Test 8

Question 1

1. Hemodialysis nursing interventions

Answer 1

 Assess for infection.
 Feel the thrill and hear the bruit.
 Pre and post dialysis you need to know their weight.
 Avoid puncturing the same site that was used previously.
 Measure V/S every 30 minutes

 Disequilibrium syndrome: Mannitol IV to prevent it and decrease ICP.
• Dizziness, ataxia, N/V, headache, confusion, and restlessness

Question 2

2. Age related changes in the renal system (slide 17)

Answer 2

 Nocturnal polyuria.
 Decreased glomerular filtration rate.
 Bladder loses elasticity and can’t hold as much urine.
 Bladder muscles weaken and can cause retention.

Question 3

3. Dipstick interpretation(video/slide 10): urine PH and urine specific gravity

Answer 3

Urine PH:
Normal - 6 (4-8)

Ph less than 4
-Urine Acidosis
-Bacterial Infection
-Diabetic Ketoacidosis

PH greater than 8
-Urine Alkalosis
-Medication Related
————————————————-
Urine Specific Gravity:
Normal -1.003-1.030

Less than 1.003
-Fluid Volume Overload
-Diabetes incipidus

Greater than 1.030
-Fluid Volume Deficit (dehydration)
-SIADH

Question 4

3. Dipstick interpretation(video/slide 10): Color

Answer 4

Normal color: amber yellow

BLUE/GREEN:
-Food coloring
-Pseudomonas deruginosa bacterial infection
-Propofol

ORANGE:
-Dehydration
-Phenazopyridine (Pyridium) for UTI

BROWN:
-Metronidazole
-Chloroquine
-Liver (due to bilirubin)
-Rhabdomyolysis (breakdown of myoglobin)

RED (usually trauma related):
-Beets, rhubarb, blueberries
-Kidney stones
-Tumors in the bladder & kidney

Question 5

4. Renal angiography nursing interventions(slide 19)

Answer 5

 Injection of radiopaque dye into renal arteries
 Often done after trauma
 Laxative pre to secure unobstructed view.

Question 6

5. Renal disease medication contraindications

Answer 6

NSAIDS

Question 7

6. Peritoneal dialysis client education/ nursing actions

Answer 7

 Nursing priority is assessing the site for any purulent drainage, odor, numbness and tingling.
 Instillation of the fluid is about 10 minutes.
 Dwelling time is usually 15 minutes when patient is well established.
 Expected to see blood ting.

Question 8

7. Renal calculi-causes

Answer 8

 Diet: Large intake of protein can increase uric acid secretion, large intake of calcium, low fluid intake that inc. urinary concentration
 Lifestyle: Sedentary occupation, immobility
 Dehydration

Question 9

8. Acute kidney injury complications/manifestation

Answer 9

 Oliguric Phase- urine output 400mL/day, fluid & electrolyte abnormalities, + BUN & creatinine, metabolic acidosis, anemia, infection, neurologic changes
 Diuretic Phase- gradual increase in daily urine, 1-3L/day or 3-5L more, severe uremia, low creatinine clearance, (+) creatinine/BUN with persistent signs and symptoms. Dehydration!!!!!
 Recovery Phase- Begins when GFR rate (+), BUN & creatinine plateau (-) renal function may take up to 12 months stabilize.

Question 10

9. Chronic kidney disease lab findings and client education

Answer 10

Lab findings
 Elevated BUN, Creatinin

Client educations: Nutrition therapy
 Protein restriction 0.6-0.75 g/kg
 Can increase protein w/ dialysis.
 Restrict sodium, potassium and magnesium.
 Diet high in carbohydrates and moderate in fat
 Restrict fluid to 600mL.

Question 11

10. Pyelonephritis manifestations(slide 10)

Answer 11

 Costovertebral tenderness
 Fever/chills
 Flank pain
 Nausea/ vomiting
 Dysuria
 Fatigue
 Urgency/ frequency

Question 12

11. Acute glomerulonephritis manifestations(slide 12)?

Answer 12

 Inflammation of the glomeruli
 Very often after a bacterial infection-strep
 Flank pain
 Nausea/ vomiting
 Dysuria, foamy urine
 Fatigue
 Urgency/ frequency
 Dark rusty urine
 Proteinuria: client is clear from this disorder when there is no longer protein in the urine***

Question 13

12. Kidney biopsy post op nursing interventions(slide 19)

Answer 13

Needle, fine needle aspiration or open
 Lay on affected side for 30-60 minutes.
 24-hour bed rest
 Increase risk for hemorrhage.

o Nursing action: to decrease and assess for risk of hemorrhage. Signs of hemorrhage Is blood In the urine (hematuria), assess dressing site for bleeding, monitor vitals, and severe pain the back, shoulder, and abdominal can Indicate bleeding.

Question 14

13. Arteriovenous fistula client education

Answer 14

 Avoid carrying heavy items in the arm with the fistula or graft.
 Wear clothing with loose sleeves or made of fabrics that will not obstruct blood flow.
 Do not sleep on the vascular access arm.
 Do not permit venipunctures, injections, or BP in the arm with the vascular access.
 Wash the skin over the vascular access daily.
 Assess for a thrill or bruit daily.
 Report signs of an infection or sign of impaired blood flow to dialysis personnel or primary provider immediately.

Question 15

14. UTI manifestations(slide 3)

Answer 15

 Frequency
 Urgency
 Dysuria
 Supra-pubic pressure
 Hematuria

Question 16

Polycystic Kidney Disease avoid what?

Answer 16

 Avoid nephrotoxic medications like NSAIDS and Cephalosporin

Question 17

16. Diagnostic Examinations Kidney

Answer 17

 Kidneys, Ureters, and Bladder X-ray: no dye
 Intravenous Urography (ANA:IVP)
 Cystoscopy: finds abnormalities of bladder wall: monitor for infection