CKD Flashcards
CKD
Progressive, irreversible loss of kidney function
Two common causes
Diabetes and hyper tension
Risk factors CKD
Older than 60
CVD
Diabetes
Ethnicity
Nephrotoxic drugs
Family history
Hypertension
Diabetic nephropathy
Damage to the small vessels that supply the Glomeruli due to underlying diabetic condition
Individuals with CKD are frequently
Asymptomatic , under diagnosed and untreated
How many stages is CKD
5
Stage 1
Gfr of 90 or greater
Structural changes that indicate renal damage
Stage 2
Kidney damage with mild decrease in gfr
60-89
Undetectable
Stage 3
Moderate to poor kidney function
Gfr 30-59
BECAREFUL with nephrotoxic drugs
Will start to see an increase creatine level
Will see this on our labs
Stage 4
Moderate to poor kidney function
Prepare pt for renal replacement therapy but pt not there yet
Low potassium diet
Gfr 15-29
Stage 5
ESRD
Gfr 15 or less
Renal replacement needed if there is a build up of toxins in the blood and if the pt desires treatment
CKD manifestation
Effects every body system
Sodium and fluid balance altered
Altered potassium excretion
Impaired metabolic waste elimination
Neurological symptoms
Altered calcium and phosphorous levels
Metabolic acidosis
Chronic anemia
Serum creatine/bun/potassium
Increase in ckd
General sodium rule CKD
2 g a day
Creatine clearance
Decrease
Serum sodium/calcium
Decrease
Co2/hemoglobin& hematocrit
Decrease
Overall goal
Preserve existing kidney
Reduce risk of CVD
Prevent complications
Provide for pt comfort
Nursing management CVD
Nutrition /glycemic control
Fluid management
Meds
Monitor vs and lab values
Monitor I&O and daily weight
Skin care
CRF hemodialysis
Evaluate , assess site for latency and s/s of infection do not take bp or obtain blood samples from extremities that has access site
Nutrional therapy
Monitor /restrict protien
Fluid restriction
Sodium /potassium restrictions
Phosphate restriction (ESRD)
Maintain good nutrient
Monitor labs
Dietary to help hypertension
Dash diet
Lowers bp and red
Periteneal pt diet
Increase BP
Hemodialysis patient diet
Moderate or low protien diet
Why is citrus or orange juice contraindicated in pt with renal failure
Has 480 mg of potassium per serving
What foods should you avoid in ckd
High in potassium , fats and alcohol
What foods should we stress CKD eat
Fruits, veggies, fat free or low fat milk and milk products whole grains, fish , poultry, beans , seeds and nuts
CKD with phosphorous and calcium
high phosphorous =low calcium
Monitor for bone disease(CKDMBD)
10% ca glutamate
First line treatment when there is ekg changes seen renal pt
CKD erythropoietin
Makes less results in anemia so watch for anemia
IV glucose and urine
Can bring down potassium
Sodium polystyrene sulfonate
Helps excrete potassium
What else may be need CKD
Dialysis
Why should you not infuse potassium fast
Lethal injection
Antihypertensive drugs
Ace & arbs
MBD
Calcium and phosphorous out of control
Affects most people with kidney failure recieving dialysis in end stage
When do you start restricting phosphorous in pt
Till we start seeing it in the lab
When we start seeing phosphorous labs out of control what do we use
Phosphorous binders
Supplement vitamin d
Avoid aluminum prep ( antacids and other products that contain aluminum, Deo (rare))
Phosphate binders
Calcium acetate (phoslo)
Calcium carbon (Caltrate)
Bind phosphate in bowel and excrete
Sevelamer hydrochloride
phosphate binder sevelamer hydrochloride
Lowers cholesterol , ldl and phosphate
Anemia drug therapy
Erythropoietin epoetin Alfa
Helps increase Hgb and Hct in 2-3 weeks
Glycoprotein hormone
EPOstimulates the bone marrow to increase RBC production
Side effects of epoetin Alfa
Thromboembolism
Hypertension
When epoetin Alfa is administer what should we also supplement with
Iron, folic acid, vit b12
Iron supplements
Use if plasma ferritin level is less than 100 (abnormal lab)
Causes gastric irritation , constipation
Makes stool dark in color
Folic acid supplements
Needed for RBC formation
Removed by dialysis
Blood transfusions
Anemia
Try to avoid
Increase the develop of antibodies
May lead to iron overload
What happens when blood transfusion increases the development of antibodies
Makes it harder to find something compatible for them
If pt is recieving several blood products and not in ESRD and just in CKD
We can give LASIX in between.
ESRD - blood transfusion does in dialysis so they can monitor fluid
Drug toxicity
Digoxin
Diabetic agents
Antibiotics
Insulin
Opioid medication
Furosemide
Most frequently used loop diuretic
PO,IV,IM
Oral admin furosemide
Diuresis begins within 60 min -persist 8 hours
Iv admin
Diuresis begins within 5 min and last 2 hours
When do you use IV furosemide
Critical situations(pulmonary edema)
Pt with acute or chronic kidney disease with med overdose
Sent down to dialysis to pull it out
CKD-MBD
Monitor for bone disease
