4.2 Nursing Management of Chronic Kidney Disease Flashcards
(36 cards)
1
Q
Chronic Kidney Disease (CKD)
A
- Umbrella term for kidney damage or decrease in GFR lasting 3 months or more
- More progressive than Acute Kidney Failure/Injury
- Untreated CKD can result in renal replacement, dialysis, or kidney transplant
2
Q
CKD Risk Factors
A
- CVD
- Diabetes (Leading Cause)
- Hypertension (Second Leading Cause)
- Obesity
3
Q
CKD Stages and GFR
A
- Based on GFR (plasma filtered through glomeruli per unit of time)
- Normal GFR 125 mL/min.
4
Q
Nephrosclerosis
A
- Hardening of renal arteries due to prolonged hypertension and DM
5
Q
Primary Glomerular Disease
A
(Group A Beta-Hemolytic Strep Infection)
- Destroys glomerulus of kidneys
- 3rd most common cause of stage 5 CKD
Acute Nephritic Syndrome - Glomerular Inflammation
(Post-Infectious Problem)
Chronic Glomerulonephritis - Repeated syndromes of Acute Nephritic Syndrome
Nephrotic Syndrome - Any condition that damages glomerular membrane and results in increased glomerular permeability to plasma proteins
6
Q
Polycystic Kidney Disease
A
- Genetic
- Characterized by growth of numerous fluid filled cysts in kidneys which destroy nephrons.
- Can lead to chronic kidney failure and nephrosclerosis.
7
Q
End Stage Kidney Disease (ESRD)
A
- GFR < 15
8
Q
Acute Kidney Injury (AKI)
A
- Rapid loss of renal function due to damage to kidneys
- Treatment is to replace renal function temporarily to minimize lethal complications
- Goal of minimizing long-term renal function loss
- Results in drop of glomerular filtration rate, increased creatinine, dropping urine output.
- Reversible
9
Q
Pre-Renal
A
- Hypoperfusion of kidneys (volume depletion, decreased cardiac output; shock)
- Replace fluids and vasopressors
- Can see Hypertension or Hypovolemia
10
Q
Intra-renal
A
Actual damage to kidney tissues.
Nephrotoxic agents like antibiotics (gentamicin vancomycin) can cause damage to kidneys
11
Q
Acute Tubular Necrosis (ATN)
A
- Damage to kidney tubules; most common type of intrinsic AKI
12
Q
Post-Renal
A
- Obstruction to renal flow
Tumor, prostate, hyperplasia, stones
13
Q
RIFLE (Stages of Kidney Disease)
A
R - Risk of first stage AKI (First Stage) I - Injury (Second Stage) F - Failure (Third/End Stage) L - Loss E - End Stage Renal Failure
14
Q
Continuous Renal Replacement Therapy (CRRT)
A
- Common renal support for AKI
- Particularly for patients who are hemodynamically stable
- Continuous venovenous hemofiltration with either convective solute clearance, diffuse solute clearance, or hemodiafiltration (combines both dialysis and hemofiltration)
15
Q
Continuous Venovenous Hemofiltration (CVVH)
A
- Temporary treatment for patients with acute renal failure who are unable to tolerate hemodialysis.
- Dialysis catheter placed in main vein of body. Blood is taken out of body, goes into a filter, wastes are removed and fluids/electrolytes are replaced, then returned to body.
16
Q
Peritoneal Dialysis
A
- Sterile dextrose dialysate fluid is introduced into peritoneal cavity through abdominal catheter at established intervals that is not at risk for peritonitis, bleeding or leakage. Used for patients who cannot tolerate hemodialysis.
- Happens inside the body
- Takes 20-30 minutes
- Able to do at home
- High risk of peritonitis. Patient needs to be able to preform it correctly on themselves.
- CAPD Catheter Care Education
- Fever/Abdominal tenderness is abnormal
- If abdomen drainage is cloudy there is a risk of infection.
- Fluid monitoring, follow-up care, renal function tests (health promotion)
17
Q
Hemodialysis
A
- Blood is cleaned outside of body
- Usually preformed 3 times a week and takes 3-6 hours
- Dialyzer (Artificial Kidney)
- Dietary changes are required
- Hypotension is big risk
- Monitor for low blood pressure, electrolytes.
- Monitor ABC’s Cardiac/Respiratory Status
- Certain cardiac medications need to be held during the process as they may be cleared from the system.
- Address pain and discomfort
18
Q
Kidneys
A
- Superstar of balance to keep equilibrium
- Filters waste products created by metabolism
- Damage can cause abnormal sodium/potassium or retain fluids, increased blood pressure,
19
Q
Dialysis
A
- Usually started when GFR is around 12% but 20% is a cause for concern
- Usually started when patients develop symptoms such as fatigue, nausea, decreased appetite, SOB
20
Q
Conservative Care
A
- Preserve kidney function as long as possible
- Do nothing and let kidneys run its course
- Diet and Medications
- Does not stop slow decline of kidneys.
21
Q
Kidney Transplant
A
- Usually takes about 5-8 years to get
- This is the best treatment option for most people
- Live longer and better than dialysis
- Kidney’s from living donor’s tend to last longer than from deceased.
22
Q
Clinical Manifestations of Kidney Disease
A
- Fluid/Electrolyte Imbalance
- Patient weight (fluid retention or loss)
- Weight is the most accurate indicator of fluid gain/loss
in acutely ill patients - 1 kg of weight = a liter of retained fluids
23
Q
Acute Kidney Failure/Injury
A
- Rapid loss of renal function
- Due to damage of kidneys
- Can be prerenal, intrarenal, postrenal
24
Q
Signs of Glomerulonephritis
A
- Blood in urine (hematuria)
- Edema
- Azotemia (high levels of nitrogen waste)
- Protein in Urine
- Hypertension
25
Nursing Management of Glomerulonephritis
- Dietary modifications
| - Treat cause such as antibiotics, steroids, immunosuppressants.
26
Nursing Management of Acute Nephritic Syndrome
- Assess patient
- Monitor eyes and nose carefully.
- Fluids are given based off eyes, nose, and weight changes
- Provide carbohydrates for energy
- Educate safe and effective home care
- Encourage for follow up appointments
27
Chronic Glomerulonephritis
- Repeated episodes of acute nephritic syndrome as well as hypertension, increased lipids.
- Abnormal lab test would include fixed specific gravity at 1.010
- Protein in urine, electrolyte imbalance, low albumin.
28
Nephrotic Syndrome
- Increased glomerular permeability
- Massive amounts of protein in urine
- You may see diffuse edema throughout entire body
- Drop in albumin levels
- Increase in cholesterol and lipid levels
- Happens through damage to glomerular capillary membrane
29
Kidney Failure
- Cannot remove body waste or preform regulatory function.
| - Systemic disorder usually from many different causes
30
Assessing Kidney Injury
- Fluid Status, Nutritional Status, Knowledge of disorder, Activity Tolerance, Self Esteem.
- Complications such as anemia, high potassium, hypertension.
31
Complications of Kidney Failure
- Pericarditis (Inflammation of Heart Sac)
- Pericardial Effusion (Fluid in pericardial sac)
- Pericardial Tamponade
- Bone Disease
32
Goals of Kidney Failure
- Maintain body weight without excess fluid
(Maintain accurate input and output) (Limit Fluid) (Oral Hygiene)
- Maintain adequate nutrition
(Assess nutritional status, weight change, lab results, nutritional patterns, preferences)
- Increasing knowledge on disorder
- Participation of activity within tolerance
- Improving self esteem with disorder
(Assess family response to illness and treatment. Encourage open discussion about alternate sexual expression)
33
Patients who need dialysis
- Education on dialysis
- Done by diffusion, osmosis, ultrafiltration
- Objective is to extract toxic nitrogen from the blood.
- Vascular access is required for hemodialysis or dialysis of the blood. AV Fistula or AV Graft is needed. (More permanent)
- UDALL can be used for temporary dialysis, hemodialysis, used for drug overdose. It's placed in the subclavian vein and rests in right atrium.
34
AV Fistula
- Takes months for it to heal and mature enough where it can be accessed by needles for hemodialysis.
35
Graft
- Graph is placed between vein and artery if vessels are not suitable for fistula.
- Thrill can be felt over AV Fistulas. (You'll feel the blood flow)
36
Continuous Renal Replacement
- Patient is critically unstable
- ICU Patient
- Runs 24 hours a day removing toxins to manage fluid volume
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