CKD/ESKD (Exam 3) Flashcards
CKD Patho
five stages
need a 3-24 hr urine collection for GFR (kidney function)
eGFR takes into account creatinine levels, gender, race and body size but is only used for screening (usually antibiotic/med dosing), not for staging CKD
Stage 1 Kidney Disease
normal GFR with risk factors
Stage 3 Kidney Disease
fluid, protein, electrolyte restrictions, albuminuria (kidney damage) usually present
Stage 4&5 Kidney Disease
homeostasis is an issue once 3/4 of kidney function is lost, urine output is decreased, fixed osmolarity
risk for fluid overload with edema, pulmonary crackles, SOB, pleural/pericardial friction rub, decreased heart and breath sounds
CKD Causes
progressive, irreversible, no recovery; leading cause of death in pts with ESKD
african americans higher risk (HTN ESKD)
11% of adults in US; >50% with stages 3 and 4
25% die first year of dialysis
CKD S/S
uremia (azotemia: high BUN/Cr with symptoms)
azotemia (a buildup of nitrogen based (BUN/Cr) waste byproducts in blood)
anuria
uremic fetor (breath that smells like urine)
stomatitis (mouth inflammation)
halistosis (bad breath)
metallic taste in mouth (mouth has urease; breaks down urea into ammonia; uremic fetor, stomatitis, halistosis)
anorexia
nausea
polyuria in early stage 1-3 because reabsorption of water issues
pruritis (caused by uremic frost with evaporated sweat)
HTN*
hyperlipidemia*
anemia*
increased risk of infection (uremia decreases WBC)
HTN S/S (CKD)
can be cause or complication
renin increases blood flow to the kidneys,
no blood flow in damaged kidney,
increased renin,
increased vasoconstriction and BP leading to severe HTN
Hyperlipidemia S/S (CKD)
change in fat metabolism that increases triglycerides, total cholesterol and LDLs
increased CAD events (#1 cause of CVD)
Anemia S/S (CKD)
decreased erythropoietin lvls with decreased RBCs, decreased RBC survival time in uremia, iron and folic acid deficiencies
increased bleeding/bruising with impaired platelet function
CKD-MBD (Mineral and Bone Disorder)/Renal Osteodystrophy
decreased Ca (trousseaus and chvosteks sign, fractures)
increased clotting time
anxiety and irritability
heart arrhythmias
increased serum Ca and serum P
vascular and soft tissue calcifications where Ca is deposited in atherosclerotic plaques in blood vessel linings; increased CVD
CKD Risk Factors
diabetes
HTN
age >60 yrs
CVD
family history
exposure to nephrotoxic drugs
ethnic minority (AA, NA)
CKD Labs and Diagnostics
increased BUN and serum creatinine from protein metabolism
decreased Na from compromised reabsorption
increased K from tissue breakdown, transfusions and diet
P
Ca
Mg
ABG (metabolic acidosis)
H&H
UA (+protein, glucose, WBC, decreased urine osmolarity; OSMOLARITY INCREASES LATE CKD)
blood osmolarity
GFR
renal US from atrophy, fibrosis
biopsy
xray (hand bones may show CKD/MBD)
CKD Meds
loop* and thiazide diuretics
vitamins and minerals (phosphate binders, folic acid, oral iron salts, parenteral iron salts, vitamin D)
erythropoietin stimulating agents*
parathyroid hormone modulator/Cinacalcet: monitor for diarrhea and myalgia
antihypertensive therapy*
lipid lowering drugs (statins)
insulin*
Loop Diuretics (CKD)
1kg=1L of fluid
given for mild/severe CKD to decrease fluid/HTN
usually in pts with some urine output, not used usually in ESKD
expected outcome is for output to be greater than intake by 500-1000 mL/24 hr
monitor electrolytes (K!!)
Phosphate Binders (CKD)
form an insoluble calcium-phosphate complex to inhibit GI absorption
must be given with meals to prevent phosphate absorption
Ca vs non-Ca based (WATCH Ca and serum phosphorus LVLS!!)
calcium acetate and carbonate contain Ca and could increase Ca (hypercalcemia)
Sevelamer/Lanthanum carbonate (Renagel/Fosrenol) doesn’t have Ca
REPORT MUSCLE WEAKNESS OR IRREGULAR PULSE BECAUSE ITS SIGNS OF HYPOPHOSPHATEMIA
Folic Acid/Folate (CKD)
cyanocobalamin
take drugs after dialysis
take iron supplements with meals to reduce nausea
Oral Iron Salts (CKD)
ferrous sulfate
take stool softeners daily because iron can cause constipation
take with meals to reduce nausea
can change the color of stool
Parenteral Iron Salts (CKD)
iron dextran
a test dose is recommended before IV administration because allergic reaction incidence is high
Vitamin D (CKD)
calcitrol
can cause hypocalcemia
Erythropoietin-Stimulating Agents (CKD)
EPOETIN ALFA; less fatigue
drug shouldn’t be given when Hgb lvls are greater than 13 g/dL
can cause iron deficiency because of demand for iron for erythropoiesis; supplement may be needed (ferritin below 100)
prevent/corrects anemia caused by kidney disease through stimulation of bone marrow to increase RBCs
Antihypertensive Therapy (CKD)
ACEi/ARBs used mostly in pts with HTN and CKD
CCBs are used to increase GFR and increase blood flow within kidney (<135/85 is goal BP)
Insulin (CKD)
needs may decreased in CKD because kidneys excrete insulin and if they’re not working, insulin sits in body longer causing hypoglycemia
Antacids (CKD)
AVOID!!! antacids with Mg or Al because kidney can’t filter them
no OTC decongestants or any drugs with phenylephrine or pseudoephedrine because they can increase BP
CKD Nursing Care
PREVENTION IS KEY FOCUS!!! PREVENTION OF RISK FACTORS
MONITOR FOR FLUID OVERLOAD (pulmonary edema), CRACKLES IN LUNGS, WEIGHT GAIN (WEIGH CLIENTS), BALANCED I+O
PROVIDE FLUIDS AND FOOD NEEDED TO PREVENT MALNUTRITION AND COMPLICATIONS
PROTEIN RESTRICTIONS*
AVOID SODIUM*
MONITOR K AND P
Protein Restrictions (CKD)
increased protein leads to increased breakdown and waste in body
watch for low albumin because malnutrition is worse; balanced protein
BUN and serum pre albumin lvls are used to monitor adequacy of protein intake; decreased lvls indicate poor protein intake
Sodium Restrictions (CKD)
avoid foods high in Na to prevent water retention and HTN
avoid Na honestly
