CKD Flashcards
stage 1
> 90 (normal GFR ~125)
asymptomatic
plan:
diagnose and treat
CVD risk reduction
slow progression
stage 2
60-89
asymptomatic, possible HTN
plan:
estimation of progression
stage 3
45-59 goal to catch here
30-44
HTN, otherwise asymptomatic
3A: evaluate & treat complications
3B: more aggressive treatment of complications
stage 4
15-29
manifestations become apparent
*diagnosis often occurs**
plan:
prep for renal replacement therapy (dialysis, kidney transplant)
stage 5
ESRD
<15
uremic (BUN in blood)
plan:
renal replacement therapy (if uremia present and pt desires treatment)
what happens when the kidneys cannot activate vitamin D?
renal osteodystrophy
puts pt at risk for hypocalcemia
what happens when the kidneys cannot produce erythropoietin?
anemia
what happens when the kidneys no longer maintain F&E homeostasis?
edema
hyperkalemia
hyperphosphatemia
hypermagnesemia
metabolic acidosis
what happens when the kidneys no longer rid the body of wastes via urine?
anorexia
malnutrition
itching
CNS changes
prevention of CKD
diagnosis and control underlying problem –> HTN or DM
early detection and treatment crucial
CKD nursing problems
- FVE
- malnourishmnet
- risk for injury
- grieving
- risk for infection
- activity intolerance
FVE
r/t inability of kidneys to excrete fluid
monitor for FVE, weigh daily, fluid restrictions
malnourishment
r/t restricted intake of nutrients
monitor for N/V, weight trends, serum protein levels, H&H
risk for injury
r/t alterations in bone structure (d/t renal osteodystrophy)
monitor electrolyte levels, administer prescribed supplements (calcium, vitamin D)
grieving
r/t loss of kidney function & change in lifestyle
listen to expressions of grief
identify community support resources
encourage family involvement & social support
risk for infection
r/t suppressed immune system
monitor for S/S of infection
screen and limit visitors
ensure aseptic technique of line care
activity intolerance
r/t decreased RBC count secondary to decrease production of erythropoietin
provide rest periods
administer anti-anemic agents
monitor H&H
prevention
HTN, DM
decrease chance of nephrotoxicity d/t contrast dye –> acetylcystine and fluids
monitor nephrotoxic drugs (NSAIDs, aminoglycosides)
acetylcysteine
antidote to acetaminophen
given prior to contrast dye to decrease severity of dye to kidneys
acute interventions
monitor F&E levels
I&O
daily weights (more reliable than I&O)
treat symptoms
S/S of CKD
volume overload
hyperkalemia
metabolic acidosis
mineral and bone disorders –> PO4 and Ca
HTN
anemia
dyslipidemia
malnutrition
volume overload in CKD
restrict fluid
diuretics
monitor I&O and daily weights
hyperkalemia in CKD
3.5 -5 normal
>5 treat (K binders, insulin and dextrose, sodium bicarbonate, dialysis, calcium carbonate)
goal for nutrition needs
maintain good nutrition
-depend on severity of disease
-low PRO (can’t excrete, pro [BUN/Cr] levels rise)
*BUN/Cr are byproducts of protein metabolism
*can increase PRO when you start dialysis
supplements:
high cal/high PRO
low K and phosphorous
slow release CHO
F&E needs
fluid restriction (REQUIRED when oliguric)
Na, K, PO4 restrictions –> individualized
“renal diet” =
LOW: pro, K, Na
*possibly Mg and PO4
& fluid restriction
alternative ways to reduce thirst
sucking on ice cubes, lemon, hard candy
