Urinary Alternations

Question 1

why is calcium acetate (PhosLo) admistered in CKD patient ?

Answer 1

To lower the phosphorous level
Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low.

Question 2

Which assessment finding is a consequence of the oliguric phase of AKI?

Answer 2

Hyperkalemia

Question 3

What occurs in the diuretic phase of AKI

Answer 3

Hypokalemia, dehydration, hyponatremia

Question 4

How is ultrafiltration achieved in peritoneal dialysis ?

Answer 4

by increasing the osmolality of the dialysate with additional glucose.

Question 5

How is ultrafiltration achieved in hemodialysis ?

Answer 5

the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration

Question 6

During hemodialysis If the pt. complains of lightheadedness and nausea what should the nurse do?

Answer 6

The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased

Question 7

what does management of acute renal failure(ARF) include?

Answer 7

adequate protein, measures to lower potassium, potassium phosphate and sodium restriction, fluid restriction

Question 8

Measures taken to lower potassium

Answer 8

Regular insulin- potassium moves into cells when insulin is given
sodium bicarbonate- correct metabolic acidosis, potassium shifts into cells
Calcuium gluconate- given when hyperkalemia with ECG changes present to lower the excitation threshold
Hemodialysis- effective and works in short time
Sodium Polysyrene sulfontate(kaylexalate)- potassium is exchanged for sodium in GI and eliminated in feces.
potassium restriction- primarily used to prevent recurrent elevation

Question 9

What occurs in the diuretic phase of AKI

Answer 9

Hypokalemia, dehydration, hyponatremia, increased clotting tendency

Question 10

How is fluid excess managed?

Answer 10

weigh daily, Lasix( not given if pt. is hypokalemia or hypotensive), dialysis

Question 11

What discharge instructions are important for a patient diagnosed AKI?

Answer 11

weigh everyday, report if edema occurs, discuss with HCP before taking OTC meds

Question 12

Chronic renal failure (CRF)

Answer 12

progressive and irreversible

Question 13

what is the leading cause in AKI?

Answer 13

Infection

Question 14

What is the leading cause of death in CRF?

Answer 14

cardiovascular disease

Question 15

why metabolic acidosis occur in kidney injury?

Answer 15

Because kidney can not synthesize ammonia which is needed for hydrogen ion excretion.
serum bicarbonate is decreased in buffering hydrogen ions

Question 16

Why kussmal respiration occurs?

Answer 16

rapid and deep respiration in an effort to compensate metabolic acidosis by increasing exhalation of CO2

Question 17

Hyponatremia in oliguria happens because

Answer 17

tubules can not conserve Na, which results in increased urinary excretion of sodium

Question 18

Potassium in AkI

Answer 18

kidneys normal ability to excrete potassium is impaired

Question 19

Conditions that may worsen hyperkalemia

Answer 19

Bleeding, metabolic acidosis( hydrogen ion into the cells and k out of the cells)

Question 20

what changes are seen on EKG for hyperkalemia?

Answer 20

Peaked T waves, widening QRS complex, ST segment depression

Question 21

What additional factors could lead to a high BUN other than kidney injury

Answer 21

Infection, dehydration, corticosteroids, GI bleeding

Question 22

Asterixis

Answer 22

is commonly seen in advanced stage of kidney disease

Question 23

what teaching is important about Kayexalate?

Answer 23

They should expect diarrhea that is potassium rich stool.

Question 24

What are nursing interventions for uremic frosts?

Answer 24

bathing in cool water will remove the crystals and decrease the itching

Question 25

Why is cardiovascular major cause of death in CKD?

Answer 25

Due to elevated triglycerides R/T to decreased levels of enzyme that is important in the breakdown of lipoproteins.

Question 26

why anemia occurs in CKD?

Answer 26

due to decreased production of erythropoietin hormone by kidneys . iron and folic supplements may be required

Question 27

why bleeding and infection are seen in CKD?

Answer 27

impaired platelet aggregation, hyperglycemia( insensitivity to the normal action of insulin occurs and this promotes bacterial growth)

Question 28

GI problems related to CKD

Answer 28

stomatitis, constipation( from iron supplement or calcium containing phosphate binders, inactivity)

Question 29

Neurologic effects in CKD

Answer 29

decreased concentration, depression, restless leg syndrome, paresthesia, nocturnal leg cramps

Question 30

Musculosketal problems in CKD

Answer 30

low calcium( decreased serum level of active vitamin d needed for absorption of calcium from GI tract ), in response increased PTH to release calcium from bones causing accelerated rate of bone remodeling. This leads to increased risk of fractures.

Question 31

Reproduction problem in CKD?

Answer 31

decreased libido and fertilization in b oth men and women may both return after dialysis

Question 32

What cautions are important before administering sodium polystyrene sulfate ?

Answer 32

check bowel sounds. paralytic ileus is contraindicated, watch for Na and water retention

Question 33

Reproduction problem in CKD?

Answer 33

decreased libido and fertilization in both men and women may both return after dialysis

Question 34

what is given for anemia ?

Answer 34

Epogen SQ, Darbepoetin( longer acting) uncontrolled hypertension is contraindicated

Question 35

The diuretic phase of acute kidney injury is characterized by

Answer 35

an increase in urine output of more than 1000 mL in a 24 hour period. This increase in urine output indicates the return of some renal function; however, BUN and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.