Exam 2 CKD Flashcards
(39 cards)
Two leading causes
Dm and htn
(that sugar damages walls of vessels and then dec. perfusion to k idneys)
Vasoconstriction further elevates bp, impaired perfusion to kidney.
24% mortality rate?
CKD
End stage kidney disease is considered a _______
disability
Other three causes of CKD?
- Chronic Glomerulonephritis
- Polycystic Kidney Disease
- Polyenephritis
Chronic Glomerulonephritis
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/
Polycystic Kidney Disease
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
Chronic Pyelonephritis
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.
GFR
glomerular filtration rate (<60 for longer than three months results in a diagnosis of CKD)
As GFR goes down, ____-
Body accumulates waste (b/c kidneys aren’t working). BUN/Creat increase!
Although GFR goes down, ________
Normal urine output
When waste builds up in body as a result of kidneys not functioning…
Psych Neuro Cardio Gastro Endocrine/Reproductive Metabolic Hematologic Ocular Pulm Integumentary Musculoskeletal Peripheral neuro
Nursing Assessment
-Hx!
-Metabolic Disturbances
-Electrolyte & Acid-Base
(GFR decrease, BUN/Creat increase)
-Imbalance
High BUN/CREAT Sx?
Pt. doesn’t feel great: nausea, vomiting, weak, fatigue, HA, hyperglycemia, hyperinsulemia (High TGC) and Hyperkalemia, Hyponatremia.
Edemetous, heat failure, htn.
Interventions
Low sodium diet
Metabolic acidosis
Unable to excrete excess acid and thus have acidosis
. Give insulin due to CKD-hyperglycemic, hyperinsulimic (Inc. TGD = dyslipidemia)
CKD manifest Urinary issues?
At first, normal output
As disease progresses, less output
When they start dialysis; might become anuric. (no urine)
CKD manifest Hematology
Kidneys produce erythropoietin/RBC
Platelet dysfunction… might bleed more than normal
WBC dysfunction
Thus: Anemia/thrombo/neutro
Cardiovascular
- 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.
Peritoneal Dialysis
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.
Automatic Dialysis
Happens at night while sleeping, machine does for you. Have to do it 2-3x per day.
Education:
-Fluid should be CLEAR
Ambulatory Dialysis
Happens throughout day x3-4 times a day.
Education:
- @ risk for low protein.
- monitor albumin
Hemodyalysis
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?
What happens if a dialysis patient c/o of dizziness
Assess BP!!!
(If low, give NS and slow rate of filtration?)
C/O of muscle cramps?
Nausea?
CKD Manifest GI
Ulcers/metallic taste in mouth and urine order (uremia backup)
-Poor immune system
