Care of the Client with Impaired Renal Function
azotemia
(excessive) urea and nitrogenous substances in the blood
CKD
-As the nephrons are damaged the GFR begins to decline -As the GFR declines waste products in the blood begin to build up Elevated BUN Elevated CR -Renal function declines Anemia (decreased erythropoietin) Metabolic Acidosis (Low HcO3) Imbalanced calcium and phosphorus (low Vit D) Fluid Retention (Hypoalbuminemia)
Stage 2 CKD
Kidney damage with mild decrease in GFR 60-89
Stage 1 CKD
Kidney damage with normal GFR >90 with persistent albuminuria
Normal urine output per day
1,500 mL
Blood Analysis for Kidney Disease
CBC, CMP, ABG's, PTH Nursing to monitor for abnormal lab values in association with complications of renal failure.
Risk factors for CKD
DM Lupus Obesity Age HTN CHF Race: AA, Native Americans
oliguria
Decreased urine output <400cc/day
nephrosclerosis
Hardening of blood vessels in the kidney
Tall, peaked T waves
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Multiple spiked P waves Shortened QRS complex Prolonged ST segment Tall, peaked T waves
Diagnostics for Kidney Disease
KUB, Ultrasounds, CT or MRI, Bladder scan
Primary glomerular disease
Patients may exhibit proteinuria, hematuria, decreased GFR, decrease excretion of sodium, edema, and HTN
Stage 4 CKD
Severe decrease in GFR 15-29
diminished erythropoietin production
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? Electrolyte imbalances Impaired immunologic response Azotemia Diminished erythropoietin production
pH 7.20, PaCO2 36, HCO3 14
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.20, PaCO2 36, HCO3 14- pH 7.50, PaCO2 29, HCO3 22-
4000
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?
Hypovolemic shock caused by hemorrhage
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Pneumonia caused by shallow breathing because of severe incisional pain Paralytic ileus caused by manipulation of the colon during surgery Hypovolemic shock caused by hemorrhage Abdominal distention owing to reflex cessation of intestinal peristalsis
anuria
absence of urine
ESRD
chronic kidney disease leads to
Hyperphosphatemia
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Hyperphosphatemia Elevated urea and nitrogen Elevated serum creatinine Hyperkalemia
acute glomerulonephritis
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute glomerulonephritis Chronic renal failure Nephrotic syndrome Acute renal failure
Urine output 20 ml/hour
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Urine output of 20 ml/hour Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C) Serum potassium level of 4.9 mEq/L
hydrating with saline intravenously before the test
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)? Administering Garamycin (gentamicin) prophylactically Hydrating with saline intravenously before the test Performing the test without contrast Administering sodium bicarbonate after the procedure
Functions of the kidney
A-acid/base balance W-water removal E-erythropoiesis T-toxin removal B-blood pressure control E-electrolyte balance D-vitamin D activation
Primary Glomerular Disease
If a patient has had recent illnesses such as strep throat, or chicken pox. Or if a patient has a chronic disease such as Lupus, Goodpasture syndrome, or DM they may have
Stage 3 CKD
GFR 30-59
Stage 5 CKD
GFR <15 Kidney failure
Administration of sodium polystyrene sulfonate
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of a loop diuretic Administration of an insulin drip Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])
Proteinuria
What is a hallmark of the diagnosis of nephrotic syndrome? Hypokalemia Hypoalbuminemia Hyponatremia Proteinuria
sodium polystyrene sulfonate
What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Calcium supplements Sorbitol IV dextrose 50%
Uremia
Which clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Polycythemia Uremia Metabolic alkalosis
nephrotic syndrome
group of clinical signs and symptoms caused by excessive protein loss in urine
Chronic Kidney Disease (CKD)
kidney damage or a decrease in glomerular filtration rate lasting for 3 or more months. GFR <60 ml/min for 3 or months
proteinuria
A client has been diagnosed with acute glomerulonephritis. This condition causes: polyuria. pyuria. proteinuria. No option is correct.
fatigue and weakness
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: dyspnea and cyanosis. thrush and circumoral pallor. nausea and vomiting. fatigue and weakness.
metabolic acidosis
low pH, low HCO3
