renal Flashcards
chronic kidney disease
Involves progressive, irreversible loss of kidney function
Defined as presence of
Kidney damage
Pathological abnormalities
Markers of damage
Blood, urine, imaging tests
Glomerular filtration rate (GFR)
<60 mL/min for 3 months or longer
Up to 80% of GFR may be lost with few changes in functioning of body.
Remaining nephrons hypertrophy to compensate.
End result is a systemic disease involving every organ
ckd collaborative care
Conservative Therapy
Measures to lower potassium
Antihypertensive therapy
Calcium supplementation, phosphate binders
Erythropoietin therapy
Adjustment of drug dosages to degree of renal function
Nutritional therapy
drug therapy for ckd
Drug therapy to correct hyperkalemia
Stabilize myocardium
Calcium Gluconate IV
Shift potassium into cells
IV insulin – (glucose to control hypoglycemia)
Salbutamol
Sodium bicarb
Enhance Potassium removal
Polystyrene sulphonate (Kayexalate)
Loop diuretic
Antihypertensive drugs Diuretics Calcium channel blockers ACE inhibitors ARB agents
Phosphate intake restricted to <1000 mg/day
phosphate binders
Phosphate binders Calcium carbonate (Tums, Caltrate) - binds phosphate in bowel and excretes Sevelamer hydrochloride (Renagel) - lowers cholesterol and LDLs
Phosphate binders
Should be administered with each meal
Side effect: constipation
supplementing vitamin d
Supplementing vitamin D
Calcitriol (Rocaltrol)
Serum phosphate level must be lowered before calcium or vitamin D is administered
controlling secondary hyperparathyroidism with ckd
Calcimimetic agents such as Cinacalcet (Sensipar)
↑ sensitivity of calcium receptors in parathyroid glands
Subtotal parathyroidectomy
drug therapy complications
Drug toxicity Digoxin Oral glycemic agents (metformin, glyburide) Antibiotics Opioids (hydromorphone, morphine)
nutritional therapy
Protein restriction Benefits are being studied. Water restriction Intake depends on daily urine output. Sodium restriction Diets vary from 2 to 4 g, depending on degree of edema and hypertension. Sodium and salt should not be equated. Salt substitutes should not be used because they contain potassium chloride. Potassium restriction 2 to 3 g High-potassium foods should be avoided Phosphate restriction 1000 mg/day Foods high in phosphate Dairy products Most foods high in phosphate are also high in protein
overall goals of nursing management planning with ckd
Demonstrate knowledge and ability to comply with therapeutic regimen
Participate in decision making
Demonstrate effective coping strategies
Continue with activities of daily living within psychological limitations
nursing management nursing implementation
Health promotion Identify individuals at risk for CKD. History of renal disease Hypertension Diabetes mellitus Repeated urinary tract infection Regular checkups and changes in urinary appearance, frequency, and volume should be reported.
acute intervention ckd
Daily weight
Daily BPs
Identify signs and symptoms of fluid overload
Identify signs and symptoms of hyperkalemia
Strict dietary adherence
Medication education
Motivate patients in management of their disease
nursing management evaluation
Maintenance of ideal body weight Acceptance of chronic disease No infection No edema Hematocrit, hemoglobin, and serum albumin levels in acceptable range
