NURS 271 TEST 2 STUDY GUIDE WITH COMPLETE
SOLUTION!!
Acute Kidney Injury/failure
answers: 30 cc an hour, less than = why? Dehydrated, decreased perfusion?
problem with kidneys and not functioning = destabilize in clinical setting =
medical / nursing intervention
How do the kidneys function?
Responsible for maintaining fluid and electrolyte homeostasis
Ridding the body of water soluble wastes: 7 L an hour, 99%: absorb, 1% = urine,
waste
answers: Regulating the amount and composition of the urine to keep blood
volume and electrolyte composition in normal range
Performing 2 important endocrine functions: production of erythropoietin (less =
less oxygen to kidney): RBC quantity + activation of vitamin D: intestinal calcium
Electrolytes
Potassium: 3.5-5.0 = retain electrolytes, K: high or low = affect cardiovascular
system, heart irritable = extra or abnormal beats = abnormal cardiac rhythms =
atrial fibrillation/tachycardia, can be put on dialysis if medications/other treatments
not working
Calcium: 8.5-10
answers: Sodium level: 135-145 + water = high: retention, low: confusion for
elderly, disorientation, muscle cramps, weakness. major extracellular electrolyte
and osmotic pressure, water follows = dehydration (high) or fluid overload (low)
Phosphorus: 3.0-4.5 = excreting it, renal failure = can't excrete it = build up of Ph,
increase Ph = Ca decreases, hypercalcemia: signs
Acid base balance: pH of blood, 7.35-7.45, helps us determine acid base ratio,
excrete excess H ions and bicarbonate in blood
, answers: kidneys and lungs work together, if H ions are not being excreted by
kidneys = retain it = metabolic acidosis
Hormonal Regulation
Erythropoietin
Stimulates erythrocyte development in bone marrow
answers: Regulator of RBC production
Vitamin D
Secretion of these hormones are impaired in renal failure: acute / renal
insufficiency
answers: loss their ability to produce erythropoietin but can give erythropoietin
injection to patient = decrease RBC production = kidney will receive less oxygen
Renal failure
answers: hypoxia = need additional oxygen but not available because
erythropoietin production is decreased = less RBC = less oxygen to tissues/kidneys
Vitamin D is formed in the skin, kidney is also responsible for forming the active
form of vitamin D
answers: for calcium to be reabsorbed from intestines, low calcium: hypocalcemia
= Ph is elevated
Acute kidney injury: Osteodystrophy
Vitamin D is impaired
Poor calcium reabsorption
Decreased calcium
, Stimulus for parathyroid release
answers: Leads to parathyroid hormone release: pulls Ca and Ph from bone =
osteodystrophy = bones are weaker, prone to fractures, Ca low = body compensates
= elevated parathyroid hormone = condition: secondary parathyroidism, abnormal
metabolism of bone
Addressing Clinical Problems
Anemia
Erythropoietin, Epogen replacement: increase erythropoietin levels = more RBC
production = more oxygen to kidneys
Folic Acid, iron
answers: BP control: low perfusion = angiotensin = increase in BP: hypertension =
damage glomerulus = kidney disease = narrowing and constriction of blood vessels
= damage
glomerulus (filters blood) = glomerular filtration rate: GFR normal = 60-120
mL/min, less than 15 mL/min = placed on dialysis, decreases with age but
shouldn't be so low, monitor if history of hypertension
Renal Disorders
Renal Insufficiency: blood urea nitrogen, BUN: 6-20 mg/dL (only high =
dehydrated) and creatinine, CR: 0.6-1.2 mL/dL, both elevated = glomerulus failing
to filter = why? Obstruction, hypertension? = kidney is not functioning, not able to
eliminate toxins and electrolytes
Azotemia - Buildup of nitrogen waste products: high BUN/CR, no symptoms, can
urinate, no notice in changes
answers: Uremia - Buildup of urea (byproduct of protein, toxic) in the blood, high
BUN/CR and symptomatic, retention of waste products = systemic problem,
impacts entire body, increases skin oils = itching, fluid retention = BP increases =
more hypertension = retain enough fluid = heart working harder = heart failure,
SOLUTION!!
Acute Kidney Injury/failure
answers: 30 cc an hour, less than = why? Dehydrated, decreased perfusion?
problem with kidneys and not functioning = destabilize in clinical setting =
medical / nursing intervention
How do the kidneys function?
Responsible for maintaining fluid and electrolyte homeostasis
Ridding the body of water soluble wastes: 7 L an hour, 99%: absorb, 1% = urine,
waste
answers: Regulating the amount and composition of the urine to keep blood
volume and electrolyte composition in normal range
Performing 2 important endocrine functions: production of erythropoietin (less =
less oxygen to kidney): RBC quantity + activation of vitamin D: intestinal calcium
Electrolytes
Potassium: 3.5-5.0 = retain electrolytes, K: high or low = affect cardiovascular
system, heart irritable = extra or abnormal beats = abnormal cardiac rhythms =
atrial fibrillation/tachycardia, can be put on dialysis if medications/other treatments
not working
Calcium: 8.5-10
answers: Sodium level: 135-145 + water = high: retention, low: confusion for
elderly, disorientation, muscle cramps, weakness. major extracellular electrolyte
and osmotic pressure, water follows = dehydration (high) or fluid overload (low)
Phosphorus: 3.0-4.5 = excreting it, renal failure = can't excrete it = build up of Ph,
increase Ph = Ca decreases, hypercalcemia: signs
Acid base balance: pH of blood, 7.35-7.45, helps us determine acid base ratio,
excrete excess H ions and bicarbonate in blood
, answers: kidneys and lungs work together, if H ions are not being excreted by
kidneys = retain it = metabolic acidosis
Hormonal Regulation
Erythropoietin
Stimulates erythrocyte development in bone marrow
answers: Regulator of RBC production
Vitamin D
Secretion of these hormones are impaired in renal failure: acute / renal
insufficiency
answers: loss their ability to produce erythropoietin but can give erythropoietin
injection to patient = decrease RBC production = kidney will receive less oxygen
Renal failure
answers: hypoxia = need additional oxygen but not available because
erythropoietin production is decreased = less RBC = less oxygen to tissues/kidneys
Vitamin D is formed in the skin, kidney is also responsible for forming the active
form of vitamin D
answers: for calcium to be reabsorbed from intestines, low calcium: hypocalcemia
= Ph is elevated
Acute kidney injury: Osteodystrophy
Vitamin D is impaired
Poor calcium reabsorption
Decreased calcium
, Stimulus for parathyroid release
answers: Leads to parathyroid hormone release: pulls Ca and Ph from bone =
osteodystrophy = bones are weaker, prone to fractures, Ca low = body compensates
= elevated parathyroid hormone = condition: secondary parathyroidism, abnormal
metabolism of bone
Addressing Clinical Problems
Anemia
Erythropoietin, Epogen replacement: increase erythropoietin levels = more RBC
production = more oxygen to kidneys
Folic Acid, iron
answers: BP control: low perfusion = angiotensin = increase in BP: hypertension =
damage glomerulus = kidney disease = narrowing and constriction of blood vessels
= damage
glomerulus (filters blood) = glomerular filtration rate: GFR normal = 60-120
mL/min, less than 15 mL/min = placed on dialysis, decreases with age but
shouldn't be so low, monitor if history of hypertension
Renal Disorders
Renal Insufficiency: blood urea nitrogen, BUN: 6-20 mg/dL (only high =
dehydrated) and creatinine, CR: 0.6-1.2 mL/dL, both elevated = glomerulus failing
to filter = why? Obstruction, hypertension? = kidney is not functioning, not able to
eliminate toxins and electrolytes
Azotemia - Buildup of nitrogen waste products: high BUN/CR, no symptoms, can
urinate, no notice in changes
answers: Uremia - Buildup of urea (byproduct of protein, toxic) in the blood, high
BUN/CR and symptomatic, retention of waste products = systemic problem,
impacts entire body, increases skin oils = itching, fluid retention = BP increases =
more hypertension = retain enough fluid = heart working harder = heart failure,
