Week 3 - Seminar Flashcards
what are the 3 primary functions of the urinary system
- filter waste from blood
- balance electrolytes & acid/base
- excrete metabolic wastes
what are 3 secondary functions of the urinary system
- regulate BP
- regulate bone density
- regulate erythropoiesis
define chronic kidney disease
- a state in which the kidneys no longer function adequately to rid the body of wastes
- unable to maintain homeostasis
CKD is an example of_____
- altered elimination
list 7 risk factors of CKD
- diabetes
- HTN
- smoking
- heart disease
- over 65
- meds
- ethnicity
which ethnicities are risk factors for CKD (7)
- indigenous
- asian
- south asian
- pacific island
- african
- caribbean
- latin canadian
what 2 things are monitored for those at risk of CKD
- blood work
- urine
diagnosis of CKD is made when…
GFR < 60 ml/min/1.73 m2 for 3 months or longer
what is the most common renal disease that leads to dialysis & transplantation
- diabetic nephropathy
how long after the onset of diabetes does proteinuria appear?
- 10 years
what is an important way to prevent renal disease in pts w diabetes
- blood glucose control
how many clinical stages of CKD are there?
- 5
describe symptoms & GFR in stage 1
- GFR = >90
- likely asymptomatic bc kidneys can compensare well
descibre symptoms & GFR in stage 2 (2)
- GFR = 60-89
- may have decreased ability to conc urine
- develop symptoms of anemia
describe symptoms in stage 3-4 of CKD (5)
- electrolyte & fluid imbalances
- oliguria
- more severe anemia
- metabolic acidosis
- azotemia
what is stage 5 of CKD? describe symptoms instage 5 of CKD (3)
- end stage renal disease needing dialysis/transplant
- anuria
- severe electrolyte & fluid imbalance
- uremia
is CKD progressive or sudden?
- progressive deterioration
what 3 functions of the kidenys are lost during CKD
- excretory
- regulatory
- endocrine
list 6 substances the kidneys retain during CKD
- urea
- creatinine
- phenols
- hormones
- electrolytes
- water
what is uremia
- constellation of symptoms r/t to buildup of waste products & excess fluid
at what stage(s) do we see uremia in CKD
- 4/5
what should we consider during health history for CKD (8)
- current health (OPQRSTU)
- PMHx (diseases that are risk factors)
- PSHx
- famHx
- meds
- allergies
- social
- occupation/enviro
why is it important to ask about meds for health history of CKD
- some meds are nephrotoxic
- consider compliance for drugs that help reduce risk factors ex. diabetes meds –> glucose regulaion is important for preventing kidney disease
list 5 electrolyte that will be effected by CKD
- potassium –> hyperkalemia
- sodium –> normal or low –> dilutional (from retaining so much water)
- calcium
- phosphate
- magnesia –> hypermagnesia
what causes hypermagnesia in CKD
- will only occur if ingesting Mg
what are 2 examples of sources of magnesium
- supplements
- milk of Mg
list 2 symptoms r/t to hypermagnesia
- decrease in mental status
- dysarrthymia
what acid-base imbalance may occur due to CKD
- metabolic acidosis
what are symptoms of hyperkalemia
Muscle weakness
Urine output little or none
Resp failure (due to muscle weakness)
Decreased cardiac contractility (weak pulse, low HR again due to muscle weakness)
Early: muscle cramps/twitches
Rhythm changes (tall T waves, prolonged PR interval)
what are symptoms of hyponatremia
Stupor/coma
Abdominal cramping, NV
Lethargy
Trouble concentrating
Loss of urine & appetite, overactive bowel sounds
Orthostatic hypotension
Seizures, spasms of muscles
Shallow resp
what are 2 possible diagnostic test for electrolyte/acid-base imbalances r/t CKD
- electrolytes (for imbalances)
- ABGs (for metabolic acidosis)
list 3 hematological symptoms r/t to CKD
- anemia
- bleeding tendencies
- infection
list 3 causes of anemia r/t to CKD
- decreased erythropoitin
- dialysis –> causes damaged RBC
- frequent blood draws
what kind of anemia is seen in CKD
- normocytic (normal size)
- normochromic (conc of hgb is normal)
what causes bleeding tendencies r/t to CKD
- defect in platelet function r/t uremia
what causes infection r/t to CKD
- change in leukocyte function & altered immune response r/t aztoemia
describe physical assessment for hematological symptoms of CKD (4)
- observe for SOB, pale skin (for anemia)
- auscultate for tachy
- assess for unusual bleeding
- assess for infection
how can we assess for unusual bleeding
- easy bruising
- bleeding nose
- bleeding gums
- abdominal exam
- blood in stool
- signs of strok
how can we assess for infection (4)
- vital signs (temp)
- increased pain
- redness
- purulence
what are potential diagnostics for hematological signs of CKD (5)
CBC:
- low hgb
- increased WBC (infection)
- normal plt (defect, not thrombocytopenia**)
- normal pt/ptt
- ferritin/iron low
what are CNS symptoms of CKD (3)
- CNS depression
- seizures, coma (uncommon)
- peripheral neuropathy
what signs of CNS depression are seen in CKD (4)? what causes this?
due to uremia
- fatigue
- decreased loc
- irritability
- decreased conc
what are 4 signs of peripheral neuropathy
- restless legs
- paresthesia in feet/legs
- muscle weakness
- muscle twitch, asterixis
what is asterixis
- uncontrolled movement in hands = hand flapping
describe physical assessment of CNS symptoms of CKD (2)
- observe/ inspect thru change in conciousness, behavior, convo
- palpate extremities to assess for changes in sensation, unusual reflexes/tremors
what are 3 potential diagnostics for CNS symptoms of CKD
- increased BUN
- electrolytes (decreased Na)
- ABG –> acidosis
list 5 CVs symptoms of CKD
- HTN
- accelerated artherosclerosis
- HTN can lead to HF
- cardiac dysrhythmias
- uremic pericarditis
list 2 things that cause cardiac dysrythmias
- hyperkalemia
- hypocalcemia
describe physical assessment for CVS symptoms of CKD
- vital signs (BP, temp, HR, RR)
- inspect for dyspnea, edema
- auscultate lungs
why would you asculate lungs for CVS symptoms of CKD? What should you look for?
- to look for symptoms r/t to HF
- look for crackles, heart sounds
list 3 potential diagnostic tests for CVS symptoms of CKD
- EKG
- electrolytes (increased K, decreased Ca, increased P)
- BG
what are respiratory symptoms of CKD (3)
- dyspnea
- secondary infections
- kussmaul’s breathing
what causes dyspnea r/t to CKD
- fluid overload
- pulmonary edema
- pleural effusion
- uremic pleuritis
why would kussmaul’s breathing occur with CKD
- due to metabolic acidosis
describe physical assessment of resp symptoms of CKD
- observe for SOB, dyspnea, cough (infection)
- ascultate for air entry & adventitious sounds
what is a diagnostic test for resp signs of CKD
- chest xray
what are 6 GI signs of CKD
- uremic fetor
- stomatitis w ulterations
- altered sense of taste (metallic)
- NV, anemia
- bleeding & ulceration
- constipation
describe physical assessment of GI symptoms of CKD
- monitor I&O
- monitor characteristics of emesis
- observe/inspect mouth for ulceration, ammonia breath, abdomen
- asucultate abdomen
- palpate abdomen
what are GU symptoms of CKD (6)
- polyuria in early stages
- with CKD progression: oligiura & anuria
- proteinuria
- casts
- hematuria
- pyuria
what urine volume is anuria
<40 mL/day
describe physical assessment for GU signs of CKD (3)
- assess vital signs (increased BP)
- monitor I and O
- monitor urine characteristics
what urine characteristics may occur in early CKD? late CKD?
- early = dilute
- late = conc
what is a diagnostic test for GU symptoms of CKD? what results will you see?
urinalysis: - proteinuria - casta - pyuria - hematuria (depends on cause)
list 2 integumentary symptoms of CKD
- pruritus
- uremic frost
what causes pruritis in CKD (3)
- dry skin
- calcium-phosphate deposits
- sensory neuropathy
what are risks associated w pruritis (2)
- bleeding
- infection
due to scratching
what causes uremic frost
- urea crystalizing on skin (rare)
describe physical assessment of the integ system for CKD
- inspect for rashes & scratches
- inspect for signs of infection
what are 3 possible diagnostic tests for the integ system
- BG
- increase BUN
- CBC for infection
what are 2 musculoskeletal symptoms of CKD
- renal osteodystrophy
- insoluble calcification in vascular walls & soft tissues
what is renal osteodystrophy
- skeletal disorder
- alteration of bone morphology
what is a risk of renal osteodystrophy
- increased risk of fractures
what causes calcifications in CKD
- phosphate binding w calcium
describe physical assessment for musculoskeletal signs of CKD
- often asymptomatic
- assess for complains of weakness, muscle/bone pain
- observe for abnormal gait
what are 4 potential diagnostic tests for musculoskeletal signs of CKD
- alk phosphotase increased
- xrays –> fractures
- BMD tests
- Ca and phos levels
in general, what are 3 things you want to measure for physical assessment of CKD? why?
- vital signs (fluid overload, infection?)
- I and Os (anuria, oliguria)
- daily weight
in general, what are some things you want in observe/inspect for phys assessment of CKD
- gait
- LOC
- paleness
- rash
- bruising
- edema
- signs of infection
- bleeding
- uremic fetor
- dyspnea
- urine color
in general, what are 2 things you want to palpate during assessment of CKD
- extremities for sensation & edema
- abdomen for discomofrt
in general, what are 3 things you want to auscultate for assessment of CKD
- lungs (crackles, consolidation)
- heart
- abdomen (bowel sounds)
in general, what are 3 categories of diagnostics for CKD
- blood work
- imaging
- urine tests
what are 2 main types of blood work for CKD
- electrolytes
- CBC
what are 3 types of urine tests done for CKD
- urinalysis
- albumin/creatinine urine test (ACR)
- creatinine clearance (24 hr)
what is measured during urinalysis
- pH
- protein
- glucose
- blood
what are 5 types of imaging test for CKD
- abdominal xray
- renal US
- renal CT (dye)
- renal MRI
- renal biopsy
what is a risk associated with getting a renal biopsy
- risk of bleeding
what is a risk of a renal CT (dye)?
- must be processed thru the kidney & can be harmful
what is dialysis
- movement of fluid & molecules across a semi-permeable membrane from one compartment to another
what is dialysis used for
- to correct fluid & electrolyte imbalances
- remove waste products
what stage of CKD is dialysis used for
- stage 5
what are 2 methods of dialysis
- hemodialysis
2. peritoneal dialysis
what are 5 possible indications for dialysis
Acidemia (metabolic acidosis)
Electrolyte abnormalities with EKG changes (hyperkalemia)
Intoxication from meds or Infection r/t uremia
Overload of fluid (not responsible to diuretics)
Uremia complications
how does dialysis help to treat infection
- enhances WBC function to fight infection
what uremia complications indicate use of dialysis (3)
- pericarditis
- encephalopathy
- GI bleeding
what is peritoneal dialysis? how does it work
- insertion of a catheter thru the anterior abdominal wall into the perionteal
- dialysis inside the body that uses the peritoneal membrane
- put fluid into the body, let it sit for awhile (dwell), and then you drain it out
list complications of PD (6)
- abdominal/back pain
- outflow problems
- hernias
- protein loss
- pulmonary complications
- infection
what causes abdominal/back pain r/t PD (4)
- low pH of solution
- peritonitis
- intraperitoneal irritation
- catheter placement
what is an outflow problem r/t PD
- normally, 80% of fluid should be returned that is instilled
- outflow problem = not enough fluid returned
what can cause a hernia r/t PD
- due to increased intraabdominal pressure w infusion
what can cause protein loss during PD
- the peritoneal membrane is permeable to some
what can cause pulmonary complications during PD
- repeated upward displacement of the diaphragm due to extra fluid = decreased lung expansion
what two places coudl infection occur during PD
- at the exit site
2. peritonitis (inside the body)
what are signs of an infection at the exit site during PD (3)
- site redness, tenderness, drainage
what are signs of periotonitis due to PD (7)
- cloudy peritoneal effluent
- diffuse abdominal pain
- diarrhea
- vomitting
- abd distension
- hyperactive bowel sounds
- foul smell
what is hemodialysis? how does it work?
- dialysis outside the body
- blood is brought out of the body & run thru a dialyzer which filters out toxins/waste products & clean blood is returned to body
what are 2 types of hemodialysis vascular access sites
- fistula
2. graft
what is a fistula?
- joining of an artery to a vein
how does a graft work for hemodialysis
- a synthetic looped graft is inserted between the arery & vein
list 2 nursing considerations for hemodialysis
- fistula must be protected from trauma & compression (ex. tight clothing, sleeping on that side, etc.)
- no blood pressure, venipuncture (drawing of blood), IV
what are signs of good flow during hemodualysis
- palpate for thrill
- listen for bruit
list 5 complications of hemodialysis
- infection —> sepsis
- hypotension (bc fluid removed)
- muscle cramps
- loss of blood
- disequilibrium syndrome
what is disequilibrium syndrome
- where rapid removal of urea leads to cerebral edema and increased intrcranial pressure
- more common in people who are new to dialysis
what should you assess pre-dialysis (3)
- be aware of why they are having it
- ensure vital signs are stable (bp esp)
- review meds , some may be held
which meds might be held when giving dialysis
- any med that would be dialysed out
what should you monitor post-dialysis (5)
- monitor LOC, mental status
- monitor vs
- auscultate heart & lung sounds
- observe vascular access
- monitor urine & blood work
