Renal Failure Flashcards
A nurse has a paitent admitted to their unit with a history of renal failure. The nurse knows that renal failure patients have difficulty regulating these labs?
Erythropoietin production Blood pressure Phosphate Calcium Potassium Sodium Protein/Albumin BUN/creatinine PT/PTT Magnesium GFR
An ED nurse has a patient with renal failure come in with fatigue, SOB, dizziness and complains of being cold. The patients BP is 160/97 and the patient has edema in her extremities. When the nurse gets the lab results back, what specific labs would the nurse expect the patient to be abnormal? What interventions will the nurse perform?
Erythropoietin production will be abnormal r/t the s/s of anemia. Nurse will provide synthetic erythropoiesis stimulating agents.
BP is abnormal. Nurse will control HTN with ARBS or ACE Inhibitors.
Hypernatremia r/t the edema in extremities. Nurse will restrict sodium.
A renal failure patient has a BP of 164/98 and a potassium of 5.9, what is the antihypertensive drug of choice?
ARBS
*ACE Inhibitors can increase potassium levels
A nurse notices that her patients urine for the day had 41mg of protein in it and the patient has edema. What is the nurses intervention?
Increase carbs to decrease the breakdown of protein. Diuretics for the edema.
True or false. BUN/creatinine, PT/PTT, magnesium will all rise, while GFR will decrease when renal failure worsens.
True
A renal failure patient has a phosphate level of 6mEq/L, what would the nurse expect to see in this patient? What interventions?
Hyperphosphatemia: give phosphate binding agents
Hypocalcemia: increase calcium with active Vitamin D
A nurse admits a patient with an acute kidney injury. The cause was determined to be prerenal. The nurse can describe prerenal conditions as…
Conditions that decrease systemic blood flow to the kidneys
What are common causes of prerenal acute kidney injury?
Hypotension, hypovolemia, overuse of NSAIDs (vasoconstricts blood flow to the kidney’s)
A patient arrives to the ED with acute tubular necrosis and has developed an acute kidney injury. The nurse can determine the cause to be?
Intrarenal
What intrarenal cause is the number one cause of renal failure?
Diabetes
A patient who had an MRI 3 days ago has an abnormal lab value that went up 25%, what lab would the nurse suspect it is?
Creatinine
Renal calculi, BPH, tumor, clots and strictures are all possible causes of what type of acute kidney injury?
Postrenal
There are four different periods of acute renal injury, the nurse knows them as what?
Initiation Period
Oliguric Period
Diuresis Period
Recovery Period
A male patient who just had an MI is showing signs of renal complications. The patient went from 1000 mL of UO yesterday to only 700 mL of UO today. The patients BUN also went from 14 to 21 and creatinine from 0.9 to 1.3. The nurse knows that the patient is in what period of renal injury? The nurse also knows what caused the injury?
The MI caused the injury. The patient is in the initiation period.
S/S: decreased UO, but not oliguric, increase in BUN/creatinine
A nurse is asked by the physician to identify interventions on a patient in the initiation perioid. What would the nurse do?
IV fluid bolus for preeanl or intrarenal
Corrention of postrenal obstruction
A patient in the oliguric period asks his nurse how long this phase lasts. The nurses best response is?
Every patient varies, but the 18 days or greater is the most common timeframe.
The nurse is calculating her patients UO for the day and determines that the patient has only produced 220 mL of urine for the past 12 hours with a GFR of 48%. Is the patient in renal injury or failure oliguria?
The patient is in injury.
Injury is 12 hour oliguria and GFR < 50%
What does the nurse know to be failure oliguria?
< 400mL / 24 hours OR anuria / 12 hours w/ further rise in CR and decrease in GFR
Name the labs that would be affected in the oliguric period?
Increased BUN/Cr Increase K, Mg, phosphorus Decrease Ca ABG (metabolic acidosis) Low Hgb Increased protein in urine Decreased Cr clearance in urine
A patient is admitted to your floor in the oliguric period of AKI. No interventions have been done for this patient yet. Before performing any interventions you assess your patient and they have crackles in the lungs and peripheral edema. As the nurse, you would avoid attempting which intervention?
Fluid challenge
A patient comes to the ED with s/s of oliguric period AKI. What is the first intervetnion made by the nurse?
Identify the underlying cause
Your patient is a healthy 24 year old who got into a MVA and has decreased UO and is showing signs of nephron damage. You detect oliguric period AKI and decide to give a fluid challenge, what do you monitor for?
RF Ciruculatory Overload
True or false. Patients in circulatory overload can be given diuretics. If the diruetics don’t increase UO, the nurse will continute to give more diuretics.
False. If not responding to diuretics the patient will need diaylsis.
A nurse who has a patient newly transitioned into the diuresis period knows that their patients AKI will what?
Resolve with further treatment. B/c kidney’s will begin to regain function.
What is a risk for the diuresis period?
Fluid loss and electrolyte changes. Dehydration, hypovolemia, decrease electrolytes.
True or false. In the diuresis period, patients BUN/Cr will increase.
False. They will begin the decrease.
A nurse will know that their patient in the diuresis period when their UO is gradual increasing and meeting which minimun?
> 400 mL/day and up to 10L /day of dilute urine
The nurse is educating their patient on the recovery period of AKI for discharge teaching. The patient asks how long will the recovery period last and if they need to go see a doctor, the nurse says?
Months to a year and that follow up is required with HCP (nephrologist) for frequent labs
In AKI the nephron involvement is what %?
50%
In CKD the nephron involvement is what %?
75%
How long does CKD last?
Permanent
A nurse is teaching a class for specific populations of people at risk for CKD. What comorbidites should be discussed at the class that increases the risk of developing CKD?
DM
HTN
Cardiovascular Disease
A nursing students sees Azotemia mentioned on the chart of a CKD patient. The student know that means?
A collection of nitrogenous waste in the blood
A chef has recently been diagnosed with CKD. He is extremely concerned about diet modifications that will have to occur. What renal diet information can the nurse provide to the patient?
Renal diets are stage dependent. If the client manages to stay in stages 1-3 then no changes will need to be made.
Stage 4/5 decrease protein, phos, potassium and include fluid restriciton
Stage 5 or diaylsis same as stage 4, but increase protein
PD: increase protein, decrease phos, no potassium change, fluid restriction only if anuric
Which stage of CKD is described as a slight decrease in nephron function, no waste accumulation, healthy renal cells still compensating for dead renal cells?
Stage 1
What are interventions for Stage 1 CKD?
GOAL: keep in stage 1 as long as possible
Focus on CVD risk reduction
Decrease sodium, smoking cessation, exercise and weight control
Assess medications and eliminate any contributing factors: NSAID use and aminoglycosides (end in cin)
Which stage of CKD is described as some waste accumulation, decrease in Cr clearance, slight BUN/Cr increase, microalbuminuria is possible, decreased ability to concentrate urine (waterlike), nocturia, polyuria?
Stage 2
What are interventions for Stage 2 CKD?
Monitor by 24 hr urine: discard the first urination and then keep on ice
Monitor labs and s/s
Which stage of CKD is described as seperated into 3a and 3b based on GFR. Metabolic waste is apparent, increase in BUN/Cr, microalbuminuria and polyuria cont., initial f/e imbalance, beginning to look ill?
Stage 3
