Management of Patients with Kidney Disorders

Question 1

Acute kidney injury

Answer 1

rapid loss of renal function due to damage to the kidneys

Question 2

What is the greatest indicator of kidney damage in AKI?

Answer 2

50% or greater increase in serum creatinine above baseline

Question 3

Causes of AKI

Answer 3

Hypovolemia
Hypotension
Reduced cardiac output
Heart failure
Obstruction of kidney or lower urinary tract
Obstruction of renal arteries or veins
Nephrotoxic agents

Question 4

3 Categories of an Acute Kidney Injury

Answer 4

Prerenal
Intrarenal
Postrenal

Question 5

4 Phases of an Acute Kidney Injury

Answer 5

Initiation
Oliguria
Diuresis
Recovery

Question 6

Prerenal AKIs are often due to what?

Answer 6

Hypoperfusion from shock

Question 7

Intrarenal AKIs are often due to what?

Answer 7

Nephrotoxic drugs or agents

Question 8

Postrenal AKIs are often due to what?

Answer 8

Stone or tumor

Question 9

How long can recovery take in an acute AKI?

Answer 9

up to 12 months

Question 10

Chronic kidney disease

Answer 10

umbrella term that describes kidney damage or a decrease in the GFD lasting for 3 months or more

Question 11

Untreated CKD leads to what?

Answer 11

ESKD

Question 12

Causes of chronic kidney disease

Answer 12

DM
HTN
Chronic glomerulonephritis
Pyelonephritis
Hereditary lesions
Vascular disorders
Medications or toxic agents

Question 13

What is nephrosclerosis?

Answer 13

Hardening of renal arteries

Question 14

What is the main cause of CKD?

Answer 14

DM

Question 15

What is the second main cause of CKD?

Answer 15

HTN

Question 16

2 types of nephrosclerosis

Answer 16

Acute hypertensive
Benign

Question 17

How is nephrosclerosis treated?

Answer 17

Treat HTN

Question 18

Acute nephritic syndrome

Answer 18

glomerular diseases where kidneys become large and congested

Question 19

Manifestations of Acute Nephritic Syndrome

Answer 19

Hematuria
Edema
Azotemia
Proteinuria
HTN

Question 20

Nursing interventions for acute nephritic syndrome

Answer 20

Support
Dietary changes
Treat cause if known

Question 21

Glomerulonephritis

Answer 21

glomerular disease where kidneys shrink and become fibrous

Question 22

Manifestations of glomerulonephritis

Answer 22

Fixed SG
Casts in urine
Proteinuria
Electrolyte imbalances
Hypoalbuminemia

Question 23

Nephrotic syndrome

Answer 23

Glomerular diseases in which there is an increase in glomerular permeability

Question 24

Manifestations of nephrotic syndrome

Answer 24

Massive proteinuria
Edema
Hypercoaguable state

Question 25

Causes of nephrotic syndrome

Answer 25

Lupus Glomerulonephritis DM

Question 26

Polycystic Kidney Disease

Answer 26

kidney disease involving the growth of fluid filled cysts that destroy nephrons

Question 27

What is the most commonly inherited cause of kidney failure?

Answer 27

Polycystic kidney disease

Question 28

What other organs most commonly have cysts with polycystic kidney disease?

Answer 28

Liver and spleen

Question 29

When does kidney failure happen?

Answer 29

When kidneys cannot remove wastes or perform regulatory functions

Question 30

Acute kidney injury

Answer 30

a reversible syndrome that results in decreased glomerular filtration rate and oliguria

Question 31

ESRD AKA

Answer 31

chronic renal disease

Question 32

ESRD

Answer 32

progressive, irreversible deterioration of renal function that results in azotemia

Question 33

azotemia

Answer 33

elevated levels of urea and other nitrogenous wastes in blood

Question 34

What is assessed in a patient with CKD and AKI?

Answer 34

Fluid status Nutritional status Patient knowledge Activity tolerance Self-esteem Potential complications

Question 35

Complications of CKD or AKI

Answer 35

Hyperkalemia Pericarditis Pericardial effusion Pericardial tamponade HTN Anemia Bone disease with metastatic calcifications

Question 36

When is hemodialysis used?

Answer 36

For acutely ill patients with AKI until kidneys resume function and LT replacement therapy in CKD or ESKD

Question 37

What is objective of hemodialysis?

Answer 37

Extract toxic nitrogenous substances from the blood and to remove excess fluid

Question 38

What kind of access is needed during hemodialysis?

Answer 38

vascular

Question 39

What type of vascular access is used during hemodialysis?

Answer 39

Arteriovenous fistula Arteriovenous graft

Question 40

How often is vascular access assessed for AV fistula or graft?

Answer 40

Once a shift

Question 41

Types of peritoneal dialysis

Answer 41

Acute intermittent Continuous ambulatory Continuous cyclic

Question 42

Complications of PD

Answer 42

Peritonitis Leakage Bleeding

Question 43

What medications must be held prior to hemodialysis?

Answer 43

Cardiovascular medications

Question 44

Why must CV meds be held prior to hemodialysis?

Answer 44

Due to rapid fluid shifts that can cause hypotension

Question 45

Describe the onset phase of an AKI

Answer 45

Triggering event occurs Duration can be hours or days Kidney perfusion decreases Urine output drops below 0.5mL/kg/hr

Question 46

Describe the oliguric phase of an AKI

Answer 46

10-14 days, sometimes longer Urine output <400 mL/day

Question 47

Describe the diuretic phase of an AKI

Answer 47

1-3 weeks Increased output Kidneys regain ability to excrete urine but not concentrate it Hypovolemia Hypotension

Question 48

Describe the Recovery phase of an AKI

Answer 48

Can last up to 12 months Gradual return to normal function

Question 49

What is the GFR range in stage 1 of CKD?

Answer 49

>90 mL/min

Question 50

What is the GFR range in stage 2 of CKD?

Answer 50

60-89 mL/min

Question 51

What is the GFR range in stage 3 of CKD?

Answer 51

30-59 mL/min

Question 52

What is the GFR range in stage 4 of CKD?

Answer 52

15-29 mL/min

Question 53

What is the GFR range in stage 5 of CKD?

Answer 53

<15 mL/min