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Medsurg 2.0: Exam 2 💪🏼 > CHRONIC KIDNEY DISEASE > Flashcards

CHRONIC KIDNEY DISEASE Flashcards

1
Q

Kidney Disorders

A
  • Fluid and electrolyte imbalances
    —- K: up
    ——arrhythmias
    —- PHOS: up
    —- Ca: down
    —— osteoporosis
  • Most accurate indicator of fluid loss or gain, in an acutely ill patient, is weight
    — same clothes, stand up scale, same time of day

Fluid/weight conversion:
- 2 Liters= 2kg
- 1 liter= 1 kg

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2
Q

Causes of Chronic Kidney Failure
DMV - CHHOP

A
  • *Diabetes mellitus
  • Medications or toxic agents
  • Vascular disorders
  • Chronic Glomerulonephritis
  • Hereditary lesions
  • *Hypertension
  • Obstruction of urinary tract:
  • Pyelonephritis (prior to kidney) or other infections
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3
Q

Glomerular Diseases

A
  • Acute nephritic syndrome
  • Glomerulonephritis; chronic and acute
    — 24 hour urine on ice
    — know start time
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4
Q

End-Stage Kidney Disease or Chronic Kidney Disease

A
  • Results when the kidneys cannot remove wastes or perform regulatory functions
  • Chronic renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in renal replacement therapy on a permanent basis
  • Fifth stage of CKD also referred to as ESKD/ESRD
    — increased creatine = increased uric acid= scar tissue
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5
Q

Chronic Kidney Failure ASSESSMENT AND DIAGNOSTIC FINDINGS AND COMPLICATONS

A
  • GLOMERULAR FILTRATION RATE
    — kidney not working: GFR decreases
  • SODIUM AND WATER RETENTION
  • ACIDOSIS
    — metabolic acidosis
  • ANEMIA
    — poor production of erythropoietin (creates RBCs) from Kidney
    — low H&H is expected (not significant)
  • CALCIUM AND PHOSPHORUS IMBALANCE
    — if phosphorus goes up calcium goes down
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6
Q

Chronic Kidney Failure MEDICAL MANAGEMENT

A
  • PHARMACOLOGIC THERAPY
    — Calcium and Phosphorus Binders
    — Antihypertensive and Cardiovascular Agents
    — Anticonvulsant Agents
    — Erythropoietin (Epogen/ Epoetin Alfa)
  • NUTRITIONAL THERAPY
  • DIALYSIS
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7
Q

Nursing Process: The Care of Patients With Chronic Kidney Disease and Acute Kidney Injury—Assessment

A
  • Fluid status
  • Nutritional status
  • Patient knowledge
  • Activity tolerance
  • Self-esteem
  • Potential complications
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8
Q

Nursing Process: The Care of Patients With Chronic Kidney Disease and Acute Kidney Injury—Diagnosis

A
  • Excess fluid volume
  • Imbalanced nutrition
  • Deficient knowledge
  • Risk for situational low self-esteem
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9
Q

Nursing Process: The Care of Patients With Chronic Kidney Disease and Acute Kidney Injury—Planning

A

Goals may include:
- Maintaining IBW without excess fluid
- Maintenance of adequate nutritional intake
- Increased knowledge
- Participation of activity within tolerance
- Improved self-esteem
- Absence of complications

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10
Q

Excess Fluid Volume

A
  • Assess for s/s of fluid volume excess, *keep accurate I&O, and daily weights
  • Limit fluid to prescribed amounts
  • Identify sources of fluid
  • Explain to patient and family the rationale for fluid restrictions
  • Assist patient to cope with the fluid restrictions
  • Provide or encourage frequent oral hygiene
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11
Q

Imbalanced Nutrition: Assessment

A
  • Nutritional status; weight changes, laboratory data
  • Nutritional patterns, history, preferences
  • *Provide food preferences within restrictions
  • Encourage high-quality nutritional foods while maintaining nutritional restrictions
    — shake for kidney pts: Nepro
  • Stomatitis or anorexia: modify intake related to factors that contribute to alterations
  • Adjust medication times related to meals
    — no HTN meds before dialysis
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12
Q

Risk for Situational Low Self-Esteem

A
  • Assess patient and family responses to illness and treatment
  • Assess relationships and coping patterns
  • Encourage open discussion about changes and concerns
  • Explore alternate ways of sexual expression
  • Discuss role of giving and receiving love, warmth, and affection
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13
Q

Renal Replacement Therapy- Hemodialysis

A
  • Hemodialysis: used when patient is acutely ill until kidneys resume function and for long-term replacement therapy in CKD and ESKD
  • Objective is to extract toxic nitrogenous substances from the blood and to remove excess fluid:
    — *Diffusion, osmosis, and ultrafiltration
  • *Vascular access
    — Arteriovenous fistula/ graft (same thing)
    —- takes time to mature: 3-6 months
    —- may have temp access in IJ (neck) or subclavian
    — red port: in
    — Blue port: out
    — listen for bruit
    — Feel for thrill (cant feel really new ones)
    — cap refill
    — no BP/ IV on effected arm
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14
Q

Hemodialysis Catheter

A

Perma Caths are tunneled

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15
Q

Hemodialysis System

A

Filter: acts like kidney via osmosis etc.
Treatment: prior to discharge: need a dialysis center apt
Hemodialysis is the best way to filter the blood
— done by weight
— 2-3 L out (2-3 kg)
— restricted diet: low protein/ phosphorus
—- sodium restriction: no more than 2 grams a day
- need specialized catheter/nurse
- hypovolemia risk (fluid comes out)
- bleeding (from catheter)

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16
Q

Internal Arteriovenous Fistula and Graft

A
17
Q

Renal Replacement Therapy- Peritoneal Dialysis

A
  • Goals are to remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance
  • Peritoneal membrane serves as semipermeable membrane
    — Diffusion and Osmosis
    — Peritoneal catheter
  • Acute intermittent, continuous ambulatory, continuous cyclic
  • Complications: peritonitis, leakage, bleeding
18
Q

Peritoneal Dialysis #1

A

Peritoneal dialysis: doesn’t clean the blood as well
- catheter put in peritoneal cavity
- dwell time: time it takes for fluid to enter
— cant get fluid out: roll towards catheter, sit up, lower bag
- Wash hands, wear mask, regulate who comes into your house,
- no cats
- has to be done more often (4-6 times a day)
- dont recommend for pt (doctors job)

19
Q

Peritoneal Dialysis #2

A
20
Q

Comparison of Dialysis Types
Hemodialysis

A
  • More efficient clearance / Easy access
  • Shorter treatment time
  • Strict diet
  • Vascular access care
  • Complex- requires specialized nurse and equipment
21
Q

Comparison of Dialysis Types
Peritoneal Dialysis

A
  • Easy access
  • Few hemodynamic complications
  • Diet is flexible
  • Intra-abdominal catheter care
  • Simple
22
Q

Question #1
Is the following statement true or false?
- The most accurate indicator of fluid loss or gain in an acutely ill patient is weight

A

True?

23
Q

Question #2

  • Is the following statement true or false?
  • Failure of the temporary dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis
A

False,
Failure of the permanent dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis

24
Q

Nursing Process: The Care of the Hospitalized Patient on Dialysis—Assessment

A
  • Protect vascular access; assess site for patency, signs of potential infection, do not use for blood pressure or blood draws
  • Carefully monitor fluid balance, IV therapy, accurate I&O, IV administration pump
  • s/s of uremia and electrolyte imbalance, regularly check lab data
  • Monitor cardiac/respiratory status carefully
  • Cardiovascular medications must be held prior to dialysis
25
Q

Nursing Process: The Care of the Hospitalized Patient on Dialysis—Interventions

A
  • Monitor all medications and medication dosages carefully
  • Address pain and discomfort
  • Stringent infection control measures
  • Dietary considerations: sodium, potassium, protein, fluid, individual nutritional needs
  • Skin care: pruritus, keep skin clean and well moisturized, trim nails, and avoid scratching
  • CAPD catheter care
26
Q

Kidney Surgery

A
  • Preoperative considerations
  • Perioperative concerns
  • Postoperative management
    — Potential hemorrhage and shock
    — Potential abdominal distention and paralytic ileus
    — Potential infection
    — Potential thromboembolism
  • monitor kidney output
  • ## dont use kidney harmful meds
27
Q

Positioning and Incisional Approaches

A
28
Q

Postoperative Nursing Management

A
  • Assessment:
    — include all body systems, pain, fluid and electrolyte status, and patency and adequacy of urinary drainage system
  • Diagnoses:
    — ineffective airway clearance
    — ineffective breathing pattern
    — acute pain
    — fear and anxiety
    — impaired urinary elimination
    — risk for fluid imbalance
  • Complications:
    — bleeding , pneumonia, infection, and DVT
29
Q

Postoperative Interventions

A
  • Pain relief measures, analgesic medications
  • Promote airway clearance and effective breathing pattern, turn, cough, deep breathe, incentive spirometry, positioning
  • Monitor UO and maintain patency of urinary drainage systems
  • Use strict asepsis with catheter
  • Monitor for signs and symptoms of bleeding
  • Encourage leg exercises, early ambulation, and monitor for signs of DVT
30
Q

Patient Education

A
  • Instruct both patient and family
  • Drainage system care
  • Strategies to prevent complications
  • Signs and symptoms
  • Follow-up care
  • Fluid intake
  • Health promotion and health screening
  • take meds forever;
31
Q

Kidney Transplantation

A

Medsurg 2.0: Exam 2 💪🏼 (11 decks)

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