Chronic Renal Failure (Kidney Disease) Nursing | End Stage Renal Disease Pathophysiology NCLEX

RegisteredNurseRN

22 Jul 201729:32

EducationalLearning

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TLDRThe video script provides a comprehensive overview of chronic kidney disease (CKD), also known as chronic renal failure. It explains the gradual and irreversible decrease in renal function over time, contrasting it with acute kidney injury. The script delves into the role of the glomerulus and the importance of the glomerular filtration rate (GFR) in assessing kidney health. It outlines the stages of CKD, highlighting the progressive decrease in GFR and the associated health risks, such as uremia, anemia, and electrolyte imbalances. The video also discusses the impact of CKD on hormone production, including EPO and renin, and the resulting complications like hypertension and weakened bones. Causes of CKD are explored, with a focus on diabetes and high blood pressure as primary contributors. Treatment strategies are presented, ranging from lifestyle changes and medication in early stages to dialysis and kidney transplant in advanced cases. Nursing interventions for managing symptoms and complications are also covered, emphasizing the importance of monitoring and dietary adjustments. The script concludes with a reminder to take a free quiz and subscribe for more informative content.

Takeaways

📉 Chronic Kidney Disease (CKD) is characterized by a significant and irreversible decrease in renal function over time, as opposed to acute kidney injury which is sudden and often reversible.
🧬 The nephron, the kidney's functional unit, is central to renal function, particularly the glomerulus which filters waste products like urea and creatinine, but not proteins or blood cells.
📚 Glomerular Filtration Rate (GFR) is a critical measure of how well the kidneys are filtering the blood and maintaining homeostasis; a normal GFR is greater than 90 milliliters per minute.
📉 CKD is staged by GFR levels, with Stage 1 indicating kidney damage with normal renal function and Stage 5 representing severe renal disease where GFR is less than 15 milliliters per minute.
💉 Creatinine is a significant waste product that, when measured in blood and urine, indicates the effectiveness of the glomerulus's filtration.
🚫 In CKD, the GFR progressively decreases leading to issues with waste accumulation, electrolyte imbalances, and fluid overload.
🩸 The presence of protein and blood in the urine is indicative of CKD, as the glomerulus is damaged and not properly filtering these elements.
🌀 Kidney hormone production is affected in CKD, leading to anemia due to decreased EPO and potential hypertension due to increased renin.
💊 Treatment for CKD includes managing blood pressure and glucose levels, using medications like ACE inhibitors and ARBs, and possibly dialysis or kidney transplant in advanced stages.
🧪 Nursing interventions for CKD patients involve monitoring for signs of uremia, anemia, fluid overload, and electrolyte imbalances, and implementing dietary and fluid restrictions.
📈 Hyperkalemia, hyperphosphatemia, and hypermagnesemia are common electrolyte imbalances in CKD that require close monitoring and may necessitate specific treatments or dietary changes.

Q & A

What is chronic kidney disease (CKD)?
-Chronic kidney disease is a condition characterized by a significant and irreversible decrease in renal function over a long period of time, which is the opposite of acute kidney injury.
How is the glomerular filtration rate (GFR) related to kidney function?
-The glomerular filtration rate (GFR) is a measure of how well the kidneys are filtering waste ions and water from the blood. It is an important indicator of kidney function and overall renal health.
What are the stages of CKD and what is the GFR range for each?
-CKD is divided into five stages: Stage 1 (GFR > 90 mL/min with kidney damage), Stage 2 (GFR 60-89 mL/min with kidney damage), Stage 3 (GFR 30-59 mL/min with mild to severe loss of renal function), Stage 4 (GFR 15-29 mL/min with severe loss of renal function), and Stage 5 (GFR < 15 mL/min, requiring dialysis or kidney transplant).
Why is creatinine important in assessing kidney function?
-Creatinine is a waste product that is fully filtered by the glomerulus and not reabsorbed in the renal tubules. Its levels in the blood and urine are a good indicator of how well the glomerulus is filtering the blood.
What are the main symptoms and complications of uremia?
-Uremia is characterized by a build-up of waste in the blood, leading to symptoms such as itching (due to urea crystal deposits on the skin), uremic frost, confusion, neurological changes, and an increased risk for injury and falls.
How does CKD affect the body's fluid and electrolyte balance?
-CKD can lead to fluid overload due to the kidneys' inability to remove excess water from the blood. It can also cause electrolyte imbalances, such as hyperkalemia (high potassium levels), hyperphosphatemia (high phosphate levels), and hypocalcemia (low calcium levels).
What role do the kidneys play in producing hormones?
-The kidneys produce several hormones, including EPO (which stimulates red blood cell production), renin (which helps regulate blood pressure), and activate vitamin D (which aids in calcium absorption). In CKD, the production of these hormones can be affected, leading to anemia and other complications.
What are the common causes of chronic kidney disease?
-The most common causes of CKD include diabetes mellitus and high blood pressure. Other causes can include acute kidney injury, polycystic kidney disease, infections, or the use of nephrotoxic drugs.
What are the treatment options for patients with CKD?
-Early-stage CKD treatment focuses on controlling blood pressure and blood glucose levels to prevent further damage. In advanced stages, patients may require dialysis or be candidates for a kidney transplant. Medications such as ACE inhibitors and angiotensin receptor blockers may also be prescribed to protect the kidneys.
What nursing interventions are important for patients with CKD, especially in the later stages?
-Nursing interventions for CKD patients in later stages include monitoring for uremia symptoms, managing anemia with supplements or transfusions, closely monitoring fluid intake and output, daily weight checks, assessing for fluid overload and hypertension, and implementing dietary restrictions to manage electrolyte imbalances.
How can a low protein diet help manage CKD?
-A low protein diet can help manage CKD by reducing the amount of urea, a waste product from protein breakdown, that the kidneys need to filter. This can help prevent the build-up of waste products in the blood and reduce the workload on the kidneys.

Outlines

00:00

😀 Introduction to Chronic Kidney Disease (CKD)

Sarah Chris Turner introduces the topic of chronic kidney disease (CKD), also known as chronic renal failure. The video is part of an inkless review series on the renal system. CKD is characterized by a significant and irreversible decrease in renal function over time, contrasting with acute kidney injury which is sudden and often reversible. The importance of understanding the glomerular filtration rate (GFR) is emphasized, as it is a key indicator of renal function. The nephron, the kidney's functional unit, and its role in filtering blood and producing urine are discussed. The normal GFR is described, along with the various stages of CKD and their corresponding GFR ranges.

05:00

😨 Stages of CKD and Patient Symptoms

The video outlines the stages of CKD, detailing the GFR ranges and the severity of renal function loss in each stage. Stage four is marked by a severe loss of renal function with a GFR between 15 to 29 milliliters per minute, while stage five indicates end-stage renal disease with a GFR less than 15 milliliters per minute. Patients in these stages may experience uremia, electrolyte imbalances, fluid overload, and low urinary output. The importance of nursing interventions for these patients is highlighted, focusing on managing symptoms and complications associated with CKD.

10:02

🚫 Impact of CKD on Electrolytes and Hormones

The effects of CKD on electrolyte levels and hormone production by the kidneys are discussed. Hyperkalemia, hypocalcemia, and hypermagnesemia are common imbalances due to the kidney's impaired filtration capabilities. The video explains how the kidney's inability to filter proteins and blood cells can lead to proteinuria and anemia. Additionally, the diminished production of EPO and renin, and the activation of vitamin D by the kidneys are covered, showing how these factors contribute to the overall health of CKD patients.

15:02

🔍 Causes and Treatment of Chronic Kidney Disease

The video identifies diabetes mellitus and high blood pressure as the most common causes of CKD, with other causes including acute kidney injury, polycystic kidney disease, and nephrotoxic drugs. Treatment strategies for early and advanced stages of CKD are presented, including blood pressure and glucose control, the use of ACE inhibitors and angiotensin receptor blockers, and regular monitoring of GFR. For advanced stages, dialysis and kidney transplant are discussed as potential treatments.

20:03

🩺 Nursing Interventions for CKD Patients

Nursing interventions for patients with CKD are explored, focusing on managing the build-up of wastes in the blood, anemia, electrolyte imbalances, low urinary output, and fluid overload. The importance of monitoring intake and output, daily weights, and respiratory status is emphasized. The video also discusses dietary restrictions, fluid restrictions, and the use of medications to manage hyperkalemia and hyperphosphatemia. The role of phosphate binders and the necessity of a low phosphate diet are highlighted.

25:04

📉 Managing Electrolyte Imbalances in CKD

The video concludes with a discussion on managing electrolyte imbalances, particularly hyperkalemia and hyperphosphatemia. It advises on dietary restrictions for potassium and strategies for monitoring and treating these conditions. The use of kayexalate for potassium excretion and the importance of replenishing calcium to manage magnesium levels are covered. The video wraps up by encouraging viewers to take a free quiz and subscribe for more educational content.

Mindmap

Keywords

💡Chronic Kidney Disease (CKD)

Chronic Kidney Disease, also known as chronic renal failure, is a condition characterized by a significant and irreversible decrease in renal function over a long period of time. It is the main theme of the video, as it discusses the stages, causes, and effects of CKD on the body. The video emphasizes the progressive nature of CKD, with stages ranging from mild loss of function to severe loss requiring dialysis or kidney transplant.

💡Glomerulus

The glomerulus is a network of capillaries within the kidney where blood is filtered. It plays a central role in CKD as its filtration capacity, measured by Glomerular Filtration Rate (GFR), is a key indicator of kidney function. The video explains that in CKD, the glomerulus's ability to filter waste and maintain homeostasis is compromised, leading to a decrease in GFR and accumulation of waste products like urea and creatinine in the blood.

💡Glomerular Filtration Rate (GFR)

GFR is the rate at which the glomerulus filters waste ions and water from the blood. A normal GFR is greater than 90 milliliters per minute. The video outlines that in CKD, GFR progressively decreases, with stages four and five indicating severe loss of renal function. GFR is used to diagnose and monitor the progression of CKD, and it is influenced by factors such as age, gender, race, and weight.

💡Uremia

Uremia is a condition that arises from the accumulation of waste products in the blood due to reduced kidney function. It is a significant aspect of CKD discussed in the video, where it leads to symptoms like itching, neurological changes, and a potential risk for injury due to confusion. The video mentions uremic frost, a visible sign of uremia, where crystals are deposited on the skin.

💡Anemia

Anemia, characterized by a deficiency in red blood cells, is a common complication of CKD. The video explains that anemia in CKD is due to decreased production of Erythropoietin (EPO), a hormone that stimulates red blood cell production. Symptoms of anemia include fatigue, shortness of breath, and confusion. Treatments may include iron supplements, EPO injections, or blood transfusions.

💡Electrolyte Imbalances

Electrolyte imbalances are a consequence of CKD, where the kidneys' inability to filter properly leads to abnormal levels of substances like potassium, phosphate, and calcium in the blood. The video discusses hyperkalemia, hypocalcemia, and hypermagnesemia, which can cause cardiac issues, bone problems, and muscle weakness, respectively. Monitoring and managing these imbalances are critical aspects of CKD treatment.

💡Dialysis

Dialysis is a medical treatment that replicates the function of the kidneys by filtering the blood of waste products and excess fluid when the kidneys can no longer do so effectively. The video mentions that in advanced stages of CKD (stages 4 and 5), patients may require regular dialysis. It serves as a life-supporting treatment for those awaiting a kidney transplant or managing end-stage renal disease.

💡Nephron

The nephron is the functional unit of the kidney responsible for filtering blood and producing urine. The video emphasizes that millions of nephrons in each kidney are affected in CKD, leading to a decrease in GFR and impaired reabsorption of necessary substances like water and electrolytes. Damage to nephrons contributes to the progression of CKD.

💡Proteinuria

Proteinuria refers to the presence of protein in the urine, which is an abnormal condition and an early sign of kidney damage. The video notes that proteinuria that persists for three months or more can be indicative of stage one CKD, where renal function may still be normal, but there is evidence of kidney damage.

💡Hormonal Imbalances

The kidneys play a role in producing and regulating various hormones, such as EPO and renin. The video explains that in CKD, the production of these hormones is affected, leading to complications like anemia and high blood pressure. Additionally, the kidneys activate vitamin D, which helps the body absorb calcium; in CKD, this function is impaired, contributing to electrolyte imbalances.

💡Nursing Interventions

Nursing interventions are critical for managing patients with CKD, especially in the later stages. The video discusses various interventions, including monitoring for signs of uremia, providing a low-protein diet, administering medications to manage anemia, and implementing fluid and electrolyte management strategies. These interventions aim to alleviate symptoms, prevent complications, and improve the quality of life for patients with CKD.

Highlights

Chronic kidney disease (CKD) is characterized by a significant and irreversible decrease in renal function over a long period of time.

CKD is the opposite of acute kidney injury, which is a sudden and often reversible decrease in renal function.

The glomerulus and its function in filtering substances such as water, ions, urea, and creatinine are central to understanding CKD.

Glomerular filtration rate (GFR) is a key indicator of renal function, with a normal GFR being greater than 90 milliliters per minute.

CKD is staged, with Stage 5 indicating severe loss of renal function and the need for regular dialysis or kidney transplant.

Patients in early stages of CKD may be asymptomatic, while those in later stages can experience symptoms like uremia and fluid overload.

Electrolyte imbalances, such as hyperkalemia and hypocalcemia, are common in CKD due to the kidney's impaired filtering ability.

Anemia is a frequent complication in CKD patients, caused by decreased production of EPO and blood loss through urine.

The kidney's role in hormone production, including EPO and renin, is compromised in CKD, affecting red blood cell production and blood pressure regulation.

Diabetes and high blood pressure are the most common causes of CKD, leading to arterial damage and decreased nutrient supply to the kidneys.

Treatment for early-stage CKD involves controlling blood pressure and glucose levels to prevent further kidney damage.

In advanced CKD stages, patients may require dialysis or kidney transplant, along with monitoring and managing GFR and blood pressure.

Nursing interventions for CKD patients focus on managing waste buildup, anemia, electrolyte imbalances, low urinary output, and fluid overload.

A low protein diet is recommended for CKD patients to reduce the production of waste products like urea that the kidneys cannot effectively filter.

Fluid restriction and a low sodium diet are often necessary to manage fluid overload and control blood pressure in CKD patients.

Monitoring and managing electrolyte levels with medications like phosphate binders and potassium excretion agents is crucial for CKD patient care.

Patients with CKD are at risk for bone issues due to low calcium levels caused by high phosphate levels and decreased vitamin D activation.

Nursing care for CKD patients includes close monitoring of neuro status, respiratory status, and cardiac function due to potential complications.

Transcripts

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