Critical care part 2

Critical care part 2-Renal system

by Maam Li

​1. RENAL SYSTEM

​The renal system is the body’s water treatment plant. Its job is to

collect waste products and expel them as urine. The structures

of the renal system include:

• kidneys

• ureters

• bladder

• urethra

​KIDNEY

​The kidneys are located on each side of the abdomen

near the lower back. These compact organs contain

a filtration system that processes about 45 gallons of

fluid each day. The by-product of this process is urine,

which contains water and waste products

​FUNCTION OF RENAL SYSTEM

​The renal system is a major regulatory system as well. Its roles

include:

• maintaining fluid and electrolyte balance

• maintaining acid–base balance

• detoxifying the blood and eliminating wastes

• regulating blood pressure

• aiding red blood cell (RBC) production.

​DIAGNOSTIC STUDIES

​Diagnostic tests commonly ordered for a patient with known or

suspected renal disease may include:

• blood studies

• kidney-ureter bladder

• (KUB) radiography

• renal angiography

• renal ultrasound

  urine studies.

​TREATMENT

​Renal disorders can adversely affect virtually every body system

in a critically ill patient and may be fatal without effective treatment.

• Drug therapy: alkalinizing agents, diuretics, and sulfonate cation-exchange resins to correct hyperkalemia.

• Dialysis: to remove toxic waste and excess fluid from the body.Depending on the patient’s condition, hemodialysis or peritoneal dialysis may be used.

​DIALYSIS

​ACUTE RENAL INJURY

​AKI is the sudden interruption of renal function resulting from:

• obstruction

• reduced circulation

• renal parenchymal disease.

AKI is sometimes reversible, but if it’s left untreated, permanent

damage can lead to chronic renal failure. As a critical care

nurse, you play a vital role in assessing and treating patients with

AKI. Each classification of AKI—prerenal, intrarenal

and postrenal—has its own pathophysiology:

​

​

​TREATMENT

Multiple Choice

The kidneys secrete erythropoietin when:

• oxygen supply in tissue decreases.

• calcium levels are insufficient.

• vitamin D becomes inactive.

• pH level drops below 7.35.

Multiple Choice

Prerenal failure results from:

• bilateral obstruction of urine outflow.

• conditions that diminish blood flow to the kidneys.

• damage to the kidneys.

• ischemic damage to renal parenchyma.

Multiple Choice

Acute tubular necrosis following ischemic renal injury may

be due to:

• fluid-volume overload.

• inhaling toxic chemicals.

• a hypersensitivity reaction to radiographic contrast

  agents.

• severe hypotension.

Multiple Choice

______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine.

• Urea

• Potassium

• Creatinine

• Magnesium

Multiple Choice

A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply:

• Hypervolemia

• Hypokalemia

• Increased BUN level

• Decreased Creatinine level

Multiple Choice

You’re assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician?

• Potassium level 4.2 mEq/L

• Creatinine clearance 35 mL/min

• BUN 20 mg/dL

• Blood pH 7.40

Multiple Choice

4. A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury?

• Post-renal

• ntra-renal

• Pre-renal

• Intrinsic renal

Multiple Select

Select all the patients below that are at risk for acute intra-renal injury?

• A 45 year old male with a renal calculus.

• A 65 year old male with benign prostatic hyperplasia.

• A 25 year old female receiving chemotherapy.

• A 6 year old male with acute glomerulonephritis.

• An 87 year old male who is taking an aminoglycoside medication for an infection.

Multiple Choice

A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient’s 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in?

• Initiation

• Diuresis

• Oliguric

• Recover

Multiple Select

A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply:

• Water intoxication

• Hypotension

• Low urine specific gravity

• Hypokalemia

• Normal GFR

Multiple Choice

True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage.

• true

• false

Multiple Choice

Which patient below with acute kidney injury is in the oliguric stage of AKI:

• A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day.

• A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day.

• A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day.

• A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

Multiple Choice

You’re developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan?

• A. Excess fluid volume

• B. Risk for electrolyte imbalance

• C. Urinary retention

• D. Acute pain

Multiple Choice

While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last?

• 1-2 weeks

• 1-3 days

• Few hours to 2 weeks

• 12 months

Multiple Choice

A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient?

• Low-sodium, high-protein, and low-potassium

• High-protein, low-potassium, and low-sodium

• Low-protein, low-potassium, and low-sodium

• High-protein and high-potassium

Multiple Choice

In peritoneal dialysis, particles move through a semipermeable

membrane from an area of high-solute concentration to an

area of low-solute concentration in a process called:

• Diffusion

• Active transport

• permission

• Osmosis