Term
| What is the most accurate indicator of fluid loss or gain? |
|
Definition
|
|
Term
| what are the causes of acute renal failure? |
|
Definition
Hypovolemia
Hypotension
Reduced cardiac output and heart failure
Obstruction of the kidney or lower urinary tract
Obstruction of renal arteries or veins |
|
|
Term
| what are the causes of chronic renal failure? |
|
Definition
Diabetes mellitus
Hypertension
Chronic glomerulonephritis,
Pyelonephritis or other infections
Obstruction of urinary tract
Hereditary lesions
Vascular disorders
Medications or toxic agents |
|
|
Term
| What is Chronic renal Failure? |
|
Definition
| a progressive, irreversible deterioration of renal function that results in azotemia |
|
|
Term
| What is acute renal Failure? |
|
Definition
| a reversible syndrome that results in decreased GFR and oliguria |
|
|
Term
| when does renal failure occur? |
|
Definition
| when the kidneys cannot remove wastes or perform regulatory functions |
|
|
Term
| what med must be held on dialysis days? |
|
Definition
| antihypertensive agents must be held on dialysis days to avoid hypotension. |
|
|
Term
| what is a common skin problem for patients with renal failure? |
|
Definition
| pruritis- itchy skin due to toxins etc not being flushed out |
|
|
Term
| what are potential problems of the post-operative kidney surgery patient? |
|
Definition
Potential hemorrhage and shock
Potential abdominal distention and paralytic ileus
Potential infection
Potential thromboembolism |
|
|
Term
| what does the intrarenal category of acute renal failure encompass? |
|
Definition
-increased BUN
-increased creatine
-low specific gravity of urine
-increased urine sodium |
|
|
Term
| True or False: The nurse should clamp the nephrostomy tube when the patient is moved. |
|
Definition
| False; a nephrostomy tube should never be clamped, to do so could cause obstruction and resultant pylonephritis |
|
|
Term
| what angle should the penis be positioned in to facilitate entry of a catheter? |
|
Definition
| 902 degrees (in relation to body) |
|
|
Term
|
Definition
| The concentration of urea and other nitrogenous wastes into the blood. |
|
|
Term
|
Definition
| excess of urea and other nitrogenous wastes into the blood, results from azotemia |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Movement of solutes (waste products) from an area of higher concentration to an area of lower concentration. |
|
|
Term
|
Definition
| Final state of renal failure that results in retention of uremic waste products and the need for renal replacement therapies. |
|
|
Term
|
Definition
| Inflammation within the renal tissue |
|
|
Term
|
Definition
| hardening of the renal arteries |
|
|
Term
|
Definition
| Term used to describe the drained fluid from a periotoneal dialysis exchange. |
|
|
Term
| Continuous cyclic peritoneal dialysis |
|
Definition
| Method of peritoneal dialysis in which a peritoneal dialysis machine automatically performs exchanges usually while the patient sleeps. |
|
|
Term
| Continuous renal replacement therapy |
|
Definition
| Variety of methods used to replace normal kidney function by circulating the patients blood through a filter and returning it to the patient. |
|
|
Term
|
Definition
| Solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis. |
|
|
Term
|
Definition
| "artificial kidney" or dialysis machine; contains a semipermeable membrane through which particles of certain size can pass. |
|
|
Term
|
Definition
| type of renal failure with increased glomerular permeability and massive proteinuria |
|
|
Term
|
Definition
| any substance medication or action that destroys kidney tissue |
|
|
Term
|
Definition
| movement of water through a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. |
|
|
Term
|
Definition
| procedure that uses the lining of the patients peritoneal cavity as the semipermeable membrane for exchange of fluid and solutes |
|
|
Term
|
Definition
| inflammation of the peritoneal membrane |
|
|
Term
|
Definition
| Inflammation of the renal pelvis |
|
|
Term
|
Definition
| process whereby water is removed from the blood by means of a pressure gradient between the patients blood and the dialysate |
|
|
Term
|
Definition
| proteins secreted by damaged kidney tubules |
|
|
Term
|
Definition
| type of renal failure with glomerular inflammation |
|
|
Term
|
Definition
| sudden rapid deterioration of kidney function that is sometimes reversible. |
|
|
Term
|
Definition
| type of acute renal failure in which there is actual damage to the kidney tubules |
|
|
Term
|
Definition
| total urine output less than 50mL in 24hr |
|
|
Term
|
Definition
| Type of vascular access for dialysis; created by surgically connecting an artery to a vein |
|
|
Term
|
Definition
| Type of surgically created vascular access for dialysis by which a piece of biologic semi-biologic, or synthetic graft material connects the patients artery to a vein. |
|
|
Term
|
Definition
| abnormal concentrations of nitrogenous wastes in the blood |
|
|
Term
|
Definition
| chronic progressive and irreversible disease of the kidneys |
|
|
Term
| continuous ambulatory peritoneal dialysis |
|
Definition
| method of peritoneal dialysis whereby a patient manually performs four or five completes exchanges or cycles through the day. |
|
|
Term
A patient is admitted with electrolyte imbalance. He has carpo-pedal spasm, ECG changes, and a positive chvostek's sign (slight twitch when flicking the patients cheek). The nurse suspects a deficit of?
a. calcium
b. magnesium
c. phosphorus
d. sodium |
|
Definition
|
|
Term
Acute glomerulonphritis refers to a group of kidney disease in which there is?
a. an inflammatory reaction
b. an antigen antibody reaction to streptococci that results in circulating molecular complexes
c. cellular complexes that lodge in the glomeruli and injure the kidney.
d. all the above |
|
Definition
|
|
Term
In most cases the major stimulus to acute glomerulonephritis is?
a. escherichia coli
b. group A streptococcal infection of the throat.
c. staphylococcus aureus
d. neisseria gonorrhoeae |
|
Definition
|
|
Term
Laboratory findings consistent with acute glomerulonephritis include all of the following except?
a. hermaturia
b. polyuria
c. proteinuria
d. white cell casts |
|
Definition
|
|
Term
Chronic glomerulonephritis is manifested by?
a. anemai secondary to erythropoiesis.
b. Hypercalcemia and decreased serum phyosphorus.
c. hypokalemia and elevated bicarbonate
d. metabolic alkalosis |
|
Definition
|
|
Term
The major manifestation of nephrotic syndrome is?
a. hematuria
b. hyperalbuminemia
c. edema
d. anemia |
|
Definition
|
|
Term
A clinical diagnosis of nephrotic syndrome is consistent with an exceedingly high level of?
a. albumin
b. low density lipoproteins
c. protein in the urine
d. serum cholesterol |
|
Definition
|
|
Term
Acute renal failure (ARF) caused by parenchymal damage to the glomeruli or kidney tubules results in all of the following except?
a. decreased GFR
b. increased urine specific gravity
c. impaired electrolyte balance
d. progressive azotemia |
|
Definition
|
|
Term
Oliguria is a clinical sign of ARF that refers to a daily urine output of?
a. 1.5 L
b. 1.0L
c. less than 500mL
d. Less than 50mL |
|
Definition
|
|
Term
| A fall in CO2 combining power and blood pH indicates what state accompanying renal function? |
|
Definition
|
|
Term
Hyperkalemia is a serious electrolyte imbalance that occurs in ARF and results from?
a. protein catabolism
b. electrolyte shifts in response to metabolic acidosis
c. tissue breakdown
d. all of the above. |
|
Definition
|
|
Term
Potassium intake can be restricted by eliminating high potassium foods such as?
a. butter
b. citrus fruits
c. cooked white rice
d. salad oils |
|
Definition
| b- also kiwi, bananas, and salt substitutes |
|
|
Term
A patient with ARF and negative nitrogen balance is expected to lose about?
a. 0.5kg/day
b. 1.0kg/day
c. 1.5kg/day
d. 2.0kg/day |
|
Definition
|
|
Term
The leading cause of end stage renal disease is?
a. diabetes mellitus
b. hypertention
c. glomerulonephritis
d. toxic agents |
|
Definition
|
|
Term
A patient with stage 3, chronic renal failure would be expected to have?
a. a GFR of >90ml/min/1.73
b. a GFR = 30 to 59 ml/min/1.73
c. severe decreases in GFR
d. kidney failure |
|
Definition
|
|
Term
In chronic renal failure (end stage renal disease), decreased glomerular filtration leads to?
a. increased pH
b. decreased creatinine clearance.
c. increased blood urea nitrogen (BUN)
d. all of the above. |
|
Definition
|
|
Term
Decreased levels of erythropoietin, a substance normally secreted by the kidneys leads to which serious complication of chronic renal failure?
a. Anemia
b. acidosis
c. hyperkalemia
d. pericarditis |
|
Definition
|
|
Term
Recent research about the long term toxicity of aluminum products has lead physicians to recommend antacids that lower serum phosphorus such as?
a. calcium carbonate
b. sodium bicarbonate
c. magaldrate
d. milk of magnesia |
|
Definition
|
|
Term
Dietary intervention for renal deterioration includes limiting the intake of?
a. fluid
b. protein
c. sodium and potassium
d. all of the above. |
|
Definition
|
|
Term
The process that under lies and supports the procedure of hemodialysis is?
a. diffusion
b. osmosis
c. ultra-filtration
d. all of the above. |
|
Definition
|
|
Term
An incomplete protein not recommended for the diet of a patient managed by long term hemodialysis is that found in?
a. eggs
b. fish
c. milk
d. nuts |
|
Definition
|
|
Term
At the end of five peritoneal exchanges the patients fluid loss was 500mL. This loss is equal to approximately?
a. 0.5lbs
b. 1.0 lbs
c. 1.5 lbs
d. 2 lbs |
|
Definition
|
|
Term
Preoperative management for a patient who is to undergo kidney transplantation includes?
a. bringing the metabolic state to as normal a level as possible.
b. make certain that the patient is free of infection.
c. suppressing immunologic defense mechanisms
d. all of the above. |
|
Definition
|
|
Term
Postoperative management for a recipient of a transplanted kidney includes?
a. Aseptic technique to avoid infection.
b. hourly urinary output measurements to estimate the degree of kidney function.
c. protective isolation while immunosuppressive drug therapy is at its maximum dosage.
d. all of the above. |
|
Definition
|
|
Term
|
Definition
| Carpopedal spasm and tetany |
|
|
Term
|
Definition
| muscle hypotonicity and flank pain |
|
|
Term
| positive chvosteck's sign is indicative of? |
|
Definition
|
|
Term
| crackles and dyspnea is indicative of? |
|
Definition
|
|
Term
| chronic weight loss and fatigability is indicative of? |
|
Definition
|
|
Term
| The primary cause of chronic kidney disease is? |
|
Definition
|
|
Term
| Nephrosclerosis is primarily caused by ___________ and ____________ |
|
Definition
| prolonged hypertension and diabetes |
|
|
Term
| List six major clinical manifestation of glomerular injury. |
|
Definition
1. Proteinuria
2. hematuria
3. decreased GFR
4. Edema
5. hypertension,
6. decreased sodium excretion |
|
|
Term
| Two blood levels that are significantly increased in ARF are _____________ and ____________ |
|
Definition
|
|
Term
| List three major condition that cause ARF |
|
Definition
1. Prerenal conditions are hemorrhage and sepsis
2. intrarenal conditions are crush injuries and infection
3. Postrenal conditions are obstruction distal to kidney |
|
|
Term
| In ARF name two clinical signs of hyperkalemia |
|
Definition
1. Potassium levels greater than 5.5
2. T wave elevation in the QRS complex. |
|
|
Term
| List six potential complication of dialysis treatment. |
|
Definition
1. lethargy
2. headache
3. muscle twitching
4. seizures
5. nausea
6. vomiting and diarrhea |
|
|
Term
| The leading cause of death for patients undergoing chronic hemodialysis is? |
|
Definition
| arteriosclerotic cardiovac |
|
|
Term
| The most common and serious complication of continuous ambulatory peritoneal dialysis (CAPD) is ? |
|
Definition
|
|
Term
| Two complicatoin of renal surgery that are believed to be caused by reflex paralysis of intestinal peristalsis and manipulation of the colon or duodenum during surgery are ___________ and ____________ |
|
Definition
| abdominal distention and paralytic ileus |
|
|
Term
| A new fistula requires ___________ months to mature. This time is necessary because? |
|
Definition
| 2 to 3 months; time is needed for the venous segment of the fistula to dilate to accommodate two large bore needles |
|
|
Term
| Describe the exercise the patient should perform to help increase the vessel size. |
|
Definition
| squeeze a rubber ball for forearm fistulas |
|
|
Term
Edward chose CAPD because it helped him?
a. avoid severe dietary restriction
b. control his blood pressure
c. have control over his daily activities
d. do all of the above. |
|
Definition
|
|
Term
| continuous ambulatory peritoneal dialysis= |
|
Definition
|
|
Term
Using CAPD Edward need to dialyze himself?
a. approximately four to five times a day with no night changes
b. every 3hrs
c. every 4 hours
d. once in the morning and once in the evening. |
|
Definition
|
|
Term
Edward need sto be aware that toxic wastes are exchanged during the equilibration or dwell time which usually lasts for?
a. 10 to 15mins
b. 30mins
c. 1hr
d. 2 to 3hr |
|
Definition
|
|
Term
Edward needs to be taught how to detect signs of the most serious and most common complication of CAPD, which is?
a. an abdominal hernia
b. anorexia
c. edema
d. peritonitis |
|
Definition
|
|
Term
Nurses need to assess for symptoms consistent with pathology secondary to reduced renal blood flow. Symptoms would include?
a. reduced glomerular filtration
b. renal ischemia
c. tubular damage
d. all of the above |
|
Definition
|
|
Term
During the oliguric phase of ARF, Frans protein intake for her 156lb body weight should be approximately?
a. 35 g/24hr
b. 70 g/24hr
c. 120 g/24hr
d. 156 g/24hr |
|
Definition
|
|
Term
While evaluating laboratory studies the nurse expect that Frans oliguric phase will be marked by all of the following except:
a. blood urea nitrogen of 10mg/dL
b. serum creatinine of 0.8 mg/dL
c. Serum potassium of 6mEq/L
d. urinary volume less than 600 mL/24h |
|
Definition
|
|
Term
After the diruetic phase the nurse should recommend a?
a. high potassium diet
b. high protein diet
c. low carbohydrate diet
d. low fat diet |
|
Definition
|
|
Term
The nurse expects the period of recovery to follow a period of oliguria and to last approximately?
a. 2wks
b. 6wks
c. 2 months
d. 6 to 12 months |
|
Definition
|
|
Term
| what are neurological manifestations of CRF? |
|
Definition
| asterixis, tremors & seizures |
|
|
Term
| what is an integumentary manifestation of CRF |
|
Definition
|
|
Term
| what is kayexalate used for? |
|
Definition
| decrease potassium level seen in ARF |
|
|
Term
| when is acute dialysis indicated? |
|
Definition
| when ther is a high and increasing level or serum potassium, fluid overload, or impending pulmonary edema or increasing acidosis |
|
|
Term
| How long should the nurse wait after administering heparin to a dialysis patient before administering any other injections? |
|
Definition
|
|
Term
| metabolic acidosis in CRF is treated how? |
|
Definition
| it usually is not treated and produces no symptoms |
|
|
Term
| what is most common sign of acute renal failure |
|
Definition
|
|
Term
| what is most common categorey of ARF? |
|
Definition
| prerenal- 60-70% of cases |
|
|
Term
|
Definition
Initiation – initial insult to oliguria
Oliguria – uremic symptoms appear - hyperkalemia
Diuresis – gradual increase in urine output
Recovery – improvement of renal function, lab results to normal |
|
|
Term
|
Definition
Changes in urine
Kidney contour
Lab values
May see altered volume, hematuria, low specific gravity
US, CT, MRI
BUN level, creatinine levels |
|
|
Term
| what does medical management of ARF entail? |
|
Definition
Fluid balance
Hemodialysis
Peritoneal dialysis
CRRT |
|
|
Term
| what is most life threatening fluid change? |
|
Definition
|
|
Term
| what do we give is someone is hemodynamically unstable? |
|
Definition
| IV dextrose, insulin and calcium |
|
|
Term
| how does ARF affect nutrition? |
|
Definition
| causes electrolyte causes imbalances, impaired glucose use, and protein synthesis |
|
|
Term
| what condition makes ESRD progress more rapidly? |
|
Definition
|
|
Term
| what is a sign of renal function declining in ESRD? |
|
Definition
| more protein wastes accumulate in blood |
|
|
Term
| what are complications of ESRD? |
|
Definition
Hyperkalemia
Pericarditis
Pericardial effusion
Pericardial tamponade
Hypertension
Anemia
Bone disease and metastatic calcifications |
|
|
Term
|
Definition
Calcium and phosphorus binders – Renagel
Antihypertensives and CV agents
Antiseizure agents
Erythropoetin
Heparin
Dialysis |
|
|
Term
| what should you remember about renagel? |
|
Definition
| most be given with food – avoid magnesium antacids. |
|
|
Term
| what kind of restrictions will someone with ESRD have? |
|
Definition
| protein and fluid restrictions |
|
|
Term
|
Definition
Used for short and long term
Prevents death but doesn’t cure
Usually 3x/week for 3-4 hours/session |
|
|
Term
| what are complications of hemodialysis? |
|
Definition
Complications of ESRD
Heart failure
CV disease leading cause of death in dialysis patients
Anemia
GI bleeds
Sleep disturbance
SOB
Hypotension
Muscle cramps
Exsanguination
Embolism |
|
|
Term
| when is (continuous renal replacement therapy (CRRT) commonly used? |
|
Definition
| when the patient is too unstable for hemodialysis |
|
|
Term
|
Definition
Slower rate than HD – better suited for some patients
Peritoneal membrane serves as semipermeable membrane
Takes 36-48 hours versus 6-8 with HD |
|
|
Term
| what is procedure for peritoneal dialysis? |
|
Definition
Informed consent
Vitals
Empty bladder and bowels
Concentration of dialysate and additives
Infusion by gravity 5-10 minutes for 2=3 mL
Tube in unclamped and fluid drains out - should be clear
Higher concentration of dextrose = more fluid removed |
|
|
Term
| what is the first sign of peritonitis? |
|
Definition
|
|
Term
| if you see drainage from a peritoneal patient that is cloudy, what should you do? |
|
Definition
| collect sample so a cell count and gram stain can be performed |
|
|
Term
| when a patient is on dialysis what should the nurse keep in mind about the vascular access point? |
|
Definition
- protect this assess point
-don't take B/P point, tight dressing or apply restraints on side of assess
- assess for bruit or thrill over site every 8 hours |
|
|
Term
| for kidney surgery, what are pre op concerns? |
|
Definition
| fluid maintenance, lab values, patient education |
|
|
Term
| for kidney surgery, what are post op concerns? |
|
Definition
hemorrhage and shock major concerns
Fluid/blood replacement
Abdominal distention/paralytic ileus
Infection |
|
|
Term
| what is treatment of choice for ESRD |
|
Definition
|
|
Term
| what are contraindications for receiving a transplant |
|
Definition
| cancer, infection, irreversible disease, active autoimmune disease, morbid obesity, inability to give consent, non-compliance |
|
|
Term
| pre op managment of a kidney transplant |
|
Definition
| stabilizing metabolic rate, infection control, surgery prep and patient education |
|
|
Term
| rejection of a kidney transplant |
|
Definition
rejection can occur from 24 hours to 14 days
Assessing for rejection:
Oliguria
Edema
fever,
Increasing BP
Weight gain
Swelling/tenderness over graft
Asymptomatic rise in creatinine (while on cyclosporine) |
|
|
Term
| what should the nurse keep in mind for both donor and recipient? |
|
Definition
Infection prevention – hand hygiene!!!!!!!
Urinary function
Psychosocial
Complications -surgical and after
Self care |
|
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