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Module 4 (MedSurg 2) > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Chronic Kidney Disease

A

Progressive, irreversible loss of kidney function

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2
Q

Most common causes of CKD

A

DM
HTN

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3
Q

Diabetic Nephropathy

A

damage to small vessels that supply the glomeruli due to DM condition

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4
Q

CKD RISK FACTORS

A

Age > 60 years
Males
Cardiovascular disease
Diabetes
Ethnicity – AA and Native Americans
Exposure to nephrotoxic drugs (severe IV infections) – contrast dye
Family history of CKD
Hypertension

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5
Q

If at risk of CKD, then you should get screened

A

annually

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6
Q

If albuminuria is present

A

use drugs to delay progression
-ACE, ANGIOTENSIN receptor antagonists

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7
Q

CKD pts need to tightly control

A

HTN and BG

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8
Q

Individuals with CKD are frequently

A

asymptomatic 70%
usually underdx and undertx

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9
Q

What are the stages of CKD?

A

1,2,3,4
Stage 5: ESRD or Kindey failure

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10
Q

Treatments of CKD are determined by

A

underlying cause

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11
Q

The stages of CKD are determined by

A

GFR

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12
Q

Stage 1 CKD GFR #

A

90+

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13
Q

Stage 1 CKD kidney function

A

normal function
BUT structural changes indicate damage
lacks perfusion

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14
Q

Normal GFR

A

125

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15
Q

Stage 2 CKD GFR #

A

60-89

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16
Q

Stage 2 CKD kidney function

A

damage with a mild decrease in GFR
UNDETECTABLE

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17
Q

Stage 3 CKD GFR #

A

30-59

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18
Q

Stage 3 CKD kidney function
+ Creatinine level

A

moderate to poor
increase in creatinine levels

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19
Q

At stage 3 CKD, you should use caution with

A

nephrotoxic agents (dye)

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20
Q

Stage 4 CKD GFR #

A

15-29

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21
Q

Stage 4 CKD kidney function
Prep for

A

poor
Dialysis prep
monitor electrolytes closely

no nephrotoxic

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22
Q

What electolyte should be closely monitored through diet and labs for Stage 4 CKD ?

A

K

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23
Q

CKD occurs after

A

pt does not hit the recovery phase
irreversible damage

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24
Q

Stage 5 CKD GFR**

A

15 OR LESS

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25
Q

Stage 5 CKD kidney function

A

End-stage renal disease
little to no function

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26
Q

What is needed for a Stage 5 CKD

A

RENAL REPLACEMENT or Transplant
build up of toxins (uremia) and only if desired

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27
Q

S/S of CKD

A

Devastating SYSTEMIC effect
Sodium/fluid balance alteration
increase of K
Toxic build up
Neurological symptoms
Altered calcium and phosphorus levels
Metabolic acidosis
Chronic anemia
HTN

28
Q

Tx ESRD Metabolic acidosis

A

Bicarb

29
Q

Lab Values of CKD

A

High serum creatinine/BUN/potassium
HIgh Mg (anemia and bleeding)
LOW creatinine clearance (excreted)
EITHER WAY serum sodium
LOW serum calcium
LOW CO2/hemoglobin & hematocrit

30
Q

In general, is in ESRD the Na should be limited to

A

2 g a day

31
Q

Nursing Managements of CKD

A

Preserve existing kidney function
Reduce risks of cardiovascular events and disease (CVD)
Prevent complications
Provide for patient’s comfort
Nutrition/glycemic control
Fluid management
Medication: ADVOCATE against nephotoxic
Monitor VS and lab values
Monitor I&O and daily weight
Skin care – tight and fragile

32
Q

________ recognition, diagnosis, and treatment can slow the progression of kidney disease

A

Early

33
Q

What medication needs to be used with caution for diabetics, and why?

A

Insulin
stay in system longer as usually filtered by the kidneys

34
Q

Hemodialysis needs to evaluated

A

patency
infection

35
Q

Hemodialysis arms should not take

A

BP
blood samples

36
Q

Nutrition for ESRD

A

monitor and restrict:
protein (lean meats chicken or fish)
fluid (diuretics = no overload)
Na and K
Phosphate

37
Q

Pts of Peritoneal Dialysis need to watch out for what in nutrition

A

protein intake high to compensate for loss
may need to increase

38
Q

Protein InTAke for CKD

A

Should be carefully monitored
Normal for HD patient
Increased for Peritoneal D patient**

39
Q

What lab parameters need to be watched for CKD?

A

Albumin
pre albumin
ferritin

40
Q

Phosphate is _________ in ESRD

A

RESTRICTED

41
Q

What juice is contraindicated in end-stage renal failure pts?

A

citrus = 480 mg of Potassium
give apple or water with sugar

42
Q

Dietary approaches to stop HTN

A

fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts
-leafy greens

43
Q

What meal plan should be used for ESRD?

A

DASH

44
Q

The DASH plan is significantly

A

lower BP
and lowers LDL cholesterol

45
Q

Drug Therapy for CKD

A

K based on levels
control HTN and hyperlipidemia
bone disease = low Ca
anemia

46
Q

Hyperkalemia

A

Restriction of high-potassium foods and drugs
IV glucose and insulin
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate)
**Dialysis may be needed **(too much K)

47
Q

AntiHTN drugs

A

ACE
ARBs

48
Q

Lethal Injection is

A

HIGH K
muscle relaxant
sedative

49
Q

ACE reduces

A

reduce systemic vascular resistance in patientswith hypertension, heart failure or chronic renal disease

50
Q

ARBs are used to

A

treat high blood pressure and heart failure. They are also used for chronic kidney disease and prescribed following a heart attack.

51
Q

CKD- MINERAL AND BONE DISORDER

A

ca and Phosphours out of balance
- receiving dialysis

52
Q

Phosphate not restricted until patient

A

requires renal replacement therapy

53
Q

What phosphate is given for CKD-MBD

A

Phosphate binders

54
Q

What should be avoided with phosphate and supplemented?

A

avoid aluminum
supplement Vitamin D

55
Q

Phosphate BInders for Ca

A

Calcium acetate (PhosLo)/Calcium carbonate (Caltrate)
- bind and excreted in bowels

56
Q

Sevelamer hydrochloride (Renagel)

A

lowers cholestrol and LDL
without cuasing High Ca

57
Q

If anemis occurs in a CKD pt

A

Erythropoietin
aka Epoetin alfa (Epogen, Procrit)/Darbepoeitin alfa (Aranesp)

58
Q

Erythropoietin does

A

GLYCOPROTEIN STIMULATES MARROW TO INCREASE RBCS
increased Hct and Hemoglobin 2-3 weeks effect

59
Q

Erythropoietin side effects

A

Thromboembolism
HTN

60
Q

Erythropoietin needs to be used with

A

iron
folic acid
Vitamin B12

61
Q

Iron supplements used when

A

lower than 100 ferritin level

62
Q

Iron causes

A

gastric irritation
constipation
dark-colored stool

63
Q

Folic acid needed for

A

RBC formation
removed by dialysis

64
Q

Blood transfusions

A

avoid if possible but if erythropoietin
Lasix
increase antibody development
Iron and fluid overload

65
Q

Drug Therapy Complications for Anemia Toxicity by ESRD

A

Digoxin
Diabetic agents (insulin sensitivity)
Antibiotics
Opioid medications**(esp. after surgery)

66
Q

Furosemide (Lasix)

A

The most frequently prescribed loop diuretic
Acts in the thick segment of the ascending Loop of Henle to block the reabsorption of water
Can promote diuresis even when renal blood flow and GFR are low
- lower K and pull fluid off

67
Q

How long does it take erythropoietin to take effect?

A

2-3 weeks

Module 4 (MedSurg 2) (36 decks)

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