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Module 4 (MedSurg 2) > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

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1
Q

Chronic Kidney Disease

A

Progressive, irreversible loss of kidney function

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2
Q

Most common causes of CKD

A

DM
HTN

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3
Q

Diabetic Nephropathy

A

damage to small vessels that supply the glomeruli due to DM condition

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4
Q

CKD RISK FACTORS

A

Age > 60 years
Males
Cardiovascular disease
Diabetes
Ethnicity – AA and Native Americans
Exposure to nephrotoxic drugs (severe IV infections) – contrast dye
Family history of CKD
Hypertension

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5
Q

If at risk of CKD, then you should get screened

A

annually

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6
Q

If albuminuria is present

A

use drugs to delay progression
-ACE, ANGIOTENSIN receptor antagonists

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7
Q

CKD pts need to tightly control

A

HTN and BG

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8
Q

Individuals with CKD are frequently

A

asymptomatic 70%
usually underdx and undertx

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9
Q

What are the stages of CKD?

A

1,2,3,4
Stage 5: ESRD or Kindey failure

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10
Q

Treatments of CKD are determined by

A

underlying cause

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11
Q

The stages of CKD are determined by

A

GFR

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12
Q

Stage 1 CKD GFR #

A

90+

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13
Q

Stage 1 CKD kidney function

A

normal function
BUT structural changes indicate damage
lacks perfusion

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14
Q

Normal GFR

A

125

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15
Q

Stage 2 CKD GFR #

A

60-89

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16
Q

Stage 2 CKD kidney function

A

damage with a mild decrease in GFR
UNDETECTABLE

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17
Q

Stage 3 CKD GFR #

A

30-59

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18
Q

Stage 3 CKD kidney function
+ Creatinine level

A

moderate to poor
increase in creatinine levels

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19
Q

At stage 3 CKD, you should use caution with

A

nephrotoxic agents (dye)

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20
Q

Stage 4 CKD GFR #

A

15-29

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21
Q

Stage 4 CKD kidney function
Prep for

A

poor
Dialysis prep
monitor electrolytes closely

no nephrotoxic

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22
Q

What electolyte should be closely monitored through diet and labs for Stage 4 CKD ?

A

K

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23
Q

CKD occurs after

A

pt does not hit the recovery phase
irreversible damage

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24
Q

Stage 5 CKD GFR**

A

15 OR LESS

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25
Stage 5 CKD kidney function
End-stage renal disease little to no function
26
What is needed for a Stage 5 CKD
RENAL REPLACEMENT or Transplant build up of toxins (uremia) and only if desired
27
S/S of CKD
Devastating SYSTEMIC effect Sodium/**fluid balance** alteration increase of K Toxic build up **Neurological** symptoms Altered calcium and phosphorus levels **Metabolic acidosis** **Chronic anemia HTN**
28
Tx ESRD Metabolic acidosis
Bicarb
29
Lab Values of CKD
High serum creatinine/BUN/potassium HIgh Mg (anemia and bleeding) LOW creatinine clearance (excreted) EITHER WAY serum sodium LOW serum calcium LOW CO2/hemoglobin & hematocrit
30
In general, is in ESRD the Na should be limited to
2 g a day
31
Nursing Managements of CKD
**Preserve existing kidney function** **Reduce risks** of cardiovascular events and disease (CVD) Prevent complications Provide for patient’s comfort Nutrition/glycemic control **Fluid management** Medication: ADVOCATE against nephotoxic **Monitor VS and lab values** **Monitor I&O and daily weight** Skin care – tight and fragile
32
________ recognition, diagnosis, and treatment can slow the progression of kidney disease
Early
33
What medication needs to be used with caution for diabetics, and why?
Insulin stay in system longer as usually filtered by the kidneys
34
Hemodialysis needs to evaluated
patency infection
35
Hemodialysis arms should not take
BP blood samples
36
Nutrition for ESRD
monitor and restrict: protein (lean meats chicken or fish) fluid (diuretics = no overload) Na and K Phosphate
37
Pts of Peritoneal Dialysis need to watch out for what in nutrition
protein intake high to compensate for loss may need to **increase**
38
Protein InTAke for CKD
Should be carefully monitored Normal for HD patient Increased for Peritoneal D patient**
39
What lab parameters need to be watched for CKD?
Albumin pre albumin ferritin
40
Phosphate is _________ in ESRD
RESTRICTED
41
What juice is contraindicated in end-stage renal failure pts?
citrus = 480 mg of Potassium give apple or water with sugar
42
Dietary approaches to stop HTN
fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts -leafy greens
43
What meal plan should be used for ESRD?
DASH
44
The DASH plan is significantly
lower BP and lowers LDL cholesterol
45
Drug Therapy for CKD
K based on levels control HTN and hyperlipidemia bone disease = low Ca anemia
46
Hyperkalemia
Restriction of high-potassium foods and drugs IV glucose and insulin **IV 10% calcium gluconate** Sodium polystyrene sulfonate **(Kayexalate)** **Dialysis may be needed **(too much K)
47
AntiHTN drugs
ACE ARBs
48
Lethal Injection is
HIGH K muscle relaxant sedative
49
ACE reduces
reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease
50
ARBs are used to
treat high blood pressure and heart failure. They are also used for chronic kidney disease and prescribed following a heart attack.
51
CKD- MINERAL AND BONE DISORDER
ca and Phosphours out of balance - receiving dialysis
52
Phosphate not restricted until patient
requires renal replacement therapy
53
What phosphate is given for CKD-MBD
Phosphate binders
54
What should be avoided with phosphate and supplemented?
avoid aluminum supplement Vitamin D
55
Phosphate BInders for Ca
Calcium acetate (PhosLo)/Calcium carbonate (Caltrate) - bind and excreted in bowels
56
Sevelamer hydrochloride (Renagel)
lowers cholestrol and LDL without cuasing High Ca
57
If anemis occurs in a CKD pt
Erythropoietin aka Epoetin alfa (Epogen, Procrit)/Darbepoeitin alfa (Aranesp)
58
Erythropoietin does
GLYCOPROTEIN STIMULATES MARROW TO INCREASE RBCS increased Hct and Hemoglobin 2-3 weeks effect
59
Erythropoietin side effects
Thromboembolism HTN
60
Erythropoietin needs to be used with
iron folic acid Vitamin B12
61
Iron supplements used when
lower than 100 ferritin level
62
Iron causes
gastric irritation constipation **dark-colored stool**
63
Folic acid needed for
RBC formation removed by dialysis
64
Blood transfusions
avoid if possible but if erythropoietin Lasix increase antibody development **Iron and fluid overload**
65
Drug Therapy Complications for Anemia Toxicity by ESRD
**Digoxin** Diabetic agents (insulin sensitivity) Antibiotics Opioid medications**(esp. after surgery)
66
Furosemide (Lasix)
The most frequently prescribed loop diuretic Acts in the thick segment of the ascending **Loop of Henle to block the reabsorption of water** Can promote **diuresis even when renal blood flow and GFR are low** - lower K and pull fluid off
67
How long does it take erythropoietin to take effect?
2-3 weeks

Module 4 (MedSurg 2) (36 decks)

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