Regulation Flashcards
Common findings of CKD
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
Maintain bp less than what for CKD
<130/80
Stage 1 CKD interventions
Dx stage and treatment of etiology
CVD risk reduction (stabilize BP)
CKD2 interventions
Estimate and slow progression, control BP and DM, avoid nephrotoxins
CKD3 interventions
Sx treatment
CKD 4 interventions
Prep for renal replacement therapy hemodialysis and initiation kidney transplant workup
CKD 5 interventions
Req. Permanent renal replacement therapy to sustain life (controlling increased electrolytes and metabolic acidosis: accumulation of waste products in blood)
CKD manifestations
Kussmahl breathing (rapid shallow)
Pruritus (itchy skin)
Uremic futor (fruity breath)
Mental confusión
Arrhythmias (hyperkalemia)
Sexual dysfunction and moobs
Asterixes
Poor skin turger
Anemia
Calcium and phosphorous binders
Calcium carbonate
Calcium acetate
Meds for CkD
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
CkD Nutrition therapy
- restricted protein, only complete proteins
- 500-600 ml more output than prev. Day
-Vit. Supplements - Sodium and potassium restriction
What medication is given for hyperkalemia
Sodium polystyrene (kayexalate), discontinue Ace inhibitors
Meds for dyslipidemia
Statin therapy
Indications of dialysis
Uremic s/s
Hyperkalemia
Fluid overload not responsive to diuretics and restriction
General lack of well being
Av fistula shunt
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
Av grafts
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
Bruit and thrill
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!!!
Stage l of encephalopathy
Normal lvl loc with lethargy and euphoria and disturbed sleep patterns
Stage 2 encephalopathy
Increased drowsiness and disorientation, inappropriate behavior
Stage 3 encephalopathy
Stupurous, incourharent speech, sleeps most of the time
Stage 4 encephalopathy
Comatose
Hepatorenal syndrome
Elevations of Serum creatinine without the presence of renal disease
Pharmacological therapy for hypervolemia
Diuretics and potassium supplements
Normal potassium levels
3.5-5
