CKD

Question 1

stage 1

Answer 1

> 90 (normal GFR ~125)

asymptomatic

plan:
diagnose and treat
CVD risk reduction
slow progression

Question 2

stage 2

Answer 2

60-89

asymptomatic, possible HTN

plan:
estimation of progression

Question 3

stage 3

Answer 3

45-59 goal to catch here
30-44
HTN, otherwise asymptomatic

3A: evaluate & treat complications
3B: more aggressive treatment of complications

Question 4

stage 4

Answer 4

15-29

manifestations become apparent
*diagnosis often occurs**

plan:
prep for renal replacement therapy (dialysis, kidney transplant)

Question 5

stage 5

Answer 5

ESRD
<15

uremic (BUN in blood)

plan:
renal replacement therapy (if uremia present and pt desires treatment)

Question 6

what happens when the kidneys cannot activate vitamin D?

Answer 6

renal osteodystrophy

puts pt at risk for hypocalcemia

Question 7

what happens when the kidneys cannot produce erythropoietin?

Answer 7

anemia

Question 8

what happens when the kidneys no longer maintain F&E homeostasis?

Answer 8

edema
hyperkalemia
hyperphosphatemia
hypermagnesemia
metabolic acidosis

Question 9

what happens when the kidneys no longer rid the body of wastes via urine?

Answer 9

anorexia
malnutrition
itching
CNS changes

Question 10

prevention of CKD

Answer 10

diagnosis and control underlying problem –> HTN or DM

early detection and treatment crucial

Question 11

CKD nursing problems

Answer 11

1. FVE
2. malnourishmnet
3. risk for injury
4. grieving
5. risk for infection
6. activity intolerance

Question 12

FVE

Answer 12

r/t inability of kidneys to excrete fluid

monitor for FVE, weigh daily, fluid restrictions

Question 13

malnourishment

Answer 13

r/t restricted intake of nutrients

monitor for N/V, weight trends, serum protein levels, H&H

Question 14

risk for injury

Answer 14

r/t alterations in bone structure (d/t renal osteodystrophy)

monitor electrolyte levels, administer prescribed supplements (calcium, vitamin D)

Question 15

grieving

Answer 15

r/t loss of kidney function & change in lifestyle

listen to expressions of grief
identify community support resources
encourage family involvement & social support

Question 16

risk for infection

Answer 16

r/t suppressed immune system

monitor for S/S of infection
screen and limit visitors
ensure aseptic technique of line care

Question 17

activity intolerance

Answer 17

r/t decreased RBC count secondary to decrease production of erythropoietin

provide rest periods
administer anti-anemic agents
monitor H&H

Question 18

prevention

Answer 18

HTN, DM
decrease chance of nephrotoxicity d/t contrast dye –> acetylcystine and fluids

monitor nephrotoxic drugs (NSAIDs, aminoglycosides)

Question 19

acetylcysteine

Answer 19

antidote to acetaminophen

given prior to contrast dye to decrease severity of dye to kidneys

Question 20

acute interventions

Answer 20

monitor F&E levels
I&O
daily weights (more reliable than I&O)
treat symptoms

Question 21

S/S of CKD

Answer 21

volume overload
hyperkalemia
metabolic acidosis
mineral and bone disorders –> PO4 and Ca
HTN
anemia
dyslipidemia
malnutrition

Question 22

volume overload in CKD

Answer 22

restrict fluid
diuretics
monitor I&O and daily weights

Question 23

hyperkalemia in CKD

Answer 23

3.5 -5 normal
>5 treat (K binders, insulin and dextrose, sodium bicarbonate, dialysis, calcium carbonate)

Question 24

goal for nutrition needs

Answer 24

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

Question 25

F&E needs

Answer 25

fluid restriction (REQUIRED when oliguric)
Na, K, PO4 restrictions –> individualized

Question 26

“renal diet” =

Answer 26

LOW: pro, K, Na
*possibly Mg and PO4
& fluid restriction

Question 27

alternative ways to reduce thirst

Answer 27

sucking on ice cubes, lemon, hard candy