CHRONIC KIDNEY DISEASE Flashcards
Kidney Disorders
- 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
Causes of Chronic Kidney Failure
DMV - CHHOP
- *Diabetes mellitus
- Medications or toxic agents
- Vascular disorders
- Chronic Glomerulonephritis
- Hereditary lesions
- *Hypertension
- Obstruction of urinary tract:
- Pyelonephritis (prior to kidney) or other infections
Glomerular Diseases
- Acute nephritic syndrome
- Glomerulonephritis; chronic and acute
— 24 hour urine on ice
— know start time
End-Stage Kidney Disease or Chronic Kidney Disease
- 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
Chronic Kidney Failure ASSESSMENT AND DIAGNOSTIC FINDINGS AND COMPLICATONS
- 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
Chronic Kidney Failure MEDICAL MANAGEMENT
- PHARMACOLOGIC THERAPY
— Calcium and Phosphorus Binders
— Antihypertensive and Cardiovascular Agents
— Anticonvulsant Agents
— Erythropoietin (Epogen/ Epoetin Alfa) - NUTRITIONAL THERAPY
- DIALYSIS
Nursing Process: The Care of Patients With Chronic Kidney Disease and Acute Kidney Injury—Assessment
- Fluid status
- Nutritional status
- Patient knowledge
- Activity tolerance
- Self-esteem
- Potential complications
Nursing Process: The Care of Patients With Chronic Kidney Disease and Acute Kidney Injury—Diagnosis
- Excess fluid volume
- Imbalanced nutrition
- Deficient knowledge
- Risk for situational low self-esteem
Nursing Process: The Care of Patients With Chronic Kidney Disease and Acute Kidney Injury—Planning
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
Excess Fluid Volume
- 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
Imbalanced Nutrition: Assessment
- 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
Risk for Situational Low Self-Esteem
- 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
Renal Replacement Therapy- Hemodialysis
- 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
Hemodialysis Catheter
Perma Caths are tunneled
Hemodialysis System
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)
Internal Arteriovenous Fistula and Graft
Renal Replacement Therapy- Peritoneal Dialysis
- 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
Peritoneal Dialysis #1
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)
Peritoneal Dialysis #2
Comparison of Dialysis Types
Hemodialysis
- More efficient clearance / Easy access
- Shorter treatment time
- Strict diet
- Vascular access care
- Complex- requires specialized nurse and equipment
Comparison of Dialysis Types
Peritoneal Dialysis
- Easy access
- Few hemodynamic complications
- Diet is flexible
- Intra-abdominal catheter care
- Simple
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
True?
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
False,
Failure of the permanent dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis
Nursing Process: The Care of the Hospitalized Patient on Dialysis—Assessment
- 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
Nursing Process: The Care of the Hospitalized Patient on Dialysis—Interventions
- 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
Kidney Surgery
- 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
Positioning and Incisional Approaches
Postoperative Nursing Management
- 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
Postoperative Interventions
- 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
Patient Education
- 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;
Kidney Transplantation
