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NUR 201 Week 8 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

?

Defined as a progressive, irreversible kidney injury & function does NOT recover

A

Chronic Kidney Disease

When kidney fxn becomes too poor to sustain life, it becomes end stage renal/kidney disease (ESRD or ESKD)

Described in 5 stages (stage 1 is @ risk & has normal kidney function as opposed to stage 2 where actual CKD begins & GFR is worse)

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2
Q

GFR

Kidney Failure: 0-15

Kidney Disease: 15-60

A

Normal: 60-120

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3
Q

Stage ?

<15 mL/min
- End-stage kidney disease (ESKD)

Implement RRT or kidney transplantation

A

Stage 5

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4
Q

Stage ?

30-59 mL/min
- Moderate CKD

Implement strategies to slow disease progression

A

Stage 3

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5
Q

Stage ?

60-89 mL/min
- Mild CKD; reduced kidney function; lab values and other findings (e.g., structural change) point to kidney disease

Focus on reduction of risk factors

A

Stage 2

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6
Q

Stage ?

15-29 mL/min
- Severe CKD

Manage complications
Discuss patient preferences & values
Educate about options & prepare for RRT

A

Stage 4

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7
Q

Stage ?

> 90 mL/min
- @ risk; normal kidney function but urine findings or structural abnormalities or genetic trait point to kidney disease

Screen for risk factors & manage care to reduce risk
> Uncontrolled HTN
> DM
> Chronic kidney or UTI
> Fhx of genetic kidney dz
> Exposure to nephrotoxic substances

A

Stage 1

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8
Q

CKD

  • Up to 80% of GFR may be lost w/few changes in functioning of body
  • Remaining nephrons hypertrophy to compensate
A
  • End result is a systemic dz involving every organ
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9
Q

What are 2 of the leading causes of ESRD?

A

Diabetes (1/2 cases); HTN (1/3)

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10
Q

?

Is azotemia w/clinical sx’s
- GFR </= to 10 mL/min

A

Uremia

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11
Q

?

Is the buildup of nitrogen-based wastes in the blood

A

Azotemia

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12
Q

?

Is a condition that incorporates all s/s seen in various systems throughout the body

A

Uremic syndrome

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13
Q

Urinary System

  • Oliguria (occurs as CKD worsens)

? (urine output <40 mL over 24 hrs)

A

Anuria

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14
Q

?

Results from inability of kidneys to concentrate urine
- Occurs most often at night
- SG fixed around 1.010

A

Polyuria

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15
Q

Metabolic Disturbances

  • Waste product accumulation

As GFR ↓, BUN ↑ & serum creatinine lvls ↑
> BUN ↑
- Not only by kidney failure but by protein intake, fever, corticosteroids, & catabolism
- N/V, lethargy, fatigue, impaired thought processes, & headache may occur

A
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16
Q
  • Altered carbohydrate metabolism
    > Caused by impaired glucose use
    > From cellular insensitivity to the normal action of insulin
A
  • Defective carbohydrate metabolism
    > Pts w/diabetes who become uremic may require less insulin than before onset of CKD
    > Insulin dependent on kidneys for excretion
    > HYPOglycemia becomes a concern
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17
Q
  • Elevated triglycerides
    > Hyperinsulinemia stimulates hepatic production of triglycerides

> Altered lipid metabolism
- ↓ lvls of enzyme lipoprotein lipase
- Important in breakdown of lipoproteins

A

! Most pts w/CKD die from cardiovascular disease

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18
Q

Acid-Base Imbalances

  • Potassium
    > Hyperkalemia
  • Most serious electrolyte disorder in kidney dz
  • Fatal dysrhythmias = K levels 7-8 or >
    ! Tall, tented/peaked T waves
A
  • Hyperkalemia d/t
    > Dec excretion of K by kidneys
    > Breakdown of cellular protein
    > Bleeding
    > Metabolic acidosis
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19
Q

Sodium

> May be normal or low
B/c of impaired excretion, sodium is retained = water is retained
Edema, HTN, CHF

A

! Sodium intake restricted indiv but ~2 g/day

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20
Q
  • Calcium & phosphate alterations
A
  • Mg alterations
    > Absence of reflexes
    > Dec mental status
    > Cardiac dysrhythmias
    > Hypotension
    > Resp failure
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21
Q
  • P is excreted by the kidneys; RF leads to retention
  • Rx’s are given PO to combine w/P in GI tract for excretion through intestines
  • aluminum hydroxide
  • calcium carbonate (Tums)
  • calcium acetate (Phos-Ex) [give w/food to promote P binding to rx]
A
  • As P lvls inc, body tries to keep normal P:Ca ratio by taking Ca from bones
    > bone demineralization & path fx’s
  • Hypocalcemia d/t inability of dz’d kidney to convert Vit D to active form
  • Treatment: active forms of Vit D = calcitrol & DHT
22
Q

Metabolic Acidosis

  • From
    > Inability of kidneys to excrete acid load (primary ammonia)
    > Defective reabsorption/regeneration of bicarbonate
A

S&S
> Anorexia, weakness, lethargy, may become stuporus or comatose
> Kussmaul’s respirations, severe CNS depression causing shock, death

23
Q

Treatment

  • Promote output
  • Maintain pulmonary function to allow some excretion (carbonic acid) via lungs (C&DB, avoid URI’s)
A
  • Na bicarbonate given PO/IV to buffer acids
  • Bistro (alkalinizing agent; chemicals in med convert to bicarbonate)
24
Q

Hematologic System

  • Anemia
    > D/t ↓ production of erythropoietin (from ↓ in functioning of renal tubular cells)
A
  • Bleeding tendencies
    > Defect in platelet function (Factor III)
25
Q
  • Infection
    > Changes in leukocyte function
    > Altered immune response & function
    > Diminished inflammatory response
A

Uremic pneumonia

  • In uremia have thick, sticky secretions plus high susceptibility to infection; have them turn, C&DB
26
Q

Cardiovascular System

  • HTN (may be cause or result)
  • HF & LVH (r/t inc work load)
A
  • Peripheral edema
  • Dysrhythmias
  • Uremic pericarditis
    > Inflamed pericardial sac r/t toxins/infection; leads to tamponade (dec PP & bradycardia) which requires removal of pericardial fluid w/needle, cath, drainage tube into pericardium
27
Q

Respiratory System

  • Kussmaul’s respirations (r/t acidosis; when too much is blown off, resp alkalosis can happen)
  • Dyspnea (r/t HF)
  • Pulmonary edema (r/t heart being overworked)
A
  • Uremic pericarditis
  • Pleural effusion
  • Predisposition to resp infection
28
Q

Gastrointestinal System

! Every part of GI is affected (d/t excessive urea)
> Mucosal alterations
> Stomatitis
> Uremic feitor (urinous odor of breath)
> GI bleeding
> Anorexia (lack of appetite), N/V

A
29
Q

Neurological System

  • ↑ nitrogenous waste products
  • Electrolyte imbalance; metabolic acidosis
  • Axonal atrophy
  • Demyelination of nerve fibers
  • RLS
  • Muscle twitching
A
  • Irritability
  • Decreased ability to concentrate
  • Peripheral neuropathy
  • AMS
  • Seizures
  • Coma
  • Dialysis encephalopathy
30
Q

Musculoskeletal System

  • CKD mineral & bone disorder
    > Systemic disorder of mineral & bone metabolism
A

> Results in skeletal complications (osteomalacia, osteitis fibrosa) & extra-skeletal (vascular) calcifications

31
Q

Integumentary System

  • Pruritus
  • Uremic frost (rare)
A

Reproductive System

  • Infertility (experienced by both sexes)
  • Dec libido
  • Low sperm counts
  • Sexual dysfunction
32
Q

Psychological Changes

  • Personality & behavioral changes
  • Emotional lability (laughter/crying extremes @ inopportune times)
A
  • Withdrawal
  • Depression
33
Q

CRF: Take Action - Drug Therapies

! Diuretic therapy cautiously (Lasix [ototoxic], Mannitol)
> Used to inc u/o

  • Cardiac glycosides (digoxin)
    > Improves ventricular contraction & inc SV & CO
A
  • Bicarbonate for metabolic acidosis
  • Cation exchange resins (Kayexalate for ↑ K)
34
Q
  • Abx if infection
  • Vitamins, minerals (folic acid, FeSO4)
    > Iron replacements taken w/food; dialysis removes essential V&M’s
A
  • Synthetic erythropoietin (Epogen/Procrit; Aranesp)
    > Prevent anemia by stimulating blood cell growth & maturation in bone marrow
  • Phosphate binders
    > High phosphate causes hypocalcemia; (rx’s bind w/P in food & excrete) [separate Dig & P binders by 2 hrs]
35
Q

Conservative Therapy

  • Correction of ECF volume overload or deficit
A
  • Nutritional therapy
36
Q

Drug Therapy

A
  • Hyperkalemia
  • IV insulin
    > IV glucose to manage hypoglycemia
  • IV 10% calcium gluconate
  • Sodium polystyrene sulfate (Kayexalate) [! diarrhea]
    > Cation-exchange resin
    > Resin in bowel exchanges P for Na
37
Q
  • HTN
  • Weight loss
  • Lifestyle changes
  • Diet recommendations
  • Na & fluid restriction
A
  • Antihypertensive rx’s (diabetic or not?)
    > Diuretics
    > Calcium channel blockers
    > ACE inhibitors
    > ARB agents
38
Q

Target BP <130/80 mmHg pts w/CKD

A

125/75 for pts w/significant proteinuria

39
Q
  • Dyslipidemia
  • Goal
    > Lowering LDL below 100 mg/dL
    > TG lvl <200 mg/dL
A
  • Statins
    > HMG-CoA reductase inhibitors (most effective for lowering LDL)
40
Q
  • Erythropoietin therapy
  • Ca supplement; phos binders
A
  • Sevelamer hydrochloride (Renagel)
    > Lowers cholesterol & LDLs
  • Adjustment of drug dosages to degree of renal function
41
Q

Drug Therapy - Complications

  • Drug toxicity
  • Digitalis
  • Abx
  • Pain medication (Demerol, NSAIDs)
A

Nutritional Therapy

42
Q
  • Protein restriction (benefits are being studied)

> Protein not usually restricted for pt undergoing dialysis
Calorie-protein malnutrition is a serious problem
Malnutrition b/c depression & complex diets that restrict protein, P, K, & Na

A
  • Water restriction (intake depends on daily u/o)

> Generally 600mL (from insensible loss) plus an amt equal to the prev day’s u/o is allowed for a pt receiving hemodialysis

43
Q
  • Sodium restriction; 2-4g
    > Salt substitutes shouldn’t be used b/c they contain KCl
A
  • Potassium restriction
    > 2-3g
    > High-K foods should be avoided
44
Q
  • Phosphate restriction
    > 1000 mg/day
    > Foods high in phosphate (dairy products [meat, milk, ice cream, cheese, yogurt, pudding])
    > Most foods high in phosphate are also high in protein
A

Nursing Diagnoses

45
Q

Deficient Fluid Volume r/t fluid loss from a variety of causes

Excess Fluid Volume r/t inability of the kidneys to produce urine

A

Outcomes

> Deficient fluid volume will not occur

> Excess fluid volume will be managed

46
Q

Imbalanced Nutrition: Less Than Body Requirements r/t anorexia & altered metabolic state

Outcome
> Maintain adequate nutrition aeb sufficient intake to prevent protein catabolism & maintain lab values within safe lvls

A

Risk for Impaired Skin Integrity r/t poor cellular nutrition & edema

Outcomes
> Intact skin

Interventions
> Frequent turning
> Meticulous skin care
> Special mattresses

47
Q

Risk for Infection

Outcomes
> No infection

Interventions
> Meticulous resp tract, wound, central line, & urinary catheter care

A

Anxiety r/t unknown outcome of dz process

Outcome(s)
> Demonstrated ability to manage anxiety

Interventions
> Freq & careful explanations
> Provide emotional support

48
Q

Diagnostic Studies

  • HPE
  • Dipstick eval
    > A person w/persistent proteinuria (1+ protein on standard dipstick testing 2 or more times over a 3-month period) should have further assessment of risk factors & a diagnostic workup w/blood urine tests
  • Albumin-creatinine ratio (1st am void)
  • GFR
A
  • Renal ultrasound
  • Renal scan
  • CT scan
  • Renal bx
49
Q

Nursing Management: Planning

Overall goals
- Demonstrate knowledge & ability to comply w/therapeutic regimen
- Participate in decision making

A
  • Demonstrate effective coping strategies
  • Continue w/ADL’s within psychologic limitations
50
Q

Nursing Management: Implementation/Taking Action

Health Promotion
* ID individuals @ risk for CKD
- H/o renal dz
- HTN
- DM [check for microalbuminuria]
- Repeated UTI

  • Regular checkups & changes in urinary appearance, freq, & volume should be reported
A

Acute Intervention

  • Daily weight & BP’s
  • ID s/s of fluid overload & hyperkalemia
  • Strict dietary adherence
  • Medication education
  • Motivate pts in management of their dz
51
Q

Ambulatory & home care

  • When conservative therapy is no longer effective, HD, PD, & transplantation are treatment options
  • Pt/family need clear explanation of dialysis & transplantation
A

Nursing Management: Evaluation

  • Maintenance of ideal body weight
  • Acceptance of chronic dz
  • No infection
  • No edema
  • Hct, Hgb, & serum albumin lvls in acceptable range

NUR 201 Week 8 (5 decks)

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