NUR1212 exam 3 exemplars
diuresis stage - correct answer nephrons on their way to recovery, filters the blood but cant concentrate urine GFR starts improving (still abnormal), allows BUN and creatinine (abnormal still), pt mental status increases
voiding 3-6L/day due to osmotic diuresis (increase amounts of urea in newly filtered filtrate)
hypovolemic, dehydration, htn, hypokalemia, <1.020 urine specific gravity, last week-3 weeks
interventions: strict I&O's, daily weights, IV fluids, s/s of dehydration, supplement
acute kidney injury - correct answer acute, sudden decrease in renal function, build up of waste, fluid, electrolytes
causes of aki - correct answer prerenal intrarenal
postrenal
prerenal - correct answer issue with perfusion to kidney, causes decreased function of kidney
decrease amount of blood to kidneys to filter and deprives kidney of nutrients (leads to intrarenal injury)
what leads to this? cardiac issue, damage to heart muscle (MI), causes decreased cardiac output, bleeding internally or externally, dehydration (leads to hypovolemia, burns)
intrarenal - correct answer direct damage to the kidney, damage to nephrons, decreased ability to filter blood, remove waste and excessive h2o, maintain electrolyte levels causes? nephrotoxicity drugs (NSAIDs, antibiotics, aminoglycosides, chemo drugs, contrast dye, infection
(glomeurulonephoritis), injury
postrenal - correct answer blockage in urinary tract after the kidney to the urethra that prevents urine draining out of system, causes increased pressure in kidney and waste, this decreases kidney function
causes? renal calculi, enlarged prostate, neuro injury (stroke) bladder doesn't empty properly
basics about kidneys - correct answer adults should void between 1-2L per day, urine consists of what our body doesn't need --> water, ions (sodium, chloride, calcium, phosphate etc), creatinine (waste product from muscle breakdown), urea
labs for kidney function - correct answer creatinine level, creatinine clearance,
BUN, glomerular filtration rate (GFR)
normal creatinine level - correct answer 0.6-1.20 mg/dL
creatinine - correct answer is solely filtered from blood via glomerulus and is NOT reabsorbed or secreted in the nephron (why its measurement is a great indicator of kidney filtering ability)
creatinine clearance level - correct answer amount of blood kidneys make per minute that's FREE of creatinine
females 85-125 mL/min
males 95-140 mL/min
**use these values along with pt's age, gender, weight, race to determine the GFR
normal GFR level - correct answer 90 mL/min or higher rate of blood flow through the kidneys
decreased GFR = - correct answer decreased urine output, increased amount of water in body, increased amount of waste/electrolyte imbalances
s/s- oliguria, concentrated urine, HTN, edema, azotemia, acidosis, hyperkalemia
normal BUN levels - correct answer 6-20 mg/dL
breakdown of protein in liver, secreted in blood and filtered in kidneys
stages of aki - correct answer initiation, oliguria, diuresis, recovery
initiation stage - correct answer starts from the cause (prerenal, intrarenal, postrenal) to the kidneys and end when s/s appear (few hrs-several days)
must find cause and correct to prevent long term damage to nephrons
oliguric stage - correct answer some pts skip this stage and enter next (diuresis)
urine output less than 400ml per day because glomerulus decreases ability to filter blood- decreased GFR, increase BUN and creatinine (neuro checks, itching), hyperkalemia (due to decrease excretion of waste, monitor EKG)
nursing interventions: low protein diet, safety, restrict K+ foods, monitor EKG, labs, kayexalate PO or rectal to decrease K+ level, limit fluid intake, strict I&O's, daily weights, monitor BP, lung sounds, O2 sats, swelling, safety, resp status increase fluid in body- edema, risk pulmonary and cardiac issues, HTN
