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Nurs 2514 final > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

1
Q

Kidney anatomy

A

Retroperitoneal in the costovertebral angle (CVA)

Capsule - outer layer, helium is the place with blood vessels and ureter sits, Medulla with pyramids, pelvis

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2
Q

Nephrons

A

Functional unit of kidney (about 1 millions)
Contains
i) Bowman capsule
Collect glomerular filtrate
ii) PCT
Reabsorption of 80% of electrolyte, 100% glucose and 70% of water
iii) Loop of Henle
Concentrates filtrate
iv) DCT
Juxtaglomerular cells - respond to drop in BP, blood volume or sodium and release renin

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3
Q

Glomerulus

A

Has fenestrations for particles to pass

Endothelial - connect with blood
Basement membrane - mesh-like connective tissue
Epithelial

Filtraction factors
Hydrostatic pressure (BP) that filters into the bowmans
Oncotic pressure + capsular hydrostatic pressure
Overall net hydrostatic pressure is stronger

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4
Q

Autoregulation

A

Too much blood pressure/flow = afferent constricts, efferent dilates to decrease GFR

Too little blood pressure/flow = afferent dilates, efferent constricts to increase GFR

LIMITATION =
Fails if the BP is below 65-70 mmHg

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5
Q

Hormone functions of the kidney

A

1) RAAS system - angiotensin 2 causes vasoconstriction, aldosterone for Na/H20 retention

2) Erythropoitein - hormone for RBC

3) Activate vitamin D

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6
Q

Abnormal kidney

A

Azotemia = accumulation of metabolic waste products in blood (eg. urea, creatinine)

Uremia = group of signs and sympotms of inadequate renal function

Oliguria - urine output less than 400 ml/day

Anuria - urine output less than 40 ml/day

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7
Q

AKI vs CKD

A

CKD - gradual onset, common cause id diabetic nephropathy and HTN
progressive and irreversible
Death from CVD

AKI - Sudden onset, common cause is acute tubular necrosis (ATN)
Reversible, cause of death is sepsis

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8
Q

Chronic kidney disease (CKD)

A

Progressive irreversible loss of nephrons
Diagnosed as under 60ml/min GFR for longer than 3 months

Hyperfiltration = remaining kidneys work harder (thatss why symptoms dont show until about 75%
of nephrons stop working)

Glomerulosclerosis = hyperfiltration cause fibrosis and scarring of the overworked nephron

Stages 1/2 likely asymptomatic
Albuminuria occurs in stage 2/3

3-4-5, 30-20-10 ml/min GFR

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9
Q

CKD signs and symptoms

A

ESRD = Final stage of kidney function

Uremia = fluid retention, electrolyte imbalance, waste product accumulation, hormone insufficiency, increase in blood lipoprotein, bone metabolism

Urea/creatinine rise = toxic

High potassium, phosphate, magnesium
Low calcium as phosphate binds to it + vit d not activated, PTH is released to resorb from bones
Sodium initially low, then comes high

Metabolic acidosis due to hydrogen not excreted and bicarb not reabsorbed
= Kaussmaul respiration

Anemia = no erytroipoitin
Platelet and wbc dysfunctional due to uremia toxicity

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10
Q

Kidney dosage

A

Note that drugs are usually excreted by the kidney. However when dyfunctional they dont excrete well and therefore the drugs can accumulate too toxic levels

Dosages must be decreased by physician

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11
Q

Captopril

A

ACE inhibitor

MOA - inhibits angiotensin 2 therefore no vasoconstriction and no water/Na retention

AE
- Dry cough because bradykinin not broken down
- First dose hypotension
- Hyperkalemia - aldosterone
- Angioedema, neutropenia

CI - pregnancy/breastfeeding, bilateral renal artery stenosis

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12
Q

Candesartan

A

ARB (like valsartan)
Note that ARNI is ARB+sacubitril (increases ANP)

MOA - block angiotensin 2 receptors
good thing is that bradykinin are broken down so no dry cough, however ACE have lower mortality rate than ARB

AE
- Like ACE except dry cough
- First dose hypotension
- Hyperkalemia

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13
Q

Atorvastatin (Lipitor)

A

HMG-CoA inhibitor

AE - generally well tolerates
HA, dizzy, GI
Mylo/rhabdomyolsis and hepatotoxicity which is rare

NC
Evening dose
Assess LFT, CK

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14
Q

Diuretics (cause im sick of writing them)

A

Furosemide - loop diuretic effecting loop of henle for diuresis even in low GFR
But cant be used in anuria

Lasix challenge - giving it even when oliguric
AE - hyponatremic, hyptension, hypokalemia, ototoxicity

Hydrochlorothiazide - works on DCT
Ineffective when CKD under 15-20 (stage 4)
AE - hyponatremic, hypokalemia, hypotension

Spironolactone - blocks aldosterone
ineffective when CKD under 30 (stage 3)

CI - anuria, addisons, hyperkalemia

AE - hyperkalemia, encrine like mentrual irregularity, deeper voice, gynecomastia

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15
Q

Erythropoietin (Epogen)

A

Hematopoietic agents

AE - HTN, CVD
CI in uncontrolled HTN

SC 3x a week, goal to have lower than normal Hgb because high risk of thrombotic events
Works in 2-3 weeks, peak in 2-3 months

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16
Q

Calcium carbonate (TUMS)

A

Binds to phosphate and excrete in stool for hyperphosphatemia

CI in hypercalcemia and severe cardiac disease

AE - constipation, GI irritation, renal calculi
DIGOXIN TOXICITY

NC - monitor blood work, 1 hour after meals as antacid as well

17
Q

Kayexalate

A

Given in hyperkalemia to get rid of potassium by exchanging it for sodium

CI - bowel obstruction as excreted in stool

AE - constipation, N/V, diarrhea, digoxin toxicity

NC - hyperkalemia, GI assessment, sandlike texture

18
Q

Ferrous sulfate

A

Iron preparation for RBC development (anemia caused by erythropiotin)

AE
Nausea, constipation
Epigastric pain
Black tarry stool (not melena)

NC - monitor HgB, GI

19
Q

Calcitriol (Rocaltrol)

A

Vitamin D activation to increase absorption of calcium

CI in hyperphosphatemia (will just keep binding to calcium), hypercalcemia

Indication - renal osteodystrophy

Adverse effect - GI upset

20
Q

Diabetic nephropathy

A

Proteinuria appears around 5-10 months
Must screen frequently

21
Q

Risk of CKD

A

METAL CANS

Metal - eg. mercury, leads

C - Chemo

A - Antibiotics like aminoglycides

N - NSAIDs

S - Solvents (eg. ethylene glycol)

22
Q

Lab work

A

Electrolyte and acid/base imbalance
Hyperkalemia
Hyponatremia early on and hypernatremia later
Hypocalcemia
Hyperphosphatemia
Metabolic acidosis
Esp in hyperkalemia
Hematological imbalance
Anemia (low erythropiotin)
Platelet dysfunction = increased bleeding, brusing
Leukocyte dysfunction = altered immune response

23
Q

Neurological effects

A

Uremic encephalopathy - fatigue, decreased conc, seizures, coma

Uremic neuropathies - tremors, asterixis, paresthesia (also occurs in diabetes, use HgBA1C to differentite)

Assess LOC, palpate extremities
Hypo/Hyperreflexia can occur due to magnesium

High BUN, metabolic acidosis

24
Q

Cardiovascular effects

A

HTN, anemia, fluid overload causes cardiorenal syndrome & HF
Accelerated artherosclerosis due to Ca/phosphate deposits
Peripheral edema

Uremic pericarditis = inflammation of pericardium sac that surrounds the heart
Chest pain and friction rub

Assess VS (temp for WBC dysfunction), JVP, dyspnea, edema, crackles, heart sounds, chest pain

EKG if needed

25
Q

Respiratory effects

A

Dyspnea from fluid can cause pulmonary edema, pleural effusion, uremic pleuritis

Secondary infections (dysfunctional WBC)

Kussmaul breathing = metabolic acidosis

CXR, sputum, C&S, CBC

26
Q

Gastrointestinal effects

A

Inflammation of mucosa
Uremic fetor - foul breath
Stomatitis
Metalic taste
N/V, Anorexia, hiccups
Constipation
Malnutrition

Uremic gastritis/colitis = bleeding/diarrhea

27
Q

Genitourinary

A

Polyuria in early stage, oliguria, then anuria

Proteinuria, casts, hematuria, pyuria

Urinalysis, urine osmolarity, creatinine clearance

28
Q

Integumentary

A

Pigment changes - yellowish colouration in yt ppl, darkening in black/bwon

Pruritis from decreased skin oils/turgor

Uremic frost = urea crystallizes on skin (rare)

Note that infections and bleeding can occur secondary to scrating

29
Q

Renal diagnostics

A

Urea, creatinine
Urea:creatinine ratio (normally 10:1)
eGFR = Screening, NOT a diagnostic
Electrolyte
CBC - HgB, platelet, WBC
HCO3

Urine tests like
Urinalysis = pH, protein, glucose, blood
Creatinine clearance = 3-24 hr Urine (staging CKD)
Urine albumin: creatinine ratio

30
Q

MSK effects

A

Renal osteodystrophy

Calcification in vascular walls = CVD disease

Muscle cramping and wakness

Loss of height, bone pain, spinal curvature

31
Q

Dialysis indication

A

AEIOU
A - Acidemia (metabolic acidosis)
E - Electrolyte imbalances with EKG changes (hyperkalemia)
I - Intoxication from med or infection
O - Overload of fluid with no response to diuretic
U - Uremic complications like pericarditis, encephalopathy, GI bleeding

32
Q

Hemodialysis

A
  • No protein diet required
  • In clinic 3x a week
  • 3-4 hours
  • Monitor VS and blood - hypotension, bleeding, infection risk
  • Through arteriovenous fistula or central line (but temporary)

Arteriovenous fistula are sensitive and can burst - never do acu check or BP in the same arm

33
Q

Peritoneal dialysis

A

-Catheter in the abdomen
- 30 min to 8 hours

  • Increase protein intake due to protein loss in dialysate
  • Keep access site clean, monitor infection, avoid constipation
  • Monitor for outflow obstruction, infection, back/abdomen pain

Nurs 2514 final (12 decks)

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