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6200 Adult /Older Adult II > Chronic Kidney Disease (CKD) > Flashcards

Chronic Kidney Disease (CKD) Flashcards

1
Q

Chronic Kidney Disease (CKD) occurs with a GFR of _____ for ______?

A
  • <60 mL/min for 3 months or longer
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2
Q

End-Stage Renal Disease (ESRD) occurs when a GFR of?

A

< 15

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3
Q

GFR for the stages of CKD?

A

1) 90 or greater
2) 60 - 89
3) 30 - 59
4) 15-29
5) < 15

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4
Q

Leading causes of CKD?

A
  • Diabetes (50%)

- HTN (25%)

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5
Q

Risk Factors for CKD?

A
  • Diabetes (50%)
  • HTN (25%)
  • Age
  • Obesity
  • Health Disparities
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6
Q

Clinical Manifestations of CKD/Uremia - GI?

A

anorexia, N/V, bleeding, gastritis

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7
Q

Clinical Manifestations of CKD/Uremia -Endocrine/Reprodutive

A

hyperparathyroidism, thyroid abnormalities, amenorrhea, ED

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8
Q

Clinical Manifestations of CKD/Uremia - Hematologic?

A

anemia, bleeding, infection

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9
Q

Clinical Manifestations of CKD/Uremia -Pulmonary/

A

pulmonary edema, uremic pleuritis, pneumonia

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10
Q

Metabolic Complications of CKD?

A
  • Waste product accumulation
    • As GFR ↓, BUN ↑ , creatinine levels ↑
  • Altered carbohydrate metabolism
    • ↑ triglycerides
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11
Q

Electrolyte/Acid-Base Imbalances of CKD?

A
  • Metabolic Acidosis
  • Hyperkalemia
  • Hypermagnesemia
  • Sodium – normal or altered
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12
Q

GFR is base on what factors?

A

age, creatinine, gender and race

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13
Q

CKD Diagnostic Studies?

A
  • H &P
  • Urine
    • dipstick: +protein >2x in 3 months
    • Albumin-to-creatinine ratio elevated
    • use first void
  • GFR
  • Renal ultrasound
  • Renal biopsy
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14
Q

What is the goal for BP in a patient with CKD?

A

130/80

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15
Q

Why does CKD cause anemia?

A

impaired production of erythropoietin by the kidneys

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16
Q

Which drugs should be used with caution in patients in ESRD and why?

A

ACE inhibitors and ARB’s because they decrease the GFR and increase K

17
Q

Which drug exchanges potassium for sodium in the bowels and is used to tx hyperkalemia?

A

sodium polystyrene sulfonate (Kayexalate)

18
Q

Why does CKD cause mineral/bone disorders?

A
  • low GFR = elevated serum phosphate which causes low serum Ca++, so Ca++ is taken from the bone - decreased vitamin D from the kidneys = decrease in Ca++ absorption
19
Q

Tx for CKD caused mineral/bone disorders?

A 
- Phosphate binders
use based on PTH and serum Ca+ levels (PhosLo, Caltrate)
- Vitamin D supplements/active form 
   - Calcitriol (oral/IV),
   - Paricalcitrol (IV)
   - Doxercalciferol (oral/IV)
20
Q

List of Vitamin D supplements?

A
  • Calcitriol (oral/IV),
  • Paricalcitrol (IV)
  • Doxercalciferol (oral/IV)
21
Q

Tx for CKD caused anemia?

A
  • Erythropoietin (q 2-3 wks)
  • iron supplements
    • if low plasma feritin levels
  • folic acid supplements
    • fa loss by dialysis
22
Q

Side effects of oral Iron supplements?

A
  • gastric irritation, constipation, may make stool dark in color and liquid version may stain teeth
  • phosphate binds and decreases absorption
23
Q

Nutritional Therapy: Pre-ESRD

A
  • Restrictions possible
    fluid, sodium, potassium, phosphate, protein
  • No salt substitutes (contain potassium)
24
Q

Patient Teaching - CKD?

A
  • Strict dietary and fluid restriction adherence
  • Daily weights
  • Daily BPs
  • Med Management
  • Identify S/S of:
    • fluid overload
    • electrolyte imbalance (hyperkalemia)
25
Q

When should dialysis be started on a CKD patient?

A
  • for uremia failing conservative management

- when GFR <15 mL/min

26
Q

Why is glucose used during peritoneal dialysis?

A

it is an osmotic diuretic that pulls fluid towards it

27
Q

What are the phases of PD?

A

Inflow (about 10 min)
Dwell (0.5 - 8 hrs)
Drain (15 - 30 mins)

28
Q

What should the nurse do if the patient complains of discomfort during a cycle of PD?

A

slow the rate, don’t stop it

29
Q

What is used to clean the connector port prior to PD?

A

iodine

30
Q

Is a mask necessary during the PD cycle?

A

yes, PD is a sterile procedure and anyone in the room needs to wear a mask

31
Q

Cloudy PD fluid could be indicative of what?

A

infection/peritonitis

32
Q

Peritoneal Dialysis Complications

A
  • Exit site infection
  • Peritonitis
  • Hernias
  • Lower back problems
  • Bleeding
  • Pulmonary complications
  • Protein loss
33
Q

AV Fistula or Graft Post-OP Teaching?

A
  • Do not sleep on side of affected arm

- Do not carry heavy objects with affected arm

34
Q

AV Fistula or Graft Post-OP Nursing?

A
  • Assess bruit and thrill
    every 4 hours
    • document findings
    • pulsations should be synchronous with HR
35
Q

How often should vitals be taken during hemodialysis?

A

q 30-60 mins

36
Q

Hemodialysis Complications

A
  • Hypotension due to a rapid change in volume
  • Muscle cramps due to hypotension, hypovolemia, high rate, dialysate rate
  • Loss of blood from
    tubing, access site, heparin
  • Hepatitis, high prevalence in dialysis pts
37
Q

Continual Renal Replacement Therapy (CRRT) is reserved for which patient population?

A
  • Hemodynamically unstable, fluid overload and/or sepsis/septic shock
  • can’t handle large shifts of fluid within a short period
38
Q

What is the most common cause of death in CKD?

A

cardiovascular disease

6200 Adult /Older Adult II (17 decks)

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