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ACVN - MEDICAL NURSING > Nursing the CKD Cat > Flashcards

Nursing the CKD Cat Flashcards

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1
Q

What is the management of CKD aimed at?

A

reducing the workload of the remaining nephrons and preventing further damage

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2
Q

What type of disease is chronic kidney disease?

A

funtional and/or structural which is gradual, progressive, irreversible and involves nehron loss

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3
Q

What can you do to prevent progression of the disease?

A

therapeutic intervention

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4
Q

What is polynephritis?

A

inflammation of the kidney and renal pelivs

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5
Q

What is ureterolithiasis?

A

post renal, causes renal damage

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6
Q

What are the majority of cases of CKD due to?

A

chronic interstitial nephritis

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7
Q

What is chronic interstitial nephritis?

A

inflammation of the renal interstitium

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8
Q

What can happen over time if asymptomamatic?

A

progressive nephron loss, progressive decreased glomerular filtration rate

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9
Q

What age does CKD usually occur?

A

mature-geriatric cats

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10
Q

Why might a younger cat be affected?

A

if it is congenital

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11
Q

What should you discuss with the owner about CKD?

A
  • weight/condition changes
  • drinking/urinating (PUPD)
  • appetite
  • demeanour, activity levels
  • vomiting +/- diarrhoea +/- haematemsis/malaena
  • constipation secondary to dehydration
  • signs associated with hypertension (blindness, neurological)
  • medication
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12
Q

What should you assess in the CKD cat?

A
  • hydration status
  • weakness (neck ventroflexion - hypokalaemic myopathy)
  • uraemic ulcers +/- uraemic halitosis
  • hypertensive retinopathy
  • kidneys typically small or irregular on palpation
  • rubber jaw (renal secondary hyperparathyroidism)
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13
Q

What tests can be done to diagnose CKD?

A
  • urine specific gravity
  • urine protein:creatinine ratio
  • serum creatinine and urea
  • glomerular filtration rate
  • symmetric dimethylarginine (SDMA)
  • diagnostic imaging - ultrasound and radiography
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14
Q

What is azotaemia?

A

increased urea and creatinine

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15
Q

What would a symmetic dimethylarginine (SDMA) do?

A

identify kidney disease earlier than elevated urea and creatinine

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16
Q

What would an ultrasound check for with CKD?

A

renal size and architecture

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17
Q
A
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18
Q

What would radiography check for?

A

(uretero)liths

19
Q

What else can ultrasounds and radiography look for?

A

uretric obrstruction, pyelonephritis, lymphoma

20
Q

What is the most common cause of CKS in cats and dogs?

A

hypertension

21
Q

What can we do to reduce stress when taking blood pressure readings?

A
  • use tail
  • minimal restraint
  • medication
  • quiet room
  • feliway plug
  • patience
  • feline friendly room
  • headphones so don’t get scared by loud noise of doppler
22
Q

What is rubber jaw?

A

demineralisation of the bones in the jawdue to increased PTH activity

23
Q

What does CKD lead to

A

increased serum phosphate

24
Q

What does increased serum phosphate lead to?

A

parathyroid hormone secretion leading to decreased phospate and increased calcium

25
Q

What can progressive CKD lead to?

A

increased phosphate therefore persistent PTH release

26
Q

What does hypokalaemia cause?

A
  • weakness - neck ventroflexion
  • inappetance
27
Q

What is hypokalaemia due to?

A
  • inappetance
  • GI losses
  • urinary losses
28
Q

What species is proteinuria more common in?

A

dogs

29
Q

Why is a dipstick not sufficent at testing for proteinuria?

A

because you need the urine:protein creatinine ratio

30
Q

What causes anaemia in CKD patients?

A

-lack of erythropoietin
- reduced RBC lifespan
- potentially GI losses

31
Q

What does anaemia contribute to?

A

weakness, lethargy and inappetance

32
Q

What parameters should be monitored/recorded with the CKD cat?

A
  • hydration status
  • urea and creatinine
  • bloods
  • blood pressure
  • potassium
  • calcium
  • body weight
33
Q

What should be included when performing a consultation for a CKD patient?

A
  • history, particularly appetite, drinking, GI signs
  • weight, body condition score
  • blood pressurel, retinal examination
  • PCV
  • urea, creatinine, phospahte, calium, electrolytes
  • urinalysis
34
Q

How often should patients with CKS have check ups?

A
  • every 3-6 months depending on the stage if they are stable
  • more frequent if unstable
35
Q

What is IRIS staging?

A

The staging undertaken following diagnosis of CKD in order to facilitate appropriate treatment and monitoring of the patient

36
Q

What is involved in stage 2 feline patients of the IRIS staging?

A
  1. discontinue all potentially nephrotixic drugs if possible
  2. identify and treat any pre-renal or post-renal abnormalities
  3. rule out any treatable conditions like pyelonephritis and renal urolithiasis with radiographs and/or ultrasonography
  4. measure blood pressure and urine protein to creatinine ratio (UP/C)
  5. consider feeding a clinical renal diet, this may be accomplished more easily early in the course of CKD, efore inappetance develops
37
Q

What do stage 2 feline patients usually have?

A

dehydration

38
Q

How would you manage a stage 2 feline with dehydration?

A
  • provide fresh water at all times
  • correct fluid losses with isotonic polyionic replacement fluid solutions like ringers IV or SQ
39
Q

What are the benefits of feeding a renal diet?

A
  • low phospate content
  • good antioxidants
  • essential fatty acids to maintain blood flow through kindeys
  • adding bicarbonate prevents acidosis
40
Q

Tips for introducing new diet

A
  • don’t introduce in hospital environment
  • heat up food to make more palatable
  • mix with existing diet
  • slow introduction
  • must be stable first
41
Q

How would you manage hypertension?

A

amlodopine for cats
ACE inhibitors for dogs

42
Q

How would you manage hyperphospahtaemia?

A

renal diet, phosphate binders

43
Q

How would you manage hypokalaemia?

A

renal diet, potassium supplementation

44
Q

How would you manage proteinuria?

A

renal diet, ACE inhibitors, omega 3 polyunsatuaated fatty acids, anti-platelets

ACVN - MEDICAL NURSING (22 decks)

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