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

hey everyone is Sarah Chris Turner sorry and calm and in this video I'm going to be going over chronic kidney disease also known as chronic renal failure and this video is part of an inkless review series over the renal system and as always don't forget to take a free quiz that you can access at the end of this video so let's get started first let's start out talking about what is chronic kidney disease it is where you have a significant decrease in renal function and this happens over a long period of time and it is irreversible now that is the complete opposite of whenever we talked about in the previous lecture are about acute kidney injury remember that was a sudden decrease in renal function and it tends to be reversible if they can figure out the cause and treat it appropriately now let's look at our kidney and we're going to look specifically at the nephron because whenever we're talking about a decrease in renal function we're really talking about this glomerulus and how it is filtering specifically the glomerular filtration rate or GFR so we'll be using that term a lot GFR because if you can understand the GFR everything else tends to make sense okay so the kidney the functional unit of your kidney that actually produces urine are the nephron and in each can you have millions of these nephrons and the whole goal is to filter our blood that are received from the heart and the glomerulus is the structure that does that so it filters all these substances such as water ions which are like your electrolyzed 5-card things like that urea and creatinine which are waste products and remember urea is a waste product from protein right down in the liver and creatinine is a waste product from the breakdown of muscles so it filters back now the glomerulus does not filter proteins and blood cells you should not find that in your filtrate unless your glomerulus is messed up in here your long barrel is mess up so we can probably expect to find an address down into Bowman's capsule and then it's going to go down through the renal tubules in the renal tubules our innocence what they're going to do is they're just going to tweak that filtrate because the filtrate was created by the glomerulus and it's going to take what the body needs to maintain homeostasis so it's going to reabsorb the amounts of water you need it's going to reabsorb a little bit of urea and it's going to reabsorb our electrolytes that we need however it is not going to reabsorb creatinine so let's talk about creatinine for a second so creatinine is that waste product and it's fully filtered by that Vomero is from the blood stream and it's not going to be reabsorb in that renal tubules so that's why we care so much about creatinine when we measure it in the urine in the blood because it gives us a good indicator of how well that glomerulus is filtering that blood so whenever we measure a lamellar filtration rate we take a lot of things into calculation such as their creatinine clearance level the patient's gender their age their race and their weight and that helps us determine that now what is AGA GFR specifically it is the rate that the glomerulus filters waste ions and water in the blood so it tells us how well the kidneys are performing physically that nephron in helping our body maintain that beautiful homeostasis environment now we want a normal GFR in our patients and a normal GFR is greater than 90 milliliters per minute so ninety milliliters per minute or higher is a normal GFR so in chronic kidney disease what happens is that that GFR progressively decreases and there's various stages of CKD and for exams I would be familiar with the GFR for each stage especially stage four and five because that's when you have severe loss of renal function because sometimes pests like to ask questions about that so let's go over this okay Stage one is where you have kidney damage with normal renal functions so their GFR is going to be normal greater than 90 milliliters per minute but there's going to be proteinuria protein in the urine that has presented for three months or more then they can progress in stage two which is kidney damage with mild loss of renal function with a GFR between sixty to eighty nine milliliters per minute and they'll have proteinuria that's been present for three months or more then stage three is mild to severe loss of renal functions with the GFR between thirty to fifty nine milliliters per minute and then we go into the really severe stages stage four is severe loss of renal function where the GS are between fifteen to twenty nine milliliters per minute and then the very last stage which is the worst stage of all at Stage five and this is in stage renal disease and this is where the GFR is less than 15 milliliters per minute and this is where the patient's going to getting dialysis regularly and will be a candidate for a kidney transplant and these stages are sourced from the National Institute of Diabetes and digestive and kidney disease health statistics therefore as that GFR is decreasing the patient is going to have issues they're going to have issues with ways with electrolyte imbalances and fluid overload and as you've seen in those stages as they go from one to five that GFR is progressively decreasing so the patient who's in the early stages of chronic kidney disease they're going to probably be asymptomatic because that def R is normal compared to that patient in stage four or five where the GFR is really low so this is really what we're going to be concentrating on are those patients who are in the last stages of chronic kidney disease especially when we're talking about our nursing interventions and things like that okay so when we have a decrease yes or our glomerulus is not filtering the way it should so think of it this way every should be filtered is a stain in the blood and it's just building up because it's not going through here to be dripped down into Bowman's capsule and go through the tubules and the tubular will pick and choose what it wants so what is going to happen to our waste levels in our body specifically the view in which we measure it which is urea and creatinine it's going to increase in our body so those waste levels are going to be high and this is going to lead to problems such as Asia tinea uranium you're going to see neurological changes and itching things like that which we'll talk in more in depth and our nursing interventions then what's going to happen to our fluid status issues again the glomerulus is not removing the water it should so what's going to happen to that water it's going to stay in the blood so we're going to get fluid overload so we're going to be hypo or hyper bulimic we're going to be hi furball leeming now what's going to happen with that think about when there's too much water in the blood we have a lot of pressure in there our blood pressure is going to be high hypertension this can cause a lot of pressure on the heart which can cause it to become weak which can lead to fluid backing up into the lungs so pulmonary edema cardiac issues things like that how do you expect their urinary output to be if this squall Maryalice is not filtering the way it should will the urinary output be high or will it be low it will be low it'll be decreased okay so let's go over some terms if their urinary output was less than 400 milliliters per day what's that term it's terms of Luria okay if the urinary output was less than 100 milliliters per day what would that be that would be in urea so you'll be seeing some really low urinary output mutation okay let's go over to fluid and electrolyte okay so glomerulus is not removing the ion that should so we're going to do is those ions electrolytes are going to stay in the blood so which electrolytes are going to be high number one are potassium and we really care about the passing because it can cause cardiac issues so we're going to have hyperkalemia how their phosphate level is going to be they're also going to be high as well along with our magnesium levels now what about calcium levels well remember in our flu in an electrolyte series if you haven't checked it out I recommend you do because it'll help you when you're studying this material phosphate and calcium have a relationship and they are always opposite of each other so whenever you have high phosphate levels you're going to have low calcium levels now why is that okay calcium binds the phosphate so if we have all this phosphate in our blood it's going to take the calcium and bind it to itself which is going to remove the calcium from our blood so we'll have hypocalcemia now let's take it a step further what's going to happen with that well whenever your parathyroid gland senses high phosphate levels it causes the parathyroid gland to release PTH parathyroid hormone what does parathyroid hormone hormone do well we learn from our endocrine series it stimulates the bone to release calcium from within itself to go into the blood to increase the blood serum of calcium well what does that do to our bones it makes them weak and brittle so keep that in mind for whenever we're talking about nursing intervention so we're going to have hyperkalemia where you have hyper falsity Nia we're gonna have hypocalcemia and we're going to have hyper magnesium eeeh okay now let's look at this our protein and blood okay our glomerulus remember should not filter proteins and blood cells well here in chronic kidney disease the whole structure is being affected not only is our net we're going to be a fret affected but here in a second you're going to see that this whole kidney the cells with ended up to create form owns and activate vitamin D are going to be effective so what's getting through protein so the patient will probably have some protein in the urine and they're probably going to have blood in the urine as well so think what's going to happen when we're losing all this protein in our urine well we know that albumin one of those proteins regulates oncotic pressure whenever you have decrease oncotic pressure it allows fluid within that capillary to leak into that interstitial tissue so we're going to get even more swelling and edema then with the hematuria we're losing red blood cells in our urine we're going to get anemia because we're losing blood into the urine okay so now let's talk about our kidneys producing hormones because in a lot of patients have you ever work on a dialysis for flora renal floor you're going to notice these patients have very simular electrolyte imbalances and it will have these issues because of what's going on so the kidneys produce a hormone called EPO which is short for a reef Roco Etten and what does BPO do it helps create red blood cells in the bone marrow well in CKD EPO is not being produced like a show that's going to be decreased so we're not producing red blood cells where we at risk for we're at risk for anemia so patient can have that another hormone the kidneys produce is called renin cells within the kidney produce fat and what does Brandon do it plays a role in increasing our blood pressure it maintains our blood pressure for it so what's happening with the glomerulus how much water is it filtering it's not really filtering a lot of water so those cells sense that and they say oh the kidneys are filtering a lot of water that means our blood pressure must be low so we need to release some renin to increase that blood pressure which is not a good thing because remember we're already in a hyperbola McStay we already have hypertension going on so we're going to release more rhiannon which is going to increase our blood pressure even more and here in a second when we talk about the causes of this condition hypertension is one of them so we're causing even more damage to our kidneys okay and another thing that the kidneys do is kidneys activate vitamin D and what does vitamin D do it plays a crucial role in helping our body reabsorb calcium from the food we take in but with CKD you're not really activating that vitamin D so guess what you're not really going to be reabsorbing that calcium taken from food because we need that vitamin D to help us do that so they're going to be they're going to experience even more hyper hypocalcemia which remember with the high phosphate levels they're going to even have even lower calcium levels so that's going to be a double whammy with our calcium now let's look at the causes of chronic kidney disease okay one cause is diabetes mellitus and how does this cause this condition well when the patient has uncontrolled hyperglycemia so they have a lot of glucose in that blood their blood sugars are running very very high this causes glucose to stick to the artery wall and remember sugar is sticky so it sticks to the artery wall and that causes damage to the arteries that supply the kidneys so they can develop chronic kidney disease because your kidneys are being deprived of the nutrients it needs to function another thing that can cause it is high blood pressure so the patient has uncontrolled hypertension and we learned from our hypertension video that hypertension is one of those things that happen that causes really no signs and symptoms until it's too late it's like the silent killer so a lot of times the patient is unaware that they even have high blood pressure so there is a constant high pressure hitting those artery walls to the kidneys and the Khitan it becomes damaged which whenever the artery that's feeding the kidney becomes damaged that's less blood just going to go through the kidneys and go through that nephron and cause kidney damage so these two diseases these two issues are the most common causes for developing chronic kidney disease other causes can include acute kidney injury acute renal failure is what we talked about in the previous video maybe they don't progress to the recovery stage of that disease and they progress to chronic kidney disease instead polycystic kidney disease they can develop this and this is a genetic condition where this develops in the kidneys causing issues with renal functions infection or nephrotoxic drugs those drugs that are very very toxic to the kidneys like incest I mean I like a size chemotherapy drugs or contrast dye for testing procedures okay so what is the treatment for chronic kidney disease okay remember we have various stages so in those early stages where that GFR is normal why is usually ordered is to for the patient to control their blood pressure and to control the blood glucose level to prevent any further damage to that kitty so they can hopefully preserve that current GFR not how to decrease anymore also they may prescribe the physician may prescribe blood pressure medicine to keep that blood pressure low and to help protect the kidneys because there's two groups of medications that they have found that actually provide a protective mechanism to the kidneys and they include ACE inhibitors which are those angiotensin converting enzyme inhibitors and those are your drugs that engine krill like lisinopril or the arms the angiotensin receptor blockers and these are the drugs that end in Fartman Sarpa in likes losartan and in addition to that they'll be monitoring their GFR regularly making sure it's not getting progressively worse and having the patient monitor their blood pressure and making sure it's same within a normal range now when they progress or in those advanced stages like stages 3 4 & 5 especially that last stage stage 5 where that's where the GFR is abnormal the patient may need dialysis on a regular schedule a lot of patients are like they have the alysus on Monday Wednesday Friday or Tuesday Thursday and what is ballast again this is really what it is is it's a machine that's going to take the blood and filter it like how the nephron of the kidneys should have so it's going to remove the excess of water the waste and regulate those electrolyte levels and if it's really really bad like in the in stage renal disease they if they're attended it they can be a candidate for a kidney transplant now let's look at our nursing interventions okay what are we going to be doing for this patient as a nurse well let's ask ourselves what is going on with this patient with those late stages of chronic kidney disease well they're going to have a buildup of waste in the blood they're going to have anemia electrolyte imbalances low urinary output and fluid overload so we want to tailor our nursing interventions based on what is going on with the patient so first let's talk about the build-up of wastes in the blood patients going to have what's called uremia and whatever they have this they will have some specific signs and symptoms because remember our goal merula still try some right and decrease so it's not filtering all that waste out it should so that waste is trying to go somewhere when we make an have is itching and this is due to deposits of your reer crystals on the skin and it's being secreted through the sweat glands and has a unique look to it it will actually look like this white frost on the skin and this is known as your emic frost another thing the patient had because of those all because of those levels really high in the blood they can have confusion and you need to be assessing their neuro status and they're at risk for injury Falls so you want to be thinking of safety issues and diet what kind of diet would we want them to follow we want them to follow a low protein diet because remember urea is the breakdown of protein in the liver so we want them to have some protein to prevent muscle lasing but we don't want them to have high milk because it's just going to be broken down into more URI more ways that our kidneys cannot get rid of and our blood is going to become really acidic from all this waste in there so the blood pH can be less than 7.35 and there they can enter into two conditions known as metabolic acidosis and whenever that happens you may see what's called cosmo breathing and these are deep rapid breaths and it's the respiratory system of trying to blow off carbon dioxide because carbon dioxide is an acid and it's trying to increase the blood pH so make sure you're watching the respiratory status counting those respirations as Labour does it rapid what's going on now another thing is anemia what's anemia again it's low red blood cells and what red blood cells do because they're really important in our body they help transport oxygen to our tissues to your body so it can function properly now why are we seeing anemia again just a recap because we have low production of EPO remember EPO a reef rope Owenton helps stimulate our bone marrows produce red blood cells if we're not getting that another thing is we can be losing blood through our urine so that can decrease it it even more along with being deficient in other minerals such as iron folic acid and vitamin b12 because those substances play a role in helping us produce hemoglobin which helps transport red blood cells throughout the system now your patient when you look at this they will be Pelle they will be very tired they can be short of breath just getting up from the bed to the bedside chair they get really winded and they can be confused so what are some treatments for this as a physician may order supplements of iron to help replenish those levels to help produce more red blood cells if they're low in that also a repro couette and shots EPO shots and these are given sub-q and this will help stimulate that bone marrow to produce red blood cells where your kidneys are able to stimulate them to do that anymore or a blood transfusion to replace them with some more fresh red blood cells okay another thing we have going on with lower urinary output and fluid overload so anytime we're dealing with fluid issues what are we always going to do in any type of patient we're going to monitor their intake and output very very closely we're also an performed daily weights because Wayne patient patients and looking at their weight is a good indicator of fluid retention so we'll be using the same scale every day in the morning and we'll be looking at those weights what's their weight today compared to their weight yesterday are they gaining any are they losing any we're going to assess the swelling status in their extremities and their legs and their arms and their belly and in their face is it going down or is it getting worse lungs film we're going to be listening to that because when you hear crackles that can indicate pulmonary edema so throwing fluid overload the heart maybe becoming weak and so it's allowing fluid to stay into the lungs or flow over into the lungs we're going to monitor the blood pressure because we want to get their blood pressure at a normal range because remember high blood pressure is really hard on those kidneys and assessing the respiratory status again that goes back to the fluid overload another thing that may be ordered by the physician is a fluid restriction because we want to watch their urinary outfit really closely and make sure that we're not just giving them or allowing them to have so much fluids compared to what their kidneys can actually put out so we based on what the physician orders with that and a low sodium diet because sodium loves water so the more sodium they have in their system because they're not really excreting the sodium as they should that draws more water into the vascular system which can increase the blood pressure even more along with other diet restrictions which we're going to talk about whenever we go over our fluid and electrolyte problems and again one of those electrolyte imbalances the patient can have is called hyperkalemia where you have a high potassium level and the potassium level can be higher than 5.1 million per liter and what is a normal - level three point five five point 1 million quid lent for leader that's where we want them now the reason the tapping is so important is because it plays a role in muscle contraction and what's happened is that there has been a decreased ability on the nephrons part to filter and excrete that potassium so the patient is at risk for a cardiac event so we really want to monitor their EKG have them on a bedside monitor and we're looking at that EKG specifically for any tall peak t-waves like this one right here also the QRS complex can widen as you can see right here and your PR interval can get long so you're looking at that but most tests they like to ask about this t way remember it's going to be tall and Pete okay on the nurses part you'll want to be restricting those foods that are rich in potassium and that includes foods like potatoes avocados strawberries bananas spinach and oranges and in my fluid electrolyte videos if you're wanting to know foods that are really rich in the certain substances goes to that series or on the website because I have new monix on how to remember those foods so check that out and the physician may order kayexalate which will you can give it orally or rectally and it will take that potassium and excrete it out of the body another thing that electrolyte known they can have is remember that hyper phosphate Amy aware they have a high phosphate level and that's greater than four point five milligrams per deciliter and normal false level is two point seven to four point five milligrams per deciliter and what is that going to do to our calcium level and phosphate high because remember phosphate likes to bind with calcium it's going to decrease our calcium levels so we're going to get hypocalcemia and that is a level less than eight point six milligrams per deciliter and you usually want your calcium levels between eight point six to ten milligram per decilitre and again this is because that nephron is damaged so that phosphate has increased from the blood and it's finding with calcium and bring that level down and what's another reason why we're having low calcium levels because of that decrease ability of activating vitamin D by the kidneys because we're not going to be absorbing as much calcium as we should so what happens this patient is definitely at risk for some bone issues because again just to recap that high phosphate level stimulates the parathyroid gland to produce PTH parathyroid hormone and parathyroid hormone stimulates the bones to release calcium into the blood to increase the serum calcium level well doing that it hurts bone health so that risk for injury and so you want to prevent that so what do physicians order to help bring those phosphate levels down because we want those normal so it doesn't deplete our calcium levels anymore phosphate binders and this will help decrease phosphate and some drugs are calcium carbonate or calcium acetate also known as false low and what these drugs do is they bind with the phosphate in the foods and it excretes the phosphate in the stool so ask yourself when is the best time to give a patient or calcium carbonate or false low right with meals like five minutes of for meals or immediately after because we want them to take it with food because it's working on the food that they're taking the house phosphate in it so we can excrete out of the stool so you want to give it with that and they want to follow a low low phosphate diet so this will be to restrict flu foods like poultry fish dairy products nuts especially your cam photos that have phosphate in them and oatmeal next patient is at risk for - I'm using yeah and this is a high magnesium level and the level can be greater than two point six milligrams per deciliter and we like our bat mag levels in between one point six to two point six milligrams per deciliter and when you have a high magnesium level it's usually because you have a low calcium level because those go hand-in-hand as we've learned in our fluid and electrolyte series and with this the patient's tendon reflexes will be diminished or completely absent depending on how high that magnesium level is and they can be lethargic so what you want to remember with this is you want to not give them any magnesium based antacid or laxatives because you're just giving them more magnesium and you want to make sure you're restricting those foods high in magnesium also the physician may order IV calcium to help decrease this level because as we replenish the calcium level our mag level will come back down to normal okay so that wraps up this video on chronic kidney disease thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos

Channel: RegisteredNurseRN

Views: 976,318

Keywords: chronic kidney disease, chronic kidney disease diet, chronic kidney disease pathophysiology, chronic kidney disease nclex, chronic kidney disease lecture, chronic kidney disease treatment, chronic kidney disease stage 2, chronic kidney disease stage 4, chronic renal failure nursing, chronic renal failure, chronic renal failure lecture, chronic renal failure nclex, end stage renal disease, end stage renal disease pathophysiology, end stage renal disease nursing

Id: Hwl8WubnO-M

Length: 29min 32sec (1772 seconds)

Published: Sat Jul 22 2017