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NUR326: exam 2 > urologic problems: chronic kidney disease > Flashcards

urologic problems: chronic kidney disease Flashcards

1
Q

kidney function

A

-maintain fluid and electrolyte homeostasis
-rid the body of water soluble wastes via urine
-endocrine fxns:
*produces erythropoietin
*activates vit D
*produces renin (helps regulate BP)

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2
Q

RAAS system

A
  1. renin converts angiotensinogen to angiotensin I
  2. ACE converts angiotensin I to angiotensin II
  3. angiotensin II –> aldosterone

blood pressure regulation
- blood volume
- sodium reabsorption
- potassium secretion
- water reabsorption

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3
Q

BUN and Cr lab values

A

BUN = 10-20 mg/dL
Cr = 0.5-1.2 mg/dL

BUN:Cr = 10:1

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4
Q

GFR lab value

A

> 90 mL/min

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5
Q

when would you see a 20:1 BUN:Cr ratio?

A

glomerulonephritis and nephrotic syndrome

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6
Q

chronic kidney disease (CKD)

A

presence of kidney damage for > 3 months with/without GFR <60

-inability to maintain acid-base balance, remove end products of metabolism (build up of toxins), maintain fluid/electrolyte balance

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7
Q

CKD stage 1

A

kidney damage with normal or increased GFR

greater than or equal to 90

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8
Q

CKD stage 2

A

kidney damage with mild decrease in GFR

60-89

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9
Q

CKD stage 3

A

moderate decrease in GFR

30-59

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10
Q

CKD stage 4

A

severe decrease in GFR

15-29

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11
Q

CKD stage 5

A

ESRD

<15

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12
Q

causes of ESRD

A

diabetes (50%)
HTN (30%)
glomerulonephritis (10%)
other (10%)

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13
Q

risk factors for CKD

A

family history
>60
male
african american
HTN, DM
smoking
overweight/obesity

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14
Q

3 characteristics of CKD

A
  1. glomerulosclerosis: scar tissue in glomerulus – can’t filter blood properly (nonfunctional fibrotic tissue)
  2. interstitial fibrosis: obstruction of renal tubules and interstitial capillaries
  3. interstitial inflammation
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15
Q

what plays a major role in CKD

A

complement - part of inflammatory process that destroys kidney tissue

angiotensin II - an increase causes increased BP, thus increased damage

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16
Q

S/S stage 1 CKD

A

asymptomatic

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17
Q

S/S stage 2 CKD

A

asymptomatic, possible HTN

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18
Q

S/S stage 3 CKD

A

asymptomatic, possible HTN

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19
Q

S/S stage 4 CKD

A

manifestations becoming apparent
*diagnosis often occurs here

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20
Q

S/S stage 5 CKD

A

uremia
GFR < 15

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21
Q

uremia

A

high levels of waste in blood

-BUN
-Cr
-phenols
-hormones
-electrolytes
-water (retained)

seen when GFR < 10

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22
Q

psychologic/neurologic S/S of ESRD

A

anxiety and depression
fatigue
headache
sleep disturbances
encephalopathy
paresthesia
restless legs syndrome

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23
Q

cardiovascular S/S of ESRD

A

HTN
heart failure
CAD
pericarditis
peripheral artery disease

24
Q

GI S/S of ESRD

A

anorexia
N/V
GI bleeding
gastritis

25
Q

pulmonary S/S of ESRD

A

PE
uremic pleuritis
pneumonia

26
Q

ocular S/S of ESRD

A

HTN retinopathy

27
Q

endocrine S/S of ESRD

A

hyperparathyroidism
thyroid abnormalities
amenorrhea
erectile dysfunction

28
Q

metabolic S/S of ESRD

A

carb intolerance
HLD

29
Q

hematologic S/S of ESRD

A

anemia
bleeding
infection

30
Q

integumentary S/S of ESRD

A

pruritus
ecchymosis
dry, scaly skin

31
Q

MSK S/S of ESRD

A

vascular and soft tissue calcifications (hardness causing soreness)
osteomalacia (softening of bones bc decrease in Vit D)
osteitis fibrosa (loss of bone mass)

32
Q

abnormal kidney functions

A

-no longer maintain F/E homeostatis
-no longer rids the body of wastes via urine
-decreased production of erythropoietin
-decreased activation of vitamin D

33
Q

unable to maintain f/e homeostasis results in

A

edema
high potassium
high phos
high mag
metabolic acidosis

34
Q

unable to rid body of wastes results in

A

anorexia
malnutrition
itching
CNS changes

*uremic frost (crystallized deposits on skin - white spots)

35
Q

decreased production of erythropoietin results in

A

anemia

36
Q

decreased activation of vit D results in

A

renal osteodystrophy (weakening of bones)

37
Q

drugs can be used to

A

slow the rate of progression by decreasing BP < 140/90 and treating HLD <200 (cholesterol)

& treat complications of CKD

38
Q

complications of CKD

A

volume overload
hyperkalemia
metabolic acidosis
hyperphosphatemia
renal osteodystrophy
anemia

39
Q

how to control BP

A

ACE or ARB

maintain SBP 110-130

40
Q

how to control lipids

A

statins

41
Q

treatment for volume overload

A

loop diuretic

used with low salt diet

42
Q

treatment for hyperkalemia

A

multiple – diuretics

addressed with hemodialysis in ESRD

43
Q

treatment for metabolic acidosis

A

sodium bicarbonate

*alkaline agent

44
Q

treatment for hyperphosphatemia

A

calcium carbonate

a phosphate binder

45
Q

treatment for renal osteodystrophy

A

calcitrol

activated vitamin D

46
Q

treatment for anemia

A

erythropoietin

*must have iron

BLACK BOX WARNING: increase CV problems

47
Q

goal of sodium bicarbonate

A

metabolic acidosis

goal: slow CKD progression, prevent bone loss, improve nutritional status

48
Q

administration of sodium bicarbonate

A

initiate when HCO3 <15 (tested with CO2 on BMP

titrate to a HCO3 of 18-20

consider switch to sodium citrate if bloating is a problem

49
Q

calcium carbonate MOA + goal

A

MOA: binds to phosphate

GOAL: treat hyperphosphatemia
-keep phosphate levels normal (near)
-reduce mortality

50
Q

considerations + SE’s with calcium carbonate

A

take with meals to increase absorption

SE: high Ca –> monitor levels (acts as sedative)

51
Q

calcitriol MOA

A

activated form of vit D
stimulates intestinal absorption of calcium/phosphate and bone mineralization

52
Q

calcitriol SE

A

high Ca - toxicity
high phosphate

53
Q

signs of Ca toxicity

A

GI upset
bone pain
neuro effects
cardiac arrythmias

54
Q

complications of drug therapy

A

many drugs are excreted through kidneys, so if the kidneys are functioning may need to have renal dosing (decreased dose + frequency)

55
Q

drugs of concern when treating CKD

A

digoxin
diabetic agents (glyburide, metformin)
antibiotics (vancomycin)
opioids (morphine)

NUR326: exam 2 (12 decks)

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