HESI Case Studies-Chronic Kidney Disease – Flashcards
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WHAT IS THE BEST DESCRIPTION OF CKD?
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A FATAL DISORDER UNLESS DIALYSIS OR ORGAN TRANSPLANT IS RECEIVED
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WHAT LAB VALUE DECREASES WITH CKD?
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SERUM CALCIUM
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WHAT CAUSES HBG TO DROP IN CKD?
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FEWER RBCS ARE BEING FORMED BECAUSE KIDNEYS ARE LESS ABLE TO PRODUCE ERYTHORPOIETIN
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WHAT CAUSES HYPERTENSION IN CKD?
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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
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WHAT ASSESSMENT FINDING INDICATES THAT CALCIUM ACETATE (PHOSIO) HAS BEEN EFFECTIVE?
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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?
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NORMAL B/P
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IF A CKD PT IS GIVEN EPOGEN WHAT ASSESSMENT FINDING WOULD INDICATE THE DRUG WORKING?
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CONJUNCTIVAL SAC TURNS REDDISH PINK COLOR
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WHAT INTERVENTIONS WOULD YOU PERORM FOR A CKD PT?
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MONITOR DAILY WEIGHTS ENCOURAGE HIGH BIOLOGIC VALUE PROTEINS(EGGS) CALCIUM & IRON SUPPLEMENTS OR FOODS URINE OUTPUT +600
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WHEN A PT IS ON FLUID RESTRICTIONS HOW MUCH FLUIDS SHOULD THEY CONSUME?
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PREVIOUS 24 HR URINE OUTPUT +600 ML
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CLIENT UNDERGOING HEMODIALYSIS ARE AT HIGHER RISK FOR?
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AIR EMBOLUS HEP B & C
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MAX AMOUNT OF WEIGHT GAIN BETWEEN EACH DIALYSIS TREATMENT?
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1.5 KG (3LBS)
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WHAT IS A THRILL?
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BUZZING SENSATION DIRECTLY OVER GRAFT
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WHAT IS A BRUIT?
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AUSCULTATED SOUND HEARD AT PATENT GRAFT SIGHT
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WHICH NURSING DIAGNOSIS HAS GREATEST PRIORITY FOR A CLIENT RECEIVING IMMUNOSURPRESSANT AGENTS?
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RISK FOR INFECTION
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WHAT INTERVENTIONS SHOULD A NURSE PERFORM WITH A PT RECEIVING MULTIPLE IMMUNOSURPRESSANT AGENTS?
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AVOID FRESH FLOWERS, FRUITS, VEGGIES HAND HYGIENE HEALTHY ADULT VISITORS AVOID SHARING HOSPITAL EQUIPMENT
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OCCURS WITHIN FIRST 48 HRS AFTER TRANSPLANTATION REQUIRES IMMEDIATE REMOVAL OF TRANSPLANTED ORGAN?
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HYPERACUTE REJECTION
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OCCURS UP TO 2 YRS AFTER SURGERY MOST COMMONLY DURING THE 1ST 2 WEEKS?
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ACUTE REJECTION
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GRADUAL PROCESS OCCURING OVER MONTHS TO YEARS DESCRIBES WHAT TYPE OF REJECTION?
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CHRONIC REJECTION
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A MALE PT WHO IS 82 SUFFERS FROM URINARY INCONTINENCE, WHAT FACTORS SHOULD THE NURSE ASSESS FOR BEFORE BEGINNING A BLADDER TRAINING PROGRAM?
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PHYSICAL & ENVIRONMENTAL CONDITIONS
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WHAT IS A CHANGE THAT OCCURS IN CHRONIC GLOMERULONEPHRITIS?
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ANEMIA HPERKALEMIA METABOLIC ACIDOSIS HYPERPHOSPHATEMIA
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WHAT PERIOD OF ACUTE RENAL FAILURE IS ACCOMPANIED BY AN INCREASE IN SERUM CONCENTRATION SUBSTANCES USUALLY EXCRETED BY THE KIDNEYS?
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OLIGURIA (UREA & CREATININE IS EXCRETED)
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PERIOD IN RENAL FAILURE THAT BEGINS WITH INITIAL INSULT & ENDS WHEN OLIGURIA DEVELOPS?
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INITIATION PERIOD
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WHAT PERIOD OF RENAL FAILURE IS MARKED BY INCREASED URINE OUTPUT?
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DIARESIS
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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?
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AVOID ADMINISTERING INJECTIONS FOR 2-4 HRS AFTER HEPARIN ADMINISTRATION
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WHAT PERIOD OF ACUTE RENAL FAILURE SIGNALS THE IMPROVEMENT OF RENAL FUNCTION & MAY TAKE 3-12 MONTHS?
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RECOVERY
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WHAT IS THE TERM FOR THE CONCENTRATION OF UREA & OTHER NITROGENOUS WASTES IN THE BLOOD?
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AZOTEMIA
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ACUTE DIALYSIS IS INDICATED IN WHICH SITUATION?
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IMPENDING PULMONARY EDEMA HYPERKALEMIA FLUID OVERLOAD ACIDOSIS
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WHAT IS THE HALLMARK OF THE DIAGNOSIS OF NEPHRITIC SYNDROME?
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PROTEINURIA SERUM ALBUMIN EXCEEDING 3.5 G PER DAY
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WHAT IS A CHARACTERISTIC OF THE INTRARENAL CATEGORY OF ACUTE RENAL FAILURE?
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INCREASED BUN
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WHAT IS USED TO DECREASE THE POTASSIUM LEVEL SEEN IN ACUTE RENAL FAILURE?
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KAYEXALATE (EXCHANGES SODIUM FOR POTASSIUM IN INTESTINES)
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TREATMENT OF METABOLIC ACIDOSIS IN CHRONIC RENAL FAILURE INCLUDES?
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NO TREATMENT
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WHAT IS A INTEGUMENTARY MANIFESTATION OF CHRONIC RENAL FAILURE?
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GRAY BROWN SKIN COLOR
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WHEN CARING FOR PATIENTS WITH CHRONIC GLOMERULONEPHRITIS THE NURSE SHOULD DO WHAT?
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ALLOW FOR UNINTERRUPTED SLEEP AT NIGHT, & PERIODS OF REST DURING THE DAY
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THE NURSE IS HELPING A CLIENT TO PERFORM PERITONEAL DIALYSIS AT HOME WHAT TEACHING SHOULD THE NURSE IMPLEMENT?
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KEEP DIALYSIS SUPPLIES IN CLEAN AREA AWAY FROM CHILDREN & PETS CLEAN CATHETER WITH BETADINE STABALIZE CATH ABOVE BELTLINE
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WHAT INTERVENTIONS SHOULD A NURSE TAKE WHEN CARING FOR A PT IWTH BILATERAL NEPHROSTOMY TUBES?
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NEVER CLAMP TUBES REPORT DISLODGED TUBE IMMEDIATELY MEASURE URINE OUTPUT FROM EACH TUBE SEPERATELY
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T OR F? 1 KG WEIGHT GAIN IS EQUIVALENT TO 1000mL OF RETAINED FLUID?
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TRUE
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GFR 90 mL/min/1.73 m2Kidney damage with normal or increased GFR
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STAGE 1 CKD
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GFR 60-89 mL/min/1.73 m2Mild decrease in GFR
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STAGE 2 CKD
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GFR 30-59 mL/min/1.73 m2Moderate decrease in GFR
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STAGE 3 CKD
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GFR 15-29 mL/min/1.73 m2Severe decrease in GFR
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STAGE 4 CKD
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GFR 15 mL/min/1.73 m2Kidney failure (end-stage renal disease [ESRD])
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STAGE 5 CKD
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What lab would indicate underlying kid-ney disease?
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SERUM CREATININE
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DECREASED ERYTHROPOIETIN PRODUCTION BY THE KIDNEYS PRODUCES?
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ANEMIA
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WHAT DEVELOPS FROM CKD?
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EDEMA CHF HYPERTENSION
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(hardening of the renal arteries) is mostoften due to prolonged hypertension and diabetes, is a major cause of CKD and ESRD
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Nephrosclerosis
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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?
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Malignant nephrosclerosis
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WHAT DRUG IS USED TO TREAT MALIGNANT NEPHROSCLEROSIS?
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ACE INHIBITORS
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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)
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acute glomerular inflammation (glomerulonephritis)
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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?
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chronic glomerulonephritis
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As renal failure progresses and the GFRfalls below 50 mL/min, the following changes occur:
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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)
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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?
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nephrotic syndrome
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albumin exceeding 3.5g/day is a hallmark sign that what has occured?
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nephrotic syndrome
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treatment for nephrotic syndrome includes?
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ace inhibitors to reduce proteinuria diuretics for edema lipid lowering agents
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WHAT ARE THE RISK FACTORS FOR RENAL CANCER?
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MALE GENDER TOBACCO USE PETROLEUM PRODUCTS, ABESTOS, HEAVY METALS ESTROGEN THERAPY POLYCYSTIC KIDNEY DISEASE
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WHAT CAN CAUSE ACUTE RENAL FAILURE?
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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
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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.
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Prerenal ARF
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parenchymal damage to the glomeruli or kidney tubules.
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Intrarenal ARF
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CAUSES OF ACUTE PRERENAL FAILURE?
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HEMORRHAGE DIURETICS/OSMOTIC DIURESIS VOMITING/DIARRHEA/NG SUCTION MI, CARDIOGENIC SHOCK, HF, DISRYTHMIAS SEPSIS ANAPHYLAXIS ANTIHYPERTENSIVE MEDS
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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
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ARF
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INCREASED CREATININE, HYPOPERFUSION, DECREASED URINE OUTPUT, DECREASED URINE SODIUM < 20 mEq, NORMAL URINARY SEDIMENT, INCREASED URINE OSMOLALITY 500MOSM, INCREASED URINE SPECIFIC GRAVITY
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PRERENAL CLINICAL CHARACTERISTICS
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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
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INTRARENAL CHARACTERISTICS OF ARF
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OBSTRUCTION, INCREASED BUN, INCREASED CREATININE, URINE OUTPUT VARIES, URINE SODIUM VARIES, URINARY SEDIMENT IS NORMAL, URINE OSMOLALITY VARIES AND URINE SPECIFIC GREAVITY VARIES
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POSTRENAL CHARACTERISTICS OF ARF
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> 5.0, TALL TENTED T WAVES, IRRITABILITY, ABDOMINAL CRAMPING, DIARRHEA, PARESTHESIA, GENERALIZED MUSCLE WEAKNESS, SLURRED SPEECH, DIFFICULTHY BREATHING INDICATE
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HYPERKALEMIA
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WHAT IS USED TO TREAT HYPERKALEMIA?
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KAYEXALATE
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WHAT MAY BE ADMINISTERED WITH KAYEXALATE TO INDUCE A DIARRHEA TYPE EFFECT
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SORBITOL
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WHAT ARE DIET RESTRICTS FOR PATIENTS WITH ARF?
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HIGH CARBS PROTEINS(EGGS & MEAT) NO COFFEE, BANANAS, CITRUS FRUITS
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WHAT ARE SOME COMPLICATIONS OF ESRD?
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HYPERKALEMIA PERICARDITIS, PERICARDIAL EFFUSION, PERICARDIAL TAMPONADE, HYPERTENSION ANEMIA BONE DISEASE, METASTATIC & VASCULAR CALCIFICATIONS
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IF CALCIUM IS HIGH IN THE BODY DUE TO ESRD WHAT DRUG MIGHT BE GIVEN?
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RENAGEL
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IF PHOSPHATE LEVELS ARE HIGH IN ESRD WHAT DRUG MIGHT BE GIVEN?
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CALCIUM CARBONATE CALCIUM ACETATE
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HYPERTENSION CAUSED BY ESRD IS MANAGED BY WHAT DRUGS?
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DIGOXIN DOBUTREX
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WHAT DRUG IS GIVEN TO TREAT ANEMIA IN ESRD?
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EPOGEN
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WHAT DRUG WOULD YOU GIVE A PT WITH ESRD THAT HAS A HCT OF < 30%
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EPOGEN
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DIETARY RESTRICTIONS FOR ESRD?
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EGGS/MEAT FLUID 500-600 ML MORE THAN PREVIOUS 24 HR URINE OUTPUT CARBS & FATS VITAMIN SUPPLEMENTS
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WHAT SYMPTOMS SHOULD A PT WITH ESRD REPORT TO THEIR DOCTOR OR NURSE?
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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)
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WHAT NURSING INTERVENTIONS ARE NEED FOR A PT WITH ESRD?
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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.
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WHAT ARE SOME COMPLICATIONS OF DIALYSIS TREATMENT?
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SOB HYPOTENSION MUSCLE CRAMPING EXSANGUINATION DYSRHYTHMIAS AIR EMBOLISM CHEST PAIN DIEQUILIBRIUM
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WHAT ARE SOME ASSESSMENT FINDINGS OF ARF?
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HX OF TAKING SALICYLATES, NSAIDS ALTERATIONS IN URINARY OUTPUT EDEMA/WEIGHT GAIN(TIGHT WAISTBANDS) AMS
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WHAT ARE THE PRIMARY EXTRACELLULAR IONS?
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NA+ & CL-
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WHAT ARE THE PRIMARY INTRACELLULAR IONS?
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K+ & PHOSPHATE
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DIAGNOSTIC FINDINGS FOR THE OLIGURIC PHASE IN ARF?
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INCREASED BUN & CREATININE INCREASED K+ DECREASED NA(HYPONATREMIA, ACIDOSIS) FLUID OVERLOAD(HYPERVOLEMIA) HIGH URINE SPECIFIC GRAVITY (>1.020)
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DIAGNOSTIC FINDINGS IN DIURETIC PHASE OF ARF?
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DECREASED FLUID VOLUME DECREASED K+ DECREASED NA+(HYPONATREMIA) LOW URINE SPECIFIC GRAVITY(< 1.020)
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T OR F? IN THE DIRUECTIC PHASE OF ARF, URINE OUTPUT MAY BE AS MUCH AS 10L PER DAY?
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TRUE
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S &S OF FVE?
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DYSPNEA TACHYCARDIA JUGULAR VEIN DISTENTION PERIPHERAL EDEMA PULMONARY EDEMA WEIGHT GAIN
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S & S OF FVD?
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DECREASE URINE OUTPUT WEIGHT LOSS DECREASED SKIN TURGOR DRY MUCOUS MEMBRANES HYPOTENSION TACHYCARDIA
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S & S OF HYPERKALEMIA?
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DIZZINESS WEAKNESS CARDIAC IRREGULARITIES MUSCLE CRAMPS DIARRHEA/NAUSEA
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NORMAL RANGE FOR POTASSIUM?
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3.5-5.0
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WHAT ARE SOME HIGH POTASSIUM FOODS?
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BANANAS STRAWBERRIES ORANGE JUICE CANTALOUPE AVOCADOS SPINACH FISH
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T OR F? MONITOR FLUIDS & SODIUM IN CLIENTS WITH ARF?
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TRUE
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WHAT DIET SHOULD ARF PATIENTS HAVE?
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LOW PROTEIN HIGH FAT & CARBS
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S & S OF ESRD?
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HYPERTENSION EDEMA/PULMONARY EDEMA WEAKNESS/DROWSINESS DECREASED URINARY FUNCTION(CLOUDY URINE) HEMATURIA PROTEINURIA OLIGURIC(100-400 ML/DAY) ANURIC(
