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MS4 ADRN.210 - rotation 2 > week 4 - Chronic Kidney Disease (CKD) > Flashcards

week 4 - Chronic Kidney Disease (CKD) Flashcards

chapter 48

1
Q

AKI is the rapid loss of what?

A

renal function

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2
Q

Acute Nephrotic Syndrome is the inflammation of the ??

A

Glomerulus

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3
Q

What is a type of AKI, where there is damage to the kidney tubules?

A

ATN - Acute Tubular Necrosis

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4
Q

Anuria is the total urine output in 24 hours that is less than _____mL .

A

50

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5
Q

This type of access for dialysis is surgically created by connecting an artery to a vein.

A

an arteriovenous fistula

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6
Q

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

A

an arteriovenous graft

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7
Q

Azotemia is a abnormal concentration of what in the blood?

A

nitrogenous waste products

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8
Q

CKD- Chronic Kidney Disease is characterized by kidney damage or decreased GFR of how much, for at least how long?

A

<60mL/min. for 3 months or more

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9
Q

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?

A

this is performed by the patient

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10
Q

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?

A

usually at night, while the patient is asleep

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11
Q

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?

A

CRRT- continuous renal replacement therapy

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12
Q

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?

A

dialysate

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13
Q

A dialyzer is acting as an ______ _______.

A

artificial kidney

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14
Q

diffusion is the movement of _____ _____ to a place of higher concentration to a place of lower concentration.

A

waste products – (solutes)

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15
Q

what is the drained fluid from a peritoneal dialysis exchange called?

A

effluent

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16
Q

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?

A

uremic waste products

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17
Q

if exchange is complete, the phases of peritoneal dialysis are all complete. What are the 3 phases of this cycle?

A

-fill
-dwell
-drain

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18
Q

GFR is the amount of _______filtered through the glomeruli.

A

plasma

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19
Q

what is the inflammation of the glomerular capillaries?

A

glomerulonephritis

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20
Q

hemodialysis (HD) is the process of the patient blood being circulated through a dialyzer to remove _______ products + excess _____.

A

waste; fluid

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21
Q

interstitial nephritis is inflammation where?

A

renal tissue

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22
Q

what is nephrosclerosis?

A

hardening of renal arteries

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23
Q

What type of kidney disease is characterized by
-damage to glomerular membrane
-increased glomerular permeability
-increased/ massive proteinuria?

A

nephrotic syndrome

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24
Q

a substance, medication or action that is toxic to the kidney tissue.

A

nephrotoxic

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25
Q

oliguria is characterized by a urine output of <_____mL/24 hours OR <_____mL/kg/hr in a 6 hour period.

A

400; 0.5

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26
Q

Which procedure uses the patients peritoneal cavity + membrane to exchange fluid and solutes to filter the blood.

A

peritoneal dialysis (PD)

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27
Q

what is inflammation of the peritoneal membrane?

A

peritonitis

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28
Q

polyuria is ______ urine production.

A

excessive

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29
Q

what is the process called where water is removed from the blood by a pressure gradient between their blood and the dialysate?

A

ultrafiltration

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30
Q

uremia is the excess of _____+ other __________ waste in the blood.

A

urea; nitrogenous

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31
Q

what proteins are secreted when the kidney tubules are damaged?

A

urinary casts

32
Q

CKD is a _______ + ________ loss of kidney function.

A

progressive + irreversible

33
Q

What is a normal GFR?

A

125mL/min.

34
Q

End Stage Renal Disease is when the GFR is < ______.

A

15

35
Q

what are the 2 leading causes of CKD, due to decreased perfusion?

A

-diabetes
-hypertension

36
Q

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?

A

1.010

37
Q

Other affects on the urinary system include oliguria. As well as anuria, which is a urine output of less than _____mL in 24 hours.

A

40mL

38
Q

The waste accumulation leads to metabolic disturbances. As GFR decreases, what 2 labs are increasing?

A

BUN and Creatinine

39
Q

What are 4 other things besides kidney failure, that are going to raise your BUN?

A

-increased protein intake
-fever
-corticosteroids
-catabolism

40
Q

what are 5 S+S of increased BUN levels you may see?

A

-N/V
-lethargy
-impaired thinking/ processing
-headaches

41
Q

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?

A

they may require less insulin because insulin is dependent on the kidneys to be excreted because it’s not being used properly

42
Q

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.

A

triglycerides

43
Q

What is the most serious electrolyte imbalance in kidney disease, and what can it fatally lead to?

A

–hyperkalemia

–dysrhythmias

44
Q

how does hyperkalemia occur in CKD?

A

-decreased potassium excretion through the kidneys

45
Q

Because of impaired excretion, sodium is retained, which means water is retained. What 3 things can this water retention lead to?

A

-edema
-hypertension
-CHF

46
Q

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?

A

metabolic acidosis

47
Q

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?

A

anemia + bleeding

48
Q

changes in leukocyte function, altered immune response/ function, and diminished inflammatory response put these patients at a higher risk of developing what?

A

infections

49
Q

What are the 6 cardiac related complications of CKD?

Harry Loves Hotcakes, Pie, Donuts and Upside down cake

A

-HF
-Left ventricular hypertrophy
-HTN
-peripheral edema
-dysrhythmias
-uremic pericarditis

50
Q

What 7 S+S will you in CKD related to the respiratory system?

A

-kussmaul respirations
-dyspnea
-pulmonary edema
-uremic pleuritis/ uremic lung
-pleural effusion
-rx. of respiratory infections
-depressed cough reflex

51
Q

Due to the excessive urea, every part of the GI system is affected. What 6 S+S will you see?

A

-N/V
-mucosal ulcers
-stomatitis
-Uremic fetor “feeder; mouth; urine breath”
-GI bleeding
-Anorexia

* oral care is SO important*

52
Q

What are some complications related to the neurological system seen in CKD?

A

-altered mental status/ ability
-seizures
-coma
-dialysis encephalopathy
-peripheral neuropathy
-restless leg
-muscle twitching

53
Q

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.

A

osteodystrophy;
pathological fractures

54
Q

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.

A

osteitis fibrosa

55
Q

Since CKD patients are absorbing and retaining urinary pigments, what kinds of things are you going to see in their skin?

A

-yellow/gray discoloration
-uremic frost
-pruritus
-dry, pale skin

55
Q

true or false? CKD patients are also at risk for developing metastatic calcifications.

A

true

56
Q

Being in a uremic state, what will the patients hair and nails be like?

A

dry + brittle, nails will be thin

57
Q

Patients who have CKD, also have uremic blood, what things will you see on their skin as signs that they are uremic?

A

ecchymosis and petechiae

58
Q

Men and Women will both experience what s+s related to sexual function and reproduction, while having CKD.

A

-infertility
-decreased libido
-low sperm count
-sexual dysfunction

59
Q

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?

A

hypothyroidism

60
Q

Why is a urinalysis and a urine culture important lab tests to have done?

A

because CKD patients are at an increased risk of developing UTIs

61
Q

CKD patients are also at a high risk of developing anemia, what laboratory tests should you be monitoring as a nurse?

A

CBC, Hct, Hgb

62
Q

Why should CKD patients be getting somewhat regular renal ultrasounds and renal scans?

A

they are at an increased risk of developing cancer + tumors with such a high accumulation of waste products

63
Q

What kind of diet should a patient with CKD be on?

A

-low sodium
-low potassium diet
-low protein
-water restriction
-low phosphate

64
Q

What does it mean to give a “renal dose” of a drug?

A

this is when you adjust the dose of a drug depending on the degree of renal function - usually a lower dose than normal

65
Q

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?

A

because dialysis removes folic acid

65
Q

what are some complications of peritoneal dialysis?

A

-Infection
-Peritonitis
-ABD pain
-Hernias
-Lower back pain
-Bleeding

66
Q

What are some complications of hemodialysis?

Harry Makes Lucy the Hedgehog Sleep During hemodialysis

A

-Hypotension
-Muscle cramps
-Loss of blood
-Hepatitis
-Sepsis
-Disequilibrium syndrome

66
Q

What is Disequilibrium Syndrome?

A

DDS - neurological symptoms due to cerebral edema caused during or shortly after “aggressive or high solute removal” HD

67
Q

What is the only treatment for CKD?

A

a transplant; dialysis is only going to “slow” degeneration + remove toxins

68
Q

What are we monitoring post kidney transplant to evaluate for successful transplantation?

A

-no infection
-maintain ideal body weight
-no edema
-Hct, Hgb + albumin at acceptable levels

69
Q

if your patient is starting to get muscle cramps while receiving hemodialysis, what should you do first?

A

SLOW the down dialysis but NEVER stop it

70
Q

if your patient becomes hypotensive during dialysis, what should you give them?

A

a bolus of fluids

71
Q

what are the 3 parts or phases of a complete exchange of dialysis?

A

-hang
-dwell
-empty

72
Q

how many exchanges of PD will a patient typically have in 1 day?

A

3-5

73
Q

what are 3 things you DONT want to see with dialysis output?

A

-cloudy output
-less volume than what was put in
-an excessive amount more than what you put in

74
Q

what are the 2 things you want to assess for when your patient has a fistula for dialysis access?

A

a bruit and a thrill

MS4 ADRN.210 - rotation 2 (7 decks)

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