What's up with your blood?
This is considered necessary (for patient survival) at ESRD stage five.
What is dialysis
This lab is considered WNL at 10-20mg/dL. (older adults MAY be slightly increased) This is important to monitor because it is a waste product of ______ _________.
What are the greatest risk factors for developing CKD?
___________ & __________
What are HTN & DM
Your patient has a GFR of 12. What does this mean?
Your patient is in what is considered Stage 5 of CKD. Hopefully the discussion of dialysis has been had prior to this and a catheter/fistula has been implanted. If your patient does not receive dialysis they will die.
Stage 5- GFR<15 dialysis or death
When we do renal imaging to confirm chronic pyelonephritis, what will it show?
Atrophy/scarring of the kidney
Your patient's GFR is 15. They are lethargic, have an increased BUN, and muscle weakness, and are on telemetry for possible dysrhythmias. They were admitted to your unit for metabolic acidosis. These are all clinical manifestations of ________ _________.
What is missing dialysis?
WNL for serum sodium is _____-_______.
135-145
Osteoporosis commonly occurs in patients with end-stage-renal disease due to?
What is: Deficient active Vitamin D.
This is considered mild with a GFR 89-60.
Stage 2
You have a (male) patient with chronic kidney disease. When analyzing their CBC you notice they have an Hgb of 9.5, HCT of 28%, RBC of 3.9 million. Is this normal? If not, what may cause an issue?
This is NOT normal. This patient's labs indicate signs of anemia. The client with CKD has anemia because of a decreased production of erythropoietin.
This is an elevated level of nitrogen in the blood.
What is azotemia?
Your patient has CKD. You know that when you look at their labs their CREA will be elevated. What is considered WNL and what do elevated levels lead to?
CREA: male-0.6-1.2, female 0.5-1.1/decreased renal function
This particular group is at higher risk for contracting UTIs
What is: sexually active women
*Tip-men also can obtain UTIs from STIs or being immunocompromised (although women are more likely because they have shorter ureters.)
The effect on renal tubules during the post-oliguric phase of acute tubular necrosis involves:
a)reconstruction of the basement membrane
b)blocking the tubule lumens by dead cells
c)making the glomeruli patent again
d)regeneration of the renal tubular epithelium
d) Regeneration of the renal tubular epithelium
During the post oliguric phase of acute tubular necrosis, the renal tubular epithelium is regenerating. Disruption of basement membranes is not characteristic of acute tubular necrosis. Blockage of the tubule lumens would cause oliguria. The glomeruli are not clogged during acute tubular necrosis.
Kidney Stone
This clinical manifestation of chronic kidney disease is due to a lack of erythropoietin needed for bone marrow.
What is anemia?
Potassium (K+)/3.5-5
Persons that are at highest risk for acute pyelonephritis?
Diabetes, pregnancy
This is a part of two stages labeled a & b with a GFR of 59-45 and considered "moderate".
What is Stage 3a?
The glomerular filtration rate is most accurately reflected in the __________ ___________.
Creatinine level
This syndrome is a complication of Chronic Kidney disease. It is the retention of metabolic waste in the blood.
What is uremic syndrome?
Your client is in ESRD. You notice they're very itchy and it is making them anxious. You check their labs and notice their __________ is high. WNL labs for ________ is ______-_______.
Phosphorus/phosphorus 3.0-4.5mg/dL
Regarding CKD, what do you want to teach your patient? What might they need to include/cut out in their diet?
Decrease potassium intake, increase hemoglobin (dark leafy greens), and decrease sodium intake.
Cut out
-high sodium, highly processed foods,fatty/fried foods
-foods like tomatoes, bananas, foods high in potassium
Add on
-dark leafy greens
-plant proteins/healthy protein options
-sometimes a fluid restriction can be in place
Fluid excess and electrolyte imbalance
The oliguric phase of ATN is characterized by fluid and electrolyte imbalance. During this phase sodium is lost in the urine and potassium is not excreted. Magnesium and phosphorus are retained in the body.
Serious renal impairment does not occur until ______ of the total nephrons have been damaged.
75-80%