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Maria > CHRONIC RENAL > Flashcards

CHRONIC RENAL Flashcards

1
Q

What is the 5th stage of kidney chronic kidney disease?

A

= CRF or ESRD
when enough kidney damage to require renal replacement therapy on a permanent basis
= stage of CKD

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2
Q

What factors affect decline of renal fx in kidney disease?

A
  • The rate of decline in renal fx relates to the underlying disorder, the urinary excretion of protein, and the presence of HTN
  • Tends to progress more rapidly in those who exrete large amounts of protein or have high BP
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3
Q

manifestations of ESRD?

A

• ESRD affects every body system→many mnfts whose severity depends on the degree of renal impairment, other underlying conditions, and pts age

  • Can have peripheral neuropathy, Restless leg syndrome and burning feet result
  • Severe pain and discomfort
  • These mnfts most likey d/t the acum of uremic waste products
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4
Q

____is predominant cause of death for CRF pt

A

Cardiovascular disease

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5
Q

Which is more sensitive detector of kidney fx, creatinine or BUN?

A

• Creatinine is more sensitive indicator of renal fx than BUN as BUN is affected by protein intake in diet, catabolism (tissue and RBC breakdown), parenteral nutrition, and meds like corticosteroids

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6
Q

What changes r/t H2O + lytes occur with kidney disease?

A

• Kidneys cant respond properly by conc or diluting urine, change lytes
• Some pts retain sodium with inc rsk of edema, heart failure and HTN.
Can also have HoTN nd hypovolemia d/t sodium loss. Vomiting and diarrhea can worsen sodium and water loss and→worse uremic state

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7
Q

Why anemia in CRF?

What symptoms if prfound?

A

d/t Inadequate erythropoietin production, shorter RBC lifespan, nutritional deficiency and pt tendency to bleed (esp from GI tract)

fatigue, angina, SOB

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8
Q

Calcium and phosphorous imbalance in CRF?

What complications result from this?

A
  • Calcium and phosphate have reciprocal relationship. With dec filtration through glomerulus of the kidney: inc in serum phosphate level and dec in serum calcium, which inc parathyroid –> calcium leaves the bone → bone changes and calcification of the major vessels.
  • Uremic bone disease develops (aka renal osteodystrophy)
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9
Q

CKD complications

A
  • Hyperkalemia
  • Pericarditis, pericardial effusion + pericardial tamponade
  • HTN
  • Anemia
    • Bone disease and metastatic and vascular calcifications
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10
Q

Why pericarditis, etc?

A

d/t retention of uremic waste products and inadequate dialysis

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11
Q

Why HTN?

A

d/t sodium and water retention and malfunction of the RAA

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12
Q

How is CKF primarily managed?

A

Mgmt is accomplished mostly through meds and diet therapy although dialysis may also be nec to dec the level of uremic waste products in blood and control lyte balance

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13
Q

Pharmacology for CKF?

A
  • calcium supplements
  • phosphate binding agents
  • antihypertensives
  • cardiac meds
  • antiseizure meds
  • erythropoietin Eprex
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14
Q

WHat sort of antiHTN and cardiac meds may be needed for CKF?

A

o May need fluid restriction, diuretics, regular hypertensive meds, digoxin or dobutamine etc

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15
Q

How is metb acidosis treated?

A

The metb acidosis usually produces no symptoms and requires no tx but bicarb supplement or dialysis may be nec to correct the acidosis

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16
Q

WHy antiseizure meds in CKF?
Which are used?
What other precaution should the nurse take in this regard?

A

o Neuro abn can occur so watch pt for early evidence of twitching, headache, delirium, or seizure activity
o IV diazepam or phenytoin is usually given to control seizure.
o Padded bed rails

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17
Q

WHy Eprex given?

A

is recombinant human EPO

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18
Q

When is dialysis usually initiated for

A

• Usually initiated when pt cannot maintain a reasonable lifestyle with conservative tx

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19
Q

Nursing diagnoses/problems for CRF:

A
  • Excess fluid volume r/t dec urine output, dietary excess, retention of sodium nd water.
  • Imbalanced nutrition: less than body requirements r/t anorexia, N, V, dietary restrictions, ad altered oral mucous membranes
  • Deficient knowledge regarding condtion and tx
  • Activity intolerance r/t fatigue, anemia, retention of waste products and dialysis procedure
  • Risk for situational low self-esteem r/t dependency, role changes, change in body image, and change in sexual function
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20
Q

Important nursing interventions for pt with CKF?

A
  • Assess fluid status and identify sources of imbalance
  • implement diet to ensure proper nutritional intake within the limits of the tx regimen
  • promote positive feelings by encouraging inc self care and greater independence
  • Teaching is important.
  • Emotional support is necessary d/t numerous changes.
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21
Q

Collaborative problems of CKF?

A

(complications!)

  • Hyperkalemia
  • Pericaridtis
  • Pericardial effusion
  • Pericardial tamponade
  • HTN
  • ANemia
  • Bone disease + metastatic calcifications
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22
Q

Nursing interventions for dietary imbalances

A

o Assess nutritional status: wt changes, lab values (lytes, BUN, creatinine, protein, transferring, iron levels). Diet history, food preferences, calorie counts
o Assess for factors contributing to altered nutritional intake eg anorexia, N, V, unpalatable diet, depression, lack of understanding, stomatitis
o Provide pt food preferences while adhering to restrictions
o Promote intake of high biologic protein foods: egg, diary, meats (complete proteins nec for growth and healing)
o Enc high calorie, low protein, low sodium, low K snaks bet meals
o Alter med schedule so theyre not right before meals as this can cause anorexia and fullness
o Give written list of foods allowed and suggestions for improving their taste without use of sodium or potassium
o Daily wt
o Assess for evidence of inadequate protein intake eg edema, delayed wound healing, dec serum albumin levels

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23
Q

Nursing inteventions for pt activity intolerance

A

o Look for factors that contribute to activity intolerance as above in diagnosis and depression, lyte imbalances, fluid imbalances
o Promote independence in self care activities as tolerated, assist if tired
o Enc alternating activity with rest
o Enc pt to rest after dialysis

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24
Q

Nursing interventions for:

• Risk for situational low self-esteem r/t dependency, role changes, change in body image, and change in sexual function

A

o Assess rxns, family rxns to illness and tx, family relationships, coping
o Enc open disocussion of changes cause by disease and tx eg sexual changes, role changes, lifestyle
o Explore other ways of sexual expression other than intercourse and discuss role of giing and receiving love warmth and affection

25
Q

Hyperkalemia nursing inteventions:

A

o Monitor serum K levels. Notify dr if >5.5 and prep to tx

o Assess pt for muscle weakness, diarrhea, ECG changes

26
Q

Nursing interventions for anemia in CKF patient

A

o monitor RBC, Hgb, HCt
o give meds eg iron and folic acid supplement, Epogen, multivitamins
o avoid taking unnec blood specs
o teach pt to avoid vigorous nose blowing and contact sports and use soft toothbrush
o admin blood component therapy as indicated

27
Q

Nursing interventions for

bone disease and metastatic calcifications

A

o Meds=phosphate binders, calcium supplements, vit D supplements
o Monitor serum labs as indicated (Ca, PO, aluminum levels)
o Assist pt with exercise program (bone demineralization inc with immobility)

28
Q

causes of ESRD in o adult?
S/s in this pop?
Tx?

A

• Diabetes, HTN, chronic glomerulonephritis, interstitial nephritis, and urinary tract obstr

  • s/s in o adult are often nonspecific (may be masked by other disorders). May dev s/s of nephritic syndrome eg edema and proteinuria
  • hemodialysis and PD are used effectively in treating older pts. May not have transplant after certain age d/t concomitant disorders
29
Q

When are renal replacement therapies necessary?

What does this include? Are they short or long term?

A
  • the use of renal replacemet therapies is nec when the kidneys can no longer remove wastes, maint lytes and regulate fluid balance. Can happen rapidly or over LT. Need for replacement therapy can be ST or LT.
  • The main renal replacement therapies incude the various types of dialysis and kidney transplantation
30
Q

Types of dialysis?

A

hemodialysis, CRRT, and PD

31
Q

Acute dialysis indicated when?

A

theres high and inc level of serum potassium, fluid overload, or impending pulm edema, inc acidosis, pericarditis, and severe confusion

•May also be nec to remove meds or toxins from the blood or for edema that is unresponsive to tx, hepatic coma, hyperkalemia, hypercalcemia, HTN and uremia.

32
Q

Chronic or maint dialysis is indicated in?

A

advanced CKD and ESRD int he following instances: the presence of uremic s/s affect all body systems (N, V, severe anorexia, inc lethargy, mental confusion), hyperkalemia, fluid overload, not responsive to diuretics and fluid restriction, general lack of wellbeing.

33
Q

Who has better survival rate - those on dialysis? or those with transplants?

A

Transplants

34
Q

Hemodialysis - is it a cure?

How long does it take? Where is it done?

A

• Hemodialysis prevents death but doesn’t cure renal disease or compensate for the loss of endocrine or metb activities of the kidneys
• Most pts receive intermittent hemodialysis that involves tx duration of 3-4hrs in an outpatient setting. Cn also be done at home
- about 3X/week

• Used as short-term, long term, or permanent form of therapy

35
Q

What are the objectives of hemodialysis?

A

to extract toxic nitrogenous substances frot he blood and remove excess water

36
Q

How does hemodialysis work?

how are toxins removed?

A
  • Dialyzer (aka artificial kidney) serves as synthetic semipermb membrane that replaces the renal glomeruli and tubules as the filter for the impaired kidneys
  • In hemodialysis the blood goes through dialyser where toxins re filtered out and then blood returned to pt
  • The toxins and wastes int he blood are removed by diffusion (move to lower conc in the dialysate). The lyte level in the pts blood can be changed by adjusting the dialysate bath
37
Q

Risks to pt on dialysis?

A

patients can become very hypoglycemic or very hypovolemic during dialysis

38
Q

What kinds of vascular access is used for dialysis patients?

A

Vascular access devices (VAD) - for immediate needs, infection (septicemia) common

Arteriovenous fistula

Arteriovenous graft

39
Q

Arteriovenous fistula

How is it made and used?
How long after sx before can use?

A

o Preferred method of permanent access. Sx created, usually in forearm by anastomosing artery to vein either side to side or end to side
o Use the arterial segment of the fistula for arterial flow and the venous segment for reinfusion of the dialyzed blood
o Needs 2-3 months to mature before it can be used

40
Q

Arteriovenous graft

A

o Can be made by subut interposing a biologic, semibiologic or synthetic graft material between an artery and vein
o Usually a graft is made when the pts vessels aren’t suited for AV fistula
o Grafts are usually in arm but can be in chest or thigh

41
Q

Complications of hemodialysis?

A

o Dialysis→disturbances of lipid metb are accentuated and adds to CV complic (eg HF, CVD, angina, stroke, PVD)
o Anemia is added to by blood loss during hemodialysis
o V may occur during hemodialysis tx when rapid fluid shifts and HoTN occur. Adds to malnutrition in pts on dialysis
o Bone fxs etc from worsening cacium metb. Calcification of blood vessels
o Many ts have fatigue, up to 85% have sleep issues
o Phosphorous deposits can cause itching

Others
• SOB bet tx d/t fluid accum
• HoTN during tx as fluid removed
• Painful muscle cramping (gen late in dialysis) as lytes leave EC space rapidly
• Air embolism (rare)
• Dysrhythmia
• Chest pain in pt w anemia or arteriosclerotic heart disease

42
Q

what is the leading cause of death of dialysis pts

A

Cardiovascular disease

43
Q

Does hemodialysis completely replace kidney funciton?
Does it alter the natural course of the underlying CDK?
Can it prolong life indefinitley?

A

No

No –> symptoms of CKD will continue to progress + need more aggressive tx

Yes

44
Q

What might patients with uremia report when needing dialysis?

A

Metallic taste + nausea

45
Q

What roles does nurse play in hemodialysis unit?

What complication are you assessing for during the dialysis process?

A 
•	monitoring, supporting, assessing, educating
•	During dialysis the pt, dialyzer and dialysate bath need constant monitoring d/t the numerous complic eg clotting 
air embolism
hoTN
Cramping
Vom 
Blood leaks
contamination
Complications in access point
46
Q

What happens to meds in bloodstream with dialysis?
What timing consideration is needed in this regard?

How does the type of med differ in terms of effect of dialysis?

A
  • Many meds are removed from blood during hemodialysis. Dose and timing may need adjusting
  • Often can hold once daily meds until after the dialysis tx
  • Meds that are water soluble are readily removed during hemodialysis tx and fat soluble/meds that adhere to other substances like albumin aren’t dialyzed out very well (this is why some ODs are treated with emerg hemodialysis and others aren’t)
  • Pts w dialysis and meds are monitored closely to ensure blood and tissue levels of the meds don’t get toxic.
47
Q

Teaching for pt on antiHTN and dialysis?

A

IF antiHTN is taken on dialysis day they may have HoTN

48
Q

Diet + fluid considerations for pt on dialysis?

A

• Goals are to reduce uremic symtoms and fluid and lyte imbal; maint food nutritional status; enable pt to eat palatable and enjoyable diet
• Restriction of protein dec accum of nitrogeonous waste. Restriction of fluid to prevent wt gain, HF, pulm edema
- eats high biologic proteins
• With initiation of hemodialysis pt usually needs restriction of dietary protein, sodium, K, fluid
• Want wt gain bet dialysis tx under 1.5kg
• Pt can feel stigmatized in social situations with the lack of choices. Pt feels punished
• Avoid harsh, judgemntal or punitive tones when communicating w pt. They need reinforcement and reg education to achieve this hard change

49
Q

What sources of psychological difficulties may be experienced by dialysis patient?

A

• Often pts worry of unpredictability of the illness, have financial diff, hard to hold job, sexual desire is waning and have impotence, depression from chronic illness, fear of dying
• Young pts worry about marriage, children, burden on family
• Regimented lifestyle that freq ialyis tx and restrictions in food & flud intake is demoralizing
- possible depression
-

50
Q

What family difficulties arise from dialysis and how should it be dealt with?
What can occur if is not dealt with?

A

• Dialysis takes long time. Can be hard for family to express anger and negative feelings give family opportunity to expess feelings of anger and concern about the limitations that the disease and tx impose, possible financial probles and job insecurity. If anger is unexpressed it can be directed inward→suicide (more common in diaysis pt).

51
Q

Important consideration for teaching style/attention in patients with ESRD

A
  • Pts with ESRD often have dec mentation, shortened attention span, dec level of conc, altered perception
  • Teaching must occur in bried 10-15 min sessions with time added for clarification, repetition, reinforcement, and questions from pt and family
52
Q

What is often used to prevent coagulation during hemodialysis?

A

Heparin (Given to pt I assume?)

53
Q

What are continual renal replacement therapies and when are they used?

A
  • For pt with acute or CRF who are too unstable for traditional hemodialysis, for pt with fuid overload secondary to oliguric renal failure, and for pt whose kidneys cant handle their acutely high metb or nutritional needs
  • CRRT doesn’t cause rapid flud shifts, desnt need dialysis machines or dialysis personnel and can be started quickly
  • Several types are avail and widely used in critical care units. All use hemofilter (extremely porous semipermb membrane)
54
Q

Who is peritoneal dialysis used in

A
  • May be tx of choice for those unable or unwilling to do dialysis or transplant
  • Pts who’re prone to rapid fluid shifts, lyte changes, metb changes during hemodialysis have less of these problems with the slower rate of PD
  • Pts with DM or cardiovascular disease, older adults and those who may be t risk for adverse effects o systemic heparin are likely candidates for PD
55
Q

What occurs in PD?

How long is the process?

A
  • In PD the peritoneal memb is the semipermb membrane. Sterile dialysate fluid is put into peritoneal cavity through abdominal cavity.
  • Osmosis, diffusion, and ultrafiltration (water removal) occur.
  • peritoneal diayss can be performed using: acute intermittent peritoneal dialysos, continuous ambulatory peritoneal dialysis, and continuous cyclic peritoneal dialysis

PD takes 36-48hrs to achieve what hemodialysis does in 6-8hrs

56
Q

Acute complications of PD?

A
  • peritonitis (most common and serious. Indicated by cloudy dialysate drainage fluid, s/s of shock),
  • leakage
  • bleeding
  • hypertriglyceridemia is common (therapy may accelerate atherogenesis).
  • abdominal hernias,
  • low back pain and anorexia from fluid in abdm, constant sweet taste
57
Q

Psychological concerns for pt with PD?

A

o in addition to complications of PD pts who elect to do PD may experience altered body image d/t presence of abdm catheter, bag, tubing, and cycler. Waist size inc from 2.5cm-5cm or more with fluid in the abdm (the pt)
o pts may have sexual issues such as thinking the catheter is in the way of sexual performace. The continual connection and sound at night can be disruptive

58
Q

No flashcards for
Pillitteri 1368-1369
(see notes for summary…)

A

I just don’t seem them testing us on this??

Maria (14 decks)

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