week 4 - Chronic Kidney Disease (CKD) Flashcards
chapter 48
AKI is the rapid loss of what?
renal function
Acute Nephrotic Syndrome is the inflammation of the ??
Glomerulus
What is a type of AKI, where there is damage to the kidney tubules?
ATN - Acute Tubular Necrosis
Anuria is the total urine output in 24 hours that is less than _____mL .
50
This type of access for dialysis is surgically created by connecting an artery to a vein.
an arteriovenous fistula
this type of access for dialysis is surgically made by taking a piece of graft material to connect the patient’s artery to a vein
an arteriovenous graft
Azotemia is a abnormal concentration of what in the blood?
nitrogenous waste products
CKD- Chronic Kidney Disease is characterized by kidney damage or decreased GFR of how much, for at least how long?
<60mL/min. for 3 months or more
CAPD- Continuous Ambulatory Peritoneal Dialysis is where the prescribed number of cycles or exchanges are performed manually throughout the day? Is this done by the patient or a healthcare provider?
this is performed by the patient
CCPD- Continuous Cyclic Peritoneal Dialysis is where a cycler (peritoneal dialysis machine) is automatically performing the exchanges/ cycles. When is the preferred time of day for this to be performed?
usually at night, while the patient is asleep
If a patient is hemodynamically unstable, what kind of therapy takes their blood and circulates it through a hemofilter and returns it to their body to replace normal kidney function?
CRRT- continuous renal replacement therapy
What is the electrolyte solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis, that is cleansing the blood + helping to maintain electrolyte balance?
dialysate
A dialyzer is acting as an ______ _______.
artificial kidney
diffusion is the movement of _____ _____ to a place of higher concentration to a place of lower concentration.
waste products – (solutes)
what is the drained fluid from a peritoneal dialysis exchange called?
effluent
ESRD/ESKD is the final stage of CKD, these patients will need renal replacement therapy. What does being in this stage result in the retention of?
uremic waste products
if exchange is complete, the phases of peritoneal dialysis are all complete. What are the 3 phases of this cycle?
-fill
-dwell
-drain
GFR is the amount of _______filtered through the glomeruli.
plasma
what is the inflammation of the glomerular capillaries?
glomerulonephritis
hemodialysis (HD) is the process of the patient blood being circulated through a dialyzer to remove _______ products + excess _____.
waste; fluid
interstitial nephritis is inflammation where?
renal tissue
what is nephrosclerosis?
hardening of renal arteries
What type of kidney disease is characterized by
-damage to glomerular membrane
-increased glomerular permeability
-increased/ massive proteinuria?
nephrotic syndrome
a substance, medication or action that is toxic to the kidney tissue.
nephrotoxic
oliguria is characterized by a urine output of <_____mL/24 hours OR <_____mL/kg/hr in a 6 hour period.
400; 0.5
Which procedure uses the patients peritoneal cavity + membrane to exchange fluid and solutes to filter the blood.
peritoneal dialysis (PD)
what is inflammation of the peritoneal membrane?
peritonitis
polyuria is ______ urine production.
excessive
what is the process called where water is removed from the blood by a pressure gradient between their blood and the dialysate?
ultrafiltration
uremia is the excess of _____+ other __________ waste in the blood.
urea; nitrogenous
what proteins are secreted when the kidney tubules are damaged?
urinary casts
CKD is a _______ + ________ loss of kidney function.
progressive + irreversible
What is a normal GFR?
125mL/min.
End Stage Renal Disease is when the GFR is < ______.
15
what are the 2 leading causes of CKD, due to decreased perfusion?
-diabetes
-hypertension
If a patient has CKD, the patient will experience polyuria due to the inability to concentrate urine. About where will their urine specific gravity be?
1.010
Other affects on the urinary system include oliguria. As well as anuria, which is a urine output of less than _____mL in 24 hours.
40mL
The waste accumulation leads to metabolic disturbances. As GFR decreases, what 2 labs are increasing?
BUN and Creatinine
What are 4 other things besides kidney failure, that are going to raise your BUN?
-increased protein intake
-fever
-corticosteroids
-catabolism
what are 5 S+S of increased BUN levels you may see?
-N/V
-lethargy
-impaired thinking/ processing
-headaches
CKD can also cause the impaired use of glucose due to an insensitivity to insulin. If a diabetic becomes uremic, will they need more or less insulin compared to before they had CKD?
they may require less insulin because insulin is dependent on the kidneys to be excreted because it’s not being used properly
Because CKD causes insulin to not be used properly, this is going to cause hyperinsulinemia. This is going to cause the liver to produce ___________. Due to delayed lipid metabolism from a decrease in lipoprotein lipase.
triglycerides
What is the most serious electrolyte imbalance in kidney disease, and what can it fatally lead to?
–hyperkalemia
–dysrhythmias
how does hyperkalemia occur in CKD?
-decreased potassium excretion through the kidneys
Because of impaired excretion, sodium is retained, which means water is retained. What 3 things can this water retention lead to?
-edema
-hypertension
-CHF
if the body can’t excrete the acid (primarily ammonia), can’t reabsorb or regenerate bicarbonate, what acid base imbalance is going to be a result?
metabolic acidosis
In CKD there is a decrease in production of erythropoietin, function in renal tubular cells, and defects in platelet function. What complications are a result of this?
anemia + bleeding
changes in leukocyte function, altered immune response/ function, and diminished inflammatory response put these patients at a higher risk of developing what?
infections
What are the 6 cardiac related complications of CKD?
Harry Loves Hotcakes, Pie, Donuts and Upside down cake
-HF
-Left ventricular hypertrophy
-HTN
-peripheral edema
-dysrhythmias
-uremic pericarditis
What 7 S+S will you in CKD related to the respiratory system?
-kussmaul respirations
-dyspnea
-pulmonary edema
-uremic pleuritis/ uremic lung
-pleural effusion
-rx. of respiratory infections
-depressed cough reflex
Due to the excessive urea, every part of the GI system is affected. What 6 S+S will you see?
-N/V
-mucosal ulcers
-stomatitis
-Uremic fetor “feeder; mouth; urine breath”
-GI bleeding
-Anorexia
* oral care is SO important*
What are some complications related to the neurological system seen in CKD?
-altered mental status/ ability
-seizures
-coma
-dialysis encephalopathy
-peripheral neuropathy
-restless leg
-muscle twitching
In CKD vitamin D and calcium are both decreased, this puts patients at a high risk of ________. And due to the weakening of bones, __________ _________ are common.
osteodystrophy;
pathological fractures
Due to decreased calcium + vitamin D, Osteomalacia is common, which is the softening of bones. What is the disorder that is the softening of bones, and also the deformity of bones.
osteitis fibrosa
Since CKD patients are absorbing and retaining urinary pigments, what kinds of things are you going to see in their skin?
-yellow/gray discoloration
-uremic frost
-pruritus
-dry, pale skin
true or false? CKD patients are also at risk for developing metastatic calcifications.
true
Being in a uremic state, what will the patients hair and nails be like?
dry + brittle, nails will be thin
Patients who have CKD, also have uremic blood, what things will you see on their skin as signs that they are uremic?
ecchymosis and petechiae
Men and Women will both experience what s+s related to sexual function and reproduction, while having CKD.
-infertility
-decreased libido
-low sperm count
-sexual dysfunction
As a nurse you need to monitor for low T3, T4 and TSH in your patient who has CKD, because they are risk for developing what, related to the endocrine system?
hypothyroidism
Why is a urinalysis and a urine culture important lab tests to have done?
because CKD patients are at an increased risk of developing UTIs
CKD patients are also at a high risk of developing anemia, what laboratory tests should you be monitoring as a nurse?
CBC, Hct, Hgb
Why should CKD patients be getting somewhat regular renal ultrasounds and renal scans?
they are at an increased risk of developing cancer + tumors with such a high accumulation of waste products
What kind of diet should a patient with CKD be on?
-low sodium
-low potassium diet
-low protein
-water restriction
-low phosphate
What does it mean to give a “renal dose” of a drug?
this is when you adjust the dose of a drug depending on the degree of renal function - usually a lower dose than normal
CKD/ Dialysis patients will need folic acid supplementation because they are needed for RBC formation. Why do they need the supplementation of they are getting dialysis?
because dialysis removes folic acid
what are some complications of peritoneal dialysis?
-Infection
-Peritonitis
-ABD pain
-Hernias
-Lower back pain
-Bleeding
What are some complications of hemodialysis?
Harry Makes Lucy the Hedgehog Sleep During hemodialysis
-Hypotension
-Muscle cramps
-Loss of blood
-Hepatitis
-Sepsis
-Disequilibrium syndrome
What is Disequilibrium Syndrome?
DDS - neurological symptoms due to cerebral edema caused during or shortly after “aggressive or high solute removal” HD
What is the only treatment for CKD?
a transplant; dialysis is only going to “slow” degeneration + remove toxins
What are we monitoring post kidney transplant to evaluate for successful transplantation?
-no infection
-maintain ideal body weight
-no edema
-Hct, Hgb + albumin at acceptable levels
if your patient is starting to get muscle cramps while receiving hemodialysis, what should you do first?
SLOW the down dialysis but NEVER stop it
if your patient becomes hypotensive during dialysis, what should you give them?
a bolus of fluids
what are the 3 parts or phases of a complete exchange of dialysis?
-hang
-dwell
-empty
how many exchanges of PD will a patient typically have in 1 day?
3-5
what are 3 things you DONT want to see with dialysis output?
-cloudy output
-less volume than what was put in
-an excessive amount more than what you put in
what are the 2 things you want to assess for when your patient has a fistula for dialysis access?
a bruit and a thrill
