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2514 Patho/phys/assess > Week 10 CKD Kidney disease assessment > Flashcards

Week 10 CKD Kidney disease assessment Flashcards

1
Q

What are the 3 major risk factors for CKD?

A

1.Diabetes (44%)
2.HTN (29%)
3.family history of kidney disease

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2
Q

What are the 5 kidney disease/injuries that lead to CKD?

A
  1. glomerulonephritis (7%)
  2. Polyscystic kidney disease (<2%)
  3. phelonephritis
  4. Renal stenosis
  5. Acute kidney injury (AKI)
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3
Q

What are the 4 other reasons people develop CKD?

A
  • age >65
  • Meds
  • Smoking
  • Hyperlipidemia
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4
Q

Which ethnicities are at increased risk of developing CKD?

A
  1. Indigenous
  2. Filippino
  3. Asian
  4. African
  5. Caribbean
  6. Latin Canadian
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5
Q

What is the most common disease leading to dialysis and transplantation?

A

Diabetic Nephropathy (NOT neuropathy- words are diff.)

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6
Q

How long after the onset of diabetes does proteinuria usually appear?

A
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7
Q

What 3 things do we monitor in people with CKD?

A
  1. blood pressure changes (hypertension)
  2. Blood work (urea, creatinine)
  3. Urine (proteinuria/albuminuria)
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8
Q

how many ml/min GFR is CKD diagnosed?

A

GFR <60ml/min/1.73m2 for 3 months or longer

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9
Q

What do we focus our care on for someone in stage 1 of CKD?

A

Screening

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10
Q

What do we focus our care on for someone in stage 2 of CKD?

A

Reduction of risk factors

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11
Q

What do we focus our care on for someone in stage 3 of CKD?

A
  1. DM and HTN control
  2. restriction of fluids
  3. restriction of protein
  4. electrolytes
  5. azotemia - waste product accumulation
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12
Q

What do we focus our care on for someone in stage 4 of CKD?

A
  1. manage possible complications like anemia, fluid and electrolyte imbalance or acid and base imbalance
  2. educate about treatment options
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13
Q

What do we focus our care on for someone who is in stage 5 of CKD?

A

Renal replacement therapy (Dialysis)

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14
Q

What does a person with CKD look like?

A

puffy
edema
anemic
infection
GI bleeding

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15
Q

What is the subjective data we will ask during the nursing assessment?

A
  1. Hx of current illness
  2. Presenting symptoms
  3. PMHx
  4. Medications
  5. Recent diagnostic tests/surgeries
  6. Family Hx of kidney disease
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16
Q

What is the objective data we will collect during the nursing assessment?

A
  1. Vitals
  2. Physical assessment using systems approach
  3. Lab values
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17
Q

What will we see in blood work for Uremia if there is an electrolyte and acid-base imbalance?

A
  1. K+ will be raised b/c RAAS is holding in Na+ at first
  2. Na+ will be low (early) b/c RAAS, high (late if diet has more Na+)
  3. Calcium will be low (late) b/c can’t produce vit D so not being absorbed from food into blood
  4. Phosphate will be high (late) b/c kidneys can’t excrete it well
  5. Magnesium will be high - if ingesting Mg (late) b/c kidneys can’t secrete it well
  6. Metabolic acidosis - high H+. esp. if K+ is high (late)
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18
Q

What will we see in blood work for Uremia if there is a hematological imbalance?

A
  1. Anemia - because EPO is decreased
  2. Platelet dysfunction and increased bleeding/bruising because of uremia (blocks platelet aggrigation)
  3. Leukocyte dysfunction and altered immune response b/c of uremia - lowers WBC
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19
Q

What are most symptoms of CKD related to?

A
  1. electrolyte imbalance
  2. acid-base imbalance
  3. nitrogen build up
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20
Q

What are the neurological clinical manifestations of CKD and what is the physical assessments for each?

A

Uremic encephalopathy - watch for change in consciousness/behaviour
Uremic neuropathies- Palpate extremities for changes in sensation, unusual reflexes/tremors

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21
Q

What diagnostic tests might be done for neurological manifestations of CKD?

A
  1. BUN (elevated)
  2. electrolytes (Na low, Mg high, Ca low)
  3. ABG - check acidosis
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22
Q

what would I see in uremic encephalopathy?

A
  1. fatigue
  2. decreased concentration
  3. seizures
  4. coma
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23
Q

What would I see in Uremic neuropathies?

A

1.Twitching/tremors
2. Paresthesia in feet/legs
3. Asterixis

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24
Q

What is Asterixis?

A

Flapping tremor of hands

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25
What are the cardiovascular clinical manifestations of CKD and what is the physical assessments for each?
1. HTN *most common- BP*, temp, HR*, RR 2. Anemia 3. Fluid overload - check JVP, dyspnea, edema 4. heart failure (cardiorenal syndrome) - auscultate lungs 5. atherosclerosis and Ca deposits - chest pain, SOB 6. Peripheral edema- palpate 7. Cardiac dysrhythmias - irregular HR 8. Uremic pericarditis - Heart sounds (friction rub or S3)
26
What diagnostic tests might be done for cardiovascular manifestations of CKD?
1. EKG 2. Electrolytes (K will be high, Na, Urea, Cr)
27
What is Uremic pericarditis
The uremic toxins build up irritates the heart tissues (pericardial sac)
28
What are the symptoms of Uremic pericarditis?
1. chest pain 2. low grade fever 3. pericardial friction rub 4. pericardial effusion or tamponade (too much fluid in the pericardial sac so you get less CO and then shock)
29
What are the physical assessments for respiratory clinical manifestations of CKD?
1. SOB 2. Dyspnea 3. Cough 4. O2 sats/RR 5. Auscultate air entry (none = PN maybe), adventitous = crackles/fluid
30
What are the Respiratory clinical manifestations of CKD ?
1. Dyspnea b/c fluid overload, pulmonary edema, pleural effusion, uremic pleuritis 2. secondary infections b/c decreased immune response 3. uremic pleuritis
31
what is uremic pleuritis?
Thick sputum, tachypnea, fever
32
What is pleural effusion?
Accumulation of fluid in the pleural cavity
33
What diagnostic tests might be done for respiratory manifestations of CKD?
1. CXR 2. sputum C&S 3. WBC 4. ABG 5. urea/creatinine
34
What are the GI clinical manifestations of CKD and physical assessment ?
1. *Uremic fetor - ammonia breath 2. *Stomatitis with ulcerations - observe/inspect oral mucosa 3. *Altered sense of taste - metalic 4. N&V - monitor I&O, emesis 5. Anorexia 6. *Hiccups 7. Uremic Gastritis (bleeding) - emesis 8. Uremic Colitis (diarrhea) 9. constipation (due to meds) - palpate abdomen, auscultate for bowel sounds 10. weight loss & malnutrition
35
Why does CKD cause GI issues?
inflammation of mucosa due to waste toxins uremic gastritis uremic colitis
36
What is Uremic fetor? (usually advanced CKD)
1. breath smells like urine 2. person has metalic taste
37
What is Stomatitis?
- swelling and redness of the lining of your mouth. - hard for you to eat, drink, or swallow. - can be with painful ulcerations in the mouth
38
What diagnostic tests might be done for GI manifestations of CKD?
lab - urea & creatinine Stool- occult blood
39
What are the GU clinical manifestations of CKD and physical assessment ?
1. polyuria in early stages (nocturia) 2. Oliguria if progressed 3. anuria in ESRD 4. urine has protein, casts, pyuria, hematuria
40
what are the 5 Musculoskeletal and Integumentary manifestations of CKD and physical assessment?
1. bone loss - renal osteodystrophy 2. bone weakness 3. muscle cramping and weakness 4. vascular and soft tissue calcifications 5. skin issues - puritis (bad itching), ecchymosis (bruising b/c platelets) , dry skin, uremic frost (crystalized urea on the skin)
41
what is uremic frost?
*urea* that crystalizes on the skin. yikes
42
what are 3 reasons why people with CKD are at risk for malnutrition?
uremic gastroenteritis - anorexia , N& V - nutrient absorption issues in GI - loss of protein in urine
43
As CKD progresses, how will the amount of urine production change?
It will decrease as the disease progresses
44
What is CKD an example of?
altered elimination
45
How long after the onset of diabetes does proteinuria usually appear?
approx 10-15 years
46
What should we always be assessing in people with diabetes?
proteinuria
47
For people with diabetes and HTN what 3 things are always monitored regarding kidney function?
1. BP - for HTN 2. blood work - urea, creatinine 3. urine - for proteinuria/albuminuria
48
what stage of CKD is albuminuria likely to appear?
stage 3
49
which stage of CKD is there increased urine production that is dilute?
stage 2
50
What medications tend to lead to CKD?
NSAIDS
51
what saying helps us remember what is toxic to kidneys and can contribute to CKD and what does each one mean?
Metal- mercury, lead C- chemo A - anitbiotics (aminoglycosides) N- NSAIDS (chronic use) S- solvents (ethylene glycol - car)
52
If urine is dilute, will the specific gravity test be low or high?
low
53
what disease do insoluble calcification with CKD in the vascular wall and soft tissue lead to ?
Cardiovascular disease
54
What bloodwork will we see in someone with renal osteodystrophy?
-increased PTH - increased phosphorus - increased magnesium - increased potassium - decreased calcium
55
What 6 blood work tests are done in renal diagnostics?
1. Urea, creatinine 2. urea/creatinine ration (normal is 10:1) 3. eGFR screening 4. electrolytes (Na, K, Cal, phos, nitrogen, mag) 5. CBC ( wbc, rbc, platelets) 6. HCO3 bicarb
56
What 3 things are tested in urine in renal diagnostics?
1. Urinalysis (protein, blood, pH, glucose) 2. Creatinine clearance 3-24 hour to help choose CKD stage 3. Urine albumin : creatinine ratio - urine albumin = how much protein is being wasted - creatinine ratio= how much creatinine can the kidneys excrete
57
What are the two purposes of dialysis?
1. correct fluid and electrolyte imbalances 2. filter the blood to remove waste from the blood
58
What is hemodialysis?
machine - HSC dialysis unit
59
what is peritoneal dialysis?
your peritoneal layer cleans your blood CAPD & APD
60
what are the possible indications for Dialysis?
AEIOU A-acidemia (metabolic acidosis) E- EKG changes due to hyperkalemia I- intoxication from meds - infection b/c uremia blocks WBC O - Overload of fluids (diuretics not working) U- Uremia complications - pericarditis/encephalopathy/GI bleeding
61
What is the difference between hemodialysis and peritoneal dialysis in terms of access points?
hemodialysis - arm arteriovenous fistula peritoneal dialysis - catheter in the abdomen
62
what is arteriovenous fistula?
your vein and artery are sewen together for hemodialysis
63
What is the difference between hemodialysis and peritoneal dialysis in terms of treatment time?
hemodialysis - 3-4 hours 3x/wk peritoneal dialysis - dwells of 30 min to 8 hours
64
What is the difference between hemodialysis and peritoneal dialysis in terms of monitoring?
hemodialysis - vitals (esp BP), blood work peritoneal dialysis - no monitoring
65
How does a nurse monitor a fistula with someone on hemodialysis?
1. Palpate fistula for a thrill (wooshing) - good 2. Auscultate fistula for a bruit (wooshing)- good feel a thrill - hear a bruit
66
How does a nurse monitor the site of someone with peritoneal dialyisis?
1. check for infection 2. keep catheter site clean and dry
67
What is the 1 restriction (1 each) for both types of dialysis?
1. hemo- don't put BP on fistula arm 2. Peri- avoid constipation (straining abdomen)
68
what are the 3 complications of hemodialysis after treatment?
1. hypotension 2. bleeding 3. infection
69
What are the 3 complications of peritoneal dialysis after treatment?
1. Outflow obstruction 2. infection at site or in peritoneum 3. back and abdominal pain - b/c fluid shifts
70
Are there diet changes for someone on hemodialysis?
no
71
are there diet changes for someone using peritoneal dialysis?
yes - eat MORE protein b/c some is lost in the dialysate (fluid from the bag used to filter the blood)
72
what are 4 dietary changes someone should make when they have diagnosed CKD?
1. less protein - hard on kidneys 2. no excess sodium - help with HTN 3. less phophate - cuz kidneys can't deal with it and then it binds to calcium and forms calcifications 4. no extra K+ because it's already raised and could get worse with metabolic acidosis
73
What can a patient with CKD do at home on a regular basis to monitor their kidney function?
monitor their *weight* - for I/O to ensure kidneys are functioning ok. This will also indicate signs of fluid retention which is bad for CVD and fluid in lungs increase of 1kg = 1 L of fluid retention
74
what are the 2 most important ways to preserve kidney function?
-management of diabetes - management of HTN

2514 Patho/phys/assess (27 decks)

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