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Exam 4 > Chronic Kidney Disease/chronic renal failure > Flashcards

Chronic Kidney Disease/chronic renal failure Flashcards

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1
Q

In the early stages of chronic kidney disease the GFR will be about ____% and the patient is usually ___ with normal ___ and ___ levels.

A
  • -50%
  • -asymptomatic
  • -BUN and creatinine
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2
Q

With end stage renal disease the GFR is less than ______%.

What therapy should be initiated?

A
    • <10-15%

- -renal replacement therapy

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3
Q

What three insults can further reduce kidney fx.?

A
  • -infection
  • -dehydration
  • -nephrotoxic drugs
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4
Q

What are the #1 and #2 RF for chronic kidney disease?

What race is this more prevalent in?

A
  • -HTN (#1 cause)
  • -Diabetes (#2 cause)
  • -African Americans (4x’s more likely)
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5
Q

This cause of chronic kidney disease is lead by increased glomerular flow rate leading to hyperfiltration which causes thickening and sclerosis of basement membrane leading to a reduced GFR.

A

Diabetic Nephropathy

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6
Q

Chronic issues with this condition can lead to ischemia, glomerular destruction, and tubular nephropathy due to sclerosis and narrowing of renal arteries leading to reduced blood flow.

A

Hypertensive Nephrosclerosis

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7
Q

this condition is characterized by a chronic infection associated with vesicoureteral reflux that leads to scarring and deformity of renal calyces and pelvis resulting in intrarenal reflux and nephropathy.

A

Chronic Pyelonephritis

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8
Q

This condition is characterized by multiple bilateral cysts that gradually compress renal tissue, impairing renal perfusion.

A

Polycystic Kidney disease

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9
Q

Ways to prevent chronic kidney disease are:

A
  • -Low Na+ diet
  • -exercise
  • -don’t smoke
  • -limit alcohol
  • -lower BP
  • -Control diabetes
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10
Q

Stage 1 of CKD will present with a GFR of ____

A

> 90 mL/min/1.73 m^2

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11
Q

Stage 1 of CKD will have manifestations such as:

A
  • **Asymptomatic
  • **Normal/Increased GFR
  • -Normal BUN, Creatinine
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12
Q

Stage 2 of CKD will present with a GFR of ____

A

60-89 mL/min/1.73 m^2

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13
Q

Stage 2 manifestations are:

A

–Asymptomatic
***possible HTN
(blood work generally normally)

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14
Q

Stage 3 of CKD will present with a GFR of____

A

30-59 mL/min/1.73 m^2

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15
Q

Stage 3 manifestations include:

A
  • *HTN
  • *possible anemia, fatigue, anorexia, malnutrition, bone pain
  • *Slightly elevated BUN and creatinine
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16
Q

Stage 4 of CKD presents with a GFR of____

A

15-29 mL/min/1.73 m^2

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17
Q

Stage 4 manifestations include:

A
  • -HTN
  • -anemia
  • -malnutrition
  • -altered bone metabolism
  • -edema
  • **metabolic acidosis
  • **hypercalcemia
  • **possible uremia
  • **azotemia
    • increased BUN and creatinine
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18
Q

Stage 5 of CKD will present with a GFR of ____

A

< 15 mL/min/1.73 m^2

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19
Q

Stage 5 manifestations are:

A
  • ** end stage renal disease
  • **kidney failure
  • **azotemia
  • **uremia
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20
Q

This manifestation is when there is urea present in the blood. This alters fluid and electrolyte balance and causes an accumulation of metabolic wastes that effect other organ systems.

A

Uremia

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21
Q

Uremia may have manifestations of (present with flu like symptoms)…

A
  • -N/V
  • -Fatigue
  • -weakness, lethargy
  • -confusion
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22
Q

Impaired filtration in the kidneys can lead to what two symptoms?

A
  • -proteinuria

- -hematuria

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23
Q

When salt and water are poorly conserved it can lead to risk for….

A

Dehydration

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24
Q

What fluid and electrolyte imbalances will the patient have?

What acid/base imbalance will they have?

A
  • *Hyperkalemia
  • *Hyperphosphatemia, and hypocalcemia (opposites)
  • *Hypermagnesemia (advanced renal failure)

**Metabolic acidosis (kussmaul respirations)

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25
clinical manifestation of hyperkalemia are:
- -Muscle weakness - -Parasthesia - -ECG changes (tall T-waves)
26
A patient will have issues with their cardiac system due to perfusion complications. What signs may we see in someone with CKD, when it comes to the heart?
- -HTN - -Edema - -Heart failure - -Pericarditis
27
What is a complication of pericarditis that occurs when inflammatory fluid in pericardial sac interferes with ventricular filling and CO?
Cardiac Tamponade
28
A patient may present with this sign due to the decline of eryhtropoietin release.
anemia
29
Signs of anemia include:
- -weakness - -fatigue - -pallor
30
A person with Anemia is at risk for bleeding due to platelet fx. They may present with...
- -nosebleeds (epistaxis) | - -GI bleed
31
A person with CKD is at risk for Infection due to a decrease in platelet fx. Acute inflammatory response and delayed hypersensitivity reaction responses are affected leading to ____ which can delay diagnosis.
Suppressed fever
32
The GI system is affected and the patient may present with...
- -anorexia - -Ulcerations (risk GI bleed) - -Uremic fetor
33
--What is the symptom called that is caused by uremia build up which causes urine smelling breath. --What care is important when a pt. presents with this?
- -Uremic fetor | - -mouth care before meals (may contribute to anorexia because of metallic taste)
34
Early (effects CNS) neurological symptoms include:
- -fatigue, hard time concentrating - -insomnia - -seizures - -coma
35
Advanced neuro symptoms include:
- -RLS (restless leg syndrome) - -Paresthesia - -peripheral neuropathy
36
Decreased calcium absorption and vitamin D synthesis in CKD can lead to GI tract issues such as:
* **Renal Rickets (due to low Vit. D and Calcium) * **osteomalacia (soft bones) - -osteoporosis
37
Patients that have Renal Rickets, Osteomalacia, or osteoporosis will have bone pain, muscle weakness and may be at risk for...
Spontaneous bone fractures
38
If uric acid levels are increased, this puts the patient at risk for...
Gout
39
In uremia, tissues become resistant to effects of insulin, which can cause...
Glucose intolerance
40
A pt. with CKD may have reduced reproductive fx. They may have..
- -reduced sperm - -preterm labor/miscarriage (most won't carry to term) - -irregular periods
41
High levels of urea in the sweat causes...
Uremic frost (crystals on the skin)
42
Diagnostic tests include:
- -UA - -BUN, creatinine - -GFR (reduced) - -Electrolytes- Na+ (down), K+ (up), Phosphate (up), Calcium (down) - -ABG's (Metabolic acidosis) - -CBC (RBC's and platelets reduced) - -Renal ultrasound (size of kidneys) - -Kidney Biopsy (determines acute or chronic)
43
Meds that can be given for someone with CKD are:
- -antihypertensives * *Diuretic (furosemide) - -Acidosis (sodium bicarb) - -Calcium Carbonate * *Aluminum hydroxide (treat acute Hyperphosphatemia)
44
Restricting protein reduces the progression of CKD. The daily protein intake should be about...
0.6 g/kg (need protein for tissue repair)
45
The pt. should restrict potassium and phosphorus intake. Potassium should be less than...
<60-70 day (normal is 100)
46
Avoid foods high in phosphorus such as:
- -eggs - -dairy - -meat
47
The patient will need this form of treatment due to reduced kidney function. It is done by replacing the function of the kidneys and there are 2 types.
Dialysis (hemodialysis or Peritoneal dialysis)
48
The treatment of choice for a patient with CKD is
Kidney transplant
49
If a pt. needs a kidney transplant the kidney will be removed from the donor when the patient has been confirmed brain dead. It is preserved by hypothermia and must be transplanted within...
24-48 hours
50
When a patient needs a kidney transplant they will be given immunosuppressant drugs to minimize rejection. This drug is...
--Azathioprine or Mycophenolate (In combination with prednisone)
51
Nephrectomy is a major surgery and the donor faces ___ ___ for the remaining kidney in the future. The nurse should provide... The nurse should monitor for....
- -Kidney failure - -emotional support to the donor and recipient - -monitor for infection
52
This glucocorticoid can manage an acute rejection episode.
Methylprednisolone
53
Manifestations of chronic rejection include progressive...
- -Azotemia - -proteinuria - -HTN
54
Methylprednisolone can cause severe reactions such as:
chills, fever, Hypotension, headache, pulmonary edema
55
Three Nursing Dx. for someone with CKD is:
- -Ineffective tissue perfusion (renal) - -Excess fluid volume - -Risk for infection
56
The nurse should promote tissue perfusion by implementing these things in the care plan...
- -Monitor I and O's, VS, weight, Respirations - -Place pt. on fluid restriction - -Allow rest periods (cluster care)
57
The nurse should promote a balanced nutrition. The patient may be anorexic due to the uremia (metallic taste) which makes them not want to eat. What should the nurse implement in the care plan?
- -Weigh the pt. daily - -Give antiemetics 30-60 min before meals - -Provide mouth care prior to meals - -give small meals
58
If the patient is to receive parenteral nutrition, they are at risk for...
- -infection | - -hyperglycemia
59
The nurse should prevent infection in the pt. What should the nurse implement in the care plan?
- -hand hygiene - -monitor VS - -Monitor WBC's - -Limit visitors
60
when a patient goes through dialysis the nurse must monitor the dialysate return. It should be..
clear (cloudy indicate peritonitis)
61
Good respiratory hygiene can be promoted through...
- -Deep breathing exercises - -coughing - -position changes

Exam 4 (10 decks)

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