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Questions and Answers
What is a key dietary concern for patients with Chronic Kidney Disease (CKD)?
Which of the following is an important nursing intervention to prevent complications in CKD patients?
What complication should nurses specifically monitor for in CKD patients during dialysis?
How should the head of bed (HOB) be positioned for patients post-transplant?
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What sign indicates a functioning fistula in dialysis patients?
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What is a common risk factor for chronic kidney disease?
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Which of the following complications is associated with chronic kidney disease?
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Which of the following is a clinical manifestation of chronic kidney disease?
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What is the primary method for diagnosing chronic kidney disease?
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Which nursing diagnosis is commonly associated with patients suffering from chronic kidney disease?
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What is a potential endocrine complication of chronic kidney disease?
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What treatment aims to support the remaining kidney function in patients with chronic kidney disease?
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Which assessment should be prioritized in nursing management for chronic kidney disease?
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What is a significant pathophysiological characteristic of chronic kidney disease?
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What alteration is most commonly seen in patients with chronic kidney disease related to fluid balance?
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Which of the following is a common risk factor for the development of chronic kidney disease?
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Which clinical manifestation is associated with impaired metabolic waste elimination in chronic kidney disease?
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What is a common complication following a renal transplant?
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Which of the following interventions should nurses emphasize to patients on dialysis?
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What is a common endocrine complication in patients with chronic kidney disease?
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What key assessment should be prioritized in managing patients with chronic kidney disease?
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Study Notes
Chronic Kidney Disease (CKD)
- Epidemiology: Affects one in seven Americans, totaling 37 million people.
- Risk Factors: Diabetes, hypertension, hyperlipidemia, smoking, recreational drug use, NSAID use, and obesity.
- Pathophysiology: Progressive and irreversible loss of kidney function.
-
Clinical Manifestations:
- Fluid and Electrolyte Imbalances: Hypertension, heart failure, pulmonary edema, lethal arrhythmias due to altered potassium excretion.
- Waste Elimination: Nausea, vomiting, anorexia, neurological symptoms due to impaired metabolic waste elimination.
- Calcium and Phosphorus Imbalance: Bone breakdown, osteodystrophies, defective bone development.
- Acid-Base Imbalance: Metabolic acidosis due to decreased acid clearance and bicarbonate production.
- Endocrine: Infertility, amenorrhea, hyperparathyroidism, thyroid abnormalities.
- Hematologic: Chronic anemia.
- Medical Management - Diagnosis: Elevated serum creatinine, decreased creatinine clearance, protein/albumin in urine, uremia, renal ultrasound, CT scan, and renal biopsy.
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Medical Management - Treatment:
- Renal Replacement Therapy (RRT): Continuous Renal Replacement Therapy (CRRT) and dialysis.
- Restorative Therapies: Support remaining kidney function.
- Symptomatic Management: Treat clinical manifestations.
- Preventative Measures: Prevent complications.
- Surgical Management: Renal transplant.
- Complications: Rejection after renal transplant and long-term immunosuppression.
- Nursing Management - Assessment and Analysis: Clinical manifestations can affect all bodily systems.
-
Nursing Management - Nursing Diagnoses:
- Excess fluid volume.
- Disturbed thought processes.
- Fatigue.
- Potential Complications: Dysrhythmia, anorexia, nausea/vomiting, bone demineralization.
- Nursing Interventions - Assessments: Vital signs, pulmonary, cardiac, peripheral vascular, laboratory values, and post-transplant assessment.
- Nursing Interventions - Actions: Maintain cardiac monitor, weigh patient, restrict fluids and sodium, administer medications as prescribed, and provide post-transplant care.
-
Nursing Interventions - Teaching:
- Dialysis: Adhere to dialysis appointments to prevent electrolyte complications, particularly hyperkalemia.
- Dietary Restrictions: Follow dietary restrictions.
- Clinical Manifestations: Recognize clinical manifestations of CKD and complications.
- Nephrotoxic Substances: Avoid nephrotoxic substances.
- Weight Monitoring: Monitor daily weight.
- Post-transplant Care: Follow post-transplant instructions.
- Positioning: Maintain head of bed (HOB) elevated.
- Cardiac Monitoring: Monitor cardiac function.
- Nursing Management - Evaluating Care Outcomes: Maintain dialysis schedule, comply with diet and medications, remain free from complications, and ensure fistula maintains thrill (pulsating) and bruit (whooshing sounds).
Renal Replacement Therapy
- Mechanism: Solute and water movement across a semipermeable membrane.
- Principles: Solutes and water move based on diffusion (concentration gradient), driven by dialysate addition, and filtration (hydrostatic pressure gradient).
Epidemiology
- Affects 1 in 7 Americans, affecting approximately 37 million people.
Risk Factors
- Diabetes
- Hypertension
- Hyperlipidemia
- Smoking
- Recreational drug use
- NSAIDs
- Obesity
Pathophysiology
- Progressive and irreversible loss of kidney function.
Clinical Manifestations
-
Fluid and Electrolyte Disturbances:
-
Sodium and Fluid Imbalance:
- Hypertension
- Heart failure
- Pulmonary edema
-
Altered Potassium Excretion:
- Lethal arrhythmias
-
Sodium and Fluid Imbalance:
-
Metabolic Waste Accumulation:
- Nausea
- Vomiting
- Anorexia
- Neurological symptoms
-
Calcium and Phosphorus Imbalances:
- Bone breakdown
- Osteodystrophies
- Defective bone development
-
Acid-Base Disturbances:
- Decreased acid clearance
- Bicarbonate production
- Metabolic acidosis
-
Endocrine System Complications:
- Infertility
- Amenorrhea
- Hyperparathyroidism
- Thyroid abnormalities
- Chronic Anemia
Medical Management - Diagnosis
- Elevated serum creatinine
- Decreased creatinine clearance
- Protein/albumin in urine
- Uremia
- Renal ultrasound
- CT scan
- Renal biopsy
Medical Management - Treatment
-
Renal Replacement Therapy:
- Continuous Renal Replacement Therapy (CRRT)
-
Support Remaining Kidney Function:
- Medications
- Lifestyle modifications
-
Treatment of Clinical Manifestations:
- Addressing fluid and electrolyte imbalances
- Managing hypertension
- Treating anemia
-
Prevention of Complications:
- Monitoring for infection
- Controlling blood sugar levels
- Managing cardiovascular risk factors
Surgical Management
- Renal transplant.
Complications
- Rejection after renal transplant.
- Long-term immunosuppression.
Nursing Management - Assessment and Analysis
- Assess for clinical manifestations across all body systems.
Nursing Management - Nursing Diagnoses
- Excess fluid volume
- Disturbed thought processes
- Fatigue
- Potential complications:
- Dysrhythmia
- Anorexia
- Nausea/vomiting
- Bone demineralization
Nursing Interventions - Assessments
- Vital signs
- Pulmonary, cardiac, peripheral vascular assessments
- Laboratory values
- Post-transplant assessment
Nursing Interventions - Actions
- Maintain cardiac monitoring
- Weigh the patient
- Restrict fluids and sodium
- Administer medications as prescribed
- Post-transplant care
Nursing Interventions - Teaching
-
Dialysis:
- Do not miss dialysis appointments (risk of electrolyte complications, especially hyperkalemia)
-
Dietary Restrictions:
- Adherence to dietary restrictions
-
Clinical Manifestations and Complications:
- Educate on signs and symptoms of CKD and potential complications
-
Nephrotoxic Substances:
- Avoidance of nephrotoxic substances
-
Daily Weight Monitoring:
- Importance of monitoring daily weight
-
Post-transplant Care:
- Post-transplant education
-
Positioning:
- Head of bed elevated
-
Cardiac Monitoring:
- Continuous cardiac monitoring
Nursing Management - Evaluating Care Outcomes
- Adherence to dialysis schedule
- Dietary compliance
- Medication compliance
- Freedom from complications
- Assessment of fistula patency (thrill and bruit)
Renal Replacement Therapy
- Solutes and water movement across a semipermeable membrane.
- Movement is driven by diffusion, filtration, and dialysate.
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Description
This quiz covers the essential aspects of Chronic Kidney Disease (CKD), including its epidemiology, risk factors, pathophysiology, and clinical manifestations. Test your knowledge on how CKD impacts the body and explore its medical management and diagnosis.
