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Chronic Health Challenges > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What are the primary functions of the kidneys?

A
  • filter waste from the bloodstream
  • reabsorbs everything the body needs
  • maintain fluid, electrolyte and acid-base balance
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2
Q

what are the secondary functions of the kidney?

A
  • helps regulate BP
  • activates vitamin D so it can absorb calcium from GI tract
  • produce a substance called erythropoietin that acts on bone marrow to produce RBCs
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3
Q

what is the functional unit of a kidney called? how many of these units does a kidney have?

A

a nephron, each kidney has about 1 million

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4
Q

explain chronic kidney disease (CKD)

A
  • involves the progressive, irreversible destruction of nephrons in both kidneys
  • is related to kidney damage or renal insufficiency that is present for 3 months or longer
  • usually develops over months/years
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5
Q

how is CKD classified?

A

CKD is classified at one of 5 stages based on the severity which is based on glomerular filtration rate

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6
Q

what are the risk factors for CKD?

A

hypertension, smoking, diabetes, and aging

- Hypertension is both a cause and an affect of CKD

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7
Q

what is the glomerular filtration rate?

A
  • the amount of blood filtered by glomeruli in a given time mls/min
  • is affected by age, gender and muscle mass
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8
Q

how does the GFR decrease after the age of 30?

A

the GFR decreases by 1ml/year after 30

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9
Q

what is the estimated glomerular filtration rate (eGFR)?

A

the eGFR is a mathematical equation used to determine the stage of kidney disease and how well they are working.
- it is used clinically and helps decide if meds need to be changed and how often meds need to be given

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10
Q

what is the best overall index of renal function?

A

60 mls/min a minute or greater. if it is less than 60mls/min it is defined as CDK

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11
Q

what is stage 5 of CKD?

A

stage 5 is end-stage renal disease. it is advanced kidney disease with a GFR of less than 15mls/min

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12
Q

how much urine is made from what the kidneys filter?

A

for every 125mls filtered, only 1ml of urine is made

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13
Q

what is creatinine?

A

a waste product of muscle and protein breakdown

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14
Q

what is uremia?

A

uremia is a constellation of signs and symptoms resulting from the buildup of waste products and excess fluid associated with kidney failure

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15
Q

what are the signs and symptoms of uremia?

A
  • elevated serum creatinine and blood urea nitrogen, abnormal electrolytes, acidosis, anemia, fluid volume excess, nausea, loss of appetite, fatigue, decreased cognition, pruritus and neuropathy
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16
Q

what are the goals of treatment?

A
  • modifying risk factors, avoiding nephrotoxic substances, being careful with NSAIDs, protect existing kidney function, correct anemia
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17
Q

why do you need to be careful with NSAIDs when it comes to CKD?

A

because NSAIDs block synthesis of prostaglandins which cause vasodilation. this causes blood vessels to constrict increasing BP
- increased BP is a cause of CKD

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18
Q

how can you correct anemia in a patient with CKD?

A
  • use meds like erythropoietin (eprex) or darbepoetin alfa (aranesp)
  • monitor Hgb and BP
  • use iron supplements like folic acid or ferrous sulfate
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19
Q

how do you correct fluid volume overload?

A
  • add all the losses from the previous 24 hours and then add 600 ml to this of insensible losses
20
Q

why may some patients with diabetes who are uremic require less insulin after the onset of CKD?

A

because since insulin is dependant on the kidneys for excretion, it remains in the circulation longer

21
Q

why are bones at risk with CKD?

A

as kidney function declines, phosphorus elimination decreases and less vitamin D is converted to its active form. this lowers serum levels.
- activated vitamin D is needed to absorb calcium from the GI tract

22
Q

what happens when hypocalcemia occurs?

A

the parathyroid gland secretes PTH and this stimulates bone demineralization with the release of calcium from the bones.

23
Q

what do you use to treat elevated phosphorus (hyperphosphatemia)

A

give phosphate binders with meals and restrict phosphorus in diet by limiting dairy products

24
Q

why are those with CKD at risk for fractures?

A

because the parathyroid gland releases hormones that pulls calcium from bones which makes them weaker

25
Q

what does hyperphosphatemia, decreased vitamin D levels and hypocalcemia lead too?

A

they lead to overstimulation of the parathyroid glands, resulting in excess secretion of PTH and if PTH levels remain elevated for a long time it can lead to hypertrophy of the glands and bone disease

26
Q

how is hyperkalemia treated with meds?

A

treatment with IV glucose and insulin or beta-adrenergic agonists such as salbutamol which shifts potassium into the cells

27
Q

what medications are used to treat hypertension in CKD?

A
  • it is treated with diuretics such as furosemide which increases renal excretion of water, sodium, chloride, magnesium, potassium and calcium.
  • also use beta-blockers like metoprolol and calcium channel blockers like nifedipine (adalat) and ACE inhibitors such as ramipril
28
Q

why must ACE inhibitors such as ramipril and ARBs be used cautiously in CKD patients?

A

because they can further decrease the GFR and increase serum potassium levels

29
Q

what are some potential assessment findings you’ll see in a CKD patient?

A
  • altered cognitive ability & concentration
  • fatigue, headache, cold intolerance
  • metallic or off taste
  • hypertension
  • dyspnea, palpation, angine
  • nocturia
30
Q

why are CKD patients at risk for drug toxicity?

A

because many drugs are either partially or totally excreted by the kidneys, delayed or decreased elimination leads to an accumulation of the drugs in the body

31
Q

what are some examples of high potassium foods?

A

avocados, bananas, carrots, mushrooms, chicken, chocolate, sunflower seeds

32
Q

examples of CKD nursing diagnosis

A
  • excess fluid volume r/t excessive fluid intake
  • impaired electrolyte imbalance AEB excessive fluid volume
  • imbalanced nutrition r/t insufficient dietary intake
33
Q

what is dialysis?

A

dialysis is a technique where substances move from the blood through a semipermeable membrane (dialyzer) and into a dialysis solution

34
Q

why is dialysis used?

A

it is used to correct fluid and electrolyte balance and to remove waste products in renal failure

35
Q

when is dialysis needed?

A

needed when there is volume overload, hyperkalemia, metabolic acidosis, decreased in eGFR, increased serum creatinine and BUN and changes in mental status

36
Q

what is peritoneal dialysis?

A
  • it is the method of removing waste products and excess fluid from the blood using a natural semipermeable membrane, the peritoneal
  • a catheter is in the abdomen and hooked to long bags of fluid with varying concentrations of glucose
37
Q

what are some complications of peritoneal dialysis?

A

exit site, infection, peritonitis, abdominal pain, outflow problems, hernias, lower back problems, bleeding, protein loss

38
Q

what is hemodialysis?

A
  • in hemodialysis waste products and excess fluid are removed from the blood using a machine to pump the blood through an artificial semipermeable membrane
39
Q

what is required for hemodialysis treatment?

A

vascular access arterial-venous (A-V) fistula, dialyzer and dialysate

40
Q

when is dialysis initiated?

A

when the GFR is less than 15ml/min.

- when patients symptoms, fluid volume status, or both can longer be managed with dialysis

41
Q

what is diffusion?

A

the movement of solutes from an area of greater concentration to an area of lesser concentration

42
Q

what is osmosis?

A

movement of fluid from an area of lesser to an area of higher concentration of solutes

43
Q

what is ultrafiltration (water & fluid removal)

A

results when there is an osmotic gradient or pressure gradient across the membrane

44
Q

what are the 3 phases of peritoneal dialysis?

A
  1. inflow (fill)
  2. dwell (equilibration)
  3. drain
45
Q

what are the advantages of kidney transplantation?

A
  • when normal kidney function is restored, many of the pathophysiological changes associated with renal failure are reversed
  • also eliminates the dependence of dialysis, dietary and lifestyle restricitons
46
Q

what is the required age of a kidney donor? can they be alive or deceased?

A

age of donor can be between 2-70, their health is considered.
- donors can be either deceased or live

Chronic Health Challenges (6 decks)

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