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Med Surg 2 > Quiz 6 > Flashcards

Quiz 6 Flashcards

1
Q

What is glomerulonephritis? What can it lead to?

A

inflammation and scarring of the kidney

lead to end stage kidney disease

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2
Q

What are the risk factors of glomerulonephritis?

A

beta-hemolytic streptococcal infection
tonsillitis or pharyngitis
presence of systemic disease

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3
Q

What are the clinical manifestations of glomerulonephritis?

A

hematuria (blood in urine)
oliguria or anuria (decreased or no)
azotemia (increased BUN)
proteinuria (protein foamy)
dysuria (pain)
flank or abd pain
fatigue
HTN
weight gain
low grade fever

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4
Q

What are the diagnostic studies for glomerulonephritis?

A

increased BUN, CR, ESR, K, Phosphate
decreased GFR, albumin, CA
+ ANA, + ASO titer

urinalysis - hematuria, proteinuria, RBS, sediments, casts

kidney bx

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5
Q

What medications are given for glomerulonephritis?

A

PCN for strep infection
corticosteroids for inflammation
antihypertensives for increased BP

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6
Q

What are nursing interventions for glomerulonephritis?

A

bed rest
monitoring for F/E imbalance (potassium)
high-calorie, low-protein, low-sodium diet, restrict fluids

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7
Q

What is a priority for a patient with acute glomerulonephritis?

A

check the patient’s daily weight

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8
Q

What can be done to confirm a diagnosis of chronic glomerulonephritis?

A

bx of kidney to check for sclerosis

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9
Q

What lab value would decrease for a patient with chronic glomerulonephritis?

A

RBC

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10
Q

What do you expect for a male with chronic glomerulonephritis?

A

serum creatinine of 7mg/dl

over 1.3 is BAD

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11
Q

When does a pt with glomerulonephritis need further teaching about a sodium restricted diet?

A

when they say they can still drink 3-4 carbonated drinks daily

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12
Q

When can a patient with glomerulonephritis resume normal activities?

A

when HTN and hematuria are resolved

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13
Q

What is a ileal conduit?

A

ureters are implanted into part of ileum or colon that has been resected from intestinal tract

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14
Q

What is a cutaneous ureterostomy?

A

ureters are excised from bladder and brought through abdominal wall

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15
Q

What is a nephrostomy?

A

catheter is inserted into pelvis of kidney

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16
Q

What is acute kidney injury?

A

sudden short term loss of kidney function (curable)
can lead to chronic kidney disease

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17
Q

What are the classifications of acute kidney injury?

A

prerenal - blood not perfusing kidneys
intrarenal - damage inside
postrenal - obstruction in outflow of urine

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18
Q

What are the phases of acute kidney injury?

A

onset
oliguric phase
diuresis phase
recovery phase

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19
Q

What are the clinical manifestations of acute kidney injury during the oliguric phase?

A

LOW URINE OUTPUT

metabolic acidosis (below 7.35)
sodium HIGH
phosphorus HIGH
potassium HIGH
BUN/CR HIGH
fluid overload (edema)

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20
Q

What are the clinical manifestations of acute kidney injury during the diuretic phase?

A

up to 5L/day, electrolyte losses
decreased BUN, then normalizes
decreased specific gravity
normal kidney function back

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21
Q

What happens during the recovery phase of acute kidney injury?

A

return to baseline (30mL/kg/hr)
complete recovery may take 12 months
residual kidney dysfunction may be noted

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22
Q

What medications are given to decrease potassium as a result of acute kidney injury?

A

IV insulin (regular)
IV glucose
IV sodium bicarb (decrease acidity)
IV calcium gluconate
PO or PR sodium polystyrene sulfonate (used in less severe cases, BM = Rx working)

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23
Q

What medications are given to decrease phosphorus as a result of acute kidney injury?

A

phosphate binders

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24
Q

What medications are given for anemia as a result of acute kidney injury?

A

epoetin alfa

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25
Q

What are the nursing interventions for acute kidney injury?

A

monitor I&O, weigh daily
examine urine
monitor electrolyte balance
assess for HF or pulm. edema
review nephrotoxic drugs

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26
Q

What is the diet for a patient with acute kidney injury?

A

high calorie
fluid restriction
low protein
restrict potassium, phosphorus, sodium, magnesium

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27
Q

What is an expected blood gas for a patient with acute kidney injury?

A

pH below 7.35
HCO3 14
PaCO2 30

28
Q

When does a pt with acute kidney injury need further teaching about potassium diet source?

A

when they say adding pecans will be a change that they can readily make

29
Q

What indicates an increased risk of acute kidney injury?

A

creatinine over 1.3

30
Q

What will indicate understanding for a patient with acute kidney injury about fluid restrictions?

A

i will make a list of my favorite beverages

31
Q

What is chronic kidney disease?

A

irreversible damage to the kidneys
no cure
GFR <60mL/min for at least 3 months

32
Q

What are the stages of chronic kidney disease?

A

GFR
greater than or equal to 90 - normal
stage 1: <90
stage 2: 60-80
stage 3: 30-59
stage 4: 15-29
stage 5 (end stage renal): <15

33
Q

What are the causes of chronic renal disease?

A

uncontrolled diabetes
uncontrolled HTN

34
Q

What are the clinical manifestations of chronic kidney disease?

A

uremic frost

similar to acute kidney disease

35
Q

What are the diagnostic studies of chronic kidney disease?

A

urinalysis
cystoscopy
renal bx
albumin to creatinine ratio

36
Q

What are the therapeutic procedures for chronic kidney disease?

A

dialysis
kidney transplant

37
Q

What are the nursing interventions for chronic kidney disease?

A

strict I&O
monitor BP
monitor for s/s of FVO and hyperK
do not administer antacids w/ Mg
do no administer enemas w/ phosphorus
Avoid loop diuretics

38
Q

What is the diet for someone with chronic kidney disease?

A

high carb
low protein
low potassium
low sodium
low phosphate

39
Q

When would you take the daily weight of a patient with chronic kidney disease?

A

After they void

40
Q

What is the most reliable measurement of fluid retention for a patient with chronic kidney disease include volume increase?

A

Daily weight

41
Q

What are the expected findings of end-stage renal disease?

A

Slurred speech
Bone pain
Pruitis

42
Q

What should be taught for a patient with chronic kidney disease about low protein diet?

A

A low protein diet reduces risk of uremia

43
Q

What would you expect the blood gas to be for a patient with chronic kidney disease?

A

pH 7.25
HCO3 19
PaCO2 30

44
Q

Why would aluminum hydroxide be given for a patient with chronic kidney disease instead of Pepcid?

A

Phosphorus levels lower when taking aluminum hydroxide

45
Q

What is an adverse reaction of aluminum hydroxide?

A

Constipation

46
Q

A patient with chronic kidney disease should limit which nutrients?

A

Protein
phosphorus
sodium

47
Q

For a patient taking epoetin alfa, what would should be increased in their diet?

A

Iron

48
Q

What is a manifestation of hyperkalemia in a patient with chronic kidney disease?

A

Decreased deep tendon reflexes

49
Q

What foods that are high in potassium will you tell a patient with chronic kidney disease to avoid?

A

Tomato
Bananas
Raisins

50
Q

What are examples of renal replacement therapy?

A

Peritoneal dialysis
Intermittent hemodialysis
Continuous renal replacement therapy

51
Q

Describe hemodialysis

A

Requires vascular access
AV fistula or AV graft
Lifespan: 20-40 years, die from CLABSI
Duration: 3 to 4 hours

52
Q

What are the nursing interventions for hemodialysis?

A

Before: assess fluid status, assess AVF/AVG, weigh the client, hold morning meds, report any symptoms during procedure

During: monitor BP

After: prevent infection, monitor, complications, weight, client, provide adequate nutrition, rest

53
Q

Describe continuous renal replacement therapy

A

Alternative method for treating AKI
Uremic toxins and fluids are removed
Duration: 24 hours

54
Q

Describe peritoneal dialysis

A

Catheter inserted through anterior abdominal wall - solution dwells for 4 hours - fluid comes out

More than inserted should come out

Once a day

More stable patients

Types: continuous ambulatory PD and automated PD

55
Q

What does it mean if the dialysate is cloudy

A

Peritonitis

56
Q

What are the phases of the peritoneal dialysis cycle?

A

Inflow (fill)
Dwell (equilibration)
Drain

57
Q

What food is contraindicated for a patient who is taking bumetanide?

A

Ham sandwich

58
Q

when do you administer phenytoin after a patient gets dialysis?

A

When they complain of headache and restlessness

59
Q

When teaching a patient about continuous ambulatory peritoneal dialysis what should you tell the patient?

A

Require the patient to follow fewer dietary and fluid restrictions than hemodialysis

60
Q

What should a nurse do prior to exchanging dialysate for peritoneal dialysis?

A

Warm the solution prior to insulation

61
Q

What should be reported immediately for a patient who is undergoing peritoneal dialysis?

A

Purulent dialysis outflow

62
Q

For a patient with a new AV fistula to the right arm, what would indicate venous insufficiency?

A

Cold and numbness distal to the fish site

63
Q

What can low calcium in the blood cause?

A

Seizures

64
Q

What are the discharge instructions for a patient who is going to do a peritoneal dialysis at home?

A

Anticipate pain the first week during the inflow of dialysate

65
Q

What are the manifestations of peritonitis?

A

Nausea and vomiting

Med Surg 2 (7 decks)

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