Common: Renal

Question 1

CKD: Describe an AV graft and how to assess one for patency

Answer 1

An AV graft is similar to an AV fistula, but uses a synthetic graft. Both are assessed for patency using touch to feel a thrill and auscultation to hear a bruit.

Question 2

CKD: What manifestation would indicate that a peritoneal dialysis patient may have peritonitis?

Answer 2

Peritonitis is an inflammation of the peritoneum and a major complication of peritoneal dialysis. Purulent drainage from the PD catheter would indicate that the nurse should notify the doctor immediately.

Question 3

CKD: Normal BUN range is 8-20

Normal Creatinine is 0.5-1.5

Chronic kidney disease causes what disruption to these normals and why?

Answer 3

In CKD, the kidneys are not excreting toxins effectively and the BUN and Cr would become elevated

Question 4

CKD: Urea is a biproduct of protein breakdown. Why is this important to patients with chronic kidney disease?

Answer 4

The kidneys do not excrete urea and can cause uremia

Question 5

CKD: Describe the symptoms of hypervolemia

Answer 5

Dyspnea

Pitting edema

Crackles in the lungs

Hypertension

Jugular vein distension

Question 6

CKD: Describe the electrolyte imbalances that occur with chronic kidney failure

Answer 6

risk for hypocalcemia due to an alteration in the conversion of vitamin D by the kidneys.

risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys.

risk for hypernatremia, edema, and hypertension due to sodium retention.

Question 7

CKD: Discuss the importance of daily weights in patients with chronic kidney disease

Answer 7

Patients with CKD are at risk of hypervolemia and the best way to determine fluid volume overload is to perform daily weights at the same time each day, with similar clothes on, with the same scale, and after the patient voids.

Question 8

Renal: Describe the relationship between pyelonephritis and kidney disease

Answer 8

pyelonephritis can cause scarring on the kidneys. Multiple infections and repeated inflammation causes scarring that can lead to end stage kidney disease.

Question 9

Renal: A nonpharmacologic prevention recommendation for kidney stones.

Answer 9

2000-3000 ml of daily fluid intake will help flush the kidneys of minerals that can cause calculi.

Question 10

Renal: Risk factors for CKD

Answer 10

Diabetes
Hypertension
Ethnicity
Age
Family history
Drug exposure

Question 11

Renal: Documentation of a patent AV fistula

Answer 11

Thrill felt on palpation, bruit heard on auscultation, normal color and sensation of extremity with strong radial pulse.

Question 12

Renal: Rationale for delayed use of a new AV fistula

Answer 12

An AVF is the anastomosis between an artery and a vein. Maturation can take up to months to occur. At least 3 months should be allowed before use for HD.

Question 13

Renal: Drugs that should be adjusted for patients with CKD

Answer 13

Pts with CKD may have increased sensitivity to certain medications that are primarily metabolized in the kidneys.
Specifically: Metformin, Glyburide, Digoxin, some antibiotics, opioids

Question 14

Renal: The difference between Hemodialysis and Peritoneal dialysis

Answer 14

Question 15

Renal: Causes of Prerenal Acute Kidney Injury

Answer 15

Prerenal- Decreased cardiac output, Decreased PVR, Decreased renovascular blood flow, hypovolemia

Question 16

Renal: Causes of Intrarenal AKI

Answer 16

Intrarenal: Interstitial nephritis, nephrotoxic injury, other causes

Question 17

Renal: Causes of postrenal AKI

Answer 17

Postrenal: BPH, bladder Ca, calculi formation, neuromuscular d/o, prostate Ca, spinal cord disease, strictures, trauma

Question 18

Renal: Patients who receive radiation dye for imaging may be at risk for what?

Answer 18

Acute tubular necrosis

Question 19

Renal: Blood Urea Nitrogen (BUN), is a measure of what?

Answer 19

The amount of nitrogen in the blood as a byproduct of urea, which comes from protein breakdown. When KIDNEY function is compromised, the BUN will be elevated.