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Med Surg Unit 4 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Pathophysiology of CKD

A

A progressive, irreversible disorder lasting longer than 3 months

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2
Q

Kidney Changes

A
  1. Polyuria, noturia
  2. Oliguria
  3. Proteinuria
  4. Hematuria
  5. Diluted, straw-colored urine appearance
  6. Concentrated and cloudy urine appearance
  7. Change in appearance, amount, and frequency; possible protein, sediment, or blood in the urine
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3
Q

Respiratory Changes

A
  1. Shortness of breath
  2. Possible tachypnea
  3. Possible Kussmaul’s respirations
  4. Possible coughing, and possible sputum;
  5. Crackles in the lungs; breath can smell like urine, which is called uremic fetor or uremic halitosis.
  6. Deep sighing and yawning.
  7. Depressed cough reflex
  8. Crackles
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4
Q

Cardiac Changes

A
  1. Occur because of FVO,
  2. HTN
  3. HF
  4. Pericarditis
  5. Dysrhythmias due to abnormal potassium levels
  6. Cholesterol or calcium buildup in the blood vessels.
  7. Peripheral Edema
  8. Pericardial Friction Rub
  9. Pericardial Effusion
  10. Cardiac Tamponade
  11. Cardiorenal syndrome
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5
Q

Hematologic and Immunity Changes

A
  1. Think anemia and abnormal bleeding
  2. Fatigue, pallor, lethargy, weakness, shortness of breath, and dizziness
  3. Bruising, petechiae (tiny round brownish-purple spots on the skin), purpura (a rash of purple spots on the skin), nosebleeds or bleeding gums.
  4. CKD causes reduced immunity, which increases the risk for infection
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6
Q

GI changes

A
  1. Foul breath (halitosis), ulcerations in the mouth
  2. Abdominal pain, cramping, nausea, or vomiting, and black, tarry stools.
  3. Metallic taste in the mouth
  4. Changes in taste acuity and sensation
  5. Uremic colitis (diarrhea)
  6. Constipation
  7. Uremic gastritis (possible GI bleed)
  8. Stomatitis
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7
Q

Neurologic Changes

A
  1. Lethargy and daytime drowsiness
  2. Inability to concentrate or decreased attention span
  3. Seizures
  4. Coma
  5. Slurred Speech
  6. Asterixis (jerky movement)
  7. Tremors
  8. Myoclonus
  9. Ataxia
  10. Paresthesia from peripheral neuropathy
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8
Q

Skeletal Changes

A
  1. Stem from osteodystrophy due to poor absorption of calcium and continuous bone calcium loss
  2. Osteodystrophy presents with thin, fragile bones that are at a high risk for fractures
  3. Possible loss of height due to vertebrae becoming more compact, causing the adult to bend forward a bit
  4. Bone pain, spinal curvatures, and any unusual bumps.
  5. Muscle Weakness
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9
Q

Integumentary Changes

A
  1. Decreased skin tugor
  2. Yellow-gray pallor
  3. Dry skin
  4. Pruritus
  5. Ecchymosis
  6. Purpura
  7. Soft-tissue calcification
  8. Uremic frost (late)
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10
Q

Metabolic Changes

A
  1. Hyperparathyroidism
  2. Hyperlipidemia
  3. Alterations in vitamin D, calcium, and phosphorus adsorption and metabolism
  4. Metabolic Acidosis
  5. Hyperkalemia
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11
Q

Psychosocial Symptoms

A
  1. Depression
  2. Fatigue
  3. Sleep Disturbance
  4. Sexual Dysfunction
  5. Cognitive impairment
  6. Unemployment
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12
Q

Reproductive Symptom

A
  1. Decreased fertility
  2. Infrequent or absent menses
  3. Decreased libido
  4. Impotence
  5. Sexual dysfunction
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13
Q

Nursing Assessment: Health History

A
  1. Ask patient for age, gender and accurately measure weight and height and recent weight gain or loss
  2. Ask about history of kidney and urologic disorders, chronic health problems and drug use
  3. Document the use of current and past prescribed and over-the-counter drugs
  4. Examine dietary habits and discuss GI problems
  5. Ask about presence of nausea, vomiting, anorexia, hiccups, diarrhea or constipation
  6. Ask about energy level and any recent injuries or bleeding
    > Explore changes in his or her daily routine
  7. Discuss urine elimination (frequency if urination, appearance of urine, and any difficulty starting or controlling urination
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14
Q

Health Promotion and Maintenance

A
  1. Focus on controlling the disease that lead to its development such as diabetes and hypertension
  2. Education and encourage the patient to accept lifestyle modification
  3. Diet adjustment (sodium, protein and cholesterol restriction), weight maintenance, smoking cession, exercise and limitation of alcohol
  4. Drug adherence
  5. Treat infection anywhere in the kidney/urinary system with taking all antibiotics prescribed
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15
Q

Laboratory Assessment

A
  1. Creatinine: Elevated
  2. BUN: Elevated
  3. Sodium: Normal, increased or decreased
  4. Potassium: Increased
  5. Phosphorus: Increased
  6. Calcium: Decreased
  7. Magnesium: Increased or decreased
  8. Hemoglobin: Decreased
  9. Hematocrit: Decreased
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16
Q

Diagnostic Assessment

A
  1. Bone X-rays of the hand can show renal osteodystrophy
  2. Kidney Ultrasound or CT scan without contrast medium may be used to rule out an obstruction
17
Q

Nursing Interventions: Managing Fluid Volume

A

1.Monitor I & O – STRICT!
2. Monitor hydration status
> Fluid restriction; include oral, IV, and enteral routes
> Spread intake throughout the day
3. Assess for fluid volume overload
> Daily weights; lung assessment; edema assessment; JVD assessment
4. Assess for pulmonary edema: restlessness, anxiety, tachycardia, SOB, crackles in lung bases; possible frothy, blood-tinged sputum; cyanosis, diaphoresis
> High-Fowler’s position
> Oxygen therapy
5. Monitor serum electrolytes – imbalances can cause cardiac dysrhythmias (some fatal)
> Cardiac monitoring
6. Administer drug therapy
> Diuretics: to help with urinary elimination
> Furosemide (Lasix), Bumetanide (Bumex)
> Morphine: to reduce myocardial oxygen demand, especially with pulmonary edema
> Dosages must be precise! Do not want to cause respiratory depression
> Nitroglycerine: can also reduce pulmonary pressure caused by left-sided heart failure from FVO

18
Q

Nursing Intervention: Improving Cardiac Function

A
  1. BLOOD PRESSURE CONTROL IS ESSENTIAL IN PRESERVING KIDNEY FUNCTION
    > Diuretics (especially thiazides): Hydrochlorothiazide [HCTZ] (Microzide)
    > Calcium channel blockers: Amlodipine (Norvasc), Diltiazem (Cardizem)
    > ACE inhibitors: lisinopril (Zestril), Enalapril (Vasotec)
    > Alpha blockers: Doxazosin (Cardura), Prazosin (Minipress)
    > Beta blockers: metoprolol (Lopressor), atenolol (Tenormin), propranolol (Inderal)
    > Vasodilators: vasopressin, dopamine, Phenylephrine, Norepinephrine
  2. These medications will be prescribed on the provider based on the individual patient and anticipated complications that could occur. Many times a combination of these medications are used and shown to be more effective.
  3. Teach the patient and the family how to appropriately measure blood pressure and how to keep a log of their findings. Provide important teaching about diet and its correlation with blood pressure and blood pressure medications.
19
Q

Nursing Intervention: Enhancing Nutrition

A
  1. The purpose of nutrition therapy is to provide the food and fluids needed to prevent malnutrition and avoid complications from CKD
  2. Collaborate with a Registered Dietitian Nutritionist
  3. Each individual’s nutritional needs will be different based on:
    > weight-to-height ratio, muscle tone, and lab values (like serum albumin, hematocrit, and hemoglobin).
  4. Dietary Changes for CKD:
    > Protein restriction
    > Fluid restriction
    > Sodium restriction
    > Potassium restriction
    > Phosphorus restriction
    > Vitamin and mineral supplements
    > Iron, vitamin D, calcium
20
Q

Nursing Intervention: Preventing Injury

A
  1. Patients with CKD can have very brittle, very fragile bones that fracture very easily.
    > Use lift sheets or other lifting technology
  2. Medication education: OTC meds alter kidney function
    > Avoid magnesium-containing antacids like MOM (milk of magnesia)
  3. Monitor for infection
    > Fever, enlargement of lymph nodes, elevated white blood cell counts and positive blood or urine cultures
    > For any patient that is undergoing dialysis, be sure to assess the vascular access site for any redness, swelling, drainage or pain.
21
Q

Nursing Intervention: Minimizing Psychosocial Compromise

A

(1) Psychosocial issues
> Anxiety
> Social isolation
> Depression
> Loss: loss of work, loss of family role, loss of a kidney, loss of independence
> Interferes with adherence/compliance to treatment regimen
> Sleep disturbances that lead to overwhelming fatigue

(2) Overall goal is to conserve the client’s energy by balancing periods of activity with periods of rest, reducing anxiety, and reducing depression

(3) Assess
> Level of fatigue and sleep patterns
> Anxiety, depression, and coping mechanisms

(4) Explain all procedures, tests and treatments to help lessen the anxiety

(5) Form trusting relationship
> Continuity of care

Med Surg Unit 4 (8 decks)

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