CKD

When does CKD occur?

If GFR is less than 60 ml/min for 3 months or more.

Risk factors and causes of CKD

Acute kidney injury Chronic glomerulonephritis Nephrotoxic medications or chemicals Autoimmune disorders Polycystic kidney pyelonephritis renal artery stenosis Recurrent severe infections Obstructive uropathies ( BPH or urothialis) HTN DM

What are the subjective clinical manifestations of CKD

Fatigue Lethargy Involuntary leg movement depression Intractable hiccups

What is the acronym for the hematologic manifestations of CKD

PEA M

what is the acronym for skeletal clinical manifestations

POW W

What is the acronym for the respiratory manifestations for CKD

PUF TUF SHY K

What are the respiratory clinical manifestations of CKD?

Pleural friction rub Uremic lung which has sx like pneumonia and has halitosis with deep sighing. Fever Tachypnea Uremic pneumonitis Frothy pink sputum SOB Hyperpnea yawning Kussmauls respirations

What are the electrolyte changes related to CKD?

Sodium increases and decreases potassium increases Metabolic acidosis bicarbonate decreases Ca decreases and phosphate increases PTH increases Triglycerides increase Hemoglobin decreases

What is uremia?

Urine in blood stream Azotemia with clinical manifestations

What kidney changes are seen in CKD

Urine production is changed, severe disruption of F and E balances occur and metabolic disturbances arise.

How many stages does CKD have

5

What is the usual GFR for the elderly and infants?

60 to 89

Ca increasing and phosphate increasing r/t CKD

1) Kidney produces hormone to activate V-D this enhances intestinal absorption of Ca. No V-D, No absorption hypocalcemia. 2) Kidneys excrete PO4 normally, bad kidneys occur , phosphates retention, bonds with Ca further decreases Ca levels. 3) PTH is stimulated and under it's influence Ca is released, from bone , bone density loss.

A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE). Which of the following values should give the nurse the best indication of the client's renal function?

A.Serum creatinine A renal function disorder reduces the excretion of creatinine, resulting in increased levels of blood creatinine. Creatinine is a specific and sensitive indicator of renal function.

What is renal osteodystrophy?

Bone Dz r/t kidneys failing to maintain Ca and Phosphorous levels.

Anemia r/t CKD

Decreasing erythropoietin level causes decrease RBC production uremia cause RBS survival time, iron and folic acid deficiencies from altered diet, increase bleeding from impaired PLT function.

Why does the aging process cause CKD?

Due to decreasing number of functioning nephrons, decrease GFR and water and sodium conserving and compensation methods.

What is the top two risk factors/ causes of CKD

HTN and DM

what is stage 5 of CKD?

Kidney failure and ESRD with little to no GFR ( less than 15 ml/min)

Whats the acronym for the GI clinical manifestations for CKD

MC BUN FS

What is stage 3 of CKD?

Moderate kidney damage with moderate decreased GFR ( 30 to 59 ml/min)

What are the cardio manifestations of CKD

S3 sound is sound 1 orthostatic hypotension Bounding or weak pulse cholesterol deposits pericarditis. pericardial friction rub potassium induced dysrhythmias ( peaked T waves) Hdy HTN Fluid overload

What's the acronym for cardio clinical manifestations of CKD?

SOB CPP HH F

What metabolic changes arise with CKD?

Urea: made from protein metabolism and how highly they are and are directly related to dietary protein intake. Creatine: protein from skeletal muscle and rate of execration depends on muscle mass physical activity and diet which is a better indicator of renal function.

GI problems r/t CKD

Uremic colitis can cause constipation or watery diarrhea, ulcers will develop and erode through blood vessels which can lead to severe GI bleed, hem shock.

Merabolic acidosis r/t CKD

Usually occurs later in CKD, serum bicarbonate more than 22 meq/L, correction of this condition may slow CKD and improve patient functioning status.

what is a huge contributor to arthritis

obesity

Which complication does the nurse monitor for in a pregnant patient who is diagnosed with cystitis?

preterm labor

Are NSAIDs nephrotoxic?

yes

What is uremic syndrome?

Fluid and electrolyte as well as hormonal imbalances with metabolic abnormalities.

What are the neurological clinical manifestations of CKD?

Lethargy encephalopathy ( resolves with hdy) Ataxia Paresthesia Confusion decreased attention span Seizure Tremors or jerky movements coma slurred speech

What does a pleural friction rub sound like

Like walking on fresh snow or a leather type sound.

Heart failure r/t CKD

Liver dysfunction is very common uremic cardiomyopathy; cardiac dz is leading cause of death 4 ESDR. Anemia will cause arrhythmias, hypoxia, ischemia

The nurse is instructing an older adult female patient about interventions to decrease the risk for cystitis. Which patient comment indicates that the teaching was effective?

A. "I should consume cranberry supplements 4x/week." •Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. •Cranberry products consumed >4 weeks to be effective. This produces a biofilm inside the bladder which reduces bacteria's ability to attach itself • Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. We encourage pts to decrease carb bev intake bc these are irritating when someone has a current infection. • Avoiding fluids after 8 pm would help prevent nocturia but not cystitis. •It is recommended that patients with incontinence problems limit their late-night fluid intake to 120 mL.

The nurse teaches a female patient about ways to prevent urinary tract infections. Which statements made by the patient indicate effective learning? Select all that apply. A. "I should take a daily bubble bath." B. "I should drink 3 liters of fluid per day." C. "I should use flavored lubricants for intercourse." D. "I should wash the perineal area before intercourse." E. "I should include foods rich in vitamin C in my daily diet."

A. "I should wash the perineal area before intercourse." B. "I should urinate frequently thoughout the day." A. "I should drink 3 liters of fluid per day." •Adequate fluid intake and frequent urination helps flush bacteria from the urinary tract and thereby prevent urinary tract infection; •Washing the perineal area before intercourse reduces the presence of bacteria and thereby reduces the risk of infection. •Bubble baths may irritate the genital area and make it more susceptible to infection. •Flavored lubricants may increase irritation and the risk of infection in the genital area; therefore, the patient avoids using flavored lubricants to reduce the risk of infection

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make?

A."A low-protein diet reduces the risk for uremia." Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.

A male patient comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question would the nurse ask first when taking this patient's history?

A."Do you have anyone in your family with renal failure?" B."Have you had a diet that is low in protein recently?" C."Has a relative had a kidney transplant lately?" •There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both the serum creatinine and BUN are elevated, indicating some renal problems. A family history of renal failure and kidney transplantation would not be part of the questioning and could cause anxiety in the patient. A diet high in protein could be a factor in an increased BUN

A nurse is providing care to a group of patients on a urology unit. Which patient does the nurse identify as being at the greatest risk for developing urinary stones? A.A. 35-year-old female with quadriplegia from an auto accident B.A 65-year-old male with a recent history of myocardial infarction C.50-year-old male with type II diabetes mellitus D.A 25-year-old female with a current episode of urinary tract infection

A.A. 35-year-old female with quadriplegia from an auto accident The quadriplegic who was in auto accident experiences prolonged immobility, this will increase calcium loss from bones and therefore increase the chance of calcium stones precipitating in the urinary system. The MI, DM, and UTI patient do not have an increased risk for stone development at this time.

The nurse in the urology clinic is providing teaching for a female patient with cystitis. Which instructions does the nurse include in the teaching plan? Select all that apply.

A.If urine remains cloudy, call the clinic. B.Try to take in 64 ounces of fluid each day. C. Be sure to complete the full course of antibiotics. •Between 64 and 100 ounces (2-3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. •Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. •For persistent symptoms of infection, the patient should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. •Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.

The nurse is triaging a patient who presents to the urgent care clinic with symptoms of severe flank pain with spasms, nausea, vomiting, and oliguria. The patient states that the pain was initially intermittent and radiated from the lower back to the lower quadrants of the abdomen. Which action by the nurse is the most appropriate? A.Complete the physical assessment B.Perform a renal ultrasound C.Instruct the patient to increase fluids D.Obtain a urine specimen for culture

A.Perform a renal ultrasound A.A full physical assessment is not needed at this time as the focused assessment has complete data. Complete assessment would not be appropriate in an emergency situation. B.Hydroureter is a complication that occurs when a renal calculus moves into the ureter and blocks and dilates the ureter. Symptoms include severe pain and spasms, nausea, vomiting, and diminished volume of urine. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; diagnosis of this condition is needed for immediate intervention. C.While this action is important, it would not be appropriate in an emergency situation. D.While this action is important, it would not be appropriate in an emergency situation.

The charge nurse of the medical-surgical unit is making staff assignments. Which staff member would be assigned to a patient with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub

A.Registered nurse who was assigned the same patient yesterday- •The patient is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is important to assess subtle differences in patients. Therefore, the registered nurse (RN) who was assigned to this patient previously would again give care to this patient. The float nurses would not be as knowledgeable about the unit and its patients. The licensed practical nurse may not have the education level of the RN to assess for pericarditis.

Which antibiotic for treating cystitis may cause side effects of sunburn and skin darkening?

A.Sulfamethoxazole

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

A.The hematocrit (Hct) Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct.

A nurse is preparing to obtain a daily weight from a client who has chronic kidney disease. Which of the following actions should the nurse implement?

A.Weigh the client after he has voided. The nurse should have the client void before obtaining a daily weight.

What is Azotemia

Build of nitrogenous waste in blood

Bicarbonate decreases r/t CKD

Build up of hydrogen ions and reabsorption of bicarbonate ions doesn't occur, base deficit.

What's the acronym for the urinary clinical manifestations?

COP P

what is Calciphylaxis and vascular calcification r/t CKD

Ca phosphorus complexes deposit like atherosclerotic plaques in the intima of blood vessels. Vascular Ca deposits are a marker of significant risk for CVD dz

What are the urinary clinical manifestations for CKD

Changes in the amount, color and concentration of urine Oliguria, anuria ( late stage) Particles in the urine Polyuria dilute urine ( early stages)

What does the diagnostic interpret with azotemia?

Diagnostic indices are commonly used to differentiate prerenal azotemia from azotemia from intrarenal or postrenal azotemia.

Why does sodium decrease with CKD?

Early in CKD they can't reabsorb the sodium this and polyuria is seen in mild to moderate kidney dz or if they are in ate CKD and have fluid volume overload.

Hyperlipidemia r/t CKD

Fat metabolism is changed and triglycerides, total cholesterol, and LDLS are increased. Problems with atherosclerosis and lipids are significantly increased if pt has CKD and DM.

what is HTN is what to CKD

HTN is the cause and a results of CKD.

why does sodium increase with CKD?

Lat or low sodium in CKD excretion is decreasing b/c urine production decreases. Sodium retention causes HTN and fluid imbalances; but if fluid retention occurs at a greater rate than sodium you may see a falsely normal or low sodium b/c fluid is diluting it. Check serum osmolarity to figure out which is which.

What's the acronym for the neuro manifestations

Leap Cds Tcs

what are the GI clinical manifestations of CKD

Meats= metallic taste Changes in taste Blood in stools Ulcers in mouth and throat N/V Foul breath Stomatitis ( document any pain, abd pain, cramping or vomiting)

What is stage 2 of CKD?

Mild kidney damage with mildly decreased GFR ( 60 to 89 ml/min)

What is stage 1 of CKD?

Minimal kidney damage with normal GFR ( > 90 ml/min)

HTN r/t CKD

Na management is damaged and fluid excretion is impaired, plus damage to the RAS system. In most cases HTN ruins the arterioles which deliver blood to kidney, kidneys release renin stimulating angiotensin and aldosterone release. This raises pressure and worsens kidney function

What is end stage renal disease?

Need transplant or dialysis to live.

Why are older adult clients more at risk for CKD?

Normal aging process bedrest confused have lack of thirst don't have easy access to water

Why does potassium increase with CKD?

Normal levels are maintained until UOP is less than 500 ml/24hr period. This can increase if ingesting drugs that alter K excretion or take K supplements. Don't restrict K intake Tissue breaks down, blood transfusion, bleeding or hemorrhage.

Who is most at risk for CKD?

Older adult clients

What are the symptoms of Anemia

Pallor Dizziness weakness

What is stage 4 of CKD?

Severe kidney damage with severe decreased in GFR (15 to 29 ml/min)

Pericarditis r/t CKD

Pericardial sac becomes inflamed from uremic toxins or infection.

What are the skeletal clinical manifestations of CKD

Person may bend forward and lose Ht Osteodystrophy WT loss: anorexia from high urea lvl wt gain: from fluid retention

What are the hematologic clinical manifestations of CKD

Petechiae Ecchymosis Anemia Melena

What is Chronic Kidney Disease

Progressive, irreversible kidney injury, kidney function does not recover. CKD may be asymptomatic except during periods of stress. Clinical manifestations become apparent the longer Kidney dysfunction progresses.

When does ESRD occur?

When 90 percent of functioning nephrons have been destroyed and are no longer able to maintain fluid, electrolyte and acid base homeostasis.

What are the skin clinical manifestations for CKD

Yellow cast to skin ( swallow appearance) Decreased skin turgor Dry purities urea crystals on skin (uremic frost)

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? A.pH 7.25, PaCO2 30 mm Hg, HCO3- 19 mEq/L B.pH 7.36, PaCO2 50 mm Hg, HCO3- 27 mEq/L C.pH 7.50, PaCO2 32 mm Hg, HCO3- 20 mEq/L D.pH 7.55, PaCO2 40 mm Hg, HCO3- 30 mEq/L

•A: Partially Comp Metabolic Acidosis- this is common to people who have kidney disease •B: Compensated Respiratory Acidosis •C: Partially Comp Respiratory Alkalosis •D: Uncompensated Metabolic Alkalosis •Normals are pH 7.35-7.45 •CO2 35-45 •HCO3 22-26 •Which of these is a compensated ABG? B •Which of these is an uncompensated ABG? D •What does that makes the others? Partially compensated The answer is A

The nurse is teaching a group of older adult women about the signs and symptoms of a urinary tract infection (UTI). Which concepts does the nurse explain in the presentation?Select all that apply.

•Dysuria (painful urination), •Enuresis (bed-wetting) •Nocturia (frequent urinating at night), •urgency (having the urge to urinate quickly), •polyuria (increased amounts of urine production •Frequency are symptoms of UTI.