Renal

Renal: Acute Renal Injury and Dialysis

By Professor Diane Davis MS, RN

Multiple Select

Acute Kidney Injury (AKI)can lead to life threatening consequences. What are they? SATA

• fluid, electrolyte & metabolic imbalances

• Once AKI occurs, it is never reversible

• may progress to severe renal impairment

• If treated early, AKI may be reversible

Multiple Choice

This term means that there is reduction in urine output to less than 400ml per day.

• Azotemia

• Oliguria

• Uremia

• Acute Tubular Necrosis

Multiple Choice

This clinical syndrome is associated with fluid, electrolyte, hormone imbalances and metabolic abnormalities. What is the term to describe this?

• oliguria

• azotemia

• ATN

• uremia

Multiple Choice

In this condition, the patient would exhibit areas of patchy destruction of the kidney characterized by ischemia, nephrotoxins, or sepsis

• azotemia

• uremia

• Acute Tubular Necrosis (ATN)

• oliguria

Multiple Select

Categories of AKI include? SATA

• Pre-Renal

• Extra-Renal

• Intra-Renal

• Post-Renal

Multiple Choice

Exactly what are the phases of how AKI works? Please select the correct order in which AKI occurs.

• Oliguria

  Initiation

  Diuresis

  Recovery

• Initiation

  Oliguria

  Diuresis

  Recovery

• Oliguria

  Diuresis

  Initiation

  Recovery

• Recovery

  Diuresis

  Oliguria

  Initiation

Multiple Select

Your patient is diagnosed with an AKI. What would you likely observe? SATA

• low URINE creatinine clearance (kidney not able to clear creatinine sufficiently through urine)

• increased serum BUN and Creatinine levels

• insomnia

• hyperkalemia

Multiple Select

Pre-Renal phase of AKI causes reduced blood flow to the kidneys. Depending on the cause, what observations might the nurse see? SATA

• hypovolemia

• neurogenic injury

• anaphylaxis

• decreased cardiac output as evidenced by dysrhythmias or CHF

Multiple Select

Intra-Renal AKI deals more with the direct damage that occurs to renal tissue. Given this, what might the nurse expect? SATA

• damage from nephrotoxins (like antibiotics, IV contrast etc)

• hypertension that is well controlled

• Thrombus

• Infections (pyelonephritits)

Multiple Select

Post-Renal AKI is much easier to asses because it deals with an obstruction of urinary outflow. What are examples of this? SATA

• tumors

• strictures

• infection

• stones

Multiple Select

What are ways we can help to prevent AKI in our patients? SATA

• meticulous catheter care to prevent infection

• be alert for poor kidney function by checking & notifying the provider if the GFR is low when IV contrast is ordered

• prevent dehydration

• Wait to treat dehydration to see if it improves on its own

Multiple Select

What interventions will help the nurse maintain fluid balance? SATA

• Obtain accurate daily weights & document them

• Monitor the CVP measurements. A CVP greater than 12 is a sign of fluid overload

• Assess for dyspnea, tachycardia, distended neck veins, crackles, & edema as they are signs of fluid overload

• Recognize that diuretics should not be used to maintain fluid balance

Multiple Select

How would the nurse treat hyperkalemia? SATA

• Give Potassium Chloride IV 10meq over 1 hour

• Administer 10 units of Regular insulin IV and 25 gms of D50W IV to reduce the potassium rapidly per hospital policy

• Administer Calcium Gluconate IV

• Give Kayexalate to bind the K+ and excrete it via the GI system (stool)

Multiple Select

What dietary restrictions should the nurse be concerned with for patients with AKI? SATA

• Protein may be restricted until AFTER the diuretic phase

• Encourage foods high in potassium

• Restrict foods and fluids with potassium or phosphorous

• Encourage foods high in phosphorous

Multiple Select

Which statements are true regarding the nurse's role for monitoring fluid & electrolyte balance? SATA

• monitor fluid overload via lung sounds, edema, SOB, JVD

• Turn, cough, and deep breath to promote pulmonary function

• Weigh patient every other day

• Ensure daily skin care to prevent breakdown r/t to edema or skin dryness

• Monitor for dehydration or electrolyte abnormalities

Multiple Select

Hemodialysis relies on what items in order to remove wastes and correct fluid and electrolyte imbalance through osmosis? SATA

• Use of semi-permeable membrane

  (the artificial kidney called the dialyzer)

• Use of dialysate fluid (to pull the wastes products and send them out of the body)

• Use of the semi-permeable membrane in the abdomen (peritoneum)

Multiple Select

Which statements are true about Peritoneal Dialysis (PD)? SATA

• PD uses the peritoneal membrane in the abdomen to serve as a "semi-permeable" membrane to filter waste

• requires someone to instill cool dialysate solution and dwell for 1 hour

• requires a peritoneal catheter in the abdomen for access (Tenckhoff)

• Strict aseptic technique must be followed to prevent infection

• warmed solution is instilled and may be left to dwell for 5-8 hours

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Multiple Choice

When might we see Continuous Renal replacement therapy used (CRRT)?

• When there are insurance problems

• When a patient cannot tolerate a typical hemodialysis treatment due to hypotension or other hemodynamic factors

• When the patient is too hypertensive to tolerate a hemodialysis treatment

Multiple Select

What are the different access options available for patients requiring hemodialysis? SATA

• AV Fistula

  (requires a planned surgical procedure)

• AV Graft (requires a planned surgical procedure)

• Temporary Access (Central Venous Catheter or CV line for emergent situations)

• A large bore peripheral IV catheter (for emergency use)

Multiple Select

When caring for an AV fistula or graft, what must the nurse be aware of? SATA

• Absolutely no BPs or Venipunctures on the access arm

• Must listen for a "bruit" & feel for a "thrill" over the access site

• if distal circulation to the access appears compromised; must call the provider STAT

• any nurse can draw or use the access device

Multiple Choice

Your patient begins to experience lightheadedness during the hemodialysis treatment. How could it be treated?

• Increase the rate that fluids (wastes) are being removed

• infuse a small bolus of normal saline through the dialysis machine

Multiple Select

Your patient complains of muscle cramps during hemodialysis. What could be done to resolve them? SATA

• Decrease the ultrafiltration rate of the treatment (slow it down)

• Increase the ultrafiltration rate of the treatment (speed it up)

• give a NS bolus

Multiple Select

Other complications of HD include? SATA

• hypovolemia

• Disequilibrium Syndrome

• hyperactivity

• sepsis

Multiple Choice

What is a crucial teaching element that nurses must recognize when teaching hemodialysis patients about medications?

• Making sure patients know which medications are removed by dialysis & which ones are not affected

• teach patients that medications are not affected by HD

• Teach patients that all medications are washed out with dialysis

Multiple Select

The key components in Peritoneal Dialysis are? SATA

• Dialysate

• Placement of a Tenckhoff catheter

• Central Venous Access Catheter

• A healthy peritoneal membrane, unaffected by surgery or trauma

• Drainage bag

Multiple Choice

A serious complication of PD is?

• Congestive Heart Failure

• Dehydration

• Peritonitis

• Constipation

Multiple Select

How would you teach your patient to recognize signs of infection? SATA

• unusual abdominal pain--mild or severe

• fever or chills

• to closely examine the drainage to ensure it is clear

• teach the patient that the drainage is typically cloudy or discolored

Multiple Select

When performing PD, we recognize that an exchange consists of ? SATA

• instillation/fill

• binding time

• dwell time

• drainage

Multiple Choice

In PD, it is crucial that dialysate drainage be at least the amount that was infused. However; the goal is to have the peritoneal drainage be more than what was infused.

True of False?

• False

• True

Multiple Select

Peritonitis is a significant complication of PD. What are signs of peritonitis? SATA

• hard, rigid abdomen

• Soft, non-tender abdomen

• Fever

Multiple Select

If a patient has low outflow, what are the initial nursing interventions used to resolve this? SATA

• check for kinks in the outflow tubing

• Stop the treatmentent

• Position the patient from side to side

• check for clots in the drainage tubing

Multiple Select

List some special considerations for patients undergoing dialysis. SATA

• Teach patient to expect pain and discomfort

• Monitor for symptoms of uremia (cognitive dysfunction, SOB, Muscle cramping, N & V, itching)

• provide psychological support (offer Dialysis Support Groups

• Prevent infection: Assess how the patient is caring for their catheter site

• Protect vascular access if present

Multiple Choice

Can AKI progress to chronic kidney failure?

• Yes

• No

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