WVU NSG 460 Exam 3 Renal/Fluid and
Electrolyte Content Questions And
Answers Graded A+ Solutions
Renal Labs
BUN and Creatinine (Cr)
-Cr is more specific to kidney function
-BUN fluctuates with fluid status
^BUN may be increased if the patient is fluid depleted, but Cr is ok
AKI/Acute Renal Failure
-acute renal failure in the critically ill/injured patient can be caused by
hypovolemia or decreased renal perfusion
-we worry about not getting enough blood throughout the body
Prerenal Kidney Injury
-reminiscent of hypovolemia or early shock
-decreased fluid volume, leads to decreased renal blood flow, which leads to
decreased urine output
^UO is a tell-tale sign of our fluid volume status
Tx for Prerenal Kidney Injury
-if they are bleeding, we will give them PRBCs
-if they are hypovolemic, then we will give fluids
^isotonic: normal saline, lactated ringers, or plasmalyte
,-we can also use fluid volume expanders if necessary (albumin)
Diagnostic Studies
Arterial Blood Gases
-the acid-base imbalance that occurs with renal failure is metabolic acidosis
-this is because the kidneys lack the ability for bicarb reabsorption and they end
up excreting it, which throws off our acid-base balance
What are the two most common serious complications associated with chronic renal
failure?
-hyperkalemia
^watch for dysrhythmias
-fluid volume overload
^watch for CHF s/sx like pulmonary edema
Nursing Assessment w/ Renal Failure
Neuro
-restlessness and confusion
Respiratory
-may be compensating for the acid-base imbalances
-listen to lung sounds (be mindful of crackles in the bases)
Cardiovascular
-looking for signs of CHF
-monitor for JVD, peripheral edema, pulmonary edema, and hepatic congestion
, Weight Gain & Weight Loss
Serial Weights
-1 cc = 1 g
-500 cc= 0.5 kg
-1 L = 1 kg
*rapid weight gain/loss is typically due to fluid
Dialysis
-taking blood out of the body and taking it to a synthetic kidney where it is
bathed in fluid with certain electrolytes
-we can pull off the electrolytes the kidneys aren't excreting, as well as excess
fluid, and we can pull off wastes
-we typically reserve dialysis for those who are in kidney failure
Serum Osmolarity
-stuff in blood compared to H2O
^Na, urea, glucose
^normal value: 280 to 300
Thick & Thin Serum Osmolarity
Thick
-too much stuff or not enough water
Thin
-too much water or not enough stuff
Electrolyte Content Questions And
Answers Graded A+ Solutions
Renal Labs
BUN and Creatinine (Cr)
-Cr is more specific to kidney function
-BUN fluctuates with fluid status
^BUN may be increased if the patient is fluid depleted, but Cr is ok
AKI/Acute Renal Failure
-acute renal failure in the critically ill/injured patient can be caused by
hypovolemia or decreased renal perfusion
-we worry about not getting enough blood throughout the body
Prerenal Kidney Injury
-reminiscent of hypovolemia or early shock
-decreased fluid volume, leads to decreased renal blood flow, which leads to
decreased urine output
^UO is a tell-tale sign of our fluid volume status
Tx for Prerenal Kidney Injury
-if they are bleeding, we will give them PRBCs
-if they are hypovolemic, then we will give fluids
^isotonic: normal saline, lactated ringers, or plasmalyte
,-we can also use fluid volume expanders if necessary (albumin)
Diagnostic Studies
Arterial Blood Gases
-the acid-base imbalance that occurs with renal failure is metabolic acidosis
-this is because the kidneys lack the ability for bicarb reabsorption and they end
up excreting it, which throws off our acid-base balance
What are the two most common serious complications associated with chronic renal
failure?
-hyperkalemia
^watch for dysrhythmias
-fluid volume overload
^watch for CHF s/sx like pulmonary edema
Nursing Assessment w/ Renal Failure
Neuro
-restlessness and confusion
Respiratory
-may be compensating for the acid-base imbalances
-listen to lung sounds (be mindful of crackles in the bases)
Cardiovascular
-looking for signs of CHF
-monitor for JVD, peripheral edema, pulmonary edema, and hepatic congestion
, Weight Gain & Weight Loss
Serial Weights
-1 cc = 1 g
-500 cc= 0.5 kg
-1 L = 1 kg
*rapid weight gain/loss is typically due to fluid
Dialysis
-taking blood out of the body and taking it to a synthetic kidney where it is
bathed in fluid with certain electrolytes
-we can pull off the electrolytes the kidneys aren't excreting, as well as excess
fluid, and we can pull off wastes
-we typically reserve dialysis for those who are in kidney failure
Serum Osmolarity
-stuff in blood compared to H2O
^Na, urea, glucose
^normal value: 280 to 300
Thick & Thin Serum Osmolarity
Thick
-too much stuff or not enough water
Thin
-too much water or not enough stuff
