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NURS
NURS617/ NURS 617 EXAM 6 (NEW 2024/ 2025
UPDATE) PHARMACOTHERAPEUTICS GUIDE| QS & AS|
GRADE A| 100% CORRECT (VERIFIED ANSWERS)-
peritoneal dialysis (PD) - ANS ✓-removal of wastes, electrolytes and fluids
from the body using peritoneum as dialysis membrane
-4 exchanges/day; usually done qHS
-used in neonates-5 y/o
CKD in kids: causes, s/s, tx - ANS ✓-1-2:100,000 incidence of CKD in kids
-<5: d/t renal dysplasia or obstructive uropathy
-5+ y/o: d/t polycystic kidney disease, glomerulonephritis
-any child with CKD=increased risk of ectopic vascular calcification
-renal osteodystrophies =more common in kids (s/s=bone pain, easily fractured
bones, muscle weakness)
-s/s: delay in growth + sexual maturation, bone abnormalities (d/t
hypocalcemia)
-tx: dialysis causes cardiovascular function to decrease quickly once initiated
x3/week; TRANSPLANT NEEDED
renal calculi: calcium (oxalate & phosphate) - ANS ✓-causes: excessive
calcium taken from bone d/t immobility, bone dx, hyperparathyroidism
-avoid: diet high in oxalates (green leafy vegetables, soy, almonds, potatoes, tea,
rhubarb, cereal grains and beets) / high protein
-tx: increase fluids, thiazide diuretics
renal calculi: magnesium ammonium phosphate - ANS ✓-aka struvite stones;
only form in alkaline urine (high phosphate levels=high pH)
-causes: high oxalate diet (green leafy vegetables, soy, nuts, potatoes, tea, cereal
grains), UTI (bacteria has urease, splits urea into ammonia & co2)
renal calculi: uric acid (urate) - ANS ✓-formed in urine of 5.5 (acidic)
-causes: gout, high purine diet (proteins)
-tx: allopurinol, increase fluids, potassium alkali salts to increase pH of urine
-does not show on xray
renal calculi: cystine - ANS ✓-inherited dec. absorption of cystine; impaired
amino acid metabolism
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NURS
-tx: alkalization of urine, hydration, potassium citrate
Renal dysplasia - ANS ✓-abnormal development of one or both kidneys;
presents as an enlarged, irregular, cystic flank mass
-if bilateral, may lead to renal failure
-ex: multicystic kidney (does not function)
renal agenesis - ANS ✓-absence of one or both kidneys
-unilateral=common, total agenesis=incompatible for life
-often have "potter syndrome" d/t oligohydramnios (small amount of amniotic
fluid d/t obstruction of flow or nonfunctional kidneys)
-potter syndrome s/s=widely separated eyes, broad/flat nose, receding chin, low
set ears
renal hypoplasia - ANS ✓-an underdeveloped kidney; smaller than normal dize
-if both affected=progressive renal failure
ectopic kidney - ANS ✓-a kidney that is out of its normal position, usually lower
than normal in pelvic cavity
-may be horseshoe shaped
autosomal dominant vs recessive polycystic kidney disease - ANS ✓-
autosomal dom (ADPD): more common; formation of circular, fluid-filled cysts on
kidneys; can spread to other organs (spleen, liver, pancreas); 50% develop end
stage renal failure
-autosomal recessive (ARPD): cystic dilation of cortical & medullary collecting
tubules; associated w/ lower life expectancy, some fetuses die in utero d/t severe
pulmonary HTN (vent support necessary)
s/s: liver fibrosis, portal HTN, impaired lung development (d/t pulmonary
hypoplasia from HTN)
simple vs acquired renal cysts - ANS ✓-simple= typically do not produce s/s or
compromise renal function
-acquired=d/t aging, dialysis, CKD, or HTN
-dx: CT or ultrasonography
-cysts may be single, multiple, differing sizes; grow by active fluid secretion from
epithelial lining cells
how renal calculi form - ANS ✓-supersaturated urine that allows stone to grow;
most common cause of upper urinary tract obstruction
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-composed of calcium salts, uric acid, cystine, or magnesium ammonium
phosphate
-supersaturation=requires nucleus that facilitates crystal aggregation; presence
of natural stone inhibitors (magnesium and citrate)=protective of formation
**supplement with potassium citrate to increase citrate levels & increase
alkalinity of urine
renal calculi: s/s - ANS ✓-usually have s/s when 1-5mm in size
-severe pain in the flank area, RUQ pain
-N/V, urinary urgency, hematuria, fever, chills, abdominal distention
-pain exaggerated by drinking large amounts of fluids
-hydronephrosis can develop (dilation of renal collecting ducts)
hydronephrosis - ANS ✓-the dilation (swelling) of one or both kidneys
-progressive dilation of renal collecting ducts and renal tubular structures;
causes destruction & atrophy of renal tissue
2 most damaging effects of urinary obstruction? - ANS ✓1. stasis of urine -
causes increase risk of infection + stone formation
2. hydronephrosis - progressive dilation of renal collecting ducts + tubular
structures causes destruction & atrophy of renal tissue
causes of obstructive uropathies - ANS ✓-pregnancy
-BPH (stasis of urine=increase UTI risk)
-urinary stones
-scar tissue
-tumors
-neurologic dx - MS, cervical spine injuries, neurogenic bladder
UTI: expected defense mechanisms - ANS ✓-wash out: urine washes out
bacteria
-bladder lining: bacterial flora protect from invasive organisms
-immune system: immunocompromised=increased risk; can enter urinary tract
through blood stream
*probiotics used to increase defense against pathogens by increasing natural
flora; ex: lactobacillus in women
-pathogen strength: increase in pili of bacteria to attach to urinary
tract=enhanced virulence
Cystitis (UTI) - ANS ✓-inflammation and infection of the bladder; 100,000 CFU
or more/mL
-low nitrates, high leukocytes; more basic pH
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