1. Risk Factors (El Hussein & Osuji, 2020, p.1285).
1.1. diabetes, HTN. infection, smoking, UTI/kidney infection, age, polycystic kidney disease, CT/MRI DYE, genetics, ETOH, lupus, race, cancer, obesity, high cholesterol, high sodium intake, sepsis, one kidney at birth/loss of, nephrotoxic drugs
2. Etiology (El Hussein & Osuji, 2020, p.1284-1285).
2.1. Stages are based on the glomerular filtration rate
2.1.1. Stage 1: GFR > or = 90; kidney damage with normal or increased GRF
2.1.2. Stage 2: GFR 60-89; mild decrease in GFR
2.1.3. Stage 3: GFR = 30-59; moderate decrease in GFR
2.1.4. Stage 4: GFR =15-29; severe decrease in GFR
2.1.5. Stage 5: GFR < 15; End-stage kidney disease or chronic kidney disease
2.2. The pathology of CKD is not yet clearly understood, but the damage to the kidneys is thought to be caused by prolonged acute inflammation.
3. Medical Management (Pharmacological/Surgical) includes treatment of underlying causes. (El Hussein & Osuji, 2020, p.1285)
3.1. Diuretics
3.2. Nutritionist
3.3. Regular clinical and laboratory assessment to ensure BP below 130/80.
3.4. Referral to nephrology to assess kidney health status and initiation of kidney replacement therapies
3.5. Prevention of complications is accompanied by controlling cardiovascular risk factors; treating hyperglycemia, managing anemia, smoking cessation, weight loss and exercise programs, reduction of salt and alcohol intake
3.6. Dialysis - insertion of permacath or fistula for hemodialysis, or PD dialysis
4. Assessment Findings (El Hussein & Osuji, 2020, p.1297-1298).
4.1. Decreased GFR, decreased creatinine clearance, increased creatinine and BUN
4.2. Sodium and Water retention
4.2.1. difficulties concentrating or diluting the urine in ESRD
4.2.2. Difficulty balancing electrolytes and aldosterone levels , thus risk for edema, CHF, HTN
4.3. Metabolic Acidosis
4.3.1. occurs in ESKD as the kidneys are unable to excrete increased loads of acid. Inability of the kidney tubules to excrete ammonia and to reabsorb sodium bicarbonate. Decreased excretion of phosphates and other organic acids
4.4. Anemia
4.4.1. inadequate erythropoietin production, shortened lifespan of RBCs, nutritional deficiency, GI bleeds
4.4.1.1. fatigue, angina, SOB
4.5. Calcium and Phosphorus Imbalance
4.5.1. Inverse relation to each other; as one increases the other decreases
4.5.2. With decreased filtration of the kidneys, increased serum phosphate causes reciprocal decreased serum calcium
4.5.2.1. recommend a vitamin d, calcium supplementation
5. Nursing Management/Care
5.1. Avoiding complications of reduced kidney function and the stress and anxiety of dealing with a life-threatening illness.
5.2. Assessing fluid and electrolyte status and identifying potential sources of imbalance
5.3. Implementing a dietary program - Renal Diet, high protein, low sodium and potassium
5.3.1. Referral to Nutritionist
5.4. Promoting positive feelings by encouraging increased self-care and greater independence
5.5. Explaining treatment options and potential complications
5.6. Emotional Support
5.6.1. Spiritual and Cultural Needs
5.7. Care of Permacath, fistula, and PD Catheters
5.7.1. Avoiding BP on Fistula arm
5.7.2. checking vascular access device/PD cath patency and placement
5.7.3. Avoiding venipuncture and BP on arm with vascular device
5.8. Report the following
5.8.1. worsening S+S of kidney failure - nausea, vomiting, change in usual urine output, ammonia odour on breath
5.8.2. S+S of hyperkalemia - muscle weakness, diarrhea, abdominal cramps
5.8.3. S+S of access problems - Clotted fistula or graft, infection
5.9. Continuing and Transitional care in the community with follow-up examinations
6. Diabetes (Hypoglycemia)
6.1. Risk Factors
6.1.1. CKD, genetics, high sugar/fat/cholesterol diets
6.2. Signs and Symptoms
6.2.1. polydipsia, polyphagia, polyuria, blurred vision, poor healing, dry mouth, weight loss, headache, fatigue, neuropathy, retinopathy, irritability, hunger
6.3. Medical Management (Pharmacological/Surgical)
6.4. Assessment Findings
6.5. Teaching
6.5.1. Diabetes Clinics
6.5.2. Carb counting
6.6. Nursing Management/Care
6.7. Potential Complications
6.7.1. retinopathy, neuropathy, CKD, PVD, PAD
6.8. Etiology
6.9. Labs and Diagnostics
6.9.1. A1C, GTT, random glucose,