ckd

Question 1

What is GFR of Stage 1 CKD?

Answer 1

> or equal to 90

Question 2

What is GFR of Stage 2 CKD?

Answer 2

60-89

Question 3

What is GFR of Stage 3A CKD?

Answer 3

45-59

Question 4

What is GFR of Stage 3B CKD?

Answer 4

30-44

Question 5

What is GFR of Stage 4 CKD?

Answer 5

15-29

Question 6

What is GFR of Stage 5 CKD?

Answer 6

<15 (or dialysis)

Question 7

Manifestations of Stage 1 CKD?

try to diagnose here

Answer 7

Asymptomatic

Question 8

Manifestations of Stage 2 CKD?

Answer 8

Asymptomatic, possible HTN

Question 9

Manifestations of Stage 3A & 3B CKD?

Answer 9

HTN, otherwise asymptomatic

Question 10

Manifestations of Stage 4 CKD?

Answer 10

Manifestations becoming apparent

- dx often occurs here

Question 11

Manifestations of Stage 5 CKD?

Answer 11

“Uremic”

Question 12

Description of Stage 1 CKD

Answer 12

Kidney damage with normal or increased GFR

Question 13

Description of Stage 2 CKD

Answer 13

Kidney damage with mild decreased GFR

Question 14

Description of Stage 3A & 3B CKD

Answer 14

Moderate decreased GFR

Question 15

Description of Stage 4 CKD

Answer 15

Severe decreased GFR

Question 16

Description of Stage 5 CKD

Answer 16

Kidney failure

Question 17

Action plan for Stage 1 CKD?

Answer 17

Diagnose and treat
CVD risk reduction
Slow progression

Question 18

Action plan for Stage 2 CKD?

Answer 18

Estimation of progression

Question 19

Action plan for Stage 3A CKD?

Answer 19

Evaluation and treatment of complications

Question 20

Action plan for Stage 3B CKD?

Answer 20

More aggressive treatment of complications

Question 21

Action plan for Stage 4 CKD?

Answer 21

Prep for renal replacement therapy ( dialysis, kidney transplant)

Question 22

Action plan for Stage 5 CKD?

Answer 22

Renal replacement therapy (if uremia present and patient desires treatment)

Question 23

ESRD: No longer maintaining F & E homeostasis =

Answer 23

Edema
Hyperkalemia
Hyperphosphatemia
Hypermagnesemia
Metabolic Acidosis

Question 24

ESRD: No longer rids the body of wastes via urine =

Answer 24

Anorexia
Malnutrition
Itching
CNS changes

Question 25

ESRD: Decreased production of erythropoietin =

Answer 25

Anemia

Question 26

ESRD: Decreased activation of Vitamin D =

Answer 26

Renal osteodystrophy

Question 27

How to prevent CKD?

Answer 27

Diagnose and control underlying problems like: HTN & DM | Early detection and treatment of CKD

Question 28

Nursing Problems r/t CKD

Answer 28

``` Excess Fluid Volume Malnourishment Risk for Injury Grieving Risk for Infection Activity Intolerance ```

Question 29

Collaborative Care for CKD (NOT Dialysis)

Answer 29

Prevention: control HTN, DM If needing contrast dye: Acetylcysteine, Force Fluids Monitor nephrotoxic drugs: NSAIDS, aminoglycosides Monitor F & E levels I&Os, daily weight Treat the symptoms

Question 30

Symptoms of CKD

Answer 30

``` Volume Overload Hyperkalemia Metabolic acidosis Mineral and Bone disorders (PO4 and Ca) HTNAnemia Dyslipidemia Malnutrition ```

Question 31

CKD Drug Therapy | Want to treat:

Answer 31

``` HTN - keep below 140/90 - ACE/ARB hyperlipidemia - keep total cholesterol less than 200 - statin Overload Hyperkalemia renal osteodystrophy Anemia hyperphosphatemia metabolic acidosis ```

Question 32

What is the renal diet?

Answer 32

Decreased protein, decreased potassium, decreased sodium (possibly decreased magnesium, decreased phosphorus) and fluid restriction

Question 33

Goals with CKD?

Answer 33

Meet nutritional needs | Meet F & E needs

Question 34

CKD: Teach patient to report:

Answer 34

``` Weight gain > 4lbs Increasing BP SOA Edema Increasing fatigue/weakness Confusion/lethargy ```

Question 35

CKD: Teach alternate ways to reduce thirst:

Answer 35

suck on ice cubes, lemon, hard candy

Question 36

Teach:

Answer 36

medications and common side effects

Question 37

CKD: Teach:

Answer 37

dietary restrictions, dietary modifications, fluid restrictions and fluid intake

Question 38

CKD: Teach importance of :

Answer 38

support and encouragement(r/t lifestyle changes, living with chronic illness, decisions about type of dialysis, etc)

Question 39

Important for CKD patients to comply with these 3 things:

Answer 39

Nutritional consult and follow up Good written resources Good support system

Question 40

ckd definition

Answer 40

Defined: Presence of kidney damage for more than 3 months with or without a GFR of < 60 An inability to: Maintain acid-base balance Remove end products of metabolism Maintain fluid and electrolyte balance

Question 41

causes end stage kidney disease

Answer 41

diabetes - 50% HTN- 30% glomerulonephritis - 10% other

Question 42

risk factors ckd

Answer 42

``` Family history Increasing age (>60) Male African American HTN, DM, smoking Overweight and obesity ```

Question 43

treat metabolic acidosis

Answer 43

``` Prototype: Sodium Bicarbonate (oral) Goals of therapy: Slow progression of CKD Prevent bone loss Improve nutritional status Administration: Initiate when plasma HCO3 is < 15 mEq/mL What lab test do we use to measure this? CO2 on BMP Titrate to a HCO3 of 18-20 Consider switch to sodium citrate if bloating is a problem ```

Question 44

tx hyperphosphatemia

Answer 44

``` Prototype: Calcium carbonate (Tums) MOA: Binds to phosphate Goals of therapy: Keep phosphate levels normal (or near normal) Reduce mortality Important for patient to take with meals Why? - helps absorption ``` Adverse effect: Hypercalcemia (monitor calcium levels)

Question 45

tx renal osteodystrophy

Answer 45

Prototype: Calcitriol (1, 25-dihydroxyvitamin D) MOA: Activated form of Vitamin D Stimulates intestinal absorption of calcium/phosphate and bone mineralization ``` Adverse effects: Hypercalcemia  Hyperphosphatemia What are signs of calcium toxicity? GI upset, bone pain, neuro effects, cardiac arrhythmias ```

Question 46

drug therapy complications

Answer 46

``` Many drugs are excreted through the kidneys What happens if drug elimination is decreased? Drug doses and frequency may be adjusted Drugs of particular concern: Digoxin Diabetic agents (glyburide, metformin) Antibiotics (Vancomycin) Opioids (morphine) ```