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Exam 4 > Chronic Kidney Disease/chronic renal failure > Flashcards

Chronic Kidney Disease/chronic renal failure Flashcards

1
Q

In the early stages of chronic kidney disease the GFR will be about ____% and the patient is usually ___ with normal ___ and ___ levels.

A
  • -50%
  • -asymptomatic
  • -BUN and creatinine
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2
Q

With end stage renal disease the GFR is less than ______%.

What therapy should be initiated?

A
    • <10-15%

- -renal replacement therapy

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3
Q

What three insults can further reduce kidney fx.?

A
  • -infection
  • -dehydration
  • -nephrotoxic drugs
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4
Q

What are the #1 and #2 RF for chronic kidney disease?

What race is this more prevalent in?

A
  • -HTN (#1 cause)
  • -Diabetes (#2 cause)
  • -African Americans (4x’s more likely)
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5
Q

This cause of chronic kidney disease is lead by increased glomerular flow rate leading to hyperfiltration which causes thickening and sclerosis of basement membrane leading to a reduced GFR.

A

Diabetic Nephropathy

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6
Q

Chronic issues with this condition can lead to ischemia, glomerular destruction, and tubular nephropathy due to sclerosis and narrowing of renal arteries leading to reduced blood flow.

A

Hypertensive Nephrosclerosis

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7
Q

this condition is characterized by a chronic infection associated with vesicoureteral reflux that leads to scarring and deformity of renal calyces and pelvis resulting in intrarenal reflux and nephropathy.

A

Chronic Pyelonephritis

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8
Q

This condition is characterized by multiple bilateral cysts that gradually compress renal tissue, impairing renal perfusion.

A

Polycystic Kidney disease

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9
Q

Ways to prevent chronic kidney disease are:

A
  • -Low Na+ diet
  • -exercise
  • -don’t smoke
  • -limit alcohol
  • -lower BP
  • -Control diabetes
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10
Q

Stage 1 of CKD will present with a GFR of ____

A

> 90 mL/min/1.73 m^2

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11
Q

Stage 1 of CKD will have manifestations such as:

A
  • **Asymptomatic
  • **Normal/Increased GFR
  • -Normal BUN, Creatinine
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12
Q

Stage 2 of CKD will present with a GFR of ____

A

60-89 mL/min/1.73 m^2

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13
Q

Stage 2 manifestations are:

A

–Asymptomatic
***possible HTN
(blood work generally normally)

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14
Q

Stage 3 of CKD will present with a GFR of____

A

30-59 mL/min/1.73 m^2

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15
Q

Stage 3 manifestations include:

A
  • *HTN
  • *possible anemia, fatigue, anorexia, malnutrition, bone pain
  • *Slightly elevated BUN and creatinine
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16
Q

Stage 4 of CKD presents with a GFR of____

A

15-29 mL/min/1.73 m^2

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17
Q

Stage 4 manifestations include:

A
  • -HTN
  • -anemia
  • -malnutrition
  • -altered bone metabolism
  • -edema
  • **metabolic acidosis
  • **hypercalcemia
  • **possible uremia
  • **azotemia
    • increased BUN and creatinine
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18
Q

Stage 5 of CKD will present with a GFR of ____

A

< 15 mL/min/1.73 m^2

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19
Q

Stage 5 manifestations are:

A
  • ** end stage renal disease
  • **kidney failure
  • **azotemia
  • **uremia
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20
Q

This manifestation is when there is urea present in the blood. This alters fluid and electrolyte balance and causes an accumulation of metabolic wastes that effect other organ systems.

A

Uremia

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21
Q

Uremia may have manifestations of (present with flu like symptoms)…

A
  • -N/V
  • -Fatigue
  • -weakness, lethargy
  • -confusion
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22
Q

Impaired filtration in the kidneys can lead to what two symptoms?

A
  • -proteinuria

- -hematuria

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23
Q

When salt and water are poorly conserved it can lead to risk for….

A

Dehydration

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24
Q

What fluid and electrolyte imbalances will the patient have?

What acid/base imbalance will they have?

A
  • *Hyperkalemia
  • *Hyperphosphatemia, and hypocalcemia (opposites)
  • *Hypermagnesemia (advanced renal failure)

**Metabolic acidosis (kussmaul respirations)

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25
Q

clinical manifestation of hyperkalemia are:

A
  • -Muscle weakness
  • -Parasthesia
  • -ECG changes (tall T-waves)
26
Q

A patient will have issues with their cardiac system due to perfusion complications. What signs may we see in someone with CKD, when it comes to the heart?

A
  • -HTN
  • -Edema
  • -Heart failure
  • -Pericarditis
27
Q

What is a complication of pericarditis that occurs when inflammatory fluid in pericardial sac interferes with ventricular filling and CO?

A

Cardiac Tamponade

28
Q

A patient may present with this sign due to the decline of eryhtropoietin release.

A

anemia

29
Q

Signs of anemia include:

A
  • -weakness
  • -fatigue
  • -pallor
30
Q

A person with Anemia is at risk for bleeding due to platelet fx. They may present with…

A
  • -nosebleeds (epistaxis)

- -GI bleed

31
Q

A person with CKD is at risk for Infection due to a decrease in platelet fx. Acute inflammatory response and delayed hypersensitivity reaction responses are affected leading to ____ which can delay diagnosis.

A

Suppressed fever

32
Q

The GI system is affected and the patient may present with…

A
  • -anorexia
  • -Ulcerations (risk GI bleed)
  • -Uremic fetor
33
Q

–What is the symptom called that is caused by uremia build up which causes urine smelling breath.

–What care is important when a pt. presents with this?

A
  • -Uremic fetor

- -mouth care before meals (may contribute to anorexia because of metallic taste)

34
Q

Early (effects CNS) neurological symptoms include:

A
  • -fatigue, hard time concentrating
  • -insomnia
  • -seizures
  • -coma
35
Q

Advanced neuro symptoms include:

A
  • -RLS (restless leg syndrome)
  • -Paresthesia
  • -peripheral neuropathy
36
Q

Decreased calcium absorption and vitamin D synthesis in CKD can lead to GI tract issues such as:

A
  • **Renal Rickets (due to low Vit. D and Calcium)
  • **osteomalacia (soft bones)
  • -osteoporosis
37
Q

Patients that have Renal Rickets, Osteomalacia, or osteoporosis will have bone pain, muscle weakness and may be at risk for…

A

Spontaneous bone fractures

38
Q

If uric acid levels are increased, this puts the patient at risk for…

A

Gout

39
Q

In uremia, tissues become resistant to effects of insulin, which can cause…

A

Glucose intolerance

40
Q

A pt. with CKD may have reduced reproductive fx. They may have..

A
  • -reduced sperm
  • -preterm labor/miscarriage (most won’t carry to term)
  • -irregular periods
41
Q

High levels of urea in the sweat causes…

A

Uremic frost (crystals on the skin)

42
Q

Diagnostic tests include:

A
  • -UA
  • -BUN, creatinine
  • -GFR (reduced)
  • -Electrolytes- Na+ (down), K+ (up), Phosphate (up), Calcium (down)
  • -ABG’s (Metabolic acidosis)
  • -CBC (RBC’s and platelets reduced)
  • -Renal ultrasound (size of kidneys)
  • -Kidney Biopsy (determines acute or chronic)
43
Q

Meds that can be given for someone with CKD are:

A
  • -antihypertensives
  • *Diuretic (furosemide)
  • -Acidosis (sodium bicarb)
  • -Calcium Carbonate
  • *Aluminum hydroxide (treat acute Hyperphosphatemia)
44
Q

Restricting protein reduces the progression of CKD. The daily protein intake should be about…

A

0.6 g/kg (need protein for tissue repair)

45
Q

The pt. should restrict potassium and phosphorus intake. Potassium should be less than…

A

<60-70 day (normal is 100)

46
Q

Avoid foods high in phosphorus such as:

A
  • -eggs
  • -dairy
  • -meat
47
Q

The patient will need this form of treatment due to reduced kidney function. It is done by replacing the function of the kidneys and there are 2 types.

A

Dialysis (hemodialysis or Peritoneal dialysis)

48
Q

The treatment of choice for a patient with CKD is

A

Kidney transplant

49
Q

If a pt. needs a kidney transplant the kidney will be removed from the donor when the patient has been confirmed brain dead. It is preserved by hypothermia and must be transplanted within…

A

24-48 hours

50
Q

When a patient needs a kidney transplant they will be given immunosuppressant drugs to minimize rejection. This drug is…

A

–Azathioprine or Mycophenolate (In combination with prednisone)

51
Q

Nephrectomy is a major surgery and the donor faces ___ ___ for the remaining kidney in the future. The nurse should provide…
The nurse should monitor for….

A
  • -Kidney failure
  • -emotional support to the donor and recipient
  • -monitor for infection
52
Q

This glucocorticoid can manage an acute rejection episode.

A

Methylprednisolone

53
Q

Manifestations of chronic rejection include progressive…

A
  • -Azotemia
  • -proteinuria
  • -HTN
54
Q

Methylprednisolone can cause severe reactions such as:

A

chills, fever, Hypotension, headache, pulmonary edema

55
Q

Three Nursing Dx. for someone with CKD is:

A
  • -Ineffective tissue perfusion (renal)
  • -Excess fluid volume
  • -Risk for infection
56
Q

The nurse should promote tissue perfusion by implementing these things in the care plan…

A
  • -Monitor I and O’s, VS, weight, Respirations
  • -Place pt. on fluid restriction
  • -Allow rest periods (cluster care)
57
Q

The nurse should promote a balanced nutrition. The patient may be anorexic due to the uremia (metallic taste) which makes them not want to eat. What should the nurse implement in the care plan?

A
  • -Weigh the pt. daily
  • -Give antiemetics 30-60 min before meals
  • -Provide mouth care prior to meals
  • -give small meals
58
Q

If the patient is to receive parenteral nutrition, they are at risk for…

A
  • -infection

- -hyperglycemia

59
Q

The nurse should prevent infection in the pt. What should the nurse implement in the care plan?

A
  • -hand hygiene
  • -monitor VS
  • -Monitor WBC’s
  • -Limit visitors
60
Q

when a patient goes through dialysis the nurse must monitor the dialysate return. It should be..

A

clear (cloudy indicate peritonitis)

61
Q

Good respiratory hygiene can be promoted through…

A
  • -Deep breathing exercises
  • -coughing
  • -position changes

Exam 4 (10 decks)

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