Download NSG-430, 6 AKI, Dialysis, Transplant, Stones Exam with Q&A. and more Exams Nursing in PDF only on Docsity!
NSG-430, 6 AKI, Dialysis, Transplant,
Stones Exam with Q&A.
- Risk, injury, failure, loss, end-stage renal disease
What does the RIFLE classification stand for?
- Post-renal
Anuria is commonly seen with what type of AKI?
- Pre-renal
Oliguria is commonly seen with what type of AKI?
- Oliguria
- Distended neck veins
- Hypertension
- Bounding pulse
- Decreased UO
- Edema
- Fluid overload
- Decreased serum bicarb
- Kussmauls respirations
- Hyponatremia
- Hyperkalemia
- EKG changes
- LOC changes
- Elevated creatinine/BUN
- Lasts 10-14 days
During the oliguric phase of AKI, what are some expected S/S?
5.Creatinine
What is the "best" lab diagnostic to test for kidney function?
-6. Daily UO 1-5L/day
- Dehydration
- Low electrolytes
During the diuretic phase of AKI, what are some expected S/S?
- Fluids and electrolytes
Your Pt comes into his 20 day check up after his AKI diagnosis. You notice serum K levels are 2.1, Na is 115, and the client's BP is 89/51. What would you expect the Dr to order for your Pt?
- Stop their metformin 48 hr before the MRI
Your Pt is a type 2 diabetic who takes metformin daily. They are scheduled for a MRI with contrast in a week. What would you educate them about?
9 False (These can be fatal!)
True or False
Patients with kidney failure can get MRIs or MRAs
- Yesterday 24hr urine output + 600mL
How do you calculate the fluid restriction for a patient with AKI?
- No IVs
- Bruit and thrill is normal
What are education interventions for a Pt with a AvF?
- Vascular access catheter
Temporary double-lumen vascular access catheter for acute hemodialysis. Usually inserted at neck. Has high infection rates
- HeRO graft
Special bridge access for hemodialysis when other options are exhausted. Uses a tube that connects between an artery and the superior vena cava
- Steal syndrome
Too much blood going to the fistula, leaving the hand ischemic!
- To prevent clotting
Why is heparin added to the hemodialysis needle?
- False
True or False
CRRT uses a dialyzer
- Assess fluid status/temp/vascular status before
- Monitor weight before and during
- Take VS Q30-60mins during
What should be done for a Pt undergoing hemodialysis?
- Muscle cramps
- Hepatitis (need vaccine)
- Loss of blood
What are complications from hemodialysis?
23.CCRT
What is the preferred method for treating AKI?
24. CRRT:
- Is continuous
- Can be done over 40 days if needed
- Doesn't require constant monitoring
- Hemofilter changed q24-48h
What is the difference between CRRT and HD?
- Yellow. If becomes bloody them stop to prevent blood loss!
What should the ultra filtrate from CRRT NORMALLY look like? What do you do if it is different?
- Monitor labs
- Assess I/O, VS, and hemodynamics every hour
What are specific nursing interventions for CRRT?
- Ultrasound
- True
True or False
Dialysis may still be required for a little after kidney transplant
- Yes
Do we foley Cath kidney donors before surgery?
- Renal function
What needs to be monitored for Pt's post op kidney surgery?
- Maintaining fluid and electrolytes is #1!
- Large UO may be present right after surgery
- Replacement fluid 1:1 for first 12-24 hours
- New kidney usually placed on iliac crest
- Maintain catheter patent
- K supplements?
What are some post-op kidney transplant considerations?
- Dialysis
Your Pt post op kidney transplant develops acute tubular necrosis. What do you expect the provider to order in the mean time?
- Grapefruit juice
What should be avoided if the client is taking cyclosporine or tacrolimus for lifelong anti rejection drugs?
- Mycophenolate
The drug ___ must be given as a long IV drug and be reconstituted in D5W
- Hyperacute
Rejection type occurs within first 24 hours of transplant
- Acute
Rejection type occurs within a few days to 6 months after transplant
- Chronic
Rejection type occurs over months and years and is irreversible
- First month
When are infections post op kidney transplant most common?
- Acyclovir
What antiviral is given prophylactically to prevent HSV infections in Pt's post op kidney transplant?
- Lower cholesterol, triglycerides, blood glucose, and weight
What are ways Pt's should be educated to decrease chances of CV disease after a kidney transplant?
- Sunscreen and protective clothing
What are the best ways to prevent malignancies in Pt's post op kidney transplant?
- Helical CT (followed by urinalysis)
What would be the first test you would order if your patient is suspected to have kidney stones and aortic aneurysm is ruled out?
What are S/S of aortic aneurysm that differentiates it from kidney stones S/S?
- Ketorolac
After the kidney stone is diagnosed, what medication can be given to treat bladder spasms?
- Pain
What is the main focus of care for a Pt with a kidney stone?
- Flomax, hytrin
What medications can be given to a Pt with kidney stones to dilate the smooth muscle of the ureter?
Kidney stones smaller than ___mm can be managed on an outpatient basis
How do we treat a struvite stone?
- Cytoscopy
Flexible ureteroscope used to break down small stones!
- Cystolitholapaxy
Treatment of choice to break up large stones with a lithotrite (stone crusher)
- Cytoscopic lithotripsy
Ultrasonic lithotrite to pulverize stones
65.- Increase fluids
- Don't FORCE fluids
- Low sodium diet
- Drink 3L/day, pee 2L/day
- Self monitor pH
- Use a urine strainer
- Ask for assistance when ambulating
What are nursing interventions for a patient with kidney stones?
What are normal creatinine values?
What are normal BUN levels?
Oliguria is defined as < ____mL/day
What are normal vanco trough levels?
- Every 3 days
How often are vanco troughs done?
- Hydronephrosis
The dilation (swelling) of one or both kidneys caused by B/L ureteral obstruction (Needs to be fixed in 48 hours for complete function return)
74. - BPH
- Kidney stones
- Prostate cancer
- Trauma
What are some key causes of post-renal AKI?
