Test 4/Week 11: CKD Flashcards
CKD Etiology
GFR<60 for 3 months
Leading Causes of CKD
Hypertension, diabetes
Others: glomerulonephritis, Hypercalcemia, multiple myeloma, chronic UTI
CKD Stages
GFR 1. >90: normal 2. 60-89: mild 3. 30-59: moderate 4. 15-29: severe, pre-hemodialysis 5 <15: kidney failure, uremia
CKD General signs and symptoms
Check creatinine and GFR, hypertension, pulmonary edema
Fatigue, malaise, vision changes, HF, CAD, anorexia, N/V, pruritus, pallor, MS changes, seizures, neuropathy, hyperglycemia
CKD Management/treatment
Identify and treat factors associated with the progression of CKD.
Dialysis, HTN, glucose control, anemia, hyperlipidemia, transplant
Target BP
<130/80
<125/75 with proteinuria
Best predictor of CKD progression
Proteinuria
Normal albumin excretion: <30mg/day
Nephrotic: >3g/day
CKD metabolic changes
Down: H/H, bicarb, calcium, sodium
Up: phosphate, PTH, triglycerides, creatinine, potassium
Leads to acidosis
Hematologic changes
Anemia (decreased erythropoietin and platelet function), leukocyte function, humoral/cellular response
Epoetin alfa (Epogen/Procrit) Treatment
Hemodialysis: 50-109 units/kg IV/SC 3x/wk
Non-hemodialysis: 10,000 units/week
AE: iron deficiency and constipation from iron treatment
Darbepoetin alfa (Aranesp) Treatment
HD: 0.45 mcg/kg weekly
Non-HD: 60 mcg q2wks
Metabolic acidosis
Leads to release of bone calcium/phosphorus, muscle catabolism (decreased albumin synthesis), maintain bicarb>22
CKD Nutrition Restrictions
Restrict: protein, water (1-3kg between dialysis), sodium (2-4g), potassium (2-3g), phosphate (1g)
Hemodialysis assessment/priorities
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
Arteriovenous Fistula Types
- Radiocephalic
- Brachiocephalic
- Brachiobasilic
- Rare in lower extremities
AVF Assessment
Look: condition, infection
Feel: for thrill, pulse is bad
Listen: low pitched bruit, high pitched/short is bad
Arteriovenous Grafts
Synthetic conduit between artery/vein, straight or looped
3 Phases of PD
Called an exchange: inflow (fill), dwell (equilibration), drain
Inflow Phase of PD
Prescribed amount of solution infused through catheter over 10 minutes. After infused inflow clamp is closed to prevent air from entering tubing
Dwell Phase of PD
Diffusion/osmosis occur between blood and peritoneal cavity, duration varies
Drain Phase of PD
15-30 minutes, facilitated by gently massaging abdomen/position changes
Call MD for any drainage at insertion site
PD Management/Assessment
Maintain sterile environment, mask/gloves, sterile tubing, skin cleansing/sterile dressing
VS q 30-60mins, watch for changes in LoC, post treatment weight
PD Complications
Hypotension, muscle cramping
Blood loss, hepatitis, sepsis
Collaboration with Dialysis Nurse
Hold meds? BP, ABx, diuretics, analgesics
Lab results, device assessment
