Unit 3 - Chronic Kidney Disease Flashcards
Definition: little or no kidney function (5 stages)
end-stage renal disease (ESRD)
Definition: may progress for years unrecognized
Chronic Kidney Disease
Describe the early stage of Chronic Kidney Disease (Decreased renal reserve)
- unaffected nephrons compensate
- GFR: ~50% normal
- asymptomatic, normal BUN, creatinine
1 cause of CKD (Chronic Kidney Disease)
Diabetes Mellitus
What happens to creatinine levels in renal failure
rise sharply
*The damaged kidney is unable to excrete waste products, including creatinine
In ESRD:
_____ _____ _____ is necessary to sustain life
renal replacement therapy
Longstanding _____ leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy.
hypertension
Diabetic ______ causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons.
nephropathy
_____ _____ _____ causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue.
Polycystic kidney disease
_____ _____ _____ causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis
Systemic lupus erythematosus
_____ _____ are nearly 4 times as likely to develop kidney disease as Caucasians
African Americans
Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially \_\_\_\_\_ (control blood glucose levels) and \_\_\_\_\_ (medication compliance)
In addition, clients should consume diets low in _____, exercise regularly, keep healthcare provider appointments, avoid _____, and limit _____ intake.
diabetes hypertension sodium smoking alcohol
What is uremia
urea in the blood
_____ is common in clients with renal disease. Among the factors causing the _____ are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow
Anemia, anemia
______: The manifestations of renal failure often are missed in aging clients because _____ may be attributed to heart failure or high blood pressure to preexisting hypertension. (new hypertension may be an indicator of the disease)
Edema, edema
How are uric acid levels effected with CKD
increased -> gout
Describe BUN levels with CKD
increased due to damaged kidneys
Describe serum osmolality with CKD
increased, because damaged kidney is unable to excrete solutes
Describe urine osmolality with CKD
decreased, because damaged kidney is unable to excrete solutes
Describe Phosphorus and Potassium levels during renal failure
increase, due to inability of the kidney to excrete them
T/F: There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.
T
_____ is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema.
Furosemide (Lasix)
_____ _____ also can reduce hypertension and cause potassium wasting, lowering serum potassium levels
Diuretic therapy
_____ _____-_____ _____, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels.
Oral phosphorus-binding agents
_____ _____ and _____ supplements are given to combat anemia associated with chronic kidney disease.
Folic acid, iron
The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange _____ for potassium in the _____ _____, resulting in decreased serum potassium levels. Therapeutic effectiveness of the drug is measured by monitoring the serum potassium.
sodium, large intestine
_____ _____ are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce _____ red blood cells. In chronic kidney disease, this hormone production will be _____.
Epoetin injections, more, reduced
_____ _____ and _____ may be used to reduce excessive potassium that is caused by chronic kidney disease.
Intravenous glucose and insulin
Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will _____ _____.
worsen hyperkalemia
Increases in weight needs to be reported to the healthcare provider as a possible indication of _____ _____ _____
fluid volume excess
Renal failure clients who are experiencing _____, need education on food choices and meal planning for the avoidance of high potassium foods i.e. Carrots; green, leafy vegetables; pears; and bananas are high in potassium.
Other high potassium food includes: Cantaloupe, Bananas, Oranges, Apricots, Avocado, Strawberries, Potatoes, Tomatoes, Cucumber, Cabbage, Cauliflower, Chard ,Bell pepper, Eggplant, Squash, Brussels sprouts, Spinach, Broccoli, Tuna, Halibut
hyperkalemia
A fluid restriction would be indicated for _____ caused by chronic kidney disease
uremia
A _____-_____ diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.
low-sodium
Diet modifications for CKD:
carbohydrates
increase
Diet modifications for CKD:
protein
restrict intake
Diet modifications for CKD:
water & sodium
regulate
Diet modifications for CKD:
salt substitutes
avoid
Diet modifications for CKD:
eggs
avoid
Diet modifications for CKD:
dairy products
avoid
Diet modifications for CKD:
meat
avoid
Where can hemodialysis be done
dialysis center or home
How often does hemodialysis need to be done
3x per week
Where can peritoneal dialysis be done
in the home
For living donors:
What medications are given to minimize organ rejection
- prednisone
- immunosuppressive agents
The client with chronic kidney disease with osteoporosis is at high risk for fractures; therefore, _____ _____ is the priority nursing diagnosis.
preventing injury
T/F: It is possible that the client on hemodialysis may have a disturbed body image
T
*use therapeutic communication to access.
The nurse tracks the client’s serum albumin level for the diagnosis of _____ _____: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin.
Diagnosis: _____ _____ _____. Assessing for edema and monitoring heart rate and blood pressure would be interventions
Risk for _____ _____: Monitoring for orthostatic blood pressure changes would be appropriate
Risk for _____ _____ the white blood cell count would be an intervention appropriate for this diagnosis
Imbalanced Nutrition
Diagnosis: Excess Fluid Volume
Risk for: Ineffective Perfusion
Risk for: Infection Monitoring
The control of _____ is essential in the management of a client with kidney disease
hypertension
Constipation _____ hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium.
exacerbates
The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Give _____ _____, with meals, it will bind serum phosphorus and therefore _____ the serum level.
Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease.
Calcium acetate, lower
When should you administer antiemetic agents
30-60 minutes before eating
_____ herbal supplements. Why?
Avoid
- May contain minerals that may be harmful to the kidneys
- May be contraindicated with one or more medications the client may be taking
An _____ _____ does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.
AV fistula (An abnormal connection between an artery and a vein)
Do you want to take BP on the same arm with the shunt?
NO!
How does Calcium Acetate help
Binds with phosphate to bring the phosphate levels down
