Kidney Disease

Calcium Acetate (PhosLo)

A phosphate BINDER, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after.

Kidney functions (other than filtering)

-Convert inactive vitamin D to its active form calcitriol—>incr GI absorb of calcium and DECR release of PTH -Releases Renin —> INCR BP -Releases Erythropoietin (EPO): stimulates RBC production

Creatinine

0.6-1.2 mg/dL Muscle Breakdown waste product ONLY filtered in Glomerulus (not resorbed in tubules)—>proxy for GFR

Normal GFR

90-120 mL/min

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

Pericarditis occurs in many people with stage 5 CKD due to the uremia and prolonged dialysis. The manifestations of uremic pericarditis resemble those of viral pericarditis with all its potential complications, including cardiac tamponade.

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which dietary intervention would be most appropriate for the nurse to provide?

Restrict intake of dietary protein. Early morning nausea is common in CKD. Nausea and vomiting often improve with the restriction of dietary protein and after initiation of dialysis and disappears after kidney transplant.

Potassium Sparing

S for Sparing! SPIRONOLACTONE "-tone" for Blocks Aldosterone Nursing Teaching: -Avoid foods with K+ -Avoid slat substitutes -Watch for signs of HyPERkalemia (NUMBNESS or paresthesia in extremities, PEAKED T-waves, ST ELEVATION, Arrhythmias, Cramping, Confusion)

CKD Stages 1-5

Stage 1: Normal GFR >90 + proteinuria (>3 months) Stage 2: GFR 60-89 + proteinuria (>3 months) Stage 3: GFR 30-59 Stage 4: severe, GFR 15-29 Stage 5: kidney failure, GFR less than 15

Diuretics Nursing Consideration

TAKE IN MORNING (avoid pee at night) Slow position Changes (any BP med) SUNBURN RISK DAILY weights (report 2-3 lb loss or gain) Hold for low BP Check BUN and Creatinine Check for K+ Imbalances (priority action is to put on cardiac monitor) Low Sodium Diet (sodium swells)

Peritoneal Dialysis Exchange Schedule Types

The process of filling and then draining your abdomen is called an exchange. The two main schedules are: 1) Continuous AMBULATORY peritoneal dialysis (CAPD): - client can go about daily activity during dwell time -3-5 exchanges during the day and 1 with a longer dwell time while you sleep -GRAVITY drains dialysate 2) Continuous CYCLING peritoneal dialysis (CCPD): -uses a MACHINE (automated cycler) that performs multiple exchanges at night while you sleep. -must remain attached to machine for 10-12 hrs -disconnected from machine during the day, but in the morning you begin one exchange with a dwell time that lasts the ENTIRE DAY -lower risk of peritonitis because you connect and disconnect to the dialysis equipment less frequently than you do with CAPD.

Signs of Anemia (occurs with CKD)

Uncorrected anemia provokes... -Fatigue -Insomnia -Decrease in blood viscosity, -Decrease in myocardial oxygen supply, and -Tachycardia as the heart attempts to supply sufficient oxygen to the heart and brain.

Urea (BUN, blood urea nitrogen)

Waste product of protein breakdown in Liver Normal: 6-20 mg/dL

Asterixis

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend. involuntary dorsiflexion of hands and feet, can develop as CKD worsens. Burning sensation in feet, unsteady gait and demyelination of nerves can also accompany CKD

Pruritus

severe itching

Food Sources of Calcium

Broccoli, Kale Fortified Grains Dairy

What is the recommended daily fluid intake for a CKD client?

Daily fluid intake of 500 to 800 mL/day will replace insensible water loss plus a quantity equal to the 24-hour urine output. (*Intake of 2000 mL will exceed the renal ability to excrete water and will lead to circulatory overload and edema)

Peritoneal Dialysis

During peritoneal dialysis: 1) a cleansing fluid called dialysate flows through a catheter into the abdomen. 2) Dextrose in the dialysate helps filter and pulls waste, chemicals and extra fluid out from tiny blood vessels in the lining of your abdominal cavity into the peritoneum 3) After a set period of time (dwell time=usually 4-6 hours) fluid with the filtered waste products flows out of your abdomen into a collection bag. Considerations: - Teach NO soaking in bath or swimming in non-chlorinated water (infection risk), but showers and chlorinated pools are OK -Temporary Hyperglycemia and weight gain is EXPECTED because the dialysate contains dextrose! Potential Complications: infection, peritonitis (cloudy fluid) and hernia

Food Sources of Vitamin D

Fatty Fish (Salmon, Herring) Fortified products (Cereals, Milk, OJ)

Potassium Wasting Diuretics

Give when K+ levels are normal! end in -ide FUROSEMIDE (Loop Diuretic) HYDROCHLOROTHIAZIDE Considerations: -K+ foods okay -Avoid Licorice Root (lowers K+) -Watch for s/o HyPOkalemia (flat T wave, ST depression, muscle cramps, confusion, dysrhythmias) If hypokalemia, give IV K+ over >1 hr (typically never IV push!)

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value?

Hyperkalemia. Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities

Signs of CKD

Low pH (Acidosis) Low Calcium + Calcitriol + Vitamin D Decr erythropoietin (EPO) (anemia) High Phosphate + Potassium + Magnesium Incr Parathyroid Hormone (PTH) Incr Blood Urea + Creatinine (Uremia = raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys) -Proteinuria, Hematuria

Food Sources of Potassium

MELONS Tomatoes Orange Banana Green Leafy Veggies Avocado Broccoli Potato Dairy Products Dried Peas and Fruit (apricots) Kidney Beans Whole Grains Meat Liver

Signs of Hypocalcemia include...

Muscle twitching, irritability, and tetany + Chvostek's and Trousseau's Sign (hand wrist contraction with BP cuff) ECG Changes Nursing Actions: Monitor ECG and Respiratory status. Give PO tabs with Vitamin D

Phosphate

Normal: 2.5-4.5 mg/dL Phosphate and Calcium bind together so they have opposite levels (i.e. high phosphate levels in blood decr free calcium bc calcium binds to phosphate)