Regulation

Question 1

Common findings of CKD

Answer 1

Everything will be increased except GFR, eurythroprotein, and calcium
Increased serum creatinine and BUN, Na, potassium, and phosphorus
Fluid retention (edema and HF)
Metabolic acidosis (retention of H+ and decrease bicarb)
Low gfr euthropoetin (anemia), and Ca

Question 2

Maintain bp less than what for CKD

Answer 2

<130/80

Question 3

Stage 1 CKD interventions

Answer 3

Dx stage and treatment of etiology
CVD risk reduction (stabilize BP)

Question 4

CKD2 interventions

Answer 4

Estimate and slow progression, control BP and DM, avoid nephrotoxins

Question 5

CKD3 interventions

Answer 5

Sx treatment

Question 6

CKD 4 interventions

Answer 6

Prep for renal replacement therapy hemodialysis and initiation kidney transplant workup

Question 7

CKD 5 interventions

Answer 7

Req. Permanent renal replacement therapy to sustain life (controlling increased electrolytes and metabolic acidosis: accumulation of waste products in blood)

Question 8

CKD manifestations

Answer 8

Kussmahl breathing (rapid shallow)
Pruritus (itchy skin)
Uremic futor (fruity breath)
Mental confusión
Arrhythmias (hyperkalemia)
Sexual dysfunction and moobs
Asterixes
Poor skin turger
Anemia

Question 9

Calcium and phosphorous binders

Answer 9

Calcium carbonate
Calcium acetate

Question 10

Meds for CkD

Answer 10

Antihypertensive and cv agents: diuretics, digoxin, ace inhibitors, dialysis
Antiepileptic agents: neuropathy and seizures seen in uremia
Erytrocyte-stimutating agents: erythropoietin <33% <12 hct and hgb, usually given with iron

Question 11

CkD Nutrition therapy

Answer 11

• restricted protein, only complete proteins
• 500-600 ml more output than prev. Day
  -Vit. Supplements
• Sodium and potassium restriction

Question 12

What medication is given for hyperkalemia

Answer 12

Sodium polystyrene (kayexalate), discontinue Ace inhibitors

Question 13

Meds for dyslipidemia

Answer 13

Statin therapy

Question 14

Indications of dialysis

Answer 14

Uremic s/s
Hyperkalemia
Fluid overload not responsive to diuretics and restriction
General lack of well being

Question 15

Av fistula shunt

Answer 15

Hemodialysis access, permanent access, connects artery directly to a vein
In thru vein out thru artery
Less chance of infections aNd clots compared to av grafts

Question 16

Av grafts

Answer 16

Hemodialysis access
Vein and artery connected to a graft
Alternative for a patient who’s vessels aren’t suitable for an Av fistula
Can be used 2-3 weeks after placed, fistulas 2-3 months

Question 17

Bruit and thrill

Answer 17

Bruit: swooshing with auscultation
Thrill: buzzing sensation with palpitations

Every shift access site needs to be accessed

No BP or IVs or blood draws on dialysis access arm!!!

Question 18

Stage l of encephalopathy

Answer 18

Normal lvl loc with lethargy and euphoria and disturbed sleep patterns

Question 19

Stage 2 encephalopathy

Answer 19

Increased drowsiness and disorientation, inappropriate behavior

Question 20

Stage 3 encephalopathy

Answer 20

Stupurous, incourharent speech, sleeps most of the time

Question 21

Stage 4 encephalopathy

Answer 21

Comatose

Question 22

Hepatorenal syndrome

Answer 22

Elevations of Serum creatinine without the presence of renal disease

Question 23

Pharmacological therapy for hypervolemia

Answer 23

Diuretics and potassium supplements

Question 24

Normal potassium levels

Answer 24

3.5-5