Week 3 - Study Guide

Question 1

what is CKD

Answer 1

• the progressive, irreversible loss of kidney function

- GFR < 60 for 3 months or longer

Question 2

what stage of CKD is considered end-stage renal disease? what do most patients in this stage require?

Answer 2

• stage 5

- require either dialysis or transplant

Question 3

define uremia; at what point does it usually occur?

Answer 3

• constellation of signs & symptoms resulting from buildup of waste products & excess fluid associated w kidney failure
• often occurs when GFR is 10 or less

Question 4

what 3 main functions are lost during CKD? what does this cause

Answer 4

• excretory
• regulatory
• endocrine
  = causes symptoms in every body system

Question 5

define oliguria

Answer 5

• diminished urine volume

Question 6

define anuria

Answer 6

• absence of urine production

Question 7

define azotemia

Answer 7

• the accumulation of metabolic wastes that are typically excreted by the kidneys in the blood

Question 8

describe the effect of CKD on carb metabolism; what does this cause

Answer 8

• insulin resistance occurs resulting in impaired glucose use & defective carb metabolism
• this causes hyperglycemia & hyperinsulinemia
• hyperinsulinemia then causes elevated triglycerides & dyslipidemia

Question 9

describe the clinical manifestations of CKD on the urinary system

Answer 9

• in the early stages, we get polyuria & nocturia bc of increased GFR due to increased wokrload on the remaining nephrons
• eventually get oliguria & anuria as loss of renal function progresses

Question 10

define proteinuria

Answer 10

• protein in the urine

Question 11

what is urine osmolality? what does a large value indicate? small?

Answer 11

• a measure of urine conc
• high value = v concentrated
• small = not v concentrated/diluted

Question 12

what is a pleural effusion

Answer 12

• fluid in the pleural cavity

Question 13

define pruitis

Answer 13

• itching

Question 14

define pericarditis

Answer 14

• inflamamtion of the pericardium (membrane around the heart)

Question 15

define thrombocytopenia

Answer 15

• low plt levels

Question 16

define stomatitis

Answer 16

• inflammation of the mouth & lips

Question 17

define paresthesias

Answer 17

• abnormal sensation of the skin

- tingling, prickling feeling

Question 18

define paresthesias

Answer 18

• abnormal sensation of the skin

- tingling, prickling feeling

Question 19

define uremic frost

Answer 19

• deposits of tiny yellow-white urea crystals on the skin

Question 20

define renal osteodystrophy

Answer 20

• deformities of the bone that occur due to abnormal blood levels of calcium & phosphate, leading to demineralization

Question 21

define asterixis

Answer 21

• tremor of the hand when the wrist is extended

- “hand flapping”

Question 22

define hyperparathyroidism

Answer 22

• excessive parathyroid hormone due to overactivity of the parathyroid gland

Question 23

define ecchymosis

Answer 23

• bruise

Question 24

define encephalopathy

Answer 24

• damage or disease that effects the brain

Question 25

what is acute tubular necrosis

Answer 25

- the most common intrarenal cause of AKI | - necrotic death of tubule epithelia cells

Question 26

define peritoneal dialysis; how does it work

Answer 26

- dialysis that involves the use of the peritoneum as a natural semipermeable membrane (filter) to remove wastes and excesss fluid from the body - fluid is infused into the peritoneum, excess fluid & wastes cross the membrane into the fluid, which is then drained out

Question 27

define hemodialysis

Answer 27

- dialysis that uses a machine with an artificial semipermeable membrane to filter wastes out of your blood

Question 28

what is an arteriovenous fistula

Answer 28

- hemodialysis that requires the connection of an artery & vein

Question 29

what is chemotherapy

Answer 29

- pharmacologic treatment for cancer

Question 30

what is dialysis

Answer 30

- movement of fluid & molecules acorss semipermeable membrane from one compartment to another - clinically, it is a technique in which substances move from the blood thru a semipermeable membrane (dialyzer) and into a dialysis solution (dialysate)

Question 31

what are the 2 types of dialysis

Answer 31

- peritoneal dialysis | - hemodialysis

Question 32

when is dialysis therapy initiated

Answer 32

- when CKD progresses to the point that the pt's symptoms, fluid volume status, or both can not be managed without dialysis - usually when GFR < 15

Question 33

what are the pros to peritoneal dialysis (7)

Answer 33

- less complicated than hemo - portable system - fewer diet restriction - short training time - usable in pt's with vascular access problems - less cardio stress - preferred for the diabetic pt

Question 34

list the cons to peritoneal dialysis (8)

Answer 34

- protein loss into dialysate - exit site & tunnel infection - self-image problems w catheter placement - hyperglycemia - surgery required for catheter - catheter can migrate - contraindication in patients with multiple abdom surgeries, unrepaired hernia, trauma - bacterial or chemic peritonitis

Question 35

list the pros to hemodialysis (7)

Answer 35

- rapid fluid removal - rapid removal of urea & creatinine - effective K+ removal - less protein loss - lowering of serum triglycerides - home dialysis possible - temp access can be placed at bedside

Question 36

list the cons to hemodialysis

Answer 36

- vascular access problems - dietary & fluid resitrctions - heparinization may be required - hypotension during dialysis - added blood loss contributes to anemia - surgery for perm access placement - self-image problems w perm access

Question 37

how often do patients receive dialysis?

Answer 37

- minimum 3 days/week | - 3-5 hrs long

Question 38

list 2 other options for a person w end-stage renal disease

Answer 38

- continuous renal replacement therapy | - kidney transplant

Question 39

what is continuous renal replacement theraoy

Answer 39

-

Question 40

why do some people w ESRD get kidney transplants? (3)

Answer 40

- when normal kidney function is restored, the pathophysiological changes associated w renal failrue are reversed - eliminates dependence on dialysis & diety and fluid restrictions - less expensive than dialsysis after the first year