Chronic Kidney Disease

Question 1

CKD - Pathophysiology

Answer 1

• Progressive, irreversible disorder; kidney function does not recover
• Can turn into ESRD
• Azotemia
  > build up of nitrogen-based wastes in blood
• Uremia
  > azotemia with symptoms: muscle wasting/cramps, fatigue, N/V, tremor, anorexia, metabolic acidosis, dyspnea/shallow RRs
• Hemolytic Uremic Syndrome
  > RBC destruction

Question 2

CKD - Risk Factors/Etiology

Answer 2

• Diabetes
• HTN
• Glomerulonephritis
• Pyelonephritis
• PKD
• Renal cx
• Hereditary conditions
  combination of morbidity incrs the risk

Question 3

CKD - Diagnostics

Answer 3

• Lab assessment
  > Cr (0.6-1.3)
  > BUN (10-20)
  > Potassium (3.5-5.0)
  > GFR
• Imaging Assessment
  > kidney or CT scan

Question 4

Glomerular Filtration Rate (GFR) - Stage I

Answer 4

• At risk; normal kidney function, but urine findings indicate kidney disease
• > 90mL/min/1.73m
• Screen for risk factors & manage care to reduce:
  > unctrolled HTN
  > diabetes w/ poor control
  > congenital or acquired urinary tract abn.
  > fam hx
  > exposure to nephrotoxic substances

Question 5

Glomerular Filtration Rate (GFR) - Stage II

Answer 5

• Slightly reduced kidney function
• 60-89mL/min/1.73m
• Focus on reduction of risk factors

Question 6

Glomerular Filtration Rate (GFR) - Stage III

Answer 6

• Moderately reduced kidney function
• 30-59mL/min/1.73m
• Implement strategies to slow disease progression

Question 7

Glomerular Filtration Rate (GFR) - Stage IV

Answer 7

• Severely reduced kidney function; a noticeable jaundice can occur, particulary around eyes
• 15-29mL/min/1.73m
• Manage complications
• Discuss pt preferences & values
• Educate abt options & prepare for renal replacement therapy

Question 8

Glomerular Filtration Rate (GFR) - Stage V

Answer 8

• End-stage kidney disease
• <15mL/min/1.73m
• Implement renal replacement therapy or kidney transplantation

Question 9

CKD - Medical Surgical Treatment

Answer 9

• Dialysis
• Diuretics/fluid restrictions
• Lab assessments: electrolytes, BUN, Cr, BNP (shows how much fluid)
• Clinical assessments: fluid vol, HTN, HF
• Renal replacement therapies
• Anemia treatments: epogen
• Antihypertensives(ACE-I)/Electrolyte replacement
• Kidney transplant

Question 10

CKD - Nursing Diagnosis

Answer 10

• Excess fluid volume
• Risk for elect imbalance
• Monitor for comps
• Dcrd cardiac output
• Risk for infection
• Risk for injury
• Impaired urinary elmination

Question 11

CKD - Nursing Interventions

Answer 11

• Fluid overload/Daily weight
• Lab values
  > BUN, Cr, elect
• Vital signs
  > for HTN
• Heart(for failure), lungs(for fluid), neurological(for HTN enceph & build up of nitrogenous waste)
• Fluid/Na restrictions
• Dietary restrictions
• Cardiac monitor
  > for peaked T waves
• Kussmaul respiration
  > deep, rapid breaths trying to blow off metabolic acid

Question 12

CKD - Nursing Education

Answer 12

• Antibiotic before dentistry
• Medication dose reduction
  > antacids w/ magnesium
  > antibiotics
  > antidiabetic
  > insulin
  > opioids
  > anticoags
• Diet
  > low protein, sodium, potassium
  > high calories (don’t want protein to break down)
• Fluid restriction
• Smoking cessation
• Limit alcohol
• Exercise
• Control risk factors
• Treatment regimen
  > pt depression
  > treatment refusal

Question 13

Peritoneal Dialysis

Answer 13

• Cath placed in abdominal cavity
• Semipermeable membrane allows exchange
• Complications:
  > peritonitis (if occurs twice must switch to hemodialysis)
  > leakage
  > bleeding
• Nursing
  > maintain sterility
  > monitor output; bloody or straw color
  > measure output

Question 14

Hemodialysis & Continuous Renal Replacement Therapy (CRRT)

Answer 14

• CRRT form of hemodialysis
  > CRRT in ICU only
  > Hemodialysis in blocks of hours usually 3x/wk
• Check Bruit over AV graft
  > listen for whoosh
• Dialysis cath
  > safe & sterile dressing
  > never use for IV infusions
• Pharm therapy
  > dosage adjustments
• Nutritional/fluid therapy
• Psychosocial needs