**CHRONIC KIDNEY DISEASE**

# PATIENT EDUCATION PROTOCOLS

# 

# CKD-AP ANATOMY AND PHYSIOLOGY

**OUTCOME:** Patient and family will have a basic understanding of where
the kidneys are located in the body and their function

**STANDARDS:**

1.  Explain that there are two kidneys in the body located on either
    side of the spine and extend a little below the ribs.

2.  Explain that the kidneys are bean-shaped organs and is about the
    size of a fist.

3.  Explain that the kidneys receive approximately 10% of the blood that
    is pumped out of our heart every minute.

4.  Explain that the kidneys are responsible for performing various
    roles in maintaining a balance of fluid and chemicals in the body.
    They have four basic functions:

    a.  Regulation of body fluid

    b.  Balance of chemicals in the body (potassium, calcium, sodium,
        phosphorus)

    c.  Removal of waste products from bloodstream/body (urea,
        creatinine, phosphorus).

    d.  Secretion of three hormones: Renin, which regulates blood
        pressure. Erythropoietin, which stimulates the bone marrow to
        produce red blood cells. Calcitrol (1,25 dihydroxyvitamin D3),
        the active form of vitamin D helps stimulate absorption of
        calcium by the intestine and bone.

# CKD-C COMPLICATIONS 

**OUTCOME (S):** (a) Patient and family will understand the
complications/symptoms of untreated or progressive kidney disease. (b)
The patient/family will understand the complications associated with
dialysis treatment. (Please choose from the following standards as they
apply to the patient's specific disease process.)

**STANDARDS:**

1.  Explain that CKD is progressive in nature.

2.  Explain that anemia is a common consequence of chronic kidney
    failure due to a decrease in erythropoietin production from the
    kidneys or there may be a lack of iron in the blood.

3.  Explain how uncontrolled hypertension hurts the blood vessels in the
    kidneys and increases the risk for cardiovascular disease.

4.  Explain how malnutrition can result from inadequate caloric and
    protein intake due to loss of appetite or uremia.

5.  Explain how bone disease develops from a consequence of phosphorus
    retention and calcitriol deficiency leading to secondary
    hyperparathyroidism.

6.  Explain that as the kidney function decreases, functional status
    (i.e. quality of life) may decrease and well-being may be affected.

7.  Explain how CKD increases the risk for heart/cardiovascular disease.

8.  Explain that as toxins build up in the blood, patient may experience
    symptoms of uremia (inability to think clearly, nausea, vomiting,
    itchiness, loss of appetite, altered smell & taste, etc.)

9.  Explain that as the kidney function declines, a patient may
    experience weight gain from excess fluids, swollen ankles and feet,
    puffiness around eyes, including high blood pressure.

> 10\. Explain that as the kidney function declines, a patient with
> diabetes may have changes in
>
> diabetes control and need less diabetes medications, to reduce risk
> for low blood sugar.
>
> 11\. Explain that even with proper dialysis, patients may experience
> fluid imbalances;
>
> shortness of breath, unusual swelling, dizziness, etc. should prompt
> medical evaluation.

# CKD-DP DISEASE PROCESS

**OUTCOME**: Patient and family will have an understanding of their
specific type of chronic kidney disease (CKD). (Choose from the
following standards that apply to this patient's specific chronic kidney
disease process.)

**STANDARDS:**

1.  Explain that chronic kidney disease is irreversible and progressive.
    CKD can have many causes including:

```{=html}
<!-- -->
```
a.  Diabetic nephropathy

b.  Hypertension

c.  Glomerulonephritis

d.  Infections, urinary tract abnormalities.

```{=html}
<!-- -->
```
2.  Explain the basic pathophysiology of the specific type of CKD and
    its symptoms.

**CKD -- LA LIFESTYLE ADAPTATION**

**OUTCOME**: The patient/ family will strive to make the lifestyle
adaptation necessary to deal with and prevent complications of the
specific kidney disease and improve overall health

STANDARDS

1.  Discuss that kidney disease is different for everyone. Advice from
    the doctor may change if the disease continues to progress. Explain
    that they can participate in their own care and ask questions.

2.  Review the lifestyle aspects/changes that the patient has control
    over -- food and exercise, taking medications safely, follow-up
    appointments, tobacco, alcohol.

3.  Explain that the patient should avoid blood draws (venipuncture),
    IVs and blood pressures on the non-dominant arm to protect blood
    vessels for potential dialysis access.

4.  When discussing renal replacement therapy options, explain that
    people on dialysis or who have had a kidney transplant can still
    work. Rehabilitation is preferred.

> 5\. Review the community resources available to assist the patient in
> making lifestyle changes and make referrals as appropriate.
>
> 6\. Explain that kidney failure affects not only the patient but,
> family and friends as a major crisis. It is not uncommon for patients
> and their families to have feelings of fear, guilt, denial, anger,
> depression, and frustration but there is help available.
>
> 7\. Explain that a mental health assessment might be beneficial - to
> allow patient to grieve
>
> through the emotional aspect (loss of kidney function). The patient
> may need to assess their own traditional beliefs to begin accepting
> dialysis treatment.

**CKD - M MEDICATIONS**

**OUTCOME:** The patient/family will understand the medications
prescribed in the management of his/her kidney disease

STANDARDS:

1.  Discuss proper use, benefits, common side effects and common
    interactions of prescribed medication including drug/drug and
    drug/food interactions.

2.  Explain to the patient/family that the patient's physician(s) should
    be contacted before starting, stopping or changing any prescription
    medications, over-the-counter medications or dietary supplements.

3.  Explain that the doctor may tell the patient to avoid certain
    medications like NSAIDs.

> 4\. Explain that phosphate binding medications are necessary for many
> people with
>
> kidney disease. They serve two purposes- increase calcium in bones &
> help reduce phosphate levels.
>
> 5\. Explain that the patient's medications may change after starting
> dialysis (prn).
>
> 6\. Emphasize the importance of bringing all medications to medical
> appointments.

**CKD - N NUTRITION**

**OUTCOME**: The patient/family will verbalize an understanding of the
ways diet relates to kidney disease

STANDARDS:

1\. Explain that an appropriate dietary regimen is essential in the
management and treatment

of kidney disease.

2\. Discuss that the diet will probably change as time goes on.

3\. Discuss avoiding salt and salty foods. Explain that their dietitian
will be teaching them

> about protein, sodium, phosphorus, potassium and fluids.

4\. Explain that the patient may need to meet regularly with their
dietitian for ongoing medical nutrition therapy.

# 

# CKD-P PREVENTION

**OUTCOME (S):**

a)  The patient/family will understand how to prevent or slow
    progression of chronic kidney disease (CKD).

b)  The patient/family will understand how to prevent complication(s)
    associated with vascular access placement, i.e. AV fistula, graft,
    or central line catheter.

**STANDARDS:**

1.  Discuss with patient/family the importance of treating/controlling
    other medical conditions associated with CKD such as adequate blood
    glucose control in diabetic patients, high blood pressure control,
    and control of elevated cholesterol.

2.  Screening family members who are at high risk for chronic kidney
    disease.

3.  Emphasize the importance of using aseptic technique with peritoneal
    catheter care and during exchanges.

4.  Emphasize the importance of keeping the central line catheter clean,
    dry, and avoid touching to prevent infection.

5.  Emphasize the importance of assessing vascular access, i.e. feeling
    for thrill, checking for numbness, bleeding, and redness.

# CKD-PRO PROCEDURES

**OUTCOME:** The patient/family will verbalize understanding of the
risks, benefits, and alternatives of the proposed procedure(s) to be
performed.

**STANDARDS:**

1.  Explain the specific proposed procedure(s), i.e. biopsy, fistula,
    graft, central catheter, or peritoneal catheter to be performed,
    including the risks and benefits.

2.  Discuss possible alternative(s) to the proposed procedure(s), i.e.
    fistula, graft, central catheter, or peritoneal catheter, in the
    event that the proposed procedure is not recommended.

3.  Discuss with patient/family the involvement of required
    post-operative and maintenance care following the proposed
    procedure(s).

# CKD-TE TESTS

**OUTCOME:** The patient/family will have a basic understanding of the
test(s) to be performed, indications, and its influence on further care.

**STANDARDS:**

1.  Explain the specific test(s) ordered, i.e. blood urea nitrogen,
    creatinine, phosphorus, calcium, albumin, urinalysis, CBC, etc.

2.  Explain the necessity, benefits, and risks of the test(s) to be
    performed and how it relates to the course of treatment.

3.  Explain any necessary preparation for the testing, i.e. fasting.

4.  Explain the meaning of the test results and its impact on further
    treatment.

# CKD-TX TREATMENT

**OUTCOME (S):**

a)  The patient/family will have a basic understanding of treatment plan
    for CKD.

b)  The patient/family will have a basic understanding of the various
    modalities of renal replacement therapy to make an informed
    decision.

**STANDARDS:**

1.  Discuss the specific treatment plan for CKD including treatment to
    conserve renal function and eventual need for renal replacement
    therapy.

2.  Emphasize adherence to medications, dietary, and lifestyle changes
    that may impede the rate of progression of chronic kidney disease.

3.  Discuss the treatment plan with patient/family; emphasize the
    importance of compliance with therapeutic regimen, even if the
    patient is asymptomatic.

4.  Explain each possible renal replacement therapy:

```{=html}
<!-- -->
```
a.  Hemodialysis

b.  Peritoneal dialysis

c.  Kidney transplant.

> 5\. Review with the patient/family the risks and benefits of each
> renal replacement therapy option and the consequences of refusing
> treatment.