Acute Kidney Injury
Name the three etiologogical locations of acute kidney injury
Pre renal-outside of kidney, related to intravascular volume depletion, decreased cardiac output, pre renal infection or obstruction
Intra renal-within the parenchyma of the kidney: tubular necrosis, intrarenal infection, obstruction, nephrotoxic
Post renal-between kidney and urethral meatus such as post renal infection
Two patients with suspected kidney disease have laboratory testing. The nurse will report which abnormal BUN or creatinine result?
a) BUN 14mg/dL
b) BUN 26mg/dL
c) Creatinine 0.9mg/dL
d)Creatnine 1.1mg/dL
b) BUN 26mg/dL
Describe presenting signs and symptoms of Pancreatitis
-Nausea/vomiting
-epigastric pain that radiates to
the back
-Cullen's sign (discoloration of abdomen and periumbilical area)
-Turner's sign (flank discoloration)
Chronic Hep C
nonalcoholic fatty liver disease (NAFLD)
Non alcoholic steatohepatitis (NASH)
most common causes of cirrhosis
Findings of Hepatic Encephalopathy
Increased ammonia level in blood
change in LOC/mental status
TX: Lactulose-which decreases ph of bowel, decreases production of ammonia by bacteria in the bowel, and facilitates the excretion of ammonia.
A sample is obtained for a routine patient urinalysis. After reviewing the results, the nurse noted that an expected finding of the urinalysis is
a) pH 8.0
b)specific gravity 1.018
c) protein amounts 12mg/100mL
d)white blood cells (WBCs) of 5-8 per lower field casts
b). 1.018 (normal 1.003-1.030)
Normal BUN 6-24 mg/dL
Normal Creatinine 0.7-1.3 mg/dL (men), 0.6-1.1 mg/dL
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent?
1)Palpation of thrill over fistula
2)Presence of radial pulse in left wrist
3)visualization of enlarged blood vessels at the fistula site
4)Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand
Palpation of thrill over fistula
Describe presenting S & S of cholecystitis
nausea, vomiting, belching, flatulence
RUQ pain that radiates to r shoulder/scapula (Kehr's sign)
Murphy's sign (cannot take a deep breath when examiner's fingers pass below hepatic margin due to pain
Bilary obstruction (jaundice)
ascites
portal hypertension
esophageal varices
coagulation defects
jaundice
portal systemic encephalopathy
hepatorenal syndrome (decreased urinary output, increased BUN, creatinine, dereased sodium excretion, increased urine osmolarity
Complications of Cirrhosis
Functions of the LIVER
Remove excess glucose and amino acids from portal venous blood
store glycogen to synthesize glucose, amino acids, and fats
secretion of fat emulsifying bile
A client with acute kideny injury has a serum potassium of 7.0 mEq/L. The nurse would plan which actions as priority, select all that apply:
1)place patient on cardiac monitor
2)Notify the primary care provider (PCP)
3)Put the patient on NPO except for ice chips
4) review patient medications to determine whether any retain/contain potassium
5)Allow an extra 500mL of intravenous fluid intake to dilute the electrolyte concentration
1,2,4
A patient with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The nurse suspects air embolism. What are the priority nursing actions? Select all that apply.
1)Administer oxygen to the client
2) continue dialysis at a slower rate
3)Notify PCP and rapid response team
4)stop dialysis and turn the client on the left side with head lower then feet
5)bolus the client with 500mL of normal saline to break up air embolus
1,3,4
two functions of the pancreas
exocrine-secretes bicarb to neutralize acidity of stomach contents that enter the doudenum
endocrine-secrete glucogon to raise blood glucose levels, the islets of Langerhans secrete insulin
elevate head of bed to prevent SOB
high protein diet, except in the case of edema and impending coma (due to renal insufficiency)
restrict sodium intake, fluid intake as prescribed
administer diuretics to treat ascites
monitor I & Os, electrolyte balance
monitor LOC
monitor for asterixis
Monitor client weight and abdominal girth
monitor coags, adm vit K if needed
avoid medications such as opioids, barbiturates, and any hepatotoxic medications/substance
Nursing interventions for cirrhosis
Complications of paracentesis
infection, hypovolemia, and electrolyte loss
rapid removal of fluid can cause shock and HR, BP must be monitored closely
How does a nurse reduce the incidence of CAUTI?
-empty drainage bag when 2-3 full
-cleanse up the length of the catheter to the perinium with an antiseptic
-do not open drainage system to obtain sample (use port)
-place bag on patient's lap for transport within the hospital
-working with provider to discontinue indwelling catheter as soon as medically possible
Provide GFR for each stage of renal failure
At risk>90 mL/min
Mild CKD 60-89mL/min
Moderate CKD 30-59mL/min
Severe CKD 15-29mL/min
ESRD<15 mL/min
Lab findings for acute pancreatitis
elevated pancreatic enzymes: lipase, amylase
In the case of rupture of esophageal varices and subsequent hemorrhage, the nurse should anticipate the insertion of
NG tube or balloon tamponade
*other interventions include:
blood transfusions
fluids to store volume
Hemoglobin/hct
medications that induce vasoconstriction and reduce bleeding
The nurse is preparing a client for a liver biopsy. During chart review, the nurse notes PTT is at 35 sec and Platelot count is 100,000. What are the nursing priority actions?
The client is at risk for bleeding. Notify the PCP and place on bleeding precautions
What are the phases of acute kidney injury
Oliguria-8-15 days, the longer the duration, the less likely recovery, elevated BUN/creatinine, decreased GFR and creatinine clearance, hypervolemia (monitor lungs for crackles, wheezes, rhonchi)
Diuresis-output rises, followed by diuresis
Recovery-can take 1-2 years
*signs and symptoms of AKI-retention of nitrogenous wastes, retention of fluids, inability of kidney's regulate electrolytes
A patient is admitted to the ED after a fall from a horse, the PCP prescribes insertion of a urinary catheter. While preparing for the procedure the nurse notes blood at the urinary meatus. The nurse should take which action?
a) notify PCP b/f catheterization
b) use a small size catheter and anesthetic gel as lubricant
c) administer parenteral pain medication b/f inserting the catheter
d)Clean the meatus with soap and water before opening the catheterization kit
notify PCP, possibility of internal trauma, foley contraindicated
The nurse is reviewing prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would nurse expect:
a) maintain NPO
b) encourage coughing, deep breathing
c)give small, frequent high calorie meals, maintain the client in a supine, flat position
d) maintain client in supine position
e)give hydromorphone IV as prescribed
f) maintain intravenous fluids at KVO
1,2,5
due to NPO status, adequate IV hydration is necessary
pain can cause shallow breathing, increasing the risk for PNU
patient may be most comfortable in side lying position with head elevated 45 degrees decrease tension on the abdomen
IV drug abuse
long term hemodialysis
helathcare personnel
are at increased risk for this type of hep[atitis?
Hep B-blood or body fluid contact
Hep A and C are curable. Hep A and B may resolve without treatment. Hep B is more likely to result in chronic liver dysfunction.
The nurse is reviewing the lab findings for a patient with cirrhosis. She notes that the ammonia level is 85mcg/dL. Which dietary suggestion does the nurse give the client?
a) roast pork
b) cheese omelet
c) pasta with sauce
d)tuna fish sandwich
C. Normal ammonia level is (10-80mcg/dL), need to decrease protein intake if above.