Chronic Kidney Disease (CKD) is an abnormality of kidney structure or function for 3 months or mo...

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Chronic Kidney Disease (CKD) is an abnormality of kidney structure or function for 3 months or more and is identified by the glomerular filtration rate (GFR) and other markers that indicate kidney damage (El Hussein & Osuji, 2020, p.1284). by Mind Map: Chronic Kidney Disease (CKD) is an abnormality of kidney structure or function for 3 months or more and is identified by the glomerular filtration rate (GFR) and other markers that indicate kidney damage (El Hussein & Osuji, 2020, p.1284).

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. Health Teaching

5.1. daily weight

5.2. monitor K+

5.3. monitor outputs - clarity, frequency, colour

5.4. medication compliance

5.5. manage diabetes and htn

5.6. Limit dietary: K+, cholesterol, fat, salt,

5.7. Smoking Sessation

5.8. Weight Loss

6. Labs/Diagnostic Tests

6.1. CBC, SMA with extended lytes - calcium, phosphorus, magnesium, sodium, chloride, potassium, creatinine, bun, GFR, 24 hour urine, CT, MRI, US, Biopsy, urinalysis, urine cultures, bicarbonate, serum albumin

7. Potential Complications

7.1. Hyperkalemia

7.2. Pericarditis, pericardial effusion, and pericardial tamponade due to retention of waster and inadequate dialysis/retention

7.3. Hypertension due to sodium and water retention and malfunction of renin-angiotensin-aldosterone system

7.4. Anemia

7.5. Done disease and metastatic and vascular calcification due to retention of phosphorus. low serum calcium, abnormal vit d metabolism, elevated aluminum levels

8. Nursing Management/Care

8.1. Avoiding complications of reduced kidney function and the stress and anxiety of dealing with a life-threatening illness.

8.2. Assessing fluid and electrolyte status and identifying potential sources of imbalance

8.3. Implementing a dietary program - Renal Diet, high protein, low sodium and potassium

8.3.1. Referral to Nutritionist

8.4. Promoting positive feelings by encouraging increased self-care and greater independence

8.5. Explaining treatment options and potential complications

8.6. Emotional Support

8.6.1. Spiritual and Cultural Needs

8.7. Care of Permacath, fistula, and PD Catheters

8.7.1. Avoiding BP on Fistula arm

8.7.2. checking vascular access device/PD cath patency and placement

8.7.3. Avoiding venipuncture and BP on arm with vascular device

8.8. Report the following

8.8.1. worsening S+S of kidney failure - nausea, vomiting, change in usual urine output, ammonia odour on breath

8.8.2. S+S of hyperkalemia - muscle weakness, diarrhea, abdominal cramps

8.8.3. S+S of access problems - Clotted fistula or graft, infection

8.9. Continuing and Transitional care in the community with follow-up examinations

9. Diabetes (Hypoglycemia)

9.1. Risk Factors

9.1.1. CKD, genetics, high sugar/fat/cholesterol diets

9.2. Signs and Symptoms

9.2.1. polydipsia, polyphagia, polyuria, blurred vision, poor healing, dry mouth, weight loss, headache, fatigue, neuropathy, retinopathy, irritability, hunger

9.3. Medical Management (Pharmacological/Surgical)

9.4. Assessment Findings

9.5. Teaching

9.5.1. Diabetes Clinics

9.5.2. Carb counting

9.6. Nursing Management/Care

9.7. Potential Complications

9.7.1. retinopathy, neuropathy, CKD, PVD, PAD

9.8. Etiology

9.9. Labs and Diagnostics

9.9.1. A1C, GTT, random glucose,

9.10. Mediterranean diet

10. Preventative Measures (El Hussein & Osuji, 2020, p.1294).

10.1. Provide adequate hydration to patients at risk for dehydration: before, during, and after sx

10.2. prevent and treat shock promptly with blood and fluid replacement

10.3. monitor central venous and arterial pressures and hourly urine output of critically ill patients to detect early onset kidney injury

10.4. Treat hypotension promptly

10.5. Continuous assess kidney function (Urine output and labs)

10.6. Take precautions to ensure that the appropriate blood is administered to the correct patient in over to avoid severe transfusion reactions, precipitating kidney failure

10.7. Prevent and treat infection promptly

10.8. Pay attentions to wounds, and other precursors to sepsis

10.9. Reduce the use of indwelling catheters. Remove catheters as soon as possible.

10.10. Prevent toxid drug affects, closely monitor dosage, duration of use, and blood levels of all medications. ie. abo tx, digoxin, antihypertensives such as norvasc, metformin, ivp dyes