Complex Test 3: Renal

Question 1

CKD Stages

Answer 1

Stage 1: minimal kidney damage, GFR is greater than 90
Stage 2: minor kidney damage, GFR is between 60-89
Stage 3: moderate kidney damage, GFR is between 30-59
Stage 4: severe kidney damage, GFR is between 15-29
Stage 5: kidney failure and end stage kidney disease with little or no GFR (less than 15 mL/min)

Question 2

CKD Health Promotion and Disease Prevention

Answer 2

• limit alcohol intake
• NO smoking
• drink at least 2 L of water daily. consult w/provider about any restrictions
• diet and exercise to manage weight and prevent or control DM and HTN
• adhere to medication prescription guidelines to prevent kidney damage
• test for albumin in the urine yearly (PT’s who have DM or HTN)
• take ALL antibiotics until completed
• limit OTC NSAIDs

Question 3

Risk factors for CKD

Answer 3

• diabetes
• hypertension
• acute kidney injury
• PKD
• nephrotoxic medications (gentamicin, NSAIDs, or chemicals like contrast dye for tests)
• autoimmune disorders (systemic lupus erythematosus)
• renal artery sensosi
• pyelonephrosis
• recurrent severe infections
• chronic glomerulonephritis

Question 4

CKD Clinical Manifestations general

Answer 4

Nausea, fatigue, lethargy, involuntary movement of legs, depression, intractable hiccups.
In most cases, findings of CKD are related to FV overload.

Question 5

CKD Neuro manifestations

Answer 5

lethargy, decreased attention span, slurred speech, tremors or jerky movements, ataxia, seizures, coma

Question 6

CKD cardiovascular manifestations

Answer 6

fluid overload (JVD, sacrum, ocular, or peripheral edema), HTN, dysrhythmias, HF, orthostatic hypo, peaked T waves on ECG (hyperkalemia)

Question 7

CKD Respiratory manifestations

Answer 7

uremic halitosis with deep sighing, yawning, SOB, tachypnea, hyperpnea, Kussmaul respirations, crackles, pleural friction rub, frothy pink sputum

Question 8

CKD hematologic manifestations

Answer 8

anemia (pallor, weakness, dizziness, ecchymoses, petechiae, melena)

Question 9

CKD GI manifestations

Answer 9

ulcers in mouth and threat, foul breath, blood in stools, vomiting

Question 10

CKD Musculoskeletal manifestations

Answer 10

osteodystrophy (thin fragile bones)

Question 11

CKD renal manifestations

Answer 11

urine contains protein, blood, particles, change in the amount, color, concentration

Question 12

CKD skin manifestations

Answer 12

decreased skin turgor, yellow cast to skin, dry, pruritus, urea crystal on skin (uremic frost)

Question 13

CKD reproductive manifestations

Answer 13

ED

Question 14

Lab tests for CKD

Answer 14

Urinalysis: hematuria, proteinuria, and decrease in specific gravity

Serum Creatinine: gradual increase over mo. to years for CKD exceeding 4 mg/dL

BUN: gradual increase with elevated serum creatinine over months to years for CKD

Serum Electrolytes: DECREASED sodium (dilutional) and calcium; INCREASED potassium, phosphorus, and magnesium

CBC: decreased HGB and HCT from anemia, secondary to the loss of erythropoietin in CKD

Question 15

Nursing Care for CKD

Answer 15

Report and monitor irregular findings:

• urinary elimination patterns: amount, color, odor, consistency
• vital signs: BP may be increased or decreased
• weight: 1 kg (2.2 lb) daily weight increase is approximately 1 L of fluid retained
• assess and monitor vascular access or peritoneal dialysis insertion site
• obtain a detailed medication and herb history to determine the PT’s risk for continued kidney injury
• control protein intake based on the client’s stage of CKD and type of dialysis prescribed
• monitor for weight gain trends
• restrict Intake of fluids (based on urinary output)
• protect PT from injury
• provide emotional support to the PT and family
• encourage the PT to ask questions and discuss fears
• administer meds as prescribed
• provide skin care in order to increase comfort and prevent breakdown
• balance the PT’s activity and rest
• adhere to meticulous cleaning of areas on skin not intact and access sites to control infections

Question 16

Goals for CKD nutritional therapy

Answer 16

• slow the progression of CKD
• control blood glucose and HTN
• help preserve remaining kidney function by limiting the intake of protein and phosphorus
• restricting phosphorus intake slows the progression of kidney disease. high levels of phosphorus contribute to calcium and phosphorus deposits in the kidneys
• Protein restriction is essential for PT’s who have stage 1-4 CKD b/c it helps slow progression of kidney disease and too little protein results in the breakdown of body protein. Carefully determine protein intake

Question 17

CKD dietary recommendations

Answer 17

• RESTRICT sodium intake to maintain BP
• RESTRICT K+ intake to prevent HYPERkalemia
• The recommended daily protein intake is 0.8 to 1.0 g/kg/day of ideal body weight.
• High biological value proteins are recommended for PT’s who have CKD to prevent catabolism of muscle tissue. These proteins include eggs, meats, poultry, game, fish, soy, and dairy products
• limit meat intake to 5-6 oz/day for most men and 4 oz/day for most women
• limit dairy products to 1/2 cup per day
• limit high phosphorus foods (peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains) to one serving or less per day.
• Avoid high protein sports drinks, energy drinks, or meal supplements.
• Avoid herbal supplements that can affect bleeding time and BP.

-Provide a diet that is high in carbs and moderate in fats

Question 18

End Stage Kidney disease Nutrition

Answer 18

• Protein restrictions are decreased as the disease progresses to ESKD, and to decrease the workload on the kidneys.
• Protein needs increase once dialysis has begun as protein and amino acids are lost in the dialysate
• a high-protein, low phosphorus, low potassium, low sodium (2 to 4 g/day), fluid restricted diet is recommended

Question 19

Foods high in phosphorus

Answer 19

milk products, beef liver, chocolate, nuts, and legumes