Transcript Mary had a little lamb…

Kidneys and Kidney Disease
November 11, 2008
Sharon Bunnell BSN RN CNN
Program Manager, CKD
Primaris
Publication MO-08-06-CKD November
This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy
Objectives
Gain an understanding of kidney functions
Learn possible causes of kidney disease
Learn types of kidney disease
Learn symptoms of kidney disease
Understand emotional aspects of kidney disease
Learn type and care of dialysis access
Urinary catheter care
Anatomoy and Purpose
Most people have two
kidneys.
Main purpose is to clean the
blood by removing water, salt
and other waste products
Other Kidney Functions
Balance body fluids and chemical levels
Keep valuable substances
Release hormones
Control blood pressure
Make red blood cells
Maintain healthy bones
Filtering the Blood
Kidneys remove wastes and excess water (fluid) collected by, and
carried in, the blood as it flows through the body.
About 190 liters (335 pints) of blood enter kidneys daily via renal
arteries. Millions of tiny filters, called glomeruli, inside the
kidneys separate wastes and water from the blood.
Most unwanted substances come from what we eat and drink.
Kidneys automatically remove the right amount of salt and other
minerals from the blood, leaving only needed quantities.
The cleansed blood returns to the heart and recirculates through
the body.
Excess wastes and fluid leave kidneys in the form of urine. Urine
is stored in bladder until it is full, then exits via the urethra. Most
people pass about 2 liters (4 pints) of urine daily.
Balancing Fluid Levels
By removing proper amount of excess fluid, healthy kidneys maintain
what is called the body's fluid balance.
In women, fluid content stays at about 55% of total weight; in men
about 60% . Kidneys maintain these proportions by balancing the
amount of fluid that leaves the body against the amount entering
the body.
Fluid comes into our bodies from what we drink and from high-liquid
foods like soup. If we drink a lot, healthy kidneys remove the excess
fluid and we pass a lot of urine. If we don't drink much, kidneys retain
fluid and we don't pass much urine.
Fluid also leaves the body through sweat, breath, and feces. If weather
is hot and we lose a lot of fluid by sweating, the kidneys will not pass
much urine.
As kidneys fail, maintaining balance becomes difficult. Proper diet and
fluid intake are vital.
Symtoms of Excess Fluid
Swelling or Edema
Feet or legs
Facial
Lower back (Sacral area)
Elevated Blood Pressure
Blood pressure elevates due to excess fluid in blood
vessels
Shortness of Breath
Difficulty talking
Sleeping in chair or with extra pillows
Controlling Blood Pressure
An important kidney function is regulating blood
pressure.
Healthy kidneys make hormones such as renin and
angiotensin. These hormones regulate how much
sodium (salt) and fluid the body keeps and how well
blood vessels can expand and contract. This, in turn,
helps control blood pressure.
Kidneys Control
Amount of water in the body
Too much water (fluid overload) blood pressure rises.
Too little water (dehydration) blood pressure drops.
Width of arteries
Arteries constantly change in width as blood flows
through them. The narrower the arteries, the higher
the blood pressure. Renin helps control narrowing of
the arteries. Failing kidneys often make too much
renin. This raises blood pressure. If your blood
pressure is high, your heart is working harder than
normal to pump blood through your body.
Helping Make Red Blood Cells
Healthy kidneys produce a hormone called erythropoeitin (EPO),
which is carried in blood to bone marrow where it stimulates
production of red blood cells. These cells carry oxygen
throughout the body. Without enough healthy red blood cells a
person develops anemia, a condition which makes them feel
weak, cold, tired, and short of breath
Maintaining Strong Healthy Bones
Healthy kidneys keep bones strong by producing the
hormone calcitriol. Calcitriol maintains the right levels
of calcium and phosphate in the blood and bones.
Calcium and phosphate balance are important to
keep bones healthy.
When the kidneys fail they may not produce enough
calcitriol. This leads to abnormal levels of phosphate,
calcium, and vitamin D, causing Renal Bone Disease
Types of Kidney Disease
Acute kidney failure occurs when kidneys suddenly
stop working. Often this condition is temporary. The
cause may be disease, serious injury, poisons or
chemicals in the system. Dialysis treatment supports
the patient while the kidneys recover. In some cases
acute kidney failure may progress to chronic kidney
failure and require dialysis or kidney transplant.
Chronic Kidney Disease
Chronic kidney failure occurs when kidneys gradually
lose their ability to do their job.
The causes of kidney disease are not always known,
but conditions such as diabetes and high blood
pressure clearly increase the risks of kidney failure.
Sometimes people are unaware that their kidneys are
not functioning properly. This is because kidneys are
very adaptable. Even when most of a kidney is not
working the remaining portion will increase its activity
to compensate for the loss.
Symtoms of Kidney Disease
Swelling
Weakness, fatigue, feeling cold, shortness of breath
Poor concentration, trouble sleeping
Changes in urination
Rash or itchy, dry skin
Metallic taste in mouth, lack of appetite, nausea
Restless, cramped or sore legs
Swelling
When kidneys are failing, excess fluid builds up in the
body and can lead to a condition known as edema,
which is swelling in the hands, ankles, feet, or face
(especially around the eyes, when you first wake up).
Fluid can also collect in the lungs, which may cause
shortness of breath.
Weakness, Fatigue, Feeling Cold
or Shortness of Breath
Kidney damage can slow down production of a hormone
called erythropoeitin, which leads to a low red blood cell
count. This causes anemia, a common and treatable
complication of kidney disease that can make you feel
tired very quickly
Poor Concentration or Trouble Sleeping
Anemia can prevent your brain from getting enough
oxygen, which can lead to difficulty in sleeping or
concentrating, and dizziness
Changes in Urination
Your kidneys make urine; kidney disease can cause
urine to change. Urination problems include foamy or
bloody urine, more or less urine than normal, a
change in frequency, or pressure or difficulty
urinating.
Rash or Itchy Skin
Kidneys remove waste from the bloodstream, so
when kidneys fail, the buildup of waste in your
bloodstream can cause skin rashes or severe itching.
Metallic Taste, Loss of Appetite or Nausea
Buildup of waste in the blood (called uremia) can
make food taste different or cause bad breath, which
can lead to a loss of appetite, vomiting, nausea or
weight loss.
Restless, Cramped or Sore Legs
Build up of waste products can cause nerve damage
which may cause restless leg syndrome
What Can Be Done to Prevent or Delay CKD
Control Blood Sugar Goal A1C <6.5
*Diabetes is the leading cause of CKD
Control Blood Pressure <130/80
*Elevated BP causes increased stress on the kidneys
Limit Salt and Sodium (Na) intake
*Salt causes the body to retain fluid, thus increasing BP
Limit Protein and Phosphorus intake
*Large amounts of protein causes excess workload on the kidneys. The ability to
regulate phosphorus is diminished.
Stop Smoking
*Smoking causes constriction of the blood vessels reducing blood flow to the
kidneys thus increasing BP
Emotional Effects of Kidney Disease
Most people don't like change. Kidney failure is
particularly stressful because it not only involves
change in physical health and body image but in
work, family, and relationships
Emotions resulting from kidney disease
Fear---What does the future hold
Anger---- Why me
Loss of Control ------ Will I be dependent on others
Stages of Grief
Denial: this isn’t happening to me
Anger: why is it happening to me
Guilt: I should have done differently
Depression: I don’t care anymore
Acceptance: I am ready for whatever comes
Dialysis Access
AV Fistula
--- A direct connection of an artery to a vein.
--- Once created it is a natural part of the body.
--- Preferred type of access; as it matures it gets
stronger, provides long-lasting blood flow that can last
for decades.
--- After surgically created, requires weeks to months
to mature and use for hemodialysis.
AV Graft
An arteriovenous (AV) graft is created by connecting a
vein to an artery using a soft plastic tube. After the
graft heals, hemodialysis is performed by placing two
needles in the graft; one in the arterial side and one in
the venous side. Graft allows for increased blood flow.
Catheter for Dialysis
Catheter is inserted into a large vein in either the neck or chest.
A catheter is usually a short-term option; however, in some cases
a catheter is used as a permanent access. With most dialysis
catheters, a cuff is placed under the skin to help hold the
catheter in place.
Catheters have a greater tendency to become infected than
other access types because it is both inside and outside of the
body. A catheter must always be kept clean and dry; swimming
or bathing are usually restricted. Getting dressed may disturb the
catheter at the exit site, so care needs to be taken
Care of Dialysis Access
Keep access clean at all times.
Access site is only for dialysis.
Be careful not to bump or cut access.
Don’t put a blood pressure cuff on access arm.
Don’t place jewelry or tight clothes over access site.
Don’t position client with access arm under their head
or body.
Check pulse in access every day.
DO NOT get catheter site wet.
Every Day Living with Chronic Kidney Disease
Restrict sodium intake in diet
Do not use salt substitutes
Follow physician recommended diet
Maintain good blood pressure control
If diabetic, maintain tight control of blood sugar
Practice good foot and skin care
Urinary Catheter Care
Make sure that urine is flowing out of catheter into
the drainage bag.
Check area around the urethra for inflammation or
signs of infection, such as irritated, swollen, red or
tender skin at the insertion site or drainage around
the catheter.
Make sure urinary drainage bag does not drag and
pull on catheter.
Catheter Care
Clean area around drainage tube twice each day.
Use soap and water to carefully wash around
drainage tube.
Rinse well and dry with a clean towel.
Do not tug or pull on the drainage tube
Unless you have been instructed otherwise, persons
may take a shower wearing urinary catheter.
Catheter care cont.
Do not apply powder or lotion to the catheter insertion
site.
Prevent constipation.
Make sure you drink enough fluids. Most adults
should drink between 8 and 10 glasses of water,
noncaffeinated beverages, or fruit juice each day.
Include fruits, vegetables, and fiber in your diet each
day.
Try a stool softener, such as Colace, if your stools are
very hard
Catheter care cont
Keep the drainage bag below the level of the bladder.
At night you may wish to hang the bag on the side of
your bed.
Do not allow the bag to drag and pull on the catheter.
Check the drainage tube frequently to make sure it is
not kinked.
Do not pull or tug on the catheter
Draining the Catheter
Wash your hands with soap and water. Put on gloves. Always
wash your hands before you put on the gloves and after you
remove them.
Unfasten the tube from the drainage bag.
Fasten the tubing clamp and remove the drainage cap.
Drain the urine into the toilet. You may also drain the urine into
another container and then empty it into the toilet. Avoid
touching the tubing or drainage cap on the toilet, the collection
container, or the floor.
If monitoring fluid intake and output, measure the amount of
urine, do so before you have emptied the urine into the toilet.
Replace the drainage cap, close the clamp, and refasten the
collection tube to the drainage bag.
Wash your hands with soap and water
When to call the Nurse or Doctor
No urine or very little urine is flowing into the collection bag for 4 or
more hours.
No urine or very little urine is flowing into the collection bag; person
feels bladder is full.
New pain in abdomen, pelvis, legs, or back.
Urine changes color, very cloudy, looks bloody, or has large blood
clots in it.
Insertion site becomes irritated, swollen, red, or tender, or pus draining
from catheter insertion site.
Urine has a foul odor.
Urine leaking from insertion site.
Fever of 100°F (37.8°C) or higher or back or flank pain.
Nausea, vomiting, or shaking chills develop.
Questions?
Contact information
Sharon Bunnell BSN RN CNN
Primaris
[email protected]