CKD Flashcards
Chronic Renal Failure S/S
Headaches Decreased ability to concentrate urine Polyuria --> Oliguria Increased BUN and Serum Creatinine Edema GFR- progressive decrease from 90-30 ml/min Mild Anemia Increased Serum K Increased BP Weakness and Fatigue
Stages of CKD
When will dialysis be started?
1 to start, progresses to 5
GFR<26 typically when dialysis starts
Start dialysis in stage 4
UREMIA – CLINICAL MANIFESTATIONS
Hyperparathyroidism Glucose intolerance Pulmonary edema Pleuritis Kussmaul inspirations Proteinuria Hematuria Fixed specific gravity Nocturia Oliguria Anorexia, N/V, gastroenteritis Hiccups Abd pain, peptic ulcer, GI bleeding Uremic fetor Osteodystrophy, bone pain, spontaneous fx Apathy, lethargy, headache, impaired cognition, insomnia, restless leg, gait disturbances HTN, edema, coronary heart disease or failure Anemias, impaired clotting Pallor, uremic skin color, poor skin turgor, pruritis
UREMIA – CLINICAL THERAPIES
Often the only option is dialysis.
Cardiorespiratory monitoring.
Accurate I/O.
Diuretic administration.
Fluid restriction.
Dietary consult to improve nutritional status.
ANEMIA: Clinical Manifestations
Fatigue
Pallor
Dizziness, confusion, lethargy
Tachycardia, tachypnea, hypotension
ANEMIA: Clinical Therapies
Iron supplementation
Administration of epoetin
Blood transfusion
Therapies aimed at treating underlying cause
FLUID VOLUME EXCESS: Clinical Manifestations
Dependent pitting edema
Respiratory crackles
Dyspnea, pulmonary edema, hypoxemia
Weight gain
Tachycardia
JVD
FLUID VOLUME EXCESS: Clinical Therapies
Fluid restriction
Sodium-restricted diet
Diuretics
Dialysis
HYPERKALEMIA: Clinical Manifestations
Ventricular arrhythmias
Tall, peaked T waves; widened QRS
Cardiac arrest
Smooth muscle hyperactivity
N/V
Abdominal cramping
Diarrhea
Muscle weakness
Paresthesia’s
Flaccid paralysis
HYPERKALEMIA: Clinical Therapies
Removal of all K from IV solutions
Low K diet
Administration of glucose and insulin to drive K into cell
K-absorbing enema solutions
Dialysis
ASSESSMENT
HEALTH HISTORY
Complaints of anorexia, nausea, weight gain or edema
Current treatment
Previous transplant
Chronic diseases
PHYSICAL EXAMINATION Mental status VS Heart and lung sounds Peripheral pulses Urine output (if any) Edema BS Location of AV fistula or shunt
Ineffective Teaching Statement regarding sodium restriction
I will comply with sodium restrictions by using salt substitutes.
Teaching should include which common complication of peritoneal dialysis?
Peritonitis
Priority complication to be evaluated for during hemodialysis treatment
Hypotension
When teaching about P. Dialysis which statement should be included regarding peritoneum?
Semi-permeable - wastes moved by diffusion and osmosis
Patient asks the nurse why they are anemic, what’s the best response?
Decreased production of erythropoetin
Potassium of 7.0, where should patient go?
A room with cardiac monitoring
A pt. with CKD has fluid overload. Na is 120. What should the nurse conclude?
Possible hemodillution effect.
The nurse should report a urine output of less than this for two consecutive hours
Less than 30
GFR of 25 is which stage of Renal Failure?
Stage 4
A patient with CKD has a low erythropoeitin level, what are they at risk for?
Anemia
GFR -55; Hx of HTN, which antihypertensive should they get?
Lisinopril
Ace Inhibitor
What are the top two causes of CKD?
Hypertension and Diabetes
Cause of extreme pruitis in CKD
Increased urea -
Phosphate level of 6.2, what will Calcium level be?
Low
What type of diet should a patient with CKD follow
low protein, low sodium, low K, and low phosphate diet
