Kidney Disease

ESRD

100

Name 2 possible causes of End Stage Renal Disease

Systemic diseases like diabetes mellitus & hypertension, chronic glomerulonephritis, pyelonephritis=inflammation of renal pelvis, urinary tract obstruction, lesions from polycystic kidney disease, vascular diseases, infection, medications, toxic agents

200

Water/sodium retention or activation of renin/angiotensin/aldosterone system cause this

Hypertension

300

Name any 5 symptoms of End Stage Renal Disease (ESRD)

CVS: HTN (due to water/sodium retention or activation of renin angiotensin aldosterone system); heart failure & pul. edema (due to fluid overload); pericarditis (due to irritation of the pericardial lining from uremic toxins). Dermatologic: severe pruritus (itching); uremic frost or deposit of uremic crystals on the skin (uncommon). GI: anorexia; N&V; hiccups; metallic taste; ammonia odour to breath; mouth ulcerations; and bleeding. CNS: altered LOC; inability to concentrate; tremors; agitation; confusion; and seizures. Pulmonary: crackles; thick sputum; depressed cough reflex; pleuritic pain; SOB; tachypnea. **Mechanism for many of the S&S have not been identified but majority are due to accumulation of uremic waste products. (Day et al p. 1440-41)

400

This condition results from uremic toxins irritate the lining of the membranes encasing the heart.

What is Pericarditis

500

What does Glomerular Filtration Rate (GFR) indicate and how many stages does it measure?

five stages & indicates functioning of kidney. The normal is GFR 125ml/min/1.72m2 and stage 5 is GRF<15mL/min/1.73m2. Stage 5 indicates Kidney failure.

Epidemiology & Levels of Prevention

100

In the context of renal disease, appropriate patient teaching on proper use of NSAIDs would be what level of prevention

Primary

200

Which ethnicity is at an increased risk for developing kidney disease?

Aboriginals

300

This autosomal dominant progressive disease causes cysts to develop in the kidneys. What disease is this and what percentage of kidney failure is caused by it?

polycystic kidney disease, 8-10%

400

DAILY DOUBLE Video Clue: http://youtu.be/kBX4bD10MXM?t=5m19s Name & explain the procedure shown in the video

Peritoneal Dialysis Patients receiving peritoneal dialysis are able to self dialyse through a permanent tube in the abdomen. A carefully calibrated solution of electrolytes and glucose is infused across the peritoneal membrane and the blood is able to exchange electrolytes and waste this way. This form of dialysis has an increased risk of infection due to the permanent tube in the abdomen

500

You are a community health nurse in a small rural Alberta community with one patient in end stage renal disease and two patients who are in the early stages of renal failure. All three patients are elderly and unable to make the hour and a half long drive to the nearest hospital with dialysis and specialist appointments on their own, therefore requiring family members to take time off work three times a week to drive them to their clinics. Pick one of the 5 health promotion strategies and discuss how you would use it to help these patients and their families.

1. Strengthening community action 2. Building healthy public policy 3. Creating supportive environments 4. Developing personal skills 5. Reorienting health services

DOH & Promoting Health

100

Definition: Enabling people to increase control over and to improve their health

What is Health Promotion

200

DAILY DOUBLE Name 3 determinants of health and relate them to the scenario. [HINT: Name the ones from the handout (there are 5) or you'll need to be incredibly convincing for the other 7]

1. Income and social status a. High rates of poverty described in scenario b. 9.1% of Albertans are living in poverty or low income households c. This population experiences a 60% greater rate of two or more chronic diseases 2. Employment and working conditions a. Unemployment is high in this community b. Many community members have CKD, how would this affect their employment? How would it affect employment of a spouse for example if they must drive them for dialysis 3 times a week to the nearest centre 200kn away? 3. Social environment a. High rates of crime, substance abuse and family violence b. Development of socioenvironmental health promotion programs might be beneficial to this community 4. Personal health practices and coping skills a. Organization of community meeting to brainstorm potential health promotion programs to improve overall health b. High prevalence DMII, obesity, HTN in this scenario c. According to the Kidney Foundation of Canada, diabetes and renal vascular disease (including HTN) are leading causes of kidney disease (38% and 15% respectively) d. How might cost of living in a northern, rural Alberta community affect these chronic diseases? Are there educational programs and personal health practice programs in place at the local hospital or health centre? 5. Health services a. Local hospital is over capacity and unable to provide space for dialysis program b. The development of a satellite dialysis unit allows appropriate health services to be delivered to the community and addresses this need c. The population requires suitable health services in order for the community to address determinants of health appropriately Remaining 7: Social Support Networks, Education and Literacy, Physical Environments, Healthy Child Development, Biology and Genetic Endowment, Gender, Culture

300

Name any 3 principles of health promotion

1. The determinants of health guide what health promotion programs may be important in a community 2. It “involves the population as a whole in the context of their everyday life” (p.117) 3. A variety of diverse and complementary health promotion approaches are used 4. Effective and concrete public participation in health promotion is a high priority 5. “Health professionals...have an important role in nurturing and enabling health promotion” (p.118)

400

Define the three approaches to health promotion: Biomedical, Behavioural, and Socioenvironemental and provide an example of each in the context of kidney disease.

Biomedical (health is absence of disease) Behavioral (health is the result of lifestyle choices) Socioenvironmental (health is the result of DOHs that provide benefits and barriers to health)

500

Name any 3 health promotion strategies (there are 5)

Strengthening community action Building healthy public policy Creating supportive environments Developing personal skills Reorienting health services

Nursing Care & Evaluation

100

Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions? a)Osmosis and diffusion b)Passage of fluid toward a solution with a lower solute concentration c)Allowing the passage of blood cells and protein molecules through it. d)Passage of solute particles toward a solution with a higher concentration

A. Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it.

200

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client’s status after dialysis? a)Potassium level and weight b)BUN and creatinine levels c)VS and BUN d)VS and weight.

D. Following dialysis, the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

300

DAILY DOUBLE!! A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first? a)Administer oxygen b)Elevate the foot of the bed c)Restrict the client’s fluids d)Prepare the client for hemodialysis.

A. Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to reduce edema, but this isn’t the priority.

400

Which of the following nursing interventions should be included in the client’s care plan during dialysis therapy? a)Limit the client’s visitors b)Monitor the client’s blood pressure c)Pad the side rails of the bed d)Keep the client NPO.

B. Because hypotension is a complication of peritoneal dialysis, the nurse records intake and output, monitors VS, and observes the client’s behavior. The nurse also encourages visiting and other diversional activities. A client on PD does not need to be placed in bed with padded side rails or kept NPO.

500

What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure? a)The danger of hemorrhage is high. b)It cannot correct severe imbalances. c)It is a time consuming method of treatment. d)The risk of contracting hepatitis is high.

C. The disadvantages of peritoneal dialysis in long-term management of chronic renal failure is that is requires large blocks of time. The risk of hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a client’s fluid and electrolyte balance.