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NURS 232 > CKD > Flashcards

CKD Flashcards

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1
Q

Primary Kidney Function

A

Filtration
Regulate fluid, electrolyte and acid-base balance in the body
Secretion

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2
Q

Secondary kidney function

A

Help regulate

BP
bone density
erythropoiesis (production of RBC)

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3
Q

Location of kidneys

A

below the rib cage

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4
Q

Renal artery/vein function

A

blood enters through the artery and then the vein returns the reabsorbed nutrients back into the bladder

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5
Q

Three main steps of urine formation

A

glomerular filtration, reabsorption, and secretion

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6
Q

Glomerular filtration

A

Glomerulus (part of nephrons) = site of blood filtration –> water and solutes leave the blood stream and enter the filtration system

network of capillaries that

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7
Q

Reabsorption

A

Filtrate (glomerulus) contains waste and other substances such as essential ions, glucose, amino acids and smaller proteins .
After filtration, goes to renal tubule and water and needed nutrients goes back into blood stream.

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8
Q

Secretion

A

Waste ions and hyrdogen ions pass from the capillaries into the renal tubule (create urine).
Goes from nephron tubule to the collecting duct

Out kidneys - renal pelvis - ureter - bladder

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9
Q

Urine

A

95% water

5% waste

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10
Q

Nitrogenous wastes in Urine

A

urea, creatinine, ammonia, uric acid

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11
Q

Ions in urine

A

Na, K, H, Ca

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12
Q

Kidney disease is irreversible and progressive (T/F)

A

T

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13
Q

CKD can be defined as…

A

kidney damage

GFR , 60mL/minute/1.73 m for 3 months or longer

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14
Q

What does the end result/progression look like?

A

nephrons hypertrophy to compensate

systemic disease involving every organ

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15
Q

Causes of ESRD

A

DM

Renal vascular disease

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16
Q

ESRD treatment

A

Renal replacement therapy
- Hemodialysis
- Peritoneal dialysis
Transplant

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17
Q

Dialysis

A

A technique in which substances move from the blood through a semipermeable membrane (dialyzer) and into a dialysis solution (dialysate)

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18
Q

Hemodialysis (HD)

A

Removes waste products and excess fluid from the blood using a machine which
pumps the blood through an artificial semipermeable membrane called a dialyzer or an artificial kidney

3 sessions a week at a clinic or trained at home (equipment)

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19
Q

Peritoneal Dialysis (PD)

A

Blood is cleansed within the peritoneal cavity everyday by the patient’s
themselves. A surgically inserted catheter is placed in the abdomen

People with AKI or ESRD

CAPD = no machine, 3-5 times a day
APD = cycler machine at night while sleeping
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20
Q

Retained substances

A 
Urea
Creatinine
Phenols
Hormones
Electrolytes
Water
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21
Q

Uremia

A

Build up of toxins in the body (kidney failure) - can not filter out and secrete

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22
Q

Manifestations

Urinary System

A

Polyuria
Oliguria
Anuria

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23
Q

Polyuria

A

Excessive urination

Early stages

results from inability of kidneys to concentrate urine.
occurs most often at night (nocturia).
specific gravity fixed around 1.010.

(if they are on dialysis, are they making urine?)

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24
Q

Oliguria

A

<400mL daily of urine

shows worsening CKD

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25
Anuria
Urine output <40mL/day
26
Manifestations Metabolic
Waste product accumulation Altered carbohydrate metabolism Defective carbohydrate metabolism Elevated triglycerides
27
Waste product accumulation
Decreased GFR, increased BUN and creatinine levels
28
BUN
measures urea levels in the blood (waste products)
29
Altered carbohydrate metabolism
caused by impaired glucose use from cellular insensitivity to the normal action of insulin
30
Defective carbohydrate metabolism
Insulin is dependent on kidneys for excretion people with DM might need more insulin when uremic
31
Elevated triglycerides
Hyperinsulinemia stimulates hepatic production of triglycerides Altered lipid metabolism (decreased levels of enzyme lipoprotein lipase - breaks down lipoproteins)
32
Manifestations Electrolyte/Acid-base imbalances
Potassium (hyperkalemia) - fatal dysrhythmias when serum K level is 7-8 mmol/L Sodium (normal/low) - retained with water Calcium and phosphate alterations Magnesium alterations (hypermagnesemia) Metabolic acidosis (inability for kidneys to excrete acid load, defective reabsorption of bicarbonate)
33
Manifestations of hypermagnesemia
absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, respiratory failure
34
Manifestations Hematological System
Anemia Bleeding tendencies Increased susceptibility to infection
35
Anemia in CKD
Very common Increased production of erythropoietin, nutritional deficiencies, increased hemolysis of RBCs, frequent blood sampling, GI bleeding
36
Erythropoietin
hormone that stimulates RBC production in bone marrow elevated PTH levels (d/t low serum calcium) inhibits this hormone
37
Bleeding tendencies
Defect in platelet function
38
Increased infection CKD
Changes in leukocyte function Altered immune response Diminished inflammatory response
39
Manifestations CVS
``` HTN HF L ventricular hypertrophy Peripheral edema Dysrhythmias Uremic pericarditis ```
40
Manifestations Respiratory System
``` Kussmaul's resps Dyspnea Pulmonary edema Uremic pleuritis Uremic pneumonitis Pleural effusion Predisposition to respiratory infection ```
41
Manifestations GI System
Inflammation of mucosa related to excessive urea Constipation (limited fluid intake)
42
Symptoms of inflammation of mucosa in GI
Stomatitis with exudates and ulcerations Uremic fetor (urinous odour of breath) GI bleeding
43
Manifestation Neurological System
``` Restless leg syndrome depressed speaking muscle twitching fatigue, irritability Apathy Decreased ability to concentrate Peripheral Neuropathy ```
44
Manifestations Musculo-skeletal system
Mineral and bone disorder Bone abnormalities, changes in mineral balance, vascular and other soft tissue calcifications results in renal osteodystrophy and vascular and soft tissue complications
45
Manifestations
Pruritus | Uremic frost
46
Manifestation Reproductive System
infertility decreased libido low sperm counts sexual dysfunction
47
Manifestations Psychological Changes
Personality and behavioral changes emotional lability Withdrawal Depression
48
5 stages of CKD
Stage 1 with normal or high GFR (GFR > 90 mL/min) Stage 2 Mild CKD (GFR = 60-89 mL/min) Stage 3A Moderate CKD (GFR = 45-59 mL/min) Stage 3B Moderate CKD (GFR = 30-44 mL/min) Stage 4 Severe CKD (GFR = 15-29 mL/min) Stage 5 End Stage CKD (GFR <15 mL/min)
49
Diagnostic studies for CKD
``` Urinalysis dipstick (proteinuria +1, 2 or more times in 3 month period) Albumin-creatinine ratio (proteinuria) Renal ultrasound Xray KUB CT KUB Renal biopsy ```
50
Most important risk factor
Protein in the urine
51
People that should be screened for proteinuria
``` DM HTN vascular disease autoimmune diseases GFR <60 edema ```
52
Specific gravity
1.005-1.030 Measure of conc. of solutes in the urine Shows kidneys ability to create urine
53
Urine pH
4.6-8
54
Bilirubin
Product of RBC breakdown Indicates liver disease
55
Casts
Indicates kidney health
56
Labs
BUN Creatinine Creatinine Clearance GFR
57
Creatinine
nitrogenous waste produced from muscle metabolism | elevated in CKD
58
Creatinine Clearance
used to assess GFR | how efficiently kidneys clear creatinine from the blood
59
GFR
determines how fast blood is filtered through the glomerulus
60
Management measures (when everything else has failed)
prepare patients for renal therapy and transplantation Correction of extracellular fluid volume overload or deficit Nutritional therapy Erythropoietin therapy Calcium supplementation (phosphate binders) Antihypertensive therapy Measures to lower potassium Adjustment of drug doses to degree of renal function
61
Drug therapy Hyperkalemia
Calcium gluconate (stabilize myocardium) B-B2 adrenergic agonists (shift potassium into the cells) IV insulin (shift K into cells) IV glucose to manage hypoglycemia Kayexalate Diuretics or dialysis
62
Hypertension tx (with CKD)
Sodium and fluid restriction Antihypertensive drugs (loop diuretics, CCB, ACE, ARB)
63
CKD MBD tx
Phosphate intake restricted to <1000mg/24 hrs phosphate binders Supplementing vit D (phosphate has to be normal first Controlling secondary hyperparathyroidism
64
Anemia tx (with CKD)
Erythropoietin iron supplements folic acid supplements avoid blood transfusions
65
Dyslipidemia tx (with CKD)
Statins in clients in stage 1-3 CKD
66
Drug toxicity tx (with CKD)
Digoxin oral glycemic agents antibiotics opioids NO NSAIDS (acetaminophen instead)

NURS 232 (19 decks)

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