midterm #2 Flashcards
(49 cards)
relevant subj and obj data that should be collected to determine clinical manifestations of pts w/ CKD
age-related changed in the urinary system
the number of functioning nephrons decreases with age
describe CKD
involves the progressive, irreversible loss of kidney function
5 stages of CKD based on GFR
Normal GFR = 125 mL/minute
Stage 1: GFR > 90
Stage 2: GFR = 60-89
Stage 3: GFR = 30-59
Stage 4: GFR = 15-29
Stage 5 ESRD occurs when GFR < 15 mL/minute
select risk factors that contribute to the development of CKD
DM, HTN, obesity, renal vascular disease
summarize the significance of CV disease in pts w/ CKD
hypertension
multi-system clinical manifestations in pts w/ uremia
Syndrome that incorporates all signs and symptoms seen in various systems throughout the body due to the build-up of waste products and excess fluid associated with kidney failure.
CKD
– collaborative care
Detect and tx any reversable causes
Goals of CKD care:
- delay progression of renal disease
- preserve existing renal function
- treat clinical manifestations
- prevent complication
- educate pt and family regarding kidney disease and options for care
- prepare pts for renal replacement therapy or transplantation
Care must be tailored to pts stage
hemodialysis vs peritoneal dialysis
hemodialysis:
- blood leaves the body
peritoneal dialysis:
- cleaning fluid enters the body and filters the waste
- via osmosis and diffusion
describe composition of the major body fluid compartments
intracellular: 2/3
extracellular: 1/3
- plasma, interstitial fluid
transcellular:
- CSF, joints
- pleural/cardiac lubricants
fluid & electrolytes
– diffusion, osmosis,
diffusion:
[high] to [low] through a semipermeable membrane
osmosis:
movement of water between two compartments by a membrane permeable to H2O but not to solute
- moves from low [solute] to high [solute]
- requires no energy
hydrostatic pressure, oncotic pressure, and osmotic pressure
if oncotic pressure drops and you don’t have the pull pressure (12mmHg)
- the fluid is going to stay in the tissues = edema
- in a case of low albumin we can give it supplementally or synthetic intravascular bulking agents that ↑ the oncotic pull pressure
- ↑ interstitial hydrostatic push pressure (30mmHg)
- a counter pressure (compression) to overcome hydrostatic pressure
2nd and 3rd spacing + examples
2nd spacing:
- fluid moved into the interstitial space
- not useful to the body
- w/ therapy push or pull it where it can be useful
3rd spacing:
- in a cavity where we cant draw it back or push it back
- needs to be removed
- ascites
- fluid no longer available to the body
list and summarize the ways in which the body regulates water balance
- hypothalamic regulation - thirst, stimulates pituitary
- pituitary regulation
- ADH , less urine output - Adrenal Cortical Regulation
- RAAS system; renin aldosterone (Sodium retention (therefore H2O) acts on kidneys - Renal regulation
- release Na, vasodilation - Cardiac regulation
- ANF - GI regulation
- LI, H2O absorption (c-diff, viral infections, cholera, Crohn’s,) - Insensible H2O loss
- What happens with body (900mL lost)
regulation of H2O balance
– hypothalamus
1 ) senses thirst
2 ) stimulates posterior pituitary to release ADH
3 ) ADH makes the kidneys permeable to reabsorb H2O
4 ) aldosterone released from adrenal gland makes kidneys reabsorb H20 + Na and excrete K+
regulation of H2O balance
– kidney
renin-angiotensin system
regulation of H2O balance
– cardiac
ANF/ANP released when volume and pressure ↑
- ANF causes vasodilation and ↑ urinary excretion of Na and H2O
- blood volume ↓
the impact of normal aging on fluid and electrolyte balance
structural change to kidney
loss of SUBQ
> loss of moisture
↓ thirst mechanism
isotonic solution
to ↑ intervascular fluid
NS 0.9% > not if hyponatremic
Lactated Ringers
D5W > not w/ pts who are DM or those with ↑ICP
hypotonic solution
NS 0.45%
Dextrose 5% in H2O
tx of cellular dehydration
- don’t give for ↑ICP, trauma, burns or hypovolemia
hypertonic solution
5% in 0.45/0.9% Dextrose
- cerebral edema
- hyponatremia
- don’t give if HF/ CKD
collab care
– Hyperkalemia
C big K drop
C- Calcium gluconate- stabilize myocardium
B- β2-adrenergic agonists such as salbutamol to shift potassium into the cells
I- IV insulin (shift K+ into cells), and
G- IV Glucose to manage hypoglycemia
K- Kayexalate
D- diuretics or Dialysis
the process of acid-base regulation
buffer system:
- reacts imediately
resp system:
- responds in min
- max effectiveness reached within hrs
renal system:
- 2-3 days to reach max response
- maintain balance for a long period of time
biochemistry and physiology involved with acid-base balance in the body
buffer system:
- K+ exchanged w/ H+
- alkalosis > hypokalemia
- acidosis > hyperkalemia
lungs
- rapid resps > ↓ CO2 > ↓ acidity
slow resps > ↑CO2 > ↑ acidity
kidneys
- excretion and/or retention of acids and bicarb
- ↓ H+ and ↑HCO3 > ↓ acidity
