AKI
A client with acute kidney injury has peaked T waves on an ECG. This electrolyte imbalance is the most life threatening complication the nurse should recognize
What is hyperkalemia?
In AKI the kidneys cannot excrete potassium effectively, leading to hyperkalemia. A potassium above 5.0 mEq/L can cause ECG changes (peaked T waves and widened QRS) and life threatening dysrhythmias.
A 58 year old client with diabetes and hypertension asks the nurse why their kidneys are failing slowly over the past few years. Chronic kidney disease is defined as kidney damage or decreased kidney function for this minimum duration.
What is greater than 3 months?
CKD is a chronic, progressive loss of kidney function. CKD is defined as kidney damage or GFR < 60 for greater than 3 months. Recognizing early signs helps prevent complications.
This complication may occur if too much fluid is removed too quickly during hemodialysis.
What is hypotension?
Hypotension occurs during hemodialysis because rapid fluid removal decreases blood volume and lowers blood pressure. Other possible complications include hemorrhage and infection.
This complication occurs when ammonia builds up and causes confusion and asterixis.
hepatic encephalopathy
Rationale:
Damaged liver cannot convert ammonia to urea. Ammonia crosses the blood-brain barrier → altered LOC, asterixis, confusion.
Lactulose traps ammonia in the gut and promotes excretion through stool. Goal 2–3 soft stools per day.
A patient reports RUQ pain after eating a fatty meal. The nurse suspects what condition
cholelithiasis
Rationale:
Fatty foods stimulate gallbladder contraction. If stones block cystic duct biliar. If the client is experiencing pain they should be NPO
When a patient with acute kidney injury has an ABG pH of 7.30, the nurse will expect an assessment finding of?
a. persistent skin tenting
b. rapid, deep respirations
c. hot, flushed face and neck
d. bounding peripheral pulses
What is B. rapid, deep respirations
Patients with metabolic acidosis caused by AKI may have Kussmaul respirations while they try to regulate carbon dioxide. This is a sign of metabolic acidosis.
A client with diabetes and high blood pressure asks why they are at risk for chronic kidney disease. What are the two conditions that are the most common causes of CKD?
What are diabetes mellitus and hypertension?
High blood glucose damages the tiny filters in the kidneys called glomeruli. This is called diabetic nephropathy.
High blood pressure puts extra stress on the blood vessels in the kidneys, which can cause kidney damage. This is called hypertensive nephrosclerosis.
Controlling blood sugar and BP is important because it helps slow down the worsening chronic kidney disease.
These medications must be taken for life after transplant to prevent rejection.
What are immunosuppressants?
After a kidney transplant, the body sees the new kidney as something foreign and tries to attack it. Immunosuppressants help stop the immune system from attacking the transplanted organ so it can keep working. Because these medications weaken the immune system, the patient has a higher risk for infection, so infection control measures are important, such as frequent hand hygiene, avoiding crowds or sick people, and wearing a face mask in public.
A cirrhosis patient suddenly vomits large amounts of bright red blood. The nurse anticipates bleeding from what condition?
Answer: Ruptured Esophageal Varices
Rationale:
Portal hypertension causes collateral vessel formation in esophagus. These vessels are fragile and can rupture. massive hemorrhage.
Do not strain.
The nurse assesses inspiratory arrest when palpating the RUQ. This is known as what sign?
What is Murphy’s sign?
Rationale:
Pain with inspiration during RUQ palpation indicates inflamed gallbladder
A client recovering from acute kidney injury begins producing 4000 mL of urine per day. The nurse recognizes the client is in this phase and is at greatest risk for dehydration and hypokalemia.
What is the diuretic phase?
This phase will show increased urine output and put the patient at risk for dehydration, hypotension, and hypokalemia.
Which statement by a client with stage 5 chronic kidney disease indicates that the nurse's teaching about management of CKD has been effective?
a. "I need to get most of my protein from low fat dairy products."
b. "I will increase my intake of fruits and vegetables to 5 per day."
c. "I will measure my urinary output each day to calculate the amount I can drink."
d. "I need to take erythropoietin to boost my immune system and help prevent infection."
What is C. "I will measure my urinary output each day to calculate the amount I can drink."
A client with end stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake.
Erythropoietin is given to increase the RBCs and does not benefit the immune system.
Dairy products are restricted because of high phosphate levels.
Fruits and vegetables are high in potassium and should be restricted in a client with CKD.
In this type of dialysis, dialysate is placed into the abdomen, where a membrane filters waste products and excess fluid from the blood.
What is peritoneal dialysis?
Peritoneal dialysis works by putting dialysate into the peritoneal cavity. The peritoneum acts like a filter, allowing waste products and extra fluid to move from the blood into the dialysate, which is then drained out. Peritoneal dialysis treats clients requiring dialysis who:
This procedure removes fluid from the abdomen to relieve respiratory distress
paracentesis
Rationale:
Used to treat ascites and improve breathing. Improve breathing means the procedure is successful.
Monitor vital signs frequently Reassess abdominal girth Re-weigh client Assess puncture site for bleeding and infection.
After cholecystectomy, the nurse notes rigid abdomen, hypotension, and severe pain. The nurse suspects what complication
bile peritonitis
Rationale:
Leakage of bile into the peritoneal cavity causes inflammation and shock.
A client was admitted with septic shock and developed acute kidney injury.
The nurse reviews the following data:
Urine output 20 mL/hr
Potassium 6.1 mEq/L
BUN 72 mg/dL
Creatinine 4.0 mg/dL
Crackles in the lungs and 3+ peripheral edema
BP 168/94
The provider prescribes IV fluids at 150 mL/hr
What phase of AKI is occurring and what order should the nurse question?
What is the oliguric phase and the nurse should question the IV fluid order.
The oliguric phase is shown by very low urine output, high BUN/creatinine, and fluid overload. Giving IV fluids now could worsen pulmonary edema and hypertension, so the nurse should question the order and prioritize fluid management and hyperkalemia treatment.
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease?
a. blood pressure
b. phosphate level
c. neurologic status
d. creatinine clearance
What is B. phosphate level?
Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in clients with CKD.
This type of dialysis is used for hemodynamically unstable patients because it removes fluid and waste slowly and continuously over many hours.
What is Continuous Renal Replacement Therapy (CRRT)?
CRRT is used for patients who cannot tolerate regular hemodialysis because it removes fluids and solutes slowly over a long period of time. This gradual process helps maintain stable blood pressure and prevents rapid fluid shifts.
This shunting procedure is used for refractory ascites or variceal bleeding.
TIPS (transjugular intrahepatic portosystemic shunt)
Rationale:
Creates alternate blood flow pathway to reduce portal pressure. It increases risk of hepatic encephalopathy.l so monitor for confusion due to increased ammonia levels
A client with gallstones develops fever, jaundice, and RUQ pain. This triad suggests what life-threatening condition?
ascending cholangitis
Rationale:
Obstruction + infection of bile duct Charcot’s triad. Can progress to sepsis.
A client with acute kidney injury develops nausea, vomiting, and confusion. Lab results show:
Potassium 6.5 mEq/L
BUN 90 mg/dL
Creatinine 5.2 mg/dL
pH 7.28
The provider prescribes Kayexalate.
The nurse recognizes the client is at highest risk for this life threatening complication and must monitor this system closely.
What is cardiac dysrhythmia from hyperkalemia. The nurse should monitor the cardiovascular system closely.
AKI causes hyperkalemia, which can lead to life threatening dysrhythmias. Kayexalate helps lower potassium, but the heart is still at immediate risk. Cardiac monitoring will be the priority since the potassium is elevated.
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
a. Increased calories are needed because glucose is lost during hemodialysis.
b. More protein is allowed because urea and creatinine are removed by dialysis.
c. Dietary potassium is not restricted because the level is normalized by dialysis.
d. Unlimited fluids are allowed because retained fluid is removed during dialysis.
What is B. more protein is allowed because urea and creatinine are removed by dialysis?
When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged.
Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath.
Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
These two findings must be checked before hemodialysis to ensure the access is working.
What are a thrill and a bruit?
Before dialysis, the nurse checks for a thrill (vibration) and bruit (swooshing sound) to make sure the AV fistula or graft is working properly.
This physical finding is a flapping tremor caused by ammonia buildup
Answer: Asterixis
Rationale:
Ammonia crosses the blood-brain barrier in hepatic encephalopathy. Ammonia and the brain do not get along and causes confusion.
This diagnostic test assesses patency of the biliary duct system using IV contrast.
HIDA scan
Rationale: Hepatobiliary scan evaluates bile flow and obstruction.