Download NUR 425 Exam 5: Renal System and Fluid & Electrolyte Balance and more Exams Nursing in PDF only on Docsity!
NUR 425 exam
NUR 425 Exam 5 quizzes
The kidneys are responsible for excreting 90% of the body's ________? Potassium Sodium Calcium Magnesium - potassium Which of the following is a function of the kidneys? Break down platelets Regulate blood pressure Synthesize clotting factors Secrete bil - regulate blood pressure Which of the following could be considered a pre-renal cause of acute kidney injury? Benign prostatic hypertrophy CT contrast dye Aminoglycoside antibiotics Gastrointestinal bleed - gastrointestinal bleed
Which of the following is a function of the kidneys? Synthesize immune mediators Synthesize calcitriol Synthesize antidiuretic hormone Synthesize corticosteroids - synthesize calcitriol Which of these is considered the "functional unit" of the kidney? Nephron Loop of henle Glomerulus Collecting duct - nephron Which is true about acute kidney injury? AKI is always preceded by direct trauma to the renal tissue The most common cause is acute tubular necrosis AKI is not reversible The most common cause is infection - The most common cause is acute tubular necrosis Which is a post-renal cause of acute kidney injury? Administration of amphotericin B
- cystic kidney disease number one cause of acute kidney disease - acute tubular necrosis pre-renal etiology of acute kidney disease - - perfusion to the kidney
- when the heart isn't working well
- blood flow to the kidneys kidneys stop making enough urine in response to poor perfusion
- resolves quickly with treatment of disease intra-renal etiology of acute kidney disease - - direct hit to the kidney itself
- due to a direct problem with kidney
- acute tubular necrosis
- rhabdomyolysis
- contrast dye
- trauma post-renal etiology of acute kidney disease - - obstruction of urine outflow
- prostate cancer
- kidney stones
- resolves quickly with treatment of cause A patient with diabetes insipidus will present with which of the following? Low urine output
High urine output Low serum osmolality High urine osmolality - High urine output Which of the following is a disorder caused by low levels of antidiuretic hormone? Myxedema Diabetes Insipidus Addisons Disease Cushings - diabetes insupidus Which of the following is a common major concern related to patients with diabetes inspidus? Hyperglycemia Hypoglycemia Dehydration Heart failure - dehydration Patients with SIADH are most likely to be at risk for which of the following? Hypotension Kidney Failure Pulmonary edema Hypoperfusion - pulmonary edema Which of the following is true about SIADH and DI? SIADH is caused by head injury, DI is not
normal SaO2 for adult - 95 - 100%
- normal BP for adult - 120/
- normal HR for adult - 60 -
- infant HR - 100 - normal temp for adult - 36.5-37.2 C
- infant HR sleeping - 75 -
- infant RR - 30 -
- toddler HR - 100 -
- toddler HR sleeping - 75 -
- toddler RR - 24 -
- preschool HR - 60 -
- preschool HR sleeping - 60 -
- preschool RR - 22 -
- school age HR - 60 -
- school age HR sleeping - 60 -
- school age RR - 18 -
- adolescent HR - 50 -
- adolescent HR sleeping - 50 -
- adolescent RR - 12 -
- normal pH - 7.35-7.
- normal CO2 - 35 -
- normal HCO3 - 21 -
- normal MAP - 70 -
- used to see how well kidneys are functioning atropine - - spinal cord injury
- given for neurogenic shock due to SCI
- given for the cardiovascular system's effects from SCI norepinephrine - - spinal cord injury
- given for neurogenic shock due to SCI regular insulin and dextrose - - spinal cord injury
- quick fix for hyperkalemia
- drives potassium from the blood stream into the cell erythropoietin - - spinal cord injury
- intervention for anemia
- exogenous erythropoietin (Epogen, Procrit)
- the kidneys secrete erythropoietin which stimulates RBC production in the bone marrow furosemide (lasix) - - syndrome of inappropriate ADH (SIADH)
- promotes diuresis thiazide diuretics - - diabetes insipidus -- nephrogenic
- more supportive than curative
declomycin - - syndrome of inappropriate ADH (SIADH)
- reduces tubule response to ADH vasopressin - - vasopressor, synthetic form of ADH
- diabetes insipidus -- central
- causes less urine output and more water staying in the body, which increases BP
- IV or SQ epinephrine - - spinal cord injury
- given for neurogenic shock due to SCI 3% NaCl - - pulls fluid out of interstitial space and into the intravascular space --> decreases cerebral edema
- WARNING: must infuse SLOWLY and through a central line -- often around 30 mL/hr
- monitor Na levels --> brain tissue will shrink if sodium levels get too high too fast 0.45% NaCl - - diabetes insipidus
- hypotonic solutions in acute DI
- fluid replacement mathylphenidate hydrochloride -- Ritalin - ADHD dextroamphetamine -- Adderall - ADHD
hematologic disorders in oliguric phase - - leukocytosis: elevated WBCs
- blunt patient immune response waste product accumulation in oliguric phase - urine isn't leaving --> urine is in the bloodstream neurologic disorders in oliguric phase - - waste products irritate the brain and nervous tissue
- will cause confusion diuretic phase in AKI - - increase in urine output, but the nephrons aren't fully functioning
- fluid being pulled into blood stream due to high urea concentration
- osmotic diuresis is occurring (high urea in the blood stream)
- daily urine output is 1-3 L
- may reach 5 L or more
- concern is fluid/electrolyte balance
- can lose a lot of sodium and a lot of potassium
- risk for seizures and dysrhythmias recovery phase in AKI - - glomerular filtration starts to improve
- see dramatic improvements in first couple of weeks
- full recovery can take up to a year
CKD urinary symptoms - - polyuria (early sign); result from inability of kidneys to concentrate urine
- oliguria (as CKD worsens); hyperkalemia, infection, fluid overload
- anuria (as CKD worsens); urine output lower than 40 mL per 24 hours CKD metabolic disturbances - - waste product accumulation
- altered carbohydrate metabolism
- elevated triglycerides CKD electrolyte and acid base imbalances - - potassium (elevated)
- sodium (elevated, normal, or low)
- calcium and phosphate (hypocalcemia and hyperphosphermia)
- magensium (slightly elevated)
- metabolic acidosis CKD cardiovascular symptoms - - hypertension
- heart failure
- left ventricular hypertrophy
- peripheral edema
- dysrhythmias (hyperkalemia)
- uremic pericarditis CKD neurologic symptoms - - expected as renal failure progresses
- increase nitrogenous waste products
- electrolyte imbalances
- enteral nutrition AKI renal replacement therapy (RRT) - - peritoneal dialysis
- intermittent hemodialysis
- continuous renal replacement therapy CKD drug therapy hyperkalemia - - insulin + dextrose (drives potassium from bloodstream into cell
- Kayexelate (laxative, pulls potassium ions into intestinal lumen and gets ride of bowel movement CKD drug therapy hypertension - - ACE inhibitors
- ARBS CKD drug therapy - mineral and bone disease - - limit dietary phosphorus
- Sevelamer (phosphorus binder) CKD drug therapy anemia - - exogenous erythropoietin CKD drug therapy dyslipidemia - statins CKD protein restriction - protein metabolism produce ammonia, creatinine, urea CKD water restriction - - not routinely restricted
- HD patients: more common
- PO intake: 600+ previous days urine output CKD sodium and potassium - - avoid salt substitutes that contain KCl
- restrict sodium 2-4 g/day
- potassium restriction 2-3 g/day high potassium foods - apricot, avocado, banana, cantaloupe, orange, prunes, raisins, potatoes, spinach, tomatoes, vegetable juice, bran, chocolate, granola, milk, nuts, seeds, peanut butter, yogurt CKD phosphate restriction - - meats dairy
- reduce dietary phosphate 1 g/day dialysis - movement of fluid and molecules across a semipermeable membrane from one compartment to another diffusion - movement of solute in kidney failure, urea, creatinine, uric acid, and electrolytes from blood to dialysate (solutes from high to low) osmosis - glucose added to dialysate and creates osmotic gradient to pull fluid from blood (solutes from low to high) indications for dialysis - - correct fluid and electrolyte imbalances
- remove waste products in kidney failure
- treat drug overdoses
HD and CRRT interventions - - are they ready for dialysis
- weigh patient
- document I&O
- assess hemodynamic status
- effluent should be clear yellow PD nursing considerations - - instill, dwell, drain
- dialysate should be warmed prior to instillation
- aseptic technique
- move side-to-side or gentle massage to aid with draining possible complications from PD - - peritonitis (purulent leakage, cloudy outflow, abdominal pain/rebound tenderness, erythema, fever, weight gain)
- bleeding
- hernias
- pleural effusions, bronchitis
- protein loss fistulas and grafts - - risk for thrombosis, stenosis, occlusion
- auscultate for bruit and palpate for thrill
- risk for poor perfusion; assess perfusion distal to site
- no blood pressure, IV, lab draws on arm with fistula/graft HD complications - lots of fluid loss, electrolyte shift, water for hypotension
CRRT complications - less aggressive fluid shift, more closely monitoring electrolytes spinal shock - loss of motor, sensory, and reflex activity below level of injury
- begins within minutes of injury
- lasts up to 4-6 weeks when deep tendon reflexes return
- permanence of injury often not known until shock resolves neurogenic shock - - temporary loss of sympathetic input when injury is at T6 and above
- massive vasodilation
- hypotension, bradycardia, hypothermia
- duration variable, signalled by return of sympathetic tone drugs for neurogenic shock - - vasopressors -- constricts -- dopamine, epinephrine
- atropine: helps with bradycardia immediate goals for spinal cord injury - - assess and stabilize airway
- administer O2 as needed
- immobilize and stabilize with cervical collar, backboard straps
- establish large bore IV access X
- monitor and stabilize vitals
- assess sensation and movement
- obtain history, emphasizing incident
- assessment with extent of injuries
