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Challenge Question
A patient is concerned about her steadily worsening
chronic kidney disease and asks you at what point
she will require dialysis. Which of the following
should you mention?
Challenge Question
A patient is concerned about her steadily worsening
chronic kidney disease and asks you at what point
she will require dialysis. Which of the following
should you mention?
A. when urine albumin to Cr ratio is great than 25
B when your urine output is less than 0.5 ml/kg/h x
6 hours
C. when your GRF falls below 15mL/min/1.73m2
D. When your urine osmolality is greater than 500
Challenge Question
A patient with chronic kidney disease is receiving
an ACE inhibitor. The nurse understands that this
medication helps slow the progression of this
disease through what process?
Challenge Question
A patient with chronic kidney disease is receiving
an ACE inhibitor. The nurse understands that this
medication helps slow the progression of this
disease through what process?
A. It lowers the level of the blood glucose
B. It prevents nerphon hyperfiltration
C. It increases the urine output
D. It filters waste from the blood.
Challenge Question
A patient with chronic kidney disease has a serum K
of 5 and no changes on the ECG. What is the proper
nursing intervention?
Challenge Question
A patient with chronic kidney disease has a serum K
of 5 and no changes on the ECG. What is the proper
nursing intervention?
A. Administer sodium polystyrene as an enema
B. Administer IV calcium gluconate
C. Administer IV insulin and dextrose
D. Being dialysis
Challenge Question
A patient with a history of diabetes mellitus has
had a procedure using radiocontrast dye. The
patient's laboratory results include high urine
sodium, urine with muddy-brown granular casts
and tubular epithelial cells, and increased blood
urea nitrogen (BUN) and serum creatinine. Renal
ultrasonography is normal. Urine volume is
normal. Which treatment does the nurse
anticipate?
Challenge Question
A patient with a history of diabetes mellitus has
had a procedure using radiocontrast dye. The
patient's laboratory results include high urine
sodium, urine with muddy-brown granular casts
and tubular epithelial cells, and increased blood
urea nitrogen (BUN) and serum creatinine. Renal
ultrasonography is normal. Urine volume is
normal. Which treatment does the nurse
anticipate?
A. increased fluids
B. renal stent placement
C. irrigation of Foley catheter
D. Diuretics
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Challenge Question
A patient has just been diagnosed with type 2
diabetes mellitus. During teaching, what strategy
should the nurse emphasize as protective of kidney
cells?
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Challenge Question
A patient has just been diagnosed with type 2
diabetes mellitus. During teaching, what strategy
should the nurse emphasize as protective of kidney
cells?
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Challenge Question
A patient with chronic renal disease is involved in a
motor vehicle crash and experiences severe
hypovolemia. In caring for this patient in the CCU,
which of the following is the most important for the
nurse to monitor?
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Challenge Question
A patient with chronic renal disease is involved in a
motor vehicle crash and experiences severe
hypovolemia. In caring for this patient in the CCU,
which of the following is the most important for the
nurse to monitor?
A. Blood pressure
B. Fluid volume recovery
C. Urine output
D. Cardiac dysrhythmias
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Challenge Question
A patient with chronic renal failure also has chronic
anemia, arteriosclerotic disease, and diabetes
mellitus. The patient asks the nurse why the anemia is
persisting. In answering the patient's question, what
should the nurse most consider?
14
Challenge Question
A patient with chronic renal failure also has chronic
anemia, arteriosclerotic disease, and diabetes
mellitus. The patient asks the nurse why the anemia is
persisting. In answering the patient's question, what
should the nurse most consider?
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Challenge Question
Before administering sodium polystyrene sulfonate
(Kayexalate) to a patient with hyperkalemia, the nurse
should assess the
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Challenge Question
Before administering sodium polystyrene sulfonate
(Kayexalate) to a patient with hyperkalemia, the nurse
should assess the
A. BUN and Cr
B. blood glucose
C. bowel sounds
D. level of consciousness LOC
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28.
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28.
1. Hematuria.
2. Proteinuria.
3. Fixed urine specific gravity.
4. Urine excretion of 1,500 mL in 24 hours.
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RIFLE Classification
Risk
Injury
Failure
Loss
End-stage kidney disease
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Urinary changes
Fluid volume
Metabolic acidosis
Sodium balance
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Studies
History
Urine output
Serum Cr
UA
Ultrasound
CT
MRI
MRA
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indications
Volume overload
Elevated K
Met Acid: HCO3 < 15
BUN > 120
Mental status changes
Pericarditis, pericardial effusion, cardiac
tamponade
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therapy
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Nursing Management:
Acute Kidney Injury
Nursing Assessment
Nursing Diagnoses
Planning
Nursing Implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation
36
Gerontologic Considerations:
Acute Renal Failure
-Dehydration
-Hypotension
- Diuretic therapy
-Aminoglycoside therapy
-Prostatic hyperplasia
-Surgery
-Infection
-Contrast agents
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GI
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Psychological
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Care
Drug therapy
Hyperkalemia
Hypertension
CKDmineral and bone disease
Anemia
Dyslipidemia
Complications of drug therapy
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Nutritional Therapy
Phosphate restriction
1000 mg/day
Foods high in phosphate
Dairy products
Most foods high in phosphate are
also high in protein.
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Challenge Question
When teaching a patient with chronic kidney
disease about prevention of complications, the
nurse instructs the patient to:
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Challenge Question
When teaching a patient with chronic kidney disease
about prevention of complications, the nurse instructs
the patient to:
1. Monitor for proteinuria daily with a urine dipstick.
2. Weigh daily and report a gain of greater than 4
pounds.
3. Take calcium-based phosphate binders on an empty
stomach.
4. Perform self-catheterization every 4 hours to
accurately measure I & O.
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Nursing Management:
Chronic Kidney Disease
Nursing Assessment
Nursing Diagnoses
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Dialysis
Hemodialysis HD
Peritoneal dialysis PD
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Peritoneal Dialysis
https://www.youtube.com/watch?v=CDBNmgkIqMs
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29.
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fat
protein
calories
carbohydrates
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Peritoneal Dialysis
Automated peritoneal dialysis
APD
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Peritoneal Dialysis
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Peritoneal Dialysis
Dialysis Solutions and Cycles: 4 per day
Exchange
Inflow
Dwell
Drain
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Peritoneal Dialysis
Complications
Infection: catheter exit site
Peritonitis
Pain
Hernias
Lower back pain
Protein loss
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Peritoneal Dialysis
Continuous ambulatory peritoneal dialysis
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Hemodialysis
Vascular Access Sites
Arteriovenous fistulas AVF
Arteriovenous grafts AVG
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Hemodialysis
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Hemodialysis
3 days per week: 3 4 hours
Assessment
Weight
BP
Peripheral edema
Lung sounds
Heart sounds
Vascular access
Temp
Skin
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Hemodialysis
Complications:
Hypotension
Muscle cramps
Blood loss
Hepatitis
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Kidney Transplantation
Survival rates
Contraindications
Disseminated malignancies
Refractory or untreated cardiac disease
Chronic respiratory failure
Extensive vascular disease
Chronic infection
Unresolved psych disorders
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Kidney Transplantation
Recipient Selection
Histocompatibility Studies
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Nursing Management:
Kidney Transplant Recipient
Preoperative Care
Postoperative Care
Fluid and electrolyte balance
Infection
Surgery
Immunosuppressive Therapy
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Nursing Management:
Kidney Transplant Recipient
Complications of Transplantation
Rejection
Infection
Cardiovascular disease
Malignancies: 100% greater than general population:
immunosuppression
Recurrence of original renal disease
Corticosteroid-related complications
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