Chapter 17 Chronic And End-Stage Kidney Disease

Question 0

The kidney disease outcome quality initiative defined five stages of kidney disease on the basis of what?

Answer 0

Glomerular Filtration rate, the presence of albuminuria.

Question 1

A large percentage of all end-stage renal disease is attributed to what two things?

Answer 1

Diabetes and hypertension

Question 2

In clinical practice the GFR is most commonly estimated by the calculated what?

Answer 2

Creatinine clearance

Question 3

Risk factors for chronic kidney disease include?

Answer 3

Diabetes, hypertension, family history, advancing age, race (Black) diseases such as lupus, arterial sclerosis, and chronic NSAID use.

Question 4

a decline in renal function remains asymptomatic until approximately what percent of nephrons are lost?

Answer 4

50%, usually in stage three.

Question 5

How is stage five chronic kidney disease defined?

Answer 5

The patient will be in renal failure and need dialysis and have a GFR less than 15.

Question 6

What signs and symptoms of renal failure might you expect to see any patient with a GFR between 20 and 50?

Answer 6

Elevated BUN and creatinine, metabolic acidosis, increased potassium, polyurea, anemia, and fatigue

Question 7

What signs and symptoms of renal failure might you see in a patient with a GFR less than 20?

Answer 7

Decreased calcium, increased phosphate, metabolic acidosis, and fluid overload.

Question 8

What signs and symptoms of renal failure might you expect to see in a patient with a GFR less than 10?

Answer 8

Uremia, nausea and vomiting, heart failure, pruritus, fatigue, and insomnia.

Question 9

Patients with chronic kidney disease must be educated about the importance of controlling what?

Answer 9

Comorbidity disease processes such as hyperglycemia, hypertension, & Hyperlipidemia.

Question 10

Most agencies have set the goal for hemoglobin A-1c at less then?

Answer 10

7

Question 11

Target blood pressure to slow the progression of kidney disease is what?

Answer 11

Less then 130/80 And should be achieved with the use of ACE inhibitors or ARBs as part of the regimen.

Question 12

Patients who reach stage III kidney disease and also have diabetes are more likely to die of what then to progress to stage five kidney disease?

Answer 12

Cardiovascular disease

Question 13

The LDL cholesterol goal for patients and chronic kidney disease is what?

Answer 13

<70mg/dL In cases of patients who have cardiovascular events.

Question 14

Teaching for patients with chronic kidney disease include….

Answer 14

Smoking cessation, exercise, dietary changes with sodium, protein, and potassium restrictions. Patients should be warned to avoid medications such as NSAIDs and to avoid dehydration.

Question 15

What are the three classifications of acute renal failure?

Answer 15

Prerenal, intrinsic, Or post renal failure.

Question 16

This type of renal failure is caused by a blockage after the level of the kidney. The most common cause is BPH in men. Other causes, such as stones or retroperitoneal tumors are much less common.

Answer 16

Post obstructive renal failure

Question 17

This type of renal failure can because by nephrotoxic Drugs, Contrast dye, hypertension, glomurulonephritis, lupus,cholesterol embolization.

Answer 17

Intrinsic renal failure

Question 18

This type of renal failure occurs as a result of decreased renal perfusion. Decreased blood flow caused by stenosis of the renal arteries or any type of hypovolemia, or any cause of reduced cardiac output,or shunts blood away from the kidneys such as shock. Also drugs that lower GFR such as NSAIDs.

Answer 18

Pre-Renal azotemia

Question 19

This is decreased red blood cells, hemoglobin and hematocrit and is a symptom of an underlying problem.

Answer 19

Anemia

Question 20

Common symptoms of anemia in older adults are?

Answer 20

Fatigue, pallor, and dizziness. In severe cases patients may present with mental status changes.

Question 21

Anemias are classified by what?

Answer 21

Red blood cell size or mean corpuscle volume MCV.

Question 22

If the MCV is within normal range, the anemia is considered what?

Answer 22

Normocytic anemia

Question 23

If the MCV is elevated, the RBC is large it is called?

Answer 23

Macrocytic anemia

Question 24

If the MCV is decreased And the red blood cell is small it is called?

Answer 24

Microcytic anemia

Question 25

Common causes of normocytic anemia include?

Answer 25

Acute blood loss, and anemia of chronic disease.

Question 26

Common causes of microcytic anemia include?

Answer 26

Iron deficiency anemia. Usually G.I. bleeding is the culprit so sources must be identified

Question 27

Common causes of macrocytic anemia include?

Answer 27

B 12 or folate deficiency. Inadequate intake or absorption of one or both of these nutrients

Question 28

Nursing management of anemia centers on what?

Answer 28

Dietary education and balancing rest with activities of daily living. Assessment includes focusing on the underlying cause of the anemia. Provide patient with a list of foods high in the nutrient they are deficient.

Question 29

This type of anemia is a complete lack of production of intrinsic factor and is rare in older adults As most have been diagnosed with this as young or middle adults.

Answer 29

Pernicious anemia

Question 30

What factors interfere with the absorption of B12 in older adults?

Answer 30

The parietal cells atrophy and make less hydrochloric acid and intrinsic factor. In addition use of acid suppressing medications such as histamine blockers and proton pump inhibitors, further suppress acid production which compromises the bodies ability to absorb B12 and other nutrients.

Question 31

An older person to have low vitamin B12 levels and macrocytic anemia who fail to have their levels rise with oral vitamin B12 replacement then what?

Answer 31

Parenteral B12 injections may be needed

Question 32

This is a malignant proliferation of white blood cell precursors, or blasts, in bone marrow.

Answer 32

Leukemia

Question 33

The most common leukemia and older adults is?

Answer 33

Chronic lymphocytic leukemia or CLL

Question 34

90% of cases of CLL occur in persons after the age of what?

Answer 34

Age 50 with an average age of diagnosis at age 70. Most older adults have a normal lifespan and do not succumb to this illness.

Question 35

Common symptoms of CLL include?

Answer 35

Weakness, fatigue, weight loss, splenomegaly, abdominal pain, fever, lymphadenopathy. Painless lymphadenopathy is the most common sign. Patients with CLL have a white blood cell count of 5000 to greater than 20,000/MCL

Question 36

What is the treatment for CLL?

Answer 36

There is no treatment for this illness. Patients are treated for symptoms if any occur. Radiation, chemotherapy, and splenectomy may be done. A small percentage of patients will convert to acute lymphocytic leukemia or ALL.

Question 37

This illness requires prompt treatment with chemotherapy or bone marrow transplant or the patient will succumb to it.

Answer 37

Acute myelogenous leukemia or AML. In most cases of AML, remission can be obtained, but many older adults will experience a relapse.

Question 38

Risk factors for leukemia are thought to be?

Answer 38

Advanced age and exposure to prolonged radiation.

Question 39

Diagnostic test for leukemia include?

Answer 39

Laboratory tests, bone marrow aspiration, and histochemical stains.

Question 40

Nursing management for patients with leukemia includes?

Answer 40

Pain control, education about activity intolerance, and prevention of infection.