Chronic Kidney Disease (CKD)

Question 1

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

Answer 1

• <60 mL/min for 3 months or longer

Question 2

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

Answer 2

< 15

Question 3

GFR for the stages of CKD?

Answer 3

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

Question 4

Leading causes of CKD?

Answer 4

• Diabetes (50%)

- HTN (25%)

Question 5

Risk Factors for CKD?

Answer 5

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

Question 6

Clinical Manifestations of CKD/Uremia - GI?

Answer 6

anorexia, N/V, bleeding, gastritis

Question 7

Clinical Manifestations of CKD/Uremia -Endocrine/Reprodutive

Answer 7

hyperparathyroidism, thyroid abnormalities, amenorrhea, ED

Question 8

Clinical Manifestations of CKD/Uremia - Hematologic?

Answer 8

anemia, bleeding, infection

Question 9

Clinical Manifestations of CKD/Uremia -Pulmonary/

Answer 9

pulmonary edema, uremic pleuritis, pneumonia

Question 10

Metabolic Complications of CKD?

Answer 10

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

Question 11

Electrolyte/Acid-Base Imbalances of CKD?

Answer 11

• Metabolic Acidosis
• Hyperkalemia
• Hypermagnesemia
• Sodium – normal or altered

Question 12

GFR is base on what factors?

Answer 12

age, creatinine, gender and race

Question 13

CKD Diagnostic Studies?

Answer 13

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

Question 14

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

Answer 14

130/80

Question 15

Why does CKD cause anemia?

Answer 15

impaired production of erythropoietin by the kidneys

Question 16

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

Answer 16

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

Question 17

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

Answer 17

sodium polystyrene sulfonate (Kayexalate)

Question 18

Why does CKD cause mineral/bone disorders?

Answer 18

• 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

Question 19

Tx for CKD caused mineral/bone disorders?

Answer 19

- 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)

Question 20

List of Vitamin D supplements?

Answer 20

• Calcitriol (oral/IV),
• Paricalcitrol (IV)
• Doxercalciferol (oral/IV)

Question 21

Tx for CKD caused anemia?

Answer 21

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

Question 22

Side effects of oral Iron supplements?

Answer 22

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

Question 23

Nutritional Therapy: Pre-ESRD

Answer 23

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

Question 24

Patient Teaching - CKD?

Answer 24

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

Question 25

When should dialysis be started on a CKD patient?

Answer 25

- for uremia failing conservative management | - when GFR <15 mL/min

Question 26

Why is glucose used during peritoneal dialysis?

Answer 26

it is an osmotic diuretic that pulls fluid towards it

Question 27

What are the phases of PD?

Answer 27

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

Question 28

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

Answer 28

slow the rate, don't stop it

Question 29

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

Answer 29

iodine

Question 30

Is a mask necessary during the PD cycle?

Answer 30

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

Question 31

Cloudy PD fluid could be indicative of what?

Answer 31

infection/peritonitis

Question 32

Peritoneal Dialysis Complications

Answer 32

- Exit site infection - Peritonitis - Hernias - Lower back problems - Bleeding - Pulmonary complications - Protein loss

Question 33

AV Fistula or Graft Post-OP Teaching?

Answer 33

- Do not sleep on side of affected arm | - Do not carry heavy objects with affected arm

Question 34

AV Fistula or Graft Post-OP Nursing?

Answer 34

- Assess bruit and thrill every 4 hours - document findings - pulsations should be synchronous with HR

Question 35

How often should vitals be taken during hemodialysis?

Answer 35

q 30-60 mins

Question 36

Hemodialysis Complications

Answer 36

- 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

Question 37

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

Answer 37

- Hemodynamically unstable, fluid overload and/or sepsis/septic shock - can't handle large shifts of fluid within a short period

Question 38

What is the most common cause of death in CKD?

Answer 38

cardiovascular disease