Chronic Renal Disease (Gas#7) Flashcards
Uremia
intoxication caused by the bodys accumulation of metabolic by-products normally excreted by healthy kidneys
Non traditional risk factors of CRD
inflammation of kidneys (lupus), mineral-bone disorder that causes demineralization of bone, Anemia
What is BUN a measurement of
nitrogenous waste product of protein metabolism
what ratio do we look at when looking for renal function?
Bun & creatinine
what is creatinine a measurement of
a waste product of muscle metabolism
what follows diabetes as a major cause of ESRD?
HTN
s/s of patients at RISK for decreased renal reserve
nephrons that are unaffected compensate for the nephrons that stopped working, kidney function is 75+, BUN &Creatinine are normal, client is asymptomatic
s/s of patients who have renal insufficiency
kidney function is 15-74%, decreased urine concentration & erythropoeitin 9youll see anemia), polyurina, azotemia, HTN, increased BUN&Creatinine
s/s of patients who have renal failure
kidney function is <15%, sharp increase in BUN&Creatinine, hypocalcemia, increasing azotemia, metabolic acidosis, fluid overload, possible blood in urine
s.s of patients who have ESRF
kidney function <5%, kidney atrophy &fibrosis, overt uremia, must have dialysis
s/s of early uremia
N/V, weakness, fatigue, symptoms dismissed as viral infection or flu
2 major things you have to worry about if pt has uremia
fluid volume excess & metabolic acidosis
s/s of uremia progressing
decreased calcium & increased phosphate, bone tenderness, muscle weakness, pain, spontaneuos fractures, neurologic effects, tetany, seizures, restless leg syndrome
skin s/s of CRD
pale, grayish-bronze color, dry scaly, severe itching, bruise easily, uremic frost
eye s/s of CRD
visual blurring, blindness
fluid & electrolyte s/s of CRD
volume expansion & fluid overload, change in urine specific gravity, metabolic acidosis
what things will you see on an EKG with a K+ level of 6-7.5?
absent pwave & peaked twave
what things will you see on an EKG with a K+ level of >7.5
vtach or vfib
treatment for hyperkalemia?
kayexalate with sorbitol, IV calcium, Glucose &insulin &bicarbonate
with hperphosphatemia, is calcium levels increased or decreased
decreased, parathyroid hormone releases ca++ from the bone & deposits it in the kidneys, lungs. muscles, heart & eyes
GI s/s of CRD
uremic fetor (oder), anorexia, n/v, GI bleeding
hematologic s/s of CRD
anemia, platelet dysfunction
Treatment for Anemia b/c of CRD
Epogen, folic acid, iron supplements, multivitiam, transfusions
treatment for HTN b/c of CRD
diuretics, ACE inhibitors (or any antihypertensive)
nervous system s/s of CRD
mood swings, impaired judgement, inability to concentrate & perform simple math functions, trmors, twitching, convulsions, peripheral neuropathy
With ESRD, which nervous system s/s is a big one for ESRD
depression
musculoskeletal s/s of CRD
muscle cramps,, soft tissue calcifications, weakness, renal osteodystrophy
heart/lungs s/s of CRD
HTN, CHF, pericarditis, pulmonary edema, pleural effusion, atherosclerotic vascular disease, dysrhythmias
Endocrine s/s of CRD
erythropoietin production decreased, hypothyroidism, insulin resistance, growth hormone decreased, gonadal dysfunction, parathyroid hormone & vit D, hyperlipidemia
which electrolytes are highly effected by diuretics
sodium, magnesium, calcium, potassium
Onset of IV diuretics
10-15 min
onset of PO diuretics
30-45 mins
diuretics can make you metabolic acidosis or alkalosis?
metabolic alkalosis
what are you at risk for when pushing lasix too fast?
toxicity
side effects of diuretic: spirolactone
hyperkalemia, gynocomastia, hyponatremia
usually if K+ is low what else is low
mg
what can be given to correct acidosis
sodium bicarb or calcium carbonate may be given
what can be given to correct hyperphosphatemia/hypocalcemia
phosphate binders (give with meals) or vitamin D supplements to increase calcium absorption
protein recommendations for CRD
moderate protein slow progression of CRD & reduces uremic symptoms
carb recommendations for CRD
carb intake is increased to maintain energy requirements
water recommendations for CRD
limited to 1-2 liters/day; if dry mouth give hard candy or cough drops
sodium recommendations for CRD
2 grams/day
restrictions for GFR that is <10-20
K+ and phosphorus is restricted, avoid salt substitutes b/c they are high in K+ & phosphorus
what are salt substitutes high in?
K+ & phoshorus
Polycystic kidney disease
hereditary disease, cysts cover kidneys, renal blood vessels & nephrons are obstructed & compressed & functional tissue is destroyed & replaced with fluid filled cysts
in Autosomal dominant polycystic kidney disease what percentage of their kids will have it?
50%
Autosomal recessive polycystic kidney disease
present at birth. RARE
s/s of PKD
abd/flank pain, hematuria, proteinuria,polyuria, nocturia, HTN from isruption of renal vessels, UTI & renal calculi are common
symptoms of PKD usually start at what age?
40-50
