ckd Flashcards
What is GFR of Stage 1 CKD?
> or equal to 90
What is GFR of Stage 2 CKD?
60-89
What is GFR of Stage 3A CKD?
45-59
What is GFR of Stage 3B CKD?
30-44
What is GFR of Stage 4 CKD?
15-29
What is GFR of Stage 5 CKD?
<15 (or dialysis)
Manifestations of Stage 1 CKD?
try to diagnose here
Asymptomatic
Manifestations of Stage 2 CKD?
Asymptomatic, possible HTN
Manifestations of Stage 3A & 3B CKD?
HTN, otherwise asymptomatic
Manifestations of Stage 4 CKD?
Manifestations becoming apparent
- dx often occurs here
Manifestations of Stage 5 CKD?
“Uremic”
Description of Stage 1 CKD
Kidney damage with normal or increased GFR
Description of Stage 2 CKD
Kidney damage with mild decreased GFR
Description of Stage 3A & 3B CKD
Moderate decreased GFR
Description of Stage 4 CKD
Severe decreased GFR
Description of Stage 5 CKD
Kidney failure
Action plan for Stage 1 CKD?
Diagnose and treat
CVD risk reduction
Slow progression
Action plan for Stage 2 CKD?
Estimation of progression
Action plan for Stage 3A CKD?
Evaluation and treatment of complications
Action plan for Stage 3B CKD?
More aggressive treatment of complications
Action plan for Stage 4 CKD?
Prep for renal replacement therapy ( dialysis, kidney transplant)
Action plan for Stage 5 CKD?
Renal replacement therapy (if uremia present and patient desires treatment)
ESRD: No longer maintaining F & E homeostasis =
Edema Hyperkalemia Hyperphosphatemia Hypermagnesemia Metabolic Acidosis
ESRD: No longer rids the body of wastes via urine =
Anorexia
Malnutrition
Itching
CNS changes
ESRD: Decreased production of erythropoietin =
Anemia
ESRD: Decreased activation of Vitamin D =
Renal osteodystrophy
How to prevent CKD?
Diagnose and control underlying problems like: HTN & DM
Early detection and treatment of CKD
Nursing Problems r/t CKD
Excess Fluid Volume Malnourishment Risk for Injury Grieving Risk for Infection Activity Intolerance
Collaborative Care for CKD (NOT Dialysis)
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
Symptoms of CKD
Volume Overload Hyperkalemia Metabolic acidosis Mineral and Bone disorders (PO4 and Ca) HTNAnemia Dyslipidemia Malnutrition
CKD Drug Therapy
Want to treat:
HTN - keep below 140/90 - ACE/ARB hyperlipidemia - keep total cholesterol less than 200 - statin Overload Hyperkalemia renal osteodystrophy Anemia hyperphosphatemia metabolic acidosis
What is the renal diet?
Decreased protein, decreased potassium, decreased sodium (possibly decreased magnesium, decreased phosphorus) and fluid restriction
Goals with CKD?
Meet nutritional needs
Meet F & E needs
CKD: Teach patient to report:
Weight gain > 4lbs Increasing BP SOA Edema Increasing fatigue/weakness Confusion/lethargy
CKD: Teach alternate ways to reduce thirst:
suck on ice cubes, lemon, hard candy
Teach:
medications and common side effects
CKD: Teach:
dietary restrictions, dietary modifications, fluid restrictions and fluid intake
CKD: Teach importance of :
support and encouragement(r/t lifestyle changes, living with chronic illness, decisions about type of dialysis, etc)
Important for CKD patients to comply with these 3 things:
Nutritional consult and follow up
Good written resources
Good support system
ckd definition
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
causes end stage kidney disease
diabetes - 50%
HTN- 30%
glomerulonephritis - 10%
other
risk factors ckd
Family history Increasing age (>60) Male African American HTN, DM, smoking Overweight and obesity
treat metabolic acidosis
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
tx hyperphosphatemia
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)
tx renal osteodystrophy
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
drug therapy complications
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)
