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Nursing Semester 3 > Beth - Week 11 - Exam 4 > Flashcards

Beth - Week 11 - Exam 4 Flashcards

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1
Q

what is CKD?

A

chronic kidney disease

  • presence of kidney damage defined by structural or functional abnormalities
  • with or without ↓ GFR
  • manifested by pathological abnormalities in blood, urine, or imaging
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2
Q

what is the etiology of CKD?

A

the presence of GFR < 60mL/min/1.73 m2 for three months, with or without other signs of kidney damage

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3
Q

what is the epidemiology of CKD?

A
  • 26 million Americans have CKD
  • 1 out of 9 Americans are at risk
  • 1/2 million are receiving tx
  • Approx 435,000 have ESRD
  • Annual mortality rate for ESRD: 24%
  • 90,000 die each year `
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4
Q

Review: how does the kidney relate to regulating BP?

A
  • Hypovolemia/Na+ depletion triggers release of
    Renin (enzyme) which converts angiotensin to
    A-I (ACE) which converts to A-II in the lungs.
    A-II causes adrenal cortex to secrete
    Aldosterone (secrete K+ & absorb Na+ & H20—
    water balance)
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5
Q

Look at review slide

A

REVIEWED

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6
Q

what are the causes of CKD?

A
  • glomerulonephritis
  • nephrotic syndrome
  • hypercalcemia
  • multiple myeloma
  • chronic UTI
  • disease - (leading cause)
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7
Q

what diseases cause CKD?

A

HTN and diabetes

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8
Q

what are the stages of CKD?

A
  • Stage 1*: GFR >= 90 mL/min/1.73 m2 - Normal or elevated GFR
  • Stage 2*: GFR 60-89 (mild)
  • Stage 3: GFR 30-59 (moderate)
  • Stage 4: GFR 15-29 (severe; pre-HD)
  • Stage 5: GFR < 15 (kidney failure-uremia)
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9
Q

TEST: what are the general sxs of CKD?

A
  • General (fatigue, malaise, edema)
  • ophthalmologic (loss of •vision)
  • respiratory (pleuritis, pulmonary edema)
  • cardiac (HTN, HF, pericarditis, CAD)
  • GI (A + N + V, GI bleed)
  • Skin (pruritus, pallor)
  • Neuro (MS changes, seizures, neuropathy)
  • Metabolic (hyperglycemia)
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10
Q

what is the management/tx of CKD?

A

** ID and treat factors associated with progression of CKD **
t

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11
Q

how are the factors associated with the progression of CKD treated?

A
  • dialysis (hemodialysis (permanent/temp) or peritoneal or continuous veno-venous hemofiltration CVVH)
  • transplant
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12
Q

what are the factors ID’d that are associated with CKD?

A
  • HTN
  • proteinuria
  • metabolic changes (↑ glucose)
  • anemia
  • hyperlipidemia
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13
Q

what is the target BP for someone with CKD?

A

< 130/80 mmHg

- <125/75 mmHg for pts with proteinuria

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14
Q

what should pts with HTN consider for medications?

A
  • consider several anti-HTN meds with different mechanisms of activity
    • ACEs/ARBs
    • Diuretics
  • *HCTZ (less effective when GFR < 20)
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15
Q

_____ is the single best predictor of disease progression

A

proteinuria

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16
Q

what are the 4 stages of proteinuria?

A 
• Normal albumin excretion
- <30 mg/24 hours
• Microalbuminuria
- 20-200 µg/min or 30-300 mg/24 hours
• Macroalbuminuria
- >300 mg/24 hours
• Nephrotic range proteinuria
- >3 g/24 hours
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17
Q

what are the metabolic changes with CKD?

A
  • ↓ H+H
  • ↓ calcium **
  • ↑ phos **
  • ↑ PTH
  • ↑ triglycerides
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18
Q

what can the metabolic changes result in??

A
  • acidosis
  • ↑ K+
  • ↓ Na+

***BUN and Cr may also be ↑

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19
Q

what are the metabolic and hematologic changes within the CKD patient?

A
  • anemia (↓ erythropoietin and platelet function)
  • leukocyte function
  • humoral and cellular responses
  • metabolic changes
  • mineral metabolism
  • dyslipidemia
  • nutrition (renal diet)
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20
Q

Test: what is the tx for anemia?

A
  • epoetin alfa (rHuEPO, Epogen)

- darbepoetin alfa (aranesp)

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21
Q

what is the dosing and side effects for epoetin alfa?

A
  • HD: 50 -100 U/kg IV/SC 3x/wk
  • Non-HD: 10,000U qwk
  • *Side effect is Iron deficiency
  • Constipation from Iron treatment
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22
Q

what is the dosing for darbepoetin alfa?

A
  • HD: 0.45 µg/kg IV/SC qwk

- Non-HD: 60 µg SC q2wks

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23
Q

what causes metabolic acidosis and what is the tx?

A 
• Muscle catabolism 
- decreased albumin synthesis 
• Metabolic bone disease 
• Sodium bicarbonate 
- Maintain serum bicarbonate > 22
meq/L
- Watch for sodium loading (Volume expansion + HTN)

•• Acidosis leads to release of bone calcium/phos

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24
Q

what is mineral metabolism and the tx?

A
  • calcium and phosphate metabolism abnormalities associated with:
    • renal osteodystrophy
    • calciphylaxis and vascular calcification
  • take CaCO3 or Ca-acetate with meals to bind phos
  • ↓ phos intake
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25
Q

what is dyslipidemia and the tx?

A

abnormalities in the lipid profile

  • triglycerides and total cholesterol
  • *lipid lowering tx prevention of CV disease
26
Q

what are the characteristics of a CKD pt’s nutrition (diet)?

A 
- think about uremia (elements normally eliminated in urine)
• catabolic state 
• anorexia 
• ↓ protein intake
• water restriction (limit 1-3 kg between dialysis)
• Na+ restriction (2-4g)
• K+ restriction (2-3g)
• phosphate restriction (1g)
- renal dietitian
27
Q

Read the case study

A

READ

28
Q

what are the diagnostics of CKD?

A 
• Blood tests 
- CBC with diff
- BMP
- Ca++
- phos
- PTH
- HbA1c  
- LFTs
- uric acid and Fe2+ study
• Urine 
- urinalysis with microscopy
- spot urine for microalbumin
- 24 hr urine collection for protein and creatinine 
• Ultrasound - hydronephrosis, tumors, stones
29
Q

what are the CKD tx options?

A
  • peritoneal dialysis
  • hemodialysis
  • kidney transplant
30
Q

what are the characteristics of peritoneal dialysis?

A

surgical placement of peritoneal catheter

31
Q

what are the characteristics of hemodialysis?

A

• vascular access placed after 14 months

  • arteriovenous fistula
  • arteriovenous graft
  • temporary vascular access
  • CVVH
32
Q

what are the characteristics of kidney transplants?

A
  • live donors
  • deceased donors
  • only 1/4 ever receive a kidney
  • once transplant survival is 90%
  • lifetime medications (immunosuppressive)
  • life long concern of infection and rejection
33
Q

what is the risk for diseases for kidney transplant patients?

A
  • CV
  • malignancy (basal cell/lymphoma)
  • recurrence of original disease into new kidney
  • corticosteroid-related complications (↑glu)
  • diabetes
34
Q

what are the physiologic principles of hemodialysis?

A
  • osmosis
  • diffusion
  • ultrafiltration
35
Q

what is osmosis?

A

Movement of fluid from an area of lesser to area of

greater concentration of solutes

36
Q

what is diffusion?

A

Diffusive transport across semipermable membrane
(based on countercurrent flow of blood and
dialysate) removal of impurities

37
Q

what is ultrafiltration?

A
  • water and fluid removal (↓ BP ↑ HR)

- results when there is an osmotic gradient across the membrane

38
Q

what are the goals of dialysis?

A

• fluid removal
• osmosis and diffusion across semipermeable membrane
- solute clearance
- diffusive transport (based on countercurrent flow of blood and dialysate)
- conventive transport (solvent drage with ultrafiltration)

39
Q

what are the nursing assessment/priorities for a pt with CKD?

A
  • complete assessment (heart and lung sounds)
  • condition of access
  • temperature
  • skin condition (itchy, edema)
  • weight
  • BP
  • edema
  • labs (renal panel, lytes, CBC)
  • CXR
40
Q

what is a arteriovenous fistula?

A
  • Preferred form of dialysis access

- Typically end-to-side vein-to-artery anastamosis

41
Q

what are the different types of arteriovenous fistulas?

A
  • Radiocephalic (first choice)
  • Brachiocephalic (second choice)
  • Brachiobasilic (third choice, requires superficialization of
    basilic vein, i.e. transposition)
  • lower extremity fistulae are rare
42
Q

what are the assessments for arteriovenous fistulas?

A

• Look - site, condition, s/s infection
• Feel - look for the Thrill…Pulse is bad
• Listen - bruit, low pitched…high short is
bad

43
Q

what is a arteriovenous graft?

A

• Synthetic conduit, usually polytetrafluoroethylene (PTFE, aka Gortex), between an artery and a vein
- Either straight or looped

44
Q

what are the common sites for AV grafts?

A
  • Straight forearm : Radial artery to cephalic vein
  • Looped forearm : brachial artery to cephalic vein
  • Straight upper arm : brachial artery to axillary vein
  • Looped upper arm : axillary artery to axillary vein
45
Q

what are tunneled cuffed catheters?

A
  • dual lumen catheters
  • most commonly placed in the internal jugular vein, exiting at the upper, anterior chest
    • can also be placed in the femoral vein
  • subclavian catheters should be avoided given the risk of subclavian stenosis (rise in infection)
46
Q

what is peritoneal dialysis?

A
  • peritoneal access is obtain by inserting a catheter through the anterior wall
  • technique for catheter placement varies
  • usually done via surgery
47
Q

what are the three phases of peritoneal dialysis?

A
  • called an exchange*
  • inflow (fill)
  • dwell (equilibration)
  • drain
48
Q

what does “inflow” phase consist of?

A
  • Prescribed amount of solution infused through
    established catheter over about 10 minutes
  • After solution infused, inflow clamp closed to
    prevent air from entering tubing
49
Q

what does the “dwell” phase consist of?

A
  • Diffusion and osmosis occur between patient’s
    blood and peritoneal cavity
  • Duration of time varies depending on method
50
Q

what does the “drain” phase consist of?

A
  • 15 - 30 minutes

- may be facilitated by gently massaging abdomen or changing position

51
Q

TEST: what is the nursing management of peritoneal dialysis specific patient?

A 
- Skin must be cleaned with antiseptic
solution and sterile dressing applied
- Must be connected to sterile tubing
system
- Secured to abdomen with tape
- Mask &amp; gloves during connecting and
disconnecting
- Maintain sterile environment !!!!
52
Q

what is the nursing management and assessment of a dialysis patient before treatment?

A

• before tx, RN should

  • complete assessment of fluid status, condition of access, temp, skin condition
  • weight
  • BP
  • edema
  • heart and lung sounds
53
Q

what is the nursing management and assessment of a dialysis patient during treatment?

A
  • be alert to changes in condition

- perform VS every 30 - 60 minutes

54
Q

what is the nursing management and assessment of a dialysis pt post tx?

A

weight

55
Q

test: what are the complications of dialysis?

A
  • hypotension
  • muscle cramping
  • loss of blood (damanged during dialysis)
  • hepatitis
  • sepsis
  • disequilibrium syndrome
56
Q

what are the possible complications of the dialysis access site?

A
  • thrombosis
  • infection (10% for AVG, 5% for AVF, 2%)
  • aneurysms and pseudoaneurysms (3% of AVF, 5% of AVG)
  • HF (avoid AVFs in pt with severely depressed LVEF)
  • local bleeding
  • peritoneal dialysis (peritonitis/sepsis, cath clogged or dislodged)
57
Q

what is the pt education for someone on dialysis?

A
  • understanding of regular scheduled tx
  • acceptance of chronic disease
  • risk for infections (sxs of infection)
  • edema (daily weight)
  • dietary restrictions
58
Q

what is the family education for someone on dialysis?

A
  • same as pt
  • understand their role
  • risk for infection
  • med routine
  • maintain healthy lifestyle
59
Q

T/F it is important to be in collaboration with the dialysis nurse

A

TRUE

60
Q

what are the things we should communicate to the dialysis nurse?

A
  • clinical situation (hold meds?)
  • meds (BP, ATB, diuretic, pain meds)
  • lab results (K, Cl, BUN, Cr, H/H)
  • assessment (access device)
  • plan of care (ongoing assessment, medicate prn, pt comfort (bedrest), nutrition (hold food d/t N+V), psychosocia support, family education)

Nursing Semester 3 (29 decks)

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