Exam 2: care of pts with renal disorders and acute and chronic kidney problems

Question 1

Polycystic kidney disease genetics

Answer 1

Inherited disorder: fluid-filled cysts develop in nephrons

• Dominant
• Recessive

Question 2

Polycystic kidney disease interventions

Answer 2

• Acute and chronic pain
• Constipation
• Infection
  antibiotics
• Hypertension
  Ace inhibitors, CCB, Beta blockers
  Low sodium diet

Treatment for renal failure

Question 3

Acute Kidney Injury: RIFLE classification criteria: Risk-

Answer 3

• GFR Criteria: Increased creatinine x1.5 or GFR decrease > 25%
• Urine output criteria: UO < 0.5 mL/kg/hr x 6hrs

Question 4

Acute Kidney Injury: RIFLE classification criteria: Injury-

Answer 4

• GFR criteria: Increased creatinine x2 or GFR decrease > 50%
• Urine output criteria: UO < 0.5 mL/kg/hr x 12hrs

Question 5

Acute Kidney Injury: RIFLE classification criteria: Failure-

Answer 5

• GFR criteria: Increasedd creatinine x3 or GFR decrease > 75%
• Urine output criteria: UO < 0.3 mL/kg/hr x 24hr or Anuria x 12hrs

Question 6

Acute Kidney Injury: RIFLE classification criteria: Loss-

Answer 6

Persistent Acute renal failure = complete loss of kidney function > 4 weeks

Question 7

Acute Kidney Injury: RIFLE classification criteria: End stage Kidney disease

Answer 7

> 3 months

Question 8

Phases of Acute kidney injury: Prerenal-

Answer 8

• Decrease in renal blood flow caused by decreased circulating volume secondary to dehydration, hypotension, decreased CO, embolism, sepsis.
• Prolonged hypotension
• Prolonged low cardiac output
• Prolonged volume depletion
• Renovascular thrombosis

Question 9

Phases of Acute kidney injury: Intrarenal-

Answer 9

• Due to disturbances within the glomerulus or renal tubules
• Commonly called “Acute Tubular Necrosis”
• Actual nephron damage with decreased glomerular filtration.
• Kidney ischemia
• Endogenous toxins
• Exogenous toxins
• Infection

Question 10

Phases of Acute kidney injury: Postrenal

Answer 10

Obstruction to urinary outflow from kidneys

- caused by obstructions such as Stenosis, Renal Calculi, Prostate disease, Bladder Obstruction or Infection.

Question 11

Prerenal management

Answer 11

• Fluid bolus
• Monitor
• MAP
  Medication
• Consult
• Renal artery obstruction
• Renal toxins

Question 12

Intrarenal management

Answer 12

• Fluid
• Monitor
• Dialysis
• Assess
• Medications
• Care & Comfort

Question 13

Postrenal management

Answer 13

• Treat the cause

- Alleviate the obstruction

Question 14

Chronic kidney injury: assessment/stages: Stage 1-

Answer 14

• At risk, normal kidney fxn, some structural or genetic trait point to kidney disease
• Estimated GFR: > 90 mL/min

Question 15

Chronic kidney injury: assessment/stages: Stage 2-

Answer 15

• Mild CKD, reduced GFR

- Estimated GFR: 60-89 mL/min

Question 16

Chronic kidney injury: assessment/stages: Stage 3-

Answer 16

• Moderate CKD

- Estimated GFR: 30-59 mL/min

Question 17

Chronic kidney injury: assessment/stages: Stage 4-

Answer 17

• Severe CKD

- Estimated GFR: 15-29 mL/min

Question 18

Chronic kidney injury: assessment/stages: Stage 5-

Answer 18

• End stage kidney disease

- Estimated GFR: < 15 mL/min

Question 19

Hemodialysis assessment

Answer 19

• BUN > 90 mg/dl
• Serum creatinine > 9 mg/dl
• Hyperkalemia
• Metabolic acidosis
• Fluid overload (intravascular/extravascular)
• Uremia
• Pericarditis
• GI bleeding
• Mental changes

Question 20

Hemodialysis Nursing care

Answer 20

• Collaborate with Dialysis nurse and MD regarding medications to be held during procedure
  AV access devices
• Verify subclavian VAS cath access with x-ray
• Monitor femoral access for excessive bleeding

AV access devices

• Assess patency:
• Palpate thrill
• Auscultate bruit
• Ensure hemostasis following needle withdrawal
• Apply firm pressure after needle withdrawn
• Monitor s/s infection
• Avoid taking BP or IV sticks in arm with fistula

Question 21

Hemodialysis complications

Answer 21

• Hypotension
• Thrombus
• Infection
• Bleeding
• Skin erosion
• Vascular steal syndrome
• Disequilibrium Syndrome
• Hemodynamic Instability
• Hepatitis

Question 22

Continuous renal replacement therapy (CRRT) types: Continuous venovenous hemofiltration (CVVH/CAVH)

Answer 22

• Rate: 500-800 ml/hr

Fluid replacement
- Pre and postdilution (calculating an hourly net loss)

• Method of solute removal: Convection

Indication
- Fluid removal, moderate solute removal

Question 23

Continuous renal replacement therapy (CRRT) types: Continuous venovenous hemodialysis (CVVHD/CAVHD)

Answer 23

• Rate: 500-800 ml/hr

Fluid replacement
- Pre and Postdilution, (subtracting the dialysate & then calculating an hourly net loss)

Method of solute removal: Diffusion

Indication
- Fluid removal, maximum solute removal

Question 24

Continuous renal replacement therapy (CRRT) types: Continuous venovenous hemodiafiltration (CVVHDF)

Answer 24

• Rate: 500-800 ml/hr

Fluid replacement
Pre and Postdilution, (subtracting the dialysate & then calculating an hourly net loss)

Method of solute removal: Convection & Diffusion

Indication:

• Maximum fluid removal
• Maximum solute removal

Question 25

Peritoneal Dialysis

Answer 25

- Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate Types: - Continuous ambulatory (CAPD) - Automated - Intermittent - Continuous-cycle