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Med Surg > Chronic/Acute Kidney Failure > Flashcards

Chronic/Acute Kidney Failure Flashcards

1
Q

What labs will you anticipate for a pt. with acute/chronic renal failure?

A

Increased: BUN, Cr, K+, Mg+, Phos
Decreased: Ca+, GFR, RBC, Hgb, Hct

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2
Q

With Chronic renal failure, why would Hgb, RBC, and Hct be decreased?

A

The kidneys make erythropoietin. When is failure, they do not make it or do not make enough.

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3
Q

3 essential assessments for RF

A

Fluid volume overload
Electrolyte imbalance
Dialysis access

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4
Q

3 extreme signs and symptoms of RF

A

Peri-orbital Edema
Uremic Frost
Extreme fatigue

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5
Q

Pt with renal failure has decreased CO2 levels. Why do you think this is?

A

Most often RF pt. are in metabolic acidosis. Because they are retaining more H+. Lungs try to compensate for by excreting more CO2.

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6
Q

What is one of your main goal when treating RF pt.?

A

Manage fluid/electrolyte imbalances

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7
Q

What dietary restrictions does a RF pt. need to be on?

A

Limit fluids, Na+, K+, Phos

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8
Q

What kind of diet should a RF pt. intake?

A

Diet high in calories with vitamin supplements

Proteins, Sodium, Potassium, and Phosphorus strictly monitored

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9
Q

What is important to know about pt. protein diet?

A

It is carefully regulated. Pt. will receive foods high in protein but it is carefully portioned.

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10
Q

What kind of food can a RF pt. eat?

A

Pasta, white bread, white rice, olive oil, apples, peaches, green beans, carrots, grapes, grits - food low in K+, Na+, phos

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11
Q

What is a major nursing consideration when pt. goes to dialysis?

A

Meds that may be taken out. Especially water-soluble meds

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12
Q

Main risks when pt. goes to dialysis?

A

Infection
FVD
Loss of dialysis access site

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13
Q

A Pt. on hemodialysis is prescribed vitamin C. What is most important to teach patient?

A

Take vitamin C after dialysis (b/c water-soluble)

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14
Q

What are examples of prerenal RF?

A

Dehydration, Blood loss, occlusion in blood vessel leading to kidney

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15
Q

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?

A

Intrarenal

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16
Q

Examples of intrarenal RF?

A

Infection, Med that are nephrotoxic (NSAIDS), Direct injury to the kidney

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17
Q

Examples of postrenal RF?

A

Renal stones, Prostate enlargement (complete obstructions)

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18
Q

Pt. with acute RF caused by severe dehydration ask will I have to stay on this diet forever? What is the nurse’s response?

A

No if we can fix your RF in time it will not be permanent. Treat the severe dehydration to fix RF

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19
Q

What is the cure for chronic RF?

A

Transplant

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20
Q

At what stage of acute RF will the nurse note 3-5 L of urine output per day?

A

Diuretic Stage - Stage 3

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21
Q

In the Diuretic Stage of acute RF. What is the nurse’s greatest concern?

A

electrolyte depletion

22
Q

What is stage 1 of acute RF?

A

When the renal injury occurs

23
Q

What are the number one causes of RF?

A

Long-term/uncontrolled Diabetes and HTN

24
Q

What is the biggest risk with Peritoneal Dialysis?

A

Infection

25
Q

What assessments should the nurse preform on a Graft dialysis site?

A

Palpate for thrill
Auscultate for bruit
Assess for bleeding and infection

26
Q

If a thrill or bruit is not felt/heard on a graft dialysis site. What might the nurse suspect?

A

May be occluded

If hematoma present - ruptured vessels

27
Q

Pt. comes back from dialysis with a HR 160 and BP 90/50. What might the nurse suspect happened?

A

Dialysis removed too much fluid

28
Q

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?

A

Fluid bolus

Assess for: fluid overload, BP (want to come up)

29
Q

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

A

More fluids!

30
Q

Pt. with RF, GFR is 60. the nurse watches this lab and the next shift is is below 15. What is Tx?

A

Immediate dialysis

31
Q

What is the nurse’s intervention for a pt. in acute RF in stage 2?

A

Restrict fluids

32
Q

In stage 3 acute RF, what labs should the nurse be watching?

A

Electrolytes , there is no retention of electrolytes, may need to replace or rehydrate pt.

33
Q

Risk in stage 3 acute RF

A

Dehydrations, Dysrhythmias (heart monitor)

34
Q

Pt. on RF diet needs protein what is the best source?

a. ) Mac and Cheese
b. ) Ham
c. ) Eggs
d. ) Corn

A

C - all others are good sources of protein, but eggs have the least amount of salt in them

35
Q

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

A, B, D

36
Q

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

A

B

37
Q

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

A, D, E

38
Q

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

A

39
Q

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

A, C, D

40
Q

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

A, B, D

41
Q

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

A, B, C, E

42
Q

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

A

C

43
Q

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

A, D, E

44
Q

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

A

45
Q

Dietary restrictions for kidney failure patients

A

Fluid
Sodium
Potassium
Phosphate

46
Q

Foods high in Na+

A

cheese
processed meats (deli meat, bacon, etc)
salted butter margarine
canned vegetables canned soups

47
Q

Foods high in K+

A 
bananas
potatoes
tomatoes
avocadoes
green leafy vegetables
milk
citrus fruit/juice
pineapple
squash
beans
48
Q

Foods high in Phos

A 
whole-grain products
most cereals
milk and cheese
beans
nuts
49
Q

Before dialysis how much protein can the pt. w/ renal failure have?

A

0.6 – 0.8 g/kg/day

50
Q

After the pt. is on dialysis how much can the pt. w/ renal failure have?

A

1.2-1.3 g/kg/day

51
Q

If a pt. is on dialysis how much weight do you not want the patient to gain/lose between dialysis Tx

A

1.5 kg/3 lb.

Med Surg (22 decks)

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