Chronic Kidney Disease (CKD) Overview

Introduction

• Discussed by Cathy from Level Up RN.
• CKD is the gradual, irreversible loss of kidney function, different from acute kidney injury which is sudden and often reversible.

Risk Factors for CKD

• Older age
• Dehydration
• Acute kidney injury
• Hypertension
• Diabetes (common cause in hospitals)
• Medications
• Autoimmune disorders (e.g., Lupus)

Signs and Symptoms of CKD

• Fluid volume overload leading to:
  • Jugular vein distension
  • Hypertension
  • Edema
  • Crackles
  • Dyspnea
• Pruritis (itchiness)
• Nausea and vomiting
• Uremic frost (crystallized urea deposits on skin)

Electrolyte and Lab Abnormalities

• Elevated:
  • Potassium
  • Phosphorus
  • Magnesium
  • Creatinine
  • BUN (Blood Urea Nitrogen)
• Decreased:
  • Sodium
  • Calcium
  • Hemoglobin
  • Hematocrit
• Urinalysis may show:
  • Hematuria (blood in urine)
  • Proteinuria (protein in urine)

Staging of CKD

• Stages 1 to 5 based on GFR (Glomerular Filtration Rate)
• Stage 5: End-stage renal disease with GFR < 15

Treatment of CKD

• Medications:
  • Diuretics (for fluid removal)
  • Sodium polystyrene (to lower potassium levels)
  • Epoetin alfa (to boost red blood cells)
  • Phosphorus binding agents
  • Antihypertensive agents
  • Vitamin and mineral supplements
• Procedures:
  • Dialysis as CKD progresses
  • Kidney transplant eventually

Nursing Care for CKD

• Monitor intake and output, and daily weight.
• Restrict fluid, sodium, potassium, phosphorus, and magnesium intake.
• Protein restriction varies (depends on dialysis status).
• Protect patient’s skin from injury due to fluid overload (fragile skin).

Patient Teaching

• Avoid nephrotoxic medications (e.g., NSAIDs).
• Avoid contrast dye and magnesium-containing antacids.
• Collaborate with a dietitian for dietary management.
• Dialysis Preparation:
  • AV fistula for hemodialysis access.
  • Avoid blood pressure measurements and venipuncture on the fistula arm.
  • Don't carry heavy items or sleep on the fistula arm.
  • Perform hand exercises for new fistula maturation.

Knowledge Check Quiz

• Creatinine: Increased
• GFR: Decreased
• Potassium: Increased
• Phosphorus: Increased
• Fluid volume: Increased
• Red blood cells: Decreased
• Calcium: Decreased
• Magnesium: Increased

Conclusion

• Importance of repetition for memorization (flashcards recommended).
• Encourage subscribing and sharing the channel for more resources.