Exam 3 - Transition Chronic Renal Failure

Question 1

Case study S&S

Answer 1

diarrhea
pale
poor turgor
membranes dry
hx DM
insulin dependent since 8
thin
drowsy
warm, dry
140/88
116 - tachy
18
99.9 - warm
nauseated for 2 days
not been eating or drinking

Labs:
K+ - 6.0
Chloride - 93
Bicarb - 27
BUN - 48
Creatinine - 5.0
Glucose - 238
Sodium - 145

Question 2

What are things that can cause Acute RF

Answer 2

Sepsis - infx
Meds - nephrotoxic ones
Dehydration

Question 3

What happens to K+ in RF pts

Answer 3

they hang onto it
slightly elevated

Question 4

Leading cause of CRF and why

Answer 4

Diabetes

high amounts of blood glucose get filtered by the nephrons, when get scarred up and can’t filter anymore - nothing’s getting through

Question 5

Glucose level bad?

Answer 5

238
not terrible
probably see order for sliding scale

Question 6

Two possible causes for this pt’s low-grade fever

Answer 6

female - UTI
Dehydration
Virus - GI
Sepsis

Question 7

What is AV fistula

Answer 7

Arterioventricual
Aterialvenous

Question 8

Why need AV fistula?

Answer 8

Veins too weak to withstand repeated sticks

AV fistula formation reinforces the vein, and creates a stiff, capable source

Two needles during dialysis, the venous one and the arterial one

Question 9

What steps do you take to assess a fistula

Answer 9

Listen for bruit

means turbulent blood flow

artery and vein have anastamosed

thrill - palpating the turbulence at the fistula and radial pulse below it

visually inspect for color, infection, size, location, cap refil in the hand

clots can happen with fistula

Question 10

What to do if UAP took BP on fistula arm

Answer 10

Gently instruct to change the arm and then educate outside of room

taking BP on fistula arm can cause rupture, clots, etc.

Question 11

How long fistula take to fully mature

Answer 11

3 months

can’t use right away

Question 12

pt’s cbcq

Answer 12

WBC 7600 ok
RBC 3.2 mil low
Hgb 8.1 low
Hct 23% low
PLT 333k fine

Question 13

Why is she anemic? (low hgb/hct/rbc)

Answer 13

Erythropoietic is made in the kidneys - if they no work good then no RBCs

Hemodialysis can also result in temporarily low RBC’s

Question 14

What should be restricted in the diet

Answer 14

3 P’s:
- Potassium
- Phosphorus
- Protein

can’t filter these out

Sodium - high BP, fluid retention
Fluids - prevent fluid overload

Question 15

What is negative nitrogen balance

Answer 15

Urea is a urine waste that takes nitrogen and ammonia with it

If we can’t excrete urea, we can’t get rid of nitrogen

negative nitrogen balance results if more protein is coming in than going out

(severe malnutrition, burns, CRF can all result in neg nit bal)

Neg-nit-bal results in muscle wasting

Question 16

Vitamin needs for CRF

Answer 16

dialysis takes out water-soluble vitamins

Nephrocaps are multivitamins for RF pts

Need those vitamins for cellular growth and division

lack of these vitamins can be a secondary cause of anemia