Complex Exam #1
clinical manifestation of DI or SIADH? can't limit intake, constant thirst
DI
clinical manifestation of DI or SIADH? deficiency of ADH (vassopressin)
DI
clinical manifestation of DI or SIADH? high serum osmolality high serum sodium
DI
clinical manifestation of DI or SIADH? hypernatremia
DI
clinical manifestation of DI or SIADH? hypotension, tachycardia, weakness, S&S dehydration
DI
t/f: oversecretion of adrenocorticotropic hormone (ACTH) or the growth hormone results in Graves Disease
False Over secretion of ACTH or growth hormone results in Cushing disease. Graves' disease results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins
What is the fluid deprivation test for DI? what should you monitor for?
Fluids withheld for 8-12 hours or 3-5% of body weight lost Plasma and urine osmolality at beginning and end of test No increase in sg and osmolality of urine indicative of DI - Continue to secrete large volumes urine; low sg Monitor for tachycardia, hypotension
what hormones are secreted from the anterior pituitary?
GH ACTH TSH FSH and LH (ICSH) prolactin
nutritional needs AKI
High carbs to meet energy requirement Restrict total protein and only intake high-biological-value protein Low sodium Low potassium Low phosphorus
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."
"As the disease progresses, you will most likely require renal replacement therapy."
K+ range
3.5-5.2
normal adult bladder capacity is ----
400-500 ml
widely accepted criterion for AKI is what
50%+ increase in serum creatinine above baseline, with or without change in urine volume
BUN range
6-20
fast for how long before kidney biopsy
6-8hrs
glucose range
70-110
sudden interruption of kidney function resulting from obstruction, reduced circulation, or disease of the renal tissue
AKI (acute kidney injury)
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? The kidneys can improve over a period of months. Once on dialysis, the need will be permanent. Kidney function will improve with transplant. Acute renal failure tends to turn to end-stage failure.
The kidneys can improve over a period of months.
management of hypothyroidism
Thyroid hormone replacement therapy/Levothyroxine - Increases effect of Warfarin, can increase need for digoxin and insulin Meds that decrease absorption - Cimetidine, lansoprazole, sucralfate, colestipol Meds that can accelerate metabolism of levothyroxine - Phenytoin, carbamazepine, rifampin, sertraline, phenobarbital Geriatric Consideration - Cautious use with history of coronary artery disease. - Observe for angina and dysrhythmia
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35%
White blood cell (WBC) count of 20,000/mm3
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute renal failure Acute glomerulonephritis Chronic renal failure Nephrotic syndrome
acute glomerulonephritis
Adrenocortical insufficiency: ---- disease; damage or dysfunction of the adrenal cortex diminished production of mineralcorticoids and glucocorticoids
addison
more than 100,000 colonies/ml
bacteriuria
AKI etiology: prolonged renal ischemia nephrotoxic agents infectious processes
intrarenal
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?
oliguria
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? Initiation Oliguria Diuresis Recovery
oliguria
urine output <0.5 mL/kg/hr
oliguria
increased volume of urine voided
polyuria
where is ADH and oxytocin secreted from?
posterior pituitary
AKI etiology: urinary tract obstruction benign prostatic hypertrophy tumors
postrenal
AKI etiology: volume depletion impaired cardiac efficiency vasodilation
prerenal
position of patient for kidney biopsy
prone
which organ is associated with pain in the perineum and rectum
prostatic
clinical manifestations of AKI
pt may appear ill or lethargic and display CNS s/s such as drowsiness, headache, muscle twitching and seizures skin and mucous membranes may show signs of dehydration fluid overload may result with edema, SOB, and crackles noted on physical exam and with diagnostic films
how often for neuro status checks with hypohysectomy
q 1hr x 24 hr, then q4h
kidneys secrete erythropoietin to maintain --- concentration
rbc
Calcitonin inhibits mobilization of calcium from bone thereby ---- Ca levels
reducing
management of DI
replace ADH adequate fluids correct underlying causes
Which of the following is the most sensitive indicator of renal function? Serum creatinine Blood urea nitrogen (BUN) Creatinine clearance Potassium
serum creatinine
As glomerular filtration decreases, which of the following occurs? Select all that apply. Serum creatinine increases Blood urea nitrogen (BUN) increases Creatinine clearance decreases BUN decreases Serum creatinine decreases
serum creatinine and BUN increases, creatinine clearance decreases
laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? Serum creatinine of 1.5 mg/dL BUN of 20 mg/dLb Creatinine clearance of 90 mL/min Urinary protein level of 150 mg/24h.
serum creatinine of 1.5 mg/dL
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator? Blood pressure Urine protein Serum glucose pH and HCO3
serum glucose
GFR 15-29
severe decrease in GFR
sold cart
severity onset location duration characteristics aggravating/relieving factors treatment
what will a moderately distended bladder feel like?
smooth, firm, round mass in abdomen
what are some of the secondary causes of addison disease (adrenocortical insufficiency)?
steroid withdrawal, pituitary neoplasm, high dose radiation pituitary or brain
controls cellular metabolic activity
thyroid
how does TSH act on thyroid gland?
thyroid hormones
these hormones determine the rate of cellular metabolism
thyroid hormones
a noninvasive way to get an initial view of the GU system and can help identify fluid accumulations, masses, congenital abnormalities, and obstructions
ultrasound
which organ is associated with pain in the males: along penis to meatus; female: urethra to meatus
urethral
strong desire to void
urgency
provides information on kidney function and helps in the dx of other conditions
urinalysis (UA)
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Blood urea nitrogen (BUN) level of 22 mg/dl Serum creatinine level of 1.2 mg/dl Temperature of 100.2° F (37.8° C) Urine output of 250 ml/24 hours
urine output of 250 ml/24 hours
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Wear a mask while handling any dialysate solutions. Keep the catheter stabilized to the abdomen, below the belt line. Use an aseptic technique during the procedure. Clean the catheter insertion site daily with soap.
use an aseptic technique during the procedure
what does oxytocin act on?
uterus and breast
how does the RAAS system increase blood pressure
water and sodium retention increased circulating volume, increased renal perfusion
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? With food 2 hours before meals 2 hours after meals At bedtime with 8 ounces of fluid
with food
rbc in urine
hematuria
voiding more than every 3 hours
frequency
glomerular filtration rate formula = ?
(volume of urine x urine creatinine) / serum creatinine
SCr
0.6-1.3
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid 2,000 mL of fluid
1,500 mL of fluid
DI manifestations - dilute uringe with sg ______ -_____
1.001 - 1.005
1 kg weight gain = -- ml of fluid
1000
NA+ range
135-147
DI manifestations Polydipsia (__-__ liters of fluid daily) -cold water
2-20
diagnostics for cushing syndrome
2/3 of the following abnormal for dx: serum cortisol urine cortisol (24hr urine) dexamethasone suppression test ------------ electrolytes - Na, Glu, K, CBCd
CO2 range
22-30
DI manifestations - nephrons produce large volume of urine w/o action of ADH (> -- mL/hr)
250
Clinical manifestation of addison disease or cushing syndrome? glucose intolerance or diabetes develops with weight gain
cushing syndrome
--- evaluate for masses, stones, infections, trauma, metastasis, and soft tissue abnormalities. Can be used with contrast to enhance visualization.
CT scans, computed tomography
should you restrict fluids in DI?
Can't restrict fluids b/c of the continued high volume of urine loss would lead to hypernatremia and dehydration
Clinical manifestation of addison disease or cushing syndrome? purple striae, moon face, buffalo hump, delayed healing easy bruising, decreased immune function
cushing syndrome
manifestations of SIADH include: Hyponatremia (<---mmol/L) Low serum osmolality (< --- mOsm/kg) High urine osmolality (> --- mOsm) Nausea and vomiting (---) Lethargy, irritability, confusion, delirium Muscle weakness Seizures Coma
Hyponatremia (<128mmol/L) Low serum osmolality (< 280 mOsm/kg) High urine osmolality (> 100 mOsm) Nausea and vomiting (early) Lethargy, irritability, confusion, delirium Muscle weakness Seizures Coma
what are the diagnostics of SIADH?
Hyponatremia with corresponding hypo-serum osmolality Continued renal excretion of sodium Urine less than maximally dilute No clinical evidence of volume depletion No other causes of hyponatremia Correction of hyponatremia occurs with fluid restriction
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain
Hypovolemic shock caused by hemorrhage
Hypthalamus releases ----- who tells the pituitary gland to release ------ causing T4 to be released into circulation. TH acts on the thyroid gland, the hypothalamus and pituitary to further regulate function
Hypthalamus releasers TRH Thyrotropin Releasing Hormone who tells the pituitary gland to release TSH Thyroid stimulating Hormone causing T4 to be released into circulation. TH acts on the thyroid gland, the hypothalamus and pituitary to further regulate function
management of cushing syndrome
If pituitary mediated: - Surgical removal of tumor/pituitary gland - Radiation therapy Adrenal surgery - Rapid and definitive control of cortisol - Induces Adrenal insufficiency Medications: - Ketoconazole: Inhibits adrenal corticosteroid synthesis - Mifepristone: Controls comorbidities (glucose intolerance); DM mediated dx - Adrenal enzyme inhibitors: reduce hyperadrenalism Corticosteroid Use - Take as prescribed, tapering required to discontinue or reduce therapy - Alternate day therapy - Potential side effects and measures to reduce side effects
ways to assess for and maintain fluid balance
JVD assess for edema and obtain daily weights auscultate for crackles from pulmonary edema maintain hydration and replace fluids as needed
increased --- from AKI can lead to v-tach and cardiac arrest
K+
-- studies are used to delineate size, shape, and position of kidneys and to reveal urinary system abnormalities. Since they can be performed at the bedside, it is often one of the initial diagnostics for workup of a GU patient
KUB (kidney, ureter, and bladder)
A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? Lasix 80 mg IVP Normal saline bolus of 500 mL Chest x-ray Mannitol 12.5 g IVP
Lasix 80 mg IVP
What does prolactin stimulate?
Milk production for lactation.
describe 3 types of hypothyroidism
Primary (95-99%) - thyroid gland dysfunction - Autoimmune thyroiditis (Hashimoto thyroiditis) - Treatment for hyperthyroidism - Loss of thyroid gland Secondary - pituitary gland fails to stimulate thyroid gland Tertiary - failure of hypothalamus to produce TRH
management/actions of addisonian crisis
Restore circulation Insulin/Dextrose to reduce potassium Glucose for hypoglycemia NS infusion, Manage electrolyte imbalance Monitor closely Ulcer prophylaxis Hydrocortisone (Solu-Cortef) replacement therapy
Cannot excrete dilute urine, retain fluids and dilutional hyponatremia
SIADH
clinical manifestation of DI or SIADH? decreased urine output, concentrated high specific gravity high urine sodium
SIADH
clinical manifestation of DI or SIADH? dilute hyponatremia
SIADH
clinical manifestation of DI or SIADH? fluid restriction
SIADH
clinical manifestation of DI or SIADH? headache, muscle weakness, seizure and coma
SIADH
clinical manifestation of DI or SIADH? lethargy, irritability, confusion
SIADH
clinical manifestation of DI or SIADH? low serum osmolality low serum sodium
SIADH
clinical manifestation of DI or SIADH? oversecretion of ADH (vasopressin)
SIADH
clinical manifestation of DI or SIADH? water retention
SIADH
secreted in response to high plasma calcium level and increases calcium deposit in bone
calcitonin
A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client? Deficient fluid volume Risk for injury Activity intolerance Impaired physical mobility
deficient fluid volume
`Clinical manifestation of hypo- or hyperparathyroidism? bone decalcification, pathologic fractures, deformities
hyper
clinical manifestations of hyper- or hypoparathyroidism? hypercalcemia hypophosphatemia
hyper
The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed:
hyperacute rejection
DI restricting fluids ineffective because of potential --- and severe ----
hypernatremia and severe dehydration
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? Hypertension Extremity pain Fever Periorbital edema
hypertension
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? 1.5 L 1.0 L Less than 400 mL Less than 50 mL
less than 400 mL
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? Encouraging coughing and deep breathing Promoting carbohydrate intake Limiting fluid intake Providing pain-relief measures
limiting fluid intake
arterial blood gas from AKI will show ------
metabolic acidosis
what do the kidneys excrete
metabolic waste products foreign substances such as drugs excess fluid excess electrolytes
GFR 30-59
moderate decrease in GFR (stage 3)
what are the nursing considerations of SIADH?
monitor VS and serum sodium Monitor I & O frequent neuro checks
nursing considerations for hypothyroidism
monitor cardiovascular changes, weight, mental status/safety, respiratory status, dysrhythmias antiembolism stockings and elevation low calorie, high bulk diet encourage activity, cathartics, stool softeners extra clothing and blankets to maintain temp (NO ELECTRIC BLANKETS OR HEATING DEVICES) cautious use with medications due to decreased metabolism INCREASED risk of DVTs falls
s/s of addison disease (adrenocortical insufficiency)
muscle weakness, anorexia, n/v, fatigue, weight loss, dark pigmentation of skin and mucosa, dehydration, hypotension, hypoglycemia, hyponatremia, hyperkalemia, apathy, emotional labillity, confusion
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: no symptoms. fever. headache. polyuria.
no symptoms
awakening at night to urinate
nocturia
decrease in GFR due to what
non-functioning glomeruli
how is serum cortisol normally? how is it in cushing syndrome?
normally, serum cortisol is higher in the morning (6-8am) and lower in the evening (4-6pm)/ This variation is lost in Cushing Syndrome
Which of the following is the most accurate indicator of fluid loss or gain? Weight Urine output Caloric intake Body temperature
weight
urine output less than 50 ml a day
anuria
possible cause of leukocyte esterase and nitrite
associated with increase wbc and infection
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia
azotemia
kidneys secrete an active form of vitamin D for -- metabolism
calcium
Clinical manifestation of hypo- or hyperthyroidism? weight loss, increased appetite
hyper
GFR 60-89
kidney damage with mild decrease in GFR (stage 2)
GFR greater than or equal to 90
kidney damage with normal or increased GFR (stage 1)
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?
calcium deficit
What type of drug should be withheld before hemodialysis?
cardiac glycosides
Clinical manifestation of hypo- or hyperthyroidism? speeds everything up
hyper
GFR less than 15 or dialysis
kidney failure
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "Immunosuppressive drugs guarantee organ success." "The doctor may decide to delay the use of immunosuppressant drugs." "Let's wait until after the surgery to discuss your treatment plan."
"Even a perfect match does not guarantee organ success."
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? "I should limit foods high in potassium in my diet, such as bananas." "I should limit the amount of protein in my diet." "I should drink as much as possible to keep my kidneys working." "My intake of high sodium foods should be limited."
"I should drink as much as possible to keep my kidneys working."
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity."
"It is appropriate to warm the dialysate in a microwave."
A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? "Try washing clothes with a strong detergent to ensure that all impurities are gone." "When you shower, use really warm water and an antibacterial soap." "Keep your showers brief, patting your skin dry after showering." "Liberally apply alcohol to the areas of your skin where you itch the most."
"Keep your showers brief, patting your skin dry after showering."
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "This type of dialysis will provide more independence." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."
"This type of dialysis will provide more independence."
Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?
6
Cl range
95-106
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2
A GFR of 30-59 mL/min/1.73 m2
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of a loop diuretic Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])
Administration of sodium polystyrene sulfonate [Kayexalate])
kidneys secrete renin, which is used for -- regulation
BP
nitrogenous waste product of protein metabolism
BUN
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Increased serum levels of potassium, magnesium, and calcium Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. BUN of 18 mg/dL. Serum creatinine of 1.2 mg/dL. Glomerular filtration rate (GFR) of 100 mL/min.
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20
Patient education regarding a fistulae or graft includes which of the following? Select all that apply. Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing. Cleanse site b.i.d.
Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.
Clinical manifestation of hypo- or hyperthyroidism? tachycardia, palpitations
hyper
clinical manifestation of DI or SIADH? large volume of dilute colorless urine low urine osmolality low specific gravity (1.001-1.005) low urine sodium
DI
clinical manifestation of DI or SIADH? polydipsia
DI
Clinical manifestation of hypo- or hyperthyroidism? thin hair
hyper
what are the thyroid hormones
T3 - ATP production T4 - ATP production calcitonin - regulates calcium ion concentrations
what does the antidiuretic hormone (ADH, vassopressin) act on?
kidneys
clinical manifestation of DI or SIADH? dehydration can occur
DI
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? Decrease in the blood flow through the kidneys Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Structural damage occurred in the nephrons of the kidneys
Decrease in the blood flow through the kidneys
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.
Increase carbohydrates and limit protein intake.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? Increased serum creatinine level Decreased serum potassium level Increased red blood cell count Increased serum calcium level
Increased serum creatinine level
phases of AKI
Initiation - Initial insult to cause the AKI Oliguria - Increase in serum concentration of substances normally excreted by kidneys and decrease in urine output Diuresis - Gradual increase in urine output with stabilization of lab values. Uremic symptoms may still be present Recovery - Improvement of renal function over 3-12 months with lab values WNL and likely 1-3% decrease in GFR
contained in thyroid hormone and required to prodice T3 and T4
Iodine
transphenoidal appraoch thats typical of hypohysectomy
Monitor electrolytes (Na, K, Glu, Cl) and ECG as indicated Infection Control Monitor for Bleeding and CSF leak - Sweet tasting, clear or drainage with halo - Headache
nursing interventions of kidney biopsy
Monitor vital signs and s/s of bleeding and infection Pallor, dizziness, flank/back pain seen with internal bleeding Administer IVF to clear kidney and prevent clots Blood in urine may be seen initially Stay supine for at least for 6-8 hours after biopsy. Maintain bed rest and pressure dressing to control bleeding Administer analgesics as needed
hypohysectomy: numbness at surgical site and diminished smell __-__ months possible avoid bending at the --- floss and rinse 2 weeks, NO -----
Numbness at surgical site and diminished smell 3-4 months possible Avoid bending at the waist Floss and rinse 2 weeks, NO tooth brushing
nursing interventions with contrast
Obtain allergy history, specifically with iodine, shellfish, other seafood, and contrast Stop nephrotoxic medications (e.g. NSAIDS, metformin, vancomycin, etc.) Monitor kidney function Administer IVF and acetylcysteine Monitor for allergic reactions, U/O, and hydration status
What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Sorbitol IV dextrose 50% Calcium supplements
Sodium polystyrene sulfonate
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube
SpO2 at 90% with fine crackles in the lung bases
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
which is more potent and rapid-acting: T3 or T4?
T3
An expected outcome for the hemodialysis client is: The client identifies signs and symptoms of rejection. The client verbalizes the dwell time for the dialysate. The client demonstrates how to administer the dialysate by gravity. The client explains how to assess the venous access site.
The client explains how to assess the venous access site.
why should a person with hypothyroidism not have a heating blanket?
Vasodilation from heat along with decreased sensation an decreased alertness BURNS
TSH (thyroid stimulating hormone) released from where?
anterior pituitary controls to release TH (thyroid hormone)
assessment of cushing syndrome
activity level and ability to carry out self-care skin assessment changes in physical appearance and patient responses to these changes mental function emotional status medications
Clinical manifestation of addison disease or cushing syndrome? adrenocortical insufficiency
addison disease
Clinical manifestation of addison disease or cushing syndrome? apathy, lethargy, confusion
addison disease
Clinical manifestation of addison disease or cushing syndrome? dehydration, hyponatremia, hyperkalemia
addison disease
Clinical manifestation of addison disease or cushing syndrome? hyperpigmentation muscle weakness
addison disease
Clinical manifestation of addison disease or cushing syndrome? hypoglycemia
addison disease
Clinical manifestation of addison disease or cushing syndrome? hypotension due to cardiac insufficiency
addison disease
Clinical manifestation of addison disease or cushing syndrome?anorexia, N/V, weight loss
addison disease
gland that secretes glucocorticoids, mineralcorticoids, androgens, and estrogens
adrenal cortex
gland that functions as part of the autonomic nervous system catecholamines; epinephrine (90%) and norepinephrine
adrenal medulla
dx test of addison disease (adrenocortical insufficiency)?
adrenocortical hormone levels, ACTH (adrenocorticotropic hormone) levels, ACTH stimulation test early morning serum cortisol and plasma
how does ACTH affect the adrenal glands (adrenal cortex)?
adrenocorticosteroids
The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of hypokalemia. anemia. metabolic alkalosis. hypophosphatemia.
anemia
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have? Anemia from the decrease in maturation of red blood cells Decrease in blood sugar levels due to alteration in insulin levels Increase in blood sugar levels due to alteration in insulin levels Development of male sex characteristics
anemia from the decrease in maturation of RBCs
possible cause of proteinuria
benign finding (fever, exercise), DMII, HF, medications
--- of the kidney help to diagnose and evaluate extent of kidney disease, particularly unexplained AKI, persistent proteinuria/hematuria, transplant rejection and glomerulopathies.
biopsy
which organ is associated with pain in the suprapubic area
bladder
what does RAAS regulate
blood pressure
what do the kidneys regulate
body osmolarity and volume electrolytes acid-base balance blood pressure
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers
brief, hot daily showers
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? Check for thrill or bruit over the access site. Inspect the catheter insertion site for infection. Add the prescribed drug to the dialysate. Warm the solution to body temperature.
check for thrill or bruit over the access site
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. Citrus fruits White rice Salad oils Butter
citrus fruits
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hyperalbuminemia Peripheral neuropathy Cola-colored urine Hypotension
cola-colored urine
no vasopressin = no ---- of urine
concentration
causes of cushing syndrome
corticosteriud medications (most common) excessive adrenocortical activity - pituitary tumor causing unneeded release of ACTH (adrenocorticotropic hormone) -hyperplasia of adrenal glands w/o tumor overproduction of adrenocortical hormone - growth retardation, obesity, musculoskeletal changes, glucose intolerance excessive protein vatabolism -muscle wasting and osteoporosis increased mineralcorticoid activity - retention of sodium and water - htn and heart failure classic moon face hyperglycemia or diabetes w/ weight gain and delayed healing
waste product of muscle energy metabolism
creatinine
helps in determining microorganisms and appropriate antimicrobial therapy.
culture and sensitivity
Clinical manifestation of addison disease or cushing syndrome? excessive adrenocortical activity
cushing syndrome
Clinical manifestation of addison disease or cushing syndrome? mood swings, psychosis
cushing syndrome
Clinical manifestation of addison disease or cushing syndrome? retention of sodium and water
cushing syndrome
Clinical manifestation of addison disease or cushing syndrome? truncal obesity, weight gain, Gi disturbances
cushing syndrome
Clinical manifestation of addison disease or cushing syndrome?hypertension due to cardiac hypertrophy, heart failure
cushing syndrome
Clinical manifestation of addison disease or cushing syndrome?muscle wasting and osteoporosis
cushing syndrome
Excessive adrenocortical activity
cushing syndrome
fatty buffalo hump, central obesity, thin extremities
cushing syndrome
muscular weakness/fatigue buffalo hump hyperglycemia acne ecchymosis thin/fragile skin
cushing syndrome
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? Dehydration Hypokalemia Oliguria Renal calculi
dehydration
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hyperkalemia Crackles Hypertension
dehydration
possible cause of casts
dehydration, fever, heart failure, many kidney diseases
Deficiency of ADH (vasopressin) - polydipsia - large volume dilute urine
diabetes insipidus
possible cause of glucose
diabetes, pregnancy, kidney pathology
potential nursing dx of addisonian crisis
disturbed body image self care deficit r/t weakness, fatigue, muscle wasting, altered sleep patterns risk for injury r/t weakness risk for fluid volume deficit activity intolerance and fatigue risk for infection knowledge deficit
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? Donors are selected from compatible living donors. Donors must be relatives. Donors with hypertension may qualify. The client is placed on a transplant list at the local hospital.
donors are selected from compatible living donors
painful or difficulty urinating
dysuria
Clinical manifestation of hypo- or hyperthyroidism? warm skin, sweaty palms, flushed face
hyper
management of SIADH?
eliminate underlying causes fluid restriction loop diuretics with saline infusion 3% saline to correct hyponatremia if severe symptoms - correct the deficit at a rate that does not cause neurologic symptoms - raise serum sodium by 0.5-1 mEq/hr vasopressin-2 antagonist
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? Administer isotonic fluid therapy as ordered. Keep the drainage catheter below the level of insertion. Encourage use of incentive spirometer every 2 hours. Monitor temperature every 4 hours.
encourage use of incentive spirometer every 2 hours
involuntary urinating during sleep
enuresis
what do the kidney and urinary systems secrete
erythropoietin for rbc production 1, 25 - dihydrocycholecalciferol renin prostaglandin
what systems are affected by the endocrine system?
every single system
hallmark clinical signs of hypothyroidism
fatigue, lethargy slow thought process/speech cold intolerance weight gain bradycardia, hypotension, dysrhythmias hoarse speech decreased libido
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Diuresis Fever Absence of pain Weight loss
fever
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? Fluid volume excess Urinary retention Activity intolerance Disturbed body image
fluid volume excess
how do you give a decadron suppression test
give the decadron late in the evening or bedtime and obtain plasma cortisol level in the morning. If it is Cushing Syndrome, suppression is absent
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Ureteral calculus Dysrhythmia
glomerulonephritis
should you take medications that treat hyperthyroidism with or without food
has to be taken on an empty stomach
what are some causes of DI?
head trauma brain tumor surgical ablation or irradiation of pituitary CNS infections
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? Hemodialysis Peritoneal dialysis Continuous arteriovenous hemofiltration (CAVH) Continuous venovenous hemofiltration (CVVH)
hemodialysis
delay or difficulty in initiating void
hesitancy
diet for addison crisis
high sodium, low potassium
during kidney biopsy, patient should --- when needle is inserted
hold breath
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?
hold meds until after dialysis
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? Performing the test without contrast Administering Garamycin (gentamicin) prophylactically Hydrating with saline intravenously before the test Administering sodium bicarbonate after the procedure
hydrating with saline intravenously before the test
possible cause of altered specific gravity
hydration status
Clinical manifestation of hypo- or hyperparathyroidism? N/V, constipation
hyper
Clinical manifestation of hypo- or hyperparathyroidism? fatigue, apathy
hyper
Clinical manifestation of hypo- or hyperparathyroidism? htn, cardiac dysthmias
hyper
Clinical manifestation of hypo- or hyperparathyroidism? irritability, neurosis, psychoses
hyper
Clinical manifestation of hypo- or hyperparathyroidism? muscle weakness
hyper
Clinical manifestation of hypo- or hyperparathyroidism? renal calculi
hyper
Clinical manifestation of hypo- or hyperparathyroidism? skeletal pain or tenderness
hyper
Clinical manifestation of hypo- or hyperthyroidism? diarrhea
hyper
Clinical manifestation of hypo- or hyperthyroidism? exophthalmos
hyper
Clinical manifestation of hypo- or hyperthyroidism? heat intolerance
hyper
Clinical manifestation of hypo- or hyperthyroidism? hyperreflexia, tremors, hyperkinesia
hyper
Clinical manifestation of hypo- or hyperthyroidism? increased libido initially, overtime decreased
hyper
Clinical manifestation of hypo- or hyperthyroidism? nervousness, hyperactivity, anxiety, irritability, decreased attn span, mood swings, insomnia
hyper
Clinical manifestation of hypo- or hyperthyroidism? normal or enlarged thyroid firm nodules, possibly tender
hyper
Clinical manifestation of hypo- or hyperthyroidism? pretibial myxedema
hyper
A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would be expected? Select all that apply. hypertension pain from retroperitoneal bleeding normal urinalysis no renal stones
hypertension pain from retroperitoneal bleeding
Clinical manifestation of hypo- or hyperparathyroidism? ECG changes
hypo
Clinical manifestation of hypo- or hyperparathyroidism? anxiety or depression
hypo
Clinical manifestation of hypo- or hyperparathyroidism? broncho/laryngospasms
hypo
Clinical manifestation of hypo- or hyperparathyroidism? chvostek and trousseau sign
hypo
Clinical manifestation of hypo- or hyperparathyroidism? hypocalcemia hyperphosphatemia
hypo
Clinical manifestation of hypo- or hyperparathyroidism? neuromuscular irritability, stiffness of hands and feet
hypo
Clinical manifestation of hypo- or hyperparathyroidism? numbness or tingling in extremities, cramps
hypo
Clinical manifestation of hypo- or hyperparathyroidism? painful menstruation
hypo
Clinical manifestation of hypo- or hyperparathyroidism? tetany
hypo
Clinical manifestation of hypo- or hyperthyroidism? bradycardia, hypotension, dysrhythmias
hypo
Clinical manifestation of hypo- or hyperthyroidism? cold intolerance, low temperature
hypo
Clinical manifestation of hypo- or hyperthyroidism? comm dx: hashimoto thyroiditis
hypo
Clinical manifestation of hypo- or hyperthyroidism? common dx: Graves Disease
hypo
Clinical manifestation of hypo- or hyperthyroidism? constipation
hypo
Clinical manifestation of hypo- or hyperthyroidism? decreased bone density (osteoporosis)
hypo
Clinical manifestation of hypo- or hyperthyroidism? decreased libido
hypo
Clinical manifestation of hypo- or hyperthyroidism? fatigue, irritability, lethargy, depression, apathy, slows thought process/speech
hypo
Clinical manifestation of hypo- or hyperthyroidism? loss of hair/brittle coarse hair, thick fingernails
hypo
Clinical manifestation of hypo- or hyperthyroidism? muscle and joint pain
hypo
Clinical manifestation of hypo- or hyperthyroidism? normal, enlarged, or small thyroid soft bruit
hypo
Clinical manifestation of hypo- or hyperthyroidism? pale, dry flakey skin, brittle nails
hypo
Clinical manifestation of hypo- or hyperthyroidism? periorbital edema/puffy face
hypo
Clinical manifestation of hypo- or hyperthyroidism? slows everything down
hypo
Clinical manifestation of hypo- or hyperthyroidism? weight gain
hypo
hypo/per calcemia and hypo/per phosphatemia can result from AKI
hypocalcemia and hyperphosphatemia
removal of the pituitary gland
hypohysectomy
symptoms of addisonian crisis
hypotension, cyanosis, fever, n/v, shock, pallor, abd pain, diarrhea can lead to circulatory collapse, shock, or death can occur
TRH (throtropin releasing hormone) is released from where?
hypothalamus
inadequate circulating thyroid hormones decreased basal metabolic rate mimics aging process -women ages 30-60 more likely frequently undiagnosed
hypothyroidism
Acute dialysis is indicated during which situation? Dehydration Impending pulmonary edema Metabolic alkalosis Hypokalemia
impending pulmonary edema
involuntary loss of urine
incontinence
why should you start with a very low dose and advance slowly over 1-2 months with hypothyroidism?
increase thyroid increase metabolism and oxygen demand
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? "Be sure to eat meat at every meal." "Eat plenty of bananas." "Increase your carbohydrate intake." "Drink plenty of fluids, and use a salt substitute."
increase your carb intake
What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium
increased BUN
what is a characteristic of the intrarenal category of acute renal failure?
increased BUN
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? Increased serum creatinine level Decreased serum potassium level Increased red blood cell count Increased serum calcium level
increased serum creatinine level
possible cause of 3+ RBC (hematuria)
infection, stones, neoplasm
renal parenchyma divided into 2 main parts: the outer cortex and the
inner medulla
physical examination of thyroid gland
inspection (anterior or posterior) gentle palpation - size, shape, consistency, symmetry, tenderness auscultation for bruit
kidneys secrete prostaglandin for --- perfusion
kidney
which organ is associated with costovertebral angle location pain, may extend to umbilicus
kidney
assessment for addison disease (adrenocortical insufficiency)
note any illness or stressors that may precipitate problems fluid and electrolyte status vs and orthostatic bp note s/s r/t adrenocortical insufficiency such as: weight changes, muscle weakness, fatigue monitor for s/s of addisonian crisis (acute adrenal insufficiency)
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Acute tubular necrosis Restored glomerular function
oliguria
what do the nephrons regulate
osmolarity, electrolytes, and acid-base balance
how does FSH and LH work on the ovary and corpus luteum
ovary - estrogen corpus luteum - progesterone
When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? Penicillin Gentamicin Tobramycin Neomycin
penicillin
Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Stroke Seizure
peripheral neuropathy
what are some of the primary causes of addison disease (adrenocortical insufficiency)?
primary: autoimmune or idiopathic atrophy of glands; adrenalectomy, cancer, radiation abdomen, tuberculosis, histoplasmosis
what protects the kidneys
protected externally by bone (ribs) and by muscles of the abdomen and back
protein in urine
proteinuria
what is the hallmark of the dx of nephrotic syndrome?
proteinuria
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis
recent history of streptococcal infection
3 main fxns of kidneys and urinary system
regulation, excretion, secretion
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? Acute pyelonephritis Osmotic dieresis. Dysrhythmias Renal calculi
renal calculi
where is the specimen obtained from in a kidney biopsy
renal cortex
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium usually found in fresh fruits and vegetables. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.
restricting sources of potassium usually found in fresh fruits and vegetables
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Impaired urinary elimination Toileting self-care deficit Risk for infection Activity intolerance
risk for infection
potential nursing dx for cushing syndrome
risk for injury risk for infection self-care deficit impaired skin integrity disturbed body image disturbed thought processes
Which of the following would a nurse classify as a prerenal cause of acute renal failure? Polycystic disease Ureteral stricture Prostatic hypertrophy Septic shock
septic shock
Excessive ADH (vasopressin) secretion from Pituitary - Water retention - Hyponatremia (dilutional) Causes - CNS disorders (head injury, brain tumors or infection) - Stimulate production of ADH in pituitary - Medications
syndrome of inappropriate antidiuretic hormone (SIADH)
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Shortened QRS complex Multiple spiked P waves Prolonged ST segment
tall, peaked T waves
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? Hypotension Weight loss Polyuria Tenderness over transplant site
tenderness over transplant site
how does FSH and LH act on the testes?
testosterone
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? Notify the health care provider. Turn the client from side to side. Lower the head of the bed. Push the catheter further into the abdomen.
turn the client from side to side
which organ is associated with pain in the cosovertebral angle, flank, lower abdominal area, testis or labium
ureteral
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Serum potassium level of 4.9 mEq/L Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C) Urine output of 20 ml/hour
urine output of 20 ml/hr
