NUR 255 FINAL STUDY GUIDE
QUESTIONS WITH CORRECT ANSWERS
Ascites: - CORRECT ANSWER- Fluid in Peritoneal Cavity Due To:
-Portal hypertension resulting in increased capillary pressure and
obstruction of venous blood flow
-Vasodilation of splanchnic circulation (blood flow to the major
abdominal organs)
-#Decreased synthesis of albumin, decreasing serum osmotic pressure
then movement of albumin occurs into the peritoneal cavity, then fluid
follows.
Patho of Ascites - CORRECT ANSWER- -Cirrhosis with portal
hypertension
-splanchnic arterial vasodilation
-decrease in circulating arterial blood volume
-activation of renin-angiotensin and sympathetic nervous systems and
ADH
-kidney retains water and sodium
-hypervolemia
-persistent activation of systems for retention of sodium and water:
ascites and edema formation
-continued arterial underfilling: cycle repeats
Treatment and Care of Ascites - CORRECT ANSWER- -Low-sodium
diet
-Diuretics-Aldactone is the first line therapy in pts. with ascites with
cirrhosis.
-Bed rest
-Paracentesis
-Administration of albumin-Corrects decreases of effective arterial blood
volume that leads to sodium retention. Also, decreases the incidence of
hyponatremia (contains sodium) and renal dysfunction
,(TIPS) - CORRECT ANSWER- Transjugular intrahepatic
portosystemic shunt is a nonsurgical procedure in which a tract (shunt)
between the systemic and portal venous systems is created to redirect
portal blood flow.
Acute renal failure - CORRECT ANSWER- -AKI
-Onset: sudden
-Common cause: acute tubular necrosis
-Dx criteria: Acute reduction in urine output and or elevation in serum
creatinine
-Reversibility: potentially
-Primary cause of death: infection
-Most commonly, AKI follows severe, prolonged hypertension,
hypovolemia, or exposure to a nephrotoxic agent.
-There are increases in BUN, Creatinine and urine output can be less
than 40cc/hr but can be normal.
3 causes of AKI - CORRECT ANSWER- Causes: 3 Types.
Pre-renal,
Intra-renal
Post-renal
Phases of Acute renal failure - CORRECT ANSWER- 1. The initiation
period: initial when oliguria develops, less than 400ml a day.
2. The oliguria period is an in ability to excrete fluids, regulate fluids, and
excrete metabolic wastes thus they increase.
3. Diuretic phase is when there is large amount of fluids and electrolytes
are lost.
4. The last phase is recovery and this can last up to 12 months and most
pts. are left with some renal dysfunction. Lab values are normal for pt.
Manifestations of ARF - CORRECT ANSWER- -appears very ill and
weak
-dehydration
,-headache
-oliguria
-drowsiness
-tachycardia
-crackles
-irritability
-drowsiness
-dry skin
-n/v
Dx of ARF - CORRECT ANSWER- *Labs
-UA: proteinuria, RBC's due to glomerular dysfunction, WBC's
(inflammation).
-Serum creatinine and BUN increase rapidly and GFR declines
-Potassium increases
-anemia (reduced RBC's from decreased erythropoietin secretion)
-Metabolic acidosis occurs.
*Cat or MRI, ultrasound, biopsy may be used as well.
Treatment of ARF - CORRECT ANSWER- -Focus: Restore and
maintain renal function.
-Medications, IV fluids, and blood volume expanders are used to restore
perfusion to the kidneys.
-Proteins are limited in the diet with increased carbohydrates to minimize
azotemia.
-Some cases, may need dialysis.
Meds for ARF - CORRECT ANSWER- -Dopamine- increase
perfusion to the kidneys and increased cardiac output, and dilates blood
vessels of the kidneys.
-Furosemide and Mannitol: excrete toxins and help increase output.
-Antihypertensives: control b/p.
Nursing care for ARF - CORRECT ANSWER- -Good intake and
output, daily weights
-VS
-Semi-Fowlers to help promote respiratory and cardiac function.
, -Monitor electrolytes (esp. K as it is increased and Na as it may be
decreased to due fluid retention) and increased Phosphate.
-Fluid restriction.
-Administer medications with meals to decrease fluid intake
-good skin care.
-Good infection control as infection is the leading cause of death in AKI.
Elderly and AKI - CORRECT ANSWER- -More susceptible then than
younger adults due to dehydration and polypharmacy as well as
impaired function of CV, and diabetes can increase risk as well.
-Aging kidney is less able to compensate for changes in fluid volume
and cardiac output.
-Patients older than 65 are less likely to recover from AKI.
Chronic Renal Failure - CORRECT ANSWER- -CKD
-Onset: Gradual, often over many years
-Common Cause: diabetic nephropathy
-Dx criteria: GFR <60 mL/min/1.73 m^2 for >30 months and/or Kidney
damage >30 months
-Progressive and Irriversible
-Primary cause of death: CV disease
-The presence of kidney damage for 3 or more months with progressive
kidney dysfunction.
-Usually see proteinuria 2 or 3 times in a 3 month period.
-Renal mass decreases, loss of nephrons, deterioration of glomerular
filtration and kidney function.
Stage 1 CKD - CORRECT ANSWER- Stage 1:
-Kidney Damage with normal or increased GFR
-GFR >/= 90
-Clinical actions: Dx and tx, CVD risk reduction, slow prognosis
Stage 2 CKD - CORRECT ANSWER- Stage 2:
-Kidney Damage with mild decrease in GFR
-GFR 60-89
-Clinical Action Plan: estimation of progression
Stage 3 CKD - CORRECT ANSWER- Stage 3:
QUESTIONS WITH CORRECT ANSWERS
Ascites: - CORRECT ANSWER- Fluid in Peritoneal Cavity Due To:
-Portal hypertension resulting in increased capillary pressure and
obstruction of venous blood flow
-Vasodilation of splanchnic circulation (blood flow to the major
abdominal organs)
-#Decreased synthesis of albumin, decreasing serum osmotic pressure
then movement of albumin occurs into the peritoneal cavity, then fluid
follows.
Patho of Ascites - CORRECT ANSWER- -Cirrhosis with portal
hypertension
-splanchnic arterial vasodilation
-decrease in circulating arterial blood volume
-activation of renin-angiotensin and sympathetic nervous systems and
ADH
-kidney retains water and sodium
-hypervolemia
-persistent activation of systems for retention of sodium and water:
ascites and edema formation
-continued arterial underfilling: cycle repeats
Treatment and Care of Ascites - CORRECT ANSWER- -Low-sodium
diet
-Diuretics-Aldactone is the first line therapy in pts. with ascites with
cirrhosis.
-Bed rest
-Paracentesis
-Administration of albumin-Corrects decreases of effective arterial blood
volume that leads to sodium retention. Also, decreases the incidence of
hyponatremia (contains sodium) and renal dysfunction
,(TIPS) - CORRECT ANSWER- Transjugular intrahepatic
portosystemic shunt is a nonsurgical procedure in which a tract (shunt)
between the systemic and portal venous systems is created to redirect
portal blood flow.
Acute renal failure - CORRECT ANSWER- -AKI
-Onset: sudden
-Common cause: acute tubular necrosis
-Dx criteria: Acute reduction in urine output and or elevation in serum
creatinine
-Reversibility: potentially
-Primary cause of death: infection
-Most commonly, AKI follows severe, prolonged hypertension,
hypovolemia, or exposure to a nephrotoxic agent.
-There are increases in BUN, Creatinine and urine output can be less
than 40cc/hr but can be normal.
3 causes of AKI - CORRECT ANSWER- Causes: 3 Types.
Pre-renal,
Intra-renal
Post-renal
Phases of Acute renal failure - CORRECT ANSWER- 1. The initiation
period: initial when oliguria develops, less than 400ml a day.
2. The oliguria period is an in ability to excrete fluids, regulate fluids, and
excrete metabolic wastes thus they increase.
3. Diuretic phase is when there is large amount of fluids and electrolytes
are lost.
4. The last phase is recovery and this can last up to 12 months and most
pts. are left with some renal dysfunction. Lab values are normal for pt.
Manifestations of ARF - CORRECT ANSWER- -appears very ill and
weak
-dehydration
,-headache
-oliguria
-drowsiness
-tachycardia
-crackles
-irritability
-drowsiness
-dry skin
-n/v
Dx of ARF - CORRECT ANSWER- *Labs
-UA: proteinuria, RBC's due to glomerular dysfunction, WBC's
(inflammation).
-Serum creatinine and BUN increase rapidly and GFR declines
-Potassium increases
-anemia (reduced RBC's from decreased erythropoietin secretion)
-Metabolic acidosis occurs.
*Cat or MRI, ultrasound, biopsy may be used as well.
Treatment of ARF - CORRECT ANSWER- -Focus: Restore and
maintain renal function.
-Medications, IV fluids, and blood volume expanders are used to restore
perfusion to the kidneys.
-Proteins are limited in the diet with increased carbohydrates to minimize
azotemia.
-Some cases, may need dialysis.
Meds for ARF - CORRECT ANSWER- -Dopamine- increase
perfusion to the kidneys and increased cardiac output, and dilates blood
vessels of the kidneys.
-Furosemide and Mannitol: excrete toxins and help increase output.
-Antihypertensives: control b/p.
Nursing care for ARF - CORRECT ANSWER- -Good intake and
output, daily weights
-VS
-Semi-Fowlers to help promote respiratory and cardiac function.
, -Monitor electrolytes (esp. K as it is increased and Na as it may be
decreased to due fluid retention) and increased Phosphate.
-Fluid restriction.
-Administer medications with meals to decrease fluid intake
-good skin care.
-Good infection control as infection is the leading cause of death in AKI.
Elderly and AKI - CORRECT ANSWER- -More susceptible then than
younger adults due to dehydration and polypharmacy as well as
impaired function of CV, and diabetes can increase risk as well.
-Aging kidney is less able to compensate for changes in fluid volume
and cardiac output.
-Patients older than 65 are less likely to recover from AKI.
Chronic Renal Failure - CORRECT ANSWER- -CKD
-Onset: Gradual, often over many years
-Common Cause: diabetic nephropathy
-Dx criteria: GFR <60 mL/min/1.73 m^2 for >30 months and/or Kidney
damage >30 months
-Progressive and Irriversible
-Primary cause of death: CV disease
-The presence of kidney damage for 3 or more months with progressive
kidney dysfunction.
-Usually see proteinuria 2 or 3 times in a 3 month period.
-Renal mass decreases, loss of nephrons, deterioration of glomerular
filtration and kidney function.
Stage 1 CKD - CORRECT ANSWER- Stage 1:
-Kidney Damage with normal or increased GFR
-GFR >/= 90
-Clinical actions: Dx and tx, CVD risk reduction, slow prognosis
Stage 2 CKD - CORRECT ANSWER- Stage 2:
-Kidney Damage with mild decrease in GFR
-GFR 60-89
-Clinical Action Plan: estimation of progression
Stage 3 CKD - CORRECT ANSWER- Stage 3:
