MNT for Renal Disease Part 2 Flashcards
(106 cards)
1
Q
Chronic Kidney Disease is also known as ___ ___ ____
A
Chronic Renal Failure
2
Q
CKD is defined as either…
A
-Kidney damage
-GFR <60 ml/min/1.73 m2 for 3 or more months
3
Q
CKD causes a ___ ___ in kidney function over time
A
Gradual decline
4
Q
If detected early, ___ and ___ ___ may slow the progression
A
Medications and dietary changes
5
Q
___ ___ ___ is the best measure of kidney function
A
Glomerular filtration rate (GFR)
6
Q
GFR is used to categorize a patient regarding the ___ of chronic kidney disease
A
Stage
7
Q
Glomerular filtration rate is calculated by the MD by using the patient’s…
A
-Serum creatinine level
-Age
-Race
-Body size
-Gender
8
Q
Description and GFR for stage 1 of CKD:
A
-Kidney damage with normal GFR
-GFR: 90 or more
9
Q
Description and GFR for stage 2 of CKD:
A
-Kidney damage with mild decrease in GFR
-GFR: 60-89
10
Q
Description and GFR for stage 3 of CKD:
A
-Moderate decrease in GFR
-GFR: 30-59
11
Q
Description and GFR for stage 4 of CKD:
A
-Severe decrease in GFR
-GFR: 15-29
12
Q
Description and GFR for stage 5 of CKD:
A
-Kidney failure; End-Stage Renal Disease
-GFR: <15 or on dialysis
13
Q
____ means inadequate urine output
A
Oliguria
14
Q
___- <___ ml/day of urine output indicates oliguria
A
100 - <500
15
Q
____ is the complete cessation of urine flow
A
Anuria
16
Q
___ to <___ ml/day of urine output indicates anuria
A
0 to <100
17
Q
What are common causes of CKD?
A
-Diabetes mellitus
-Hypertension
-Glomerulonephritis
-Polycystic kidney disease
-Systemic lupus erythematosus
-Repeated urinary infections
-Nephrotic syndrome
18
Q
What are two signs/symptoms of CKD?
A
-Azotemia
-Uremia
19
Q
Azotemia is the accumulation of abnormal quantities of ___ ____ in the blood
A
Nitrogenous waste
20
Q
____ refers to physical signs and symptoms of azotemia
A
Uremia
21
Q
What are symptoms of uremia?
A
-Malaise
-Weakness
-N/V
-Muscle cramps
-Pruritus
-Dysgeusia
-Neurological impairment
22
Q
What is a normal GFR?
A
90-120 mL/min/1.73 m2
23
Q
Serum creatinine levels ____ with CKD
A
Increase
24
Q
Daily production of creatinine depends on ___ ___ and is excreted by the kidneys
A
Muscle mass
25
Normal creatinine level for women:
0.5-1.1 mg/dL
26
Normal creatinine level for men:
0.6-1.2 mg/dL
27
Blood urea nitrogen levels ____ with CKD (but levels can change for reasons other than CKD)
Increase
28
Normal BUN level:
10-20 mg/dL
29
Medical treatment for CKD may include...
-Treating/managing underlying causes
-Dialysis (hemodialysis, peritoneal dialysis)
-Transplantation
30
Hemodialysis removed ___ and ___ ___ from the body
Waste, excess fluid
31
Hemodialysis usually requires ___ sessions per week for ___-___ hours each
3 sessions; 3-5 hours
32
With hemodialysis, blood passes through a ___ ___ to be filtered
Semipermeable membrane
33
Waste products are removed via ____
Diffusion
34
Water removal by hemodialysis is called ____ and is done with pumps that are connected to the dialysis machine
Ultrafiltration
35
The ____ is made of a collection of thousands of hollow plastic fibers inside a plastic cylinder
Dialyzer
36
What are three types of vascular access used for dialysis?
-Fistula
-Graft
-Catheter
37
An ____ ____ is made by sewing together an artery and a vein in the forearm
Arteriovenous fistula
38
An arteriovenous fistula allows for strong blood flow from the artery to make the vein ___ and ___
Larger and stronger
39
With an arteriovenous fistula, 2 needles are inserted into the fistula- one for ___ ___ and one for ___ ___ ___
Withdrawing blood; returning filtered blood
40
An arteriovenous fistula is the ____ access for long-term hemodialysis
Preferred
41
Arteriovenous fistulas are less prone to ___ or ___ ___ compared to other types of access
Infections; blood clots
42
Veins and arteries self-heal after each needle stick, so fistulas can last a ___ ___
Long time
43
An ___ ___ is a piece of tubing that is used to surgically attach an artery and a vein
Arteriovenous graft
44
Those with arteriovenous grafts are more likely to have difficulty with ___ ___ because it is made from synthetic material
Blood clots
45
Some arteriovenous grafts develop ___ because the material cannot self-heal after needed punctures (may cause graft failure)
Holes
46
A catheter is placed in the neck or chest and inserted into a ___ ___
Central vein
47
Catheters are for ___-___, ____ access
Short-term; temporary
48
An advantage of a catheter is that it can be used the ___ ___
Same day
49
Disadvantages of a catheter access:
-Most prone to infection
-Can accidentally be pulled out
50
Advantages of hemodialysis:
-Patient involvement is minimal
-Treatment is controlled by trained staff
51
Disadvantages of hemodialysis:
-Time-consuming
-Loss of protein (5-8 g per treatment)
-Fluctuations in serum levels of urea, potassium, phosphorus, and fluid
52
Complications include...
-Hypotension
-Infections as access site
-Graft failure
53
____ ____ is dialysis that uses the semi-permeable membrane of the peritoneum as the dialyzer
Peritoneal dialysis
54
With peritoneal dialysis, a high ___ dialysate is infused into the peritoneal cavity via a surgically places catheter in order to create a concentration gradient
Dextrose
55
With peritoneal dialysis, ___ ___ and ____ pass from the blood through the peritoneal membrane into the dialysis via diffusion
Waste products and electrolytes
56
With peritoneal dialysis, water passes via ____
Osmosis
57
Dialysate is then drained from the ___ ___
Peritoneal cavity
58
Bags usually hold ___, ___ or ___ liters of dialysate
1.5, 2.0, 2.5
59
What are three common strengths of dialysate?
-1.5% dextrose
-2.5% dextrose
-4.25% dextrose
60
High concentrations of dextrose is used if a large amount of ___ needs to be removed
Water
61
What are two types of peritoneal dialysis?
-Continuous ambulatory peritoneal dialysis (CAPD)
-Continuous cyclic peritoneal dialysis (CCPD)
62
Continuous ambulatory peritoneal dialysis is performed using ___-___ technology
Gravity-based
63
Continuous cycle peritoneal dialysis uses a machine called a ____ for installation and drainage of the dialysis solution
Cycler
64
Steps for performing continuous ambulatory peritoneal dialysis:
1. Dialysate enters the peritoneal cavity, called "fill"
2. While fluid dwells in the peritoneal cavity, extra fluid and wastes are drawn out of the blood and into the dialysate fluid
3. After about 3-5 hours the dialysis fluid is drained, called "drain" and replaced by fresh fluid
65
Peritoneal dialysis is typically performed __-___ times per day
4-6
66
Advantages of peritoneal dialysis:
-Dialysis is done daily (less fluctuations in serum levels of urea)
-Home-based treatment
-More liberal diet
-May contribute to a more flexible lifestyle
67
Disadvantages of peritoneal dialysis:
-Protein losses of 10-20 g/day
-Dextrose can be absorbed by the dialysate and contribute, on average, 400-800 kcal/day (causes weight gain and poorly controlled diabetes)
68
A complication of peritoneal dialysis is ___ which can be severe
Peritonitis
69
Studies have shown that patients who are not adequately dialyzed have an increased risk of ___ and ____
Morbidity and mortality
70
___ ___ ____ is a measurement of reduction of urea that occurs during a dialysis treatment
Urea Reduction Ratio
71
Urea reduction ratio can be calculated with what formula?
(predialysis BUN - postdialysis BUN) / predialysis BUN
72
Someone would be well-dialyzed if there is a reduction in urea by >___%
65
73
Complications of CKD:
-Alterations in fluid volume (hypervolemia)
-Electrolyte abnormalities (sodium, potassium, and phosphorus)
-Hypertension
-Metabolic acidosis
-Secondary hyperparathyroidism
-Glucose intolerance
74
What type of anemia may be caused by CKD?
Normochromic, normocytic
75
Normochromic, normocytic anemia is caused by...
-Inability to produce erythropoietin
-Increased destruction of red blood cells due to circulating uremic waste products
76
Signs/symptoms of normocytic, normochromic anemia include...
-Decreased serum hemoglobin and hematocrit
-Fatigue, SOB, pallor, lightheadedness
77
To manage amemia, you can use ___ ___ ___
Human Recombinant Erythropoietin (EPO)
78
Drug nutrient interaction with human recombinant erythropoietin (EPO):
Increases need for iron for production of red blood cells
79
With EPO, many people are given IV iron; some examples are:
-Iron dextran (Infed)
-Iron gluconate (Ferrlecit)
-Iron sucrose (Venofer)
80
Iron stores should be measured monthly when on EPO, and we should monitor ___ ___
Serum ferritin
81
Goal serum ferritin should be over ___ ng/mL but under ____ ng/mL for hemodialysis patients receiving EPO
300; 800
82
Signs and symptoms renal osteodystrophy:
-Bone pain
-Pathologic fractures
-Metastatic calcification
83
The first step in the pathophysiology of renal osteodystrophy:
As renal function declines, the kidneys cannot excrete phosphorus load, leading to hyperphosphatemia
84
The second step in the pathophysiology of renal osteodystrophy:
Serum calcium levels decline due to a decrease in 1,25 dihydroxyvitamin D3, which leads to a decrease in intestinal absorption of calcium
85
The third step in the pathophysiology of renal osteodystrophy:
Low serum calcium levels trigger the release of parathyroid hormone, leading to bone resorption of calcium
86
The fourth step in the pathophysiology of renal osteodystrophy:
An increase in calcium phosphorus product leads to calcification of soft tissues
87
Serum calcium x serum phosphorus > ____ mg2/dL2 would lead to calcifications
70
88
The National Kidney Foundation's goal is to keep calcium x phosphorus product under ____ mg2/dL2
55
89
MNT for renal osteodystrophy:
-Calcium: adjust total intake from food, supplements, and calcium-based phosphorus binds to avoid hypercalcemia
-Active vitamin D supplementation: Rocaltrol
-Decrease dietary phosphorus intake to 800-1200 mg/d
90
Calcium supplements should be ___ ___
Calcium carbonate
91
For renal osteodystrophy, calcium supplements should be given on an empty stomach ___ meals and at bedtime
Between
92
What are some examples of phosphate-binding medications:
-MOA
-Calcium-containing binders
-Sevelamer hydrochloride (Renagel)
-Ferric citrate
93
MOA bind with phosphorus in the ___
Gut
94
What are two examples of calcium-containing binders?
-Calcium Acetate (PhosLo)
-Calcium Carbonate (Oscal)
95
What is a possible complication of calcium-containing binders?
Hypercalcemia
96
Sevelamer hydrochloride (Renagel) lowers phosphorus without increasing ____
Calcium
97
Ferric citrate is an ___-___ binder
Iron-based
98
Phosphate binders should be taken ___ ___
With meals
99
There is a high prevalence of ____ ___ is dialysis patients
Cardiovascular disease
100
__ __ ___ is commonly seen secondary to hypertension
Congestive heart failure
101
Accelerated atherosclerosis can lead to ___ ___ ___
Coronary heart disease
102
Non-traditional risk factors for coronary heart disease:
-Inflammation
-Oxidative stress
-Abnormalities of lipoprotein metabolism
-Vascular calcification
103
MNT for cardiovascular disease:
Mediterranean diet pattern may improve lipid profiles
104
Other complications of CKD:
-Increased bleeding tendency
-Impaired leukocyte function (increased susceptibility to infections
-Neurologic manifestations (insomnia, difficulty concentrating, peripheral neuropathy, restless leg syndrome, seizures, encephalopathy)
-Malnutrition
105
____ is one of the most common complications of CKD, especially for those on dialysis
Malnutrition
106
Factors leading to malnutrition:
-N/V
-Taste alterations
-Anorexia
-Fatigue
-Multiple dietary restrictions
-Inadequate intake due to depression, financial challenges, lack of family support, missed meals due to dialysis, inability to obtain or prepare food
-Food-drug interactions
-Protein loss from dialysis treatment
-Inflammatory response (increases protein requirements)
