Unit 3 Fluid imbalance

ESRD ARF Dialysis CRF

-end of stage of renal failure -acute renal failure -artificially removing waste -chronic renal failure

chronic renal failure (CRF)-renal insufficiency s/s 7

-headaches -decrease inability to concentrate urine -polyuria to oliguria -edema -GFR progressively decrease 90 to 30 -mild anemia -increase BP

expected findings of acute kidney injury 5

-hypertension, fluid overload -crackles -scant to normal or excessive urine output -lethargy -dry skin

A nurse is reviewing client laboratory data which of the following findings expected for a client who is in stage 4 for chronic kidney disease A blood urea nitrogen 15 mg/dL B glomeular filitration rate GFR 20 mL/min C blood creatine 1.1 mg/dL D blood potassium 5.0 mEq/L

B glomeular filitration rate GFR 20 mL/min-

A nurse is collecting data from client who has pre-renal AKI which of the following findings should the nurse expect select all that apply A reduce BUN B elevated cardiac enzymes C reduce urine output D elevated blood creatine E elevated blood calcium

C reduce urine output - D elevated blood creatine-

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 Magnesium Phosphorus Sodium

Calcium

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 or deceased 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 or deceased donors.

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

- Which is considered nursing consideration with hemodialysis?

Hold blood pressure medication, palpate for a thrill in the fistula

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. 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 Keep the dialysis supplies in a clean area, away from children and pets Clean the catheter insertion site daily with soap

Keep the dialysis supplies in a clean area, away from children and pets

Which of the following is most commonly seen when the peritoneal dialysis solution is drained?

Loss of Protein

The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder? Nephritic syndrome Acute glomerulonephritis Nephrotic syndrome Polycystic kidney disease (PKD)

Polycystic kidney disease (PKD)

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

A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? The dialysis was performed too rapidly. The patient is having an allergic reaction to the dialysate. The patient is experiencing a cerebral fluid shift. Too much fluid was pulled off during dialysis.

The patient is experiencing a cerebral fluid shift.

- Which statement made needs further teaching by the nurse about acute kidney injury?

The patient will need to plan their life around future dialysis appointments-We want to reverse this to prevent it to progress into stages

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 clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Uremia Metabolic alkalosis Polycythemia

Uremia-raised level in the blood of urea and other nitrogenous waste compounds

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.

peritonitis

allow micro organism into the peritoneum -need surgical asepsis during procedure

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.

When CAPD is performed 3

approximately 2000 mL of dialysate is instilled by gravity through the catheter in 30 to 40 minutes. The catheter is clamped, and the solution may dwell for 4 to 10 hours. The process is repeated three to five times a day on a continuous basis.

Why is kidney disease related fluid balance

fluid volume is altered when the kidney lose the ability to excrete

kidney failure

increase BUN and creatine

Acute kidney injury

is the sudden cessation of kidney function that occurs when blood flow to the kidney significantly comprised

· _______ refers to a condition of stones in the urinary tract.

· Urolithiasis

Fluid volume excess: 4

- : increase BP, wt gain, edema, and electrolyte imbalance

AKI CKD

- AKI: treat cause, 4 stages: onset, oliguric, diuretic, and recovery - CKD: stages, kidney transplant, dialysis (hemo and peritoneal)

A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose? 0.5 kg/day 1.0 kg/day 1.5 kg/day 2.0 kg/day

0.5 kg/day

How to compare pre procedure and post procedure weight

1 L fluid equals 1 kg

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 carbohydrate intake."

Health promotion and disease prevention in acute kidney injury 5

-drink at least 2 L daily -maintain a healthy weight -use NSAIDS -control diabetes and hypertension -take all antibiotics prescribed for infections

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.

4000 1 kg---1L

A nurse is contributing to the plan of care for a client who has chronic kidney disease which of the following action should the nurse recommend to include in the plan of care select all that apply A Monitor for pulmonary edema B provide frequent mouth rinses C restrict fluids based on urinary output D provide a high sodium diet E Monitor for weight gain trends

A Monitor for pulmonary edema- B provide frequent mouth rinses- C restrict fluids based on urinary output- E Monitor for weight gain trends-

Acute dialysis is indicated during which situation? Dehydration Impending pulmonary edema Metabolic alkalosis Hypokalemia

Impending pulmonary edema

Renal failure

Inability of the nephrons of the kidneys to maintain fluid, electrolyte, acid base balance, excrete waste. 2 Types 1. Chronic 2. Acute

Nursing Interventions to fluid volume excess: 5

monitor daily weight, fluid restrictions, dietary considerations, administer diuretics, antihypertensives, and monitor lab values

Pre-renal 55-60% 6

n Any condition that reduces blood flow to the kidneys ( upstream ) n Cardiac failure n Decreased cardiac output n Hypovolemia n Burns, dehydration, trauma, shock, diuretic overuse n Peripheral vasodilation n Antihypertensive medications n Renal artery stenosis or embolism

postrenal

occurs as a result of bilateral obstruction of structures leaving the kidney

Systematic complications of chronic kidney disease 4

-congestive heat failure -pulmonary edema / SOB - dry skin -lethargy -muscle cramps -impaired immune function

What are phosphorous foods 6

-milk products -beef -liver -choclate -nuts -legumes

During the peritoneal dialysis 4

-monitor blood glucose level(dialysate solution is hypertonic contains glucose) -monitor color (clear and light yellow) -monitor infection (fever, cloudy or frothy) -keep the outflow bag lower than the client's abdomen (drain by gravity)

prerenal intrarenal

- decrease blood flow to the kidney -damage inside renal

Common symptoms of kidney disease: 4

- wt gain, hypertension, decreased in urine output, increase toxins in the blood, and decrease in RBC

Risk factors to CKD 5

-DM -chronic glomephritis -nephrotoxic medication -HTN -autoimmune disease(lupus)

Sodium polysterone Epoetin alfa cyproheptadine (Periactin)

-Kaylexone: increases elimination of potassium; Restrict sodium can cause fluid retention and HTN -stimulate production RBC; given for anemia -can have iron to stimulate but do not need vit C -relieve allergy symptoms such as watery eyes, runny nose, itching eyes/nose, sneezing, hives, and itching. It works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction.

interventions before hemodialysis 5

-The nurse assesses and records vital signs before and after hemodialysis as well as weighing the client and obtaining blood for laboratory testing. To prepare for vascular access, the nurse · Inspects the skin over the fistula or graft for signs of infection. · Palpates for a thrill (vibration) over the vascular access or listens for a bruit, a loud sound caused by turbulent blood flow. If absent, the nurse postpones further use and reports findings. · Notes the color of skin and nailbeds and mobility of fingers. · Washes the skin over the fistula or graft with soap and water or antiseptic. · Avoids puncturing the same site that was used previously.

Different types of phosphorous and potassium

-animal protein like: cheese, yogurt, milk, and chicken) -need protein for anemia but too much can raise phosphorous san not have a lot of protein -Ex: citrus foods, grapes, rasins, and tomatoes

Peritoneal dialysis treats clients requiring dialysis who4

-are unable tolerate anticoagulation -difficulty with vascular access -have chronic infections or are unstable -have chronic diseases (DM, heart failure, and severe hypertension

A nurse is planning care for a client who has ESKD which of the following should the nurse include in the plan of care select all that apply A Monitor the clients weight daily B encourage the client to comply with fluid restrictions C evaluate intake and output D instruct the client on restricting calories from carbohydrates E Monitor for constipation

A Monitor the clients weight daily- B encourage the client to comply with fluid restrictions- C evaluate intake and output- E Monitor for constipation

The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? Assessment of the quantity of the client's urine output Assessment of the client's incision Assessment of the client's abdominal girth Assessment for flank or abdominal pain

Assessment of the quantity of the client's urine output

A nurse is contributing to the plan of care for a client who has prerenal acute kidney injury following abnormal aortic aneurysm repair urinary output is 60 mL in the past two hours and blood pressure is 92/58MMHG the nurse should recommend which of the following interventions A prepare the client for a CT with contrast dye B administer ketorolac for pain C administer fluid challenge D Position the client in Trendelenburg

C administer fluid challenge

Nurses teaching on diet restrictions to a client has acute kidney injury and who's on hemodialysis which of the following recommendations should the nurse include in the teaching A Limit calcium intake to 2500 mg a day B decrease total fat intake to 45% of daily calories C decrease potassium intake to 60 to 70 mEq/kg D Limit sodium intake to 4.5 g a day

C decrease potassium intake to 60 to 70 mEq/kg-

A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. Penicillin Gentamycin Tobramycin Neomycin Ceftriaxone

Gentamycin Tobramycin Neomycin

The nurse is caring for a client whose acute kidney injury has prerenal cause. What most likely caused this client's health problem? Heart failure Glomerulonephritis Ureterolithiasis Aminoglycoside toxicity

Heart failure

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

- The pt intake and output for the day 18 oz of fluid and 60oz of fluid and solute removal during dialysis. How many mL of fluid is the pt positive or negative for the day?

Negative 1260 mL: the amount of dialysis is negative pulling off the fluid which makes the amount negative

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? Initiation Oliguria Diuresis Recovery

Oliguria

· ______ is an acute or chronic bacterial infection of the kidney and the lining of the collecting system.

Pyelonephritis

Hemodialysis advantage 4 disadvantage 4

Rapid removal of solutes and water Takes less time No risk for peritonitis Personnel perform procedure in a dialysis center Bulge from fistula or graft is obvious Risk for vascular complications, infection, distal ischemia, carpal tunnel syndrome, hypotension, and disequilibrium Strict fluid and dietary restrictions Lifestyle revolves around dialysis appointments Home hemodialysis requires space for the machine and training to use it

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

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? Only when needed Daily at bedtime First thing in the morning With each meal

With each meal

what is urea

is a waste product of protein metabolism, and urea levels rise with kidney disease

Glomerular filtration rate 3 BUN3 Creatinine 3

n Glomerular Filtration Rate (GFR) (>100) n Used to test kidney function n Estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood. n BUN: Blood Urea Nitrogen ( 7-18 mg/dL ) n Reflects excretion of " UREA " n Urea is an end product of protein metabolism n Is affected by volume status & protein intake n Rises when GFR decreases below 40-60% n Creatinine: ( 0.6-1.3 mg/ dL ) n Product of muscle metabolism n Not affected by fluid status or diet

Post renal <5% 5

n Results from obstructed outflow n Urolithiasis n Bladder obstruction n Infection, tumor, obstructed Foley catheter (FC) n Ureteral obstruction n Blood clots, calculi, accidental ligation, edema n Urethral obstruction n Prostatic hyperplasia or tumor n Strictures of the urethra -spinal cord injury

Acute renal failure 2 cause 4 how are they classified

n Sudden interruption of renal function n Kidneys are unable to clear fluids & nitrogen waste products n Caused by: obstruction, poor circulation, kidney disease or medications n Classified as: n Prerenal- 55-60% (Heart failure, Hypovolemia) n Intrarenal-35-40% (filtering structures damaged) n Postrenal-< 5% (obstructed outflow)

The nurse teaches the client undergoing hemodialysis the following: 4

· Avoid carrying heavy items in the arm with the fistula or graft. · Wear clothing with loose sleeves or made of fabrics that will not obstruct blood flow. · Do not sleep on the vascular access arm. · Do not permit venipunctures, injections, or BP in the arm with the vascular access.

Classifications for AKI are referred to as the RIFLE criteria, and include

· Risk of renal dysfunction · Injury to the kidney · Failure of kidney function · Loss of kidney function · End-stage kidney disease

arteriovenous fistula distal and proximal venipuncture

· is a surgical anastomosis (connection) of an artery and vein lying in close proximity. The vessels usually joined are the cephalic vein and the radial artery . · They require from 1 to 4 months to mature, however, before being used. · at the time of dialysis, two venipunctures are performed at either end of the fistula. -The distal venipuncture (referred to as the arterial needle because it takes the blood away) is used to remove blood that is transported to the machine. -The proximal needle puncture (referred to as the venous needle) is used to return the dialyzed blood.

Dialysis is a

· procedure for cleaning and filtering the blood. It substitutes for kidney function when the kidneys cannot remove the nitrogenous waste products and maintain adequate fluid, electrolyte, and acid-base balances.

Healthy kidney 3 vs unhealthy kidney3

-sodium and water removal -waste removal -hormone production -fluid overlaod -elevated waste urea, creatine, potassium -change in hormones like: calcium, making of RBC, and BP

- onset phase 3 -oliguric phase 2 -Diuresis phase 2 -recovery phase 3

-It is accompanied by reduced blood flow to the nephrons to the point of acute tubular necrosis. -Uritation is also other term -1/2 mL per kg wt per hour -is associated with the excretion of less-than-adequate (below 400 mL) urinary volumes. This phase begins within 48 hours after the initial cellular insult and may last for 10 to 14 days or longer. -acute kidney injury begin dialysis -begins as the nephrons recover. Despite an increased water content of urine, the excretion of wastes and electrolytes continues to be impaired. The BUN, creatinine, potassium, and phosphate levels remain elevated in the blood. -increase 400 mL excrete more water and increase BUN depletes electrolyte -It may take 3 to 12 months or longer for recovery while normal glomerular filtration and tubular function are restored. -also known convelscent -decrease edema return GFR(70-80% normal but takes several months to a year)

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

- Which of the following statement true about the function of the kidney?

Kidneys secrete Renin in response to low blood pressure

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

Phases of acute kidney injury

Onset: begins with the onset of the event, ends when oliguria develops, last for hours to days Oliguria: begins with the kidney insult; urine output is 100 to 400 mL/24 herewith or without diuretics and lasts for 1 to 3 weeks diuresis: begins when the kidney starts to recover; diuresis of a large amount of fluid occurs, 1000 mL yo 2000 mL per day; and can last for 2 to 6 weeks. Death can result from dehydration and imbalances in serum sodium or potassium levels recovery: continues until kidney function is fully restored and can't take up to 12 months

peritoneal advantage 3 disadvantage 4

Simple to perform Facilitates independence Easier access No anticoagulation Fewer problems with hypotension or disequilibrium Less rigid dietary and fluid restrictions More flexibility in lifestyle and activities More time-consuming Weight gain from glucose in the dialysate Peritonitis is a potential complication Requires training and motivation

Accumulation of nitrogen waste products in the blood, as evidenced by elevated BUN, serum creatinine, and uric acid levels, is known as _

azotemia

Hemodialysis potential diagnoses 4 what to avoid

shunts blood from the body through a dialyzer and back into circulation.This requires vascular access. -renal insuffiency -acute kidney injury -chronic kidney disease -medication or illict drug toxicty -measuring BP, adm injections, performing venipunctures, or inserting IV catheters in the access arm

ESKD or stage 5 CKD what is the diet 2

-occurs when the GFR is less than 15 mL/min and blood creatine levels steadily rises -low protein, phosphorous, potassium, dodium, and fluid restricted -vitamin D defiency happens when kidneys unable to convert to Vit D may have to be on a calcium supplement

Nursing care CKD 4

-restrict dietary sodium, potassium, phosphorous, and magnesium -provide diet that high in carbohydrates and moderate in fat -restrict intake of fluids (based on urinary output) -monitor for weight gains

CKD dietary interventions 5

-restrict sodium to maintain BP -restrict potassium intake to prevent hyperkalemia -daily protein intake 0.8-1.0 depending on weight -limit dairy to 1/2 cup a day -limit phosphorous foods

functions of the kidney 6

n Excrete excess water n Excrete waste products of protein metabolism n Help to maintain acid base balance n Help to maintain electrolyte balance n Produce renin (enzyme) -regulates BP n Produces erythropoietin (stimulates RBC production)

Intrarenal 35-40% 4 acute glomerularnephritis:

n Filtering structures of the kidneys are damaged n Usually from " acute tubular necrosis " n Ischemic damage to tubular cells (stoma or abscess) n Nephrotoxic substances n Gentamycin, NSAID (ibuprophen), Lead, Analgesics (Tylenol), Diuretics -trauma -hypoxic injryexpecte n Acute glomerularnephritis: inflammation of the nephrons; strep not taking all the antibiotics

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.

Intrarenal

occurs as a result of direct damage to the kid new from lack of oxygen, indicating damage to the glomeruli, nephrons, or tubules

Automated-

peritoneal dialysis APD uses a cycler, which is a machine that automatically delivers dialysate and then drains the peritoneum via a dialysis catheter three to five times during the night while the client sleeps, over a 10- to 12-hour period.

Tumors of the kidney are almost always cancerous. Renal cell carcinoma is the most common type of kidney cancer in adults. The cause of kidney tumors is unknown; however, certain risk factors are known. What are the known risk factors? Select all that apply. tobacco use obesity age alcohol use

tobacco use obesity age

Peritoneal dialysis uses the peritoneum 2

·-semipermeable membrane lining the abdomen, to filter fluid, wastes, and chemicals . -The dialysate is similar in composition to normal plasma but made hypertonic by dextrose

Risks of having hemodialysis 3

-Disequilibrium syndrome: results from too rapid a decrease of BUN and circulating fluid volume. It can result in cerebral edema and increased intracranial pressure. -hypotension: antihypertensive therapy and rapid fluid depletion during dialysis -Anemia: Blood loss and removal of folate during dialysis can contribute to the anemia; administer erythropoietin to the stimulate the production of RBC

Values in renal failure 4

-calcium decreased in renal failure (8.8-10) -magnesium decreased in renal failure (1.3-2.1) -potassium increased in renal failure(3.5-5.0) -sodium increased renal failure(135-145)

Before dialysis

-check wt, BP -feel graft -no meds before dialysis (some meds do not dialyze) -take insulin -discourage large meals before dialysis

renal failure retention interventions 5

-chew gum help with dry mouth; mouth care spit not swallow -variety liquid measured different intervals -no water pitcher -avoid spicy and salty foods -daily wt, BP, and being fall precautions

Acute kidney injury (AKI) (formerly called acute renal failure [ARF])

is characterized by a sudden and rapid decrease in renal function. AKI potentially is reversible with early, aggressive treatment of its contributing etiology.

Chronic kidney disease (CKD) or chronic renal failure (CRF)

is characterized by progressive and irreversible damage to the nephrons. It may take months to years for CKD to develop.

glomeular filtration

kidney working normal rate look high intense air filter anything push through kidney microscopic filtering then gradually letting things slide through -this numeric value able to filter and quality

Calcium and magnesium in renal damage

-goes down cause tetany and cardiac dysthymia and can cause a MI

Peritoneal dialysis continous cycle peritoneal dialysis (CCPD) automated peritoneal dialysis (APD)

-involves instillation of hypertonic dialsyate solution into the peritoneal cavity and subsequent dwell times -is a 24 hour dialysis. The exchange happens at night while sleeping. The final exchange is left in to dwell during the day -is regulated by automated machinery in ambulatory settings or the clients home at night

CKD: Chronic kidney disease 3

-is a progressive, irreversible kidney disease. -can be free of manifestations except during periods of stress (infection, surgery, and trauma) -older adults have higher risk for dehydration leading to chronic kidney disease

chronic renal s/s 6

-itchy skin (puritis) -HTN -edema -fluid volume overload -crackles -vein distension

Chronic kidney disease (1-4) therapeutic interventions 2

-control blood glucose and hypertension -help preserve remaining kidney function by limiting the intake of protein which result in a decreased in phosphorous levels (high levels of phosphorous contribute calcium and phosphorous deposits in the kidneys)

Albumin

-fluid inside blood vessels; decrease in renal failure fluid leaks out into interstitial spaces permeability increase

dialysate

-fluid pull product out of the blood (sodium, potassium, urea) concentration across membranes

Nutrition in acute kidney injury 3

-implement potassium, phosphate, sodium and magnesium restrictions -restrict fluid intake -high protein diet to replace the high rate of protein breakdown due to stress from illness

Poor dialysate inflow or outflow3 interventions

-obstruction or twisting of the tubing -constipation -client positioning -change the position; lie supine with head slightly elevated during CCPD and APD treatment

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? 0.5 lb 1.0 lb 1.5 lb 2 lb

1.0 lb

Functions of dialysis 4

-rids the body excess fluid and electrolytes -achieves acid and base balance -eliminate waste products -restores internal homeostasis by osmosis, diffusion, and ultrafiltration

During hemodialysis, toxins and wastes in the blood are removed by which of the following? Diffusion Osmosis Ultrafiltration Filtration

Diffusion

During hemodialysis, which of the following may occur while the patient is undergoing the treatment?

Rapid Shifts of Fluid and Electrolytes

A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase? Hypokalemia Hypocalcemia Dehydration Acute flank pain

Dehydration

CKD expected findings 5

-fluidoverload(jugular distension) -kussmual respirations -anemia -urine contains protein, blood, particles -decreased turgor, yellow cast to skin

End stage kidney disease (ESKD)4 Acute kidney Injury (AKI)4 nephrotic syndrome

-manifestation include fatigue, decreased alertness, anemia, and decreased urination -include decrease urination, decreased sensation in the extremities, swelling of lower extremities, and flank pain -manifestation are edema and high proteinuria

prerenal

-occurs as a result of volume depletion and prolonged reduction of blood flow to the kidneys, which leads to ischemia of the nephrons. Occurs before damage to kidney.

A client who has a history of chronic renal failure is in stage 4 for CRF. What is the approximate level of nephron function loss? 75% to 90% >90% 40% to 75% 25% to 40%

75% to 90%

A nurse is teaching a client about protein needs when on dialysis which of the following instruction should the nurse include in the teaching A consume 35 cal of body weight to maintain body proteins stores B Take phosphate binders when eating protein rich foods C increase biologic sources of protein like eggs milk and soy D increase protein intake by 50% of the recommended dietary allowance E Consume daily protein intake in the morning

A consume 35 cal of body weight to maintain body proteins stores B Take phosphate binders when eating protein rich foods C increase biologic sources of protein like eggs milk and soy D increase protein intake by 50% of the recommended dietary allowance

A nurse is contributing to the plan of care for a client who is post renal OK I do to metastatic cancer the client has blood creatine of 5 mg/ DL which of the following intervention should the nurse recommend to include in the plan select all that apply A provide a high protein diet provide provide to have break down a protein during AKI B Monitor the urine for blood C Monitor for intermittent anuria D wait the client once per week E provide NSAIDS for pain

A provide a high protein diet provide provide to have break down a protein during AKI- B Monitor the urine for blood- C Monitor for intermittent anuria -

A nurse is completing discharge teaching about diet and fluid restriction to a client who has calcium oxalate-based kidney stones which of the following instruction should the nurse include in the teaching A reduce intake of spinach B decrease broccoli intake C increase intake of vitamin C supplements D Limit consumption purine substances

A reduce intake of spinach -

A nurse is teaching a client who has stage two chronic kidney disease about dietary management which of the following information should the nurse include in the instructions A restrict protein intake B maintain a high phosphorus diet C increase intake of foods high in potassium D Limit dairy products to only one cup a day

A restrict protein intake-

The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary provider? Increased pain on movement Absence of drain output Increased urine output Blood-tinged serosanguineous drain output

Absence of drain output

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 is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? Hematuria Precipitous decrease in serum creatinine levels Hypotension unresolved by fluid administration Glucosuria

Hematuria

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

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

In CKD

Metabolic acidosis develops because the tubules cannot convert carbonic acid in the blood to water and bicarbonate ions.

kidneys are GFR is the filtration Kidneys pre renal, intrarenal, and post renal

Our kidneys are highly vascular organs and receive 1-1.2 L of blood/minute (20-25% of our cardiac output) The GFR is the filtration of the plasma per unit of time = directly r/t perfusion pressure of glomerular capillaries. It reflects the function of the renal tissue. Pre-renal = anything that reduces the blood flow to the kidneys Intra-renal= inside the kidney structure there is damage of some sort Post-renal= there is something obstructing the outflow (e.g. kidney stone)

The 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

· Stages of Chronic Kidney Disease

· Stage 1: Slight kidney damage with normal or increased filtration; a GFR of more than 90* · Stage 2: Mild decrease in kidney function with a GFR of 60 to 89 · Stage 3: Moderate decrease in kidney function with a GFR of 30 to 59 · Stage 4: Severe decrease in kidney function with a GFR of 15 to 29 · Stage 5: End-stage kidney failure requiring dialysis or transplantation with a GFR less than 15

Hemodialysis

· requires transporting blood from the client through a dialyzer, a semipermeable membrane filter in a machine