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NSG 320 - MED SURG > Topic 9: CKD & Dialysis > Flashcards

Topic 9: CKD & Dialysis Flashcards

1
Q

CKD

A

involves progressive, irreversible loss of kidney function. Defined as wither presence of kidney damage or decreased GFR less than 60mL/min for longer than 3 months

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2
Q

Last stage of kidney disease is end-stage renal disease (ESRD), occurs when the GFR is

A

less than 15mL/min

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3
Q

leading causes of CKD

A

diabetes and HTN

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4
Q

Clinical Manifestations of CKD

A

· Retained urea, creatinine, phenols, hormones, electrolytes, water
· Uremia: a syndrome in which kidney function declines to a point that symptoms may develop in multiple body systems (occurs when GFR is 15mL/min or less)
· Difficulty with urine retention OLIGURIA
Increased BUN and Creatinine (waste product accumulation
· Kussmauls breathing (with severe acidosis)
· Dyspnea (fluid overload, pulmonary edema, etc.)

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5
Q

Increased BUN manifestations

A

N/V, lethargy, fatigue, impaired thought process, HA

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6
Q

CKD alters carbohydrate metabolism which means

A

client may present with Moderate hyperglycemia and hyperinsulinemia

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7
Q

most patients with CKD die from

A

CVD: increased LD and Low HDL

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8
Q

electrolyte imbalances associated with CKD

A

hyperkalemia
hypernatremia
hyperphospatemia

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9
Q

hyperkalemia can lead to

A

can lead to fatal dysrhythmias

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10
Q

Impaired sodium excretion for CKD can lead to

A

edema, HTN and HF

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11
Q

in CKD kidneys are unable to excrete acid which means

A

Metabolic acidosis

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12
Q

why is anemia a manifestation in CKD

A

due to decreased production of ERYTHROPOETIN

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13
Q

neurologic changes in CKD (Result of increased nitrogenous waste products)

A

lethargy, apathy, decreased ability to concentrate, fatigue, irritability, altered mental status

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14
Q

· CKD mineral and bone disorder

A

o Kidney is not turning vitamin D into its activated form, decreased vitamin D means decreased serum calcium levels
o This means hyperphosphatemia
o Increase risk for BONE FRACTURE

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15
Q

· Uremic frost

A

o Rare condition in which urea crystalizes on the skin
o Usually only seen when BUN levels are really high

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16
Q

what is usually the first sign of kidney damage

A

Persistent proteinuria (dipstick evaluation)

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17
Q

diagnostic assessment for CKD

A

· Renal ultrasound, renal san, CT scan
· Renal biopsy
· BUN, creatinine and creatinine clearance levels
· Serum electrolytes
· Lipid profile
· Urinalysis
· Protein-to-creatinine ratio in first morning voided specimen
· Hematocrit and hemoglobin levels

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18
Q

stage 1 CKD

A

GFR >90

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19
Q

stage 2 CKD

A

GFR 60-89

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20
Q

stage 3a CKD

A

GFR 45-59

21
Q

stage 3b CKD

A

GFR 30-44

22
Q

stage 4 CKD

A

GFR 15-29

23
Q

stage 5 CKD

A

GFR <15

24
Q

Hyperkalemia Interventions

A

· Restricting high potassium food and drugs
· IV gluconate
· IV glucose and insulin
· Sodium polystyrene sulfonate (given to lower potassium un stage 4 CKD)
· Monitor for changes in ECG

25
Q

HTN Interventions

A

· Weight loss
· Lifestyle changes (exercise, avoid alcohol and smoking)
· Diet: DASH Diet
· Antihypertensives

26
Q

CKD-MBD Interventions

A

Limit dietary phosphorus
· Supplementing vitamin D (oral or IV calcitriol) giving phosphate binders
· Controlling hyperparathyroidism

27
Q

diagnosis for CKD-MBD

A

· Gold standard for diagnosis is bone biopsy

28
Q

Anemia Interventions

A

· Exogenous erythropoietin (use lowest possible dose to avoid thrombolytic events like MI, HF, stroke)
· EPO may lead to iron deficiency: iron supplementation is recommended

29
Q

nutrition therapy CKD

A

· Protein must be high enough if patient is on HD or PD, but high protein diets can overburden diseased kidneys
· Fluid intake is usually as desired, but TEACH patients to limit fluid intake so that weight gain are no more than 1 t0 3 kg between dialyses (interdialytic weight)
· Restrict sodium
· Restrict potassium
· Restrict phosphorus

30
Q

Foods high in phosphorus

A

milk, ice cream, yogurt, pudding

31
Q

Health Promotion for CKD

A

· Ask patient about what medications they are taking as some may be nephrotoxic
· Weight and weight changes
· Patients with diabetes need to have their urine checked for albuminuria and changes in urine appearance
· Monitor creatinine, BUN, GFR if patient needs a potentially nephrotoxic drug
· MONITOR BP, treat HTN
Treat diabetes

32
Q

patient teaching CKD

A

· Dietary sodium, potassium, phosphate restrictions
· S/S of electrolyte imbalances, especially high potassium
· Alternative ways to reduce thirst (sucking on ice cubes, lemons or hard candy)

33
Q

patients with CKD should report

A

o Weight gain >4lb (2kg)
o Increasing BP
o SOB
o Edema
o Increasing fatigue or weakness, lethargy
Confusion

34
Q

Dialysis

A

corrects fluid and electrolyte imbalances and removes waste products in kidney failure

35
Q

Hemodialysis

A

· Blood taken out, “washed” and put back into the patient
· 3-4 times per week

36
Q

access site for hemodialysis

A

AV Fistula and grafts

37
Q

how long to AV grafts need to heal

A

2-4 weeks

38
Q

Peritoneal Dialysis

A

access obtained by inserting a catheter through anterior abdominal wall

39
Q

peritoneal dialysis catheter

A

· A Dacron cuff forms holding catheter in place
The tip of the catheter rests in the peritoneal cavity

40
Q

Before Dialysis

A

· Assess fluid status (weights current and previous)
· VS
· ASSESS FISTULA (SHUNT)
· HOLD MEDS (especially if the cause lowered BP)
· IV heparin is added during dialysis to prevent clots
· Consent

41
Q

assesing fistula/shunt

A

o Feel a THRILL (vibration)
o Hear a BRUIT (swoosh)
o Report to HCP if NOT present

42
Q

what is added to dialysis to prevent clots

A

iv heparin

43
Q

SAFETY for AV Fistula and Grafts

A

· Never perform BP, IV insertion, or venipuncture in the extremity with AV access
· Place signs in room and label band “No BP, blood draws, or IV in this arm”

44
Q

Complications of Hemodialysis

A

· Hypotension
o Decrease fluid volume removed and infuse 0.9% saline
· Muscle cramps
o Reduce ultrafiltration rate and give fluids
· Loss of blood
o Hold firm pressure on access sites (remember heparin was given to reduce clots)

45
Q

Disequilibrium Syndrome s/s

A

· Restless and disoriented!!!
· Causes brain cells to swell which increases ICP

46
Q

Disequilibrium Syndrome intervention

A

· STOP/SLOW THE INFUSION AND REPORT TO HCP

47
Q

Peritoneal Dialysis intervention

A

· Take weight and warm the solution
· Monitor for exit site infection
· Monitor for peritonitis
· Hernias may develop due to increased intrabdominal pressure
· Lower back pain
· Monitor for bleeding
· Monitor for pulmonary complications
Monitor for protein loss

48
Q

peritonitis s/s

A

o Abdominal pain, rebound tenderness, cloudy peritoneal effluent with a WBC greater than 100 cells/uL

NSG 320 - MED SURG (63 decks)

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