CHRONIC KIDNEY DISEASE (CKD) CKD R/F DM; HTN; Unresolved AKI; Glomerulonephritis; Autoimmune Disorders D/X GFR <60mL/min (normal = >90mL/min) Ultrasound Shows scarring/damage Decreased urine output Elevated BUN/Creatine level Assess BMP for CNS fluid Clinical Findings Azotemia ↑ BUN/Creatinine Uremia Cardiac (related to RAAS effects) Volume overload HTN CHF Integumentary Uremic Frost Pruritus Respiratory Pulmonary edema (vol. overload) Crackles Dyspnea Hematologic (↓Erythropoietin) Anemia Thrombocytopenia Gastrointestinal Anorexia (due to Azotemia) N/V (due to metabolic acidosis) Neurological (cerebral edema & uremic encephalopathy) Lethargy Confusion Coma Urinary ↓ Urine output Proteinuria (protein leakage) Skeletal Osteoporosis (↓ Calcium levels) LAB Findings ↑ BUN/Creatinine Decreased GFR Metabolic Acidosis Hyper/Hypokalemia Hyperphosphatemia Hypocalcemia Therapeutic Management Epoetin alfa = synthetic erythropoietin Avoid administering Aspirin or NSAIDs (risk for interstitial nephritis) CHRONIC KIDNEY DISEASE (CKD) Monitor potassium levels Hyperkalemia → EKG changes (peaked T waves, flat P, wide QRS, blocks, asystole) Continuous cardiac monitoring Low potassium diet Potassium lowering medications o Kayexalate o Insulin / Dextrose o Calcium gluconate o Albuterol Phosphate binders to lower phosphorus levels Given BEFORE meals Calcium supplements Hemodialysis or Peritoneal Dialysis Nursing Interventions: Monitor BP Monitor Intake & Output Assess LOC frequently Fluid & Electrolytes Obtain daily weight Monitor for signs of heart failure Monitor electrolyte levels and BUN Creatinine Sodium & potassium restriction Elimination Prepare patient for dialysis Assess urine output Safety Assess peripheral nerve function and monitor for peripheral neuropathy Assess vision – provide safe environment Protect Dialysis access site Provide End of Life care as appropriate Nursing Priorities Promote optimal electrolyte balances Promote optimal fluid balance Promote optimal cardiovascular function Who Needs Dialysis? AEIOU Mnemonic A Acid-Base Problems E Electrolyte Problems I Intoxications O Overload of fluids U Uremic Symptoms