Week 5C: Chronic Kidney Disease Flashcards
What are the top 3 causes and consequences of CKD?
HTN, DM, CVD
Stage 1 CKD
90+, normal renal function, proteinuria
Stage II
60-89, mild loss of kidney function, proteinuria
Stage III
30-59, mild to moderate loss of kidney function, proteinuria
Stage IV
15-29, severe loss of kidney function, proteinruria
Stage V
End stage renal disease, proteinuria
What system does CKD affect?
Every system.W
What is Uremia?
Onset of ESRD results in a constellation of signs and symptoms called Uremia
What are the goals of care for a CKD patient?
Prevention or slowing progression, early ID, detect and treat causes, referral to nephrologist
What meds should be avoided in patients with AKI and CKD
Those with nephrotoxic side effects
If a patient has elevated creatinine levels, what meds are avoided ?
NSAIDS
What is important for a patient before the use of intravascular dye ?
Delayed until patient is rehydrated
What are some secondary factors that can slow the rates of progression of CKD?
HTN, DM, smoking, chronic metabolic acidosis, protein restriction
What is an example of a reversible cause of CKD?
Decreased renal perfusion, administration of nephrotoxic medications
What is seen in the early stages of CKD in the urinary system?
Polyuria. More than 2.5-3L per day
What is seen in late stage CKD in the urinary system?
Less than 400ml/24h
Anuria
Less than 40mL
Respiratory system
Kussmaul respiration, dyspnea, pulmonary edema, uremetic pleuritis, pleural effusion, predisposition to resp infection
How would we treat fluid overload in CKD?
Dietary sodium restrion, diuretic therapy
Furosemide
Lasix- a loop diuretic. This is used in margins of 80-500 depending on the severity of the kidney disease.
CVD effects of CKD?
HTN, heart failure, left ventricular hypertrophy, peripheral edema, dysrhythmias, ureic pericarditis
A patient presents with CKD and HTN. What do you do?
Lifestyle changes, diet recommendations, antihypertensive drugs, fluid overload
What are some metabolic disturbances we might see in CKD patients?
An accumulation of waste product. Altered carbohydrate metabolism, elevated triglycerides, metabolic acidosis
How would you treat a patient with metaobolic acidosis?
Sodium bicarbonate, decreased protein intake, increased fruit intake
What are some common electrolyte imbalances we might see following CKD?
Hyperkalemia, sodium, calcium and phosphate, magnesium, metabolic acidosis
How do you handle hyperkalemia in CKD?
Stop supplements, low potassium diet, insulin with glucose, calcium gluconate, removal of K from body
How can you removed K from the body?
Diuretics, Kayexalate, dialysis
Nutritional therapy for CKD?
Protein restricted, water restricted, Na and K restricted, phosphate restriction, glycemic control
How might CKD impact the hematologic system?
-Anemia (decrease in erythropoietin)
-Bleeding tendencies
-Infection
Anemia seen in CKD?
-Erythropeoitin (treat w. ESAs to increase Hg and hematocrit)
-Iron supplements
-Folic acid supplements
When a patient is on dialysis, what supplements become useless?
Folic acid
Can CKD impact the MSK system?
Yes. In the mineral and bone disorders. Leads to soft tissue calcification
How would you treat a patient with a mineral and bone disorder?
-Restict phosphate intake
-Phosphate binders with meals (tums, caltrate)
-Supplementing vitamin D (calciferol)
Dyslipidemia in CKD
Admin statins
CKD leads to a _____ state which is _____
Uremic, anorexia, N/V, peripheral neuropathy
-May need kidney replacement therapy
Which parts of the GI are affected by CKD?
All
CKD: Nursing care
-Systems assessment
-Maintain skin integrity
-Monitor excess fluid overload
-Daily weights
-Risk for infection
-Monitoring nutriton
-Risk for constipation
-Risk for injury
-Balancing activity and rest
-Patient teaching
-Anticipatory grieving
