Stages of CKD
Expected GFR value for stage 1 CKD AND indicated interventions
What is:
GFR: above 90 ml/min
Intervention: screen for and tx underlying conditions (HTN, DM, chronic urinary/kidney infxn, exposure to nephrotoxins).
Expected value for potassium and sodium AND alteration of both expected in CKD (elevated, reduced, same)
What is: Elevated K+, elevated/reduced/normal Na+?
K+: 3.5-5 mEq/L
Na+: 135-145 mEq/L
Expected urine output for polyuria, expected stage of CKD that polyuria occurs within.
What is above 2.5-3L of urine within 24 hrs?
Early stages, mostly at night. Inability of kidneys to produce concentrated urine.
The best time to perform and read a non contrast CT/MRI scan at onset of CVA? What is being assessed?
What is scan within 25 min, read within 45 min?
Assessing type, location, size of stroke.
What BNP measures in regard to HF.
What is degree of ventricular stretch?
Expected GFR value for stage 2 CKD AND indicated interventions
What is
GFR=60-89 ml/min
Intervention: Reduction of risk factors, education on preserving function
K+ value that indicates hyperkalemia AND pathogenesis/concerns of hyperkalemia in CKD.
What is K=above 6.5 mEq/L
Reduced excretion of K+ by kidneys in CKD increases risk of dysrhythmias. Cardiac monitoring may be necessary.
Expected urine output for oliguria, expected stage of CKD that oliguria occurs within.
What is less than 400 mL in 24 hours?
Mid to late stage CKD. Inability to properly excrete urine.
Normal PTT range AND range that TPA is contraindicated in?
What is 11-12.5 sec (norm), above 15 sec (TPA contraindicated)?
BNP values, from normal state, at risk of HF, mild HF, moderate HF, severe HF
What is:
Norm: less than 100
At risk: 100-300
Mild: 300-599
Moderate: 600-899
Severe: above 900
Expected GFR value for stage 3a + 3b CKD AND indicated interventions
What is:
3a GFR=45-59 mL/min, 3b GFR=30-44 mL/min
3a Intervention: evaluate and slow progression, tx: complications
3b: more aggressive management of progression
Expected range values for calcium and phosphate, AND expected alteration in CKD.
Daily Double: why are these alterations expected in CKD?
What is
Ca2++: 9-10.5 mg/dL (total). Reduced in CKD
Phos: 3-4.5 mg/dL. Elevated in CKD.
Why? Decreased vitamin D synthesis in kidney->decreased absorption of Ca2++ in gut->decreased serum Ca->increased PTH->bone demineralization
Decreased PO excretion from kidney->increased PO in serum
Expected urine output for anuria, expected stage of CKD that anuria occurs within.
What is less than 40 mL in 24 hours?
Late stage CKD. Often occurs after long term hemodialysis.
Normal INR range AND range that TPA is contraindicated in?
What is 0.8-1.1, or less than 1.1?
TPA contraindication: greater than 1.7
Describe class I, class II, class III, class IV HF symptomatic classification.
What is:
Class I: no Sx
Class II: Sx with moderate exertion
Class III: Sx with minimal exertion
Class IV: Sx at rest
Expected GFR value for stage 4 CKD AND indicated interventions
What is:
GFR=15-29 mL/min
Interventions: dialysis or transplant preparation, manage complications. Fatal if untreated.
Expected range for magnesium, and expected alteration in CKD
What is: Mg=1.3-2.1 mEq/L, elevated d/t reduced excretion?
Expected findings in urinalysis of patient with CKD.
What is proteinuria (1+), at least twice over 3 month period, possible hematuria?
Normal range of platelet count AND range that TPA is contraindicated in?
What is 150,000-400,000 x 10^3?
Contraindicated range: less than 100,000 x 10^3
Describe class A (at risk), B (Pre-HF), C (symptomatic), D (advanced HF).
What is:
A: Pt has risk factors of HF
B: Structural changes w/o Sx
C: Structural changes w/ Sx
D: HF refractionary to tx
Expected GFR value for End Stage Renal Disease (ESRD) AND indicated interventions
What is:
GFR= less than 15mL/min
Intervention: dialysis necessary for life, or kidney transplant. Fatal if untreated
Which is more significant in determining CKD dx? What is the term for Cr/BUN elevation?
Daily Double: causes of BUN elevation (name 3)
What is:
BUN: 10-20 mg/dL. CKD--elevated
Cr: 0.5-1.2 mg/dL. CKD--elevated
If both are elevated: azotemia
DD: BUN elevation d/t fever, kidney failure, dehydration
Cause of expected anemia in CKD, and alteration to Hbg/Hct.
What is reduced erythropoetin secretion from kidneys?
Decreased Hbg, increased/same Hct
Normal range of aPTT AND range that TPA is contraindicated in?
What is 30-40 seconds?
Contraindication range: greater than 40 sec
How to improve LV function in HF AND describe medications, lifestyle changes, etc
What is: reduce preload, reduce afterload.