Chronic/Acute Kidney Failure Flashcards
What labs will you anticipate for a pt. with acute/chronic renal failure?
Increased: BUN, Cr, K+, Mg+, Phos
Decreased: Ca+, GFR, RBC, Hgb, Hct
With Chronic renal failure, why would Hgb, RBC, and Hct be decreased?
The kidneys make erythropoietin. When is failure, they do not make it or do not make enough.
3 essential assessments for RF
Fluid volume overload
Electrolyte imbalance
Dialysis access
3 extreme signs and symptoms of RF
Peri-orbital Edema
Uremic Frost
Extreme fatigue
Pt with renal failure has decreased CO2 levels. Why do you think this is?
Most often RF pt. are in metabolic acidosis. Because they are retaining more H+. Lungs try to compensate for by excreting more CO2.
What is one of your main goal when treating RF pt.?
Manage fluid/electrolyte imbalances
What dietary restrictions does a RF pt. need to be on?
Limit fluids, Na+, K+, Phos
What kind of diet should a RF pt. intake?
Diet high in calories with vitamin supplements
Proteins, Sodium, Potassium, and Phosphorus strictly monitored
What is important to know about pt. protein diet?
It is carefully regulated. Pt. will receive foods high in protein but it is carefully portioned.
What kind of food can a RF pt. eat?
Pasta, white bread, white rice, olive oil, apples, peaches, green beans, carrots, grapes, grits - food low in K+, Na+, phos
What is a major nursing consideration when pt. goes to dialysis?
Meds that may be taken out. Especially water-soluble meds
Main risks when pt. goes to dialysis?
Infection
FVD
Loss of dialysis access site
A Pt. on hemodialysis is prescribed vitamin C. What is most important to teach patient?
Take vitamin C after dialysis (b/c water-soluble)
What are examples of prerenal RF?
Dehydration, Blood loss, occlusion in blood vessel leading to kidney
A pt. comes in exhibiting: low urine output, high Na+, K+, and Mg+, Bun, and Cr. The pt. has been taking excessive amounts of Ibuprofen for the past 2 weeks. What can the cause of RF be classified as?
Intrarenal
Examples of intrarenal RF?
Infection, Med that are nephrotoxic (NSAIDS), Direct injury to the kidney
Examples of postrenal RF?
Renal stones, Prostate enlargement (complete obstructions)
Pt. with acute RF caused by severe dehydration ask will I have to stay on this diet forever? What is the nurse’s response?
No if we can fix your RF in time it will not be permanent. Treat the severe dehydration to fix RF
What is the cure for chronic RF?
Transplant
At what stage of acute RF will the nurse note 3-5 L of urine output per day?
Diuretic Stage - Stage 3
In the Diuretic Stage of acute RF. What is the nurse’s greatest concern?
electrolyte depletion
What is stage 1 of acute RF?
When the renal injury occurs
What are the number one causes of RF?
Long-term/uncontrolled Diabetes and HTN
What is the biggest risk with Peritoneal Dialysis?
Infection
What assessments should the nurse preform on a Graft dialysis site?
Palpate for thrill
Auscultate for bruit
Assess for bleeding and infection
If a thrill or bruit is not felt/heard on a graft dialysis site. What might the nurse suspect?
May be occluded
If hematoma present - ruptured vessels
Pt. comes back from dialysis with a HR 160 and BP 90/50. What might the nurse suspect happened?
Dialysis removed too much fluid
Pt. comes back from dialysis with a HR 160 and BP 90/50. Nurse suspects too much fluid removed. What is the Tx? What is the assessment afterward?
Fluid bolus
Assess for: fluid overload, BP (want to come up)
Pt. comes back from dialysis with a HR 160 and BP 90/50. Nurse treats with Fluid bolus. The BP still reads 94/57. What is next Tx
More fluids!
Pt. with RF, GFR is 60. the nurse watches this lab and the next shift is is below 15. What is Tx?
Immediate dialysis
What is the nurse’s intervention for a pt. in acute RF in stage 2?
Restrict fluids
In stage 3 acute RF, what labs should the nurse be watching?
Electrolytes , there is no retention of electrolytes, may need to replace or rehydrate pt.
Risk in stage 3 acute RF
Dehydrations, Dysrhythmias (heart monitor)
Pt. on RF diet needs protein what is the best source?
a. ) Mac and Cheese
b. ) Ham
c. ) Eggs
d. ) Corn
C - all others are good sources of protein, but eggs have the least amount of salt in them
The nurse is caring for a patient diagnosed with chronic kidney disease whose hemoglobin level is 10 g/dL yet remains asymptomatic. The nurse should anticipate the administration of which treatments? Select all that apply.
a. ) Folic acid supplements
b. ) Oral iron supplements
c. )Daily blood transfusion
d. ) Erythropoietin subcutaneously
e. ) Aminoglycoside therapy
A, B, D
The nurse is caring for a patient diagnosed with acute kidney injury. Which medication order should the nurse question?
a. ) Furosemide
b. ) Potassium chloride
c. ) Mannitol
d. ) Bumetanide
B
Which assessment findings should the nurse report to the healthcare provider as being indicative of possible kidney injury? Select all that apply.
a. ) Urine output less than 400 mL/day
b. ) Decreased potassium level
c. ) Increasing glomerular filtration rate
d. ) Dyspnea
e. ) Fixed specific gravity 1.010
A, D, E
A patient experiences severe blood loss and hypovolemia following a motor vehicle crash. The nurse should assess for signs and symptoms of which condition most likely to affect the patient?
a. ) Prerenal acute kidney injury
b. ) Intrarenal acute kidney injury
c. ) Postrenal acute kidney injury
d. ) Chronic kidney disease
A
The healthcare provider alerts the nurse that a patient is at risk for chronic kidney disease. Which risk factors should the nurse expect to find in this patient’s chart? Select all that apply.
a. ) Diabetes mellitus
b. ) Recent surgery
c. ) Hypertension
d. ) Obesity
e. ) Acute urinary tract infection
A, C, D
The nurse should recognize which of the following as risk factors for acute kidney injury? Select all that apply.
a. ) Dehydration
b. ) Trauma
c. ) Edema
d. ) Hypovolemia
e. ) Hypervolemia
A, B, D
The nurse should recognize that which assessment findings are consistent with chronic kidney disease? Select all that apply.
a. ) Slow manifestation of symptoms
b. ) Decreased creatinine clearance
c. ) Increased serum creatinine levels
d. ) Trace of protein in the urine
e. ) History of hypertension
A, B, C, E
What is the priority teaching point when the nurse is discussing the treatment regimen with a patient who has received a kidney transplant for end stage renal disease?
a. ) To take medications daily at the same time
b. ) To keep all follow-up appointments as scheduled
c. ) The need for meticulous immediate and lifelong care
d. ) To inform patient of scarring at the incision site
C
The nurse should include which information in the discharge teaching plan for a patient who underwent peritoneal dialysis catheter placement? Select all that apply.
a. ) Notify the provider if fluid appears cloudy.
b. ) Review numerous dietary restrictions.
c. ) Purulent drainage is expected at insertion site.
d. ) Notify provider if any redness is noted.
e. ) Pain at the insertion site may indicate infection.
A, D, E
The nurse manager has taught a new staff nurse about assessing and caring for an arteriovenous graft. The staff nurse demonstrates understanding of appropriate care when performing which action?
a. ) Feel for buzzing sensation.
b. ) Auscultate carotid pulses.
c. ) Palpate for a bruit.
d. ) Access graft for labs.
A
Dietary restrictions for kidney failure patients
Fluid
Sodium
Potassium
Phosphate
Foods high in Na+
cheese
processed meats (deli meat, bacon, etc)
salted butter margarine
canned vegetables canned soups
Foods high in K+
bananas potatoes tomatoes avocadoes green leafy vegetables milk citrus fruit/juice pineapple squash beans
Foods high in Phos
whole-grain products most cereals milk and cheese beans nuts
Before dialysis how much protein can the pt. w/ renal failure have?
0.6 – 0.8 g/kg/day
After the pt. is on dialysis how much can the pt. w/ renal failure have?
1.2-1.3 g/kg/day
If a pt. is on dialysis how much weight do you not want the patient to gain/lose between dialysis Tx
1.5 kg/3 lb.
