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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
Q

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

A
  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)
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26
Q

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

A
  1. EKG
  2. Electrolytes (K will be high, Na, Urea, Cr)
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27
Q

What is Uremic pericarditis

A

The uremic toxins build up irritates the heart tissues (pericardial sac)

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28
Q

What are the symptoms of Uremic pericarditis?

A
  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)
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29
Q

What are the physical assessments for respiratory clinical manifestations of CKD?

A
  1. SOB
  2. Dyspnea
  3. Cough
  4. O2 sats/RR
  5. Auscultate air entry (none = PN maybe), adventitous = crackles/fluid
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30
Q

What are the Respiratory clinical manifestations of CKD ?

A
  1. Dyspnea b/c fluid overload, pulmonary edema, pleural effusion, uremic pleuritis
  2. secondary infections b/c decreased immune response
  3. uremic pleuritis
31
Q

what is uremic pleuritis?

A

Thick sputum, tachypnea, fever

32
Q

What is pleural effusion?

A

Accumulation of fluid in the pleural cavity

33
Q

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

A
  1. CXR
  2. sputum C&S
  3. WBC
  4. ABG
  5. urea/creatinine
34
Q

What are the GI clinical manifestations of CKD and physical assessment ?

A
  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
Q

Why does CKD cause GI issues?

A

inflammation of mucosa due to waste toxins
uremic gastritis
uremic colitis

36
Q

What is Uremic fetor? (usually advanced CKD)

A
  1. breath smells like urine
  2. person has metalic taste
37
Q

What is Stomatitis?

A
  • 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
Q

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

A

lab - urea & creatinine
Stool- occult blood

39
Q

What are the GU clinical manifestations of CKD and physical assessment ?

A
  1. polyuria in early stages (nocturia)
  2. Oliguria if progressed
  3. anuria in ESRD
  4. urine has protein, casts, pyuria, hematuria
40
Q

what are the 5 Musculoskeletal and Integumentary manifestations of CKD and physical assessment?

A
  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
Q

what is uremic frost?

A

urea that crystalizes on the skin. yikes

42
Q

what are 3 reasons why people with CKD are at risk for malnutrition?

A

uremic gastroenteritis
- anorexia , N& V
- nutrient absorption issues in GI
- loss of protein in urine

43
Q

As CKD progresses, how will the amount of urine production change?

A

It will decrease as the disease progresses

44
Q

What is CKD an example of?

A

altered elimination

45
Q

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

A

approx 10-15 years

46
Q

What should we always be assessing in people with diabetes?

A

proteinuria

47
Q

For people with diabetes and HTN what 3 things are always monitored regarding kidney function?

A
  1. BP - for HTN
  2. blood work - urea, creatinine
  3. urine - for proteinuria/albuminuria
48
Q

what stage of CKD is albuminuria likely to appear?

A

stage 3

49
Q

which stage of CKD is there increased urine production that is dilute?

A

stage 2

50
Q

What medications tend to lead to CKD?

A

NSAIDS

51
Q

what saying helps us remember what is toxic to kidneys and can contribute to CKD and what does each one mean?

A

Metal- mercury, lead
C- chemo
A - anitbiotics (aminoglycosides)
N- NSAIDS (chronic use)
S- solvents (ethylene glycol - car)

52
Q

If urine is dilute, will the specific gravity test be low or high?

A

low

53
Q

what disease do insoluble calcification with CKD in the vascular wall and soft tissue lead to ?

A

Cardiovascular disease

54
Q

What bloodwork will we see in someone with renal osteodystrophy?

A

-increased PTH
- increased phosphorus
- increased magnesium
- increased potassium
- decreased calcium

55
Q

What 6 blood work tests are done in renal diagnostics?

A
  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
Q

What 3 things are tested in urine in renal diagnostics?

A
  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
Q

What are the two purposes of dialysis?

A
  1. correct fluid and electrolyte imbalances
  2. filter the blood to remove waste from the blood
58
Q

What is hemodialysis?

A

machine - HSC dialysis unit

59
Q

what is peritoneal dialysis?

A

your peritoneal layer cleans your blood
CAPD & APD

60
Q

what are the possible indications for Dialysis?

A

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
Q

What is the difference between hemodialysis and peritoneal dialysis in terms of access points?

A

hemodialysis - arm arteriovenous fistula
peritoneal dialysis - catheter in the abdomen

62
Q

what is arteriovenous fistula?

A

your vein and artery are sewen together for hemodialysis

63
Q

What is the difference between hemodialysis and peritoneal dialysis in terms of treatment time?

A

hemodialysis - 3-4 hours 3x/wk
peritoneal dialysis - dwells of 30 min to 8 hours

64
Q

What is the difference between hemodialysis and peritoneal dialysis in terms of monitoring?

A

hemodialysis - vitals (esp BP), blood work
peritoneal dialysis - no monitoring

65
Q

How does a nurse monitor a fistula with someone on hemodialysis?

A
  1. Palpate fistula for a thrill (wooshing) - good
  2. Auscultate fistula for a bruit (wooshing)- good
    feel a thrill - hear a bruit
66
Q

How does a nurse monitor the site of someone with peritoneal dialyisis?

A
  1. check for infection
  2. keep catheter site clean and dry
67
Q

What is the 1 restriction (1 each) for both types of dialysis?

A
  1. hemo- don’t put BP on fistula arm
  2. Peri- avoid constipation (straining abdomen)
68
Q

what are the 3 complications of hemodialysis after treatment?

A
  1. hypotension
  2. bleeding
  3. infection
69
Q

What are the 3 complications of peritoneal dialysis after treatment?

A
  1. Outflow obstruction
  2. infection at site or in peritoneum
  3. back and abdominal pain - b/c fluid shifts
70
Q

Are there diet changes for someone on hemodialysis?

A

no

71
Q

are there diet changes for someone using peritoneal dialysis?

A

yes
- eat MORE protein b/c some is lost in the dialysate (fluid from the bag used to filter the blood)

72
Q

what are 4 dietary changes someone should make when they have diagnosed CKD?

A
  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
Q

What can a patient with CKD do at home on a regular basis to monitor their kidney function?

A

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
Q

what are the 2 most important ways to preserve kidney function?

A

-management of diabetes
- management of HTN

2514 Patho/phys/assess (27 decks)

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