Chronic Kidney Disease
Individuals with advanced stage 5 chronic kidney disease may complain of restless legs syndrome, described as "bugs crawling inside the leg." Muscle twitching, jerking, asterixis (hand-flapping tremor), and nocturnal leg cramps also occur
A patient is in end-stage renal failure. What are the signs and symptoms that the nurse is likely to find while assessing neurologic function?
Hypertension and hypertensive crisis
A patient with CKD is at risk for what and can result in symptoms of headache, nausea, and vomiting?
elevated serum phosphate levels
Administration of calcium-based phosphate binders, such as calcium carbonate, and non-calcium-based phosphate binders, such as lanthanum carbonate, are only beneficial for chronic kidney failure patients with what?
BUN and serum creatinine levels ↑
As GFR decreases what happens with BUN and serum creatinine levels?
Kussmaul respirations
During severe metabolic acidosis, how does the body compensate?
Tired, weak, muscle pain,
How will the patient look and feel after dialysis?
Crackles auscultated in the lungs from fluid volume overload.
In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate?
25 to 35 kcal/kg/day
To avoid calorie-protein malnutrition, the patient should consume how many calories per day?
angiotensin receptor blockers and angiotensin-converting enzyme (ACE) inhibitors
Which medications help to decrease proteinuria and delay the progression of chronic kidney disease (CKD)?
Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur.
A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD?
meals to reduce GI effects
A patient with chronic kidney disease who is prescribed phosphate binders, such as lanthanum carbonate, should take them with >>>
The patient should be given 10% calcium gluconate intravenously to control the elevated levels of serum potassium.
A patient with chronic kidney failure (CKD) has a paralytic ileus and laboratory findings of a serum potassium level of 7 mEq/L and a phosphate level of 3.5 mg/dL. The nurse anticipates that what medication will be prescribed?
Decrease the phosphorous using phosphate binders: -calcium carbonate (Tums) -sodium bicarbonate -calcium phosphate (Phos lo) -Sevelemer (Renegel) **** -Lanthanum Carbonate (Fosrenol) ****
How do you help hypocalcemia in the pt with CKD that helps excrete phosphate and should be taken with food?
The patient's weight, blood pressure and vital signs, peripheral edema, lung and heart sounds, along with auscultating for bruits and palpating for thrill.
Prior to dialysis, what assessments of the patient should be made?
absorption of calcium thus causing hypocalcemia
The kidney produces calcitriol, the active forms of vitamin D, which then enhances intestinal absorption of calcium. Absent or insufficient vitamin D prevents what?
Most clients experience more nausea and vomiting in the morning. Therefore, to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium.
The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care?
African americans
The nurse is planning an education program on chronic kidney disease. Which ethnic group would the nurse target for promoting this event?
Milk, pudding, steak, and cheese should be decreased.
The nurse is teaching a patient with chronic kidney disease about restricting phosphorous in the diet. What foods should be restricted?
Avoid excess intake of sodium and potassium (crackers, peanut butter, potatoes), and avoid foods high in phosphorous (dairy products). Also begin a low protein diet if they are not on dialysis.
What are some dietary recommendations for a pt with CKD?
It may take 2-4 months before it can be used. On the affect arm, there must be no BP or blood taken, the pt should not sleep on it or carry items, and they should report signs and symptoms of infection.
What are some important things the pt must understand if they have a arteriovenous fistula?
This is given SubQ or via IV, it may cause hypertension and is contraindicated in HTN, and it should be held if the Hemoglobin is >11g/dL.
What are some important things to consider before giving erythropoietin?
-dyslipidemia -↑ levels of very-low-density lipoproteins (VLDLs) -normal or decreased levels of low-density lipoproteins (LDLs) -decreased levels of high-density lipoproteins (HDLs).
What are some metabolic changes for pts with CKD?
emotional lability, withdrawal, and depression
What are some personality and behavioral change that are commonly observed in patients with CKD?
The patient can stay at home, they do it while they sleep, it is more like the natural process and they don't feel as tired and weak.
What are the benefits of peritoneal dialysis?
Hyperkalemia Hypernatremia Hypocalcemia Hypermagnesemia
What are the electrolyte imbalances of CKD?
Diabetes and hypertension
What are the leading causes of ESKD?
N/V, lethargy, fatigue, impaired thought processes, and headaches
What are the major s/s of increased BUN
urea crystals
What can cause bleeding within the lungs?
>3mg/dL, tetany, pruritic, hypertension with symptoms of hypervolemia and severe electrolyte imbalances that are not corrected.
What creatinine level and symptoms would indicate that immediate dialysis would be most beneficial?
Chronic Kidney Disease (CKD)
What disease is a progressive, irreversible loss of kidney function that does not recover?
Protein rich foods
What foods are high in phosphorus and will bind with calcium causing hypocalcemia in CKD?
Baked beans, Bananas, oranges, sweet potatoes, canned mushrooms, and chocolates
What foods are rich in potassium and should be restricted in those with CKD?
Mild to moderate hyperglycemia and hyperinsulinemia
What happens when there is defective carbohydrate metabolism caused by impaired glucose metabolism resulting from cellular insensitivity to the normal action of insulin?
Dry skin, calcium-phosphate deposition in the skin, and sensory neuropathy
What is the cause of pruritis in the patient with CKD?
Cardiovascular disease due to CAD, arterial stiffness, HTN, anemia, fluid overload, uremic pericarditis and cardiac dysrhythmias due to hyperkalemia.
What is the leading cause of death for patients with CKD?
The GFR
What is the main way of staging CKD in the patient?
uremia
What is the presence of urinary waste in the blood and usually occurs when the GFR is less than 10ml/min or lower and is the extreme for of azotemia?
dialysis equilibrium syndrome
What is the rare but potentially life threatening complication that occurs in the early stages of hemodialysis that can cause cerebral edema (leading to nausea, vomiting, HA, restlessness, and seizure activity) and must be corrected at once by calling the HCP?
Stage 4 with 15-29 GFR
What is the stage of CKD where there is preparation for renal transplant and dialysis and the GFR is 15-29?
hypermagnesemia
What manifests as the absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure.
NSAIDs: Ketorolac (Toradol), or ibuprofen
What medications should be avoided in a person with CKD?
Antibiotics, antihypertensives and anything else that would be dialyzed.
What medications would you hold before dialysis?
hyperphosphatemia
What results in hypocalcemia that stimulates parathyroid glands to release PTH and calcium is released from the bones resulting in bone density loss?
Erythropoietin
What shot is necessary for production of RBCs if hemoglobin is less than 12 and will require vigilance of thrombosis and MI in the pt with CKD?
Gently irrigate tube with normal saline
What should the nurse do with the patient who has a nephrostomy tube with no drainage and flank pain that radiates to the groin along with nausea.
Check blood pressure everyday, know the signs and symptoms of myocardial infarction and get blood work (hemoglobin) done weekly.
What should you teach the patient to do at home while on dialysis?
end-stage kidney disease (ESKD)
What stage of CKD is when the kidney function is too poor to sustain life, and the GFR is less than 15 ml/min?
Folic acid
What supplement might be useful in preventing anemia and has to be supplemented when the patient is on dialysis?
hypocalcemia
When is PTH stimulated for the release of calcium from the bones resulting in weakened bones leading to Osteomalacia and fractures?
Using sterile technique when spiking the bag and changing the bags.
When preparing the dialysate of peritoneal dialysis, what is the priority nursing action?
Stomatitis with exudates and ulcerations, a metallic taste in the mouth, and uremic fetor (a urinous odor of the breath).
When the enzyme urease in the mouth contacts urea, ammonia is generated and causes what issues for the patient?
Heparin is administered during the procedure and blood pressure meds are given after the procedure.
When would you administer heparin and blood pressure meds for a patient on dialysis?
-Calcium intake of 1000 to 1500 mg/day is beneficial -Sodium intake of 1-3g/day is fine -Protein intake should be restricted to 0.6 to 1 g/day -Calorie intake of 30 to 35 kcal/kg/day
Which dietary intake guideline is appropriate for the nurse to recommend to a patient with pre-end-stage renal failure?
Anemia
↓ production of erythropoietin by the kidneys. Erythropoietin normally stimulates the precursor cells in the bone marrow to produce RBC (erythropoiesis) can lead to what problem?
