MNT II Exam 2

What does urine waste include?

nitrogenous wastes (largely the end products of protein

metabolism primarily urea) uric acid, creatinine, and ammonia

What does an A1C measure?

glucose levels from the past three months

What is polydipsia?

excessive thirst

What is dyspnea?

difficult or labored breathing

What should you not forget if a pt is underweight: less than 90% of there IBW or BMI is <18.5?

you should consider using IBW for kcal and protein needs to help provide for weight gain and improved protein status when you complete their assessment and needs

What is more likely to cause meatbolic stress?

critical illness probably in ICU and intubated, ARDS, Trauma such as a MVA, gunshot wound, stabbings, falls from high distance, SCI,TBI, Burns, major surgery

What is less likely to cause metabolic stress?

CVA, MI, out pt presenting for nutrition services, IBD, IBS, CKD, Epilepsy

What is metabolic stress?

the metabolic response to critical illness, traumatic injury, sepsis, burns or major surgery

How is carnation brk essentials powder different?

it has lactose

What is the etiology of Kidney Disease?

diabetes, hypertension, glomerulonephritis, ethnicity, family hx, hereditary factors- polycystic kidney disease, direct and forceful blow to kidneys, prolonged consumption of OTC painkillers

What is glomerulonephritis?

nephritis marked by the inflammation of the capillaries of the renal glomeruli

What ethnicities are at a higher risk for CKD?

African Americans 4 x likely and Hispanics are 1.3 x likely to develop this disease

What prolonged consumption of OTC painkillers can cause CKD?

aspirin, acetaminophen, ibuprofen

How big is the kidney?

the size of a fist

What is the main function of the kidney?

Maintain homeostatic balance with respect to fluids, electrolytes and organic solutes

How do the kidneys maintain homeostatic balance?

continuous filtration of blood and by alteration of secretion and resorption

If one segment of a nephron is destroyed is the complete nephron functional?

No

What is a urinary volume of less than 500 ml/day called?

oliguria

What is urine waste made up of?

nitrogenous wastes, urea, uric acid, creatinine, and ammonia

If a pt has oliguria, is the pt eliminating all of their daily waste?

no, it is impossible

What happens if normal waste products are not eliminated appropriately?

they collect in abnormal quantities in the blood know as azotemia.

Why would you see metabolic acidosis if there is kidney impairment?

the kidneys are unable to remove enough acid via urine

What is uremia?

Build up of toxins in the blood that the kidneys would normally filter out, literal meaning is urine in the blood

What is oliguria?

decreased urine output

Do the kidneys release hormones that regulate blood pressure?

yes by the Renin-angiotension mechanism aldosterone (RAAS)

What hormone decrease leads to anemia in CKD pts?

erythropoietin (EPO)

What does erythropoietin (EPO) do?

increases the production of red blood cells

Why do CKD pts develop weakening bones called renal CKD bone & mineral disorder?

lack of vitamin D production and an elevation of blood phosphorus due to poor excretion

What is the Renin-angiotensin-aldosterone system (RAAS)?

a regulator of blood pressure: system can constrict blood vessels to control BP

What happens in CKD pts that contributes to an elevated BP?

there is a decrease in the glomeruli

What happens with BUN as CKD progresses?

it increases but Can be elevated with dehydration so always look at creatinine which

is not affected by hydration as much.

When the kidneys fail what can happen with the levels of electrolytes?

can rise to toxic levels in the body as excess can no longer be excreted in the urine

What electrolytes do the kidneys secrete or retain?

sodium, potassium, magnesium, and phosphate

What do changes in sodium, potassium and calcium alter>

the excitability of neurons, cardiac, and skeletal muscles that can produce cardiac arrhythmias, weakness, and spasms/tremors.

Why is potassium the most urgent electrolyte to correct?

it can cause cardiac arrest whether it is high or low

What are some reasons for a high potassium?

Dehydration for any reason, CKD, refeeding syndrome

What does the parathyroid hormone (PTH) do?

aids in regulating serum calcium by stimulating bone resorption & kidney reabsorption, and converting inactive Vit D to active form

What happens when you have a low blood calcium caused by the kidney's inability to activate vitamin D and high phosphorus levels due to the inability to excrete phosphorus constantly stimulating the PTH gland in CKD?

This triggers the parathyroid glands to produce more PTH to attempt to raise calcium levels in the blood.

These steps lead to the condition known as secondary hyperparathyroidism.

What is commonly administered during dialysis to combat anemia?

EPO and iron

What physician is specialized in kidney disease?

Nephrologist

What kind of dietitian works with kidney disease?

CSR = Certified Specialist in Renal

What will happen once a pt get to stage 4 CKD?

labs will be effected, the function is very low and treatment for kidney failure may be needed soon

What happens in stage 5 CKD?

kidney failure, kidneys can no longer keep up with removing waste products and extra water

What GFR is stage 5 CKD?

<15

What has to happen once a pt is in stage 5 CKD?

dialysis

What does a pt have to do in stage 4 CKD?

make diet changes

What are the complications/symptoms of uremia in stage 4 and 5?

fatigue, anorexia, weight loss, itching, muscle cramps, pericarditis, sensory and cognitive disturbances

Will creatinine ever go down once in stage 4 and 5 CKD?

no, the kidney damage means it will never go down

What is hypervolemia?

fluid overload; condition in which the liquid portion of the blood (plasma) is too high

What causes hypervolemia?

kidney failure, heart failure, liver failure

What are the symptoms of hypervolemia?

weight gain, swelling, shortness of breath

How does hemodialysis work?

it works outside the body in a machine, through a permanent access AVF

How often is HD?

3 times a week, 4 hours each treatment

How does peritoneal dialysis work?

inside the body through a catheter of silicone rubber, places surgically into the peritoneal cavity

What are the two types of PD?

Continuous ambulatory PD (DAPD) and Continuous cycling peritoneal dialysis (CCPD)

How does Continuous ambulatory PD (DAPD) work?

no machine, dwell time of 4-6 hours.may repeat process 2-3 times a day

How does Continuous cycling peritoneal dialysis (CCPD) work?

machine used at night to empty and fill cavity 3-5 times a night.

How is an arteriovenous fistula (AVF) done?

the radial and cephalic vein are joined may take 4-6 weeks to become functional

What allows the removal of waste product in PD?

hyperosmolar dextrose dialysate

What is used temporarily for dialysis?

central line

What is needed for the dialysis machine to work?

vascular access- where blood can flow through tubes to and from the machine

What are the protein guidelines with stages 3-4 with a GFR<25?

.6-.75 g/kg/d

What does PEW stand for?

protein energy wasting

What NFPE is used to assess nutrition status in all stages of CKD for muscle?

temple region, scapular region, dorsal hand

What NFPE is used to assess nutrition status in all stages of CKD for fat?

orbital

What can hair tell you?

Easily plucked hair with no pain that is also dull and dry may indicate a protein or essential fatty acid deficiency

What weight should you use in a stage 5 CKD pt?

dry weight

What is a dry weight?

the patient's weight without the excess fluid that builds up

between dialysis treatments. would be the weight right after dialysis is completed.

What is the suggested limit to weight gain between dialysis sessions?

2.2lbs or 1 kg

What does anuric mean?

failure to produce uric

What will most dialysis pts within the first 12 months of HD become?

oliguric or anuric

What type pf protein should provide at least 50% of the total protein consumed in a CKD stage 5 pt?

high biologic value (HBV)

What are HBV products?

Animal protein such as meat, poultry, fish, eggs, milk, cheese and yogurt

What do you restrict as a stage 5 CKD pt?

potassium, sodium, phosphorus, calcium, fluid

What type of vitamins are recommended and why for stage 5 CKD?

Renal Vitamins suggested. Water soluble vitamins lost through dialysis.

What are the fluid restrictions for HD?

1000ml

What are the fluid restrictions for PD?

1500ml

What spices can a CKD pt have?

garlic powder, onion powder, and chili powder

Should a CKD pt use salt substitutes?

no they are made from potassium chloride

What the common phosphate binders used in CKD pts?

Lanthanum carbonate (Fosrenol) and Sevelamer hydrochloride (Renagel)

How should CKD pts limit milk?

Limit milk and milk products to 1 cup per day to limit calcium intake. This restriction will also help limit phosphorus intake as well.

What are some ways to control fluid intake?

Use sour candy or sugar-free gum to moisten your mouth, add lemon juice to water or ice, Try swishing your mouth with very cold water or low- alcohol mouthwash when you are thirsty (don't swallow), brush teeth often, keep lips moist, use ice cubs instead of liquids, freeze fruit and eat throughout the day, and some foods should count as liquids

What foods should be counted as fluids?

soups, Popsicles , sherbet, ice cream, yogurt, custard, and gelatin

Why is Hct not used as much to assess status in CKD pts?

it is much more responsive to hydration

What EN is used for pt on dialysis?

nepro, its lower in fluid and electrolytes, and moderate protein which can be inadequate because the protein is higher for pts on dialysis

What EN is used for pts pre-dialysis?

Suplena: Lower in fluid and electrolytes, Low protein

What is an acute kidney injury (AKI)?

Abrupt cessation or reduction in GFR that results in reduced ability of the kidney may result in CRRT

What causes a prerenal AKI?

Response to severe volume depletion and ↓BP, extensive wounds such as burns or major surgery

What causes intrinsic renal AKI?

damage within the kidney cells caused by: Exposure to toxins such as antibiotics, chemotherapy, or contrast dyes used in various imaging tests; systemic inflammatory conditions such as sepsis

What causes a postrenal AKI?

results from a blockage of the ureter or neck of the bladder: kidney stones, blood clots, and tumors

What is Continuous Renal Replacement Therapies (CRRT)?

dialysis treatments that are provided as a continuous 24 hour per day therapy.

Where is CRRT performed?

in acute care setting during AKI or as temporary treatment until pt can handle/tolerate HD or PD

Is protein restricted for AKI?

Restriction of protein should not be a component of care

What may need to happen with protein in AKI pts?

protein may need to go as high as 2.5 g/kg

What do you not restrict in AKI?

protein

What is the fluid recommendation for AKI?

Total Fluid input recommended to equal output plus 400-500 mL/day

How are CHO, proteins, and lipids metabolized?

using oxygen and producing carbon dioxide

Can malnutrition can evolve from respiratory diseases and contribute to declining pulmonary function?

yes

What makes up the upper respiratory tract?

nose, nasla cavity, sinuses, larynx & trachea

What makes up the lower respiratory tract?

lungs, bronchi, alveoli