NUR 150 EXAM #3 QUESTIONS AND
ANSWERS
urinary retention - Answer-•Inability to empty bladder with voiding or the accumulation of
urine because of inability to void
•Acute urinary retention—inability to pass urine; medical emergency
•Chronic urinary retention—incomplete emptying despite urination
-Post void residual (PVR)—normal 50 to 75 mL
•More than 100 mL—repeat or further evaluation with UTIs
•More than 200 mL—further evaluation
AKI - Answer-Onset
-Sudden
Most common
causes
-Acute tubular necrosis
Diagnostic criteria
-Acute reduction in urine output and/or elevation in serum creatinine
Reversibility
-Potentially
Cause of death
-Infection
CKD - Answer-Onset
-Gradual, over years
Causes
-Diabetic nephropathy 50%
-HTN 25%
-glomerulonephritis
-cystic diseases
-urologic diseases
Dx criteria
-GFR < 60 mL/min/1.73m2 for > 3 months
-US to rule out renal calculi
-often asymptomatic- 70% aware
,Reversibility
-Progressive and irreversible
Cause of death
-Cardiovascular disease
Stages of CKD - Answer-1. ≥ 90
Diagnosis and treatment; CVD risk reduction; slow progression
2. 60-89
Estimation of progression
3a. 45-59
Evaluation and treatment of complications
3b. 30-44
More aggressive treatment of complications
stage 1-3 drugs/intervention
-calcium acetate binds to phosphorus
-decrease protein and salt, phosphate binder each meal, fluid restriction( 600cc+
previous out)
4. 15-29
Preparation for RRT (dialysis normal peritoneal or transplant)
-
5. Kidney Failure
Less than 15 or dialysis
RRT if uremia present and patient desires treatment; necessary to maintain life
Clinical manifestations CKD - Answer-Altered carbohydrate metabolism
-Caused by impaired glucose metabolism
•From cellular insensitivity to normal action of insulin
•Mild-moderate hyperglycemia and hyperinsulinemia
Elevated triglycerides
-Hyperinsulinemia stimulates hepatic production of triglycerides
-Altered lipid metabolism
-Decreased levels of enzyme lipoprotein lipase
-Increased VLDLs and LDLs, decreased HDLs
Uremia
Metabolic acidosis
-Impaired ability of kidneys to excrete excess acid
, Early Changes
-No change in urine output
-Polyuria may be present related to diabetes.
CKD progression—increasing fluid retention; need diuretic
After a period on dialysis, patients may become anuric
uremia - Answer-Syndrome in which kidney function declines to the point that symptoms
occur in multiple body systems
management of CKD - Answer--Stages 1 to 4
-Control HTN, hyperparathyroid disease, CKD-MBD, anemia, and dyslipidemia
-Correct of ECF volume overload or deficit
-Treat CV disease
-Nutritional therapy
-Drug therapy
drug therapy CKD - Answer-Hyperkalemia
-Restriction of high-potassium foods and drugs
-Acute
•IV glucose and insulin
•IV 10% calcium gluconate
-Sodium polystyrene sulfonate (Kayexalate)
•Osmotic laxative action (diarrhea)
-Patiromer (Veltessa)—binds K+ in GI tract
-Dialysis—most effective
Anemia
-Epoetin alfa (Epogen, Procrit)
-Darbepoeitin alfa (Aranesp)
(EPO se thromboembolism,HTN)
-iron supplements (if ferritin level< 100, se: GI upset, constipation)
-Folic acid
-avoid blood transfusions (Increase the development of antibodies
May lead to iron overload)
•Dyslipidemia
-Statins (HMG-CoA reductase inhibitors)
Fibrates (fibric acid derivatives
nutritional therapy CKD - Answer-•Protein intake - should be limited in CKD until
Dialysis is initiated. Then can be restricted less
•Fluid restriction with HD
-Intake depends on daily urine output
ANSWERS
urinary retention - Answer-•Inability to empty bladder with voiding or the accumulation of
urine because of inability to void
•Acute urinary retention—inability to pass urine; medical emergency
•Chronic urinary retention—incomplete emptying despite urination
-Post void residual (PVR)—normal 50 to 75 mL
•More than 100 mL—repeat or further evaluation with UTIs
•More than 200 mL—further evaluation
AKI - Answer-Onset
-Sudden
Most common
causes
-Acute tubular necrosis
Diagnostic criteria
-Acute reduction in urine output and/or elevation in serum creatinine
Reversibility
-Potentially
Cause of death
-Infection
CKD - Answer-Onset
-Gradual, over years
Causes
-Diabetic nephropathy 50%
-HTN 25%
-glomerulonephritis
-cystic diseases
-urologic diseases
Dx criteria
-GFR < 60 mL/min/1.73m2 for > 3 months
-US to rule out renal calculi
-often asymptomatic- 70% aware
,Reversibility
-Progressive and irreversible
Cause of death
-Cardiovascular disease
Stages of CKD - Answer-1. ≥ 90
Diagnosis and treatment; CVD risk reduction; slow progression
2. 60-89
Estimation of progression
3a. 45-59
Evaluation and treatment of complications
3b. 30-44
More aggressive treatment of complications
stage 1-3 drugs/intervention
-calcium acetate binds to phosphorus
-decrease protein and salt, phosphate binder each meal, fluid restriction( 600cc+
previous out)
4. 15-29
Preparation for RRT (dialysis normal peritoneal or transplant)
-
5. Kidney Failure
Less than 15 or dialysis
RRT if uremia present and patient desires treatment; necessary to maintain life
Clinical manifestations CKD - Answer-Altered carbohydrate metabolism
-Caused by impaired glucose metabolism
•From cellular insensitivity to normal action of insulin
•Mild-moderate hyperglycemia and hyperinsulinemia
Elevated triglycerides
-Hyperinsulinemia stimulates hepatic production of triglycerides
-Altered lipid metabolism
-Decreased levels of enzyme lipoprotein lipase
-Increased VLDLs and LDLs, decreased HDLs
Uremia
Metabolic acidosis
-Impaired ability of kidneys to excrete excess acid
, Early Changes
-No change in urine output
-Polyuria may be present related to diabetes.
CKD progression—increasing fluid retention; need diuretic
After a period on dialysis, patients may become anuric
uremia - Answer-Syndrome in which kidney function declines to the point that symptoms
occur in multiple body systems
management of CKD - Answer--Stages 1 to 4
-Control HTN, hyperparathyroid disease, CKD-MBD, anemia, and dyslipidemia
-Correct of ECF volume overload or deficit
-Treat CV disease
-Nutritional therapy
-Drug therapy
drug therapy CKD - Answer-Hyperkalemia
-Restriction of high-potassium foods and drugs
-Acute
•IV glucose and insulin
•IV 10% calcium gluconate
-Sodium polystyrene sulfonate (Kayexalate)
•Osmotic laxative action (diarrhea)
-Patiromer (Veltessa)—binds K+ in GI tract
-Dialysis—most effective
Anemia
-Epoetin alfa (Epogen, Procrit)
-Darbepoeitin alfa (Aranesp)
(EPO se thromboembolism,HTN)
-iron supplements (if ferritin level< 100, se: GI upset, constipation)
-Folic acid
-avoid blood transfusions (Increase the development of antibodies
May lead to iron overload)
•Dyslipidemia
-Statins (HMG-CoA reductase inhibitors)
Fibrates (fibric acid derivatives
nutritional therapy CKD - Answer-•Protein intake - should be limited in CKD until
Dialysis is initiated. Then can be restricted less
•Fluid restriction with HD
-Intake depends on daily urine output
