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My MNTII Test 2 > Review: Dialysis & MNT > Flashcards

Review: Dialysis & MNT Flashcards

1
Q

hemodialysis types

A 
center: 3-5 hr/3 per wk
home
conventional: 3-4 hr/3 per wk
short daily: 2 hr/5-7 per wk
nocturnal: 6-8 hr/6 per wk or every other night
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2
Q

NxStage system

A

daily home dialysis, may feel better, less drastic fluid etc fluctuations

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3
Q

short daily & nocturnal HD

A

ppl need less BP & anemia meds, easier to control phos, less fluid restriction, more liberal diet, sleep better

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4
Q

HD: when is it needed

A

when BUN >80 mg/dL and creatinine >8 mg/dL

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5
Q

HD goals

A

maintain plasma levels of protein waste and electrolytes acceptable for dialysis pt.
try MNT and meds to control CKD related probs: anemia, osteodystrophy, CVD

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6
Q

HD Energy

A

30-50 kcal/kg (usual adult 35, over 60 years = 30-35)

always use dry or post-dialysis wt

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7
Q

HD Protein

A

1.0-1.5 g/kg dry wt
KDOQI = 1.2 g/kg
acutely ill = 1.2-1.3

half of protein should be high biological value

dialysis pts need a higher than RDA intake of 0.8

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8
Q

low plasma BUN and/or albumin

A

may indicate need for higher protein intake

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9
Q

high plasma BUN and/or albumin

A

may indicate protein intake is too high

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10
Q

acceptable BUN for dialysis pt

A

60-90 mg/dL

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11
Q

MNT HD tool

A

urea kinetic modeling to be sure dialysis is adequate

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12
Q

carnitine

A

decrease during dialysis (about same as normal urinary loses)

oral dose = 2g/day or less and IV 1.4g/day

higher dose have negative effects

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13
Q

MNT Variables that may help HD

A

control hypertriglyceridemia. increase HDL, improve ejection fraction/heart pumping.
lessen cardiac arrhythmias during dialysis, less muscle pain, weakness, cramps, hypotension.
help w/EPO resistant anemia.

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14
Q

acidosis

A

measure predialysis/stabilized serum bicarb monthly, should be >22mmol/L.

correct w/ oral administration of alkali therapy/bicarb dialysate solution.

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15
Q

fluid restriction

A

restricted to 1000ml/day + output.

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16
Q

excessive fluid

A

lead to edema, pulmonary edema, high wt gain b/w dialysis, high/low BP, CHF, cramps during dialysis

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17
Q

wt gain b/w treatments

A

should not exceed 1-2 lb/day.

common to see 2-4 lb b/w M & W, and 3-5 lb gains over weekend.

1 pt/2 c = 1 lb

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18
Q

thirst

A

increased by high BG or Na

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19
Q

what counts as a fluid

A

anything that melts to a liquid. IV fluids or blood. TF or liquid sups.

ice, ice cream, ices, jello, popsicles, pudding (juicy fruits also increase fluid intake)

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20
Q

K restriction

A

1500-3000 mg/day

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21
Q

K mEq

A

39 mg K = 1 mEq

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22
Q

K high plasma values

A

d/t high K consumption. salt substitutes (Morton Lite Salt, Cardia) are very high in K

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23
Q

high K foods

A

F&V, lima bean, peanut, sardine, yogurt

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24
Q

Na mEq

A

23 mg Na = 1 mEq

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25
Q

Na restriction

A

2000 mg/day

26
Q

Na high plasma levels

A

d/t high Na food consumption.

causes thirst, swelling, high BP, heart strain

27
Q

high Na foods

A

canned soup, baking soda/powder, meat tenderizer, MSG (Accent), bouillon, olive, V-8, Gatorade, ketchup, sauce/dressings, cheese, ham, tuna or smoked salmon

28
Q

Phos normal range

A

3.5-5.5 mg/dL

29
Q

Phos restriction

A

800-1600 mg/day

30
Q

meds that decrease phos absorption

A

renagel, fosrenal, RenaGum (chitosan) or aluminum antacids like amphojel, alternagel, alu-caps, alu-tabs, calcium sups. (less use of aluminum due to side effects)

31
Q

Ca sups to control phos

A

when plasma phos is <7.0 mg/dL

if above 7, calcification of soft tissues may occur

32
Q

Ca & vit D normal values

A

for dialysis pt are 8.5-9.5 mg/dL

33
Q

Ca recommendation

A

1000-1600 mg/day. limit total daily Ca load to <1500-2000

34
Q

Ca sups - Citrical

A

= calcium citrate

35
Q

Ca sups - Phoslo

A

= calcium acetate

36
Q

Ca sups - Oscal, tums, Maalox

A

= calcium carbonate

37
Q

high Ca, CaxP, phos, iPTH increase risk of

A

CVD, calciphylaxis, bone disorders

38
Q

control high iPTH meds

A

hectoral (doxercalcipherol)
zemplar (paricalcitol)
sensipar (cinacalcet) - not a form of vit D

39
Q

active vitamin D

A

1,25 dihydroxycholicalciferol made in kidneys

40
Q

lack of 1,25(OH)2D contributes to

A

bone deterioration and PTH elevation

41
Q

reval MVTs w/o vit A

A

diatx, rena, dialyvite 800, nephrocaps, nephrovit, renal tabs

42
Q

Diatx more effective in

A

lowering plasma homocysteine levels as it has more folate, B12, B6

43
Q

Vit A: serum retinol and RBP in CKD

A

are 2-5 times greater than normal d/t prolonged half-life from less renal clearance

44
Q

Vit A: most is excreted as

A

retinoic acid. excretion may be compromised in CKF

45
Q

Vit A: avoid

A

exceeding the RDA & retinol supps. carotenoids are OK

46
Q

Vit E: SPACE study

A

in HD pts w/CVD, 800 IU daily vit E reduced composite CVD endpoints & MI

47
Q

Water Sol Vits

A

may be some dialysis loss and inadequate intake

48
Q

Water Sol Vits: CKD pts are at high risk for

A

elevated plasma homocysteine (a CVD risk factor)

49
Q

Water Sol Vits: serum creatinine is a strong determinant of

A

plasma homocysteine (tHcy). tHcy levels are often 3-5 times normal in CRF d/t poor excretion & impaired nonrenal disposal

50
Q

Water Sol Vits: Hcy metabolism needs

A

folate, B12, B6

51
Q

plasma tHcy randomized supp trials

A

5 mg folate + MVT daily reduced plasma tHcy

(in 15, 30, or 60 mg folate/day, tHcy rebounded to higher than pre-therapy levels in 30 & 60 mg groups)

trials lowered plasma Hcy but failed to lower CVD…

52
Q

hyperhomocysteinemia predicts

A

CVD events in HD pts

53
Q

zinc def causes

A

hypogeusia, hyposmia, poor appetitie, rash, poor wound heal, imune and sexual dysfcn. poor child growth.

54
Q

zinc def pts should avoid

A

magnesium laxatives such as MOM

55
Q

CKD pts have lower

A

zinc status

56
Q

zinc def predisposing factors

A

poor intake, loss d/t blood loss, poor transport if low albumin, less absorption d/t Ca and Fe sups, tissue redistribution

57
Q

zinc sup recommendation

A

up to 50 mg/day. improved appetite, taste acuity, immunity, and sexual fcn have been reported

58
Q

magnesium will

A

lower P

59
Q

hypermagnesemia risks caused by CKD

A

n&v, weak, flushing, decreased consciousness, low reflexes, hypotension, arrhythmias, death

60
Q

hypermagnesemia avoid

A

Mg containing laxatives and antacids: Mg citrate, MOM, Haley’s Mo, gelusil , Maalox, mylanta, gaviscon

My MNTII Test 2 (7 decks)

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