Adult Health 1 - CKD & Male Repro Problems

Acute Kidney Injury

Rapid loss of kidney function with or without decreased urine output

Can develop over hours or days

Potentially reversible but high mortality rate

AKI Assessments

H&P

ID cause

BUN

Creatinine

UA

Renal US/scan

CT

AKI Interventions

Treat cause

Fluid restrictions (strict ins/outs)

Low sodium/potassium diet

Low protein diet

Carefully monitor K+ levels

Calcium supplements or phosphate binding agents

Dialysis if necessary

AKI Teaching

Prevention and early recognition

High risk populations (elderly, blacks, hispanics, native americans, diabetes, HTN)

No nephrotoxic drugs

Prevent hypotension and hypovolemia

Contrast screening

Peritoneal Dialysis

Cath placed in abdomen using peritoneal cavity to act as filter

Patient able to move and walk around

Takes 3-5 hours during day or 5-8 hours at night

Dialysate solution should be clear, not cloudy

No machine required, using gravity

Watch for hernias & peritonitis

Signs of infection with Peritoneal Dialysis

Signs of infection around catheter site

Cloudy dialysate fluid

Fever

Hemodialysis

"artificial kidney"

Uses dialyzer machine

Machine cleans blood and then puts blood back into patient

Patients are typically on heparin or other forms of blood thinners

3-4 hours 3x/week

Hemodialysis Assessments

Assess sight

Palpate thrill at site

Hear the bruit

Check pulse and neurovascular assessments distal to the site

Assess for hypotension

Monitor K+

Hemodialysis Don'ts

Don't place BP cuff on that arm

Don't do blood draws from that arm

Hemodialysis Complications

• CVD

• Disequilibrium syndrome

• Exsanguination

• Hepatitis

• Hypotension

• Infection, including sepsis

• Muscle cramp

Peritoneal Dialysis Complications

• Abdominal pain

• Carbohydrate abnormalities

• Catheter outflow

• CVD

• Encapsulating sclerosing peritonitis

• Exit site infection

• Hernias

• Lipid abnormalities

• Lower back pain

• Peritonitis

• Protein loss

• Pulmonary problems

• Atelectasis

• Pneumonia

• Bronchitis

Dialysis NC

Check weight before and after

Strict ins/outs

Pulmonary fluid overload

Watch for s/s of infection

Muscle cramping

abdominal pain

Immunocompromised

CKD signs

GFR below 60

BUN & Creatinine

Protein

CKD Tx

HTN & Diabetes treatment (2 highest risk factors for CKD)

Fluid overload (strict ins/outs and daily weights)

Sodium restrictions

Fluid restriction

Potassium restriction

Protein restrictions

Urine albumin

Monitor BP and GFR

Med adherence

CKD Risk Factors

Age (over 60)

Cardiovascular disease

HTN

Diabetes

Ethnicity (blacks, native americans, hispanics)

Exposure to nephrotoxic drugs

Family Hx

Certain Autoimmune Disorders (Polycystic Kidney Disease, Goodpasture's Syndrome, SLE)

Chronic Kidney Disease Stage 1

GFR 90 or higher

Chronic Kidney Disease Stage 2

GFR 60-89

Mild

Kidney Injury Stage 3

GFR 30-50

Moderate

Chronic Kidney Disease Stage 4

below 59 = CKD

Severe

GFR 15-29

Chronic Kidney Disease Stage 5

GFR Less than 15 = kidney failure

Early stages of kidney disease

treat cause

prevent worsening and progression

Renal Failure s/s

Edema

Decreased urine output

Anemia

Heart Failure

CAD

Common Causes of AKI

Decreased Cardiac Output

Decreased Peripheral Vascular Resistance

Decreased Renovascular Blood Flow

Hypovolemia

Hemodialysis Fluid Restriction

Urine output plus 600

Peritoneal Dialysis Fluid Restriction

Unrestricted if weight and BP are controlled and if the patient has residual renal function

2 Leading Causes of CKD

HTN

Diabetes

Pre-ESRD Dietary Restrictions

Calcium: 1000-1500mg

Cals: 30-35 kcal/kg/day

Fluids as desired

Iron supplement recommended if patient is on EPO

Phosphate: 1-1.8g

Protein: 0.6-1 g/kg/day

Na+: 1-3g

Hemodialysis Dietary Restrictions

Cals: 30-35 kcal/kg/day

Fluids: Urine output plus 600

Iron supplement recommended if patient is on EPO

Phosphate: 0.6-1.2 g

K+: 2-4g

Protein: 1.2 g/kg/day

Na+: 2-3 g

Peritoneal dialysis Dietary Restrictions

Cals: 25-35 kcal/kg/day

Fluids: Unrestricted if weight and BP are controlled

Iron supplement recommended if patient is on EPO

Phosphate: 0.6-1.2 g

K+: unrestricted

Protein: 1.2-1.3 g/kg/day

Na+: 2-4 g

BPH Risk Factors

Age

Obesity

Lack of physical exercise

High red meat and animal fat intake

Alcohol use

Erectile Dysfunction

Smoking

Diabetes

Family Hx

BPH s/s

Gradual onset

Irritative symptoms

nocturia

frequency

dysuria, pain

incontinence

obstructive symptoms

Decrease in force of stream

Difficulty starting stream

Intermittency

Dribbling

BPH Diagnostics

H&P

DRE

UA

Culture and sensitivity

PSA

Serum creatinine

Postvoid residual by US

Renal US to evaluate for hydronephrosis

TRUS

Uroflowmetry

Cystoscopy

Urodynamic/pressure flow studies

BPH Management

Annual PSA and DRE

Repeat diagnostics if symptoms change

BPH Drug Therapy

5 alpha-reductase inhibitors (finasteride, dutasteride)

Alpha-adrenergic receptor blockers (Tamsulosin)

Combination

Erectogenic drugs (Tadalafil)

TURP

Gold standard of surgical treatment for BPH

Prostate Cancer Risk factors

Age

Ethnicity

Family Hx

Diet

Environment

Prostate Cancer

Slow growing

Many men live with it, some die, but most don't die from it

Prostate Cancer Diagnostics

H&P with DRE

PSA

TRUS or pelvic MRI

Whole body scan

CT of abdomen and pelvis with contrast

Prostate Cancer Management & Drug therapy

Same as BPH

Prostate Cancer Surgery

Radical prostatectomy

Cryotherapy

Orchiectomy

Prostate Cancer Radiation Therapy

External beam

Brachytherapy

Erectile Dysfunction

Inability to attain or maintain an erection that allows satisfactory sexual activity

50% of men 40-70 have ED to some degree

ED Risk Factors

Alcohol or drug induced

Endocrine

Genitourinary

Neurologic

Psychologic

Vascular

Aging

ED Management

Modify reversible causes

Drugs ("-Fil")

Vacuum Erection Device

Penile Implants

Intracavernosal self-injection

Intraurethral medication pellet