Renal failure

Polystyrene sulfonate (Kayexalate) is used in renal failure to: Correct acidosis Reduce serum phosphate levels Exchange potassium for sodium Prevent constipation from sorbitol use

3. In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.

How is renal failure different from prerenal failure? With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure With prerenal failure, there is less response to such diuretics as furosemide (Lasix) With prerenal failure, an IV isotonic saline infusion increases urine output With prerenal failure, hemodialysis reduces the BUN level

3. Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.

Acute renal failure is generally identified by oliguria (urine output <_____ mL/day).

400

The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

A Pre-renal

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A. A client with chronic kidney failure who was just admitted with shortness of breath B. A client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted C. A client with azotemia whose blood urea nitrogen and creatinine are increasing D. A client receiving peritoneal dialysis who needs help changing the dialysate bag

A. A client with chronic kidney failure who was just admitted with shortness of breath: This client's dyspnea may indicate pulmonary edema and should be assessed immediately.

The client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub B. Assess for crackles C. Monitor for decreased peripheral pulses D. Determine whether the client is able to ambulate

A. Auscultate for pericardial friction rub The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present.

When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have ____________, the final stage of Chronic Renal Failure. A. End-stage renal disease (ESRD) B. Renal insufficiency C. Acute tubular necrosis D.Dialysis

A. End stage renal disease

A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance? A. Hyponatremia B. Hyperkalemia C. Hyperphosphatemia D. Hypercalcemia

A. Hyponatremia

_________ is the most frequent complication during hemodialysis. A. Hypotension B. Bleeding C. Infection D. Dialysis dementia

A. Hypotension

Which clinical manifestation indicates the need for increased fluids in the client with kidney failure? A. Increased blood urea nitrogen B. Increased creatinine C. Pale urine D. Decreased sodium

A. Increased blood urea nitrogen: An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment.

Which is the treatment of choice for many clients with end-stage renal disease? A. Hemodialysis B. Kidney transplant C. Continuous Renal Replacement Therapy (CRRT) D. Peritoneal dialysis

A. Kidney Transplant

A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client? A. Polyuria B. Polydypsia C. Oliguria D. Anuria

A. Polyuria

_________ renal Failure is a rapid decline in renal function with an abrupt onset

Acute

What can cause Intra-renal failure?

Acute tubular necrosis DIC Radiation Rhabdomylosis Glomerulonephritis

What medications should be avoided with chronic kidney disease?

Alka-seltzer milk of mag Asprin Enema or laxative Vitamins Herbal supplements

What natural process can lead to chronic kidney disease?

As you age your number of nephrons fall as does the GFR.

What is a CAT scan and what are some important questions we must ask before doing it?

Assesses kidney function with dye and is hard on the kidney It is important to ask if they have any allergies to shellfish or iodine

The client with renal failure should be on which type of diet? A. High protein, high carbohydrate, low calorie B. Adequate calorie intake, high carbohydrate, limited protein C. Limited protein, low carbohydrate, adequate calorie intake D. Low calorie, limited protein, low carbohydrate

B. Adequate calorie intake, high carbohydrate, limited protein

________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction; muscle tissur breakdown due to trauma, heatstroke) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

B. Intra-renal

When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, intake of these substances must be regulated. Fluid and Sodium intake are ________. A. Encouraged B. Limited C. Restricted

B. Limited

When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure? A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura)

B. Lisinopril (Zestril): Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers (diltiazem/Cardizem) may indirectly prevent kidney disease by controlling hypertension but are not specific to slowing progression of kidney disease.

Which phase of Acute Renal Failure results in FVE and edema due to salt and water retention, hypertension, Azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels? A. Initiation phase B. Maintenance phase C. Recovery fase D. Intrarenal phase

B. Maintenance phase

Agents that damage the kidney tissue are called: A. Nephrons B. Nephrotoxins C. Antibodies D. Enterotoxins

B. Nephrotoxins

What can cause post renal failure?

BPH Kidney and bladder stones Blood clots Tumors Neurogenic bladder- back injury

What are the three life sustaining tasks done by the kidney?

Balance solutes and water Excrete wastes and conserve nutrients Regulate acid/base balance

Why do we look at ABG's with renal failure?

Because of the Bicarb in relation to metabolic acidosis

What is uremia and is it chronic or acute?

Build up of urine in the blood and it is chronic

What is confusion caused by?

Build up of waste products in the body

The nurse recognizes that the client with end-stage kidney disease has difficulty adhering to the fluid restriction when which of these is found? A. Blood pressure 118/78 B. Weight loss of 3 lbs during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg

C. Dyspnea and anxiety at rest: Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.

Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A. Hypernatremia. B. Hypokalemia. C. Hyperkalemia. D. Hypercalcemia.

C. Hyperkalemia

For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? A. Encouraging coughing and deep breathing B. Promoting carbohydrate intake C. Limiting fluid intake D. Providing pain-relief measures

C. Limiting fluid intake

Which of these drugs is nephrotoxic? A. Diuretics B. ACE inhibitors C. NSAIDs D. Sodium bicarbonate/ Potassium bicarbonate

C. NSAIDS

__________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

C. Post renal

Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________. A. Hematuria B. Oliguria C. Uremia D. Nephrotoxins

C. Uremia

What is hypertension and is it acute or chronic?

Caused by accelerated atherosclerosis increased fluid volume due to the renin-angiotensin system not functioning. Chronic

________ renal failure is a slow, insidious process of kidney destruction. It may go unrecognized for years as nephrons are destroyed and renal mass is reduced.

Chronic

What is Acute renal failure?

Common in older adults Need to do a quick reversal or it will turn into chronic renal failure Treat with prevention and hemodialysis Caused by ischemia and nephrotoxins

The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately? A. Blood urea nitrogen 50 mg/dl B. Hemoglobin of 10.3 mg/dl C. Venous blood pH 7.30 D. Serum potassium 6 mEq/L

D. Serum Potassium of 6

What are nursing diagnosis for chronic renal failure?

Disturbed body image Risk for depression Self care deficit

What is BUN and what does it measure?

Does not tell us specifically about the kidney, but tells us about the amount of urea nitrogen in the blood

What are signs and symptoms of chronic renal failure?

Edema, Urine breath, Loss of appetite, increased risk for infection, mental status change, confusion, Increased potassium, phosphorus, and magnesium While there is a decrease in calcium There is an increase in atherosclerosis, hypertension, and they are at risk for cardiac tamponade Anemia too They can develop GI bleeds and osteoporosis related to calcium depletion

What is happening in stage five CKD?

End stage renal/kidney failure. Individual is placed on dialysis

What are common electrolyte imbalances in acute renal failure?

Hyperkalemia, hyperphosphatemia, hypocalcemia, and hypermagnesemia are common electrolyte imbalances in acute kidney failure

List the pathological causes for chronic kidney disease:

Hypertension, diabetes, Glomerulonephritis, nephrotic syndrome, polycystic kidney disease, lupus, nephotoxic agents, kidney stones, traumas

What interventions do we do for the nursing diagnosis of Risk for excess fluid volume?

I/O, daily weights, LUNG SOUNDS, edema checks Monitor for hypertension, pulmonary edema Restrict fluids Administer diuretics if the patient still has kidney function Dialysis if the patient does not have kidney function

How do we treat intra-renal failure?

Identify and treat the cause Hydrate Treat infection with antibiotics Compensate using dialysis until function returns

What are some interventions for the nursing diagnosis for at risk for infection?

Increased risk with a hemocath Increased risk with CRF and uremic syndrome Check for signs and symptoms of infection Good hand washing Teach about dialysis site care Monitor WBC AND PROCALCITONIN

What is the number one nursing diagnosis for acute and chronic renal failure?

Ineffective tissue perfusion Acute more than chronic Monitor medications- ACE and ARBS Avoid nephrotoxic medications such as: NSAIDS, Aminoglycocides, ACE inhibitors, contrast dye Monitor, I/O, weight, respiratory status, BUN and creatinine Treat electrolyte imbalance

A client with acute renal failure is aware that the most serious complication of this condition is: A. Constipation B. Anemia C. Infection D. Platelet dysfunction

Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure

What is Fluid retention:edema and is it acute or chronic?

It is caused by holding fluid in the peripheral vascular system

What is anemia and is it chronic or acute?

It is caused by the kidney's failing to produce enough erythropoetin due to damage. Chronic

Why do we do a Intravenous pyleogram?

It is dye in the renal system to look at function

What is oliguria and is it chronic or acute?

It is the excretion of less than 16 ml an hour and less than 400 ml excreted in 24 hours. It is often acute

What is metabolic acidosis and is it chronic or acute?

Kidney cannot make enough bicarb and there is a low to normal pH more so acute

What is happening in stage one of CKD?

Kidney damage with normal GFR function

What is creatinine used to measure?

Kidney function this is the most accurate measure of it It is a 24 hour collection of urine and it tests the waste products

What is the initiation phase of acute renal failure?

Limited decrease in kidney function Few signs or symptoms Main goal is prevention

During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids

Maintenance

What is happening in stage four CKD?

Malnutrition and poor absorption

What is lethargy caused by?

Metabolic acidosis and waste build up

What is happening in stage two of CKD?

Mild decrease in the GFR

What is happening in stage three of CKD?

Moderate decrease in GFR

What nursing interventions do we do for the nursing diagnosis of Imbalanced nutrition?

Monitor renal diet intake Limit fluid, low protein, sodium, potassium, and phosphorus. Small frequent meals Give antiemetics, antacids, pepcid, protonix Hyperphophatemia-use phosphorus binder calcium carbonate Hyperkalemia-Kayexelate + insulin + glucose + bicarb Supplement iron/folate Give epogen Give vitamin D

What are foods that are high in phosphorus?

Organ meat, Dark soda, Hot dogs, sausage, salt substitutes, dried beans, and peanut butter

What electrolytes do you need to watch with renal failure?

POTASSIUM Phosphorus Magnesium Sodium

What are the three different causes of renal failure?

Pre-renal- Kidneys are not getting perfused Intra-renal- damaged to the nephrons Post renal- urine unable to be excreted

What is renal osteodystrophy?

Renal osteodystrophy is a condition due to chronic kidney disease and renal failure, with elevated serum phosphorus levels, low or normal serum calcium levels, and stimulation of parathyroid function, resulting in a variable admixture of bone disease (deformation of bone, weak/brittle bone, abnormal bone metabolism).

How do we treat pre-renal failure?

Replace what was lost Fluids or blood Dopamine 1-3 mc/kg as it vasodilates Vasoconstrictors- Epiniphrine and Levophed Treat the cause Prevent additional damage Monitor urine output and kidney function Placed on hemodialysis until kidney function returns

What is renal insufficiency?

Stage 1 and 2 of chronic kidney disease Having 20%-50% of what your renal function is supposed to be

What is renal failure?

Stage 3 and 4 This is to have less than 20% renal function

What is end stage renal failure?

Stage 5 Individuals only have less than 5% renal function

How do we treat post renal failure?

TURP or OR for BPH Surgical removal of tumors Lithotripsy for stones Hemodialysis till cause is fixed

What are some interventions for the nursing diagnosis of deficient knowledge?

Teach client about disease Teach about infection control Fear/anxiety Depression Spiritual needs

What does GFR measure?

The amount of fluid that goes through filtration in one minute. Normal is 120-125

What is azotemia and is it chronic or acute?

The development of urea in the blood and it is chronic

What is the maintenance phase of acute renal failure?

The kidney begins showing signs of failing Oliguria is present S/S of renal failure are presented This will lead to chronic renal failure if not treated

What is the recovery phase of acute renal failure?

The kidney's begin to repair The tubular cell repair begins There is a gradual return to a normal GFR Diuresis occurs

How do we manage chronic renal failure?

Through diet restrictions: Control fluids Decrease intake of phosphorus, sodium, and potassium Decrease protein intake Increase calcium by eating tums Teach about hemodialysis restrictions Peritoneal dialysis Kidney transplant There is also the option of not treating

What do we use a renal angiogram for?

To look at blood flow through the kidney

Why do we use a cystoscopy?

To look for a blockage

What do we use a renal biopsy for?

To look for diseases and processes

Why do we use a CT scan on the kidney?

To look for masses in the kidney

Why do we use a MRI?

To look for structural abnormalities

What causes pre-renal failure?

Trauma/Surgery Hypovolemia Blood loss/hemorrhage Dehydration Sepsis Heart failure Medications- diuretics, vasoconstrictors, ACE inhibitors, NSAIDS