| A | B |
|---|
| what are the 4 transport mechanisms | convection, diffusion, osmosis, ultrafiltration |
| ultrafiltration | particles pushed through a SPM |
| diffusion | particles moves from high to low |
| osmosis | fluid moves from an area of low to high |
| convection | solutes dragged across SPM along with fluid |
| what are the kidneys exceretory functions | 1. normalize electrolytes 2. remove wastes 3. provide fluid and acid base balance |
| how do we replace normal excretory functions? | 1. by normalizing electrolytes through the use of acid concentrate 2. providing fluid balance through ultrafiltration |
| what is the function of acid concentrate | provides the concentration gradient for diffusion to take place and helps normalize electrolytes |
| what is the function of bicarb in the dialysate solution? | buffers the acid concentrate |
| what is the function of bicarb when it diffuses into the patients blood | normalizes body pH |
| hyperKALMIA name 4 s/s | 5.5, extreme muscle weakness, abnormal heart rhythm, possible cardiac arrest |
| HYPOkalemia name 8 s/s | 3.5, fatigue, muscle weakness, paralysis, respiratory failure, cardiac instability, arrhythmias, cardiac arrest |
| what is the normal body pH | 7.35 to 7.45 |
| what are the 3 kidney endocrine functions | 1. renin secretion 2. erythropoietin secretion 3. vitamin d activation |
| how do we replace normal endocrine kidney functions? | provide meds |
| how much of the normal kidney function is replaced by HD | 15% |
| what is uremia and how does it affect the body | buildup of wastes in the blood d/t kidney failure and affects all body systems |
| what are the 3 most common causes of CKD | 1. diabetes, 2. hypertension 3. polycystic kidney disease |
| name 6 treatment goals | 1. controlling symptoms 2. encourage pts to participate in their healthcare 3. kidney replacement therapy modality education 4. managing comorbidities and complications 5. minimize effects of ckd on lifestyle 6. slow progression of ckd |
| why is it important to know what caused your patients ckd | the nurse and pct can inquire about possible problems during data collection and assessment |
| name 3 s/sx of fluid imbalance | 1. hypertension 2. SOB 3. edema |
| why is sodium balance important | 1. volume expansion 2. increased cardiac output 3. increased peripheral vascular resistance 4. increased blood pressure |
| name systemtic effects of CKD | 1. dry, itchy skin 2. peripheral neuropathy 3. GI problems 4. physological problems |
| what to do for dry, itchy skin | use hyperfatted soaps and lotions |
| what to do for peripheral neuropathy | monitor for decreased motor function, decreased strength in legs, RLS, burning feet, do not walk barefoot, have good foot care practices |
| what to do for GI problems | inform RN and MD for any bleeding problems, constipation, diarrhea, ER visits, take meds as ordered, stool softeners |
| what to do for psychological problems | verbalize struggles to IDT (core team) especially the social worker |
| what is the consequence of prolonged fluid overload and hypertension | left ventricular hypertrophy |
| what is pericarditis | inflammation of the membrane (pericardial sac) surrounding the heart |
| what is the tx for pericarditis | decrease or stop heparin, more frequent dialysis |
| what is a common cause of hypertension in dialysis patients | fluid overload |
| left ventricular hypertrophy leads to? | 1. ischemic heart disease 2. arrhythmia 3. myocardial infarction 4. sudden death |
| why are pts with CKD anemic | RBCs only have a life span of 60 days instead of 120 days |
| name primary cause of anemia | lack of the hormone erythropoietin (EPO |
| name secondary cause of anemia | inadequate iron stores, inadequate dialysis, malnutrition, blood loss during treatment |
| what can you do to avoid contributing to lower hemoglobin and blood loss in dialysis patients | verify correct erythropoietin stimulating agent (ESA) dose is adminstered, rince back until venous line is pink tingeed, and avoid repeat lab draws |
| what are the 4 key elements contributing to CKD-Mineral bone disorder (MBD)? | 1. calcium 2. phosphorous, 3. PTH 4. Vitamin D (Calcitriol) they all lead to CKD_MBD when they are abnormal |
| what are the s/sx of CKD-MBD in addition to bone-disease? | soft tissue calcification, itching, muscle weakness, pathological fractures, tendon ruptures, compression of vertebre, atherosclerosis, heart disease |
| what is RN role in CKD-MBD management | report s/sx, urge pts to take meds, report problems related to non-compliance |
| define the term AKI | wide spectrum of kidney issues, acute kidney failure, less catastrophic kidney function changes, may dialyze in an outpatient facility until kidney function recovers |
| give 3 examples of pre renal causes of AKI | obstruction, volume depletion, impaired cardiac function, decreased cardiac output |
| give 3 examples of intra renal causes | ischemic ATN, sepsis, acute interstitial nephritis, septic shock, anaphylaxis, drugs, goodpasture syndrome, acute glomerulonephritis, trauma, open heart surgery |
| give 3 examples of post renal causes | obstruction, bladder rupture, pregnancy |
| what is the difference between AKI and CKD | with AKI if you eliminate the cause, it can lead to return of kidney function |
| what is the difference between CKD and AKI | you cant elimiate the cause of CKD like diabetes, HTN, genetic disorders (PKD) |
| how do you help in restoring AKI kidney function | find the cause of the AKI |
| what do you need to consider in regard to their vascular access | patients will typically have a dialysis catheter, be careful to avoid catheter related infections |
| how do you protect the kidneys from futher injury | avoid substances to the kidney which may be toxic (radiology contrast), amphotericin B, low dose aspirin, NSAIDS) |
| what is important when monitoring weight and bp with AKI | keep a little extra fluid on the patient so it is available to the kidneys when they start filtering/ultra-filtering on their own |
| AKI patients are at increased risk for which complications? | hypovolemia and hypotension |
