NRSG 2500 - Exam #2 (3&4)
Mechanisms that are involved in regulation homeostasis - R - A - A
- Renin-angiotensin system - Aldosterone - Antidiuretic Hormone (ADH)
RAAS System Overview Stimuli for Renin Secretion Decreased renal _________ pressure and or decreased _____ delivery to kidney tubules Examples : Hemorrhage, heart failure, cirrhosis, loop diuretics, decreased salt intake
perfusion salt
________ dialysis - Can be done during the day or overnight - Peritoneal membrane acts as a semi permeable membrane - Get baseline VS and electrolyte levels
peritoneal dialysis
Nutritional Information for the child with kidney disease - Diary products : milk, cheese, yogurt, custard, pudding, ice cream - Dried beans, peas - Nuts, peanut butter - Chocolate - Dark cola - Sausage, hot dogs This is all high _______ content foods
phosphorus
_____ imbalances have reverse symptoms of calcium imbalances minus the GI dysfunction Oral phosphorus binding agents such as calcium carbonate or calcium acetate are given to lower serum phosphate levels and normalize serum _____
phosphorus calcium
Categories and Causes of ARI - Dues to obstruction distal to kidney including obstructed arteries or veins. (Kidney stones are not common cause but can increase risk)
postrenal
Nutritional Information for the child with kidney disease - Fruits : Apricots, avocados, bananas, citrus fruits, fresh pears, nectarines, dates, figs, cantaloupe and other melons, prunes, and raisans - Vegetables : Celery, dried beans, lima beans, potatoes, leafy greens, spinach, tomatoes, winters squash - Whole graines : Especially those containing bran sardines, clams - Peanuts - Dairy products : milk, ice cream, pudding, yogurt - Potassium containing salt substitutes This is all high ______ content foods
potassium
These are Diagnostic Tests for Renal Function •Urinalysis and urine culture •_______ ______ _____- 24 hour urine test, creatinine clearance, creatinine, BUN, and BUN to creatinine ratio. •Ultrasonography •CT and MRI •Nuclear scans •Intravenous urography, retrograde pyelography, cystography, renal angiography •Endoscopic procedures •Biopsies: To evaluate extent of disease --Contraindicated in ______ ______ patients
renal function tests morbid obese
2nd line of defense, and it controls the amount of carbon dioxide in the arterial blood. In response to high CO2 levels are carbon dioxide in the blood the respiratory system will increased the depth and the rate of breathing. We will have hyperventilation to get rid of that excess CO2 and therefore get rid of those excess hydrogen ions. If there is low levels of CO2 than the system will have hypoventilation to help the body retain more CO2 and therefore and more hydrogen ions What buffers system is this?
respiratory
Hyperventilation Initial stages of pulmoney emboli, hypoxia, fever, pregnancy, high altitudes, anxiety. These can all cause what PH imbalance?
respiratory alkalosis
Nutritional Information for the child with kidney disease - Soups and sauces : example gravy, spaghetti and tomato sauce, barbecue sauce, steak sauce. - Processed lunch meats : bologna, ham, salami, hot dogs, etc. - Smoke meat and fish : bacon, chipped beef, corned beef, ham, lox Sauerkraut, pickles, and other pickled foods. - Seasonings : horseradish, soy sauce, Worcestershire sauce, meat tenderizer, and monosodium glutamate (MSG) This is all high ______ content foods
sodium
HYPOtonic: Hypo means slow... when you're slow, you get "big like a hippo" Cells in a hypotonic solution ____ on fluid and ______.
take swell
Obvious Rules for Compensating - If the CO2 is high, the HCO3- has to go up _____. -If the CO2 is low, the HCO3- has to go down ___. - If the HCO3- is high, the CO2 has to go up ____. - If the HCO3- is low, the CO2 has to go down _____.
up down up down
Metabolic alkalosis ___ pH ___ HCO3- ___ CO2 Or ok value
increase increase increase
pH is the important factor, your body cant function correctly if the pH is below _.__ or above _.__
7.35-7.45
Diagnostic Tests for Renal Failure Serum BUN : BUN <60 :
7-18 8-20
Diagnostic Tests for Renal Failure Serum Creatinine Level :
0.6-1.2
Pediatric Nuring Oliguria for pediartic patients is urine output less than __ml/kg/hr. Adult minimum is __ml/hr
1 30
Diagnostic Tests for Renal Failure Renal Concentration Specific Gravity :
1.010-1.025
Magnesium levels
1.5-2.5
Normal Phosporus Levels
2.5-4.5 mg/dL
Diagnostic Tests for Renal Failure Renal Concentration Urine Osmolality 24 hour : Urine Osmolality Random Sample :
250-900 50-1200
normal potassium levels
3.5-5.5
Normal calcium levels
8.5-10.5 mg/dL
Hemodialysis System When ____% of nephrons are no longer working dialysis is recommended. Treatment is typically ____X week for ___-____ hours in an outpatient setting Hypotension, N/V, anemia are common side effects of hemodialysis.
80 three 3-4
The nurse know which is the normal serum value for potassium? A - 3.5-5.0 mEq/L (3.5-5.0) B - 8.5-10.5 mg/dL (2.13-2.63 mmol/L) C - 96-106 mEq/L (96-106 mmol/L) D - 135-145 mEq/L (125-145 mmol/L)
A - 3.5-5.0 mEq/L (3.5-5.0)
Following the transfusion of one unit of packed red blood cells, the nurse prepares to administer another unit. Which action is most appropriate for the nurse to take before hanging the second unit? A - Assess the clients breath sounds and vital signs B - Administer an antihistamine C - Flush tubing with normal saline and hang next unit D - Instruct the client to void
A - Assess the clients breath sounds and vital signs
A client undergoes a transurethral resection of the prostate (TURP). In the immediate postoperative period, which characteristics does the nurse expect when observing the urinary drainage? A - Bloody B - Purulent C - Clear D- Bright yello
A - Bloody
A client has a transurethral resection of the prostate (TURP). Twenty four hours later, the nurse notices the clients urine is bright red. Which nursing action is most appropriate? A - Contact the healthcare provider B - Continue to monitor the client C - Irrigate the catheter D - Remove the catheter
A - Contact the healthcare provider
An adult client has a history of diabetes inspidus. The nurse identifies which imbalance is most likely to develop if this medical problem recurs? A - Hypernatremia B - Hyponatremia C - Hyperkalemia D - Hypokalemia
A - Hypernatremia
The emergency department nurse knows which cause is most frequently associated with tetany? A - Hypocalcemia B - Puncture wound from dirty and rusty metal C - Hypermagnesemia D - Genetic cardiac defect
A - Hypocalcemia
A client diagnosed with a urinary tract infection speaks with the nurse. Which client statement requires further investigation? (select all that apply). A - I can go all day without emptying my bladder B - I drink 2 liters of fluid every day C - I do not use bubble bath D - I urinate after having sex E - I douche at least once per week
A - I can go all day without emptying my bladder E - I douche at least once per week
The nurse instructs a client diagnosed with urolithiasis how to prevent calcium calculi. Which client statement indicates teaching is successful? A - I will drink at least 3,000 ml of fluid each day B - I will eat 2 servings of meat of cheese per day C - I will drink at least two glasses of cranberry juice daily D - I will eat large amount of citrus fruit each day
A - I will drink at least 3,000 ml of fluid each day
The nurse is inserting an indwelling urinary catheter into a female client. The nurse notes the catheter is inserted into the clients vagina. Which action does the nurse take first? A - Leaves the catheter in place and obtains a new catherization kit B - Removes the catheter from the vagina, and insert it into the urethra C - Removes the catheter from the vagina, and insert a new catheter D - Leaves the catheter in place, and inflates the balloon to secure placement
A - Leaves the catheter in place and obtains a new catherization kit
To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. A - PaCO2 B - HCO3 C - Na+ D - Glucose E - K+ F - pH
A - PaCO2 B - HCO3 F - pH
The nurse provides care for an older adult client immediately after a cytoscopy is performed. Which finding has the highest priority for the nurse? A - Pelvic pain B - Pink tinged urine C - Drowsiness D - Slight nausea
A - Pelvic pain
A client with pancreatic cancer has the following blood chemistry profile : Glucose fasting : 204 mg/dl, blood urea nitrogen (BUN) : 12 mg/dl, Creatinine : 0.9 mg/dl, sodium : 136 mEq/L : potassium : 2.2 mEq/L, Chloride : 99 mEq/L, CO2 : 33 mEq/L. Which result should the nurse identify as critical and report immediately? A - Potassium B - CO2 C - Sodium D - Chloride
A - Potassium
The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? A - Potassium 5.8 B - Magnesium 2 C - Calcium 10 D - Sodium 138
A - Potassium 5.8
A client is admitted with a diagnosis of acute kidney injury (AKI). The nurse understand which situation is most likely to result in acute kidney injury? A - Prolonged hypotension due to sever dehydration B - Chronic diseases, such as diabetes mellitus C - Obstruction of the ureter by a kidney stone D - An untreated step throat
A - Prolonged hypotension due to sever dehydration
The nurse instructs a client with a full thickness burn injury of the legs about an appropriate diet. The nurse determines teaching is successful if the client select which foods on the breakfast menu? A - Scrambled eggs with cheese, sausage, and orange juice B - Whole grain toast, apple sauce, and coffee C - Corn flakes, banana, and skim milk D - Mixed fruit, oatmeal, and tea
A - Scrambled eggs with cheese, sausage, and orange juice
The nurse monitors a client receiving a blood transfusion. The nurse should intervene if which is observed? (Select all that apply) A - The client reports dyspnea B - The blood is started with normal saline C - The blood is warmed to room temperature D - The blood infuses at 10 ml/min for the first 15 minutes E - The client report pruritus F - The blood infuses in three hours
A - The client reports dyspnea D - The blood infuses at 10 ml/min for the first 15 minutes E - The client report pruritus
A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess : A - Trousseaus sign B - Goodells sign C - Homans sign D - Hegars sign
A - Trousseaus sign
The nurse recognizes which signs/symptoms is expected for a client with benign prostatic hypertrophy? Select all that apply A - Urinary frequency B - Urinary urgency C - Fever and chills D - Low back pain E - Dilute urine
A - Urinary frequency B - Urinary urgency D - Low back pain
The nurse cares for a client with suspected cancer of the bladder. The nurse knows which finding is most common in the client with a diagnosis of cancer of the bladder? A - hematuria B - Potassium 5.9 C - Painful urination D - Left flank pain
A - hematuria
Renal Injury Creates Fluid and Electrolyte Imbalances •Results when the kidneys cannot remove wastes or perform regulatory functions. •A systemic disorder that results from many different causes. •____ _____ ____ (___) is a reversible syndrome that results in decreased GFR and oliguria. Criterion is greater than or equal to ____% increase in serum creatinine. (Normal = less than __.___ mg/dL.) formally called Acute Renal failure •_____ _____ ______ (____) = End Stage Renal Disease) is a progressive, irreversible deterioration of renal function that results in ______ (an excess of urea and other nitrogenous wastes in the blood as a result of kidney insufficiency; compare to uremia).
Acute kidney injury AKI 50 1.0 Chronic Renal Injury (ESRD) azotemia
Which of the following is the most common cause of symptomatic hypomagnesemia in the United States? A - Intestinal resection B - Alcoholism C - Loss of gastric acid D - Inflammatory bowel disease
B - Alcoholism
A client reports a fever for several days and is admitted to the hospital for pneumococcal pneumonia. The clients temperature is 101 F (38.4), and the client is started on penicillin therapy intravenously. It is essential for the nurse to monitor the client for which finding? A - Increased blood urea nitrogen (BUN) B - Allergic reaction C - Anemia D - Decreased appetite
B - Allergic reaction
The nurse is caring for a client with shock. The nurse is concerned about hypoxemia and metabolic acidosis with the client. What finding should the nurse analyze for evidence of hypoxemia and metabolic acidosis in a client with shock? A - Red blood cells (RBCs) and hemoglobin count findings B - Arterial blood gas (ABG) findings C - Serum thyroid level findings D - White blood cell count findings
B - Arterial blood gas (ABG) findings
The nurse provides care for a client prescribed bethanechol for urinary retention following surgery. It is most important for the nurse to review the clients history for which condition? A - Duodenal or gastric ulcer B - Asthma or bronchitis C - Hypertension D - Renal Cancer
B - Asthma or bronchitis
A client has an indwelling urinary catheter in place for two days. The nurse needs to collect a sterile urine specimen. Which approach describes the correct technique to obtain a sterile urine specimen from the catheter? A - Empty the content of the drainage bag, wait 15-30 minutes, and take a specimen of urine from the drainage bag. B - Clamp the drainage tube below the port, wait 15-30 minutes, scrub the port using an antiseptic swab, attach a sterile needleless access device and aspirate a specimen via the port. C - Scrub the tubing where the catheter connects to the drainage bag with an antiseptic swab, disconnect the tubing, and collect a specimen of urine directly from the catheter in a sterile container. D - Collect a random specimen of urine from the drainage bag
B - Clamp the drainage tube below the port, wait 15-30 minutes, scrub the port using an antiseptic swab, attach a sterile needleless access device and aspirate a specimen via the port.
The nurse is caring for a client with laboratory values indication dehydration. Which clinical symptom is consistent with the dehydration? A - Crackles in the lung fields B - Dark, concentrated urine C - Cool and pale skin D - Distended jugular veins
B - Dark, concentrated urine
A client suffers a full thickness burn injury. The nurse provides care for the client during the emergent phase. The nurse understands which finding is expected during this phase? A - Increased blood pressure B - Decreased urine output C - Hypokalemia D - Decreased pulse
B - Decreased urine output
The home care nurse visits a client reporting symptoms of a urinary tract infection. The nurse has a prescription to obtain a mid stream urine specimen. On arrival to the home, the client states the specimen was collected 2 hours ago and it is sitting in the bathroom. Which action by the nurse is correct? A - Label the specimen with the correct client information and send it to the laboratory B - Discard the specimen and obtain a new mid stream specimen C - Determine if the client used appropriate technique to clean the urethral meatus D - Collect the specimen immediately and place it in a cold container
B - Discard the specimen and obtain a new mid stream specimen
After suctioning a tracheostomy tube, the nurse assesses the client to determine the effectiveness of the suctioning. Which findings indicate that the airway is now patent? A - Restlessness, pallor, increased pulse and respiratory rates, and bubbling breath sounds B - Effective breathing at a rate of 16 breaths per minute through the established airway C - A respiratory rate of 28 breath per minute with accessory muscle use D - Increased pulse rate, rapid respirations, and cyanosis of the skin and nail beds.
B - Effective breathing at a rate of 16 breaths per minute through the established airway
The nurse cares for a client diagnosed with urinary incontinence. When implementing the plan for urinary habit training, which action does the nurse take first? A - Provides privacy for the client to toilet B - Established the clients voiding pattern C - Assists the client to the toilet every two hours D - Turns on the water faucet when the client is on the toilet
B - Established the clients voiding pattern
A client receives a blood transfusion and experiences a hemolytic transfusion reaction. Which symptoms will the nurse most likely observe? (Select all that apply) A - Slight fever, flushed skin B - Hematuria, cyanosis C - Urticaria, wheezing D - Hives, itching E - Back pain, hypotension
B - Hematuria, cyanosis E - Back pain, hypotension
The nurse understand that fatigue, weakness, nausea, and vomiting are signs of which problem? A - Hyponatremia B - Hypokalemia C - Hypernatremia D - Hyperkalemia
B - Hypokalemia
An older adult female client reports stress incontience. The client is 5 ft 2 inches tall, weighs 112 pounds, and had four vaginal births. Which statement by the nurse is most appropriate? A - Most women have that problem after giving birth to several children B - I am going to show you how to perform exercises to strengthen your pelvic muscles C - Limit the fluids you drink to avoid overextending your bladder D - Incontinence is to be expected at your age. Try wearing a pad
B - I am going to show you how to perform exercises to strengthen your pelvic muscles
The nurse provides care for a client receiving a blood transfusion. The nurse observes which symptoms if fluid overload occurs during the transfusion? A - Decreased pulse rate, increased BP, decreased respirations B - Increased pulse rate, increase BP, increased respirations C - Increased pulse rate, increased BP, decreased respirations D - Decreased pulse rate, decreased BP, increased respirations
B - Increased pulse rate, increase BP, increased respirations
A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should: A - Administer acetaminophen as ordered B - Instruct the client to breath into a paper bag C - Insert a nasogastric tube (NG) as ordered D - Administer antibiotics as ordered
B - Instruct the client to breath into a paper bag
The nurse evaluate a clients fluid balance. Which finding most likely requires an intervention? A - Output is 300 ml less than intake B - Output is 800 ml less than intake C - Intake is 1800 in 24 hours D - Intake and output are equal
B - Output is 800 ml less than intake
When measuring the central venous pressure, it is most important for the nurse to take which action? A - Find out about the previous reading B - Place the manometer at level of the right atrium C - Position the client in an upright position D - Instruct the client to hold the breath during the reading
B - Place the manometer at level of the right atrium
A central venous pressure line is inserted in a client. Following the catheter insertion, the client reports dyspnea, shortness of breath, and chest pain. The nurse understands the most probable cause of these symptoms is which condition? A - Fluid overload B - Pneumothorax C - Hypokalemia D - Pneumonia
B - Pneumothorax
A client receives magnesium sulfate IV for treatment of preeclampsia. The nurse knows it is most important to have which interventions at the bedside? A - Oxygen and padded tongue blade B - Reflex hammer and calcium gluconate C - protamine sulfate and vitamin K D - Particulate respirator and suction equipment
B - Reflex hammer and calcium gluconate
The nurse provides care for a client reporting a sudden onset of sever right flank pain. The client is diagnosed with urinary calculi. Which nursing action has the immediate priority? A - Ensuring the client remains NPO B - Relieving pain C - Straining the urine D - Obtaining a mid stream urine specimen
B - Relieving pain
Which of the following arterial blood gas results would be consistent with metabolic alkalosis? A - PaCO2 less than 35 mm Hg B - Serum bicarbonate of 28 mEq/L C - Serum bicarbonate of 21 mEq/L D - pH 7.26
B - Serum bicarbonate of 28 mEq/L
Which laboratory finding does the nurse expect if a client is diagnosed with a fluid volume deficit? (Select all that apply). A - Specific gravity 1.020 B - Specific gravity 1.034 C - Potassium 5.8 D - Potassium 4.8 E - BUN 32 mg/100 ml F - BUN 15 mg/100 ml
B - Specific gravity 1.034 C - Potassium 5.8 E - BUN 32 mg/100 ml
A client is being prepared for peritoneal dialysis. Which nursing action is take first? A - Assess for bruit B - Warm the dialysate C - Position the client on the left side D - Insert an indwelling urinary catheter
B - Warm the dialysate
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? A - Saturation 95% B - pH 7.48 C - HCO 21 mEq/L D - PaCO 36
B - pH 7.48
Diagnostic Test for Renal Failure Serves as index of renal function. Urea is the nitrogenous end product of protein metabolism. Test values are affected by protein intake, tissue breakdown, and fluid volume changes.
BUN
Diagnostic Tests for Renal Failure Evaluated hydration status. An elevated ratio is seen in hypovolemia, a normal ration with an elevated BUN and creatinine is seen with intrinsic kidney disease
BUN to creatinine ratio
Which urine output best indicate to the nurse that a client kidneys are functioning normally? A - 555 mL in 2 hour B - 30 ml in one hour C - 1500 ml in 24 hour D - 800 ml in 24 hour
C - 1500 ml in 24 hour
The nurse provides care for a client after a transurethral resection of the prostate (TURP). The client is prescribed continuous bladder irrigation, with the irrigating solution infusing at 30 ml/hr. At the end of 24 hours, the clients total output is 2,500 mL. The clients actual urine output is which action? A - 1,870 ml B - 1,850 ml C - 1780 ml D - 1720 ml
C - 1780 ml
The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from? A - A catheter in the arm vein B - The pleural surfaces C - A puncture at the radial artery D - the trachea and bronchi
C - A puncture at the radial artery
You are caring for a client with shock. You are concerned about hypoxemia and metabolic acidosis with your client. What finding should you analyze for evidence of hypoxemia and metabolic acidosis in a client with shock? A - White blood cell count findings B - Red blood cells (RBCs) and hemoglobin count findings C - Arterial blood gas (ABG) finding D - Serum thyroid level findings
C - Arterial blood gas (ABG) finding
The nurse assesses a client who sustained a burn injury. The burn area is red, blistered, and painful. Which classification best describes the burned area? A - Third degree B - Full thickness C - Deep partial thickness D - Superficial partial thickness
C - Deep partial thickness
The nurse identifies which sign or symptom indicates a client may have fluid volume excess? (Select all that apply). A - Cyanosis B - Diarrhea C - Edema D - Hypotension E - Crackles F - Tachycardia
C - Edema E - Crackles F - Tachycardia
Which nerve is implicated in the Chvosteks sign A - Hypoglossal B - Spinal accessory C - Facial D - Optic
C - Facial
The nurse notes a client with an indwelling urinary catheter repots discomfort, has a moderately distended bladder, and has had 20 mL of urinary drainage in the past hour. Which is the first action the nurse takes? A - Irrigates the catheter B - Gently massages the bladder in a distal direction C - Inspects the catheter tubing D - Briefly raises the drainage bag above the level of the bladder
C - Inspects the catheter tubing
A client has a major burn injury. The nurse known medication is best absorbed by which route for this client? A Intramsucularly B - Orally C - Intravenously D - Topically
C - Intravenously
The nurse provides care for a client who experiences a transfusion reaction. After stopping the transfusion, which action does the nurse take next? A - Check the blood tubing and bag B - Obtain vital signs C - Keep the IV line open with normal saline D - Notify the health care provider
C - Keep the IV line open with normal saline
The nurse is assessing a hospital client who has severe obesity. The nurse's review of the client's latest arterial blood gases reveals PaCO2 of 48 mm Hg and PaO2 of 76 mm Hg. Inspection reveals a respiratory rate of 22 breaths per minute with shallow ventilation. What intervention should be included in the client's plan of care? A - Keep physical activity to a minimum B - Keep the head of the clients bed at a 90 degree angle C - Keep the client in a low fowler position when in bed D - Ambulate the client at least every 2 hours
C - Keep the client in a low fowler position when in bed
Hypocalcemia is associated with which of the following manifestations? A - Bowel hypomobility B - Polyuria C - Muscle twitching D - Fatigue
C - Muscle twitching
A 64 year old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for the client? A - No, start with the sodium chloride IV B - Yes, along with the hyptonic IV C - No, sodium intake should be restricted D - Yes, this will correct the sodium deficit
C - No, sodium intake should be restricted
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A - ph 7.35, PaCO2 40 mm Hg B - pH 7.40, PaCO2 35 mm Hg C - pH 7.25, PaCO2 50 mm Hg D - pH 7.50, PaCO2 30 mm Hg
C - pH 7.25, PaCO2 50 mm Hg
The nurse provides care for a client immediately after a complete cystectomy and ileal conduit. the nurse is most concerned if which finding is observed? A - The urine output is 60 ml per hour B - The stoma appears red in color C - the stoma is edematous D - There is a small amount of serosanguineous drainage
C - the stoma is edematous
low bp, weak rapid pulse, flattened neck veins, n/v, confusion, lethargy, HA, dizzy, muscle cramps/weakness, twitching-convulsions Is this FVD or FVE
FVD
Volume expanders or plasma expanders Albumin, dextrans, hydroxyethylstarches (heta starch and hespan) colliods Uses : · Hypoproteinemia and malnourished states Plasma volume expansion that can't handle large infusions of fluid Special Considerations · Same effect as hypertonic crystalloids · Increase intravascular volume · At risk for fluid volume overload · Require less total volume · Longer duration of action More expensive What type of fluid is this?
Colloid solutions
The nurse identifies which central venous pressure (CVP) reading indicates fluid overload? A - 1.0 mm Hg B - 2.3 mm Hg C - 3.8 mm Hg D - 15 mm Hg
D - 15 mm Hg
A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. the clients spouse became alarmed when the client demonstrated confusion and elevated temeprature, and reported dry mouth. The nurse suspects the client is experiencing which condition? A - Hypervolemia B - Hypercalcemia C - Hyperkalemia D - Dehydration
D - Dehydration
During peritoneal dialysis, a client suddenly begins to breath more rapidly. Which action does the nurse take first? A - Discontinues the dialysis procedure B - Check the clients vital signs C - Notifies the health care provider D - Elevates the head of the bed
D - Elevates the head of the bed
A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? A - Hydrochlorothiazide B - Spironolactone C - Metolazone D - Furosemide
D - Furosemide
The nurse provides care for a client receiving a blood transfusion. The nurse is most concerned if which observation is made? A - The blood pressure is 130/80 B - The client reports shortness of breath C - The client report pruritis D - Hematuria occurs
D - Hematuria occurs
The nurse identifies nasogastic drainage, vomiting, diarrhea, and the use of diuretics as likely the cause of which electrolyte imbalance? A - Hypernatermia B - Hyperkalemia C - Hyponatremia D - Hypokalemia
D - Hypokalemia
The nurse cares for a client two hours after the client has a transurethral resection of the prostate (TURP). The nurse assesses the three way indwelling urinary catheter and continuous bladder irrigation (CBI) and notes the urinary output is bright red with clots present. Which is the most appropriate action for the nurse to take? A - Notify the health care provider immediately B - Place the client in trendelenburg position C - Prepare to administer blood products D - Increase the rate of the irrigation fluid
D - Increase the rate of the irrigation fluid
The older adult client repots having to urinate frequently at night. The clients adult child states my parents has been falling, and this is really unusual. Which action does the nurse take first? A - Obtains a prescription for an antibiotic B - Tells the client to drink 8-10 glasses of water per day C - Instructs the client to ask for assistance when ambulating D - Obtains a midstream urine specimen
D - Obtains a midstream urine specimen
The nurse notes tall peaked T waves on the electrocardiogram of a client diagnosed with a fractured right hip. Which laboratory result does the nurse anticipate due to this finding? A - Hgb 12 B - Hct 36% C - Sodium 130 D - Potassium 6.2
D - Potassium 6.2
A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptoms would the nurse include in the teaching? A - Flank pain B - Hypetension C - Polyuria D - Tingling sensation in the fingers
D - Tingling sensation in the fingers
Hypercalcemia : Dairy cows can wait
D - diminished reflexes c - constipation c - confusion w - weak muscles
Which set of arterial blood gas (ABG) results requires further investigation? A - pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L B - pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L C - pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, Partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L D - pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
D - pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
increased bp, bounding pulse, disteneded neck veins, oliguria, confusion, fatigue, dyspnea, edema Is this FVD or FVE
FVE
Phases of ARI •______ period: -Gradual increase in urine output; labs stabilize.
Diuresis
Gerontologic Considerations Age related urinary tract changes due to structural and functional changes: - ______ decreases - More susceptible to _____ and chronic kidney disease - Risk of ___________ and ________ due to decreased thirst - Incomplete bladder emptying (risk for _____) - Urinary incontinence
GFR AKI hypernatremia dehydration UTI
Acidic <7.35 •Acids are ____+ _____ •The lower the pH value of a fluid, the ______ the level of free hydrogen ions in that fluid. •______ is acidic and controlled by the respiratory system (lungs).
H donors higher PCO2
Hyperkalemia : Increase potassium offers death
I - irritable p - parathesias o - olifuria d - diarrhea
Respiratory Alkalosis ___ pH ____ pCO2 ____ HCO3- Or ok value
Increase decrease decrease
Case history 3 Steve Burr, 38, has type 1 diabetes. He hasn't been feeling well for the last 3 days and hasn't eaten or injected his insulin. He's confused and lethargic. His respiratory rate is 32 breaths/minute, and his breath has a fruity odor. His serum glucose level is 620 mg/dL. While receiving 40% O2, his ABG values are: pH: 7.15 Paco2: 30 mm Hg PaO2Paco2: 130mm Hg HCO3-: 10 mm Hg SaO2: 94%.
Interpretation: These ABG values reveal metabolic acidosis with partial respiratory compensation. The patient's pH and HCO3- indicate acidosis. His Paco2 is lower than normal, reflecting the lungs' attempt to compensate. Because pH is abnormal, you know compensation isn't complete.
John Stewart, 22, is brought to the ED for an overdose of a tricyclic antidepressant. He's unconscious and has a respiratory rate of 5 to 8 breaths/minute. His ABG values are as follows: pH: 7.25 Paco2: 61 mm Hg PaO2Paco2: 76 mm Hg HCO3-: 26 mm Hg SaO2: 89%.
Interpretation: These ABG values reveal respiratory acidosis without compensation. The patient's pH and Paco2 are acidotic, and his HCO3- is normal, indicating no compensation. You would administer O2, as ordered. The patient may be intubated to protect his airway and placed on a mechanical ventilator. You would also treat the underlying cause by performing gastric lavage and administering activated charcoal. This patient's condition may progress to metabolic acidosis. If so, you would give sodium bicarbonate to reverse the acidosis.
Now, interpret these values: pH: 7.25 Paco2: 56 mm Hg PaO2 Paco2: 80 mm Hg HCO3-: 15 mm Hg SaO2 : 93%
Interpretation: These values reveal mixed acidosis. The pH, HCO3-, and Paco2 all indicate acidosis.
Try interpreting this set of ABG values without a clinical scenario: pH: 7.49 Paco2: 40 mm Hg PaO2 Paco2: 85 mm Hg HCO3-: 29 mm Hg SaO2: 90%
Interpretation: These values reveal uncompensated metabolic alkalosis. The pH and HCO3- indicate alkalosis. Paco2 is normal, indicating no compensation.
What type of solution is this? Solution : Dextrose 5% in water (D5W), crystalloid Uses · Fluid loss · Dehydration · Hypernatremia (dilutes the extra sodium in extracellular fluid) Provides free water and also considered a hypotonic solution after glucose metabolism Special Considerations · Use cautiously in renal and cardiac patients · Can cause fluid overload · Use cautiously in diabetic patients · 170 calories per liter doesn't replace electrolytes · Can be categorized as hypotonic because the dextrose is rapidly metabolized by the body · Not used to treat fluid volume deficit · Contraindicated in the early post op period Contraindicated in patients with increased ICP
Isotonic
Sodium Imbalance Hyponatremia : LOW
L - low temp O - orientation W - weak, lethargic
Diabetic ketoacidosis, initial alicylate OD, shock, sepsis, severe diarrhea, and renal failure These can all cause what pH imbalance?
Metabolic acidosis
Nutritional Information for the child with kidney disease Basically low __, low ___, low ___, sugar for diabetes and _____ fluids
Na, k, phosphorus, low
Normal pH Normal PCO2 Normal HCO3-
Normal pH : 7.35-7.45 Normal PCO2 : 35-45 Normal HCO3- : 22-26
Hypocalcemia : Polly the cow did terribly (She didn't make enough)
P - parathesia t - twitching/tetany c - chvosteks d - diarrhea t - trousseaus
Categories and Causes of ARI •(Occurs in 60-70% of cases) -Due to Hypoperfusion (hypovolemia, hypotension, decreased cardiac output & heart failure) -Labs: Oliguria, elevated BUN, normal creatinine What is this?
Prerenal
Hypermagnesia : Real fridges have magnets
R - Respiratory distress or depression F - Flushing H - Hypotension M - Muscle weakness/decreaseDTR
Phases of ARI _________ period : - May takes 3-12 months, permanent _____% reduction GFR is normal
Recovery three
3rd line of defense, this system is slower to respond, but the response is more powerful and more long acting. If it sense the blood ph is too low meaning it is acidic then the kidneys will increase reabsorption of bicarbonate and will aslo excrete more hydrogen ions. If the kidneys sense that the ph is too high meaning we have alkalosos then it will increase excretion of that bicarbonate, and will increase reabsorption of the hydrogen ions. What buffer system is this?
Renal
Hypoventilation Caused by drug overdose, pulmonary edema, chest trauma, neuromuscular disease, COPD, airway obstruction These can all cause what Ph imbalance?
Respiratory acidosis
High or Low : Salt Sodium
S - seizures A - abdominal distress (cramping, n/v) L - low pressure T - tachycardia
Normal sodium levels
Sodium 135-145
Diagnostic Tests for Renal Failure A measure of the degree of concentration of the urine
Specific Gravity
How to calculate mean arterial pressure
Systolic + diastolic + diastolic / 3
Magnesium think magnets Hypomagnesia : The Tape Can Substitute
T - tetany T - trousseus C - chvosteks S - sensation changes
Assessment of Kidney Function, Perfusion, and fluid balance •VS, (MAP) •I&O •Lungs, LOC, pulses, urine, kidneys, abdomen, edema, CMS, color, flank pain, skin •Labs: Specific gravity, creatinine & GFR, BUN, potassium, sodium •______ (most accurate indicator of fluid loss or gain in acutely ill patient) -Accurate daily weight must be obtained and recorded. - A ____ Kg weight gain is equal to _____ mL of retained fluid. -____ pound is about ____ ml of retained fluid
Weight 1 kg 1000 one 450
Diagnostic Tests for Renal Failure Serum BUN To creatinine Ratio :
about 10:1
Basic >7.45 •Bases can _____ __+ ions •The higher the pH value of a fluid, the the ______ level of free hydrogen ions in that fluid. •_______ is alkalotic and controlled by the metabolic system (kidney's).
absorb H lower HCO3-
- If your pH is high than you are ______ - if your pH is low you are ________
alkalotic acidotic
RASS System Overiew ____________ in Liver - ______ Release - Angiotension I - Converting Enzyme in ______ - Angiotensin __ Renal atuoregulation - ________ arterioles constrict - _____ maintained Increased Blood Pressure - Vasoconstriction - Increased _______ contractility - _________ release Increased circulation volume - ________ release - Sodium and water reabsorption - ________ excretion - ADH release
angiotensinogen renin lungs II efferent GFR myocardial prostaglandin aldosterone potassium
Hemodialysis Catheter Internal Arteriovenous Fistular and Graft - _________ agents must be held on dialysis days to avoid hypotension - Protect vascular access, do not use for blood pressure of blood draws.
antihypertensive
High or low : bannanas have potassium - what does this stand for? - Potassium regulates _______ rhythm - an increase or decrease in potassium has a direct effect on cardiac rhythm and EKG results
cardiac B - bradycardiac h - hypotension p - PVCs, dysrhythmias
Present in our bodily fluids, and act immediately to bind or release hydrogen ions, and help to promote an acid base balance in the body. There are several of these buffers including : carbonic acid bicarbonate buffer system, phosphate buffer system, and lastly the protein buffers including albumin globulins and hemoglobins. What buffer system is this?
chemical
What is the order of effectiveness or first line of defense when it comes to pH buffers? Respiratory, chemical, and renal
chemical, respiratory, and renal
Functions of the Kidney - Renal ______ - Regulation of ____ production, Erythropoietin hormone (Chronic renal failure: Anemia) - Synthesis of Vitamin _____ to active form (Calcium balance & bone metabolism) - Secretion of _________
clearance RBC D prostaglandins
A ______ ______, such as the one shown here, can be used as a guide in standardizing descriptions of urine color. Normal urine is pale yellow. Changes in urine color can indicate the following alterations: yellow —concentrated urine; _______—bile in urine; orange—alkaline or concentrated urine; red-orange—acid pH, medications; red—blood; menses; pink—dilute blood; _______— laxatives; tea—melanin, hematuria; dark gray—medications, dyes; blues—dyes, medications.
color wheel amber burgundy
Diagnostic Test for Renal Failure Detects and evaluates progression of kidney disease. Test measure volume of blood cleared of endogenous creatinine in 1 minutes, which provides an approximation of the glomerular filtration rate. Senstivie indicator of kidney disease used to follow progression of kidney disease.
creatinine clearance
Diagnostic Test for Renal Failure Measure effectiveness of renal function. Is the end product of muscle energy metabolism. In normal function, the level of it, which is regulated and excreted by the kidneys, remains fairly constant in the body.
creatinine level
Hypernatremia : DASH : A dash too much
d - dehydrated (thirsty, dry mouth) a - agitated/twitchy s - swollen (fluid retention) H - hot/flushed/fever
Metabolic acidosis ___ pH ____ HCO3- ____ CO2 Or ok value
decrease decrease decrease
Respiratory acidosis ___ pH ___ pCO2 ____ HCO3- Or ok value
decrease increase increase
Power Trialysis Catheter - Red and blue ports are for _____ only - _____ line is most distal and can be used for blood draws, IV medication/infusion, power injection for CT, and CVP monitoring
dialysis purple
Most ________ imbalances cause vague symptoms that make the patient feel terrible, not right. This is the reason that physician order electrolyte panels frequently to identify potential problems early.
electrolytes
Causes : Hyperparathyroidism, excessive calcium supplementation, thiazide diuretics S/S : increased BP, lethargy, polyuria, polydipsia Tx : dialysis if severe, limit calcium intake, encourage fiber to prevent constipation What is this?
hypercalcemia
Causes : excessive consumption, k+ sparing diruretics (spironolactone), kidney pathology S/S : muscle twitching, fatigue, cramping, diarrhea Tx : IV administration of dextrose with regular insulin to move excess potassium into cells, administer furosemide, calcium gluconate to prevent cardiotoxicity, polystyrene sulfonate orally or rectally. What imbalance is this?
hyperkalemia
These are potential complication of renal issues. •_________ -*Most common cause of death in acute renal failure -Priority if patient has a high potassium level: Assess ____ rhythm •__________- inflammation of the fibrous sac surrounding the heart •_______ effusion- fluid around the heart •Pericardial ______ - life-threatening large amount of fluid (usually blood) compresses and constricts the heart •Hypertension •Anemia •Bone disease and metastatic calcifications
hyperkalemia ECG pericarditis pericardial tamponade
Causes : Renal insufficiency, excessive consumptions or IV administration S/s : hypotension, bradycardia, CNS Depression, coma, drowsy or lethargic Tx : dialysis if severe, restrict magnesium in diet. May use loop diuretics if renal function is normal What imbalance is this?
hypermagnesia
Causes : Impaired renal function, excessive IV fluids with NaCl, excessive sodium intake, hypertonic enteral feedings, diarrhea, burns Tx : hypovelmic-infuse hypotonic fluids Hypervolemic : diuretics may be used to remove excessive water and sodium What imbalance is this?
hypernatremia
tetany, chvosteks, trousseas This is what?
hyperphosphatemia
Chronic Renal Failure Care •_________: Antihypertensives, limit sodium, bedrest. •Fluid Overload: Fluid restrictions, diuretics, I&O, daily weights, oxygen, elevate HOB, dialysis, assess lungs & edema. •_______ & Acidosis: Limit potassium & proteins. Sodium polystyrene sulfonate (Kayexalate). Dialysis. •Phosphate & Calcium: Limit phosphate (give antacids to bind with phosphate). Calcium supplements. •_______: Epogen, iron supplements, monitor for orthostatic hypotension. •Bleeding: Monitor meds, labs, S/S bleeding. •GI Problems: N/V. Give correct diet. I&O, antiemetics. •Neuromuscular: LOC changes, limit protein, monitor labs. •Uremic frost & Uremic fetor: Skin & oral care. •_______ Risk: Handwashing, monitor for S/S infection.
hypertension Hyperkalemia anemia infection
3% sodium Chloride (3% NaCl) crystalloid What type of solution is this? Uses · Has 513 mEq/L NaCl · Raise Sodium levels in the blood stream · Highly hypertonic Special considerations · Give slowly · Used only in critical care situations where strict hemodynamic monitoring is available.
hypertonic
Dextrose 10% in water D10 W crystalloid What type of fluid is this? Uses · Water replacement · Conditions where some nutrition with glucose is required o Hypoglycemia Special considerations · Monitor blood sugar levels
hypertonic
Dextrose 50% in water D50W crystalloid What type of fluid is this? Uses · Severe hypoglycemia Given IV bolus Special considerations · Monitor for hyperglycemia after use Solutions greater than 10% dextrose should be given through a central line
hypertonic
Other hypertonic Solutions D5W & 0.45%NS D5LR D20W 5% Sodium Chloride crystalloid What type of solution is this?
hypertonic
What type of fluid is this? Dextrose 5% in normal saline (D5W & 0.9%NS) (D5W NS) crystalloid Uses · Temporary treatment for shock if plasma expanders aren't available · Addison's crisis (too little cortisol and often too little aldosterone) Special considerations · Caution with cardiac or renal patients · Slightly hypertonic · Monitor serum electrolytes Assess for hypovolemia
hypertonic
Causes : hypoparathyroidism , malabsorption, renal failure, pancreatitis S/S : Tachycardia, hypotension, cramps, bone pain Tx : Calcium supplements, increase calcium intake These are all signs of what?
hypocalcemia
Causes : K+ wasting diuretics, severe vomiting or diarrhea, strenous activity S/S : Confusion, hypoactive bowel sounds, lethargy/weakness Tx : increase K+ in diet, oral K liquid or extended release, paretneral K+ supplement, never administer rapid concentrated potassium this is a lethal injection) What imbalance is this?
hypokalemia
hyperkalemia and _______ are unique in that they are accompanied by cardiac and EKG changes, just remember potassium = heart!
hypokalemia
Causes : prolonged gastric suctioning, uncontrolled diabetes S/S : general weakness, dysrhythmias, HTN, increased reflexes and respiratory depression Tx : oral magnesium, increase consumption of magnesium What is this?
hypomagnesia
Causes : burns, high ADH secretion, excessive dilution with IV fluids Tx : treat the underlying cause, depending on the cause may be treated with loop diuretics oral sodium chlorid, IV fluids contain NaCl What imbalance is this?
hyponatremia
Confusion, weakness, diminished reflexes This is what?
hypophosphatemia
What type of fluid is this? 0.45% sodium chloride (1/2 normal saline) crystalloid Uses : · Water replacement · DKA (intracellular dehydration) · Gastric fluid loss from NG or vomiting Helps the kidneys excrete excess fluids and electrolytes (hypotonic saline solutions) Special Considerations · Use with caution · May cause cardiovascular collapse or increased intracranial pressure · Don't use with liver disease, trauma, or burns · Hydrate cells, deplete fluid within circulatory system · Other hypotonic solutions: 0.45% Nacl, 0.33% Nacl, and 2.5% dextrose in water · Do not use hypotonic solutions with liver disease, trauma, burns due to potential depletions of intravascular fluid volume
hypotonic
Fluid tonicity Fluid _____ (fluid overload and dehyrdation) are more common than electrolyte
imbalances
Phases of ARI •_______ period: -Most significant sign of ARI is _________ urine output. -Includes initial injury to when oliguria develops.
initiation decreased
The four phases of ARI
initiation, oliguria, diuresis, recovery.
Categories and Causes of ARI -Actual damage to kidney tissue occurs -Acute Tubular Necrosis (ATN) occurs What is this?
intrarenal
What is the type? Solution : 0.9% sodium chloride (Normal Saline), (NaCl), crystalloid Uses : · Shock · Hyponatremia (mild) · Blood transfusions · Resuscitation · Fluid challenges · metabolic acidosis such as DKA · hypercalcemia heavy drainage from GI suction, wounds or fistulas Special considerations · Can lead to overload - Use with caution in patients with heart failure, renal disease or edema
isotonic
What type of fluid is this? Lactated Ringer's (LR), (Ringers Lactate), (Hartmann solution), crystalloid Uses : · Dehydration · Burns · Lower GI fluid loss · Acute blood loss · Hypovolemia due to third spacing · Pts requiring electrolyte replacement Surgical patients Special considerations · Contains potassium, don't use with renal failure patients · Don't use with liver disease, can't metabolize lactate · Contains 130mEq/L Na+, 4 mEq/L K+, 3 mEq/L Ca+, 109 mEq/L Cl-, Doesn't provide calories, or magnesium and has limited potassium replacement.
isotonic
Hypokalemia : Low potassium causes cramps
l - limp p - polyuria c - constipation c - cramps
If the pH is _________ toward acidosis or alkalosis the value matching this imbalance is the primary problem.
leaning
HYPERtonic: When you're hyper you move around a lot and shrink. Cells in a hypertonic solution _____ fluid and _____.
lose shrink
______, ____, _____ are responsible to control pH - Failure to restore acid-base imbalances can lead to impairment of organs and critical body functions
lungs, kidneys, and cells
Loss of gastric juices, antacids, overuse of antiacids, and potassium wasting diuretics (loss of H+) These can all cause what pH imbalance?
metabolic alkalosis
Pediatric Nursing and Renal Function All ________ are present at birth, the ureters are short, and tubules have smaller surface area resulting in diminished water reabsorption. Nephrons grow in size, and the kidneys and the tubule system gradually develop during childhood to reach adult size during adolescence. Glomerular filtration is at ___%-___% of adult levels throughout first year of life. Glomerular filtration rate increases during childhood. Kidneys are less efficient at regulating electrolytes and acid base balance, and less able to concentrate urine. Diarrhea, infection, improper feeding may lead to sever _______ and fluid imbalance. Efficiency of the kidneys in regulating electrolytes and acid base balance increases after 2 years of age. Average daily urine output is up to 15 to 50 ml at birth to 400 ml at 2 months of age. Average daily urine output increases during childhood and reaches 700 to 1500 ml during adolescence. Reproductive system immature. Reproductive system matures after puberty.
nephrons 30-50 acidosis
Helpful Tips If the pH is uncompensated - only one of the buffers is out of range and the other is ______. The pH is also out of range.
normal
Diagnostic Study / Fluid Challenge •For patient with _______ in the acute-care setting: Administer ____-____ ml of normal saline IV. -Give over __-__ minutes •Distinguishes reduced renal blood flow (hypovolemia) from ______ renal function. Bed rest can decrease the ________ demands on the body
oliguria 100-500 10-15 decreased metabolic
Phases of ARI •_______ period (Ischemic ATN): -Less than ______ mLs urine /24 hours produced (need _____ mLs of urine to rid body of waste products). -Nonoliguric form: ________ renal function, ________ nitrogen, normal urine output (2L /day or more).
oliguria 400 400 decreased increased
If the pH is partially compensated. Both of the buffers are out of range in an attempt to correct the pH, but the pH is still ____ of _____ This can also be described as one system (respiratory or metabolic) acidosis or alkalosis with the opposite system compensation
out of range
If the pH is compensated both of the buffers are ___ of _____ and the pH is ______ (Normal range)
out of range corrected
PCO2 and HCO3- are Buffers •The buffers shift ___ or ____ to keep the pH in range •If one buffer goes out of range, the other buffer kicks in to try and fix it. •To fix the problem, the other buffer goes up or down to balance the pH. •The helping is the _______
up or down compensation
Diagnostic Tests for Renal Failure Concentration ability is lost early in kidney disease, hence, these test findings may disclose early defects in renal function
urine osmolality
Overall : I to II : _______ throughout peripheral body and more blood flow to the kidney
vasocontriction
Potential Complications : Excess Fluid Volume - Renal Complications •Assess for signs and symptoms of fluid ________ ________, and keep accurate I&O and daily weights. •Limit fluid to prescribed amounts. •Identify all sources of fluid intake. •Explain to patient and family the rationale for fluid restrictions. •Assist patient to cope with fluid restrictions. •Provide or encourage frequent ______ hygiene.
volume excess oral
- Urine Formation - Excretion of ____ products - Regulation of water excretion - Regulation of electrolytes - Regulation of _____-_____ balance - Control of water balance and ________ ______ These are all functions of what organ?
waste acid-base blood pressure kidneys
