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NRSG 326 > Week 3: CKD > Flashcards

Week 3: CKD Flashcards

1
Q

What is CKD?

A

Involves the progressive, irreversible loss of kidney function

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2
Q

How KDOQI define CKD?

A

either kidney damage or GFR less than 60mL/min/1.73 for 3 months or longer

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3
Q

What is end-stage renal disease?

A

stage 5 which is advanced renal disease where the GFR is less than 15 mL./min/1.73

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4
Q

What is uremia?

A

a constellation of signs and symptoms resulting from the buildup of waste products and excess fluid associated with kidney failure

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5
Q

What signs/symptoms are associated with uremia?

A

elevated serum creatinine and BUN, abnormal electrolytes, acidosis, anemia, fluid volume excess, nausea, loss of appetite, fatigue, decreased cognition, pruritis, neuropathy

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6
Q

What is one of the most important risk factors in the progression of CKD?

A

Proteinuria

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7
Q

How do we measure proteinuria?

A

Protein to creatinine ratio or albumin to creatinine ratio

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8
Q

What information can be obtained from a urinalysis?

A

Measurement of RBCs WBCs protein cases and glucose

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9
Q

What role does ultrasound play in CKD

A

Determine the size of the kidneys and rule out potential of obstruction

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10
Q

What is the preferred measure to determine kidney function?

A

eGFR

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11
Q

Why would a patient need a renal biopsy?

A

to provide a definitive diagnosis

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12
Q

What occurs in the urinary system with CKD?

A

polyuria from inability to concentrate urine (nocturia is most common)

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13
Q

What is Olguria?

A

< 400mL/day

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14
Q

What is Anuria?

A

<40 mL/24 hr)

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15
Q

What occurs in the metabolic system with waste product accumulation

A

as GFR decreases BUN and creatinine increases

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16
Q

Metabolic system and altered carbohydrate metabolism

A

cellular insensitivity to insulin = defective carb metabolism

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17
Q

Metabolic system an elevated triglycerides

A

hyperinsulemia stimulates triglyceride production

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18
Q

What acid base imbalance occurs with Potassium?

A

hyperkalemia from decreases excretion

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19
Q

What acid base imbalance occurs with Sodium?

A

hyponatremia from sodium retained with water (it’s peed out)

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20
Q

What acid base imbalance occurs with Magnesium?

A

Hyper magnesia from impaired excretion

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21
Q

What acid base imbalance occurs with metabolic acidosis?

A

from the inability to excrete acid load

22
Q

What hematological changes occur with anemia?

A

decreases erythropoietin production by kidneys = decreased bone marrow stim to release RBCs

23
Q

What hematological changes occur with bleeding tendencies

A

Qualitative defect in platelet function

24
Q

What hematological changes occur with infection?

A

changes in leukocytes/immune response = increased susceptibility

25
Q

What cardiovascular changes occur with CKD?

A

HTN most common

26
Q

what do increased triglycerides do?

A

rapid atherosclerosis

27
Q

What respiratory changes occur with CKD?

A

dyspnea, edema, pleuritis, pleural effusion from fluid

28
Q

What GI changes can occur with CKD?

A

every part affected from excess urea
N/V/anorexia/mal nutrition

29
Q

What causes neurological changes with CKD?

A

increased nitrogenous waste, electrolyte imbalances, acidosis

30
Q

what do high uremic levels do?

A

axonal damage

31
Q

integumentary changes with CKD?

A

from dry skin, neuropathy and calc/phosh deposition pruritis occurs

32
Q

What is one of the most important risk factors in the progression of CKD?

A

proteinuria - high protein levels in urine

33
Q

Why would a patient need a renal biopsy?

A

to provide a definitive diagnosis

34
Q

What medication therapy is used to manage hyperkalemia?

A

sodium polystyrene sulfonate

35
Q

What does sodium polystyrene sulfonate do?

A

exchanges sodium for potassium

36
Q

What are common medications used to treat patients with CKD?

A

ACEIs, ARBs, thiazide diuretics

37
Q

What are phosphate binders?

A

used to bind to phosphate so it is excreted in the stool

38
Q

What is the risk in administering magnesium containing antacids?

A

used in moderation because magnesium dependent on kidney excretion

39
Q

Why do patients with CKD need vitamin D?

A

to prevent hypocalcemia from the inability of the GI tract to absorb calcium in the absence of vitamin D

40
Q

What are erythropoiesis-stimulating agents?

A

available for the treatment of anemia, stimulate the kidneys to produce more erythropoietin so that the bone marrow produces RBCs

41
Q

Who should not receive ESA’s?

A

Patients with HTN because it produces more RBCs increasing blood

42
Q

Why do patients with CKD need iron?

A

increased demand for iron to support erythropoiesis, it uses iron stores

43
Q

Why do patients with CKD need folic acid?

A

it is needed for RBC formation and it removed by dialysis

44
Q

What medications require baseline kidney function assessment?

A

digoxin, oral glycemic agents, antibiotics, opioid medication because the dosage depends on the kidneys function, excretion etc.

45
Q

Why are protein restrictions sometimes necessary in patients with CKD?

A

BUN is an end product of protein metabolism

46
Q

Why are protein restrictions sometimes necessary in patients with CKD?

A

BUN is an end product of protein metabolism which has to be excreted by the kidneys and if the kidneys are not working it cannot be excreted

47
Q
  1. Why are potassium restrictions sometimes necessary?
A

due to the ability of the kidneys to excrete this electrolyte

48
Q

What types of potassium rich foods should patients with CKD avoid?

A

oranges, bananas, melons, tomatoes, prunes, raisins, deep green/yellow veggies, beans, legumes

49
Q

What kinds of foods are high in phosphate

A

Dairy

50
Q

What are early signs/symptoms of CKD?

A

fatigue, lethargy, pruritus, HTN/changes in urine often first signs

51
Q

How can you assess for excess fluid volume

A

edema, urine changes

NRSG 326 (3 decks)

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