NUR 288 Exam 2 – Study Guide and Exam Review Material
SCI manifestations - correct answer ✔✔-extreme pain or pressure in neck or back-weakness,
paralysis, or lack of sensation in any part of the body-loss of bladder or bowel control-impaired
breathing after injury, oddly positioned or twisted neck or back. muscle spasms-spinal shock
AKI management - correct answer ✔✔-prevention-no therapies for ischemic or nephrotoxic AKI-
AKI can be avoided by paying attention to cardiovascular function and intravascular volume in
high-risk its (elderly with preexisting renal insufficiency)-**aggressive restoration of
intravascular volume has been shown to reduce the incidence of ischemic AKI after major
surgery, trauma, or burns.-preliminary measures: exclude reversible causes, relieve obstruction,
infection treatment, improve intravascular volume and cardiac performance-maintain urine
output: maintain high loop diuretics (pg 381) will promote diuresis.-avoid insults and toxins
AKI - correct answer ✔✔-characterized by rapid decline in renal function with azotemia and
fluid electrolyte imbalances-5% of hospital admissions-up to 30% of admissions to ICUs-Most
AKI is reversible; kidney able to recover from almost complete loss of function-associated with
major in-hospital morbidity and mortality-due to serious nature of the illnesses that precipitate
Functions of the Kidneys - correct answer ✔✔- Excretion of Waste
- Fluid and electrolyte balance
- Regulation of acid-base balance
- Hormone secretion
AKI classifications - correct answer ✔✔pre-renal, intrinsic, post-renal
Pre-Renal example - correct answer ✔✔Hypovolemia, Burns, Low Cardiac Output, Sepsis/ Shock
Intra- Renal example - correct answer ✔✔ATN, Glomerulonephritis, CT contrast dye, Antibiotics,
NSAIDS, Lupus, Rhabdomyolysis, Pyelonephritis
,Post- Renal - correct answer ✔✔Tumors, Kidneys stones, BPH, blood clots in the urinary tract,
colon cancer
Stages of AKI - correct answer ✔✔Initiation, Oliguric, Diaphoresis, Recovery
Initiation stage - correct answer ✔✔Hours to days, stage where we figure out what is wrong
with the patient and causing the AKI.
Oliguric Phase - correct answer ✔✔Can take up to two weeks, Stage where GFR <90 CR >1.3
BUN >20, waste is building up in the body, Hyperkalemia, Hyperphosphatemia, Hyponatremia,
Hypermagnesium present.
Diaphoresis Phase - correct answer ✔✔Last a week - 3 weeks Nephrons on their way to
recovery, pt voiding 3-6 L per day GFR, BUN, CR starts improving patient at risk for hypovolemic
dehydration, hypotension, hypokalemia
Recovery Phase AKI - correct answer ✔✔Takes up to a year, Starts when GFR returns to normal,
CR, BUN, and electrolytes are normal at this point.
AKI complication - correct answer ✔✔-intravascular overload: weight gain, hypertension, raised
JVP, pulmonary edema, electrolyte disturbance.-hyperkalemia: greater than 5.5. decreased renal
secretion combined with tissue necrosis or hemolysis-hyponatremia: less than 135. excessive
water intake in the face of excretory failure-hyperphosphatemia: greater than 5.5 (tissue
necrosis)-hyper or hypocalcemia-metabolic acidosis (associate with sepsis or severe heart
failure-hyperuricemia: due to decreased uric acid excretion-bleeding tendency: may occur due
to platelet dysfunction and coagulopathy associate with sepsis-seizure may occur related to
uremia
Meds used for AKI - correct answer ✔✔- Ferrous Sulfate
- Dopamine
, - IV Fluids and blood volume expanders
- Epoetin Alfa
- Mannitol
- Phosphate binding agents
renal diagnostic work up - correct answer ✔✔-urinalysis: microscopic evaluation of urinary
sediment-presence of few formed elements or hyaline casts is suggestive of prerenal or post
renal azotemia-many RBCs may suggest calculi, trauma, infection or tumor-eosinophilia: occurs
in 95% of pt with acute allergic nephritis-brownish pigmented cellular casts-dipstick test: trace
or no proteinuria with pre-renal and post-renal AKI. mild to moderate proteinuria with ATN,
RBCs and RBC casts in glomerular disease, crystals and RBC and WBCs in post renal ARF-urine
and blood chemistry: osmolality or specific gravity (decreased in ATN and post-renal AKI (urine
is diluted), while increased in pre-renal AKI (urine is concentrated)-radiography/imaging
CKD - correct answer ✔✔-progressive, irreversible kidney injury (does not recover)-end stage
kidney disease-azotemia, uremia, uremic syndrome (chart on page 391)-things look somewhat
normal until around stage 3, may see elevation in BUN and creatinine
stages of CKD - correct answer ✔✔-reduced renal reserve, reduced GFR, end stage kidney
disease (pg 392 table, page 393 fluid and electrolyte effects)-cardiac changes: hypertension,
hyperlipidemia, HF, pericarditis-hematologic changes and GI changes
Major Risk factors for CKD - correct answer ✔✔Uncontrolled Diabetes
Long Term HTN
Nephrosclerosis
Polycystic Kidney Disease
CKD clinical manifestations - correct answer ✔✔neurologic, cardio, resp, hematological, GI,
skeletal, urinary, skin
SCI manifestations - correct answer ✔✔-extreme pain or pressure in neck or back-weakness,
paralysis, or lack of sensation in any part of the body-loss of bladder or bowel control-impaired
breathing after injury, oddly positioned or twisted neck or back. muscle spasms-spinal shock
AKI management - correct answer ✔✔-prevention-no therapies for ischemic or nephrotoxic AKI-
AKI can be avoided by paying attention to cardiovascular function and intravascular volume in
high-risk its (elderly with preexisting renal insufficiency)-**aggressive restoration of
intravascular volume has been shown to reduce the incidence of ischemic AKI after major
surgery, trauma, or burns.-preliminary measures: exclude reversible causes, relieve obstruction,
infection treatment, improve intravascular volume and cardiac performance-maintain urine
output: maintain high loop diuretics (pg 381) will promote diuresis.-avoid insults and toxins
AKI - correct answer ✔✔-characterized by rapid decline in renal function with azotemia and
fluid electrolyte imbalances-5% of hospital admissions-up to 30% of admissions to ICUs-Most
AKI is reversible; kidney able to recover from almost complete loss of function-associated with
major in-hospital morbidity and mortality-due to serious nature of the illnesses that precipitate
Functions of the Kidneys - correct answer ✔✔- Excretion of Waste
- Fluid and electrolyte balance
- Regulation of acid-base balance
- Hormone secretion
AKI classifications - correct answer ✔✔pre-renal, intrinsic, post-renal
Pre-Renal example - correct answer ✔✔Hypovolemia, Burns, Low Cardiac Output, Sepsis/ Shock
Intra- Renal example - correct answer ✔✔ATN, Glomerulonephritis, CT contrast dye, Antibiotics,
NSAIDS, Lupus, Rhabdomyolysis, Pyelonephritis
,Post- Renal - correct answer ✔✔Tumors, Kidneys stones, BPH, blood clots in the urinary tract,
colon cancer
Stages of AKI - correct answer ✔✔Initiation, Oliguric, Diaphoresis, Recovery
Initiation stage - correct answer ✔✔Hours to days, stage where we figure out what is wrong
with the patient and causing the AKI.
Oliguric Phase - correct answer ✔✔Can take up to two weeks, Stage where GFR <90 CR >1.3
BUN >20, waste is building up in the body, Hyperkalemia, Hyperphosphatemia, Hyponatremia,
Hypermagnesium present.
Diaphoresis Phase - correct answer ✔✔Last a week - 3 weeks Nephrons on their way to
recovery, pt voiding 3-6 L per day GFR, BUN, CR starts improving patient at risk for hypovolemic
dehydration, hypotension, hypokalemia
Recovery Phase AKI - correct answer ✔✔Takes up to a year, Starts when GFR returns to normal,
CR, BUN, and electrolytes are normal at this point.
AKI complication - correct answer ✔✔-intravascular overload: weight gain, hypertension, raised
JVP, pulmonary edema, electrolyte disturbance.-hyperkalemia: greater than 5.5. decreased renal
secretion combined with tissue necrosis or hemolysis-hyponatremia: less than 135. excessive
water intake in the face of excretory failure-hyperphosphatemia: greater than 5.5 (tissue
necrosis)-hyper or hypocalcemia-metabolic acidosis (associate with sepsis or severe heart
failure-hyperuricemia: due to decreased uric acid excretion-bleeding tendency: may occur due
to platelet dysfunction and coagulopathy associate with sepsis-seizure may occur related to
uremia
Meds used for AKI - correct answer ✔✔- Ferrous Sulfate
- Dopamine
, - IV Fluids and blood volume expanders
- Epoetin Alfa
- Mannitol
- Phosphate binding agents
renal diagnostic work up - correct answer ✔✔-urinalysis: microscopic evaluation of urinary
sediment-presence of few formed elements or hyaline casts is suggestive of prerenal or post
renal azotemia-many RBCs may suggest calculi, trauma, infection or tumor-eosinophilia: occurs
in 95% of pt with acute allergic nephritis-brownish pigmented cellular casts-dipstick test: trace
or no proteinuria with pre-renal and post-renal AKI. mild to moderate proteinuria with ATN,
RBCs and RBC casts in glomerular disease, crystals and RBC and WBCs in post renal ARF-urine
and blood chemistry: osmolality or specific gravity (decreased in ATN and post-renal AKI (urine
is diluted), while increased in pre-renal AKI (urine is concentrated)-radiography/imaging
CKD - correct answer ✔✔-progressive, irreversible kidney injury (does not recover)-end stage
kidney disease-azotemia, uremia, uremic syndrome (chart on page 391)-things look somewhat
normal until around stage 3, may see elevation in BUN and creatinine
stages of CKD - correct answer ✔✔-reduced renal reserve, reduced GFR, end stage kidney
disease (pg 392 table, page 393 fluid and electrolyte effects)-cardiac changes: hypertension,
hyperlipidemia, HF, pericarditis-hematologic changes and GI changes
Major Risk factors for CKD - correct answer ✔✔Uncontrolled Diabetes
Long Term HTN
Nephrosclerosis
Polycystic Kidney Disease
CKD clinical manifestations - correct answer ✔✔neurologic, cardio, resp, hematological, GI,
skeletal, urinary, skin
