Test # 4 Chapter 71 Care of Patients with Chronic Kidney Disease Flashcards Preview

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Flashcards in Test # 4 Chapter 71 Care of Patients with Chronic Kidney Disease Deck (50):

What is the Pathophysiology of Chronic Kidney Disease?

A progressive irreversible kidney disorder that effects 26 million people. Typically shows up when they are older.

Kidney function does not recover.

CKD become ESRD when kidney function becomes too poor to sustain life, which puts the patient on Dialysis.

Kidneys lose function in 5 stages- GFR is how we categorize them. For example. In stage 1 their GFR would be 90. Stage 5 would be less than 15. Once they get around 20 they will be placed on dialysis. GFR is effective until about 3/4 of the kidneys function is lost.

Changes in fluid volume, electrolytes and acid-base balance

Buildup of wastes


As Chronic Kidney Disease progresses, the GFR ________.


Electrolytes, Acid Base Balance, and waste products get out of control.



nitrogen waste.



urea and other waste products that build up because cannot get rid of them.

Causes S/S such as confusion, seizures, cardiac (irregular heart beat), respiratory (SOB).


What are the 2 eitiologies for Chronic Kidney Disease

The two Eitiologies are Diabetes and HTN.


What are the Metabolic Changes associated with Chronic Kidney Disease?

Could be Multiple

Urea and Creatinine- increases

Sodium- hyponatremia,


Acid-Base Balance- metabolic acidosis

Calcium decreases

Phosphorus increases

Cardiac Changes- Typically HTN


Heart Failure



Urea and Creatinine-

(waste products) going to increase causing S/S such as confusion, seizures, cardiac (irregular heart beat), respiratory (SOB).



hyponatremia, what happens is the nephrons can no longer absorb it, so sodium gets lost in the urine. As it progresses, they have hypernatremia. Urin production decreases. Causes HTN, Edema,



excretion occurs mainly through the kidneys so as the disease progresses they will become hyperkalemic. Causes dysrhythmias, irregular heart beat. T-Wave is the focal point. If hyperkalemic T-wave gets spiked.


Acid-Base Balance-

early on, it will do what it needs to do because there is enough nephrons there to take care of business. But as kidney function is lost, the acid excretion is reduced resulting in metabolic acidosis. The body will try to fix it through respirations (Kusmal Respirations) and respirations will increase. If over corrects will cause alkalosis problem.


Calcium and Phosphorus-

Phosphate is excreted by the kidneys, it increases when the kidneys are not working, which causes the calcium to be low. (since they have an inverse reaction). Parathyroid will sense this and try to help, causes calcium to be released from the bones. At risk for bone loss and fractures.


Cardiac Changes-

Typically HTN, Renin is activated which makes it worse. Activates Aldosterone which hold on to sodium and water. They will have

Heart Failure

Pericarditis (infection, cardiac tamponade) will hear friction rub with pericardial effusion.


Hematologic Changes with CKD

Anemia- caused by decrease in erythropoietin.


What are the Gastrointestinal Changes of Chronic Kidney Disease?

Uremia- also effects GI. Normal flora in the mouth changes causing halitosis (Bad Breath) and stomatitis. Hiccups. Anorexia, N/V, Peptic Ulcers


What are the S&S of Chronic Kidney Disease?

Neurological- confusion, changes in LOC

Cardiovascular- HTN, CHF

Respiratory- Crackles, Pulmonary Edema, Increased Respirations (Kusmal)

Hematologic- anemia


Skeletal Muscle and CKD

weak bones, wasting away, fatigued,


Urine and CKD

decreased urine output


Skin and CKD

dry, itchy, uremic frost- can develop on their skin. Can cause skin breakdown and can be anywhere on the body.


What are the Nursing Interventions for Chronic Kidney Disease?

Manage Fluid Volume- Urine output is a problem because the kidneys are not functioning properly. Causes back up of waste into the body. Patient will be on strict I&O’s, Assess for Prevent Pulmonary Edema- lungs, edema, weight.

Drug therapy will be diuretics


What are chronic Kidney Patients at great risk of getting?

Pulmonary Edema


Nursing Intervention
Prevent Pulmonary Edema by assessment-

listening to lung sounds, assessing their skin (are they pink) respirations ect.


Nursing Interventions -

Monitor Electrolytes- focus on K, assess for tall T-Wave. They could have irregular rhythm and can code on you.


Nursing Intervention- Increased Cardiac Output- Blood Pressure-

The higher the blood pressure, the harder it is on the kidneys. This is why we want to keep their BP lower and as normal as you can


How do you measure cardiac output?

Look at BP, assess pulses,


Drugs- (FOR CKD)

Calcium Channel Blockers help with GFR and blood flow to the kidneys. Ace Inhibitors are similar but they help slow the progression of the disease.


Nursing Intervention
Nutrition Therapy-

Typically these patients are on vitamin supplements. Monitor their protein intake depending on GFR. Fluid intake is restricted and monitored. AVOID Foods that are rich on Sodium, phosphorus, Potassium. Restrict broccoli corn peanut butter and sunflower seeds (are rich in phosphorus)


Nursing Intervention
Prevent Infection-

prevent scratching because causes sores. Monitor temperature, what their urine looks like (is it cloudy). Foley Cath care.


Nursing Intervention
Prevent Injury

waste can build up so causes confusion, this can cause them to fall. Can cause break in the bones due to bone loss. Monitor K because can cause weak or confused. Will be on CCB, BB, and ACE I so monitor their blood pressure.


The patient with chronic renal failure has a serum potassium of 6.6mEq/L. The nurse should anticipate an order for:

a) fureosimide (Lasix)

b) aluminum hydroxide (Amphojel)

c) propranolol (Inderal)

d) sodium polystyrene sulfonate (Kayexalate)

d) sodium polystyrene sulfonate (Kayexalate)

Bind with K and they Poop it out


When evaluating the lab results of a patient with chronic kidney disease, the nurse is most concerned with which result?

a)Albumin level of 4g/dL
b) Calcium level of 10mg/dL
c) Potassium level of 7mEq/L
d) GFR of 90/min

c) Potassium level of 7mEq/L


A patient with chronic kidney disease has a normal assessment at 7am. At 10am the nurse finds that the patients respiratory rate is 38breaths/min and the patient is restless. What is your primary nursing intervention?

a) Assess lab values.
b) Assess for dehydration.
c) Perform a bedside glucose.
d) Assess breathing and obtain oxygen saturation level.

d) Assess breathing and obtain oxygen saturation level.



Most Common, done at bedside

Removes excess fluids and waste products and restores chemical and electrolyte balance


Vascular Access-Required for Hemodialysis-

they have to have special access in order to get hemodialysis. The reason that we have to have a specialized access is because they will get about 300ml/min over 3-4 hours. 20G IV will not work, will blow the vein.

AV Fistula or AV Graft- Fistula- surgically connect the artery to the vein. Graft is typically used if the fistula doesn’t work right or doesn’t develop. It is just a plastic piece that connects the artery to the vein. Can take a month to set up

Subclavian Catheter- can be temporary or long term. like a central line in the chest. More than one tube. Lumens typically smaller than graft or fistula. Takes 4-8 hours to complete dialysis. Can be used if dialysis is needed immediately.


General Rule for dialysis

People will generally get dialysis on Monday Wednesday Friday or on Tuesday Wednesday Saturday. THis is important to understand especially when you get a new patient. You can understand when they will need it next.

They do not get to switch around.


Precautions for fistula graft

No BP on that arm

No stick in that arm

No tourniquet on that arm

No drawing blood from access



Heart Failure
Thrombosis or Clotting
Missing Appointments
Disequilibrium Syndrome



is biggest complication. Once they are hooked up to the machine, heparin is used to prevent clotting and remains active for 4-6 hours after dialysis. What typically happens, they will call and say that they cannot get site to quit bleeding after dialysis is done. Antidote is protamine sulfate. Might have to give blood.



they are accessing the site 3 times a week so can get infected easily.


Heart Failure-

side effect especially when they miss dialysis. causes SOB Crackles, Cyanotic.


Missing Appointments-

This is a big deal with dialysis patients. Especially with younger patients. This is usually caused by frustration and you need to educate them on how important it is to not miss.


Disequilibrium Syndrome-

fairly rare. Happens with new patients. This is why when someone is new to dialysis they will not run them the whole time. What happens is that if too much fluid is taken off, it can cause neurological symptoms. Cerebral Edema. Confused.



if they are on a medsurge unit and they are going to dialysis at 9 and you have morning meds at 8 are you going to give them or hold them. It takes 30 min or so to be absorb, so will be ok. If it were 845 and they were going to dialysis at 9, you only give the important meds such as seizure and cardiac. hold the unimportant until they get back.


The patient has just returned from hemodialysis. It is essential for the nurse to evaluate the client for:

a) CHF

b) Hyperkalemia

c) Peripheral edema and headache

d) signs of disequilibrium syndrome

d) signs of disequilibrium syndrome


A patient with chronic renal failure has had an AV Fistula created for dialysis. The nurse should assess this client for:

a) Homan’s sign
b) Periorbital edema
c) A renal bruit
d) A bruit and a thrill

d) A bruit and a thrill

hear a bruit feel a thrill


Peritoneal Dialysis

This exchange occurs in the abdominal cavity. Allows exchange of wastes, fluids, and electrolytes to occur in the peritoneal cavity. Not every patient is a candidate for peritoneal dialysis. It is determined by the doctor.


Difference between Hemodialysis and Peritoneal Dialysis-

Peritioneal dialysis can be done at home on your own schedule. Does take a little more time to complete than hemodialysis and is more stressful on the body. Dietary fluid restrictions are not strict. At risk for peritonitis. They can increase protein because some is lost in peritoneal dialysis.


Nursing Interventions

with peritonitis you would see abdominal pain, cloudy fluid, get a sample, send to lab, get vitals, call the doctor, site can get infected, If they had poor dialysis flow, they will have constipation. Need to educate to increase fiber, water, stool softeners.


A patient with ESKD appears to have pulmonary edema. Which intervention does the nurse perform first?

a) Raise the head of the bed and assess oxygen saturation

b) Notify the Rapid Response Team

c) Call the doctor

d) Apply oxygen by nasal cannula

a) Raise the head of the bed and assess oxygen saturation


Common clinical manifestations of disequilibrium include: (Select all that apply)

a) Headache
b) N/V
c) Diarrhea
d) Decreased LOC
e) Seizures

a) Headache
b) N/V
d) Decreased LOC
e) Seizures


The nurse should instruct the client who is performing peritoneal dialysis to remain in which one of the following positions?

a) Semi-Fowler’s
b) Dorsal Recumbent
c) Lateral Sims’s
d) Supine

a) Semi-Fowler’s