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Questions and Answers
Which symptom is NOT commonly associated with anemia?
Which symptom is NOT commonly associated with anemia?
What is the primary action of ACE inhibitors in managing blood pressure?
What is the primary action of ACE inhibitors in managing blood pressure?
What potential complication can arise from untreated infections in kidney disease patients?
What potential complication can arise from untreated infections in kidney disease patients?
Calcium channel blockers primarily help manage blood pressure through which mechanism?
Calcium channel blockers primarily help manage blood pressure through which mechanism?
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Which medication is typically used to decrease phosphate absorption in dialysis patients?
Which medication is typically used to decrease phosphate absorption in dialysis patients?
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Angiotensin receptor blockers (ARBs) primarily function by blocking which substance?
Angiotensin receptor blockers (ARBs) primarily function by blocking which substance?
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Which of the following is a consequence of insufficient blood supply to tissues in kidney disease?
Which of the following is a consequence of insufficient blood supply to tissues in kidney disease?
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What is a common characteristic shared by ACE inhibitors?
What is a common characteristic shared by ACE inhibitors?
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Which symptom is commonly associated with hypernatremia?
Which symptom is commonly associated with hypernatremia?
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What is a potential complication of hypokalemia?
What is a potential complication of hypokalemia?
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Which dietary modification is most critical for patients managing kidney disease?
Which dietary modification is most critical for patients managing kidney disease?
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Which of the following is a common symptom of hypocalcemia?
Which of the following is a common symptom of hypocalcemia?
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What medication effect should be monitored for patients at risk of hyperkalemia?
What medication effect should be monitored for patients at risk of hyperkalemia?
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What does dry weight refer to in the context of hemodialysis?
What does dry weight refer to in the context of hemodialysis?
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Which of the following is a sign of fluid volume excess before hemodialysis?
Which of the following is a sign of fluid volume excess before hemodialysis?
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What serious complications can arise from long-term intradialytic hypotension?
What serious complications can arise from long-term intradialytic hypotension?
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Which of the following does NOT directly affect blood pressure?
Which of the following does NOT directly affect blood pressure?
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What is the relationship between fluid removal during hemodialysis and hypotension?
What is the relationship between fluid removal during hemodialysis and hypotension?
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What is a common dietary restriction for patients undergoing hemodialysis?
What is a common dietary restriction for patients undergoing hemodialysis?
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How is euvolemia maintained in patients undergoing hemodialysis?
How is euvolemia maintained in patients undergoing hemodialysis?
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What is NOT a typical sign of hypovolemia during hemodialysis?
What is NOT a typical sign of hypovolemia during hemodialysis?
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What does peripheral/pitting edema indicate in kidney patients before dialysis?
What does peripheral/pitting edema indicate in kidney patients before dialysis?
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Which statement best explains osmosis in relation to hemodialysis?
Which statement best explains osmosis in relation to hemodialysis?
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What is the recommended timing for taking calcium carbonate pills?
What is the recommended timing for taking calcium carbonate pills?
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Which of the following foods is high in potassium and should be limited for patients with kidney disease?
Which of the following foods is high in potassium and should be limited for patients with kidney disease?
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What is a crucial dietary consideration for patients with kidney disease regarding protein intake?
What is a crucial dietary consideration for patients with kidney disease regarding protein intake?
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Which of the following symptoms may indicate fluid volume excess in a patient with kidney disease?
Which of the following symptoms may indicate fluid volume excess in a patient with kidney disease?
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For patients on dialysis, what is the safe daily fluid intake generally considered?
For patients on dialysis, what is the safe daily fluid intake generally considered?
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Which medication should be taken between meals for optimal absorption?
Which medication should be taken between meals for optimal absorption?
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What complication may arise from excessive protein intake in kidney disease patients?
What complication may arise from excessive protein intake in kidney disease patients?
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Which type of food is particularly high in sodium and should be limited in a kidney diet?
Which type of food is particularly high in sodium and should be limited in a kidney diet?
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Which symptom is NOT typically associated with fluid volume excess in kidney patients?
Which symptom is NOT typically associated with fluid volume excess in kidney patients?
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What should be included in the individualized meal plans for patients with kidney disease?
What should be included in the individualized meal plans for patients with kidney disease?
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What is a primary assessment for monitoring potential fluid volume excess before hemodialysis?
What is a primary assessment for monitoring potential fluid volume excess before hemodialysis?
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Which of the following laboratory values should be checked to assess renal function?
Which of the following laboratory values should be checked to assess renal function?
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Which symptom indicates a possible electrolyte imbalance in a kidney patient during monitoring?
Which symptom indicates a possible electrolyte imbalance in a kidney patient during monitoring?
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What dietary restriction is commonly indicated for managing kidney disease?
What dietary restriction is commonly indicated for managing kidney disease?
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Which sign is commonly assessed to monitor for signs of infection in kidney disease patients?
Which sign is commonly assessed to monitor for signs of infection in kidney disease patients?
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Which of the following is NOT a typical assessment performed on the abdominal system for kidney disease?
Which of the following is NOT a typical assessment performed on the abdominal system for kidney disease?
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What monitoring action is important to take regarding heart function in kidney disease patients?
What monitoring action is important to take regarding heart function in kidney disease patients?
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Which health indicator is most critical to observe pre and post-dialysis?
Which health indicator is most critical to observe pre and post-dialysis?
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Which vital sign assessment is essential while monitoring a patient’s respiratory system with kidney disease?
Which vital sign assessment is essential while monitoring a patient’s respiratory system with kidney disease?
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What is a potential complication of kidney disease that should be monitored?
What is a potential complication of kidney disease that should be monitored?
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Study Notes
Chronic Kidney Disease (CKD)
- CKD is defined as abnormalities of kidney structure or function that last for more than three months, impacting health.
- Includes people with kidney damage and a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 on at least two occasions, 90 days apart, with or without kidney damage markers.
- Characterized by progressive, irreversible loss of kidney function.
- Nephons lose functionality, decreasing GFR; this leads to azotemia (waste buildup in the blood).
Effects and Manifestations of CKD
- Cardiovascular: Elevated blood pressure, heart rate, fluid retention (edema), dysrhythmias, abnormal heart sounds, pericardial friction rub.
- Respiratory: Increased respiratory rate, Kussmaul respirations (deep, rapid breathing), crackles, decreased oxygen saturation, shortness of breath.
- Renal: Reduced urine output, azotemia, proteinuria, hematuria, hyperuricemia.
- Integumentary: Bruising, itching, dry skin, changes in skin color (ashen to yellowish), dry/brittle hair/nails.
- Gastrointestinal: Anorexia, nausea, vomiting, halitosis, metallic taste, gastrointestinal bleeding.
- Neurological: Peripheral neuropathy, restless legs syndrome, altered consciousness, lethargy, confusion, encephalopathy, motor function changes.
- Musculoskeletal: Renal osteodystrophy (bone disease), decreased calcium levels, impaired Vitamin D metabolism, hyperparathyroidism, pathological fractures.
- Immune: Increased susceptibility to infections (local and systemic).
- Hematological: Anemia (weakness, fatigue, pallor, lethargy, bleeding).
End-Stage Renal Disease (ESRD)
- ESRD occurs when GFR falls below 15 mL/min/1.73 m2.
- Kidneys lose filtering, secreting, reabsorbing, and excreting functions.
- Requires renal replacement therapy for survival.
Common Lab Tests and Findings in CKD
- Creatinine: Breakdown product of creatinine phosphate in muscle; used to estimate kidney function, higher levels indicate lower filtration.
- Blood Urea Nitrogen (BUN): Formed by liver during protein breakdown; filtered by kidneys; elevated BUN reflects reduced filtration.
- Oliguria: Urine output less than 400-500 ml in 24 hours.
- Anuria: Urine output less than 100 ml in 24 hours.
Renal Replacement Therapies
- Used when kidneys are unable to function properly (GFR<15 ml/min).
- Peritoneal Dialysis: Uses the peritoneum (abdominal lining) as a membrane to filter fluids and waste; dialysate is placed in peritoneum (dwell), then drained.
- Hemodialysis: Machine cleans blood, returning filtered blood to the patient; vascular access (fistula or catheter) is required.
Key Concepts Not Covered by the Sources (General Information)
- Five stages of CKD based on GFR levels.
- Specific treatment options for each stage of CKD.
- Complications associated with CKD (cardiovascular, bone disease, anemia, electrolyte imbalances)
- Long-term CKD management (lifestyle, medications)
Care of Patient Receiving Hemodialysis
- Frequency: Typically three times a week for two hours each time.
- Dry weight: Ideal weight patient can tolerate after dialysis without fluid volume issues.
Acid-Base and Electrolytes
- Pre-dialysis: Metabolic acidosis, high potassium, low sodium, low calcium, high phosphate, high magnesium, high glucose, uremia
- Post-dialysis: Metabolic alkalosis (sometimes), electrolyte shifts (generally opposite of pre-dialysis imbalances)
- Nursing Assessments: Monitor electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypophosphatemia, hyperphosphatemia including symptoms and potential issues
Other Assessments (for patients)
- Cardiovascular: Monitor blood pressure, pulses, edema, heart sounds, for fluid volume issues.
- Respiratory: Assess breathing patterns, lung sounds, oxygen saturation.
- Renal: Observe urine output, kidney palpation.
- Integumentary: Skin conditions (dryness, bruising), color changes.
- Gastrointestinal/Abdomen: Bowel sounds, abdomen size and firmness, signs of nausea, vomiting, or bleeding.
- Neurological: Mental status, reflexes, alertness, potential confusion.
Vascular Access Assessment
- Inspection: Visual assessment for sores, infections, inflammation around the access site.
- Palpation: Palpate for thrill, pulses above and below, capillary refill above and below the access site.
- Auscultation: Presence of bruit over the access site.
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Description
Explore the fundamentals of Chronic Kidney Disease (CKD), which is defined by long-term abnormalities in kidney function. This quiz covers the effects and manifestations of CKD, including cardiovascular, respiratory, renal, and integumentary symptoms. Test your knowledge on this important health topic.
