Untitled Quiz

Chronic kidney disease (CKD) is a progressive, irreversible decline in kidney function. It is characterized by abnormalities of kidney structure or function that persist for more than three months. The pathophysiology involves damage to the nephrons, the functional units of the kidneys, leading to a decrease in glomerular filtration rate (GFR). This results in the retention of waste products and fluid in the body. Manifestations of CKD can be varied and progress as the disease worsens, including fatigue, anemia, edema, hypertension, nausea, vomiting, electrolyte imbalances, and decreased urine output. Laboratory abnormalities include elevated creatinine, blood urea nitrogen (BUN), and decreased GFR.

Nursing assessments for individuals with chronic kidney disease focus on monitoring overall health, disease progression, and potential complications. Vital signs, including blood pressure, heart rate, and temperature, are regularly monitored. Additionally, assessments include evaluating fluid status (edema, weight gain), electrolyte balance, nutritional status, skin integrity, respiratory function, cardiovascular function, and mental status. The assessment process is individualized to address the specific needs and concerns of each patient.

Important assessments and on-going monitoring for patients with renal disease undergoing dialysis include:

1. Vital signs: Regularly monitor blood pressure, heart rate, temperature, and respiratory rate. Report any significant changes or fluctuations.
2. Fluid balance: Assess for signs of fluid overload (edema, weight gain) or fluid depletion (hypotension, dry mucous membranes).
3. Electrolytes: Monitor potassium, sodium, calcium, phosphorus, and magnesium levels. Report any abnormal values.
4. Vascular access: Inspect and palpate the vascular access site for signs of infection, inflammation, or thrombosis.
5. Dialysis adequacy: Monitor the adequacy of dialysis treatment by checking the post-dialysis urea reduction ratio (URR) and Kt/V values.
6. Nutritional status: Assess for signs of malnutrition and monitor protein intake.
7. Other assessments: Evaluate mental status, skin integrity, and for any signs of infection or inflammation, and report any abnormal findings.

<p>Creatinine is a waste product produced by muscle metabolism and filtered by the kidneys. The level of creatinine in the blood is inversely proportional to kidney function. Higher creatinine levels indicate a lower filtration rate (GFR), suggesting impaired kidney function. Regular creatinine tests help assess overall kidney health and monitor disease progression.</p> Signup and view all the answers

<p>BUN (Blood Urea Nitrogen) is a waste product formed from the breakdown of protein in the liver. It is filtered by the kidneys. A high BUN level usually indicates reduced kidney function, as the kidneys are not effectively removing urea from the blood. However, it is crucial to note that factors like dehydration, certain medications, and high protein intake can also elevate BUN levels independently of kidney function. Therefore, it is necessary to consider these factors while interpreting BUN test results.</p> Signup and view all the answers

<p>Intrinsic</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>All of the above</p> Signup and view all the answers

<p>Common causes of acute kidney injury (AKI) include:</p> <ol> <li>Prerenal AKI: Low blood volume, heart failure, sepsis, severe dehydration</li> <li>Intrinsic AKI: Nephrotoxic medications, infections, trauma to the kidneys</li> <li>Postrenal AKI: Kidney stones, blockage of the urinary tract, prostate enlargement</li> </ol> Signup and view all the answers

<p>Autoregulation</p> Signup and view all the answers

<p>The four phases of AKI are the onset phase, oliguric (anuric) phase, diuretic phase, and recovery phase. The onset phase refers to the initial period when the kidney injury occurs and is usually characterized by a sudden decrease in kidney function and urine output. The oliguric/anuric phase is marked by significantly reduced urine output, often below 400 mL/day. In the diuretic phase, urine output increases as kidney function recovers, but there may still be electrolyte imbalances and fluid overload. Finally, the recovery phase signifies the restoration of normal or near-normal kidney function.</p> Signup and view all the answers

<p>Risks during the Oliguric and Diuretic phases of AKI include:</p> <ol> <li>Electrolyte imbalances: These can range from hyperkalemia to hypocalcemia leading to serious heart rhythm abnormalities and cardiac arrest.</li> <li>Fluid overload: As the kidneys are unable to eliminate excess fluid, fluid overload can occur, leading to pulmonary edema, heart failure, and other complications.</li> <li>Infection: Impaired immune function during AKI makes patients susceptible to infections that can worsen the condition.</li> </ol> Signup and view all the answers

<p>Chronic kidney disease (CKD) refers to the presence of abnormalities of kidney function or structure that persist for over three months, impacting overall health. The condition can be caused by a variety of factors, including diabetes, hypertension, and certain medical conditions, leading to long-term damage to the kidneys and a gradual decline in filtration function.</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>A and B</p> Signup and view all the answers

<p>G1 = Normal or high GFR G2 = Mildly decreased GFR G3a = Mildly to moderately decreased GFR G3b = Moderately to severely decreased GFR G4 = Severely decreased GFR G5 = Kidney failure</p> Signup and view all the answers

<p>Chronic kidney disease (CKD) can have a range of effects on the body, affecting many organ systems. Here are some key effects:</p> <ol> <li>Electrolyte imbalances: CKD affects the kidneys ability to regulate electrolytes leading to issues with potassium, sodium, calcium, and phosphorus levels, impacting heart function, bone health, and mental state.</li> <li>Anemia: CKD can cause anemia due to its inability to produce erythropoietin, a hormone essential for red blood cell production.</li> <li>Cardiovascular problems: CKD frequently leads to hypertension, heart failure, and increased risk of heart attacks and strokes.</li> <li>Bone disease: CKD affects the kidneys' ability to regulate vitamin D metabolism, which is essential for bone health, often causing brittle bones and risk of fractures.</li> <li>Fluid overload: The kidneys' inability to eliminate waste products and retain fluid can result in fluid overload and edema.</li> <li>Gastrointestinal problems: CKD can cause nausea, vomiting, and gastrointestinal bleeding.</li> <li>Neurologic complications: CKD can impact brain function and lead to cognitive deficits, confusion, changes in consciousness, and peripheral neuropathy.</li> </ol> Signup and view all the answers

<p>Clinical manifestations of chronic kidney disease are diverse and can vary depending on the stage of the disease. Some common signs and symptoms include:</p> <ol> <li>Integumentary: Skin changes, such as pallor, dryness, itching, and bruising.</li> <li>Respiratory: Shortness of breath, increased respiratory rate, and crackles in the lungs.</li> <li>Renal: Decreased urine output, proteinuria, hematuria, azotemia, and hyperuricemia.</li> <li>Cardiovascular: High blood pressure, increased heart rate, dysrhythmias, abnormal heart sound, edema, and pericardial friction rub.</li> <li>Gastrointestinal: Anorexia, nausea, vomiting, halitosis, and gastrointestinal bleeding.</li> <li>Neurological: Peripheral neuropathy, restless legs, changes in level of consciousness (LOC), lethargy, confusion, encephalopathy, and altered motor function.</li> <li>Musculoskeletal: Renal osteodystrophy, decreased calcium, vitamin D deficiency, hyperparathyroidism, and pathologic fractures.</li> <li>Hematological: Anemia, weakness, fatigue, pallor, lethargy, and bleeding due to impaired platelet aggregation.</li> <li>Immune: Increased risk of infection, both local and systemic.</li> </ol> Signup and view all the answers

<p>Common lab tests and findings associated with CKD include:</p> <ol> <li>CBC (Complete Blood Count): Low red blood cell count (RBC), hemoglobin, hematocrit, platelets, and albumin levels.</li> <li>Electrolytes: High potassium and phosphorus levels. Low calcium levels. Sodium levels can be high or low depending on the water balance.</li> <li>Renal function tests: Elevated creatinine and Blood Urea Nitrogen (BUN) levels.</li> </ol> Signup and view all the answers

<p>The two main categories of renal replacement therapies are:</p> <ol> <li>Peritoneal dialysis: This uses the peritoneal membrane as a filter to remove waste products and excess fluid from the body.</li> <li>Hemodialysis: This uses a machine to filter the blood, removing waste products and excess fluid, and returning cleaned blood back to the body.</li> </ol> Signup and view all the answers

<p>Renal replacement therapies are needed when the kidneys are no longer able to function properly, usually when the GFR falls below 15 mL/min. In this situation, the kidneys cannot effectively filter waste products and excess fluid from the body. Renal replacement therapies provide a way to mimic the kidneys' function and sustain life.</p> Signup and view all the answers

<p>Peritoneal dialysis utilizes the lining of the abdomen (the peritoneum) as a natural filter. A special solution, called dialysate, is infused into the abdominal cavity, where it draws out waste products and excess fluid from the blood through a process of osmosis and diffusion. This process is continuous, with dialysate being exchanged several times a day.</p> Signup and view all the answers

<p>Hemodialysis is a process where blood is cleaned outside the body using a machine. The blood is passed through a semipermeable membrane in the dialysis machine, which removes waste products and excess fluid. Cleaned blood is then returned to the body. This process typically involves multiple sessions per week, each lasting for several hours.</p> Signup and view all the answers

<p>Vascular access is essential for hemodialysis as it provides a direct route for the passage of blood to and from the dialysis machine. The access needs to be easily accessible, have a large enough diameter to accommodate the necessary blood flow rate, and function reliably over time. Common types of vascular access include arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central venous catheters.</p> Signup and view all the answers

<p>Hemodialysis is typically performed 3 times per week, with each session lasting for several hours. However, the frequency and duration of dialysis treatment can vary depending on the individual's needs, overall health, and the severity of kidney disease.</p> Signup and view all the answers

<p>After hemodialysis, it is crucial to monitor the patient's volume status, blood pressure, electrolytes, anemia, nutritional status, and for any signs of infection or inflammation.</p> <ol> <li>Volume status: Check for signs of dehydration and fluid overload.</li> <li>Blood pressure: Monitor for both hypertension and hypotension.</li> <li>Electrolytes: Assess for electrolyte imbalances, especially potassium levels.</li> <li>Anemia: Monitor hemoglobin levels and assess for symptoms of anemia.</li> <li>Nutritional status: Evaluate nutritional intake and monitor for signs of malnutrition.</li> <li>Infection: Assess for signs of infection at the access site.</li> </ol> Signup and view all the answers

<p>The &quot;dry weight&quot; in hemodialysis refers to the ideal body weight a patient should maintain between dialysis sessions. It is crucial for managing fluid balance and preventing fluid overload. To determine the dry weight, healthcare professionals collaborate with the patient to gradually adjust fluid removal during dialysis, seeking to achieve optimal weight without experiencing symptoms of fluid depletion or overload.</p> Signup and view all the answers

<p>Managing volume status in patients undergoing hemodialysis is critical to prevent both fluid overload and fluid depletion.</p> <ol> <li>Fluid overload: Can lead to edema, hypertension, pulmonary edema, and congestive heart failure.</li> <li>Fluid depletion: Can cause hypotension, decreased cardiac output, and tissue ischemia. Proper volume management contributes to improving cardiovascular stability, reducing the risk of complications, and ensuring safe and effective dialysis treatment.</li> </ol> Signup and view all the answers

<p>Intradialytic hypotension refers to a drop in blood pressure during a hemodialysis session. It commonly occurs due to rapid fluid removal, leading to reduced blood volume and a decrease in blood pressure. Preventing intradialytic hypotension involves careful monitoring of fluid removal, maintaining adequate blood volume, and adjusting dialysis parameters if necessary. Interventions may include slowing fluid removal rates, using medications like normal saline, or administering volume expanders. Effective communication between the patient and the dialysis team is crucial for managing this condition.</p> Signup and view all the answers

<p>Patients with ESRD often experience acid-base and electrolyte imbalances:</p> <ol> <li>Before hemodialysis: Metabolic acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia, and potential hyperglycemia.</li> <li>After hemodialysis: Metabolic alkalosis, electrolyte shifts (often opposite to predialysis levels), and possible hypokalemia. Management involves monitoring these imbalances, adjusting medications, and adjusting the composition of the dialysate solution to address the specific needs of the patient.</li> </ol> Signup and view all the answers

<p>Nursing assessments to monitor electrolyte imbalances include:</p> <ol> <li>Hyponatremia: Assess for irritability, apprehension, confusion, seizures, headache, and nausea and vomiting.</li> <li>Hypernatremia: Evaluate for weight loss, dehydration, lethargy, intense thirst, restlessness, agitation, twitching, seizures, and coma.</li> <li>Hypokalemia: Check for fatigue, muscle weakness, bradycardia, leg cramps, polyuria, hyperglycemia, and arrhythmias.</li> <li>Hyperkalemia: Monitor for cardiac and neuromuscular symptoms, including weakness, fatigue, paresthesia, decreased deep tendon reflexes, palpitations, and arrhythmias.</li> <li>Hypocalcemia: Assess for tetany, paresthesia, Chvostek's sign, Trousseau's sign, seizures, increased fatigue, depression, anxiety, confusion, hypotension, and respiratory signs like laryngeal spasm, bronchospasm, and stridor.</li> <li>Hypercalcemia: Monitor for lethargy, muscle weakness, decreased deep tendon reflexes, memory impairment, confusion, personality changes, psychosis, stupor, coma, bone pain, fractures, anorexia, nausea, vomiting, increased thirst, and constipation.</li> <li>Hypophosphatemia: Assess for muscle weakness, tremors, paresthesia, bone pain, decreased reflexes, seizures, delirium, hallucinations, respiratory weakness, and gastrointestinal issues like anorexia and dysphagia.</li> <li>Hyperphosphatemia: Monitor for tetany, hyperreflexia, muscle weakness, flaccid paralysis, painful joints, tachycardia, gastrointestinal issues (nausea, vomiting, abdominal cramps), and dry itchy skin.</li> <li>Monitor laboratory values: Regularly assess electrolytes levels to identify any imbalances and guide treatment decisions.</li> </ol> Signup and view all the answers

<p>Malnutrition in CKD is a significant concern because it can exacerbate existing kidney problems and lead to further complications. It is characterized by inadequate intake or reduced storage of protein and energy, often resulting from decreased appetite, nausea, vomiting, and electrolyte imbalances. Malnutrition can lead to muscle wasting, weakened immune function, increased risk of infections, and delayed healing. It also contributes to bone disease, anemia, and cardiovascular problems.</p> Signup and view all the answers

<p>Mineral Bone Disorder (MBD) is a condition that occurs in patients with CKD. The kidneys play a vital role in regulating calcium, phosphorus, and vitamin D levels. When kidney function declines, the body loses its ability to control these minerals, leading to imbalances in the body, which can negatively impact bone health. MBD is a significant concern because it can lead to bone weakness, fractures, and even cardiovascular disease. It requires careful management to prevent complications and improve quality of life for patients with CKD.</p> Signup and view all the answers

<p>Anemia refers to a condition characterized by a decreased number of red blood cells in the body, resulting in reduced oxygen-carrying capacity. In patients with CKD, the kidneys produce erythropoietin (EPO), a hormone that stimulates red blood cell production. When kidney function declines, EPO production is impaired leading to anemia. This can lead to fatigue, weakness, shortness of breath, pale skin, and decreased physical activity. Anemia in CKD is a concern as it can exacerbate existing health problems, affect quality of life, and impact the effectiveness of dialysis treatments.</p> Signup and view all the answers

<p>Common manifestations of anemia include:</p> <ol> <li>Weakness</li> <li>Fatigue</li> <li>Headaches</li> <li>Problems with concentration</li> <li>Pale skin</li> <li>Dizziness</li> <li>Difficulty breathing or shortness of breath</li> <li>Chest pain</li> <li>Tachycardia</li> <li>Irregular heart rhythm.</li> </ol> Signup and view all the answers

<p>Inflammation and infection are serious concerns for patients with CKD because they can worsen the condition and lead to complications. Individuals with CKD often have compromised immune systems, making them more susceptible to infections.</p> <ol> <li>Impaired Immune Function: A weakened immune system makes it difficult to fight off infections effectively.</li> <li>Increased Risk of Tissue Ischemia: The reduced blood flow caused by CKD increases the risk of tissue ischemia, which makes the body less able to heal wounds, increasing the risk of infections.</li> <li>Chronic Wounds: Delayed healing can lead to chronic wounds, which are more difficult to treat and increase the risk of complications.</li> <li>Amputation: If infections are not controlled, they can lead to severe complications such as necrosis and possible amputation of the affected limb.</li> </ol> Signup and view all the answers

<p>Renal management involves a multidisciplinary approach with a focus on controlling blood pressure, managing medications, adhering to dietary restrictions, and supporting the patient's overall well-being.</p> <ol> <li>Blood pressure management: Strict control of blood pressure is essential to slow the progression of CKD and prevent cardiovascular complications.</li> <li>Medications: ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers are often prescribed to control blood pressure and reduce kidney damage.</li> <li>Diet: Dietary modifications, including sodium and fluid restrictions and protein adjustments, are crucial for managing fluid balance, controlling blood pressure, and preventing electrolyte imbalances.</li> <li>Other therapies: Dialysis or kidney transplantation may be necessary when CKD progresses to end-stage renal failure. Supportive measures, including emotional and psychological support, are important for patients and their families.</li> </ol> Signup and view all the answers

<p>Patients with CKD may have a restricted daily fluid intake for the following reasons:</p> <ol> <li>Fluid overload: When the kidneys are unable to adequately filter fluid, the body retains excess fluid leading to edema, hypertension, and other complications.</li> <li>To manage blood pressure: Fluid restriction can be a useful measure for managing blood pressure, especially for patients with hypertension.</li> <li>To prevent electrolyte imbalances: Fluids play a significant role in regulating electrolyte balance. Fluid restriction can help prevent or manage certain electrolyte disturbances.</li> </ol> Signup and view all the answers

<p>Some common medications used to control blood pressure in CKD include:</p> <ol> <li>ACE inhibitors: These medications block the conversion of angiotensin I to angiotensin II, resulting in vasodilation and decreased blood pressure. Examples include lisinopril (Prinivil, Zestril), enalapril (Vasotec), and ramipril (Altace).</li> <li>Angiotensin receptor blockers (ARBs): These medications block the action of angiotensin II by preventing it from binding to its receptors, leading to vasodilation and lower blood pressure. Examples include losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro).</li> <li>Calcium channel blockers: These medications prevent calcium from entering certain cells, allowing for relaxation of blood vessels and reduced blood pressure. Examples include nifedipine (Procardia, Adalat), amlodipine (Norvasc), diltiazem (Cardizem), and verapamil (Calan, Isoptin).</li> </ol> Signup and view all the answers

<p>Dietary considerations for patients with CKD aim to manage potassium, phosphorus, sodium, and fluid intake to minimize the workload on the kidneys and prevent complications.</p> <ol> <li>Restriction of Potassium: Foods rich in potassium, like bananas, potatoes, tomatoes, oranges, squash, and beans should be limited.</li> <li>Restriction of Phosphorus: Milk, cheese, and other milk products, protein-rich foods (meat, fish, poultry) should be restricted.</li> <li>Restriction of Sodium: Processed foods, salty snacks, and salted seasonings should be avoided.</li> <li>Restriction of Fluid: Fluids should be limited to address potential fluid overload issues, and patients should be closely monitored for signs of fluid depletion and overload.</li> </ol> Signup and view all the answers

<p>Fluid restriction is generally calculated by adding the patient's daily urine output to a standard amount, typically 400-600mL. The 400-600mL accounts for fluid loss through skin and lungs. However, it's crucial to note that many dialysis patients do not urinate. In such cases, a daily intake of 500-1000mL is often recommended to keep weight gain within a safe range, usually between 0.5 to 1 kilogram.</p> Signup and view all the answers