Exam 2 CKD Flashcards
Two leading causes
Dm and htn
(that sugar damages walls of vessels and then dec. perfusion to k idneys)
Vasoconstriction further elevates bp, impaired perfusion to kidney.
24% mortality rate?
CKD
End stage kidney disease is considered a _______
disability
Other three causes of CKD?
- Chronic Glomerulonephritis
- Polycystic Kidney Disease
- Polyenephritis
Chronic Glomerulonephritis
Etiology: doing drugs/viruses…genetic syndromes. *Very progressive (over years)
Manifest:
- hematuria
- proteinuria (kidneys not working)
- urine tests
- **-inc. BUN/creatinine
Diagnose:
-CT of kidneys
-biopsy
-routine urinalysis
-elevated BP
(*People often symptomatic and don’t even know)
-hx of viral disease/bacterial disease/drug/lupus/
Polycystic Kidney Disease
Etiology?
Genetic (50% per parent)
Kidney(s) fills with cysts and press on kidney…which can grow to the size of football. Sx don’t show until much later in life.
Manifest:
- htn
- heaviness behind ribs/in back
- end stage kidney disease by 60yr old
- UTIs
- Kidney Stones
- Chronic Pain
- Ability to feel kidneys
- Affects rest of body
- Aneurisms in blood vessels (bubble in vessel which weakens vessel and could rupture)
- Diverticulitis (aneurism in intestine)
- cerebral aneurisms
Diagnosis:
- ASK patients if you see sx
- Family Hx!
- No cure
- Prevent further damage
- Genetic testing for kids
Chronic Pyelonephritis
May affect one or both kidneys
- Anatomic abnormality
- Acute pyelenephritis puts you at risk.
Etiology:
Inflamed, scar, atrophy (when shrunken it doesn’t work as well). Can effect both kidneys.
Diagnose:
- CT, biopsy, ultrasound
- Hx of acute phyelenephritis?
Care:
-Prevent further damage.
GFR
glomerular filtration rate (<60 for longer than three months results in a diagnosis of CKD)
As GFR goes down, ____-
Body accumulates waste (b/c kidneys aren’t working). BUN/Creat increase!
Although GFR goes down, ________
Normal urine output
When waste builds up in body as a result of kidneys not functioning…
Psych Neuro Cardio Gastro Endocrine/Reproductive Metabolic Hematologic Ocular Pulm Integumentary Musculoskeletal Peripheral neuro
Nursing Assessment
-Hx!
-Metabolic Disturbances
-Electrolyte & Acid-Base
(GFR decrease, BUN/Creat increase)
-Imbalance
High BUN/CREAT Sx?
Pt. doesn’t feel great: nausea, vomiting, weak, fatigue, HA, hyperglycemia, hyperinsulemia (High TGC) and Hyperkalemia, Hyponatremia.
Edemetous, heat failure, htn.
Interventions
Low sodium diet
Metabolic acidosis
Unable to excrete excess acid and thus have acidosis
. Give insulin due to CKD-hyperglycemic, hyperinsulimic (Inc. TGD = dyslipidemia)
CKD manifest Urinary issues?
At first, normal output
As disease progresses, less output
When they start dialysis; might become anuric. (no urine)
CKD manifest Hematology
Kidneys produce erythropoietin/RBC
Platelet dysfunction… might bleed more than normal
WBC dysfunction
Thus: Anemia/thrombo/neutro
Cardiovascular
- MI!! Leading cause of death in CKD.
- HTN (kidneys help with bp) Also this is a cause and consequence of kidney disease.
- WATCH bp control.
Peritoneal Dialysis
Uses peritoneal membrane to filter waste.
@ Risk for Infection!!
Know levels.
Does patient have ability to do the work of peritoneal?
At risk for peritonitis.
Fluid should be clear.
Automatic Dialysis
Happens at night while sleeping, machine does for you. Have to do it 2-3x per day.
Education:
-Fluid should be CLEAR
Ambulatory Dialysis
Happens throughout day x3-4 times a day.
Education:
- @ risk for low protein.
- monitor albumin
Hemodyalysis
Blood exchange! Different than peritoneal which is all day every day. Uses a machine
Uses artificial membrane to filter waste by use of tunnel between vein and artery = fistula. Creates thicker wall for more punctures!
(Other than fistula; can use:
-arteriovenous graft
-temp. vasc. access jugular/femoral…emergent)
Go 3-4x per week
Educate: -No damage to fistula area. (tight clothing...) -No bp pills day of -If it's low day of, slow down rate.
Complications: Hypotension, Muscle Cramps, Loss of blood, hepatitis.
Are they working?
Do they have time?
Can patient manage regimen?
What happens if a dialysis patient c/o of dizziness
Assess BP!!!
(If low, give NS and slow rate of filtration?)
C/O of muscle cramps?
Nausea?
CKD Manifest GI
Ulcers/metallic taste in mouth and urine order (uremia backup)
-Poor immune system
Electrolyte & Acid/Base Imbalance
Elevated potassium!
(@ risk for cardiac dyss)
NA (high/low/or normal)
Metabolic Acidosis!! Kidneys not functioning.
CKD manifest respiratory
- Kussmal breathing to blow off excess acid
- Dyspnea
- Pulmonary Edema
CKD manifest neuro
Metabolic encephalopathy
CNS depression (fatigue/lethargy/seizures)
Peripheral neuropathy
Musculoskeletal system
CKD manifestation musculoskeletal
Bone structure diminishes
High Phosphate!
CKD manifestation integumentary
Scratch/itch = at risk for infection and wounds.
When BUN is >200 = uremic frost (urea is crystallizing on skin)
CKD manifestations Reproductive
Reproductive issues
Dec. libido
Amenorrhea
Testicular Consistency… (lower sperm counts, dec. testosterone)
CKD manifest psychological
Anxiety and Depression
Fatigue/Withdrawal
Diagnosing CKD?
**Microalbuminuria (proteinuria) Dipstick that is 1+ twice or more over a 1 month = CKD Urinalysis! BUN/creat GFR Electrolytes (will be elevated) Hgb and hematocrit will be low Lipid panel (cardiac disease) Renal ultrasound Kidney biopsy
NANDA
Fluid imbalance Elec. Imbalance Impaired skin integrity Deficient knoweldge Risk for infection Sexual dysfunction
Nurse Planning
CARDIAC
Weight loss
controll BP
COPING
Patient comfort
FUNCTION INDEPENDENTLY
Adhere to plan??
Collaborative Care!
Drug Therapy for -hyperkalemia -kayexalate (K exits but assess for bowel sounds) -IV glucose & Insulin (pushes K into cells)
HTN
-Exercise/diet/bp control/no alcohol/DASH diet/monitor at home.
CKD-MBD (bone disorder)
- calcium and vit. D
- thyroid! Disease and secondary hyperaparaparathyroidism
Anemia
- Protein alpha
- Epogen/Procrit (hold off if htn)
Dyslipidemia
-Statin!
Nutrition
- Tailored to needs of each patient.
- supplement w/ inc. protein.
- Glucerna (dm)
- NEPRO (kidney)
MONITOR LABS FREQ
Monitor labs for what?
Edematous - fluid restriction
Sodium- max 2g sodium diet
Potassium - restricted or Kayexalate
Who is at risk??
DM and HTN:) = monitor BUN/creat/GFR.
- repeated UTIs
- Family Hx
- Check for protein
At home??
Avoid NSAIDS Avoid ZOSIN but if they get it, monitor labs! Antacids... If dm, A1C Htn, monitor bp exercise!
Evaluating patients with CKD:
- normal electrolyte levels
- normal fluid balance
- minimal weight gain and weight loss
