Chronic Renal Failure (Chronic Kidney Disease) ESRD l Nursing NCLEX RN & LPN

[Applause] [Music] now switching gears to chronic kidney disease this is a gradual loss of kidney function going in stages kind of like shirt sizes going from extra small to extra extra large problems now we have five stages of ckd based on the gfr the glomerular filtration rate stating how much blood can be washed by the kidneys in each minute specifically inside these little washing machine bubbles called the glomerulus now key term write this down over 90 mls per minute is considered normal as you can see here as the gfr gets less and less this means the kidneys are in distress this means that less and less blood is being washed resulting in the blood filling up with waste and excess fluid and way too many electrolytes now this is no laughing matter because the kidneys are in distress here but here's the key point the five stages are not really tested on the nclex but it can be on your nursing exams so really focus on the stages four and five here since it means that the end stage of this renal disease is getting really bad here the kidneys are failing basically failing to filter the blood with this low glomerular filtration rate that low gfr so stage four we have 29 to 15 gfr and stage five this is the worst 15 or less gfr this is considered end stage renal disease now the kidneys are basically dead in this stage there's no way to bring the kidneys back to life so we typically have to do a kidney transplant and put our patients on dialysis in the meantime click here to check out our brand new app based nclex product loaded with the highest quality nclex style practice questions and complete with detailed video rationales that break down the question for you so finally master all those darn select multiply questions plus all our nclex memberships come included with our entire library of over a thousand videos and study guides and cheat sheets come see why over a hundred thousand students have trusted their future to simplenursing.com click here to get started for free now dialysis that machine version of the kidneys that are used to wash the blood which we covered in a separate video now let's cover the causes of chronic renal failure the first cause is older age geriatrics typically lose 10 of renal function each decade technically older age just leads to physiological decrease of renal function and not renal failure specifically but you get the idea here now the most tested causes for chronic renal failure is from long term years and years of chronic damage so please write this down you have to know that uncontrolled diabetes from uncontrolled high sugar is a major cause as well as uncontrolled hypertension from that uncontrolled high blood pressure and even unchecked autoimmune diseases where the body attacks the kidney so to help you paint the picture better here just think of a patient with diabetes who has uncontrolled hyperglycemia for years just think of all this thick syrupy blood like sugary maple syrup being poured into the body it's like mud inside the delicate kidneys specifically inside the delicate glomeruli what do you think it's going to do to the kidneys here do you think it's going to destroy them well yes it's like thick cement being poured into a delicate washing machine which eventually kills the kidneys resulting in renal failure or what about a patient with years and years of uncontrolled high blood pressure think about all that pressure coming from the heart and just pounding against these poor little blood vessels inside the kidneys eventually scarring and hardening those glomeruli leading to less blood flow and resulting in kidney failure that's why it's so important to educate your clients to control their sugar and high blood pressure lastly other main causes include infection causing glomerular nephritis acute renal failure that worsens and progresses into chronic kidney disease and even polycystic kidney disease where cysts develop inside the kidneys themselves hesi mentioned this asking about polycystic kidney disease indicating that the client is at risk for end-stage renal disease now whatever the cause the diagnostics are typically the same here so creatinine our number one kidney lab remember over 1.3 means bad kidney again think of the c's c for creatinine c for critical lab value so a key term to know is creatinine clearance test this measures how much creatinine waste is being cleared from the body and into the body specifically how well the glomerular filtration rate is working to wash the waste out of the blood the test requires both a urine specimen and a blood specimen in 24 hours so the key points to write down and to know for your exams is 24 hour collection of all urine in a container and we put it on ice to keep it cold and another key point is you discard the first urine specimen when the test begins write that down it's always a test question now don't let the nclex trick you here we do not need a midstream sample or a sterile container that's mostly used for utis when you're checking for bacteria or infection now a hessie question asks what's the correct understanding of creatinine clearance test and the answer is to save all the urine samples in a container for a designated period after discarding the first urine so you kind of see how those two key points are tied in there now switching gears to signs and symptoms just think about the patho here you have broken washer machines right so we can't wash the blood from waste or excess electrolytes and even fluid but most importantly we can't get fluid out of the body and into the body this lack of urine output is called oliguria so remember the os for low urine output in oleguria very very low urinary output like less than 400 mls per day so kaplan mentions a patient with chronic kidney disease all liguria is expected for low urinary output another highly tested area is the critical complications so just think all this excess fluid and electrolytes are trapped inside the body and can cause dangerously high blood pressure from all that fluid volume overload now dangerously high blood pressure can lead to strokes heart attacks and even further kidney damage from that high tension on all the organs so the first priority is to monitor for hypertensive crisis now the priority key signs to write down huge nclex tip here so number one is headache number two is nausea and vomiting and number three a really big one here is change in mental status now these three are always priority requiring immediate assessment write these down we sell them on various question banks for key term hypertension crisis you must report these key signs to the hcp provider immediately now clients can also get multiple other signs revolving around fluid volume overload including crackles in the lungs those wet fluid-filled lungs jvd that jugular vein distension as well as bounding pulses from that fluid volume excess but these do not take priority over hypertension crisis so you must know that for your exams and ultimately the nclex another sign is anemia those low rbcs red blood cells since the kidneys release erythropoietin which is that hormone that stimulates bone marrow to produce red blood cells which helps carry oxygen around the body but typically that's expected to know and not tested now what is tested is excess waste and electrolytes in the blood due to these broken washing machines so for waste we have hydrogen ions just think acid when you see hydrogen ions we get metabolic acidosis with the ph below key number here 7.35 due to the retention of all those hydrogen ions and we also see urea since it can't get out of the body and into the potty which eventually develops into uremic frost those crystallized urea deposits on the skin basically white frost causing paritis that itchy skin but again these are normal and to be expected and not priority over hypertension crisis remember those headaches nausea and vomiting and change in mental status are all priority here so don't get it twisted now for the electrolyte values these are always exam favorites so be sure to write these down sodium is high over 145 just think high sodium we get high swelling which can lead to hypertension crisis phosphorus is high over 4.5 which leads to decreases in our calcium leading to osteoporosis those porous weak bones making a huge risk for fractures now the big critical one here is potassium that is high over 5.0 now this is the most important number one electrolyte on the nclex and nursing exams since it pumps the heart so the memory trick we use is the three ps just think p for potassium is p priority since it pumps the heart muscles so with high potassium over 5.0 we get high pumps of the heart resulting in peak t waves and st elevations from high pumps so key terms to know peak t waves happens when potassium is six to seven micro equilibriums per liter st elevation happens when potassium is between seven to eight and wide qrs complexes is a late sign over eight basically the heart is cramping up from too much potassium too much high pumps makes a very tight heart that is just basically cramping all up you have to think that the heart's a muscle right so do you really think the heart can pump normal if this muscle is cramping well no so this leads to bradycardia that low heart rate since the heart is too tight and can't beat correctly and which ultimately results in weakness fatigue and lethargy from less cardiac output meaning less oxygen out of the heart into the body and then finally leading to deadly ventricular dysrhythmias like v-tac and v-fib that ventricular tachycardia and ventricular fibrillation if not treated immediately this will cause death by cardiac arrest basically that stopped heart so that's why potassium is priority on the nclex and nursing exams since it pumps those heart muscles now kaplan had a scenario asking a client with kidney disease is very weak lethargic and bradycardic asking for a suspected finding for this patient so the key term here is kidney disease that is weak lethargic and bradycardic that low heart rate so you have to automatically prioritize and think about potassium here so potassium 8.5 is the lab value to be suspected now in terms of treatments the long-term solution is to wash the blood with dialysis but this can take some time to set up so the immediate priority solution and treatment is to lower the potassium and protect the heart from deadly dysrhythmias we do this with drugs in a very specific order so write this down for priority treatment number one is iv calcium gluconate for the key term write this down dysrhythmias just think gluconates helps to glue down those crazy heart muscles preventing deadly dysrhythmias like wide qrs complexes which will eventually progress into deadly v-tac and v-fib we must glue down those heart muscles with calcium gluconate now if the key term of dysrhythmias is not involved in the question then we progress number two which is iv 50 dextrose and regular insulin this helps to lower the potassium so just think insulin puts sugar and potassium into the cell out of the blood and into the cell which lowers blood serum potassium most effective way to lower blood potassium very quickly but insulin also lowers blood glucose too basically that blood sugar so that's why we also give dextrose to help prevent that low blood sugar that hypoglycemia now don't let the nclex trick you here what if the key term dysrhythmias is not in the question well then we progress to option 2 which is just to give the iv dextrose and insulin first to lower that high potassium and lastly 3 and 4 we can also give k excellate that polystyrene sulfonate as well as dialysis but again these typically take longer to lower potassium so that's why we put them last here on the list because they take a longer time now for the top two missed nclex questions so question number one a patient with chronic kidney disease missed three dialysis sessions oh with key terms here potassium level of 8.1 wide qrs complexes a heart rate of 58 and lethargy which order or prescription should the nurse implement first so the key term here is high potassium with wide qrs complexes that key term indicates dysrhythmias so just think you have to give calcium gluconate first to glue down those crazy heart muscles and prevent the progression into those deadly heart dysrhythmias so option number four iv calcium gluconate because the key term was about dysrhythmias and high potassium now question number two end stage renal disease with a potassium of 7.2 a bun of 35 creatinine of 38 and urinary output of 300 ml in 24 hours which order is priority so this question says high potassium right but nothing about ecg dysrhythmias or basically heart dysrhythmias so we need to lower that potassium first with insulin which puts sugar and potassium in to the cell so option number one iv regular insulin and 50 dextrose yes we give this first not loop diuretics and not dialysis this is used later and definitely not option number four the vacation time even though it's pretty tempting now as far as nursing interventions generally we check daily weights at the same time every single day so the key number to know is one kilogram equals one liter of fluid retained so we must report any type of fluid retention to the hcp immediately because this can lead to fluid volume overload and hypertension crisis now we also avoid the top drugs that can cause kidney injury like nsaids as mentioned before so just think n in nsaids is n for not good for the entire body we also avoid milk of magnesia that anti-acid as well as antibiotics those vancomycin and gentamicin remember it's a sin to give a maya sin since it kills the kidneys as well as ct contrasts die remember contrast kills those kidneys just think of that contrast dye like thick cement in those delicate washing machines of the kidneys now as far as procedures as mentioned before hemodialysis which is the machine version of the kidney is used to wash the blood but only used for a number of years until a kidney transplant is available now we cover both of these in their own separate videos now as far as patient education diet is huge so we must restrict fluid sodium and potassium to make sure they don't go even higher inside the blood and we must consume low phosphorous and low protein in the diet now more specifically for restriction of sodium just think no sodium here think of the s in sodium as s for swelling of the body leading to edema and fluid retention so this means no canned or packaged foods so we're avoiding salad dressings canned soup soy sauce anything that's packaged or can and no processed meats that was highly tested on various question banks so no cold cuts no cured meats or steaks or sausages you get the idea next is no potassium since remember potassium is priority remember the kidney washing machines are broken here so keep potassium low since there is no way to get it out of the body so write this down apples are typically the best choice that's a huge nclex tip right there they have the lowest amount of potassium and it was mentioned by two quiz banks as well as no salt substitutes another big nclex tip this contains potassium and it was mentioned by three different question banks and generally speaking no leafy veggies like spinach no avocados carrots or tomatoes and no strawberries oranges or bananas these key terms were mentioned various times in many different question banks so hesse had a question about best food choice for potassium of 6.5 so that's high potassium over 5.0 and the answer was apple slices or apple juice for their low potassium levels and the second question which statement needs further education and the statement that says i should reduce my sodium intake by using salt substitutes no salt substitutes have high potassium lastly the double lows for the double peas here low phosphorus and low protein just think lower the double peas for the double kit knees so low phosphorus we have key terms no dairy so avoid yogurt puddings or even milk huge nclex tip there all these contain both potassium and high phosphorus levels so write that down there so the memory trick we use is avoid the yolk earth if your kidneys are hurt and for low protein just think low protein preserves kidney function since low protein means lower workload for the kidneys to filter now the key point is that all kidney conditions need low protein in the diet except nephrotic syndrome where we have nasty loss of protein but we cover that in the nephrotic syndrome video so overall in general less animal products is best for any kidney condition so low chicken eggs turkey steaks and meats you get the idea some also contain high amounts of phosphorus too so a few kaplan questions mentioned the rationale for lower protein in the diet and the answer was to preserve that renal function so again remember low protein preserves that renal function and the second question we'll be doing in an english accent teaching about the nutrition has been effective when the client states the answer was i will eat red bell peppers and avoid red meats yes this is correct here so avoid high protein to preserve those kidneys all right guys that wraps it up thanks so much for watching to the end don't forget to take your quiz and download the study guides thanks for watching for our full video and new quiz bank click right up here to access your free trial and please consider subscribing to our youtube channel last but not least a big thanks to our team of experts helping us make these great videos alright guys see you next time [Music] you

Channel: Simple Nursing

Views: 37,447

Rating: 4.8748498 out of 5

Keywords: chronic kidney failure, chronic kidney disease, chronic kidney insufficiency, CKD, end stage kidney disease, ESKD, end stage renal disease, ESRD, NCLEX, RN

Id: 0cIoZhjfC1E

Length: 22min 5sec (1325 seconds)

Published: Tue Mar 30 2021