Chap 54 Chronic Kidney Disease

Question 1

what are the only reasons in which a catheter should be used

Answer 1

1. acute urinary retention or bladder outlet obstruction
2. hemodynamic instability to use as an indirect measurement of CO
3. perioperative use: (urologic surgery)
4. open sacral or perineal wounds
5. prolonged immobilization
6. comfort at end of life

Question 2

what are the four top causes of CKD

Answer 2

1. HTN, 2. DM 3. glomerulonephritis 4. pyelonephritis

Question 3

how does pyelonephritis present and what is the RX

Answer 3

S/S: nausea/vomiting, flank pain, fever, chills, pyuria, elevated WBC, shift to the left 6% bands.
RX: 2weeks of Abx., liberalize fluids, follow up in 2weeks for f/u culture.

Question 4

who is at risk for pyelonephritis?

Answer 4

weakened immune system, damaged nerves in bladder, obtruction of urinary tract, prolonged use of urinary catheter, or conditions in which urine flows the opposite direction

Question 5

what is acute glomerulonephritis and its presenting s/s

Answer 5

acute glomerulonephritis also known as acute nephritic syndrome. Manifestation is often post strep.
S/S: hematuria, edema, azotemia, RBCs in UA
cadiomegaly, pulm. edema, and neuro symptoms may be present. increases in BUN and Cr, anorexia, hypertension

Question 6

what are the potential complications and treatment of acute glomerulonephritis/acute NEPHRITIC syndrome?

Answer 6

complications: kidney failure, hypertensive encephalopathy pulmonary edema and heart failure.

Rx: plasmapheresis, high dose steroids, and cytoxic agents

Question 7

what are the nursing considerations in treating patients with glomerulonephritis

Answer 7

1. mon. vs. I&O, urine characteristics
2. daily weights at the same time
3. limit activity
4. Na restriction, possible K restriction
5. monitor for complications
6. admin diuretics
7. initiate seizure precautions

Question 8

how does NephROTIC syndrome present? S/S

Answer 8

NephrOTIC syndrome is a disorder that involves that podocytes and basement membrane it causes the body to excrete massive amounts of protein via the urine. This has insidious onset,
S/S: insidious onset, frothy urine, 3.5g of protein/day, increases of lipids in blood, no active sedimentation, edematous, AT-III, dereased albumin, decrease in UO,

Question 9

what is the Rx for NephROTIC syndrome

Answer 9

fluid restriction, lasix, steriods,

Question 10

what are the stages of CKD and their corresponding GFRs?

Answer 10

Stage Rx:
Stage 1: GFR >90
Manage risk, A1c:<7, BS<170, BP 130/90
Stage 2: GFR 60-89 (susceptible)
Protein restriction, ACE-I
Stage 3: GFR 30-59 (insufficiency)
Diuretics, phosphate binders, , calcium, bicarb, insulin, D5W, kayexelate, diet restrictions
Stage 4: GFR 15-29 (severe decreases)
Manage fluids, restrict fluids, bicarb, diuretics, insulin, d5w, kayexalate, calcium, diet restrictions, blood
ESRD: <15 Dialysis, transplant

Question 11

what are the electrolyte, acid base, and hematologic abnormalities

Answer 11

high K, high phos, high Mg, low calcium, low RBCs, acidosis, low bicarb, high na, high water retention,

Question 12

what are the diet and fluid recommendations before and during dialysis? in hemodialysis versus peritoneal?

Answer 12

fluid restrictions: 
BEFORE: 500-800mL + UO
During: 700-1100mL + UO
Hemodialysis: 700-1100mL + UO
Peritoneal: A little more liberal

Question 13

how are the electrolyte abnormalities addressed/treated in CKD?

Answer 13

hyperkalemia: kayexalate, insulin, D5W, bicarb, diet restrictions
hypernatremia: dietary restrictions
hyperphosphatemia: dietary restrictions
hypocalcemia: diet,
hypermagnesemia: dialysis

Question 14

how does uremia present?

Answer 14

Nausea.
    Vomiting.
    Fatigue.
    Anorexia.
    Weight loss.
    Muscle cramps.
    Pruritus.
    Change in mental status.

Question 15

which medications are more easily dialyzed

Answer 15

water soluble drugs that are NOT bound to protein. drugs with LMW: tylenol, aspirin, captopril, reglan, protamine, theophylline

Question 16

which drugs are poorly dialyzed?

Answer 16

Protein bound drugs: lasix, heparin, iron, nifedipine, verapamil, quinidine, propanolol, hydralazine

Question 17

what are some potential complications of an AV Graft Fistula

Answer 17

Immediately after surgery, hemorrhage, low venous flow or hematoma may occur. At a later stage, there may be complications, such as infections, the development of an aneurysm and/or false aneurysm, fistula vein stenosis, congestive heart failure, steal syndrome, ischemic neuropathy and thrombosis

Question 18

what is the cardiac-CKD connection

Answer 18

HTN and DM cause stress on both renal and cardiac systems. When the cardiac system is taxed, there is often a decrease in tissue perfusion, which leads to acute kidney disease. When kidney function is impaired, the RAAS is turned on, which in turn increases demand on the cardiac system.