Chronic Kidney Disease (CKD) Flashcards
Chronic Kidney Disease (CKD) occurs with a GFR of _____ for ______?
- <60 mL/min for 3 months or longer
End-Stage Renal Disease (ESRD) occurs when a GFR of?
< 15
GFR for the stages of CKD?
1) 90 or greater
2) 60 - 89
3) 30 - 59
4) 15-29
5) < 15
Leading causes of CKD?
- Diabetes (50%)
- HTN (25%)
Risk Factors for CKD?
- Diabetes (50%)
- HTN (25%)
- Age
- Obesity
- Health Disparities
Clinical Manifestations of CKD/Uremia - GI?
anorexia, N/V, bleeding, gastritis
Clinical Manifestations of CKD/Uremia -Endocrine/Reprodutive
hyperparathyroidism, thyroid abnormalities, amenorrhea, ED
Clinical Manifestations of CKD/Uremia - Hematologic?
anemia, bleeding, infection
Clinical Manifestations of CKD/Uremia -Pulmonary/
pulmonary edema, uremic pleuritis, pneumonia
Metabolic Complications of CKD?
- Waste product accumulation
- As GFR ↓, BUN ↑ , creatinine levels ↑
- Altered carbohydrate metabolism
- ↑ triglycerides
Electrolyte/Acid-Base Imbalances of CKD?
- Metabolic Acidosis
- Hyperkalemia
- Hypermagnesemia
- Sodium – normal or altered
GFR is base on what factors?
age, creatinine, gender and race
CKD Diagnostic Studies?
- H &P
- Urine
- dipstick: +protein >2x in 3 months
- Albumin-to-creatinine ratio elevated
- use first void
- GFR
- Renal ultrasound
- Renal biopsy
What is the goal for BP in a patient with CKD?
130/80
Why does CKD cause anemia?
impaired production of erythropoietin by the kidneys
Which drugs should be used with caution in patients in ESRD and why?
ACE inhibitors and ARB’s because they decrease the GFR and increase K
Which drug exchanges potassium for sodium in the bowels and is used to tx hyperkalemia?
sodium polystyrene sulfonate (Kayexalate)
Why does CKD cause mineral/bone disorders?
- 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
Tx for CKD caused mineral/bone disorders?
- 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)
List of Vitamin D supplements?
- Calcitriol (oral/IV),
- Paricalcitrol (IV)
- Doxercalciferol (oral/IV)
Tx for CKD caused anemia?
- Erythropoietin (q 2-3 wks)
- iron supplements
- if low plasma feritin levels
- folic acid supplements
- fa loss by dialysis
Side effects of oral Iron supplements?
- gastric irritation, constipation, may make stool dark in color and liquid version may stain teeth
- phosphate binds and decreases absorption
Nutritional Therapy: Pre-ESRD
- Restrictions possible
fluid, sodium, potassium, phosphate, protein - No salt substitutes (contain potassium)
Patient Teaching - CKD?
- Strict dietary and fluid restriction adherence
- Daily weights
- Daily BPs
- Med Management
- Identify S/S of:
- fluid overload
- electrolyte imbalance (hyperkalemia)
When should dialysis be started on a CKD patient?
- for uremia failing conservative management
- when GFR <15 mL/min
Why is glucose used during peritoneal dialysis?
it is an osmotic diuretic that pulls fluid towards it
What are the phases of PD?
Inflow (about 10 min)
Dwell (0.5 - 8 hrs)
Drain (15 - 30 mins)
What should the nurse do if the patient complains of discomfort during a cycle of PD?
slow the rate, don’t stop it
What is used to clean the connector port prior to PD?
iodine
Is a mask necessary during the PD cycle?
yes, PD is a sterile procedure and anyone in the room needs to wear a mask
Cloudy PD fluid could be indicative of what?
infection/peritonitis
Peritoneal Dialysis Complications
- Exit site infection
- Peritonitis
- Hernias
- Lower back problems
- Bleeding
- Pulmonary complications
- Protein loss
AV Fistula or Graft Post-OP Teaching?
- Do not sleep on side of affected arm
- Do not carry heavy objects with affected arm
AV Fistula or Graft Post-OP Nursing?
- Assess bruit and thrill
every 4 hours- document findings
- pulsations should be synchronous with HR
How often should vitals be taken during hemodialysis?
q 30-60 mins
Hemodialysis Complications
- 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
Continual Renal Replacement Therapy (CRRT) is reserved for which patient population?
- Hemodynamically unstable, fluid overload and/or sepsis/septic shock
- can’t handle large shifts of fluid within a short period
What is the most common cause of death in CKD?
cardiovascular disease
