx “Fatigue related to anemia/altered metabolic state”
Iron for the anemia
rest
exercise
2 interventions for Impaired skin integrity
avoid soap
use oils
CRF patient’s breath may smell like
ammonia
Hemodialysis does have a risk for ___ loss
blood loss
Hemodialysis does not have a risk for ___ loss
protein loss
What medication is needed for hemodialysis patients
heparin
Hemodialysis: watch out for these blood born pathogens
Hep B and C
Continuous arteriovenous hemofiltration is limited to
inpatient use, not home use
Does Continuous arteriovenous hemofiltration cause blood loss
It shouldn’t, but this can happen if the filter ruptures
Something important that is lost in peritoneal dialysis
protein
Something that is Not required in peritoneal dialysis
heparin
Complication of peritoneal dialysis: perforation of the ___ or ___
bowel or bladder
The major difference between the dialysate used for peritoneal and hemodialysis is the amount of
glucose (peritoneal is much higher in glucose)
Because of the high glucose content, if peritoneal dialysate is left in the body too long you can get
hyperglycemia
Upon assessment, phosphorus and magnesium will be
increased
CRF diet should be low p____, s____, p____, p____
protein
sodium
potassium
phosphate
Ensure the patient eats a lot of calories because
this way their body doesn’t have to use up its protein
Epogen is aka
erythropoietin
do not give antacids that are ___ based
magnesium based
For patients unable to excrete phosphate, give
phosphate binders
With CRF, how much fluids are they allowed to have
the amount voided yesterday plus 500 ml
sodium polystyrene sulfonate is aka
Kayexalate
