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4092 2 Chronic Renal failure Flashcards

1
Q

CRF Causes

A
  • Diabetic Nephropathy
  • High Blood Pressure
  • Glomerular Diseases
  • Inherited and Congenital Kidney Diseases (Polycystic kidney disease)
  • Poisons
  • Trauma
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2
Q

CRF: Stage 1

A
  • Signs of mild kidney disease but with normal or better GFR (greater than 90% kidney function)
  • Usually few or no physical symptoms
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3
Q

CRF: Stage 2

A
  • Signs of mild kidney disease with reduced GFR (indicating 60% to 89% kidney function).
  • Usually few or no physical symptoms
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4
Q

CRF: Stage 3

A

Signs of moderate chronic renal insufficiency (where the GFR indicates 40% to 59% kidney function)

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5
Q

CRF: Stage 3 symptoms

A
  • High Serum creatinine.
  • Tiredness
  • Edema (puffiness)
  • Back pain
  • Appetite/sense of taste changes
  • Urine changes
  • HTN
  • Poor digestion
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6
Q

CRF symptoms: puffiness is first noted around the

A

eyes

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7
Q

CRF: in stage 3, why might the urine be exceptionally clear

A

because the kidneys aren’t filtering anything. This is also why proteinuria etc can “improve” at this point

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8
Q

CRF: stage 4 symptoms

A

same as stage 3

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9
Q

CRF: stage 4

A

Signs of severe chronic renal insufficiency (where the GFR indicates 15% to 29% kidney function)

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10
Q

CRF: stage 5

A

Signs of end stage renal failure (where the GFR indicates less than 15% kidney function).

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11
Q

CRF: stage 5 symptoms

A
  • 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
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12
Q

Medication that can cause HTN to occur in the early stages of CRF (HTN normally doesn’t occur until later stages)

A

IgAN

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13
Q

Even in ESRD some patients might have clear urine because

A

the kidneys get rid of water but not wastes

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14
Q

CRF: Investigate reports of chest pain and whether or not it is intensified by deep inspiration and supine position. What’s the rationale?

A

half of CRF patients on dialysis develop pericarditis, potentiating risk of pericardial effusion or tamponade.

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15
Q

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

A

tamponade (which is an emergency)

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16
Q

CRF: a dx test that is useful in identifying developing cardiac failure or soft-tissue calcification.

A

chest x ray

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17
Q

CRF: You may need to decrease the accumulation of fluid within pericardial sac with this procedure:

A

pericardiocentesis

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18
Q

CRF: 2 meds that prevent having to strain to defecate

A

Stool softener

Bulk laxative

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19
Q

azotemia

A

high build up of wastes (e.g. urea, creatinine)

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20
Q

Why might change in LOC indicate the need for dialysis

A

LOC can mean azotemia (build of waste)

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21
Q

CRF: Provide skin care. Restrict use of

A

soaps

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22
Q

___ ___, ___ baths decrease itching

A

Baking soda, cornstarch

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23
Q

_____ and _____ may be desired to relieve dry, cracked skin

A

Lotions and ointments

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24
Q

rather than scratching pruritic areas

A

Recommend patient use cool, moist compresses to apply pressure

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25
To prevent scratching skin with fingernails encourage use of
gloves during sleep if needed
26
CRF patient should wear
loose-fitting cotton garments
27
The mattress should be
foam or flotation
28
Nursing Dx for a patient that has chemical irritation, conversion of urea in saliva to ammonia
Risk for Impaired Oral Mucous Membrane
29
Offer frequent mouth care and rinse with 0.25% ____ ____ solution
acetic acid
30
dental hygiene: avoid 3 things
1. dental floss 2. lemon or glycerine products 3. mouthwash containing alcohol
31
Administer medications as indicated such as antihistamines: cyproheptadine (Periactin). What is the purpose?
Itch relief
32
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
33
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
34
the 2 types of Peritoneal dialysis
``` Continuous Ambulatory Continuous Cycling (this one involves a machine) ```
35
Home Dialysis – Hemodialysis. What are the benefits
* Flexible treatment time * Doctor visits and labs only once a month * Nocturnal allows dialysis while you sleep
36
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
37
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
38
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.
39
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
40
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
41
Compatible Deceased Donor | Kidney Transplant. Benefits
* No longer need dialysis | * Improved health with more active lifestyle
42
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
43
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
44
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
45
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
46
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
47
Which stage: kidney damage with normal or increased GFR
1
48
Which stage: kidney damage with mild or decreased GFR
2
49
Which stage: moderate decrease in GRF
3
50
Which stage: severe decrease in GRF
4
51
Which stage: kidney failure
5
52
Goal: Preserve renal function and delay d____
dialysis
53
dialysis complication: something to do with the heart
Cardiac dysrhythmias
54
dialysis complications of the GI system
Hemorrhage and gastric ulcers
55
dialysis complications of the musculoskeletal system
Restless legs syndrome and muscle cramps
56
3 things to give for constipation
Bran bulk laxative stool softener
57
3 interventions for the dx "Fatigue related to anemia/altered metabolic state"
Iron for the anemia rest exercise
58
2 interventions for Impaired skin integrity
avoid soap use oils
59
CRF patient's breath may smell like
ammonia
60
Hemodialysis does have a risk for ___ loss
blood loss
61
Hemodialysis does not have a risk for ___ loss
protein loss
62
What medication is needed for hemodialysis patients
heparin
63
Hemodialysis: watch out for these blood born pathogens
Hep B and C
64
Continuous arteriovenous hemofiltration is limited to
inpatient use, not home use
65
Does Continuous arteriovenous hemofiltration cause blood loss
It shouldn't, but this can happen if the filter ruptures
66
Something important that is lost in peritoneal dialysis
protein
67
Something that is Not required in peritoneal dialysis
heparin
68
Complication of peritoneal dialysis: perforation of the ___ or ___
bowel or bladder
69
The major difference between the dialysate used for peritoneal and hemodialysis is the amount of
glucose (peritoneal is much higher in glucose)
70
Because of the high glucose content, if peritoneal dialysate is left in the body too long you can get
hyperglycemia
71
Upon assessment, phosphorus and magnesium will be
increased
72
CRF diet should be low p____, s____, p____, p____
protein sodium potassium phosphate
73
Ensure the patient eats a lot of calories because
this way their body doesn't have to use up its protein
74
Epogen is aka
erythropoietin
75
do not give antacids that are ___ based
magnesium based
76
For patients unable to excrete phosphate, give
phosphate binders
77
With CRF, how much fluids are they allowed to have
the amount voided yesterday plus 500 ml
78
sodium polystyrene sulfonate is aka
Kayexalate

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