NUR 205 Chapter 44 Renal Disorders

Method of peritoneal dialysis in which a peritoneal dialysis machine automatically performs exchanges usually while the patient sleeps.

Continuous cyclic peritoneal dialysis

Variety of methods used to replace normal kidney function by circulating the patients blood through a filter and returning it to the patient.

Continuous renal replacement therapy

Solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis.

Dialysate

"artificial kidney" or dialysis machine; contains a semipermeable membrane through which particles of certain size can pass.

Dialyzer

Movement of solutes (waste products) from an area of higher concentration to an area of lower concentration.

diffusion

Term used to describe the drained fluid from a periotoneal dialysis exchange.

effluent

Final state of renal failure that results in retention of uremic waste products and the need for renal replacement therapies.

end stage renal disease

Inflammation within the renal tissue

interstitial nephritis

hardening of the renal arteries

nephrosclerosis

type of renal failure with increased glomerular permeability and massive proteinuria

nephrotic syndrome

any substance medication or action that destroys kidney tissue

nephrotoxic

movement of water through a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration.

osmosis

procedure that uses the lining of the patients peritoneal cavity as the semipermeable membrane for exchange of fluid and solutes

peritoneal dialysis

inflammation of the peritoneal membrane

pertonitis

Inflammation of the renal pelvis

pyelonephritis

process whereby water is removed from the blood by means of a pressure gradient between the patients blood and the dialysate.

untrafiltration

an excess of urea and other nitrogenous wastes in the blood

uremia

proteins secreted by damaged kidney tubules

urinary casts

type of renal failure with glomerular inflammation

acute nephritic syndrome

sudden rapid deterioration of kidney function that is sometimes reversible.

acute renal failure

type of acute renal failure in which there is actual damage to the kidney tubules

acute tubular necrosis

total urine output less than 50mL in 24hr

anuria

Type of vascular access for dialysis; created by surgically connecting an artery to a vein

arteriovenous fistula

Type of surgically created vascular access for dialysis by which a piece of biologic semi-biologic, or synthetic graft material connects the patients artery to a vein.

arteriovenous graft

abnormal concentrations of nitrogenous wastes in the blood

azotemia

chronic progressive and irreversible disease of the kidneys

chronic kidney disease

method of peritoneal dialysis whereby a patient manually performs four or five completes exchanges or cycles through the day.

continuous ambulatory peritoneal dialysis

The most accurate indicator of fluid loss or gain in an acutely ill patient is?

a. blood pressure

b. capillary refill

c. serum sodium levels

d. weight

d

The nurse notes that a patient who is retaining fluid had a 1kg weight gain. The nurse knows that this is equivalent to about?

a. 250ml

b. 500ml

c. 750ml

d. 1000 ml

d

A patient is admitted with electrolyte imbalance. He has carpo-pedal spasm, ECG changes, and a positive chvostek's sign (slight twitch when flicking the patients cheek). The nurse suspects a deficit of?

a. calcium

b. magnesium

c. phosphorus

d. sodium

a

Acute glomerulonphritis refers to a group of kidney disease in which there is?

a. an inflammatory reaction

b. an antigen antibody reaction to streptococci that results in circulating molecular complexes

c. cellular complexes that lodge in the glomeruli and injure the kidney.

d. all the above

d

In most cases the major stimulus to acute glomerulonephritis is?

a. escherichia coli

b. group A streptococcal infection of the throat.

c. staphylococcus aureus

d. neisseria gonorrhoeae

b

Laboratory findings consistent with acute glomerulonephritis include all of the following except?

a. hermaturia

b. polyuria

c. proteinuria

d. white cell casts

b

Chronic glomerulonephritis is manifested by?

a. anemai secondary to erythropoiesis.

b. Hypercalcemia and decreased serum phyosphorus.

c. hypokalemia and elevated bicarbonate

d. metabolic alkalosis

a

The major manifestation of nephrotic syndrome is?

a. hematuria

b. hyperalbuminemia

c. edama

d. anemia

c

A clinical diagnosis of nephrotic syndrome is consistent with an exceedingly high level of?

a. albumin

b. low density lipoproteins

c. protein in the urine

d. serum cholesterol

c

Acute renal failure (ARF) caused by parenchymal damage to the glomeruli or kidney tubules results in all of the following except?

a. decreased GFR

b. increased urine specific gravity

c. impaired electrolyte balance

d. progressive azotemia

b

Oliguria is a clinical sign of ARF that refers to a daily urine output of?

a. 1.5 L

b. 1.0L

c. less than 400mL

d. Less than 50mL

c

A fall in CO2 combining power and blood pH indicates what state accompanying renal function?

a. Metabolic acidosis

b. Metabolic alkalosis

c. Respiratory acidosis

d. Respiratory alkalosis

a

Hyperkalemia is a serious electrolyte imbalance that occurs in ARF and results from?

a. protein catabolism

b. electrolyte shifts in response to metabolic acidosis

c. tissue breakdown

d. all of the above.

d

Potassium intake can be restricted by eliminating high potassium foods such as?

a. butter

b. citrus fruits

c. cooked white rice

d. salad oils

b

A patient with ARF and negative nitrogen balance is expected to lose about?

a. 0.5kg/day

b. 1.0kg/day

c. 1.5kg/day

d. 2.0kg/day

a

The leading cause of end stage renal disease is?

a. diabetes mellitus

b. hypertention

c. glomerulonephritis

d. toxic agents

a

A patient with stage 3, chronic renal failure would be expected to have?

a. a GFR of >90ml/min/1.73

b. a GFR = 30 to 59 ml/min/1.73

c. severe decreases in GFR

d. kidney failure

b

In chronic renal failure (end stage renal disease), decreased glomerular filtration leads to?

a. increased pH

b. decreased creatinine clearance.

c. increased blood urea nitrogen (BUN)

d. all of the above.

d

Decreased levels of erythropoietin, a substance normally secreted by the kidneys leads to which serious complication of chronic renal failure?

a. Anemia

b. acidosis

c. hyperkalemia

d. pericarditis

a

Recent research about the long term toxicity of aluminum products has lead physicians to recommend antacids that lower serum phosphorus such as?

a. calcium carbonate

b. sodium bicarbonate

c. magaldrate

d. milk of magnesia

a

Dietary intervention for renal deterioration includes limiting the intake of?

a. fluid

b. protein

c. sodium and potassium

d. all of the above.

d

The process that under lies and supports the procedure of hemodialysis is?

a. diffusion

b. osmosis

c. ultra-filtration

d. all of the above.

d

An incomplete protein not recommended for the diet of a patient managed by long term hemodialysis is that found in?

a. eggs

b. fish

c. milk

d. nuts

d

At the end of five peritoneal exchanges the patients fluid loss was 500mL. This loss is equal to approximately?

a. 0.5lbs

b. 1.0 lbs

c. 1.5 lbs

d. 2 lbs

b

Preoperative management for a patient who is to undergo kidney transplantation includes?

a. bringing the metabolic state to as normal a level as possible.

b. make certain that the patient is free of infection.

c. suppressing immunologic defense mechanisms

d. all of the above.

d

Postoperative management for a recipient of a transplanted kidney includes?

a. Aseptic technique to avoid infection.

b. hourly urinary output measurements to estimate the degree of kidney function.

c. protective isolation while immunosuppressive drug therapy is at its maximum dosage.

d. all of the above.

d

Carpopedal spasm and tetany

calcium deficit

muscle hypotonicity and flank pain

Calcium excess

Oliguria and weight loss

fluid volume deficit

Positive chvosteck's sign

hypocalcemia

crackles and dyspnea

fluid volume excess

chronic weight loss and fatigability

Protein deficit

fingerprinting on the sternum

sodium deficit

irritability and interstinal colic

Potassium excess

rough dry tongue and thirst

Potassium deficit

Soft flabby muscles and weakness

potassium deficit

The primary cause of chronic kidney disease is?

Diabetes mellitus

Nephrosclerosis is primarily caused by ___________ and ____________

prolonged hypertension and diabetes

List six major clinical manifestation of glomerular injury.

1. Proteinuria

2. hematuria

3. decreased GFR

4. Edema

5. hypertension,

6. decreased sodium excretion

Describe the physical appearance of the urine early in the stage of acute glomerulonephritis.

The urine is the early stages of acute glomerulonphritis is characteristically cola colored

Two blood levels that are significantly increased in ARF are _____________ and ____________

Creatinine and BUN

Name five physiologic disorder that characterize the nephrotic syndrome

1. Proteinuria
2. hypoalbuminemia
3. diffuse edema
4. hypercholesterolemia
5. hyperlipidemia

List the 6 risk factors for renal cancer

1. Gender, affects men more than women.

2. tobacco use

3. occupational exposure to industrial chemicals such as petroleum products, heavy metals, and asbestose

4. Obesity

5. Unopposed estrogen therapy

6. Polysystic kidney disease.

List three major condition that cause ARF

1. Prerenal conditions are hemorrhage and sepsis

2. intrarenal conditions are crush injuries and infection

3. Postrenal conditions are obstruction distal to kidney

In ARF name two clinical signs of hyperkalemia

1. Potassium levels greater than 5.5

2. T wave elevation in the QRS complex.

List six potential complication of dialysis treatment.

1. lethargy

2. headache

3. muscle twitching

4. seizures

5. nausea

6. vomiting and diarrhea

List six clinical manifestation seen in chronic renal failure

1. hypotention

2. air embolism

3. dysrhythmias

4. pruritus

5. dialysis disequilibrium

6. exsanguination

The leading cause of death for patients undergoing chronic hemodialysis is?

arteriosclerotic cardiovac

The most common and serious complication of continuous ambulatory peritoneal dialysis (CAPD) is ?

pertonitis

Two complicatoin of renal surgery that are believed to be caused by reflex paralysis of intestinal peristalsis and manipulation of the colon or duodenum during surgery are ___________ and ____________

abdominal distention and paralytic ileus

A needle is inserted into the arterial segment of the fistual to?

Support arterial flow to the dialyers

A needle is inserted into the venous segment of the fistula to

support re-infusion of the dialysed blood

A new fistula requires ___________ months to mature. This time is necessary because?

2 to 3 months; time is needed for the venous segment of the fistula to dilate to accommodate two large bore needles

Describe the exercise the patient should perform to help increase the vessel size.

squeeze a rubber ball for forearm fistulas

The most commonly used synthetic graft material is ________ grafts allow access in as little as ______ days.

polytetrafluoroethylene; 10 days

Edward chose CAPD because it helped him?

a. avoid severe dietary restriction

b. control his blood pressure

c. have control over his daily activities

d. do all of the above.

d

Using CAPD Edward need to dialyze himself?

a. approximately four to five times a day with no night changes

b. every 3hrs

c. every 4 hours

d. once in the morning and once in the evening.

a

Edward need sto be aware that toxic wastes are exchanged during the equilibration or dwell time which usually lasts for?

a. 10 to 15mins

b. 30mins

c. 1hr

d. 2 to 3hr

a

Edward needs to be taught how to detect signs of the most serious and most common complication of CAPD, which is?

a. an abdominal hernia

b. anorexia

c. edema

d. peritonitis

d

Nurses need to assess for symptoms consistent with pathology secondary to reduced renal blood flow. Symptoms would include?

a. reduced glomerular filtration

b. renal ischemia

c. tubular damage

d. all of the above

d

During the oliguric phase of ARF, Frans protein intake for her 156lb body weight should be approximately?

a. 35 g/24hr

b. 70 g/24hr

c. 120 g/24hr

d. 156 g/24hr

b

While evaluating laboratory studies the nurse expect that Frans oliguric phase will be marked by all of the following except:

a. blood urea nitrogen of 10mg/dL

b. serum creatinine of 0.8 mg/dL

c. Serum potassium of 6mEq/L

d. urinary volume less than 600 mL/24hr

b

After the diruetic phase the nurse should recommend a?

a. high potassium diet

b. high protein diet

c. low carbohydrate diet

d. low fat diet

b

The nurse expects the period of recovery to follow a period of oliguria and to last approximately?

a. 2wks

b. 6wks

c. 2 months

d. 6 to 12 months

d