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NSB236 > Week 3: Renal Care > Flashcards

Week 3: Renal Care Flashcards

1
Q

What are the 7 functions of the kidney? (then 4x general functions)

A
  1. Water homeostasis
  2. Electrolyte homeostasis
  3. Acid/base homeostasis
  4. BP homeostasis (RAAS)
  5. Removal of waste & toxins (e.g. urea & creatinine)
  6. Activation of Vit D3 (1.25 dihydroxycholicalciferol)
  7. Production and secretion of erythropoietin
  • Filtration
  • Excretion
  • Secretion
  • Re-absorption
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2
Q

What are the 3 most important organs?

A
  1. Brain
  2. Heart
  3. Kidneys
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3
Q

What are 7 generalised signs & symptoms of renal failure?

A
  1. Fluid overload
  2. Hyperkalaemia & hyperphosphataemia
  3. Metabolic acidosis
  4. Hypertension
  5. Uraemia
  6. Hypocalaemia, hyperparathyroidism & renal osteodystrophy (CKD mineral bone disease)
  7. Anaemia
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4
Q

What are the early symptoms of chronic kidney disease (CKD)?

A
  • Nocturia
  • Nausea & Vomiting
  • Headaches
  • Breathlessness
  • Weight loss

slowly and insidiously causes externsive irreversible damage to the kidneys

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5
Q

What are 2 methods of CKD diagnosis?

A
  1. GFR <60mL/min/1.73m2 that is present for >3months with or without evidence of kidney damage
  2. Evidence of kidney damage present >3months evidenced by:
    a) Albuminuria (micro or proteinuria)
    b) Glomerular haematria
    c) Pathological abnormalities (biopsy)
    d) Anatomical abnormalities (imaging)
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6
Q

What is eGFR?

A
  • Estimated glomerular filtration rate
  • Measures how well the kidneys filter the wastes from the body
  • Higher the filtration, the better the kidneys are working
  • Normal filtration rate is about 100mLs/min
  • Now automatically reported on blood results for GPs
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7
Q

What are the stages of CKD and corresponding effect on GFR?

A 
1 = Kidney damage with normal or increased GFR
2 = Kidney damage with mild decrease in GFR
3a = Moderate reduction in GFR
3b = Moderate reduction in GFR
4 = Severe reduction in GFR
5 = End stage kidney failure
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8
Q

What is the normal range of eGFR?

A

90 - 120 mL/min/1.73m2

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9
Q

What is the level of GFR for stage 1 CKD?

A

> 90 mL/min/1.73m2

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10
Q

What is the level of GFR for stage 2 CKD?

A

60-89 mL/min/1.73m2

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11
Q

What is the level of GFR for stage 3a CKD?

A

45-59 mL/min/1.73m2

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12
Q

What is the level of GFR for stage 3b CKD?

A

30-44 mL/min/1.73m2

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13
Q

What is the level of GFR for stage 4 CKD?

A

15-29 mL/min/1.73m2

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14
Q

What is the level of GFR for stage 5 CKD?

A

<15 mL/min/1.73m2 (or dialysis)

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15
Q

What are the 7 conditions that increase the risk of developing CKD?

A
  1. Diabetes
  2. Hypertension
  3. Smokers
  4. Age >65
  5. Aboriginals and Torres St Islanders
  6. Family Hx of KD
  7. Obesity
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16
Q

What are the sign’s of CKD?

A

Also known as “silent disease” as it can progress over months/years. It is common for people to lose up to 90% of their kidney function before getting any symptoms.

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17
Q

What are 3 common tests to check for KD?

A
  1. Blood test (creatinine)
  2. Urine test (albumin - creatinine ratio)
  3. BP
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18
Q

What is the normal result in a urinalysis for colour?

A

Yellow

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19
Q

What is the normal result in a urinalysis for smell?

A

Malodorous

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20
Q

What is the normal result in a urinalysis for specific gravity?

A

1.010 - 1.030

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21
Q

What is the normal result in a urinalysis for protein?

A

None or trace

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22
Q

What is the normal result in a urinalysis for glucose?

A

None

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23
Q

What is the normal result in a urinalysis for ketones?

A

None

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24
Q

What is the normal result in a urinalysis for bilirubin?

A

None

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25
Q

What is the normal result in a urinalysis for RBC & WBC?

A

None

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26
Q

What are 2 primary health care goals for stages 1 & 2 of CKD?

A
  1. Reduce progression of CKD

2. Reduce cardiovascular risk

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27
Q

What are 3 things are a part of the monitoring process in stages 1 & 2 of CKD?

A
  1. 3-6monthly reviews
  2. BP, weight, urine test
  3. Laboratory assessment (eGFR, BGL, cholesterol)
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28
Q

T/F

People with CKD are more likely to die from cardiovascular disease than to need dialysis or a transplant

A

True

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29
Q

What are 5 primary health care goals (or things to consider) for stage 3 of CKD?

A
  1. Reduce progression of CKD
  2. Reduce cardiovascular risk
  3. Early detection and management of complications
  4. Avoid medications toxic to kidneys (NSAIDS)
  5. Appropriate referral to nephrologist or CKD nurse practitioner
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30
Q

How frequently should stage 3 CKD Pts be reviewed?

A

1-3 months and additional laboratory assessments

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31
Q

What are 4 primary goals for Pts with stage 4 CKD?

A
  1. Reduce progression of CKD
  2. Reduce cardiovascular risk
  3. Early detection and management of complications
  4. Avoid medications toxic to kidneys (e.g. NSAIDs, contrast media)
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32
Q

What needs to happen with Pts that have stage 4 CKD?

A
  • Monthly reviews
  • Additional laboratory assessments
  • Referral to renal specialist team
  • Preparation for kidney replacement therapy
  • Education i.e. options (including not starting KRT)
  • Pre emptive transplantation
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33
Q

What is involved in the management of stage 5 CKD?

A
  • End stage KD
  • CKD managed by renal unit
  • Highly complex health care required
  • Kidney Replacement Therapy (KRT)
  • Peritoneal dialysis
  • Haemodialysis
  • Kidney Transplantation
  • Conservative care
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34
Q

What are 6 major causes of stage 5 CKD and prevalence % in Aus?

A
  1. Diabetic Nephropathy 41%
  2. Glomerulonephritis (GN) 19%
  3. Hypertension 14%
  4. Polycystic Renal Disease 7%
  5. Reflux nephropathy 4%
  6. Analgesic nephropathy 3%
35
Q

What are common CKD psychologic S&S?

A

Denial

Anxiety

36
Q

What are common CKD cardiovascular S&S?

A

Hypertension
Congestive HF
Atherosclerotic heart disease

37
Q

What are common CKD GI S&S?

A

Anorexia

N&V

38
Q

What are common CKD Endocrine/reproductive S&S?

A

Hyperparathyroidism
Thyroid abnormalities
Infertility
Sexual dysfunction

39
Q

What are common CKD metabolic S&S?

A

Carbohydrate intolerance
Hyperlipidemia
Gout
Nutritional deficiencies

40
Q

What are common CKD haematologic S&S?

A

Anemia
Bleeding
Infection

41
Q

What are common CKD Neurologic S&S?

A 
Fatigue
Headache
Sleep disturbances
Lethargy
Confusion
42
Q

What are common CKD ocular S&S?

A

Hypertensive retinopathy

43
Q

What are common CKD Pulmonary S&S?

A

Uremic lung
Pulmonary oedema
Dyspnea
Pneumonia

44
Q

What are common CKD integumentary S&S?

A

Pallor
Dry, scaly skin
Pigmentation changes
Ecchymosis

45
Q

What are common CKD peripheral neuropathy S&S?

A

Paresthesias
Motor weakness
Restless legs syndrome

46
Q

What are some examples of medications used for CKD?

A 
Antihypertensives (+ diuretics)
Phosphate binders
Sodium bicarbonate
Synthetic erythropoietin (EPO)
\+/- Resonium
\+/- calcitriol (vit D3)
47
Q

What is Acute Kidney Injury?

A

Sudden, rapid deterioration of renal function resulting in the retention of nitrogenous waste products (uraemia)

48
Q

What is often caused by AKI?

A

Oliguria or anuria

49
Q

What % of Pts develop AKI while in hospital?

A

50%

50
Q

Is AKI reversible?

A

It is mostly a reversible condition but can be irreversible leading to CKD

51
Q

What are the causes/location of AKI?

A
  1. Pre renal
  2. Intra renal
  3. Post renal
52
Q

What is the classification and causes of Pre Renal AKI?

A

Disruption of renal perfusion.

Dehydration, sepsis and nephrotoxic drugs

53
Q

What is the classification and causes of Renal (intrinsic or parenchymal) AKI?

A 
Conditions that directly disrupt kidney functioning involving either the glomerulus or the tubules.
Causes:
Acute Tubular Necrosis (ATN)
Acute Glomerulonephritis
Rhabdomyolysis
Nephrotoxic substances
Blood Transfusions
54
Q

What is the classification and causes of Post Renal AKI?

A 
Results from an obstruction to urine flow that can occur anywhere within the urinary tract.
Causes:
Benign Prostatic Hypertrophy
Nephrolithiasis
Cancer
Strictures
55
Q

What is the 4 phase clinical course & management of AKI?

A
  1. Onset phase
    a) Fluid volume replacement & restoration of BP
  2. Oliguric phase
    a) Fluid overload, electrolyte imbalances
    b) Nutritional requirements
    c) Kidney replacement therapy
  3. Diuretic phase
  4. Recovery phase
56
Q

What is the range for hyperkalaemia?

A

> 5.5mmol/L

57
Q

What is caused by hyperkalaemia?

A 
CNS changes (apathy, confusion, tingling)
Muscle weakness
Acetone breath +/- ketones in urine
ECG changes include:
- Widened QRS complex
- Peaked T waves
- Flat or absent T waves
- Bradycardia
- Asystole
58
Q

What is the immediate effect of hyperkalaemia management?

A

Within 15min:

  1. Dextrose and clear insulin (check hospital protocol, doses will vary)
  2. NaHCO3
  3. Calcium gluconate
59
Q

What is the longer acting effect of hyperkalaemia management?

A
  1. Ion-exchanging resins (resonium)

2. Dialysis

60
Q

In renal failure, which laboratory findings would be altered?

A 
\+ K
\+ urea
\+ Creatinine
- HCO3-
- Calcium
- Volume
changes in urinary Na
61
Q

What is kidney replacement therapy used for?

A

It is commenced to prevent death.
To control fluid overload (pulmonary oedema)
To control hyperkalaemia (cardiac arrest)
To control uraemia (coma)
To control metabolic acidosis

62
Q

What is the process of peritoneal dialysis (PD)?

A

Process of ridding the body of toxic wastes, excess fluid and control of BP and acidosis by using the peritoneum as a semi permeable membrane.
A fluid solution is used to crease a concentration gradient across the peritoneal membrane.

63
Q

What are some advantages of Continuous Ambulatory Peritoneal Dialysis (CAPD)?

A 
Manage own care at home
Greater independence and control
Flexible treatment schedule
Less restricted diet
Regular clinic visits (4-6 weeks)
No needles required for treatment
BP control
Less stress on body
Better for children, elderly pts with cardiac conditions and diabetes
64
Q

What are some disadvantages of CAPD?

A 
4 exchanges every day for the rest of their life
Permanent catheter
Body image changes
Risk of infection (peritonitis)
Possible weight gain
Storage space needed for supplies
65
Q

What is Haemodialysis?

A

It is the process of ridding the body of toxic wastes, excess fluid and control of BP and acidosis by pumping the blood through an artificial kidney.
A fluid solution (dialysate) is used to create a concentration gradient across a semi-permeable membrane (dialyzer).

66
Q

What checks are required for patency of an AV fistula?

A 
Thrill = buzzing, tingling, feeling over anastomosis.
Bruit = listen with stethoscope for whooshing sound
67
Q

What should never be done on a limb with a fistula?

A

Allow venepuncture or IV cannulation
Take a BP
No constrictive / circumferential dressings

68
Q

What is the haemodialysis procedure?

A

Typical treatment is 4hrs, 3x weekly, every week for a year. It can be performed in hospitals, in dialysis units or at home

69
Q

What are the advantages of haemodialysis?

A

No external access or tubing.
Treatment is only 3x per week.
It can be done in multiple locations by RN or by Pt (flexible treatment options)

70
Q

What are the disadvantages of haemodialysis?

A 
Machine is required.
2-4 needles inserted for every treatment.
May be tired or weak after treatment.
Wastes build up between treatments.
Diet and fluids are limited.
Travel, fixed schedule.
71
Q

What is another option apart from Haemodialysis (HD) and peritoneal dialysis (PD)?

A

Kidney transplantation, donor kidney is inserted into either the left or right iliac fossa.

72
Q

What are the advantages of Kidney transplant?

A 
Most like your own kidneys.
No dialysis needed.
No access needed.
Normal diet.
More 'normal' lifestyle.
Regular clinic visits.
73
Q

What are the disadvantages of kidney transplant?

A

Risks of major surgery.
Risk of rejection
Always on medication which have significant side effects.
Lowered resistance to illness/infections.
Body image changes.

74
Q

What is conservative care?

A

It is planned holistic patient-centred care, it’s an option for patients who decided not to have or are medically unsuitable for KRT.
It provides interventions to delay progression of kidney disease and minimise risk of adverse events or complications. Shared decision making. Active symptom management. Detailed communication, including advance care planning. Psychological, social and family support. Cultural and spiritual domains of care.
It doesn’t always include dialysis and may be required for several years.

75
Q

What are the 3 types of Acute Kidney Replacement Therapy?

A
  1. Haemodialysis (intermittent)
  2. Continuous renal replacement therapies (ICU)
  3. Peritoneal dialysis (rarely)
76
Q

Who is indicated for Acute Kidney Replacement Therapy?

A

It’s only indicated when symptoms of AKI cannot be controlled. E.g. severe pulmonary oedema, uncontrolled hyperkalaemia, uncontrolled acidosis or uraemic symptoms

77
Q

What is a part of the fluid assessment nursing care for AKI?

A
  • Pts wellbeing
  • BP (lying/standing)
  • Pulse (rate, rhythm, amplitude)
  • Chest (lungs and heart)
  • Daily weight
  • FBC (input vs output)
  • Oedema, skin turgor, mucous membranes
  • JVP / CVP
78
Q

What is included in the general assessments nursing care for AKI?

A
  • LOC / mental status
  • ECG
  • Review laboratory values
  • Diagnostic test results
79
Q

What are the priority problems involved in the nursing priorities of care for AKI?

A
  • Fluid volume
  • High risk for infection
  • Anxiety
  • High risk for drug toxicities
80
Q

What complications need to be monitored as part of the nursing priorities of care for CKD and ESKD?

A
  • Electrolytes
  • Increasing uraemia
  • Increased risk for drug toxicity
  • Prevent further anaemia
  • Prevent renal osteodystrophy
81
Q

What assessments / checks need to be done as part of the nursing priorities of care (CKD & ESKD)?

A
  • Slow the progression of CKD
  • Fluid assessment
  • Maintain access for dialysis (AV fistula = regular checks for patency, no BPs on fistula limb) (peritoneal dialysis catheter = daily aseptic dressing, monitor for signs of infection)
82
Q

What are the priority problems involved with CKD and ESKD?

A
  • Fluid volume
  • Pt education = adherance
  • Symptom management
  • High risk for drug toxicities
  • Psychosocial
  • Interdisciplinary team care
83
Q

What is the prevalence of CKD in Australia?

A

1 in 3 adult at risk of developing CKD, 10% of adults have CKD

6x as many indigenous were treated for ESKD

NSB236 (5 decks)

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