Unit 3 - Elimination - Class Notes & NCO

PATIENT CHART: Sodium: 135 mEq/L Potassium: 6mEq/L Hgb: 8.5 g/dL Creatinine Clearance: 20mL/min VITALS: Temp: 99F; Pulse 84; RR 24 bpm; BP: 150/100 An older adult client is admitted to the hospital with a diagnosis of chronic kidney disease. The nurse reviews the client's medical record. Which clinical finding is a priority to be communicated to the primary healthcare provider? 1 Sodium level 2 Potassium level 3 Creatinine results 4 Blood pressure results

2 Potassium level The potassium is increased outside the expected range for an adult, which places the client at risk for a cardiac dysrhythmia; the increased potassium level must be treated immediately, because elevated levels can be lethal. A serum sodium of 135 mEq/L (135 mmol/L) is expected because of the electrolyte imbalance and the anemia related to the decreased production of erythropoietin by the kidney in the presence of chronic kidney failure. A creatinine clearance of 20 mL/min (0.33 mL/sec) is low, but the priority is the high potassium level. Clients with chronic kidney disease usually have hypertension, and notification is unnecessary.

When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do? 1 Drink a glass of water 2 Turn from side to side 3 Deep breathe and cough 4 Rotate the catheter periodically

2 Turn from side to side Turning from side to side will change the position of the catheter, thereby freeing the drainage holes of the tubing, which may be obstructed. Drinking a glass of water and deep breathing and coughing do not influence drainage of dialysate from the peritoneal cavity. The position of the catheter should be changed only by the primary healthcare provider.

Which laboratory finding is suggestive of mild kidney disease in male clients? 1 Serum creatinine - 0.9 mg/dL 2 Urinary albumin - 24 mg/mmol 3 Blood urea nitrogen (BUN) - 18 mg/dL 4 Blood urea nitrogen (BUN)/creatinine ratio - 23

2 Urinary albumin - 24 mg/mmol Increased levels of albumin in the urine indicate mild or moderate kidney disease. The normal levels of albumin in the urine range between 2.0 and 20 mg/mmol in men and between 2.8 and 28 mg/mmol in women. An albumin level of 24 mg/mmol is higher than the normal range for men. Therefore a urinary albumin of 24 mg/mmol suggests mild kidney failure. The normal levels of serum creatinine range between 0.6-1.2 mg/dL in men and between 0.5-1.1 mg/dL in women. Therefore a serum creatinine value of 0.9 mg/dL is normal. Blood urea nitrogen (BUN) in the range of 10-20 mg/dL is normal. Therefore a BUN value of 18 mg/dL is a normal finding. The normal range of a BUN/creatinine ratio is between 6 and 25. Therefore a BUN/creatinine ratio of 23 is a normal value.

A client is to have hemodialysis. What must the nurse do before this treatment? 1 Obtain a urine specimen to evaluate kidney function. 2 Weigh the client to establish a baseline for later comparison. 3 Administer medications that are scheduled to be given within the next hour. 4 Explain that the peritoneum serves as a semipermeable membrane to remove wastes.

2 Weigh the client to establish a baseline for later comparison. A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.

A nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client's questions? 1 A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses. 2 Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis. 3 This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. 4 Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

3 This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys, which should be prevented. Adequate calories are provided to prevent tissue catabolism that also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high-protein diet, which is to be avoided. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.

The nurse must meet the hydration needs of a preterm infant. What should the nurse consider carefully regarding the preterm infant's kidney function? 1 Large amounts of urine are excreted. 2 It is the same as in a full-term newborn. 3 Urine is concentrated, with an increased specific gravity. 4 Acid-base and electrolyte balance are adequately maintained.

1 - Large amounts of urine are excreted. The preterm infant has a reduced glomerular filtration rate and reduced ability to concentrate urine or conserve water. The preterm infant usually has a salt and water diuresis in the first 48-72 hours of life. Preterm infants have a restricted tubular capacity to reabsorb sodium and consequently have large amounts of urine excreted. All systems of the preterm neonate are less developed than in the full-term neonate. Urine is very dilute, not concentrated. Fluid and electrolyte balance in a preterm infant is easily upset.

The nurse is providing dietary teaching to a client who is receiving hemodialysis. What should the nurse encourage the client to include in the dietary plan? 1 Rice 2 Potatoes 3 Canned salmon 4 Barbecued beef

1 Rice Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.

A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)? 1 Fluid 2 Protein 3 Sodium 4 Potassium

2 Protein The waste products of protein metabolism are the main cause of uremia. The degree of protein restriction is determined by the severity of the disease. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium is restricted to control fluid retention, not uremia. Potassium is restricted to prevent hyperkalemia, not uremia.

A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client? 1 Blood 2 Sodium 3 Glucose 4 Bacteria

2 - Sodium Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis.

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? 1 Facial flushing 2 Edema and pruritus 3 Dribbling after voiding and dysuria 4 Diminished force and caliber of stream

2 Edema and pruritus The accumulation of metabolic wastes in the blood ( uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? 1 Peritonitis 2 Hepatitis B 3 Renal calculi 4 Bladder infection

2 Hepatitis B Hepatitis type B [1] [2] is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.

A client is admitted to the hospital with a diagnosis of severe chronic kidney disease (CKD). Which assessment findings should the nurse expect the client to exhibit? Select all that apply. 1 Polyuria 2 Paresthesias 3 Hypertension 4 Metabolic alkalosis 5 Widening pulse pressure

2 Paresthesias 3 Hypertension Paresthesias [1] [2] occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.

A 9-year-old child with chronic kidney disease is undergoing peritoneal dialysis. For which associated complication should the nurse monitor the child? 1 Petechiae 2 Abdominal bruit 3 Cloudy return dialysate 4 Increased blood glucose level

3 - Cloudy return dialysate The returned dialysate should be clear; cloudy return dialysate solution is indicative of infection. Petechiae do not occur during dialysis treatments. There is no danger of developing an abdominal bruit during dialysis. Dialysis does not affect the blood glucose level.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? 1 It equals the expected urinary output for the next 24 hours. 2 It will prevent the development of pneumonia and a high fever. 3 It will compensate for both insensible and expected output over the next 24 hours. 4 It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

3 It will compensate for both insensible and expected output over the next 24 hours. Insensible losses are 500 to 1000 mL in 24 hours, with an average of about 600 mL; the measured output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever. Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to fluid intake.

A nurse educates the client about the relationship between the kidneys and blood pressure. Which term should the nurse use to describe the part of the kidney that senses changes in blood pressure? 1 Calices 2 Glomerulus 3 Macula densa 4 Juxtaglomerular cells

3 Macula densa The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood. Calices are cup-like structures, present at the end of each papilla that collect urine. The glomerulus is the initial part of the nephron, which filters blood to make urine. Juxtaglomerular cells secrete renin. Renin is produced when sensing cells in the macula densa sense changes in blood volume and pressure.

A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? 1 "I'll offer more drinks in warm weather." 2 "I should call the clinic if he vomits or has diarrhea." 3 "I'll check his pulse at the wrist on each arm every day." 4 "It's OK to take his blood pressure on the arm with the fistula."

4 "It's OK to take his blood pressure on the arm with the fistula." Taking the blood pressure on the arm with the arteriovenous fistula is contraindicated because the pressure of the inflated cuff may disrupt the integrity of the fistula. Consumption of more fluids is desirable because inadequate fluid intake can result in dehydration and an acid-base imbalance. Calling the clinic is desirable because vomiting or diarrhea may lead to dehydration and an acid-base imbalance. Not only should the pulse be monitored to assess vascular function distal to the arteriovenous fistula, but it should be done on both extremities and the results compared.

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response? 1 "The staff will provide total care, because the infection causes severe fatigue." 2 "Mood elevators will be prescribed to improve depression and irritability." 3 "Vitamin B₁₂ will be prescribed for the anemia, and the stools will be dark." 4 "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

4 "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products." One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron and folic acid supplements are used for anemia in chronic kidney disease; Vitamin B 12 is used for pernicious anemia and does not make the stools dark; iron makes the stools dark.

The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? 1 Potassium 8 mEq/L 2 Hemoglobin 10 g/dL 3 Phosphorous 7 mg/dL 4 Bicarbonate 15 mEq/L

4 Bicarbonate 15 mEq/L An increased rate and depth of breathing is called Kussmaul respiration and occurs due to metabolic acidosis in clients with kidney disease. Serum bicarbonate level decreases in metabolic acidosis. The normal range of serum bicarbonate is 23-30 mEq/L. Therefore the bicarbonate value of 15 mEq/L is associated with Kussmaul respirations in the client. The normal serum potassium is 3.5-5 mEq/L. Therefore a potassium level of 8 mEq/L indicates hyperkalemia and is associated with changes in cardiac rate and rhythm. The normal range of hemoglobin is 12-16 g/dL in females and 14-18 g/dL in males. Therefore a Hgb of 10 g/dL indicates anemia; this is associated with fatigue, pallor, and shortness of breath. The normal range of serum phosphorous is 3-4.5 mg/dL. Therefore a phosphorous value of 7 mg/dL indicates hyperphosphatemia, which is associated with hypocalcemia and demineralization of bone.

A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure? 1 Reestablishing kidney function 2 Cleaning the peritoneal membrane 3 Providing fluid for intracellular spaces 4 Removing toxins in addition to other metabolic wastes

4 Removing toxins in addition to other metabolic wastes Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment.

The most common early sign of kidney disease is?

Elevated BUN levels Increased BUN is usually and early indicator of decreased renal function. BUN/Creatinine is mainly for kidney problems and is also seen in early signs and symptoms; sodium retention however can be for many other things.

Patients with GFR of less than 15 requires what?

GFR of 15 or less indicated stage 5 Kidney failure Patients require DIALYSIS

Your patient with chronic renal failure reports pruritus, which instruction should you include in this patient's teaching plan?

Keep fingernails short and clean