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111 Cards in this Set
- Front
- Back
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What are common electrolyte imbalances in acute renal failure?
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Hyperkalemia, hyperphosphatemia, hypocalcemia, and hypermagnesemia are common electrolyte imbalances in acute kidney failure
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Which renal failure disease may show hyperkalemia, electrocardiograph changes and/or paralytic ileus?
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Chronic renal failure
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The nurse assists the client with acute kidney injury (AKI) to modify the diet in which way? Select all that apply:
A. Restricted protein B. Liberal sodium C. Fluid restriction D. Low potassium E. Low fat |
A, C, and D:
Restricted protein (Breakdown of protein leads to azotemia and increased blood urea nitrogen (BUN). Fluid is restricted during the oliguric phase of acute renal failure. Potassium intoxication may occur; dietary potassium is restricted. |
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What is the duration of the onset phase in acute renal failure?
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Hours to days from time of injury until oliguria develops
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What is the duration of the oliguric phase in acute renal failure?
What defines an oliguric urine output? Should diuretics or fluid challenges be given? |
1-3 weeks;
oliguric urine output= 100-400mL/24hr; No response to fluid challenges or diuretics |
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When caring for the client with acute kidney injury and a temporary subclavian hemodialysis catheter, which of these should the nurse report to the provider?
A. Crackles at lung bases B. Temperature of 100.8 F C. +1 ankle edema D. Anorexia |
B. Temperature of 100.8 F:
Infection is a major complication of temporary catheters. Report all symptoms of infection, including fever, to the provider. The catheter may have to be removed. Some degree of fluid retention is expected. Rising blood urea nitrogen (BUN) may result in anorexia, nausea, and vomiting. |
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Which teaching by the nurse will help the client prevent renal osteodystrophy?
A. Low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Avoiding dairy enriched with vitamin D |
Kidney failure causes hyperphosphatemia. Client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Kidney failure decreases serum calcium, resulting in demineralization of the bone; do not restrict calcium in the diet. Cola beverages are high in phosphorus and are to be avoided. Dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.
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What is renal osteodystrophy?
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Renal osteodystrophy is a condition due to chronic kidney disease and renal failure, with elevated serum phosphorus levels, low or normal serum calcium levels, and stimulation of parathyroid function, resulting in a variable admixture of bone disease (deformation of bone, weak/brittle bone, abnormal bone metabolism).
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What is the duration of the diuretic phase of acute renal failure?
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2-6 weeks after oliguria with high urine output
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Define prerenal azotemia acute renal failure
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Prerenal azotemia is a type of acute renal failure caused by decreased blood flow, severe volume depletion or low blood pressure.
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How long does the recovery phase of ARF last?
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Up to a year, normal urinary activity returns
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The client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted?
A. Auscultate for pericardial friction rub B. Assess for crackles C. Monitor for decreased peripheral pulses D. Determine whether the client is able to ambulate |
A. Auscultate for pericardial friction rub
The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. |
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Define intrarenal acute renal failure
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Intrarenal acute renal failure is caused by inflammation or ischemia (insufficient supply of blood to an organ) within the kidneys or by cytotoxic retention (high levels of toxic substances within the body).
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Postrenal acute renal failure is caused by...?
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Postrenal ARF is caused by obstruction of the urine.
Use bladder scanner to determine retention. |
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Define osmolality. What is the normal blood osmolality range?
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Osmolality is the concentration of all chemicals in the blood.
Normal range= 285-295 MOsm/kg |
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What is the function of aldosterone, a hormone secreted by the adrenal glands?
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Aldosterone promotes the retention of sodium and bicarbonate, the excretion of potassium and hydrogen ions, and the secondary retention of water. Large excesses can invoke plasma volume expansion, edema, and hypertension.
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When is aldosterone secreted?
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Aldosterone is secreted by adrenal glands when level of K+ in blood is increased.
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Define oliguria
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Oliguria= decreased urine output of 100-400 mL/24 hours
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Define uremia
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Uremia= excessive urea or waste products in the blood
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What can uremia lead to?
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Renal failure due to azotemia
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What are symptoms of azotemia?
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Nausea, anorexia, vomiting, fatigue, pruritis (itchy skin), muscle cramps, ALOC (altered level of conciousness), weight loss
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Define azotemia
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Azotemia is the build up of nitrogenous wastes in the blood, particularly BUN (blood urea nitrogen)
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The nurse teaches the client recovering from acute kidney disease to avoid which of these?
A. Nonsteroidal anti-inflammatory drugs B. Angiotensin-converting enzyme (ACE) inhibitors C. Opiates D. Acetaminophen |
A. Non-steroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs may be nephrotoxic. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Acetaminophen is hepatotoxic, not generally nephrotoxic.
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The nurse recognizes that the client with end-stage kidney disease has difficulty adhering to the fluid restriction when which of these is found?
A. Blood pressure 118/78 B. Weight loss of 3 lbs during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg |
C. Dyspnea and anxiety at rest:
Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Excess fluid intake and fluid retention are manifested by elevated CVP (>8 mm Hg). Excess fluid intake and fluid retention are manifested by weight gain, not loss. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 is a normal blood pressure. |
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When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure?
A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura) |
B. Lisinopril (Zestril): Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers (diltiazem/Cardizem) may indirectly prevent kidney disease by controlling hypertension but are not specific to slowing progression of kidney disease.
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Define anuria
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Anuria= less than 100 mL of urine output within 24 hours
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Anti-diuretic hormone (ADH), produced by the hypothalamus, is released by the pituitary gland when...?
What does ADH do? |
When blood osmolarity is increased, ADH travels through the blood stream to the kidneys.
ADH causes conservation of water, reducing blood osmolarity. |
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When kidney function fails, what happens?
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pH balance fails as kidney function fails (electrolyte balance fails, hormonal regulation, metabolism regulation)
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When pH balance fails, what happens to the respiratory system?
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The respiratory system tries to compensate pH imbalance by blowing off CO2 via hyperventilation (increase in respirations).
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What hormones does the kidney regulate?
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Renin, prostaglandins, bradykinin, erythropoietin, and activated vitamin D
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What does the hormone renin do?
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Renin is a proteinase of high specificity that is released by the kidney and acts to raise blood pressure by activating angiotensin.
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What is the function of hormonal prostaglandins?
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Prostaglandins are involved in the contraction of smooth muscle, the control of inflammation and body temperature, and can lower or raise blood pressure.
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What is the normal specific gravity range?
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1-1.03
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A high specific gravity indicates...
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Dehydration/concentration of urine due to decreased renal perfusion
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What are the causes of acute renal failure?
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-Decreased blood flow
-Infections -Trauma -Toxicity (from drugs such as antibiotics or NSAIDs) -Clotting problems -Autoimmunity |
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What are the causes of chronic renal failure?
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-Diabetes (uncontrolled glucose levels)
-Hypertension -Autoimmunity -Polycystic kidney disease |
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What does chronic renal failure progress to?
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End Stage Renal Failure (ESRF)
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A decreased specific gravity indicates what?
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Chronic renal failure
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What is the best indication of organ perfusion?
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Urine output
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What appearance is urine with a high specific gravity?
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Dark, sometimes with sediment
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What is erythropoietin?
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Erythropoietin is a glycoprotein hormone that stimulates the production of red blood cells by stem cells in bone marrow. Produced mainly by the kidneys, it is released in response to decreased levels of oxygen in body tissue.
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What does the hormone bradykinin do?
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Bradykinin mediates the inflammatory response, increases vasodilation, and causes contraction of smooth muscle.
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The nurse carefully observes for toxicity of drugs excreted through the kidney. Which of these represents a sign or symptom of digoxin toxicity?
A. Serum digoxin level of 1.2 ng/mL B. Polyphagia C. Anorexia D. Serum potassium of 5.0 mEq/L |
C. Anorexia: Anorexia, nausea, and vomiting are symptoms of digoxin toxicity.
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Which of the following represents a positive response to administration of erythropoietin (Epogen, Procrit)?
A. Hematocrit of 26.7% B. Potassium within normal range C. Free from spontaneous fractures D. Less fatigue |
D. Less fatigue: Treatment of anemia with erythropoietin will result in increased (H&H) and decreased shortness of breath (SOB) and fatigue.
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When caring for the client with a left forearm arteriovenous (AV) fistula created for hemodialysis, the nurse must do which of these? Select all that apply.
A. Check brachial pulses daily B. Auscultate for a bruit each shift C. Teach the client to palpate for a thrill over the site D. Elevate the arm above heart level E. Ensure that no blood pressures are taken in that arm |
B. Auscultate for a bruit each shift, C. Teach the client to palpate for a thrill over the site, and E. Ensure that no blood pressures are taken in that arm
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When caring for a client who receives peritoneal dialysis (PD), which of these findings must the nurse report to the provider immediately?
A. Pulse oximetry reading of 95% B. Sinus bradycardia, rate of 58 C. Blood pressure of 148/90 D. Temperature of 101.2 F |
D. Temperature of 101.2 F: Peritonitis is the major complication of PD caused by intra-abdominal catheter site contamination; use meticulous aseptic technique when caring for PD equipment.
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What happens when BP is low or Na+ levels are low?
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Renin from the kidneys become released into the bloodstream, activating angiotension I to angiotension II, which constricts arterioles and increases BP.
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When caring for the client hoping to receive a kidney transplant, the nurse recognizes that which of these problems will exclude the client from transplantation?
A. History of hiatal hernia B. Client with diabetes and HbA1c of 6.8 C. Basal cell carcinoma removed from nose 5 years ago D. Client with tuberculosis |
D. Client with tuberculosis: Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with immune suppressants required to prevent rejection.
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For a fluid retaining patient, how much fluid replacement is given?
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Replacement is based on output plus 500-700 mL/day for insensible losses
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What is sodium polystyrene sulfonate (Kayexalate) used for?
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Kayexalate (often given as an enema) treats mild to moderate hyperkalemia by decreasing serum potassium levels.
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Which of these interventions is essential for the client in the oliguric phase of acute kidney injury (AKI)?
A. Restrict fluids B. Replace potassium C. Administer blood transfusions D. Monitor arterial blood gases (ABGs) |
A. Restrict fluids: During the oliguric phase of AKI, the client will be at risk for fluid overload; fluid restriction is necessary to limit this problem.
Hyperkalemia results from kidney injury; do not replace potassium unless clearly decreased. Blood transfusions replace the oxygen-carrying capacity of the blood and are used for shortness of breath or chest pain; use is not specific to the oliguric phase. |
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The nurse in the transplantation unit assesses for which of these signs and symptoms of rejection of the transplanted kidney. Select all that apply.
A. Blood urea nitrogen (BUN) 21, creatinine 0.9 B. Crackles in lung fields C. Temperature 98.8 D. Blood pressure 164/98 E. +3 edema of lower extremities |
B. Crackles in lung fields, D. Blood pressure 164/98, E. +3 edema of lower extremities
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What is the normal blood urea nitrogen range (BUN)?
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10-20 mg/dL= normal BUN range
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Normal serum creatinine range is?
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0.5-1.2 mg/dL= normal serum creatinine range
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What are the symptoms of a patient with prerenal acute renal disease?
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-Decreased cardiac output
-Decreased urine output -Edema -Fatigue -Weight gain |
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Discharge teaching has been provided for the client recovering from kidney transplantation. Which information indicates that the client understands the instructions?
A. "I can stop my medications when my kidney function return to normal." B. "If my urine output is decreased, I should increase my fluids." C. "The anti-rejection medications will be taken for life." D. "I will drink 8 ounces of water with my medications." |
C. "The anti-rejection medications will be taken for life."
Adherence to immune suppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately. |
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Which clinical manifestation indicates the need for increased fluids in the client with kidney failure?
A. Increased blood urea nitrogen B. Increased creatinine C. Pale urine D. Decreased sodium |
A. Increased blood urea nitrogen: An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment.
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The client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include?
A. Avoiding venipuncture and blood pressure measurements in the affected arm B. Discussion on modifications to allow for complete arm rest C. Information on how to assess for bruit D. Information on proper nutrition |
A. Avoiding venipuncture and blood pressure measurements in the affected arm: Compression of vascular access causes decreased blood flow and may cause occlusion; dialysis will not be possible. The arm is exercised to encourage venous dilation, not rested.
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Which finding in the first 24 hours after kidney transplantation requires immediate intervention?
A. Abrupt decrease in urine output B. Blood-tinged urine C. Incisional pain D. Increase in urine output |
A. Abrupt decrease in urine output:
An abrupt decrease in urine output may indicate complications such as rejection, acute tubular necrosis (ATN), thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output is an expected finding after kidney transplantation. |
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The RN has just received change-of-shift report. Which of the assigned clients should be assessed first?
A. A client with chronic kidney failure who was just admitted with shortness of breath B. A client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted C. A client with azotemia whose blood urea nitrogen and creatinine are increasing D. A client receiving peritoneal dialysis who needs help changing the dialysate bag |
A. A client with chronic kidney failure who was just admitted with shortness of breath:
This client's dyspnea may indicate pulmonary edema and should be assessed immediately. |
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Calcium channel blockers are used for...?
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Calcium channel blockers are used to control blood pressure (treats high BP, angina, and abnormal heart rhythms).
Calcium channel blockers are medicines that slow the movement of calcium into the cells of the heart and blood vessels. This, in turn, relaxes blood vessels, increases the supply of oxygen-rich blood to the heart, and reduces the heart's workload. |
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Kidney failure can cause metastatic calcification. What is metastatic calcification?
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Metastatic calcification is the pathologic process whereby calcium salts accumulate in previously healthy tissues, caused by excessive levels of blood calcium, such as in hyperparathyroidism.
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What renal failure problems affect the cardiovascular system?
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-Anemia
-Fluid overload -Increased BP |
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What type of cardiovascular changes can occur due to renal failure?
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-CHF
-Left ventricular hypertrophy |
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SOB and pulmonary edema may result from which 2 renal failure problems?
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Fluid overload & metabolic acidosis (where kidneys cannot remove excess H)
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Why does anemia occur with renal failure?
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Because the kidney's no longer produce erythropoietin to stimulate RBC production
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Why does renal failure cause CNS symptoms like confusion?
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Because of the build up of azotemia (creatinine and BUN) in the patient's brain tissues
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Can peripheral nervous system changes from renal failure be reversed?
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No, peripheral nervous system changes cannot be reversed
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What are examples of peripheral nervous system changes due to renal failure?
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-Nerve impulses
-Restless leg syndrome -Sensory changes: numbness, tingling (parasthesia), and burning sensations in fingers and toes |
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What are some reproductive changes (male and female) due to renal failure?
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Female: cease of menstration, decrease in libido; Male: impotent (unable to sustain errection), decrease in libido, may be sterile.
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What are dermatologic changes due to renal failure?
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-Color changes (due to urinary pigments and anemia)
-Skin dry and scaly (due to accumulation of PO4 and Ca deposits) -Pruritis or itching |
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What are gastrointestinal changes due to renal failure?
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-Anorexia
-Nausea -Vomiting -Constipation -Diarrhea |
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What is the most common life-threatening metabolic complication of renal failure that may develop suddenly from a severe decrease in glomerular filtration rate in ESRD?
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Hyperkalemia
Acidosis results from hydrogen ion excretion and may exacerbate hyperkalemia. |
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What are symptoms of ESRD (end stage renal disease) metabolic acidosis?
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Shortness of breath (SOB) from hypernea (increased respirations)
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What are the symptoms of hypocalcemia in ESRD?
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-Neuromuscular irritability
-Tetany (hyperexcitability of nerves and muscles) -Paresthesia (tingling) |
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What are the symptoms of hypermagnesemia in ESRD?
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Neuromuscular depression (weakness, loss of reflexes)
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What are the symptoms of dilutional hyponatremia (low plasma concentration of sodium) in ESRD?
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-Mental status changes (confusion)
-Seizures |
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What is end stage renal disease (stage 5 renal insufficiency)?
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ESRD is when the kidneys are no longer able to function at a level needed for homeostasis. Occurs when chronic kidney disease worsens to a kidney function of less than 10% of normal.
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What is the normal glomerular filtration rate for healthy kidneys?
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90 mL/min or greater
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Describe the symptoms of stage 1 renal insufficiency
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-High BP
-Increased creatinine or BUN -Blood or protein in the urine -Kidney damage with normal or high GFR |
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Describe the symptoms of stage 2 renal insufficiency
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-Mild decrease in GFR (60-89 mL/min)
-High BP -Increased creatinine or BUN -Blood or protein in the urine |
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Describe the symptoms of stage 3 renal insufficiency
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-Moderate decrease in GFR (30-59 mL/min)
-Early signs and symptoms of renal osteodystrophy -Anemia |
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Describe the symptoms of stage 4 renal insufficiency
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Severe decrease in GFR (15-29 mL/min)
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What is the glomerular filtration rate for patients at stage 5 renal insufficiency?
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GFR is less than 15 mL/min
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What are the treatments for stage 4 and 5 renal insufficiency?
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-Hemodialysis
-Peritoneal dialysis -Transplantation |
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What are the components of a hemodialysis machine?
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-Pump
-Dialyzer -Dialysate solutions/ reverse osmosis water |
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What does hemodialysis do?
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Hemodialysis mimics nephron for waste (urea) removal, fluid (water) removal, and removal of electrolytes for electrolyte balance. Uses ultrafiltration and diffusion techniques.
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What type of liquids are not ok for dialysis patients?
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-Hot chocolate packets
-Diet hot chocolate packets -Skim milk (not to drink) -1% milk (not to drink) |
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In hemodialysis, what two substances are restricted?
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Orange juice and potassium
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What is a phosphate binder?
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A Phosphate binder is a substance such as aluminum hydroxide, calcium acetate, or calcium carbonate that binds phosphate in the blood, removing it from circulation; used in treatment of hyperphosphatemia, such as in patients with end-stage renal disease or hypoparathyroidism.
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At what time is the binder Renvela/Renagel given?
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Before or during meals
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At what time is the binder Fosrenol given?
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Toward the end or immediately after meals
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At what time is the binder Phos Lo given?
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Right before meals
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At what time is the binder Tums given?
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5-10 minutes before meals
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Tums taken between meals act as what?
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Tums taken between meals act as a calcium supplement
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What are some side effects of dialysis?
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-Faintness
-Cramps (result of too much fluid being removed too quickly) -Nausea -Bleeding from access (could be caused by too much heparin during treatment or low platelet count) -Hypotension |
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What is the treatment for dialysis?
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Place patient in Trendelenburg and give normal saline
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What is a thrill?
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A thrill is the feeling blood creates as it travels through a well-functioning fistula or graft. Feels like a very strong, vibrating pulse.
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What causes hypotension during hemodialysis?
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-Removing too much fluid too fast. Removing fluid faster than the body can shift fluid back into the vascular system. Hypotension due to the low osmolality of blood; low sodium and albumin)
-Removing more fluid than the patient has to give |
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What medications should the nurse hold 6 hours before dialysis treatment?
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-Anti-hypertensives
-Diuretics -Multivitamins -Folic acid -Antibiotics -Lithium |
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Which medications can you give before dialysis?
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-Steroids
-Seizure meds -Anti-depressants, anti-anxiety -Anti-ulcer meds |
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How long does hemodialysis treatment last?
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3-4 hours per treatment
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What is the treatment schedule like for someone on hemodialysis?
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3 days per week
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What is peritoneal dialysis?
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PD uses dialysate and the membrane of the patient's abdominal cavity to clean wastes and extra fluid from the blood by osmosis and diffusion.
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Define osmosis
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Osmosis is the movement of fluid across a semipermeable membrane from a lower concentration of solutes to a higher concentration of solutes (for example, the movement of water toward an area with high sodium)
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Define diffusion
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Diffusion is the movement of solutes from an area of higher concentration to an area of lower concentration. (for example, tea leaves diffuse from the tea bag into the surrounding water)
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Define filtration
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Filtration is the trapping of particles inside a filter
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What are the two types of donor kidneys?
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-Living donor (any person that matches may choose to donate)
-Cadaveric (organs from a person being kept on life support/declared brain dead) |
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When is an arteriovenous graft used?
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-Used when unable to create a fistula in patient
-Used to bypass part of stenosed (constricted) fistula |
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What are some complications of an arteriovenous graft?
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-Extensive surgery
-Short lifespan of graft (<5 years) -Clotting -Infection |
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What is a fistula?
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Surgical connection between a patient's own artery and vein
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