Chronic Kidney Disease Concept Map

Concept Map Illustrating Altered Human Need Clinical Manifestations (list expected manifestations in textbook and circle those exhibited by your patient – consider admission assessments as well. Draw links to underlying pathophysiology) Disease Name Chronic Kidney Disease (CKD) Pathophysiology (from textbook – also try to link your client’s underlying etiology) CKD is defined as either the presence of kidney damage or a decreased GFR less than 60mL/min/1.73m2 for longer than three months. CKD involves progressive, irreversible loss of kidney function. CKD is more common than AKI (Acute kidney disease). The most common risk factors for CKD include: Obesity, diabetes, and hypertension. Other less common risk factors for CKD include: glomerulonephritis, cystic diseases, and urologic diseases. Minority populations such as African Americans, Native Americans, and Hispanics have a higher incidence of CKD. Because the kidneys are highly adaptive, disease is not often recognized until there has been considerable loss of nephrons. Those with CKD are often asymptomatic, resulting in CKD being underdiagnosed and untreated. As kidney function deteriorates, all body systems become affected. The manifestations result retained urea, creatinine, phenols, hormones, electrolytes, and water. Uremia is a syndrome in which kidney function declines to the point that symptoms may develop in multiple body systems. The manifestations vary among people depending on the cause of kidney disease, co-morbid conditions, age, and degree of adherence to the prescribed medical regimen. Manifestations include: *altered urinary system (polyuria, fluid retention, anuria) *metabolic disturbances (low GFR, high BUN & Cr, nausea, vomiting, lethargy, fatigue, impaired thought process, headache *Altered carbohydrate metabolism (impaired glucose metabolism) *Elevated triglycerides *Electrolyte & acid-base imbalances *Anemia, increased bleeding, increased risk for infection *CVD, *Altered respiratory system *Impaired GI system *Neurologic changes, musculoskeletal, skin, reproductive & psychological changes Stage 1= Kidney damage with > or = 90 normal or increased GFR Stage 2= Kidney damage with 60-89 mild or decreased GFR Stage 3a= Moderate decreased GFR 45-59 Stage 4= Severe decreased GFR 15-29 Stage 5= Kidney failure < 15 for dialysis Related Lab/Diagnostic Study Results (Draw links to connect pathophysiology and/or medication effect) Dipstick of urine to check for protein or albuminuria Urinalysis to detect RBC, WBC, protein, casts, or glucose Renal ultrasound Biopsy of the kidneys Serum Creatinine GFR (preferred over Creatinine) Medications (identify classification) (Draw links to connect indication for use and client assessment findings) IV glucose & insulin (lowers potassium) IV 10% calcium gluconate (lowers potassium) Sodium polystyrene Sulfate (lowers potassium) Patiromer (Veltassa) (lowers potassium) ACE Inhibitors (lowers BP) ARB's (lowers BP) Statins (lowers cholesterol) Other Collaborative Treatments (Nutritional Therapy/Surgical Intervention/etc.) ** Other medications are used to treat alterations in other body systems as needed to manage CKD. The goal of CKD therapy is to preserve existing kidney function, reduce the risks for CVD, prevent complications, and provide comfort to the person. Nutritional therapy ***Renal diet: with restrictions on (fluid, protein, phosphate, sodium, & potassium Dialysis (2 types) ***hemodialysis ***peritoneal dialysis (allows dialysis while person sleeps) Wearable artificial kidney Continuous Renal Replacement Therapy Kidney Transplantation *** live donor vs. deceased donor Priority Nursing Diagnoses Fluid imbalance Electrolyte imbalance Impaired nutritional status Difficulty coping