Test 4/Week 11: CKD

Question 1

CKD Etiology

Answer 1

GFR<60 for 3 months

Question 2

Leading Causes of CKD

Answer 2

Hypertension, diabetes

Others: glomerulonephritis, Hypercalcemia, multiple myeloma, chronic UTI

Question 3

CKD Stages

Answer 3

GFR
1. >90: normal
2. 60-89: mild
3. 30-59: moderate
4. 15-29: severe, pre-hemodialysis
5 <15: kidney failure, uremia

Question 4

CKD General signs and symptoms

Answer 4

Check creatinine and GFR, hypertension, pulmonary edema

Fatigue, malaise, vision changes, HF, CAD, anorexia, N/V, pruritus, pallor, MS changes, seizures, neuropathy, hyperglycemia

Question 5

CKD Management/treatment

Answer 5

Identify and treat factors associated with the progression of CKD.

Dialysis, HTN, glucose control, anemia, hyperlipidemia, transplant

Question 6

Target BP

Answer 6

<130/80

<125/75 with proteinuria

Question 7

Best predictor of CKD progression

Answer 7

Proteinuria

Normal albumin excretion: <30mg/day
Nephrotic: >3g/day

Question 8

CKD metabolic changes

Answer 8

Down: H/H, bicarb, calcium, sodium

Up: phosphate, PTH, triglycerides, creatinine, potassium

Leads to acidosis

Question 9

Hematologic changes

Answer 9

Anemia (decreased erythropoietin and platelet function), leukocyte function, humoral/cellular response

Question 10

Epoetin alfa (Epogen/Procrit) Treatment

Answer 10

Hemodialysis: 50-109 units/kg IV/SC 3x/wk

Non-hemodialysis: 10,000 units/week

AE: iron deficiency and constipation from iron treatment

Question 11

Darbepoetin alfa (Aranesp) Treatment

Answer 11

HD: 0.45 mcg/kg weekly

Non-HD: 60 mcg q2wks

Question 12

Metabolic acidosis

Answer 12

Leads to release of bone calcium/phosphorus, muscle catabolism (decreased albumin synthesis), maintain bicarb>22

Question 13

CKD Nutrition Restrictions

Answer 13

Restrict: protein, water (1-3kg between dialysis), sodium (2-4g), potassium (2-3g), phosphate (1g)

Question 14

Hemodialysis assessment/priorities

Answer 14

ABCs, temperature before starting, current medications, how much fluid was taken off

complete assessment with heart and lung sounds, condition of access, weight, BP, edema, labs, CXR

Question 15

Arteriovenous Fistula Types

Answer 15

1. Radiocephalic
2. Brachiocephalic
3. Brachiobasilic
4. Rare in lower extremities

Question 16

AVF Assessment

Answer 16

Look: condition, infection
Feel: for thrill, pulse is bad
Listen: low pitched bruit, high pitched/short is bad

Question 17

Arteriovenous Grafts

Answer 17

Synthetic conduit between artery/vein, straight or looped

Question 18

3 Phases of PD

Answer 18

Called an exchange: inflow (fill), dwell (equilibration), drain

Question 19

Inflow Phase of PD

Answer 19

Prescribed amount of solution infused through catheter over 10 minutes. After infused inflow clamp is closed to prevent air from entering tubing

Question 20

Dwell Phase of PD

Answer 20

Diffusion/osmosis occur between blood and peritoneal cavity, duration varies

Question 21

Drain Phase of PD

Answer 21

15-30 minutes, facilitated by gently massaging abdomen/position changes

Call MD for any drainage at insertion site

Question 22

PD Management/Assessment

Answer 22

Maintain sterile environment, mask/gloves, sterile tubing, skin cleansing/sterile dressing

VS q 30-60mins, watch for changes in LoC, post treatment weight

Question 23

PD Complications

Answer 23

Hypotension, muscle cramping

Blood loss, hepatitis, sepsis

Question 24

Collaboration with Dialysis Nurse

Answer 24

Hold meds? BP, ABx, diuretics, analgesics

Lab results, device assessment