Diagnostic Tests
A patient develops urinary incontinence. What additional information should the nurse gather to determine a potential cause of the incontinence?
Potential causes of incontinence: UTI, trauma, menopause, medication that affect cognition or mobility, diabetes, vaginal delivery or prolapse, neurologic diseases, anxiety and stress levels, stool frequency (stool impaction can cause incontinence. (Iggy ch 61 p. 1329)
What is most accurate indicator of fluid loss or gain in a renal patient?
What is Weight
it is important to weigh the patient daily at the same time, same scale, same amount of clothing.
Why are diuretics sometimes given to patients with CKD?
Diuretics such as furosemide and bumetanide are often given to help lower blood pressure and potassium levels. They also can increase urine output to manage fluid volume overload.
Note: these are only given when urinary elimination is still present.
What assessment finding is often associated as a first symptom of urothelial cancers?
Late symptoms: gross hematuria, flank pain, palpable mass.
What is the difference between acute and chronic pyelonephritis?
Acute pyelonephritis presents like an infection.
Chronic pyelonephritis looks like kidney failure.
Rationale: chronic inflammation causes scar tissue which damages the kidney and its ability to filter waste products.
Why is Epoetin (Epogen) given to a patient with ESRD?
To increase RBC production.
Rationale: Kidneys that are damaged do not produce erythropoietin that stimulates RBC production hence they are often anemic. It is important to monitor Hgb levels and RBCs while on this med. High RBC levels can increase blood viscosity and cause HTN and increased risk of MI.
What intervention is done by the nurse in a patient receiving dialysis in order to determine if correct amount of fluid is removed from the patient?
Obtain a weight before and after dialysis. Rationale: Weight is way to determine the fluid status of the patient. Sometimes referred to as a "wet" or "dry" weight (before dialysis = wet weight and after dialysis= dry weight)
Which of the following lab values are increased in ESKD? (select all that apply)
a- creatinine
b- BUN
c- potassium
d- calcium
e- RBC/Hgb
f- GFR
Answers- creatinine, BUN, Potassium
Calcium is decreased in ESKD r/t increased reabsorption of Ca+ from the bone.
GFR is decreased in ESKD because the kidney are filtering less blood.
During what stage of renal failure does a provider generally recommend starting a patient on dialysis?
Stage 4
During this stage, the GFR is severely decreased 15-29), waste elimination is poor. The kidneys need help doing their job (filtering out bad).
A nurse is teaching a patient with ESKD who is receiving hemodialysis. How should the nurse address the patient's protein needs? (high or low protein diet)
High protein diet
Rationale: patients in ESKD or on dialysis need more protein r/t the loss of protein during dialysis. A person in early kidney disease will need a low protein diet to help preserve kidney function. GFR and the type of treatment the patient is receiving will guide safe levels of protein intake.
A patient complains of not feeling good after dialysis. This is caused by a condition that delays the removal of waste from the brain. What is this condition called?
A patient complains of fatigue, headache and nausea after hemodialysis. What is the name of this condition?
What is Disequilibrium syndrome.
Rationale: caused from rapid reduction of electrolytes and other particles during hemodialysis. Severe symptoms of this syndrome=mental status changes, seizures or coma which are rare today. Slowing the HD rate can help prevent this syndrome.
A patient is receiving calcium carbonate three times a day with meals. Why is this med ordered this way?
Calcium carbonate (Tums) is given at mealtimes to bind with phosphorous in foods thus lowering phosphorous levels via the colon (stool/ bowel movements).
Patients are often given Kayexalate (sodium polystyrene sulfonate) who are in ESKD. Why is this given and what is its action?
Kayexalate lowers potassium levels in ESKD patients by binding to potassium and excreting through the GI tract.
A patient in ESKD is experiencing fluid overload. Which of the following assessment findings would indicate signs of fluid overload? (select all that apply)
A. bilateral pedal edema
B. b/p 110/60
C. crackles in lung fields
D. urine output 200 ml in 24 hours
E. generalized edema
Answers:
A- pedal edema
C- crackles in lung fields
D- urine output 200 ml in 24 hrs.
E- generalized edema
Name 2 lab values that you will significantly see elevated when kidneys are unable to filter waste products adequately?
Elevation in BUN and serum creatinine
Rationale: BUN measures urea which should be excreted by kidneys. BUN is NOT seen elevated in blood if the kidneys are doing their job.
Creatinine: evaluates kidney function. Cr. is a by-product of the breakdown of muscle and is excreted by kidneys.When the kidneys are not doing their job, you will see higher creatinine levels in the blood.
A nurse is reviewing a patients med list during a clinic visit. The patient states that they are currently taking 2 tabs of ibuprofen 800 mg 4 times a day for arthritis pain. What teaching should the nurse do with the client regarding this medication?
Ibuprofen is a nephrotoxic medication. The maximum dose of ibuprofen used as an anti-inflammatory is 400-800 mg 4 times daily not to exceed 3200 mg/day.
This patient is taking 2 of the 800 mg tablets with each dose 4 times a day which is 6400 mg. This is way too much. Patient needs education and provider should be notified for follow up.