Kidney Patho
Best lab measure of overall kidney function
What is GFR (Glomerular Filtration Rate)
Dietary restrictions for CKD
What is low sodium, low potassium, low protein, low phosphorus, high calcium.
Most specific lab measurement for liver dysfunction
ALT (alanine aminotransferase)
Others: AST (aspartate aminotransferase), GGT (gamma-glutamyl transferase), ALP (alkaline phosphatase, Lactic Dehydrogenase
Two nursing interventions to decrease metabolic rate
Bed rest, elevate HOB for max respiratory efficiency, prevent negative outcomes of immobility
Acid-base disorder of CKD
What is Metabolic Acidosis
Name 2 blood disorders with CKD
What are Anemia and Thrombocytopenia?
3 nursing interventions for fluid volume excess in CKD
Daily weights, I&Os, fluid restrictions (500-600 mL more than previous 24 hour output)
Decreased ability of liver cells to conjugate and excrete bilirubin.
S/S: yellowing of sclera and skin, pruritis, anorexia, nausea, weight loss, malaise, fatigue, weakness, elevated AST/ALT
Two nursing interventions to reduce risk for bleeding
soft toothbrush, electric razor, safe environment (pad side rails, remove obstacles in room, prevent falls), gentle nose-blowing, observe for s/s of bleeding: melena, epistaxis, ecchymosis, petechiae, bleeding gums
Electrolyte disturbances of CKD
What are hyperkalemia, hyperphosphatemia, hypocalcemia, hypernatremia?
4 Manifestations of Uremia
Elevated BUN, Weakness, fatigue, confusion, neuropathy burning in feet and hands, pruritis, risk for seizures, metallic taste in mouth, uremic fetor
Oral medication for hyperkalemia
What is Sodium Polystyrene sulfonate (Kayexalate)?
Describe portal hypertension
Elevated pressure in the liver's venous system due to scarring and fibrosis of liver.
3 nursing interventions for pruritis from jaundice
keep fingernails short and smooth, lotion/emollients, avoid, soaps and alcohol-based lotions, avoid harsh detergents,
Major concern with hyponatremia
Neuro--risk for seizures, coma
May also cause tachycardia, weak thready pulse, respiratory arrest.
Common early symptom of CKD and why?
What is hypertension? Fluid volume excess due to hypernatremia and increased activity of RAAS.
Non-pharmacologic intervention for CKD-MBD
What is weight-bearing exercise such as walking?
Name 2 complications of portal hypertension
Splenomegaly, esophageal/gastric varices, ascites, hepatic pleural effusion
3 Assessments for Ascites
WEIGHT, I&O, Respiratory status, salt intake
Major concern with Hypo/Hyperkalemia
Heart.
Hypo: LOW and SLOW
Hyper: High, tight, contracted (can't relax and refill)
Decreased kidney perfusion>release of renin>formation of angiotensin II leading to: 1. tubular reabsorption of Na and H20 2. arteriole vasoconstriction 3. Adrenal cortex release aldosterone causing Na/H20 resorption 4.Pituitary gland secretes Anti-diuretic hormone which causes H20 reabsorption in the collecting duct
Assessments pre/post hemodialysis
Pre: bruit, thrill, site for infection or inflammation (thrombus), weight, BP
Post: weight, BP, BUN/creatinine, serum electrolytes, Hgb/Hct, dialysis disequilibrium (decreased LOC, N/V, HA, seizures)
Cause of hepatic encephalopathy
Liver unable to detoxify the byproducts of metabolism (ammonia). Ammonia crosses BB barrier leading to sleep disturbance, lethargy, asterixis, fetor hepaticus (musty sweet odor on breath)
Vitamins needing supplementation with impaired liver function
Fat-soluble A, D, E, K, Also Vit. B & Vit C
Two Signs of hypocalcemia. (Proper Names)
Chvostek sign
Trousseau sign