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Kidney Failure and DialysisMedical-Surgical Nursing-7th edition

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Question Answer
What should be monitored closely for a patient in the diuretic phasse of renal failure?
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Fluid volume status to detect hypovolemia, dehydration or hypotension. Blood serum values of potassium, and sodium to detect hypokalemia and/or hyponatremia.
How long can the diuretic phase of acute renal failure last?
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One to three weeks
What needs to be monitored for a patient on CRRT with citrate?
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Calcium. A calicum infusion is required to replace inactivated calcium.
What are the 5 major contraindications for peritoneal dialysis?
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History of multiple abdominal surgeries or pathologic conditions like pancreatitis or diverticulitis. The presence of hernias, obesity, vertebral disease, or severe obstructive pulmonary disease.
How does slow continuous ultrafiltration (SCUF) work?
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Through movement of fluid through a membrane from high pressure to low pressure. The ultrafiltrate is drained into a bag and discarded.
What is usually the first test done in order to diagnose acute renal failure?
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A renal ultrasound
What type of renal failure is caused by nephrotoxin damage? Prerenal, Intrarenal or Postrenal?
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Intrarenal. Common nephrotoxic agents are aminoglycosides, contrast dye, antibiotics, ACE inhibitors, NSAIDS, lithium, heroin, aspiring and heavy metals.
What circumstances may be contraindications for an arteriovenous fistula (5)?
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Severe hypertension, peripheral vascular disease, diabetes mellitus, IV drug use, or a history of multiple IV procedures in the forearm.
What medications are used to ensure kidneys are adequately perfused in order to prevent fluid overload associated with chronic kidney disease?
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Loop diuretics like Lasix or Bumex, osmotic diuretics like mannitol, or volume expanders like Hetastarch.
What are 6 common indicators a patient with acute renal failure should get dialysis?
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The presence of fluid volume overload that impacts the heart or lungs, increased serum potassium levels with EKG changes, metabolic acidosis, a BUN higher than 120, mental status changes, or the presence of pericarditis, pleural effusion or cardiac tamponade.
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What are the early signs of nerve atrophy and demeylination related to chronic kidney disease?
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The presence of restless leg syndrome, a tight sensation in the legs, or a stocking-like pain pattern.
End Stage Renal Disease occurs when a patient's glomerular filtration rate is less than _______.
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15 mL per minute
This type of CRRT is used for those with a moderate electrolyte imbalance and oliguria that also require parenteral nutrition, those in septic shock, or those that are resistant to diuretics.
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CVVH, used to remove fluid and a moderate amount of solutes.
How does CVVH work?
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Through convection, the removal of large volumes of fluid from areas of high pressure to low pressure. Fluid replacement is required for patients on CVVH.
What are the signs and symptoms of peritonitis associated with peritoneal dialysis?
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Cloudy, peritoneal effluent. WBC count of 100 cells per microliter in the effluent. Pain, nausea, vomiting, diarrhea, hyperactive bowel sounds and/or abdominal distention.
What signs and symptoms indicate a patient may be developing hyperkalemia?
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Muscle weakness, abdominal cramps, flaccid paralysis, decreased deep tendon reflexes, or a peaked T wave on an EKG.
Chronic kidney disease is defined as the presence of kidney damage or a glomerular filtration rate of _______ for ________ months or more.
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GFR less than 60 mL a minute for 3 months or more
How is renal osteodystrophy treated?
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By limiting dietary phosphorus, taking vitamin D supplements, taking TUMS or PhosLo to bind phosphates, Renagel or Fosrenol.
How often are vital signs assessed for a patient on CRRT?
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Every 15 minutes the first hour, then hourly
Chronic kidney failure is defined as kidney damage lasting for at least _______ or having a glomerular filtration rate less than _______, with or without kidney damage.
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3 months or more or having a GFR less than 60 mL a minute for 3 months or more with or without kidney damage.
What is the definition of end stage renal disease?
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The damage to the kidneys is permanent, the current level of kidney function cannot maintain life, and the patient requires dialysis or transplantation.
  
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