CHRONIC RENAL Flashcards
What is the 5th stage of kidney chronic kidney disease?
= CRF or ESRD
when enough kidney damage to require renal replacement therapy on a permanent basis
= stage of CKD
What factors affect decline of renal fx in kidney disease?
- The rate of decline in renal fx relates to the underlying disorder, the urinary excretion of protein, and the presence of HTN
- Tends to progress more rapidly in those who exrete large amounts of protein or have high BP
manifestations of ESRD?
• ESRD affects every body system→many mnfts whose severity depends on the degree of renal impairment, other underlying conditions, and pts age
- Can have peripheral neuropathy, Restless leg syndrome and burning feet result
- Severe pain and discomfort
- These mnfts most likey d/t the acum of uremic waste products
____is predominant cause of death for CRF pt
Cardiovascular disease
Which is more sensitive detector of kidney fx, creatinine or BUN?
• Creatinine is more sensitive indicator of renal fx than BUN as BUN is affected by protein intake in diet, catabolism (tissue and RBC breakdown), parenteral nutrition, and meds like corticosteroids
What changes r/t H2O + lytes occur with kidney disease?
• Kidneys cant respond properly by conc or diluting urine, change lytes
• Some pts retain sodium with inc rsk of edema, heart failure and HTN.
Can also have HoTN nd hypovolemia d/t sodium loss. Vomiting and diarrhea can worsen sodium and water loss and→worse uremic state
Why anemia in CRF?
What symptoms if prfound?
d/t Inadequate erythropoietin production, shorter RBC lifespan, nutritional deficiency and pt tendency to bleed (esp from GI tract)
fatigue, angina, SOB
Calcium and phosphorous imbalance in CRF?
What complications result from this?
- Calcium and phosphate have reciprocal relationship. With dec filtration through glomerulus of the kidney: inc in serum phosphate level and dec in serum calcium, which inc parathyroid –> calcium leaves the bone → bone changes and calcification of the major vessels.
- Uremic bone disease develops (aka renal osteodystrophy)
CKD complications
- Hyperkalemia
- Pericarditis, pericardial effusion + pericardial tamponade
- HTN
- Anemia
• Bone disease and metastatic and vascular calcifications
Why pericarditis, etc?
d/t retention of uremic waste products and inadequate dialysis
Why HTN?
d/t sodium and water retention and malfunction of the RAA
How is CKF primarily managed?
Mgmt is accomplished mostly through meds and diet therapy although dialysis may also be nec to dec the level of uremic waste products in blood and control lyte balance
Pharmacology for CKF?
- calcium supplements
- phosphate binding agents
- antihypertensives
- cardiac meds
- antiseizure meds
- erythropoietin Eprex
WHat sort of antiHTN and cardiac meds may be needed for CKF?
o May need fluid restriction, diuretics, regular hypertensive meds, digoxin or dobutamine etc
How is metb acidosis treated?
The metb acidosis usually produces no symptoms and requires no tx but bicarb supplement or dialysis may be nec to correct the acidosis
WHy antiseizure meds in CKF?
Which are used?
What other precaution should the nurse take in this regard?
o Neuro abn can occur so watch pt for early evidence of twitching, headache, delirium, or seizure activity
o IV diazepam or phenytoin is usually given to control seizure.
o Padded bed rails
WHy Eprex given?
is recombinant human EPO
When is dialysis usually initiated for
• Usually initiated when pt cannot maintain a reasonable lifestyle with conservative tx
Nursing diagnoses/problems for CRF:
- Excess fluid volume r/t dec urine output, dietary excess, retention of sodium nd water.
- Imbalanced nutrition: less than body requirements r/t anorexia, N, V, dietary restrictions, ad altered oral mucous membranes
- Deficient knowledge regarding condtion and tx
- Activity intolerance r/t fatigue, anemia, retention of waste products and dialysis procedure
- Risk for situational low self-esteem r/t dependency, role changes, change in body image, and change in sexual function
Important nursing interventions for pt with CKF?
- Assess fluid status and identify sources of imbalance
- implement diet to ensure proper nutritional intake within the limits of the tx regimen
- promote positive feelings by encouraging inc self care and greater independence
- Teaching is important.
- Emotional support is necessary d/t numerous changes.
Collaborative problems of CKF?
(complications!)
- Hyperkalemia
- Pericaridtis
- Pericardial effusion
- Pericardial tamponade
- HTN
- ANemia
- Bone disease + metastatic calcifications
Nursing interventions for dietary imbalances
o Assess nutritional status: wt changes, lab values (lytes, BUN, creatinine, protein, transferring, iron levels). Diet history, food preferences, calorie counts
o Assess for factors contributing to altered nutritional intake eg anorexia, N, V, unpalatable diet, depression, lack of understanding, stomatitis
o Provide pt food preferences while adhering to restrictions
o Promote intake of high biologic protein foods: egg, diary, meats (complete proteins nec for growth and healing)
o Enc high calorie, low protein, low sodium, low K snaks bet meals
o Alter med schedule so theyre not right before meals as this can cause anorexia and fullness
o Give written list of foods allowed and suggestions for improving their taste without use of sodium or potassium
o Daily wt
o Assess for evidence of inadequate protein intake eg edema, delayed wound healing, dec serum albumin levels
Nursing inteventions for pt activity intolerance
o Look for factors that contribute to activity intolerance as above in diagnosis and depression, lyte imbalances, fluid imbalances
o Promote independence in self care activities as tolerated, assist if tired
o Enc alternating activity with rest
o Enc pt to rest after dialysis