VN 36 Test 8 renal/urinary

Question 1

1. Hemodialysis nursing interventions (pg.810)

Answer 1

 Must be able to “feel the thrill” & hear the bruit
 Weight patient pre & post dialysis
 Disequilibrium syndrome: nausea, headaches, restlessness, ataxia, confusion, dizziness (mannitol IV given prophylactically)
 Assess skin over fistula/graft for signs of infection
 Avoids puncturing the same site that was used previously
 Measure VS every 30 mins

Question 2

2. Age-related changes in the renal system (ch.57 pp slide 17)

Answer 2

 Nocturnal Polyuria
 Decreased glomerular filtration rate
 Bladder loses elasticity & can’t hold as much urine
 Bladder muscles weaken & can cause retention

Question 3

3. Dipstick interpretation PH (video)

Answer 3

 Normal pH = 6 (4-8)
Abnormal PH (pH less than 4)
 Urine acidosis
 Bacterial infection
 Diabetic ketoacidosis
Ph Greater than 8: Urine alkalosis, medication related

Question 4

3. Dipstick interpretation Color- blue & orange (video)

Answer 4

BLUE/GREEN:
 Food coloring
 Pseudomonas aeruginosa bacterial infection
 Propofol

ORANGE:
 Dehydration
 Phenazopyridine (Pyridium) for UTI

Question 5

3. Dipstick interpretation brown & red (video)

Answer 5

BROWN:
 Metronidazole
 Chloroquine
 Liver (due to bilirubin)
 Rhabdomyolysis (breakdown of myoglobin)

RED (usually trauma related):
 Beets, rhubarb, blueberries
 Kidney stones
 Tumors in the bladder & kidney

Question 6

3.3. Dipstick interpretation urine specific gravity (video)

Answer 6

Normal Urine Specific Gravity: 1.003-1.030

Abnormal Urine Specific Gravity: less than 1.003:
 Fluid volume overload
 Diabetes Insipidus
 Disease that causes vasopressin to be suppressed causing very large quantities of dilute urine.
 Increase of water in the urine

Greater than 1.030 (“if the gravity is high = likely dry”)
 Fluid volume deficit (dehydration)
 SIADH
 Less water in the urine

Question 7

4. Renal angiography nursing interventions (ch.57 pp slide 19)

Answer 7

 Injection of radiopaque dye into renal arteries (check for iodine allergy)
 Often done after trauma
 Laxative pre to secure unobstructed view

Question 8

5. Renal disease and medication contraindications

Answer 8

 Nephrotoxic medications like NSAIDS & cephalosporins

Question 9

6. Peritoneal dialysis client education (pg.812)

Answer 9

 Priority: keeping site free from infection (keep exit site clean, no purulent drainage)
 Installation of fluid for peritoneal is about 10 mins
 Dwelling time is usually 15 ins when patient is well established
 Avoid using any dialysate solutions that are expired and look cloudy, discolored, or contain sediment.
 Wear a mask when performing exchanges if you have an upper respiratory infection.
 Call the primary provider if:
* A fever develops.
* There is redness, pain, or pus draining around the catheter.
* The external length of the catheter increases.
* N/V or abdominal pain develops.

Question 10

7. Renal calculi-causes (ch.58 pp slide 4)

Answer 10

Diet:
 large intake of protein can increase uric acid secretion
 large intake of calcim
 Low fluid intake that increases urinary concentration
Lifestyle:
 Sedentary occupation
 Immobility
 Dehydration

Question 11

8. Acute kidney injury complications-oliguric phase- (ch.36 pp slide 16)

Answer 11

 Urine output 400mL/day
 Fluid & electrolyte abnormalities
 (+) BUN & creatinine
 Metabolic acidosis
 Anemia
 Infection
 Neurologic changes

Question 12

8. Acute kidney injury complications-diuretic phase- (ch.36 pp slide 16)

Answer 12

 Gradual increase in daily urine (1-3L/day or 3-5L more)
 Severe uremia
 Low creatinine clearances
 (+) creatinine/BUN w/persistent s/s
 Dehydration!

Question 13

8. Acute kidney injury complications-recovery phase- (ch.36 pp slide 16)

Answer 13

 Begins when GFR rate (+)
 BUN & creatinine plateau, renal function may take up to 12 months to stabilize

Question 14

9. Chronic kidney disease manifestations(pg.805)

Answer 14

 Elevated BP & weight gain
 Facial features appear puffy from fluid retention
 Pale skin
 Urine output decreases
 Lethargy/fatigue
 pruritus

Question 15

9. Chronic kidney disease lab findings & client education(pg.805)

Answer 15

 Elevated BUN, creatinine, potassium, magnesium & phosphorus

Client Education (Ch.36 pp slide 19):
 Protein restriction (0.6-0.75g/kg)
 Can increase protein w/dialysis
 Restrict sodium, potassium & magnesium
 Diet high in carbs & moderate in fat
 Restrict fluids (600mL/day)

Question 16

10. Pyelonephritis manifestations (ch.58 pp slide 10)

Answer 16

 Costovertebral tenderness
 N/V
 Dysuria
 Urgency/ frequency
 Fever/chills
 Flank pain
 Fatigue

Question 17

11. Acute glomerulonephritis manifestations (ch.58 PP slide 12)

Answer 17

(Inflammation of the glomeruli)
 Very often after a bacterial infection (strep)
 Flank pain
 N/V
 Dysuria, foamy urine
 Fatigue
 Urgency/ frequency
 Dark rusty urine
 Proteinuria

Question 18

12. Kidney biopsy post op nursing interventions (CH.57 pp slide 19)

Answer 18

 Lay on affected side for 30-60 minutes
 24hr bed rest
 Increased risk of hemorrhage (nursing actions to decrease & assess for risk of hemorrhage)
-signs of hemorrhage: assess dressing site for bleeding, monitor v/s, severe pain in the shoulder, back or abdominal can indicate bleeding
 Monitor for blood in urine
 Provide comfort measures

Question 19

13. Arteriovenous fistula client education (pg.810)

Answer 19

 Avoid carrying heavy items in the arm with the fistula or graft.
 Wear clothing with loose sleeves or made of fabrics that will not obstruct blood flow.
 Do not sleep on the vascular access arm.
 Do not permit venipunctures, injections, or BP in the arm with the vascular access.
 Wash the skin over the vascular access daily.
 Assess for a thrill or bruit daily.
 Report signs of an infection or signs of impaired blood flow to dialysis personnel or primary provider immediately.

Question 20

14. UTI manifestations (CH.58 pp slide 3)

Answer 20

 Frequency
 Urgency
 Dysuria
 Supra-pubic pressure
 Hematuria

Question 21

15. How is it determined that client is cleared from Glomerulonephritis (pp slide 12)

Answer 21

 Client is cleared from disorder when there is no longer protein in the urine

Question 22

17. Diagnostic examinations (ch.57 pp slide 19)

Answer 22

 Kidneys, ureter & bladder x-ray (no dye)
 IV urography (ANA:IVP) contains dye
 Cystoscopy: finds abnormalities of bladder wall (monitor for infection)