End stage renal disease Flashcards
(30 cards)
Define uremia
serum accumulation of nitrogenous wastes
What are the main causes of renal failure?
HTN and diabetes
What are the clinical indications of ESRD?
N/V, anorexia, pruritis, anasarca, reduced functional status
Define anasarca
severe edema in multiple parts of the body at the same time
When would a patient be started on dialysis?
stage 5 ESRD– pt can live on for months/years if they do not wish to start dialysis
-must start conservative therapy to prevent further decline of the kidneys
Describe the deaths of pts with ESRD
-usually quick and painless because pts are prone to hypercalcemia causing arrythmias
-pts die because of arrythmia in a matter of minutes
What are the two important hormones related to ESRD?
Erythropoietin and Calcitriol
Describe Erythropoietins importance
this hormone is needed to stimulate RBC production– when the kidneys lose the ability to synthesize erythropoietin anemia of chronic disease occurs
-this is anemia related to CRF
Describe the importance of Calcitriol
-this hormone is the active form of vitamin D– it is needed to be able to take up the calcium we get form food
-when there is a depletion of Calcitriol because the kidneys are no longer able to make it, the body cannot take up calcium and the parathyroid hormone is activated
-results in softening of the bone– renal osteodystrophy
Explain renal osteodystrophy
when there is a depletion of calcitriol because the kidneys are no longer able to make it from Vitamin D the parathyroid stimulates osteomalacia (softening of the bone) in order to liberate phosphorous and calcium into the systemic circulation
–>associated with kidney failure
What symptoms may occur when withdrawing dialysis?
confusion, agitation, anxiety, myoclonus, seizures, dyspnea, edema, uremic pruritis, pain, nausea
-if pt is 100% dialysis dependent, pt can die within 3 days but average is 8 days
-if pain/dyspnea/delirium is uncontrolled they fall under the criteria for sedation for palliative purposes because their prognosis is <2 weeks
Chronic uremia
build up of waste products in the blood
What are the signs and symptoms of chronic uremia?
uremic fetor (breath smalls like urine), inflammation of GI lining (stomatitis, ulcers), anemia, prone to bleeding, sleep disturbances (RLS), prone to delirium and headaches, peripheral neuropathy, uremic pruritis, calciphylaxis
Calciphylaxis
calcifications in the vasculature which can cause clots and painful skin ulcerations
–>consult with wound care nurse
What qualifications need to be met to have Restless Leg Syndrome?
1) urge to move legs b/c of unpleasant feeling in them
2) the unpleasant feelings decrease or go away with movement
3) urge to move increases if you are resting/sitting down
4) the unpleasant feelings and urge to move get worse in the evening/at night
What are the non-pharm treatment for RLS?
sleep hygiene, exercise to relieve RSL, address causes of sleep disorders (ex. pruritis, neuropathic/bone pain)
What is the pharm intervention for RLS?
Gabapentin
Which medications should be used for pain for pts with ESRD?
methadone and fentanyl because they don’t have active metabolites
–>can use hydromorphone and oxycodone cautiously and AVOID morphine and codeine
What are the non-pharm interventions for delirium related to ESRD?
reorient, provide sensorium, decrease stimuli (quiet, low lighting), provide familiar objects
What are the pharm interventions for delirium r/t ESRD?
1st line– haloperidol, methotrimeprazine
2nd line– benzodiazepines
What does pneumonia in ESRD indicate?
-requires URGENT treatment
-rapid progression, causes severe distress, often only hours before dying
What is the 1st line treatment for Dyspnea in ESRD?
hydromorphone (but use with caution)
What is the 2nd line treatment for dyspnea in ESRD?
benzodiazepines
What is the treatment for incident dyspnea in ESRD?
fentanyl, sufentanyl
