W4P3 Alterations in Renal Function

s/s ckd

Most common marker of CKD is proteinuria, screen with dipstick also evaluate microalbuminuria (albumin to creatinine ratio >300 mg albumin per 1 gram Creatinine) Serum creatinine is not sufficiently sensitive, levels may fail to rise above normal until the GFR is less than 60 ml/min/1.73 m2 Uremia is a syndrome in which kidney function declines to the point that all body systems are affected Primary issues: Anemia, Cardiovascular Disease, Bone disorders, Fluid and Electrolyte imbalance, Infection

what is chronic kidney disease (CKD)

Reduction in kidney function or kidney damage that has been present for at least 3 months. Gradual loss of renal function from primary renal condition or diseases produce long-term renal insult It is an ongoing process of renal injury that is irreversible. GFR is the best measure of kidney function. Often asymptomatic until later stages, symptoms uncommon with GFR > 35 ml/min/1.73 m2

stage 1 (NKF classification of stages of CKD)

kidney damage with normal or increased GFR GFR: >90

stage 5 NKF classification of stages of CKD)

kidney failure GFR: less than 15 or dialysis

stage 2 NKF classification of stages of CKD)

mild reduction in GFR GFR: 60-89

stage 3 NKF classification of stages of CKD)

moderate reduction in GFR GFR: 30-59

stage 4 NKF classification of stages of CKD)

severe reduction in GFR GFR 15-29

•Which laboratory data is the most accurate indicator that a client with acute renal failure has met the expected outcomes? a.Decreasing blood urea nitrogen (BUN) levels. b.Decreasing serum creatinine. c.Decreasing neutrophil count. d.Decreasing lymphocyte count.

Answer B is correct. Creatinine is the metabolic end product of creatinine phosphate and is excreted by the kidneys in relatively constant amounts. BUN is a measurement of the nitrogen portion of urea and is also excreted in the urine - this is a good indicator of renal function. HOWEVER, conditions that increase catabolism (AKI) also cause a rise in BUN levels. Therefore the serum creatinine levels are a more appropriate evaluation of renal function. Answers A, C, and D are incorrect. Neutrophils and lymphocytes do not monitor renal function return.

•In conducting client teaching with a client who will undergo peritoneal dialysis at home, the nurse includes discussion of what common and significant complication of peritoneal dialysis? a.Pulmonary embolism b.Hypotension c.Dyspnea d.Peritonitis

Answer D is correct. Peritonitis is a grave complication of peritoneal dialysis caused by bacteria that may enter though the catheter or dialysate solution. One of the first signs of peritonitis is cloudy dialysate drainage. Answer B is incorrect. Hypotension is a common complication of hemodialysis but not peritoneal dialysis. Answers A and C are not complications of peritoneal dialysis.

•Which statement made by the client with chronic renal failure and who is on hemodialysis indicates the need for further teaching? a."I will report any increase in my weight of 5 pounds in a 2-day period." b."I take my prescribed antihypertensive drugs daily." c."I am careful to take precautions in the arm with my AV fistula." d."I comply with my salt restrictions in my diet by using salt substitutes."

Answer D is correct. The client needs further education. Many salt substitutes contain potassium chloride and this is carefully regulated in clients with renal failure. Answers A, B, and C are all correct things for the client with CRF to do.

•A client with chronic renal failure asks the nurse why he is anemic. What response by the nurse is best? a."The increased metabolic waste products in your body depress the bone marrow." b."We will need to review your dietary intake of iron rich foods." c."There is a decreased production by the kidneys of the hormone erythropoietin." d."It is most likely that you have hereditary traits for the development of anemia."

C is the correct answer. Anemia is common in clients with renal failure because of decreased production of erythropoietin by the kidneys and shortened RBC life. Erythropoietin helps bone marrow produce RBC. Answers A is incorrect. Metabolic waste doesn't influence the production of RBC's by bone marrow. Answers B and D are not correct - while this may be done - it is not related to the production of RBC's and anemia in a chronic renal failure client.

nursing implications of CKD

Dialysis will be required HTN is likely Fluid restriction and dietary restrictions of protein, potassium and phosphate Hypoxia associated with anemia (erythropoietin supplementation) Increased risk of infection GI disturbances and anorexia impact nutritional status