CHRONIC KIDNEY DISEASE (CKD)
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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)
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 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