Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) Management, Exams of Nursing

Download Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) Management and more Exams Nursing in PDF only on Docsity!

NUR 265 Exam 1 Questions and Answers

What is nephrotic syndrome? - Correct Answer - A condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted. What are key features of nephrotic syndrome? - Correct Answer --Massive proteinuria

• Hypoalbuminemia
• Edema (facial and periorbital)
• Lipiduria
• Hyperlipidemia
• Increased coagulation
• Reduced kidney function In nephrotic syndrome, severe protein loss in the urine is greater than what? - Correct Answer - 3.5g in 24 hours What is nephrotic syndrome treated with? - Correct Answer --immunosuppressant agents (if immunity based).
• ACE inhibitors (decreased protein loss in urine)
• statins (improve blood lipid levels).
• Heparin (used to treat vascular effects and improve kidney function) Describe the "risk" stage for AKI - Correct Answer - creatinine x 1.5 of normal, and GFR reduced by 25%

Describe the "injury" stage for AKI - Correct Answer - creatinine x2 & GFR reduced by 50% Describe the "failure" stage for AKI - Correct Answer - creatinine x3 normal, & GFR reduced by 75% (Cant fix) Describe Prerenal AKI. Give examples. - Correct Answer - Decreased perfusion to kidneys.

• NSAIDs
• Severe dehydration
• Renal artery stenosis
• MI or HF resulting in low ejection fraction and low cardiac output
• Blood/ fluid loss Describe Intrarenal AKI. Give examples. - Correct Answer - Tissue damage to the actual kidneys.
• Glomerulonephritis or inflammation of the glomeruli
• Sepsis
• Intrarenal bleeding
• Pyelonephritis Describe Postrenal AKI. Give examples. - Correct Answer - Obstruction that occurs after the kidney.
• Enlarged prostate (BPH)
• Bladder Cancer
• Kidney stones How do you determine the mean arterial pressure (MAP)? - Correct Answer - Systolic + (Diastolic*2) / What is the MAP needed to perfuse the kidneys? - Correct Answer - 65 mmHg What are examples of nephrotoxic drugs? - Correct Answer --NSAIDS
• Metformin
• Diuretics

• Antibiotics (especially - mycin)
• Contrast dye During the diuretic phase of AKI, what needs to be monitored? - Correct Answer - Watch for dehydration and make sure output is greater than input What are the dietary restrictions for an AKI patient? - Correct Answer --Low protein
• Low sodium
• Fluid restriction: 1000-1500mL day (for anything except perfusion problem) What are the 2 most common causes of CKD? - Correct Answer --HTN
• Uncontrolled diabetes What is azotemia? - Correct Answer - Nitrogenous waste build up What are manifestations of uremia? - Correct Answer - •Metallic taste in mouth •Anorexia •Nausea/vomiting •Muscle cramps •Uremic frost on skin •Itching •Fatigue and lethargy •Hiccups •Edema •Dyspnea •Paresthesia's What effects can CKD have on the cardiac system - Correct Answer --HTN
• Heart failure (major problem. Call the doctor)
• Pericarditis What effects can CKD have on the Integumentary system - Correct Answer --Uremic frost

What are the dietary restrictions on CKD? - Correct Answer --Protein (restrict early in disease process to preserve kidney function)

• Potassium
• Fluid
• Sodium Describe hemodialysis - Correct Answer --3x a week- 4 - 5 hours
• At risk for bleeding do to heparin
• Extremely fatigued post.
• Vitals and weight before and after
• Slight fever post is normal. Monitor. Describe peritoneal dialysis - Correct Answer --Sterile procedure at home where catheter is placed into the abdomen
• Wear a mask
• Solution may be warmed using a heating bag or blanket, not microwave!
• Make sure patient turns and repositions to mix solution in the cavity Describe nursing care for an AV fistula. - Correct Answer --Palpate and auscultate- bruit and thrill
• Distal pulses
• ROM- helps form the fistula
• Monitor for infection
• No heavy lifting or carrying
• No pressure
• Aneurysm can form at AV fistula site Describe dialysis disequilibrium syndrome - Correct Answer --Life threatening! (occurs if fluid is pulled off too fast)
• S/S: restless, headache, decreased LOC, seizures, coma
• Call a rapid immediately
• Give barbiturates and anticonvulsants What is cirrhosis? - Correct Answer - An extensive, irreversible scarring of the liver.

What are common causes of cirrhosis? - Correct Answer --ETOH

• Viral hepatitis (HEP C)
• Autoimmune hepatitis
• Drugs and chemicals (aetaminophen or anything else hepatotoxic) What are early S/S of cirrhosis? - Correct Answer --Enlarged liver
• Fatigue
• Weight loss
• Anorexia
• N/V
• Abdominal pain What are end stage S/S of cirrhosis? - Correct Answer --Ascites
• Small liver
• clotting disorder (bruising, GI bleed)
• Jaundice
• Elevated ammonia levels (give Lactulose)
• Hepatic encephalopathy
• Decreased bile production What are the stages of hepatic encephalopathy? - Correct Answer --Stage 1: personality changes, subtle things that may not be recognized
• Stage 2: Continuing mental changes, mental confusion, disorientation to time, place, and person
• Stage 3: Marked mental confusion, progressive deterioration
• Stage 4: metabolic acidosis, unresponsiveness leading to death in most patients, unarousable What causes hepatic encephalopathy? - Correct Answer - The buildup of ammonia in the body Describe the physical assessment of an end stage cirrhosis patient. - Correct Answer --Ascites
• Jaundice
• Coagulation problems

• Fatigue
• Spider angiomas
• Petechiae
• Liver flaps (asterixis) What is a Blake-Moore tube used for? - Correct Answer - Esophageal Varices Describe a paracentesis. - Correct Answer --A procedure that is needed to get rid of the fluid in the abdomen
• Have the pt. void before the procedure (ensures the bladder is out of the way and wont get punctured)
• Patient is positioned in fowlers position in bed What are the treatments for cirrhosis? - Correct Answer - Transplant is the only cure! Describe the diet for a patient with cirrhosis. - Correct Answer --Small frequent meals
• High carbs
• High protein
• Moderate fats
• Moderate vitamins What medications are given to patients with cirrhosis? - Correct Answer --Diuretics
• PPI or H blockers
• Broad spectrum antibiotics
• FFP-coags
• Platelets thrombocytopenia Describe acute pancreatitis. - Correct Answer - A serious and at times life threatening inflammation of the pancreas. It is caused by premature ativation of excessive pancreatic enzymes that destroy tissues and pancreatic cells (basically the pancreas starts digesting itself) What are causes of acute pancreatitis? - Correct Answer --Choleylithiasis
• Trauma to pancreas
• Chronic ETOH consumption
• Toxic drugs

What are signs and symptoms of acute pancreatitis? - Correct Answer --Middle epigastric/left upper quadrant

• Boring pain that doesn't radiate, but rather goes through their body
• Sudden onset
• Radiates to back, left shoulder, and flank area
• Jaundice- due to bilirubin increase
• Nausea and vomiting How is acute pancreatits diagnosed? - Correct Answer --Cat scan first
• #1 diagnostic is amylase and lipase labs Describe the physical assessment of a patient with acute pancreatitis - Correct Answer --Jaundice skin: due to bile duct obstruction
• Gray-blue skin on abdomen/flank areas (2 essential assessments- call PHCP)
• Guarding and rigidity
• Ascites
• Fetal position
• Palpable mass How is acute pancreatitis treated? - Correct Answer --Rest the gut: insert an NG tube
• Opioids for pain management Describe chronic pancreatitis. - Correct Answer - Progressive,destructive disease of the pancreas that has remissions and exacerbation. Pain is not described as "boring" pain What are the signs and symptoms of chronic pancreatitis? - Correct Answer --LUQ pain (described as burning and gnawing)
• Muscle wasting
• Unexplained weight loss
• 3 P's of diabetes (due to lack of insulin production)
• Steatorrhea
• Fatigue

What needs to be taught about enzyme replacement? - Correct Answer --Take enzymes with meals and snacks and follow with a glass of water

• Administer enzymes after H2 blockers or PPI
• Swallow without chewing to avoid irritation in the mouth
• If can't swallow, place in gelatin casing and eat with apple sauce
• Don't mix enzymes in protein-rich food!
• Wipe your lips after taking enzymes
• Don't crush enteric coated preparations
• Follow up all labs What type of diet is a pt with chronic pancreatitis on? - Correct Answer - Bland...all the time What is thrombocytopenia? - Correct Answer - Platelet numbers are below what is needed for blood clotting. Pt. will start bleeding spontaneously when the platelets fall below 20, Describe bleeding precautions - Correct Answer --Soft toothbrush
• Electric razor
• Fall precautions What medication is administered in thrombocytopenia? - Correct Answer - Platelets if needed What will a patient with thrombocytopenia look like - Correct Answer - They will have petichae and ecchymosis What is Heparin induced thrombocytopenia (HIT)? - Correct Answer - Occurs as a paradocical/rebound effect of heparin, therefore the opposite action of heparin occurs (cloting). At risk for PE or DVT What med is given to treat HIT? - Correct Answer - Argatroban (anti-coag) What is Disseminated intravascular coagulation (DIC) caused by? - Correct Answer - A problem with the blood clotting process. Patients at risk= sepsis, placenta abruptio, blood transfusions What medications are given for DIC? - Correct Answer - Heparin in the early stage and then clotting factors are given when hemorrhage is the primary problem

What is the normal range for Central venous pressure (CVP)? - Correct Answer - 4 - 12 What is the normal range for pulmonary artery wedge pressure (PAWP)? - Correct Answer - 4 - 12 What does it mean when the PAWP is increased/decreased? - Correct Answer - Increased= LSHF or hypervolemia Decreased= Hypovolemia or decrease in afterload What is the formula and the normal for cardiac output? - Correct Answer - HR * SV (4-7) What is the formula and normal for Cardiac index? - Correct Answer - CO/Body surface area (2.7-3.2) What needs to be done when assessing chest pain? - Correct Answer - PQRST P-provoking?at rest or activity? Q-quality. What type of pain? R-radiating? S-severity?rate from 1- 10 T-timing. How long?

• What type of pain? sharp, dull, squeezing
• Take a deep breath, does pain get better or worse with breathing?
• Does pain feel better if you reposition? Describe the difference between respiratory and cardiac pain. - Correct Answer - MI: Describes pain as dull or pressure ("elephant on chest"), big breath or repositioning doesn't change the pain Resp.: Sharp intermittent pain with SOB. Changing positions helps the pain Describe MONA - Correct Answer - Morphine, Oxygen, Nitro, Aspirin Administer based on ABC's

What is the pre-cath procedure? - Correct Answer --labs (check for prerenal disease)

• consents
• 12 lead EKG
• Shave prep
• ALLERGIES and Medications What is a normal troponin lab value? - Correct Answer - 0 - 0. Describe post cath care. - Correct Answer --Put them on tele monitor
• Keep affected leg straight- keep clot in place
• Keep HOB less than 30 degrees
• Don't want to kink @ leg
• Hematoma will burst and bleed!
• Pulse check of affected extremity
• IV fluids Describe contraindications for thrombolytic therapy - Correct Answer - Absolute
• Any prior intracranial hemorrhage
• Cerebral vascular lesion
• Known malignant intracranial neoplasm
• Ischemic stroke within 3 months
• Suspected aortic dissection
• Active bleeding
• Closed head or facial trauma with in 3 months Relative
• Hx of poorly controlled HTN
• BP greater than 180/
• Pregnancy
• Dementia, or other intracranial pathology
• CPR (10 minutes+) or major surgery within 3 wks
• Recent internal bleeding (2-4 weeks)
• Noncompressible vascular punctures

• Streptokinase 5 days ago or allergy to them
• Active peptic ulcer
• Anticoag use: Higher INR, higher bleeding risk Describe an MI S/S of a female - Correct Answer - indigestion, chronic fatigue, inability to "catch their breath", aching, choking, strangling Describe a CABG - Correct Answer - A Vein is taken out of the leg or artery out of an arm. It is attached at the root of the aorta, and beyond the blockage to have blood flow to the heart Describe a post op CABG - Correct Answer --rewarm slowly: if too quick- vasodilatation will occur and BP will drop
• q15 min urinary output for 24 hrs
• patient must be sitting up!!
• maintain blood pressure and vitals
• Monitor hemodynamics
• Monitor for drainage!: If more than 150 mL/hour call rapid!!!! PVC - Correct Answer - VTACH - Correct Answer - VFIB - Correct Answer - ASYSTOLE - Correct Answer - AFIB - Correct Answer - What is the #1 complication with a CABG? - Correct Answer - Sternal infection. Use antibiotics and assess REEDA What is cardiac tamponade? - Correct Answer - It occurs when fluid quickly accumulates in the pericardium and causes a sudden decrease in cardiac output

What are nursing consideration for a cardiac tamponade? - Correct Answer --Check chest tubes for acute decrease in drainage

• They will have JVD with clear lung sounds
• Muffled heart tones
• Hypotension Emergent and must be fixed ASAP What are the two types of surgeries to repair a broken valve? - Correct Answer - Bilogical: From pigs. Lasts 5-7 years. Body does not reject it Prosthetic: Man made, lasts up to 20+ years. Body will reject so coumadin is needed In which type of cardiomyopathy is Digoxin contraindicated? - Correct Answer - Hypertrophic Describe dilated cardiomyopathy - Correct Answer - The walls are very thin and everything is dilated Describe hypertrophic cardiomyopathy - Correct Answer - the thickening of the heart muscle How can cardiomyopathy be treated? - Correct Answer - Medically or surgically
• Heart transplant
• Rest
• Medications to increase cardiac output
• Diuretics What is pericarditis? - Correct Answer - Inflammation/ infection of the periardial sac What are S/S of pericarditis? - Correct Answer - Chest pain
• Sharp, stabbing
• Behind breast bone
• Left side of chest
• Elevated with tripod position
• SOB-oxygen

• Low grade temp
• Relieved with positioning What are S/S of endocarditis? - Correct Answer --Fever- night sweats, malaise, chills, fatigue
• Anorexia and weight loss
• Cardiac murmur
• Heart failure development
• Petechiae
• Osler's nodes
• Splinter hemorrhage: black longitudinal lines on nails What is endocarditis caused by? - Correct Answer - A bacterial infection: normally staph or strep What long term antibiotic is the patient with endocarditis on? - Correct Answer - Usually Vanco What are the S/S of abdominal aortic aneurysm (AAA)? - Correct Answer - gnawing pain in abdomen, flank, or back lasting for hours, pulsating in upper abdomen. Listen for bruit NEVER PALPATE PULSATING ABDOMEN!!!- RUPTURE If pain worsens and moves down the leg it is an emergency!!! What medication is given if the patient is in sinus bradycardia? - Correct Answer - Atropine. Give IV fluids and oxygen What is the treatment for sinus tachycardia? - Correct Answer - treat the underlying cause. Valsalva maneuver, stress management What medications are given if the pt is in atrial fibrillation? - Correct Answer - Amiodarone, diltiazem, metoprolol, digoxin What is the normal range for H&H? - Correct Answer - Hemoglobin: M: 14-18 g/dL

F: 12-16 g/dL Hematocrit: M: 42%- 5 2% F: 37%-47% What is the normal range for BUN? - Correct Answer - 10 - 20 mg/dL What is the normal range for creatnine? - Correct Answer - M: .06-1.2 mg/dL F: 0.5-1.1 mg/dL What is the normal PT range? - Correct Answer - 11 - 12.5 sec **1.5-2.5 times the normal on Coumadin What is the normal INR range? - Correct Answer - 0.9-1.2 sec What is the normal PTT range? - Correct Answer - 60 - 70 sec **1.5-2.5 times the normal on Heparin What is the normal APTT range? - Correct Answer - 30 - 40 sec **1.5-2.5 times the normal on Heparin What is the normal range for specific gravity? - Correct Answer - 1.005-1. What is the therapeutic Digoxin range? - Correct Answer - 0.5-2 ng/mL What is the normal platelet range? - Correct Answer - 150 - 400 m^ What is the normal albumin range? - Correct Answer - 50 - 80mg / 24 hrs at rest What is the normal triglyceride range? - Correct Answer - M: 40-60 mg/dL

F: 35-135 mg/dL What is the normal glucose range? - Correct Answer - 70 - 110 mg/dL After thrombolytic are administered, what needs to be watched? - Correct Answer - Watch for signs of bleeding What is the treatment for angina pectoris? - Correct Answer - "NBC" Nitro, Beta Blockers, Calcium Channel Blockers