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med-surg/adult health > Exam 2 CKD > Flashcards

Exam 2 CKD Flashcards

1
Q

Two leading causes

A

Dm and htn
(that sugar damages walls of vessels and then dec. perfusion to k idneys)
Vasoconstriction further elevates bp, impaired perfusion to kidney.

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2
Q

24% mortality rate?

A

CKD

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3
Q

End stage kidney disease is considered a _______

A

disability

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4
Q

Other three causes of CKD?

A
  • Chronic Glomerulonephritis
  • Polycystic Kidney Disease
  • Polyenephritis
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5
Q

Chronic Glomerulonephritis

A

Etiology: doing drugs/viruses…genetic syndromes. *Very progressive (over years)

Manifest:

  • hematuria
  • proteinuria (kidneys not working)
  • urine tests
  • **-inc. BUN/creatinine

Diagnose:
-CT of kidneys
-biopsy
-routine urinalysis
-elevated BP
(*People often symptomatic and don’t even know)
-hx of viral disease/bacterial disease/drug/lupus/

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6
Q

Polycystic Kidney Disease

A

Etiology?
Genetic (50% per parent)
Kidney(s) fills with cysts and press on kidney…which can grow to the size of football. Sx don’t show until much later in life.

Manifest:

  • htn
  • heaviness behind ribs/in back
  • end stage kidney disease by 60yr old
  • UTIs
  • Kidney Stones
  • Chronic Pain
  • Ability to feel kidneys
  • Affects rest of body
  • Aneurisms in blood vessels (bubble in vessel which weakens vessel and could rupture)
  • Diverticulitis (aneurism in intestine)
  • cerebral aneurisms

Diagnosis:

  • ASK patients if you see sx
  • Family Hx!
  • No cure
  • Prevent further damage
  • Genetic testing for kids
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7
Q

Chronic Pyelonephritis

A

May affect one or both kidneys

  • Anatomic abnormality
  • Acute pyelenephritis puts you at risk.

Etiology:
Inflamed, scar, atrophy (when shrunken it doesn’t work as well). Can effect both kidneys.

Diagnose:

  • CT, biopsy, ultrasound
  • Hx of acute phyelenephritis?

Care:
-Prevent further damage.

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8
Q

GFR

A

glomerular filtration rate (<60 for longer than three months results in a diagnosis of CKD)

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9
Q

As GFR goes down, ____-

A

Body accumulates waste (b/c kidneys aren’t working). BUN/Creat increase!

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10
Q

Although GFR goes down, ________

A

Normal urine output

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11
Q

When waste builds up in body as a result of kidneys not functioning…

A 
Psych 
Neuro
Cardio
Gastro
Endocrine/Reproductive
Metabolic
Hematologic
Ocular
Pulm
Integumentary
Musculoskeletal
Peripheral neuro
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12
Q

Nursing Assessment

A

-Hx!
-Metabolic Disturbances
-Electrolyte & Acid-Base
(GFR decrease, BUN/Creat increase)
-Imbalance

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13
Q

High BUN/CREAT Sx?

A

Pt. doesn’t feel great: nausea, vomiting, weak, fatigue, HA, hyperglycemia, hyperinsulemia (High TGC) and Hyperkalemia, Hyponatremia.
Edemetous, heat failure, htn.

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14
Q

Interventions

A

Low sodium diet

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15
Q

Metabolic acidosis

A

Unable to excrete excess acid and thus have acidosis

. Give insulin due to CKD-hyperglycemic, hyperinsulimic (Inc. TGD = dyslipidemia)

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16
Q

CKD manifest Urinary issues?

A

At first, normal output
As disease progresses, less output
When they start dialysis; might become anuric. (no urine)

17
Q

CKD manifest Hematology

A

Kidneys produce erythropoietin/RBC
Platelet dysfunction… might bleed more than normal
WBC dysfunction
Thus: Anemia/thrombo/neutro

18
Q

Cardiovascular

A
  • MI!! Leading cause of death in CKD.
  • HTN (kidneys help with bp) Also this is a cause and consequence of kidney disease.
  • WATCH bp control.
19
Q

Peritoneal Dialysis

A

Uses peritoneal membrane to filter waste.

@ Risk for Infection!!
Know levels.

Does patient have ability to do the work of peritoneal?

At risk for peritonitis.
Fluid should be clear.

20
Q

Automatic Dialysis

A

Happens at night while sleeping, machine does for you. Have to do it 2-3x per day.

Education:
-Fluid should be CLEAR

21
Q

Ambulatory Dialysis

A

Happens throughout day x3-4 times a day.

Education:

  • @ risk for low protein.
  • monitor albumin
22
Q

Hemodyalysis

A

Blood exchange! Different than peritoneal which is all day every day. Uses a machine
Uses artificial membrane to filter waste by use of tunnel between vein and artery = fistula. Creates thicker wall for more punctures!
(Other than fistula; can use:
-arteriovenous graft
-temp. vasc. access jugular/femoral…emergent)

Go 3-4x per week

Educate:
-No damage to fistula area. 
(tight clothing...)
-No bp pills day of
-If it's low day of, slow down rate.

Complications: Hypotension, Muscle Cramps, Loss of blood, hepatitis.

Are they working?
Do they have time?
Can patient manage regimen?

23
Q

What happens if a dialysis patient c/o of dizziness

A

Assess BP!!!
(If low, give NS and slow rate of filtration?)

C/O of muscle cramps?
Nausea?

24
Q

CKD Manifest GI

A

Ulcers/metallic taste in mouth and urine order (uremia backup)
-Poor immune system

25
Q

Electrolyte & Acid/Base Imbalance

A

Elevated potassium!
(@ risk for cardiac dyss)
NA (high/low/or normal)
Metabolic Acidosis!! Kidneys not functioning.

26
Q

CKD manifest respiratory

A
  • Kussmal breathing to blow off excess acid
  • Dyspnea
  • Pulmonary Edema
27
Q

CKD manifest neuro

A

Metabolic encephalopathy
CNS depression (fatigue/lethargy/seizures)
Peripheral neuropathy
Musculoskeletal system

28
Q

CKD manifestation musculoskeletal

A

Bone structure diminishes

High Phosphate!

29
Q

CKD manifestation integumentary

A

Scratch/itch = at risk for infection and wounds.

When BUN is >200 = uremic frost (urea is crystallizing on skin)

30
Q

CKD manifestations Reproductive

A

Reproductive issues
Dec. libido
Amenorrhea

Testicular Consistency… (lower sperm counts, dec. testosterone)

31
Q

CKD manifest psychological

A

Anxiety and Depression

Fatigue/Withdrawal

32
Q

Diagnosing CKD?

A 
**Microalbuminuria
(proteinuria)
Dipstick that is 1+ twice or more over a 1 month = CKD
Urinalysis! 
BUN/creat
GFR
Electrolytes (will be elevated)
Hgb and hematocrit  will be low
Lipid panel (cardiac disease)
Renal ultrasound
Kidney biopsy
33
Q

NANDA

A 
Fluid imbalance
Elec. Imbalance
Impaired skin integrity
Deficient knoweldge
Risk for infection
Sexual dysfunction
34
Q

Nurse Planning

A

CARDIAC
Weight loss
controll BP

COPING
Patient comfort

FUNCTION INDEPENDENTLY

Adhere to plan??

35
Q

Collaborative Care!

A 
Drug Therapy for 
-hyperkalemia
-kayexalate (K exits but assess for bowel sounds)
-IV glucose & Insulin
(pushes K into cells)

HTN
-Exercise/diet/bp control/no alcohol/DASH diet/monitor at home.

CKD-MBD (bone disorder)

  • calcium and vit. D
  • thyroid! Disease and secondary hyperaparaparathyroidism

Anemia

  • Protein alpha
  • Epogen/Procrit (hold off if htn)

Dyslipidemia
-Statin!

Nutrition

  • Tailored to needs of each patient.
  • supplement w/ inc. protein.
  • Glucerna (dm)
  • NEPRO (kidney)

MONITOR LABS FREQ

36
Q

Monitor labs for what?

A

Edematous - fluid restriction
Sodium- max 2g sodium diet
Potassium - restricted or Kayexalate

37
Q

Who is at risk??

A

DM and HTN:) = monitor BUN/creat/GFR.

  • repeated UTIs
  • Family Hx
  • Check for protein
38
Q

At home??

A 
Avoid NSAIDS
Avoid ZOSIN but if they get it, monitor labs!
Antacids... 
If dm, A1C
Htn, monitor bp
exercise!
39
Q

Evaluating patients with CKD:

A
  • normal electrolyte levels
  • normal fluid balance
  • minimal weight gain and weight loss

med-surg/adult health (16 decks)

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