Week 5C: Chronic Kidney Disease

Question 1

What are the top 3 causes and consequences of CKD?

Answer 1

HTN, DM, CVD

Question 2

Stage 1 CKD

Answer 2

90+, normal renal function, proteinuria

Question 3

Stage II

Answer 3

60-89, mild loss of kidney function, proteinuria

Question 4

Stage III

Answer 4

30-59, mild to moderate loss of kidney function, proteinuria

Question 5

Stage IV

Answer 5

15-29, severe loss of kidney function, proteinruria

Question 6

Stage V

Answer 6

End stage renal disease, proteinuria

Question 7

What system does CKD affect?

Answer 7

Every system.W

Question 8

What is Uremia?

Answer 8

Onset of ESRD results in a constellation of signs and symptoms called Uremia

Question 9

What are the goals of care for a CKD patient?

Answer 9

Prevention or slowing progression, early ID, detect and treat causes, referral to nephrologist

Question 10

What meds should be avoided in patients with AKI and CKD

Answer 10

Those with nephrotoxic side effects

Question 11

If a patient has elevated creatinine levels, what meds are avoided ?

Answer 11

NSAIDS

Question 12

What is important for a patient before the use of intravascular dye ?

Answer 12

Delayed until patient is rehydrated

Question 13

What are some secondary factors that can slow the rates of progression of CKD?

Answer 13

HTN, DM, smoking, chronic metabolic acidosis, protein restriction

Question 14

What is an example of a reversible cause of CKD?

Answer 14

Decreased renal perfusion, administration of nephrotoxic medications

Question 15

What is seen in the early stages of CKD in the urinary system?

Answer 15

Polyuria. More than 2.5-3L per day

Question 16

What is seen in late stage CKD in the urinary system?

Answer 16

Less than 400ml/24h

Question 17

Anuria

Answer 17

Less than 40mL

Question 18

Respiratory system

Answer 18

Kussmaul respiration, dyspnea, pulmonary edema, uremetic pleuritis, pleural effusion, predisposition to resp infection

Question 19

How would we treat fluid overload in CKD?

Answer 19

Dietary sodium restrion, diuretic therapy

Question 20

Furosemide

Answer 20

Lasix- a loop diuretic. This is used in margins of 80-500 depending on the severity of the kidney disease.

Question 21

CVD effects of CKD?

Answer 21

HTN, heart failure, left ventricular hypertrophy, peripheral edema, dysrhythmias, ureic pericarditis

Question 22

A patient presents with CKD and HTN. What do you do?

Answer 22

Lifestyle changes, diet recommendations, antihypertensive drugs, fluid overload

Question 23

What are some metabolic disturbances we might see in CKD patients?

Answer 23

An accumulation of waste product. Altered carbohydrate metabolism, elevated triglycerides, metabolic acidosis

Question 24

How would you treat a patient with metaobolic acidosis?

Answer 24

Sodium bicarbonate, decreased protein intake, increased fruit intake

Question 25

What are some common electrolyte imbalances we might see following CKD?

Answer 25

Hyperkalemia, sodium, calcium and phosphate, magnesium, metabolic acidosis

Question 26

How do you handle hyperkalemia in CKD?

Answer 26

Stop supplements, low potassium diet, insulin with glucose, calcium gluconate, removal of K from body

Question 27

How can you removed K from the body?

Answer 27

Diuretics, Kayexalate, dialysis

Question 28

Nutritional therapy for CKD?

Answer 28

Protein restricted, water restricted, Na and K restricted, phosphate restriction, glycemic control

Question 29

How might CKD impact the hematologic system?

Answer 29

-Anemia (decrease in erythropoietin) -Bleeding tendencies -Infection

Question 30

Anemia seen in CKD?

Answer 30

-Erythropeoitin (treat w. ESAs to increase Hg and hematocrit) -Iron supplements -Folic acid supplements

Question 31

When a patient is on dialysis, what supplements become useless?

Answer 31

Folic acid

Question 32

Can CKD impact the MSK system?

Answer 32

Yes. In the mineral and bone disorders. Leads to soft tissue calcification

Question 33

How would you treat a patient with a mineral and bone disorder?

Answer 33

-Restict phosphate intake -Phosphate binders with meals (tums, caltrate) -Supplementing vitamin D (calciferol)

Question 34

Dyslipidemia in CKD

Answer 34

Admin statins

Question 35

CKD leads to a _____ state which is _____

Answer 35

Uremic, anorexia, N/V, peripheral neuropathy -May need kidney replacement therapy

Question 36

Which parts of the GI are affected by CKD?

Answer 36

All

Question 37

CKD: Nursing care

Answer 37

-Systems assessment -Maintain skin integrity -Monitor excess fluid overload -Daily weights -Risk for infection -Monitoring nutriton -Risk for constipation -Risk for injury -Balancing activity and rest -Patient teaching -Anticipatory grieving