January 28 - Chronic Kidney Disease

Question 1

Kidney disease is a result of:
Creating:
Acute or Chronic

Answer 1

Kidney disease may result in the partial or complete impairment of kidney function, resulting in an inability to excrete metabolic waste products and water.

Acute or Chronic

Question 2

Acute Kidney Injury (previously termed acute renal failure)

What is the Etiology

May progress to

Answer 2

Previously termed acute renal failure (ARF)

Etiology: prerenal, intrarenal, postrenal

May progress to chronic kidney disease (CKD)

Question 3

What is Chronic Kidney Disease 
Presence:
Progressive:
How many stages:
End result is?

Answer 3

Presence of kidney damage or decreased level of kidney function (Glomerular filtration rate GFR<60ml/minutes) for 3 months or more

Progressive, irreversible loss of kidney function

Divided into 5 stages depending on level of decrease in function

End result is systemic disease affecting every organ

Question 4

5 Stage of Kidney Disease

Answer 4

1 = kidney dmg with normal GFR = > 90
2 = Kidney Dmg with mild GFR = 60-89
3 = Moderate GFR = 30-59
4 = Severe GFR = 15-29
5 = Kidney Failure < 15 (or dialysis)

Question 5

Kidney Disease Etiology

Answer 5

Diabetes
Uncontrolled Hypertension
Chronic kidney infections/inflammation
Severe Injury
Inherited disorders
Congenital Defects
Certain Medications

Question 6

Clinical Manifestations

Retained substances:

Answer 6

Urea
Creatinine
Phenols
Hormones
Electrolytes
Water
Other substances

Question 7

Nursing Assessment

Answer 7

Urinary changes
Edema
Significant change in weight
Shortness of breath (SOB)
Skin Changes
GI concerns – N & V, acute pain
Fatigue
Change in cognitive function

Question 8

Diagnostic Studies

Answer 8

Urine dipstick : Persistent proteinuria

Albumin-creatinine ratio

Question 9

What is Uremia

And SS

Answer 9

Syndrome that incorporates all the signs and symptoms resulting from build up of waste products and excess fluid associated with kidney disease.

Early s/s: n & v, fatigue, pruritus, hypertension, proteinuria, hyperglycemia

Question 10

What is Polyuria

Oliguria

Anuria

Answer 10

Polyuria
Results from inability of kidneys to concentrate urine
Specific gravity fixed around 1.010

Oliguria
Occurs as CKD worsens

Anuria
Urine output <40 mL per 24 hours

Question 11

Electrolyte/Acid-Base Imbalances

Potassium:
Sodium:
What alterations
State of:? which does

Answer 11

Potassium: hyperkalemia

Sodium: edema, hypertension, heart failure

Calcium and phosphate alterations

Magnesium alterations

Metabolic acidosis
Inability to excrete acid; defective reabsorption/regeneration of bicarbonate

Question 12

Metabolic disturbances

Accumulation

Altered Carbohydrate metabolism

Elevated Triglycerides

Answer 12

Waste product accumulation
-As GFR ↓, BUN ↑ and serum creatinine levels ↑

Altered carbohydrate metabolism
-Cellular insensitivity to the normal action of insulin

Elevated triglycerides
-Altered lipid metabolism

Question 13

Hematological System

Anemia
Bleeding tendencies
Infection

Answer 13

Anemia
-↓ production of erythropoietin

Bleeding tendencies
-Defect in platelet function

Infection

• Changes in leukocyte function
• Altered immune response and function
• Diminished inflammatory response

Question 14

Cardiovascular system

Most common form of kidney death is cardiac

CKS causes:

Answer 14

Hypertension
Heart failure
Left ventricular hypertrophy
Peripheral edema
Dysrhythmias
Pericarditis

Question 15

Gastrointestinal System

CKS causes:

Answer 15

Mucosal ulcerations
Stomatitis
Uremic fetor
GI bleeding
Anorexia
Nausea & Vomiting

Question 16

Neurological system

CKS causes:

Answer 16

Altered mental ability
Restless legs syndrome
Muscle twitching, irritability
Decreased concentration
Peripheral neuropathy
Seizures
Dialysis encephalopathy

Question 17

What does CKS cause to:

Integumentary
Musculoskeletal
Reproductive

Answer 17

Integumentary
-Pruritus

Musculoskeletal

• Systemic disorder of mineral and bone metabolism
• Results in skeletal complications

Reproductive

• Low sperm count, Infertility
• Decreased libido, sexual dysfunction

Question 18

Psychological Manifestations

-

Answer 18

Personality and behavioural changes
Emotional ability
Withdrawal
Depression

Question 19

Management Strategies

Answer 19

Dietary restrictions
Fluid Restriction***
Cholesterol management
Blood sugar management
Weight management
Anemia management*** (erythropoietin, iron, folic acid)
Blood pressure management
Daily Activity
Smoking cessation
Stress management

Question 20

Treatment Options 4

Answer 20

Transplant

Conservative Care

Hemo Dialysis

Peritoneal Dialysis

Question 21

Conservative Therapy

Answer 21

• Correct fluid volume overload or deficit
• Nutritional therapy
• Anemia therapy: erythropoietin, iron, folic acid
• Calcium supplements, phosphate binders
• Anti-hypertensives

Question 22

What is Dialysis?

Procedure which:2
2 types:

Answer 22

Procedure which:

• Removes extra water from the body
• Removes waste products from the blood stream (removes waste)

2 types:
Peritoneal Dialysis – takes place inside the body
Hemodialysis – takes place outside the body (fake kidney) [2 needles into fistula/graft and connected to machine]

Question 23

Artery - Vein fistula

Graft

What are they
and considerations

Answer 23

Connection between artery and vein

• No BPs
• No Ivs
• No blood tests
• No tight jewelry

a piece of living tissue that is transplanted surgically.

Question 24

Kidney Transplantation

• Kidneys found where
• in hospital for how long

Answer 24

Healthy kidneys come from living donors or cadaveric donors

Usually hospitalized for 1-2 weeks