Page 1830 - Saunders Comprehensive Review For NCLEX-RN

IV. Chronic Kidney Disease (CKD)

A. Description
1. CKD is a slow, progressive, irreversible loss in kidney
function, with a GFR less than or equal to 60 mL per
minute for 3 months or longer.
2. It occurs in stages (with loss of 75% of functioning
nephrons, the client becomes symptomatic) and
eventually results in uremia or end-stage kidney
disease (with loss of 90% to 95% of functioning
nephrons) (Table 54-2).
3. Hypervolemia can occur because of the kidneys’
inability to excrete sodium and water; hypovolemia
can occur because of the kidneys’ inability to conserve
sodium and water.

CKD affects all major body systems and may require dialysis

or kidney transplantation to maintain life.
B. Primary causes
1. May follow AKI
2. Diabetes mellitus and other metabolic disorders
3. Hypertension
4. Chronic urinary obstruction
5. Recurrent infections
6. Renal artery occlusion
7. Autoimmune disorders
C. Assessment

1. Assess body systems for the manifestations of CKD
(Box 54-5).
2. Assess psychological changes, which could include
emotional lability, withdrawal, depression, anxiety,
denial, dependence–independence conflict, changes
in body image, and suicidal behavior.
D. Interventions
1. Same as the interventions for AKI.
2. Administer a prescribed diet, which is usually a
moderate-protein (to decrease the workload on the
kidneys) and high-carbohydrate, low-potassium, and
low-phosphorus diet.
3. Provide oral care to prevent stomatitis and reduce
discomfort from mouth sores.
4. Provide skin care to prevent pruritus.
5. Teach the client about fluid and dietary restrictions
and the importance of daily weights.
6. Provide support to promote acceptance of the chronic

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