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Pathophysiology Midterm #2 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Primary Kidney Functions (3)

A

Filtration
Regulation
Excretion

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2
Q

Secondary Kidney Functions : to Regulate

A
  • regulate blood pressure. RAA system
  • regulation of bone density
  • regulation of erythropoiesis (the process that produces red blood cells)
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3
Q

Chronic Kidney Disease (CKD)

A
  • involves progressive, irreversible loss of kidney function
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4
Q

Definition of CKD

A
  • the presence of either kidney damage or glomerular filtration rate (eGFR) <60 mL/min for 3 months or longer
  • classified as 1 or 5 stages, depending on disease severity (measured by GFR)
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5
Q

Disease staging based on decreases in GFR

A
  • normal GFR - 125 mL/min, which is reflected by urine creatinine clearance
  • up to 80% of GFR may be lost with a few changes in functioning of body
  • remaining nephrons hypertrophy to compensate
  • end result is systemic disease in every organ
  • its presentation can be highly varied
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6
Q

Leading cause of ESRD

A
  • diabetes

- renal vascular disease

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7
Q

Stage 5 (end stage renal disease - ESRD)

A

occurs when GFR < 15 mL/min

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8
Q

ESRD treatment options

A
  • renal replacement therapy (RRT)
    Hemodialysis
    Peritoneal Dialysis
  • transplant
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9
Q

Clinical Manifestations of CKD

- result of these retained substances (6)

A
  1. urea
  2. creatinine
  3. phenols
  4. hormones
  5. electrolytes
  6. water
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10
Q

Uremia

A

syndrome that incorporates all S&S seen in various systems throughout the body due to the build-up of waste products and excess fluid associated with kidney failure

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11
Q

Clinical Manifestations: Urinary system - polyuria

A
  • polyuria (early stages) results from inability of kidneys to concentrate urine, occurs most often at night (nocturia) specific gravity fixed around 1.010
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12
Q

oliguria

A

A urinary clinical manifestation of CDK
decreased urine output < 400mL/day
occurs as CDK worsens

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13
Q

Anuria

A
  • a urinary clinical manifestation of CKD

- urine output < 40 ml/24 hours

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14
Q

Metabolic Disturbances

A
  • waste product accumulation

decreased GFR = increased BUN and Creatinine

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15
Q

Altered carbohydrate metabolism

A
  • metabolic disturbance of CKD
  • caused by impaired glucose use0 fro cellular insensitivity to normal action of insulin
  • because Type 2 diabetes and CDK often go together
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16
Q

Defective carbohydrate metabolism

A
  • clients with diabetes who become uremic may require less insulin than before the onset of CKD
  • insulin is dependent on kidneys for excretion - so the patient will need less of it when they cant get rid of it
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17
Q

Elevated triglycerides

A
  • metabolic disturbance
  • hyperinsulinemia (because the body is not excreting the insulin) stimulates hepatic production of triglycerides
  • altered lipid metabolism - due to decreased levels of enzyme lipoprotein lipase
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18
Q

what kind of drug will clients in stages 1-3 be on?

A
  • some kind of statin drug to lower cholesterol and decreases chances of hyperlipidemia that are so common with CKD because of increased triglycerides
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19
Q

Electrolyte/Acid-Base Imbalances: Potassium

A
  • hyperkalemia (most serious electrolyte disorder in kidney disease. Can cause fatal dysrhythmias when serum K levels 7-8 mmol/L)
  • Decreased excretion by the kidneys in CKD
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20
Q

Sodium

A
  • may be normal or low
  • because of impaired excretion, sodium is retained along with water
  • if water is retained (edema, hypertension, CHF, dilution hyponatremia)
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21
Q

Other Electrolyte/Acid-Base Imbalances

A
  • calcium and phosphate alterations (musculoskeletal implications)
  • magnesium alterations
  • metabolic acidosis
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22
Q

Metabolic acidosis

A

inability of kidneys to excrete acid load (primarily ammonia)
- defective reabsorption/regeneration of becarbonate

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23
Q

Anemia - very common in CKD

A
  • due to decreased production of erythropoietin, which is the hormone that stimulates RBC production in the bone marrow
  • other factors: nutritional deficiencies, increased hemolysis or RBC’s, frequent blood sampling, GI bleed
  • elevated PTH (control calcium levels in blood) levels (due to low serum calcium) can inhibit erythropoiesis (destroying bone for calcium)
  • Iron deficiencies
  • folic acid deficiencies
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24
Q

Bleeding Tendencies

A
  • defect in platelet function

- usually correctable with regular RRT

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25
Q

Increases susceptibility to infection

A
  • change in leukocyte function
  • altered immune response and function
  • diminished inflammatory response
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26
Q

Cardiovascular System (7)

A
  • hypertension
  • heart failure
  • left ventricular hypertrophy
  • peripheral edema
  • dysrhythmias
  • uremic pericarditis
  • Diabetes
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27
Q

Respiratory System (7)

A
  • Kussmaul’s respirations
  • Dyspnea
  • Pulmonary edema
  • Uremic pleuritis
  • Uremic pneumonitis
  • Pleural effusion
  • Predisposition to respiratory infection
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28
Q

GI system

A

every part of the GI is affected due to inflammation of the mucosa related to excessive urea

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29
Q

Common GI symptoms of CKD and elevated urea

A
  • stomatitis with exudates and ulcerations
  • uremic factor
  • GI bleeding
    Diabetic gastroparesis can compound the above in diabetics
    Constipation common related to supplements and limited fluid intake
30
Q

Neurological System

A
  • changes are expected as renal failure progresses

- generally speaking the CNS becomes depressed

31
Q

Neurological Changes are attributed to:

A
  • increased nitrogenous waste products
  • electrolyte imbalance
  • metabolic acidosis
  • axonal atrophy
  • demyelination of nerve fibers
32
Q

Neurological symptoms (6)

A
  • restless leg syndrome
  • muscle twitching
  • fatigue irritability
  • apathy
  • decreased ability to concentrate
  • peripheral neuropathy
33
Q

Musculo-skeletal system

A
  • CKD mineral and bone disorder - missing activated vitamin D that is needed to absorb calcium. without calcium they will break down and demineralize to release calcium into the blood stream
34
Q

Systemic sydrome that includes:

A
  • bone abnormalities
  • changes in mineral balance
  • vascular and other soft tissue calcification
    results in skeletal complications, renal osteodystrophy and extraskeletal (vascular and soft tissue complications) calcfications
35
Q

Integumentary System

A

pruritus - very common

uremic frost - very uncommon

36
Q

Reproductive System

A
  • both men and women can experience infertility, decreased libido, low sperm counts, sexual dysfunction
37
Q

Psychological Changes

A
  • personality and behavioral changes
  • emotional lability
  • withdrawal
  • depression
38
Q

Diagnostic Studies

A
  • history and physical examination
  • urinalysis dipstick evaluation - common
  • albumin - creatinine ration - preferred screening for proteinuria
39
Q

Labs: BUN

A

measures urea levels in the blood it is elevated if excretion is insufficient

40
Q

Labs: Creatinine

A

nitrogenous waste produce from muscle metabolism elevated if excretion is insufficient
- creatinine clearance - commonly used to assess GFR, determines how efficiently kidneys clear creatinine from the blood. GFR determines how fast the blood is filtered through the glomerulus

41
Q

Labs: other

A
  • renal ultrasound
  • Xray KUB (kidneys, ureters, bladder)
  • CT KUB
  • Renal biopsy’s
42
Q

Collaborative Care: common management measure in CKD (7) (MAACCEN)

A
  • correction of extracellular fluid volume overload or deficit
  • nutritional therapy
  • erythropoietin therapy
  • calcium supplementation, phosphate binders (reduce the amount of phosphate absorbed from your food and since it in inversely related to calcium this will increase calcium - since phosphate binds to calcium normally and keeps it from being available in the blood)
  • antihypertensive therapy
  • measures to lower potassium
  • adjustment of drug dosages to degree of renal function
43
Q

Hyperkalemia (C BIG K+ D (rop))

A

C - calcium gluconate - stabalize myocarium
B - B2 adrenergic agonists such as salbutamol to shift potassium into the cells
I - IV insulin (shift K+ into cells)
G - IV glucose to manage hypoglycemia
K - kayexalate - increases fecal loss of potassium
D - diuretics or dialysis

44
Q

Hypertension

A
  • lifestyle changes: (weight loss, diet recommendations, sodium and fluid restrictions)
  • antihypertensive drugs (thiazide or loop diuretics, calcium channel blockers, ACE inhibitors, ARB agents)
45
Q

CKD- MBD

A
  • phosphate intake restricted to < 1000mg/24 hr
  • phosphate binders (calcium carbonate = binds to phosphate in bowel and excretes in stool - sevelamer hydrocholoride = lowers cholesterol and LDLs -
46
Q

Phosphate binders

A
  • phosphate binders (calcium carbonate = binds to phosphate in bowel and excretes in stool - sevelamer hydrocholoride = lowers cholesterol and LDLs
  • administered with each meal
  • adverse effect - constipation
47
Q

Supplementing vitamin D

A
  • calcitriol

- serum phosphate level must be lowered before calcium or vitamin D is administered

48
Q

Controlling secondary hyperparathyroidism

A
  • calcimimetic agents - to reduce PTH
  • cinacelcet - increases sensitivity to calcium receptor glands
    subtotal parathyroidectomy
49
Q

Anemia: erythropoietin

A
  • erythropoiesis - stimulating agents
  • administered IV or subcut
  • increase hemoglobin and hematocrit in 2-3 weeks
  • adverse effect: hypertension
50
Q

Amenia: Iron Supplements

A
  • if plasma ferritin < 100 mg/ml
  • adverse effects: gastric irritation, constipation
  • may make stool darker in colour
51
Q

Anemia: Folic acid supplement

A

needed for RBC formation
removed by dialysis
avoid blood transfusions

52
Q

Dsylipidemia

A

Statins in clients with stages 1-3 CKD

53
Q

Drug Toxicity

A
  • digoxin
  • oral glycemic agents
  • antibiotics
  • opioids (hydromorphone, morhphine)
  • also avoid NSAIDS and use acetaminophen
54
Q

Protein restriction

A
  • benefits are being studied

- guided by stage of CKD

55
Q

Water Restriction

A
  • intake depends on daily urine output and overall fluid balance
  • for patients not on dialysis, fluids not generally restricted
  • fluids should be spaced throughout the day
56
Q

Sodium Restriction

A
  • diets vary from 2 to 4 g depending on degree of edema and hypertension
  • sodium and salt should not be equated
  • salt substitutes should not be used, they contain potassium chloride
57
Q

Potassium restriction

A
  • 2-4 g

- avoid foods high in potassium

58
Q

Nursing Assessment

A
  • complete health history or any existing renal disease, family history - complete med history (Rx, OTC)
  • long-term health problems
  • dietary habits
  • clinical manifestations of CKD
  • patients goals of care
59
Q

Nursing Diagnosis

A
  • excess fluid volume
  • risk for electrolyte imbalance
  • imbalanced nutrition: less than body requirements
60
Q

Nursing Planning - overall goals for the patient

A
  • to demonstrate knowledge and ability to comply with therapeutic regimen
  • to participate in decision making
  • to demonstrate effective coping strategies
  • to continue with activities of daily living within physiological limitations
61
Q

Health promotion: nursing implementation

A
  • identify individuals at risk for CKD (history of renal disease, hypertension, diabetes mellitus, repeated UTI)
  • regular checkups and changes in urinary appearance, frequency, and volume should be reported
62
Q

Care considerations for chronic kidney disease in stages 4-5

A
  • daily weight, BP
  • identify S&S of fluid overload, hyperkalemia, and electrolyte imbalances
  • strict dietary adherence
  • medication education
  • motivate clients in management of their disease
  • ambulatory and home care
63
Q

Treatment

A

when conservative therapy is no longer effective, HD, PD, and transplantation are treatment options
- client/family need clear explanation of dialysis and transplantation

64
Q

Evaluation

A
  • maintenance of ideal body weight
  • acceptance of chronic disease
  • no infection
  • no edema
  • hematocrit, hemoglobin, and serum albumin levels in acceptable range
65
Q

Hypervolemia

A
  • too much blood volume
  • too much/too fast IV fluid
  • organ issues (heart failure, kidney dysfunction, cirrhosis)
  • increase Na+ intake
  • hypertonic solution
66
Q

Hypervolemia manifestations

A 
CNS: lethargy, seizure, coma
CVS: increased HR (bounding pulse), increase BP, JVD 
Resp: pulmonary edema 
GU: increase U/O (dilute) 
Skin: edema
67
Q

Hypovolemia

A
  • decreased BV
  • vomiting/diarrhea
  • severe dehydration
  • trauma, burn
  • medications (diuretics)
  • third spacing
68
Q

Hypovolemia manifestations

A

CNS: thirst, confusion, lethargy, seizure, coma
CVS: increased HR (thready pulse), decreased BP, orthostatic hypotension
Resp: RR increased

69
Q

Sodium function

A
  • generation and transmission of nerve impulses and muscle contractions
  • maintains fluid balance
  • regulates blood pressure
70
Q

Filtration

A

to remove waste products from the bloodstream

71
Q

Regulation

A

fluid and electrolyte and acid base balance

72
Q

Excretion

A

of metabolic waste products

Pathophysiology Midterm #2 (9 decks)

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