NSG 2060 CKD Slides

Chronic Kidney Disease (CKD)

Overview

• Chronic Kidney Disease (CKD) affects the kidneys' ability to filter waste and fluids from the blood.

• Major focus for nursing includes prevention, education, and management in patients,

• Guided Notes range from pages 821-845.

Learning Objectives

• Pathophysiology: Understand CKD including risk factors, stages, and progression.

• Assessment Techniques: Comprehensive assessment involving physical exams, lab tests, and diagnostic procedures.

• Key Laboratory Values: Monitor and interpret laboratory values relevant to CKD.

• Nursing Care Plans: Develop individualized plans integrating holistic care, education, and interdisciplinary collaboration.

• Evidence-based Interventions: Manage complications such as hypertension, electrolyte imbalances, anemia, and fluid overload.

• Dialysis Competency: Understand hemodialysis and peritoneal dialysis, their purpose, functions, monitoring, and complication management.

• Patient Education: Inform patients and families about CKD management, dietary restrictions, medication adherence, and follow-up care.

• Psychosocial Impact: Evaluate the psychological effects of CKD, applying communication techniques to provide emotional support.

Anatomy and Physiology

• Kidney Structure: Kidney consists of renal cortex, renal medulla, renal blood vessels, ureters, and bladder.

• Functions: Filtration of blood, urine formation, maintaining electrolyte balance and fluid homeostasis.

Risk Factors for Kidney Failure

• Top 3 Modifiable Risk Factors:

  • Poorly controlled Diabetes (glucose control)

  • Poorly controlled Hypertension (blood pressure control)

  • Proteinuria (sign of kidney damage)

• Non-modifiable Factors:

  • Family history of renal disease

  • Increasing age

Nursing Interventions

• Focus on knowledge from NSG 2050 and build on prior learning.

• Conduct assessments considering all body systems affected by CKD:

  • Neurologic: Confusion, seizures, weakness.

  • Cardiovascular: Hypertension, fluid overload.

  • Gastrointestinal: Anorexia, nausea, vomiting.

  • Integumentary: Itchiness, dry skin.

  • Musculoskeletal: Bone pain and fractures due to CKD-MBD.

• Urinary output monitoring:

  • Normal: ~1,500mL/day

  • Oliguria: <400mL/day

  • Anuria: <50mL/day

Lab Values and Diagnostics

• Key Labs:

  • Creatinine Clearance: Reliable for GFR but labor-intensive (24hr urine)

  • Serum Creatinine: 0.6-1.2 mg/dL; practical indicator of kidney function.

  • Blood Urea Nitrogen (BUN): 7-18 mg/dL; affected by protein intake and tissue breakdown.

  • Essential electrolytes (Potassium, Sodium, Calcium, Phosphorus).

Staging of CKD

• Stages based on GFR:

  • Stage 1: GFR ≥90 mL/min; risk conditions present.

  • Stage 2 (Mild): GFR 60-89 mL/min.

  • Stage 3 (Moderate): 45-59 mL/min (3a) or 30-44 mL/min (3b).

  • Stage 4 (Severe): GFR 15-29 mL/min.

  • Stage 5 (End Stage): GFR <15 mL/min; require dialysis.

Managing CKD Complications

• Hypertension Management: Medications, lifestyle changes.

• Anemia Treatment: Erythropoietin use, monitor hemoglobin.

• Nutritional Therapies: Lower protein diets to lessen strain; focus on high-quality protein sources.

Nutritional Recommendations

• Protein Restriction: Limit to 0.8g/kg/day for kidney health; ensure quality protein intake to avoid muscle wasting.

• Fluid Intake: Limit to approx. 1 liter/day, adjusting intake techniques to optimize hydration without overwhelming the kidneys.

• Electrolyte Restrictions:

  • Sodium: 2-4g/day limit.

  • Potassium: restrict based on levels; monitor intake especially for hemodialysis patients.

  • Phosphorus: Limit to avoid buildup and related complications.

Pharmacologic Interventions

• Antihypertensives: Manage hypertension to protect kidney function.

• Phosphate Binders: For hyperphosphatemia control; crucial to take with meals.

• Anticonvulsants: Consider for seizure risks associated with azotemia.

Patient-Centered Care

• Education Strategies: Educate patients about managing their disease, potential complications, and the importance of adherence to treatment and lifestyle modifications.

• Psychosocial Support: Address emotional impacts, consider therapeutic communication methods to support patients and families.

Summary

• The management and understanding of CKD are critical in nursing practice. Emphasis on patient education, lifestyle adjustments, and medication adherence forms the basis of effective nursing interventions.