Test 2 Review
What is a major cause of hospital-acquired AKI?
Radiocontrast-induced nephropathy
What is the function of Glycosaminoglycan?
Hydrophilic protein which ererts a nonadherent protective effect against various bacteria. (forms a water barrier)
Which two corresponding electrolyte imbalances are common as renal disease progresses and GFR falls?
Hyperphosphatemia and hypocalcemia
The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet? "Chocolate, spinach, and strawberries are not allowed." "I should avoid raw fruits and vegetables." "I should limit my intake of meat and fish." "I will eliminate milk and other dairy products from my diet."
A low-purine diet is prescribed for the client with uric acid renal calculi. Organ meats, shellfish, anchovies, asparagus, and mushrooms are foods high in purine.
What is uremia?
Excess of urea and other nitrogenous waste products in the blood
What is the most common subjective presenting symnptom of UTI in older adults?
Generalized fatigue
Other causes of CKD
Glomerulonephritis, pyelonephritis; polycystic, hereditary or congenital disorders and renal cancers
Second leading cause of CKD
Hypertension
The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which instruction as a measure to prevent additional kidney stones?
The nurse should teach the client to avoid tea and other oxalate-containing foods, such as spinach, strawberries, rhubarb, peanuts, and wheat bran. The client should restrict protein intake to 60 g/day and should drink two glasses of water at bedtime. Low-calcium diets are generally not recommended.
What are a few nursing interventions aimed at preventing lower UTIs?
1. Aseptic technique for insertion 2. Securing catheter to prevent movement 3. Frequent inspection of urine for color, consistency, and odor 4. Daily, meticulous peri-care with soap 5. Maintaining a closed system 6. Follow manufactorer's instructions for obtaining a specimen
What are two possible nursing diagnoses for patients with lower UTIs?
Acute pain Deficient Knowledge
What is azotemia?
An abnormal concentration of nitrogenous wastes in the blood.
What are the four primary risk factors for CKD?
Cardiovascular disease, diabetes, HYP, and obesity.
Primary cause of CKD
Diabetes
What blood pressure measurement is often associated with malignant nephrosclerosis?
Diastolic over 130 mmHg
Treatment of metabolic acidosis in chronic renal failure includes: No response Sodium bicarbonate Hemodyalisis CRRT
No Response - It is asymptomatic, therefore no response is required.
What is the most common objective finding in older adult pts with a UTI?
Change in cognitive functioning
What are the two most common causes of nephrosclerosis?
Prolonged HYP and diabetes
What are the two types of nephrosclerosis?
Malignant (accelerated) and benign
A patient has a history of multiple urinary tract infections. The nurse catheterized the patient and confirmed the presence of residual urine. Select the urine volume that is significantly associated with the risk of infection. 25 mL 50 mL 100 mL 150 mL
Residual urine volume of more than 100 mL is significantly associated with the risk of infection. Amounts of less than 100 are within a normal range.
What are the stages of Chronic Kidney Disease as indicated by GFR (mL/min)
Stage 1 = 90 or lower Stage 2 = 60-89 Stage 3 = 30-59 Stage 4 = 15-29 Stage 5 = <15 (ESRD)
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. lethargy muscle cramps bleeding of the oral mucous membranes enhanced cognition
Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.
What are two potential serious complications of lower UTIs?
Renal Failure Sepsis (aka urosepsis; specifically, gram-negative)
What is the most common type of bacteria present in the urine for UTIs? For men?
1. E. coli 2. Pseudomonas and Enterococcus
What are three strategies for preventing hospital acquired CIN?
1. Screen pts for baseline Creatinine level of 2 or higher 2. Administer N-acetylcysteine and sodium bicarbonade before and during procedures 3. Prehydration with saline (MOST effective)
What is the concentration of bacteria in the urine for women which constitutes diagnosis of bacturia?
10^5 colonies/mL; 10^4 for men; any present for pts who are catheterized
How long is a typical antibiotic regimen for a woman with an uncomplicated lower UTI?
3-4 days; 7-10 days if institutionalized
Which form of sepsis are patient's with UTIs at risk for developing?
Gram-negative
What is nephrosclerosis?
Hardening of the renal arteries
When caring for a client with an uncomplicated mild urinary tract infection (UTI), the nurse knows that recent studies have shown which drug to be a good choice for short-course (e.g., 3-day) therapy? Levofloxacin Trimethoprim-sulfamethoxazole Nitrofurantoin Ciprofloxacin
Levofloxacin, a fluoroquinolone, is a good choice for short-course therapy of uncomplicated mild to moderate UTI. Clinical trial data show high client compliance with the 3-day regimen (95.6%) and a high eradication rate for all pathogens (96.4%). Trimethoprim-sulfamethoxazole (TMP-SMZ) and nitrofurantoin are commonly used to treat complicated UTIs, such as pyelonephritis. Ciprofloxacin is also a good choice for treatment of a complicated UTI. Recent studies have found ciprofloxacin to be significantly more effective than TMP-SMZ in community-based clients and in nursing home residents.
For which populations is a longer antibiotic regimen indcated for treatment of a lower UTI?
Men, pregnant women, pts with pyelonephritis, pts with complicated infections.
What factors contribute to the older population's risk for medication related changes in renal function?
Reduced renal blood flow, glomerular filtration, and renal clearance.
The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis? A client with acute renal failure A client with a urinary tumor A female client with preexisting chronic glomerulonephritis A client with urinary obstruction
The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high risk for developing pyelonephritis.
Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply. Acute pyelonephritis Renal abscess Cystitis Urethritis Prostatatis
Upper UTIs include acute pyelonephritis, renal abscess, perineal abscess, chronic pyelonephritis, and interstitial nephritis. Lower UTIs include cystitis, urethritis, and prostatitis.
A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief? Encourage frequent ambulation. Encourage the client to void every 2 to 3 hours. Restrict the client's sodium intake. Encourage deep-breathing exercises.
When a client with urinary calculi complains of excruciating pain, the client should be encouraged to ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis. The suggestion for restricting sodium intake is offered to a client with chronic glomerulonephritis, not urinary calculi. The nurse should promote deep-breathing exercises to provide relief to a client recovering from surgery who has an ineffective breathing pattern.
What factors other than reduced physiological reserve predispose the older population for CKD?
atherosclerosis, HYP, HF, diabetes, cancer, prescription and OTC meds
