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NURS 232 > CKD > Flashcards

CKD Flashcards

1
Q

Primary Kidney Function

A

Filtration
Regulate fluid, electrolyte and acid-base balance in the body
Secretion

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2
Q

Secondary kidney function

A

Help regulate

BP
bone density
erythropoiesis (production of RBC)

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3
Q

Location of kidneys

A

below the rib cage

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4
Q

Renal artery/vein function

A

blood enters through the artery and then the vein returns the reabsorbed nutrients back into the bladder

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5
Q

Three main steps of urine formation

A

glomerular filtration, reabsorption, and secretion

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6
Q

Glomerular filtration

A

Glomerulus (part of nephrons) = site of blood filtration –> water and solutes leave the blood stream and enter the filtration system

network of capillaries that

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7
Q

Reabsorption

A

Filtrate (glomerulus) contains waste and other substances such as essential ions, glucose, amino acids and smaller proteins .
After filtration, goes to renal tubule and water and needed nutrients goes back into blood stream.

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8
Q

Secretion

A

Waste ions and hyrdogen ions pass from the capillaries into the renal tubule (create urine).
Goes from nephron tubule to the collecting duct

Out kidneys - renal pelvis - ureter - bladder

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9
Q

Urine

A

95% water

5% waste

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10
Q

Nitrogenous wastes in Urine

A

urea, creatinine, ammonia, uric acid

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11
Q

Ions in urine

A

Na, K, H, Ca

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12
Q

Kidney disease is irreversible and progressive (T/F)

A

T

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13
Q

CKD can be defined as…

A

kidney damage

GFR , 60mL/minute/1.73 m for 3 months or longer

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14
Q

What does the end result/progression look like?

A

nephrons hypertrophy to compensate

systemic disease involving every organ

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15
Q

Causes of ESRD

A

DM

Renal vascular disease

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16
Q

ESRD treatment

A

Renal replacement therapy
- Hemodialysis
- Peritoneal dialysis
Transplant

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17
Q

Dialysis

A

A technique in which substances move from the blood through a semipermeable membrane (dialyzer) and into a dialysis solution (dialysate)

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18
Q

Hemodialysis (HD)

A

Removes waste products and excess fluid from the blood using a machine which
pumps the blood through an artificial semipermeable membrane called a dialyzer or an artificial kidney

3 sessions a week at a clinic or trained at home (equipment)

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19
Q

Peritoneal Dialysis (PD)

A

Blood is cleansed within the peritoneal cavity everyday by the patient’s
themselves. A surgically inserted catheter is placed in the abdomen

People with AKI or ESRD

CAPD = no machine, 3-5 times a day
APD = cycler machine at night while sleeping
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20
Q

Retained substances

A 
Urea
Creatinine
Phenols
Hormones
Electrolytes
Water
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21
Q

Uremia

A

Build up of toxins in the body (kidney failure) - can not filter out and secrete

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22
Q

Manifestations

Urinary System

A

Polyuria
Oliguria
Anuria

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23
Q

Polyuria

A

Excessive urination

Early stages

results from inability of kidneys to concentrate urine.
occurs most often at night (nocturia).
specific gravity fixed around 1.010.

(if they are on dialysis, are they making urine?)

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24
Q

Oliguria

A

<400mL daily of urine

shows worsening CKD

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25
Q

Anuria

A

Urine output <40mL/day

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26
Q

Manifestations

Metabolic

A

Waste product accumulation

Altered carbohydrate metabolism

Defective carbohydrate metabolism

Elevated triglycerides

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27
Q

Waste product accumulation

A

Decreased GFR, increased BUN and creatinine levels

28
Q

BUN

A

measures urea levels in the blood (waste products)

29
Q

Altered carbohydrate metabolism

A

caused by impaired glucose use from cellular insensitivity to the normal action of insulin

30
Q

Defective carbohydrate metabolism

A

Insulin is dependent on kidneys for excretion

people with DM might need more insulin when uremic

31
Q

Elevated triglycerides

A

Hyperinsulinemia stimulates hepatic production of triglycerides

Altered lipid metabolism (decreased levels of enzyme lipoprotein lipase - breaks down lipoproteins)

32
Q

Manifestations

Electrolyte/Acid-base imbalances

A

Potassium (hyperkalemia) - fatal dysrhythmias when serum K level is 7-8 mmol/L

Sodium (normal/low) - retained with water

Calcium and phosphate alterations

Magnesium alterations (hypermagnesemia)

Metabolic acidosis (inability for kidneys to excrete acid load, defective reabsorption of bicarbonate)

33
Q

Manifestations of hypermagnesemia

A

absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, respiratory failure

34
Q

Manifestations

Hematological System

A

Anemia

Bleeding tendencies

Increased susceptibility to infection

35
Q

Anemia in CKD

A

Very common

Increased production of erythropoietin, nutritional deficiencies, increased hemolysis of RBCs, frequent blood sampling, GI bleeding

36
Q

Erythropoietin

A

hormone that stimulates RBC production in bone marrow

elevated PTH levels (d/t low serum calcium) inhibits this hormone

37
Q

Bleeding tendencies

A

Defect in platelet function

38
Q

Increased infection CKD

A

Changes in leukocyte function

Altered immune response

Diminished inflammatory response

39
Q

Manifestations

CVS

A 
HTN
HF
L ventricular hypertrophy
Peripheral edema
Dysrhythmias
Uremic pericarditis
40
Q

Manifestations

Respiratory System

A 
Kussmaul's resps
Dyspnea
Pulmonary edema
Uremic pleuritis
Uremic pneumonitis 
Pleural effusion
Predisposition to respiratory infection
41
Q

Manifestations

GI System

A

Inflammation of mucosa related to excessive urea

Constipation (limited fluid intake)

42
Q

Symptoms of inflammation of mucosa in GI

A

Stomatitis with exudates and ulcerations

Uremic fetor (urinous odour of breath)

GI bleeding

43
Q

Manifestation

Neurological System

A 
Restless leg syndrome
depressed speaking
muscle twitching
fatigue, irritability
Apathy
Decreased ability to concentrate
Peripheral Neuropathy
44
Q

Manifestations

Musculo-skeletal system

A

Mineral and bone disorder

Bone abnormalities, changes in mineral balance, vascular and other soft tissue calcifications

results in renal osteodystrophy and vascular and soft tissue complications

45
Q

Manifestations

A

Pruritus

Uremic frost

46
Q

Manifestation

Reproductive System

A

infertility
decreased libido
low sperm counts
sexual dysfunction

47
Q

Manifestations

Psychological Changes

A

Personality and behavioral changes
emotional lability
Withdrawal
Depression

48
Q

5 stages of CKD

A

Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

49
Q

Diagnostic studies for CKD

A 
Urinalysis dipstick (proteinuria +1, 2 or more times in 3 month period)
Albumin-creatinine ratio (proteinuria)
Renal ultrasound
Xray KUB
CT KUB
Renal biopsy
50
Q

Most important risk factor

A

Protein in the urine

51
Q

People that should be screened for proteinuria

A 
DM
HTN
vascular disease
autoimmune diseases
GFR <60
edema
52
Q

Specific gravity

A

1.005-1.030

Measure of conc. of solutes in the urine
Shows kidneys ability to create urine

53
Q

Urine pH

A

4.6-8

54
Q

Bilirubin

A

Product of RBC breakdown

Indicates liver disease

55
Q

Casts

A

Indicates kidney health

56
Q

Labs

A

BUN
Creatinine
Creatinine Clearance
GFR

57
Q

Creatinine

A

nitrogenous waste produced from muscle metabolism

elevated in CKD

58
Q

Creatinine Clearance

A

used to assess GFR

how efficiently kidneys clear creatinine from the blood

59
Q

GFR

A

determines how fast blood is filtered through the glomerulus

60
Q

Management measures (when everything else has failed)

A

prepare patients for renal therapy and transplantation

Correction of extracellular fluid volume overload or deficit

Nutritional therapy

Erythropoietin therapy

Calcium supplementation (phosphate binders)

Antihypertensive therapy

Measures to lower potassium

Adjustment of drug doses to degree of renal function

61
Q

Drug therapy

Hyperkalemia

A

Calcium gluconate (stabilize myocardium)

B-B2 adrenergic agonists (shift potassium into the cells)

IV insulin (shift K into cells)

IV glucose to manage hypoglycemia

Kayexalate

Diuretics or dialysis

62
Q

Hypertension tx (with CKD)

A

Sodium and fluid restriction

Antihypertensive drugs (loop diuretics, CCB, ACE, ARB)

63
Q

CKD MBD tx

A

Phosphate intake restricted to <1000mg/24 hrs
phosphate binders
Supplementing vit D (phosphate has to be normal first
Controlling secondary hyperparathyroidism

64
Q

Anemia tx (with CKD)

A

Erythropoietin
iron supplements
folic acid supplements
avoid blood transfusions

65
Q

Dyslipidemia tx (with CKD)

A

Statins in clients in stage 1-3 CKD

66
Q

Drug toxicity tx (with CKD)

A

Digoxin

oral glycemic agents

antibiotics

opioids

NO NSAIDS (acetaminophen instead)

NURS 232 (19 decks)

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