NUR 3262 Chronic Final Exam With
Complete Solution
Assessment & nursing care of: Arteriovenous Fistula - ANSWER - AVF
(preferred access) - 2 -3 months to mature/ "arterialized"
- No B/P, IV insertion, or blood work.
- Assess patency - bruit (rushing sound) and thrill (buzzing sensation).
Assessment & nursing care of: Arteriovenous Graft - ANSWER - AVG -
synthetic graft. 2-4 weeks to heal.
- No B/P, IV insertion, or blood work.
- Assess patency - bruit (rushing sound) and thrill (buzzing sensation)
Hemodialysis frequency - ANSWER - Hemodialysis is usually done 3 times per
week for about 3-5 hours at a time.
- People who choose to do hemodialysis at home may do dialysis treatment
more frequently, 4-7 times per week for shorter hours each time.
Patient education regarding HD time commitment & diet modifications -
ANSWER - Dietary and fluid restrictions
- Eat high-quality proteins because it produces less waste for removal during
dialysis
- Avoid foods with high levels of sodium and phosphorus
Taking BP reading/where to take BP - ANSWER - Hold medications that lower
the blood pressure, monitor for hypotension
,- Take BP before, during, and after hemodialysis
Avoid measuring blood pressure, administering injections, performing
venipunctures, or inserting IV
- Catheters on or into an arm with an access site
CKD pathophysiology - ANSWER - The initial damage to the kidney (initiation
factor) causes a decrease in functioning nephrons
- The rest of the nephrons hypertrophy to increase GFR to compensate for
the loss of the other nephrons.
- Overtime angiotensin II is required to keep the GFR up by mainly
constricting the efferent arteriole and increasing glomerular pressures
- Overtime this damages the glomerulus and causes the basement membrane
to get larger pores
- Proteins then begin to be filtered and when they are reabsorbed they cause
inflammation which leads to further kidney disease, ultimately you end up
losing all your nephrons.
The presence of kidney damage or a decreased GFR - ANSWER - less than 60
L/min/1.732 for longer than 3 months
hyperkalemia - ANSWER the most serious electrolyte disorder in kidney
disease (serum potassium reaches 7-8 mEq/L)
CKD risk factors - ANSWER - Aging population, increased obesity, diabetes,
and hypertension
CKD signs and symptoms - ANSWER - Nausea, fatigue, lethargy, involuntary
movements of legs, depression, intractable hiccups, neurologic
,(slurred speech, tremors, seizures), psychological symptoms (anxiety,
depression),
cardiovascular symptoms, gastrointestinal symptoms (nausea, vomiting),
endocrine/reproductive
(hyperparathyroidism, erectile dysfunction), metabolic, hematologic
(anemia), ocular, pulmonary,
integumentary (decreased turgor, yellow, dry), musculoskeletal (fragile
bones)
CKD diagnostic tests - ANSWER BUN, serum creatinine, creatinine clearance,
CT scan, urinalysis, 24-hour urine, albumin-to-
creatinine ratio (first morning void), renal ultrasound/biopsy, CBC, serum
electrolytes
GFR & CKD stages/Stages of CKD are based on GFR-know ranges and relation
to stage - ANSWER - Stage 1: Minimal kidney damage when GFR within
expected reference range (greater than 90 mL/min)
- Stage 2: Mild kidney damage with mildly decreased GFR (60-89 mL/min)
- Stage 3: Moderate kidney damage with moderate decrease in GFR (30 to 59
mL/min)
, - Stage 4: Severe kidney damage with severe decrease in GFR (15 to 29
mL/min)
- Stage 5: Kidney failure and end-stage kidney disease with little to no GF
(less than 15 mL/min)
Normal GFR - ANSWER - 125 mL/min
Diet and ESKD (End Stage Kidney Disease) - ANSWER - End-stage kidney
disease exists when 90% of the functioning nephrons are destroyed and are
no longer
able to maintain fluid, electrolyte, and acid-base homeostasis
- Implement potassium, phosphate, sodium, and magnesium restrictions if
prescribed
- Restrict fluid intake
- High-protein diet to replace the high rate of protein breakdown due to
stress from the illness
Complete Solution
Assessment & nursing care of: Arteriovenous Fistula - ANSWER - AVF
(preferred access) - 2 -3 months to mature/ "arterialized"
- No B/P, IV insertion, or blood work.
- Assess patency - bruit (rushing sound) and thrill (buzzing sensation).
Assessment & nursing care of: Arteriovenous Graft - ANSWER - AVG -
synthetic graft. 2-4 weeks to heal.
- No B/P, IV insertion, or blood work.
- Assess patency - bruit (rushing sound) and thrill (buzzing sensation)
Hemodialysis frequency - ANSWER - Hemodialysis is usually done 3 times per
week for about 3-5 hours at a time.
- People who choose to do hemodialysis at home may do dialysis treatment
more frequently, 4-7 times per week for shorter hours each time.
Patient education regarding HD time commitment & diet modifications -
ANSWER - Dietary and fluid restrictions
- Eat high-quality proteins because it produces less waste for removal during
dialysis
- Avoid foods with high levels of sodium and phosphorus
Taking BP reading/where to take BP - ANSWER - Hold medications that lower
the blood pressure, monitor for hypotension
,- Take BP before, during, and after hemodialysis
Avoid measuring blood pressure, administering injections, performing
venipunctures, or inserting IV
- Catheters on or into an arm with an access site
CKD pathophysiology - ANSWER - The initial damage to the kidney (initiation
factor) causes a decrease in functioning nephrons
- The rest of the nephrons hypertrophy to increase GFR to compensate for
the loss of the other nephrons.
- Overtime angiotensin II is required to keep the GFR up by mainly
constricting the efferent arteriole and increasing glomerular pressures
- Overtime this damages the glomerulus and causes the basement membrane
to get larger pores
- Proteins then begin to be filtered and when they are reabsorbed they cause
inflammation which leads to further kidney disease, ultimately you end up
losing all your nephrons.
The presence of kidney damage or a decreased GFR - ANSWER - less than 60
L/min/1.732 for longer than 3 months
hyperkalemia - ANSWER the most serious electrolyte disorder in kidney
disease (serum potassium reaches 7-8 mEq/L)
CKD risk factors - ANSWER - Aging population, increased obesity, diabetes,
and hypertension
CKD signs and symptoms - ANSWER - Nausea, fatigue, lethargy, involuntary
movements of legs, depression, intractable hiccups, neurologic
,(slurred speech, tremors, seizures), psychological symptoms (anxiety,
depression),
cardiovascular symptoms, gastrointestinal symptoms (nausea, vomiting),
endocrine/reproductive
(hyperparathyroidism, erectile dysfunction), metabolic, hematologic
(anemia), ocular, pulmonary,
integumentary (decreased turgor, yellow, dry), musculoskeletal (fragile
bones)
CKD diagnostic tests - ANSWER BUN, serum creatinine, creatinine clearance,
CT scan, urinalysis, 24-hour urine, albumin-to-
creatinine ratio (first morning void), renal ultrasound/biopsy, CBC, serum
electrolytes
GFR & CKD stages/Stages of CKD are based on GFR-know ranges and relation
to stage - ANSWER - Stage 1: Minimal kidney damage when GFR within
expected reference range (greater than 90 mL/min)
- Stage 2: Mild kidney damage with mildly decreased GFR (60-89 mL/min)
- Stage 3: Moderate kidney damage with moderate decrease in GFR (30 to 59
mL/min)
, - Stage 4: Severe kidney damage with severe decrease in GFR (15 to 29
mL/min)
- Stage 5: Kidney failure and end-stage kidney disease with little to no GF
(less than 15 mL/min)
Normal GFR - ANSWER - 125 mL/min
Diet and ESKD (End Stage Kidney Disease) - ANSWER - End-stage kidney
disease exists when 90% of the functioning nephrons are destroyed and are
no longer
able to maintain fluid, electrolyte, and acid-base homeostasis
- Implement potassium, phosphate, sodium, and magnesium restrictions if
prescribed
- Restrict fluid intake
- High-protein diet to replace the high rate of protein breakdown due to
stress from the illness
