Questions and Answers
What is the primary cause of metabolic acidosis in chronic kidney disease?
Defective reabsorption and regeneration of bicarbonate
A patient with chronic kidney disease is experiencing dyspnea and Kussmaul respirations. What is the likely cause of these symptoms?
Severe metabolic acidosis
A patient with chronic kidney disease is experiencing nausea and vomiting. What is the likely cause of these symptoms?
Gastrointestinal symptoms of uremia
What is the term for the bone disorder associated with chronic kidney disease?
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A patient with chronic kidney disease has a potassium level of 6.5 mEq/L. What is the most likely cause of this electrolyte imbalance?
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What is the cardiovascular complication associated with chronic kidney disease?
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What is the daily limit of sodium intake recommended for patients with CKD?
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What is the primary goal of administering phosphate binders in CKD patients?
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Which of the following electrolyte imbalances is a concern in CKD patients?
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What is the primary complication of mineral bone disorder in CKD patients?
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What is the purpose of subtotal parathyroidectomy in CKD patients?
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What is the primary focus of nursing management in CKD patients with fluid overload?
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What is a key diagnostic indicator of kidney disease?
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What is the target blood pressure for patients with kidney disease?
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Which medication is used to treat hyperkalemia in patients with kidney disease?
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What is a potential complication of medication use in patients with kidney disease?
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What is the purpose of nutritional therapy in patients with kidney disease?
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Which of the following is a diagnostic test used to detect kidney disease?
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What is the preferred treatment for acute hyperkalemia?
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A patient with chronic kidney disease has a blood pressure of 140/90 mmHg. What is the next step in hypertension management?
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A patient with chronic kidney disease has a hemoglobin level of 9 g/dL. What is the most likely medication to be prescribed?
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A patient with chronic kidney disease has a low-density lipoprotein (LDL) level of 120 mg/dL. What is the most likely medication to be prescribed?
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What is the primary focus of nursing management in patients with chronic kidney disease?
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What is a critical component of nursing assessment in patients with chronic kidney disease?
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What is the primary mechanism by which the kidneys contribute to the development of metabolic acidosis in chronic kidney disease?
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What is the primary reason for restricting sodium intake to 2g/day in patients with chronic kidney disease?
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What is the primary hematologic consequence of chronic kidney disease?
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What is the primary goal of nutritional therapy in patients with chronic kidney disease?
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What is the primary nursing assessment focus for patients with chronic kidney disease?
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What is the primary risk associated with chronic kidney disease?
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What is the primary goal of restricting potassium intake in patients with CKD?
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Which of the following medications is used to treat secondary hyperparathyroidism in CKD patients?
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What is the primary focus of nursing management in CKD patients with hypertension?
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Which of the following is a potential risk associated with CKD patients?
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What is the primary goal of nursing assessment in CKD patients?
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Which of the following is a nursing intervention for CKD patients with anemia?
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Study Notes
Chronic Kidney Disease (CKD)
- CKD occurs most often at night, requiring diuretics, and worsens as CKD progresses, eventually requiring dialysis in End-Stage Renal Disease (ESRD).
Metabolic Disturbances
- Waste production accumulation leads to decreased Glomerular Filtration Rate (GFR) and increased Blood Urea Nitrogen (BUN) and serum creatinine levels.
- Altered carbohydrate metabolism and impaired glucose metabolism occur.
- Electrolyte and acid-base imbalance can lead to hyperkalemia, hyponatremia, and metabolic acidosis.
Cardiovascular System
- Hypertension and diabetes contribute to Cardiovascular Disease (CVD) and heart failure (HF).
- Dyslipidemia or hyperlipidemia increases the risk of Coronary Artery Disease (CAD).
Musculoskeletal System
- CKD Mineral Bone Disorder (MBD) is characterized by altered bone metabolism and bone disease (renal osteodystrophy).
Integumentary System
- Pruritus is a common symptom in CKD patients.
Reproductive System
- Infertility and decreased libido are common in CKD patients.
Psychologic System
- Behavioral changes, emotional changes, withdrawal, and depression are common in CKD patients.
Respiratory System
- Severe acidosis leads to dyspnea and Kussmaul respirations.
Gastrointestinal System
- Stomatitis, metallic taste, uremic breath, nausea, vomiting, anorexia, and constipation are common gastrointestinal symptoms in CKD patients.
Neurologic System
- Neurologic changes occur as CKD progresses, including lethargy, fatigue, confusion, irritability, peripheral neuropathy, asterixis, nocturnal leg cramping, and seizures.
Hematologic System
- Anemia, bleeding tendencies, and infection are common in CKD patients.
Diagnostic Tests
- Diagnostic tests include:
- Glomerular Filtration Rate (GFR)
- Urinalysis for albuminuria, red blood cells, and white blood cells
- Renal ultrasound to detect obstruction and kidney size
- Renal biopsy
Interprofessional Care
- Goals include preserving kidney function, reducing cardiovascular disease risk, preventing complications, and ensuring patient comfort.
- Drug therapy includes:
- Hyperkalemia treatment with potassium-binding agents, sodium polystyrene sulfonate, patiromer, and sodium zirconium cyclosilicate
- Hypertension treatment with diuretics, antihypertensive drugs, ACE inhibitors, and angiotensin receptor blockers
- Anemia treatment with erythropoiesis-stimulating agents (ESAs) and iron supplements
- Dyslipidemia treatment with statins
Nutritional Therapy
- Protein restriction, fluid restriction, and sodium and potassium restriction are essential in CKD patients.
CKD Mineral Bone Disorder
- Limit dietary phosphorus to less than 1000mg/day if patient requires Renal Replacement Therapy (RRT)
- Administer phosphate binders with meals, such as calcium carbonate, lanthanum carbonate, sevelamer carbonate, sucroferric oxyhydroxide, and ferric citrate
- Supplement Vitamin D and calcitriol to control secondary hyperparathyroidism
- Use calcimimetic agents, such as cinacalcet, and consider subtotal parathyroidectomy
