CHRONIC RENAL KIDNEY DISEASE Flashcards
What is Chronic Kidney Disease
Progressive, irreversible deterioration in renal function
Body unable to maintain metabolic & fluid/electrolyte balance
Build up of urea and waste products resulting in uremia
What are the risk factors?
Diabetes (number one risk factor) Hypertension None compliance with prescribed medications Uncontrolled hyperglycemia Heart disease Infections Polycystic Kidney disease
What are the stages?
1 Kidney damage with normal GFR>90 mL/min At risk 2 Kidney damage with mild ↓ GFR 60- CRI 3 Moderate decrease in GFR (30-59) CRI, CRF 4 Severe decrease in GFR (15-29) CRF 5 Kidney Failure (<15) End-stage renal disease (ESRD)
What systems are impacted (multi system involvement)
Neurologic (confusion, weakness, seizures) Immunology: weakened immune system Integumentary (pruritis) Cardiovascular (BP, edema, Pericarditis, hyperkalemia, JVD Pulmonary Pulmonary Edema Crackles Thick sputum pneumonitis GI (Ammonia breath, bleeding ulcers, N/V) Hematologic (low HB, low platelets) Reproductive (amenorrhea, infertility) Musculoskeletal (muscle cramps, bone fracture and pain)
ARF risk factors VS chronic kidney disease
ARF:
Hypovolemia & hypoperfusion
Nephrotoxicity
Urinary obstruction
CKD: diabetes (number 1) unmanaged hypertension unmanaged hyperglycemia unnoticed acute RF heart issues
What are the nursing diagnoses?
FVE related to oliguria, dietary excesses and NA and water retention
High risk of infection related to procedures
Imbalanced nutrition d/t N/V, anorexia, dietary restrictions and/or altered mucosal membranes
Activity intolerance due to bed rest, dialysis, fatigue, anemia etc.
Low self esteem related to dependency, changes in body
Fear of death
Impaired comfort/skin issues related to urate crystals on skin
Powerlessness
Decreased/ineffective sexuality patterns
Knowledge deficit related to dialysis, lifestyle changes,
Ineffective management of diet and nutritional needs
What are collaborative diagnoses?
Metabolic Acidosis Hypercalemia Pathalogical fractures Anemia Hypertension Cardiac arrest Hyperparathyroidism: Phosphate clearance stops as GFR dips below 10% despite high levels of parathormone and as reabsorption of calcium and phosphate from bones takes place, the plasma phosphate level rises. This phosphate can’t be expelled via renal route which prevents increased serum calcium thereby stimulating parathyroid secretion= secondary hyperparathyroidism develops contributing to bone degeneration. Think of this rhyme: Moans (general malaise) Groans (abod pain and gastric reflux), Stones (renal), Bones (bone pain/osteoporosis), Psychiatric overtones (depression, lethargy, memory loss).
Polyneuropathy Electrolyte imbalance (high K, Low Ca, High Phoshpate, impaired Na and Magnesium)
What is the management for CKD?
Slow progression Dialysis Prevent complications Manage anemia Manage hypertension Manage electrolytes Manage adherence Manage energy, diet Promote increased QOL
CKD- what does nursing focus on?
Teaching Loss, grief, hope, vulnerability Patience Prevention of infections Utilize complex knowledge of multi-system issues
What is the pharm for CKD?
Antacids- bind to dietary phosphorous in GI tract
Anti-hypertensives
Anti-seizure/dilantin/side rails/treat NA and acidity
Epoetin Alfa(hb <110 g/L)
Mannitol, furosemide (PE, FVE)
Kaxeylate (high K)= Retention Enema (cation-exchange resin in colon)
Considerations with CKD:
Lower doses of antibiotics, digoxin, ACE-I, Magnesium)
Dosing regime: eg daily instead of three X a day
What are possible complications for dialysis?
Hemodialysis= infection of AV fistula, sepsis (low WBC, low platelets), bleeding, monitor symptoms of uremia, cardiac and respiratory complications, monitor BP,
Peritineal= peritonitis is number one complication, leakage, bleeding
