HESI Case Studies-Chronic Kidney Disease

WHAT IS THE BEST DESCRIPTION OF CKD?
A FATAL DISORDER UNLESS DIALYSIS OR ORGAN TRANSPLANT IS RECEIVED
WHAT LAB VALUE DECREASES WITH CKD?
SERUM CALCIUM
WHAT CAUSES HBG TO DROP IN CKD?
FEWER RBCS ARE BEING FORMED BECAUSE KIDNEYS ARE LESS ABLE TO PRODUCE ERYTHORPOIETIN
WHAT CAUSES HYPERTENSION IN CKD?
THE RENIN ANGIOTENSION CYCLE CAUSES VASOCONSTRICTION OF THE PERIPHERY WHICH INCREASE THE B/P IN ADDITION THE EXCRETION OF ALDOSTERONE CAUSE THE RETENTION OF SODIUM & WATER WHICH FURTHER INCREASE FLUID VOLUME & RAISES B/P
WHAT ASSESSMENT FINDING INDICATES THAT CALCIUM ACETATE (PHOSIO) HAS BEEN EFFECTIVE?
NORMAL SERUM PHOSPHOROUS LEVEL
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IF CAPTOPRIL IS GIVEN TO A PT WHAT ASSESSMENT FINDING WOULD INDICATE THAT THE DRUG IS WORKING?
NORMAL B/P
IF A CKD PT IS GIVEN EPOGEN WHAT ASSESSMENT FINDING WOULD INDICATE THE DRUG WORKING?
CONJUNCTIVAL SAC TURNS REDDISH PINK COLOR
WHAT INTERVENTIONS WOULD YOU PERORM FOR A CKD PT?
MONITOR DAILY WEIGHTS
ENCOURAGE HIGH BIOLOGIC VALUE PROTEINS(EGGS)
CALCIUM & IRON SUPPLEMENTS OR FOODS
URINE OUTPUT +600
WHEN A PT IS ON FLUID RESTRICTIONS HOW MUCH FLUIDS SHOULD THEY CONSUME?
PREVIOUS 24 HR URINE OUTPUT
+600 ML
CLIENT UNDERGOING HEMODIALYSIS ARE AT HIGHER RISK FOR?
AIR EMBOLUS
HEP B & C
MAX AMOUNT OF WEIGHT GAIN BETWEEN EACH DIALYSIS TREATMENT?
1.5 KG (3LBS)
WHAT IS A THRILL?
BUZZING SENSATION DIRECTLY OVER GRAFT
WHAT IS A BRUIT?
AUSCULTATED SOUND HEARD AT PATENT GRAFT SIGHT
WHICH NURSING DIAGNOSIS HAS GREATEST PRIORITY FOR A CLIENT RECEIVING IMMUNOSURPRESSANT AGENTS?
RISK FOR INFECTION
WHAT INTERVENTIONS SHOULD A NURSE PERFORM WITH A PT RECEIVING MULTIPLE IMMUNOSURPRESSANT AGENTS?
AVOID FRESH FLOWERS, FRUITS, VEGGIES
HAND HYGIENE
HEALTHY ADULT VISITORS
AVOID SHARING HOSPITAL EQUIPMENT
OCCURS WITHIN FIRST 48 HRS AFTER TRANSPLANTATION REQUIRES IMMEDIATE REMOVAL OF TRANSPLANTED ORGAN?
HYPERACUTE REJECTION
OCCURS UP TO 2 YRS AFTER SURGERY MOST COMMONLY DURING THE 1ST 2 WEEKS?
ACUTE REJECTION
GRADUAL PROCESS OCCURING OVER MONTHS TO YEARS DESCRIBES WHAT TYPE OF REJECTION?
CHRONIC REJECTION
A MALE PT WHO IS 82 SUFFERS FROM URINARY INCONTINENCE, WHAT FACTORS SHOULD THE NURSE ASSESS FOR BEFORE BEGINNING A BLADDER TRAINING PROGRAM?
PHYSICAL & ENVIRONMENTAL CONDITIONS
WHAT IS A CHANGE THAT OCCURS IN CHRONIC GLOMERULONEPHRITIS?
ANEMIA
HPERKALEMIA
METABOLIC ACIDOSIS
HYPERPHOSPHATEMIA
WHAT PERIOD OF ACUTE RENAL FAILURE IS ACCOMPANIED BY AN INCREASE IN SERUM CONCENTRATION SUBSTANCES USUALLY EXCRETED BY THE KIDNEYS?
OLIGURIA
(UREA & CREATININE IS EXCRETED)
PERIOD IN RENAL FAILURE THAT BEGINS WITH INITIAL INSULT & ENDS WHEN OLIGURIA DEVELOPS?
INITIATION PERIOD
WHAT PERIOD OF RENAL FAILURE IS MARKED BY INCREASED URINE OUTPUT?
DIARESIS
A FEMALE PT UNDERGOES DIALYSIS AS PART OF TREATMENT FOR KIDNEY FAILURE. THE PT IS ADMINISTERED HEPARIN DURING DIALYSIS TO ACHIEVE THERAPEUTIC LEVELS. WHAT STEP SHOULD THE NURSE FOLLOW TO ALLOW HEPARIN TO BE METABOLIZED & EXCRETED IN THE PATIENT?
AVOID ADMINISTERING INJECTIONS FOR 2-4 HRS AFTER HEPARIN ADMINISTRATION
WHAT PERIOD OF ACUTE RENAL FAILURE SIGNALS THE IMPROVEMENT OF RENAL FUNCTION & MAY TAKE 3-12 MONTHS?
RECOVERY
WHAT IS THE TERM FOR THE CONCENTRATION OF UREA & OTHER NITROGENOUS WASTES IN THE BLOOD?
AZOTEMIA
ACUTE DIALYSIS IS INDICATED IN WHICH SITUATION?
IMPENDING PULMONARY EDEMA
HYPERKALEMIA
FLUID OVERLOAD
ACIDOSIS
WHAT IS THE HALLMARK OF THE DIAGNOSIS OF NEPHRITIC SYNDROME?
PROTEINURIA
SERUM ALBUMIN EXCEEDING 3.5 G PER DAY
WHAT IS A CHARACTERISTIC OF THE INTRARENAL CATEGORY OF ACUTE RENAL FAILURE?
INCREASED BUN
WHAT IS USED TO DECREASE THE POTASSIUM LEVEL SEEN IN ACUTE RENAL FAILURE?
KAYEXALATE (EXCHANGES SODIUM FOR POTASSIUM IN INTESTINES)
TREATMENT OF METABOLIC ACIDOSIS IN CHRONIC RENAL FAILURE INCLUDES?
NO TREATMENT
WHAT IS A INTEGUMENTARY MANIFESTATION OF CHRONIC RENAL FAILURE?
GRAY BROWN SKIN COLOR
WHEN CARING FOR PATIENTS WITH CHRONIC GLOMERULONEPHRITIS THE NURSE SHOULD DO WHAT?
ALLOW FOR UNINTERRUPTED SLEEP AT NIGHT, & PERIODS OF REST DURING THE DAY
THE NURSE IS HELPING A CLIENT TO PERFORM PERITONEAL DIALYSIS AT HOME WHAT TEACHING SHOULD THE NURSE IMPLEMENT?
KEEP DIALYSIS SUPPLIES IN CLEAN AREA AWAY FROM CHILDREN & PETS
CLEAN CATHETER WITH BETADINE
STABALIZE CATH ABOVE BELTLINE
WHAT INTERVENTIONS SHOULD A NURSE TAKE WHEN CARING FOR A PT IWTH BILATERAL NEPHROSTOMY TUBES?
NEVER CLAMP TUBES
REPORT DISLODGED TUBE IMMEDIATELY
MEASURE URINE OUTPUT FROM EACH TUBE SEPERATELY
T OR F? 1 KG WEIGHT GAIN IS EQUIVALENT TO 1000mL OF RETAINED FLUID?
TRUE
GFR 90 mL/min/1.73 m2Kidney damage with normal or increased GFR
STAGE 1 CKD
GFR 60-89 mL/min/1.73 m2Mild decrease in GFR
STAGE 2 CKD
GFR 30-59 mL/min/1.73 m2Moderate decrease in GFR
STAGE 3 CKD
GFR 15-29 mL/min/1.73 m2Severe decrease in GFR
STAGE 4 CKD
GFR 15 mL/min/1.73 m2Kidney failure (end-stage renal disease [ESRD])
STAGE 5 CKD
What lab would indicate underlying kid-ney disease?
SERUM CREATININE
DECREASED ERYTHROPOIETIN PRODUCTION BY THE KIDNEYS PRODUCES?
ANEMIA
WHAT DEVELOPS FROM CKD?
EDEMA
CHF
HYPERTENSION
(hardening of the renal arteries) is mostoften due to prolonged hypertension and diabetes, is a major cause of CKD and ESRD
Nephrosclerosis
is often associ-ated with significant hypertension (diastolic blood pressurehigher than 130 mm Hg). It usually occurs in young adultsand twice as often in men compared to women. Damage iscaused by decreased blood flow to the kidney resulting inpatchy necrosis of the renal parenchyma. Over time, fibro-sis occurs and glomeruli are destroyed, without dialysis patients die of uremia?
Malignant nephrosclerosis
WHAT DRUG IS USED TO TREAT MALIGNANT NEPHROSCLEROSIS?
ACE INHIBITORS
Clinical manifestations are hematuria, edema, azotemia, an abnormalconcentration of nitrogenous wastes in the blood, and pro-teinuria or excess protein in the urine (cocacola colored urine)
acute glomerular inflammation (glomerulonephritis)
a client reports loss of weight and strength, increasing irritability, and increased urination at night, he has yellow-grayish skin color. what should the nurse suspect?
chronic glomerulonephritis
As renal failure progresses and the GFRfalls below 50 mL/min, the following changes occur:
hyperkalemia
metabolic acidosis
anemia
hypoalbuminemia
increased serum phosphorus
decreased serum calcium
mental status changes
impaired nerve conduction
(cardiac enlargement, tall tented Twaves, decrease in renal cortex)
Increase in albumin in the urine(proteinuria) and decrease of albumin in the blood, diffused edema usually around eyes, ankles, hands or sacrum, ascites and hyperlipidemia indicate?
nephrotic syndrome
albumin exceeding 3.5g/day is a hallmark sign that what has occured?
nephrotic syndrome
treatment for nephrotic syndrome includes?
ace inhibitors to reduce proteinuria
diuretics for edema
lipid lowering agents
WHAT ARE THE RISK FACTORS FOR RENAL CANCER?
MALE GENDER
TOBACCO USE
PETROLEUM PRODUCTS,
ABESTOS, HEAVY METALS
ESTROGEN THERAPY
POLYCYSTIC KIDNEY DISEASE
WHAT CAN CAUSE ACUTE RENAL FAILURE?
HYPOVOLEMIA
HYPOTENSION
REDUCED CARDIAC OUTPUT & HF
OBSTRUCTION OF THE KIDNEY
LOWER URINARY TRACT BY TUMOR, BLOOD CLOT, KIDNEY STONE
BILATERAL OBSTRUCTION OF RENAL ARTERIES OR VEINS
whichoccurs in 60% to 70% of cases, is the result of impairedblood flow that leads to hypoperfusion of the kidney and adecrease in the GFR.
Prerenal ARF
parenchymal damage to the glomeruli or kidney tubules.
Intrarenal ARF
CAUSES OF ACUTE PRERENAL FAILURE?
HEMORRHAGE
DIURETICS/OSMOTIC DIURESIS
VOMITING/DIARRHEA/NG SUCTION
MI, CARDIOGENIC SHOCK, HF, DISRYTHMIAS
SEPSIS
ANAPHYLAXIS
ANTIHYPERTENSIVE MEDS
urine output varies from scanty to a normal vol-ume, hematuria may be present, and the urine has a low spe-cific gravity (compared with a normal value of 1.010 to1.025). One of the earliest manifestations of tubular damageis the inability to concentrate the urine
ARF
INCREASED CREATININE, HYPOPERFUSION, DECREASED URINE OUTPUT, DECREASED URINE SODIUM < 20 mEq, NORMAL URINARY SEDIMENT, INCREASED URINE OSMOLALITY 500MOSM, INCREASED URINE SPECIFIC GRAVITY
PRERENAL CLINICAL CHARACTERISTICS
PARENCHYMAL DAMAGE, INCREASED BUN, INCREASED CREATININE, A VARIED OFTEN DECREASED URINE OUTPUT, INCREASED URINE SODIUM > 40 mEq, ABNORMAL URINARY SEDIMENTS, ABOUT 350 MOSM, LOW NORMAL URINE SPECIFIC GRAVITY
INTRARENAL CHARACTERISTICS OF ARF
OBSTRUCTION, INCREASED BUN, INCREASED CREATININE, URINE OUTPUT VARIES, URINE SODIUM VARIES, URINARY SEDIMENT IS NORMAL, URINE OSMOLALITY VARIES AND URINE SPECIFIC GREAVITY VARIES
POSTRENAL CHARACTERISTICS OF ARF
> 5.0, TALL TENTED T WAVES, IRRITABILITY, ABDOMINAL CRAMPING, DIARRHEA, PARESTHESIA, GENERALIZED MUSCLE WEAKNESS, SLURRED SPEECH, DIFFICULTHY BREATHING INDICATE
HYPERKALEMIA
WHAT IS USED TO TREAT HYPERKALEMIA?
KAYEXALATE
WHAT MAY BE ADMINISTERED WITH KAYEXALATE TO INDUCE A DIARRHEA TYPE EFFECT
SORBITOL
WHAT ARE DIET RESTRICTS FOR PATIENTS WITH ARF?
HIGH CARBS
PROTEINS(EGGS & MEAT)
NO COFFEE, BANANAS, CITRUS FRUITS
WHAT ARE SOME COMPLICATIONS OF ESRD?
HYPERKALEMIA
PERICARDITIS, PERICARDIAL EFFUSION, PERICARDIAL TAMPONADE,
HYPERTENSION
ANEMIA
BONE DISEASE, METASTATIC & VASCULAR CALCIFICATIONS
IF CALCIUM IS HIGH IN THE BODY DUE TO ESRD WHAT DRUG MIGHT BE GIVEN?
RENAGEL
IF PHOSPHATE LEVELS ARE HIGH IN ESRD WHAT DRUG MIGHT BE GIVEN?
CALCIUM CARBONATE
CALCIUM ACETATE
HYPERTENSION CAUSED BY ESRD IS MANAGED BY WHAT DRUGS?
DIGOXIN
DOBUTREX
WHAT DRUG IS GIVEN TO TREAT ANEMIA IN ESRD?
EPOGEN
WHAT DRUG WOULD YOU GIVE A PT WITH ESRD THAT HAS A HCT OF < 30%
EPOGEN
DIETARY RESTRICTIONS FOR ESRD?
EGGS/MEAT
FLUID 500-600 ML MORE THAN PREVIOUS 24 HR URINE OUTPUT
CARBS & FATS
VITAMIN SUPPLEMENTS
WHAT SYMPTOMS SHOULD A PT WITH ESRD REPORT TO THEIR DOCTOR OR NURSE?
Worsening signs and symptoms of renal failure (nau-sea, vomiting, change in usual urine output [if any],ammonia odor on breath)•Signs and symptoms of hyperkalemia (muscle weak-ness, diarrhea, abdominal cramps)•Signs and symptoms of access problems (clotted fistulaor graft, infection)
WHAT NURSING INTERVENTIONS ARE NEED FOR A PT WITH ESRD?
MONITOR I/O
DAILY WEIGHTS
SKIN TURGOR/EDEMA
DISTENTION OF NECK VEINS
VITALS
LIMIT FLUID INTAKE TO PRESCRIBED VOLUME
Encourage high-calorie, low-protein,low-sodium, and low-potassiumsnacks between meals.
WHAT ARE SOME COMPLICATIONS OF DIALYSIS TREATMENT?
SOB
HYPOTENSION
MUSCLE CRAMPING
EXSANGUINATION
DYSRHYTHMIAS
AIR EMBOLISM
CHEST PAIN
DIEQUILIBRIUM
WHAT ARE SOME ASSESSMENT FINDINGS OF ARF?
HX OF TAKING SALICYLATES, NSAIDS
ALTERATIONS IN URINARY OUTPUT
EDEMA/WEIGHT GAIN(TIGHT WAISTBANDS)
AMS
WHAT ARE THE PRIMARY EXTRACELLULAR IONS?
NA+ & CL-
WHAT ARE THE PRIMARY INTRACELLULAR IONS?
K+ & PHOSPHATE
DIAGNOSTIC FINDINGS FOR THE OLIGURIC PHASE IN ARF?
INCREASED BUN & CREATININE
INCREASED K+
DECREASED NA(HYPONATREMIA, ACIDOSIS)
FLUID OVERLOAD(HYPERVOLEMIA)
HIGH URINE SPECIFIC GRAVITY (>1.020)
DIAGNOSTIC FINDINGS IN DIURETIC PHASE OF ARF?
DECREASED FLUID VOLUME
DECREASED K+
DECREASED NA+(HYPONATREMIA)
LOW URINE SPECIFIC GRAVITY(< 1.020)
T OR F? IN THE DIRUECTIC PHASE OF ARF, URINE OUTPUT MAY BE AS MUCH AS 10L PER DAY?
TRUE
S &S OF FVE?
DYSPNEA
TACHYCARDIA
JUGULAR VEIN DISTENTION
PERIPHERAL EDEMA
PULMONARY EDEMA
WEIGHT GAIN
S & S OF FVD?
DECREASE URINE OUTPUT
WEIGHT LOSS
DECREASED SKIN TURGOR
DRY MUCOUS MEMBRANES
HYPOTENSION
TACHYCARDIA
S & S OF HYPERKALEMIA?
DIZZINESS
WEAKNESS
CARDIAC IRREGULARITIES
MUSCLE CRAMPS
DIARRHEA/NAUSEA
NORMAL RANGE FOR POTASSIUM?
3.5-5.0
WHAT ARE SOME HIGH POTASSIUM FOODS?
BANANAS
STRAWBERRIES
ORANGE JUICE
CANTALOUPE
AVOCADOS
SPINACH
FISH
T OR F? MONITOR FLUIDS & SODIUM IN CLIENTS WITH ARF?
TRUE
WHAT DIET SHOULD ARF PATIENTS HAVE?
LOW PROTEIN
HIGH FAT & CARBS
S & S OF ESRD?
HYPERTENSION
EDEMA/PULMONARY EDEMA
WEAKNESS/DROWSINESS
DECREASED URINARY FUNCTION(CLOUDY URINE)
HEMATURIA
PROTEINURIA
OLIGURIC(100-400 ML/DAY)
ANURIC(<100ML/DAY) GI UPSET JAUNDICE METALLIC TASTE IN MOUTH AMMONIA BREATH DIALYSIS TRANSPLANT
_______IS MOST OFTEN USED AS AN INDICATOR OF THE LEVEL OF PROTEIN CONSUMPTION?
GFR
WHAT LABS INDICATE ESRD?
AZOTEMIA
INCREASED BUN & CREATININE
DECREASED CALCIUM
ELEVATED PHOSPHORUS & MAGNESIUM
WHAT ARE SOME NURSING INTERVENTIONS FOR ESRD?
MONITOR SERUM ELECTROLYTES
DAILY WEIGHTS
MONITOR STRICT I/O
CHECK FOR JVD & EDEMA
LOW PROTEIN, SODIM, POTASSIUM, PHOSPHATE DIET
GIVE ALUMINUM HYDROXIDE ANTACIDS NOT MAGNESIUM BASED ANTACIDS
WHAT ARE SOME NURSING INTERVENTIONS FOR DIALYSIS?
HEPARINIZATION REQUIRED
DISEQUILIBRIUM SYNDROME
POTENTIAL RISK FOR HEP B & C
AIR EMBOLISM
DONT TAKE B/P OR VENIPUNCTURE IN ARM WITH AV SHUNT
ASSESS SITE FOR THRILL OR BRUIT
WHAT ARE SOME RISKS OF PERITONEAL DIALYSIS?
BOWEL/BLADDER PERFORATION
EXIT SITE & TUNNEL INFECTION
PERITONITIS
T OR F? PERITONEAL DIALYSIS IS MUCH HIGHER IN GLUCOSE, IF THE DIALYSATE IS LEFT IN THE PERITONEAL CAVITY TOO LONG HYPERGLYCEMIA MAY OCCUR?
TRUE
WHAT DRUG IS USED WITH CAUTION IN ELDERLY BECAUSE OF RISK OF THROMBOSIS?
EPOGEN
IF A CLIENT IS RECEIVING EPOGEN WHAT SHOULD A NURSE MONITOR?
HCT WEEKLY(REPORT LEVELS >30%)
PELVIC & LIMP PAIN SHOULD DISSIPATE OVER 12 HRS
DONT SHAKE VITAL
DICARD UNUSED CONTENTS
WHAT MEDICATION MUST BE ADJUSTED FOR IN PTS WITH ESRD, HAS A HIGH POTENTIAL FOR TOXICITY BECAUSE IT IS EXCRETED BY KIDNEYS?
DIGOXIN(DIGITALIS)
WHAT INTERVENTIONS SHOULD A NURSE TAKE FOR POSTOP KIDNEY TRANSPLANT?
MONITOR RESP STATUS/ASSESS FOR FLUID IN LUNGS
SPLINT INCISION SITE DUE TO HIGH PAIN IN FLANK AREA WHEN COUGHING & INSPIRATION/EXPIRATION
ASSESS VITALS TO DETERMINE EARLY SIGNS OF BLEEDING & SHOCK
MONITOR SKIN COLOR/TEMP
MONITOR I/O
MONITOR SURGICAL SITE FOR BLEEDING
NARCOTIC ANALGESICS FOR PAIN
ENCOURAGE FLUIDS > 3000 ML/DAY
ENCOURAGE CLIENT TO VOID E. 2-3 HRS
WHAT ARE SOME SIGNS OF INFECTION FOR POSTOP KIDNEY TRANSPLANT?
FEVER/CHILLS
HEMATURIA
URINARY FREQUENCY OR DYSURIA
PAIN AT COSTOVERTEBRAL ANGLE
WBC > 10,000
S & S OF ACUTE GLOMERULONEPHRITIS?
FOLLOWS STREPTOCOCCAL INFECTION
EDEMA AROUND EYES
ELEVATED B/P
DARK URINE(COCOCOLA URINE)
NORMAL SERUM PROTEIN
POSITIVE ASO TITER
S & S OF NEPHROTIC SYNDROME?
USUALLY IDIOPATHIC (AGES 2-3 YRS)
GENERALIZED EDEMA
NORMAL B/P
DARK/FROTHY YELLOW URINE
MASSIVE PROTEINURIA
DECREASED SERUM PROTEIN
NEGATIVE ASO TITER
WHAT DRUGS ARE TYPICALLY PRESCRIBED FOR CLIENTS WITH ACUTE GLOMERLUPONEPHRITIS OR NEPHROTIC SYNDROME?
PREDNISONE & CHOLINERGICS(BETHANEHOL/URECHOLINE)
CYTOXAN IF PREDNISONE DONT WORK
WHAT SHOULD YOU KNOW REGARDING BETHANECHOL CHLORIDE?
CHOLINERGIC USED TO TREAT URINARY RETENTION, NEUROGENIC BLADDER, GASTRIC REFLUX
CAUSES ORTHOSTATIC HYPOTENSION, FLUSHING, ASTHMA, GI DISTRESS
DONT GIVE IV OR IM CAUSES CIRCULATORY COLLAPSE
MONITOR VITALS
GIVE ON EMPTY STOMACH
WHAT SHOUD YOU KNOW REGARDING PREDNISONE?
ADRENOCORTICOSTEROID USED TO TREAT IMMUNOSUPPRESSION, PROMOTES DIURESIS IN NEPHRITIC SYNDROME
SIDE EFFECTS: MOOD CHANGES, INCREASED SUSCEPTIBILITY TO INFECTION, MOON FACE/BUFFALO HUMP, ACNE, GI DISTRESS, THROMBOCYTOPENIA, EDEMA, POTASSIUM LOSS,STUNTS GROWTH IN CHILDREN
AVOID LIVE VIRUS VACCINES IN CHILDREN, GIVE EVERY OTHER DAY TO CHILDREN, TAPER DOSE
ELEVATED BUN & CREATININE, DECREASED URINE SPECIFIC GRAVITY & GFR, HYPERKALEMIA, HYPERVOLEMIA, HYPOCALCEMIA, HYPERPHOSPHATEMIA THIS DESCRIBES?
OLIGURIC PHASE OF ARF
GRADUAL DECLINE IN BUN & SERUM CREATININE LEVELS BUT STILL ELEVATED, CONTINUED CREATININE CLEARANCE WITH IMPROVING GRF, HYPOKALEMIA, HYPONATREMIA, HYPOVOLEMIA. THIS DESCRIBES?
DIURETIC PHASE IN ARF
INCREASED GFR, STABALIZE OR CONTINUAL DECLINE IN BUN & CREATININE LEVELS TOWARDS NORMAL, MAY TAKE 1-2 YRS. THIS DESCRIBES WHAT?
RECOVERY PHASE IN ARF
A GFR > 90 mL/min indicates?
RISK FOR KIDNEY DISEASE
A GFR 60-89 mL/min indicates?
MILD CKD
A GFR 30-59 mL/min indicates?
MODERATE CKD
A GFR 15-29 mL/min indicates?
SEVERE CKD
A GFR < 15 mL/min indicates?
ESRD
WHAT ARE SOME PRIMARY CAUSES OF CKD OR CRF?
DIABETES
HYPERTENSION
CHRONIC URINARY OBSTRUCTION
RECURRENT INFECTIONS
RENAL ARTERY OCCLUSION
AUTOIMMUNE DISORDERS
WHAT ARE SOME COMPLICATIONS OF CRF/CKD?
ANEMIA
DECREASED H & H
LOW IRON
GI BLEEDING DUE TO UREA BUILD UP
METALLIC TASTE IN MOUTH
HYPERKALEMIA, HYPERMAGNESEMIA, HYPERPHOSPHATEMIA, HYPOCALCEMIA
HYPERTENSION
METABOLIC ACIDOSIS
WHAT DRUGS WOULD YOU GIVE TO EXCRETE POTASSIUM?
KAYEXALATE
SODIUM BICARB
CALCIUM GLUCONATE
LOOP DIURETICS
WHAT MEDS SHOULD YOU AVOID WITH RENAL FAILURE?
ASPRIN
ALDACTONE/SPIRONOLACTONE
DYRENIUM(K+ SPARING DIURETICS)
ANTACIDS, LAXATIVES, ENEMAS
IF A CLIENT WITH RENAL DISEASE HAS HYPERPHOSPHATEMIA WHAT DRUGS WOULD YOU GIVE?
CALCIUM CARBONATE(TUMS)
CALCIUM ACETATE(PHOSLO)
RENAGEL(GIVE WITH MEALS)
WHAT INTERVENTION DO YOU TAKE IF A PT WITH KIDNEY DISEASE HAS METABOLIC ACIDOSIS?
SODIUM BICARB
MONITOR ELECTROLYTE LEVELS
WHAT MEDS SHOULD YOU WITHHOLD IF A CLIENT IS GETTING DIALYSIS?
ANTIHYPERTENSIVES
ANTIBIOTICS
DIGOXIN
A PT WHO IS UNDERGOING DIALYSIS STARTS COMPLAINING OF CHEST PAIN, SOB AND IS HYPERVENTILATING, YOU NOTICE CYANOSIS OCCURING TO HIS LIPS AND A CHANGE IN SENSORIUM. WHAT SHOULD THE NURSE SUSPECT?
AIR EMBOLUS
NOTIFY MD IMMEDIATELY
WHAT NURSING ACTION SHOULD A NURSE TAKE IF A CLIENT IS RECEIVING HEMODIALYSIS DEVELOPS A AIR EMBOLISM?
STOP HEMODIALYSIS
TURN CLIENT TO LEFT SIDE WITH HEAD DOWN(TRENDELENBURGS)
NOTIFY MD
GIVE O2
ASSESS VITALS & PULSE OX
DOCUMENT EVENTS
WHAT ARE SOME SIGNS & SYMPTOMS OF RENAL TRANSPLANT REJECTION?
FEVER
PAIN/TENDERNESS
2-3 LB WEIGHT GAIN IN 24 HRS
HYPERTENSION
EDEMA
INCREASED BUN, DECREASED CREATININE CLEARANCE
ELEVATED WBC’S
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