NUE 265 Exam 1 Content Review, Complete
Solution
EXAM #1: CONTENT REVIEW
Unit 1: Care of Patients with Complex Renal & Gastrointestinal Problems
Renal A & P
• What do the kidneys do?
o Kidneys receive 20-25% of cardiac output under resting conditions – more than 1L blood/min
o Kidneys are controller of fluid & electrolyte homeostasis in the body
o Kidneys secrete erythropoietin that inc. RBC synthesis in bone marrow
o Kidneys convert Vitamin D into its active form
o Loop of Henle concentrates urine and allows water reabsorption into bloodstream
Question: The nurse is explaining to a group of nursing students that when there is a decrease in the secretion
of renin, and aldosterone it can cause
▪ (Select all that apply.)
• A. an excretion of sodium.
• B. dilution of urine.
• C. increased intestinal absorption of calcium.
• D. increased bone density.
• E. a decreased thirst.
Physical Examination
• Skin color (ashen, yellow); crystals on skin (uremic frost)
• Tissue turgor: to detect dehydration or edema
• Periorbital edema: suggests fluid retention. Inspect the mouth for moisture and odor
• Observe respiratory rate, pattern, and effort
• Auscultate the lungs for crackles or rhonchi
• Inspect the abdomen for scars and contours, and palpate for tenderness and bladder distention
• Edema
• Inspect the genitalia
Nephrotic Syndrome
• Patho:
o A condition of increased glomerular permeability that allows large molecules to pass through the
membrane into the urine and then be excreted.
o This process causes severe proteinuria, high serum lipid levels, fats in the urine, edema and
, hypertension.
o Identified by kidney biopsy
, • Risk Factors: allergic reactions, reactions to medications, renal vein disease, sickle cell disease, HF
• Clinical Manifestations
o Massive proteinuria (Increased protein) >3.5g/day in a 24-hour urine sample
o Hypoalbuminemia (Decreased albumin (serum)) <3g/dL
o Hypertension
o Edema (esp. facial and periorbital)
o Hyperlipidemia (due to low albumin)
o Fat bodies in urine
o Delayed clotting or increased bleeding with higher-than-normal values of serum activated
partial thromboplastin time (aPTT), coagulation or internation normalized ration for
prothrombin (INR, PT)
o Reduced kidney function with elevated BUN and serum creatinine and decreased GFR
• Nursing Interventions: management varies, depending on which process is causing the disorder!
o Maintain fluid (NS) & electrolyte balance
o Monitor labs daily
o Monitor and record I&O daily
o Assess daily weight
o Restrict sodium & potassium intake (diet changes)
o Monitor skin due to edema
o Protein intake restriction with decreased GFR; normal GFR dietary intake of protein is needed!
o Medications:
▪ Administer steroids if needed for inflammation
▪ ACE inhibitors: Can decrease protein loss in the urine
▪ Cholesterol-lowering drugs can improve blood lipid levels
• NOTE! NS may progress to end stage kidney disease (ESKD) but can be prevented with
treatment!!
Kidney Injury
• Acute (AKI) vs Chronic (CRF)
o Acute develops in a few hours to days with abrupt disruption in kidney function
o Chronic is progressive deterioration over years with slow loss of kidney function
o AKI affects MANY body systems. Chronic kidney disease affects EVRY body system.
AKI
• What is it?
o Rapid reduction in kidney function resulting in a failure to maintain fluid &
electrolyte balance, and acid-base balance.
o Develops abruptly within hours to days
o If AKI occurs in patients with decreased kidney function already ESKD
o Increase in serum creatinine by 0.3mg/dL or more within 48 hours; OR increase in
serum creatinine to 1.5 times or more from baseline
▪ Occurred in previous 7 days; or a urine volume less than 0.5 mL/kg/hr for 6 hours
o GFR is not accurate acute or critical illness although best overall indicator of kidney function!
o HYPOPERFUSION (reduction in blood flow)
▪ Kidney compensates by constricting blood vessels and by activating renin-angiotension-
aldosterone which RELEASES ADH
▪ ADH- increase blood volume increasing perfusion BUT will decrease UOP causing:
• OLIGURIA = <400ml/24hour period
o Less than 0.5mL/kg/hr for 2 or more hours
o Min. UOP Q24 hours=720mL or 30mL/hr
, ▪ Symptoms of reduced blood volume MAP <65, tachycardia, thread peripheral pulses,
decreasing cognition
o Timely interventions to remove the cause of AKI may prevent progression to ESKD and the
need for lifelong renal replacement therapy or a renal transplant
• S/S: same as fluid overload Hypertension, dec. O2, high HR
• AKI Causes
o Reduced perfusion to the kidneys, damage to kidney tissue and obstruction of urine outflow
o Pre-renal: decreased perfusion to glomeruli
▪ Reduced perfusion with a sustained mean arterial pressure (MAP) of less than 65mm Hg
▪ Conditions that contribute: Blood or fluid loss, BP drugs, heart attack/HF, infection,
liver failure, use of aspirin/ibuprofen/NSAIDS, dehydration, burns, atherosclerosis
o Intra-renal: nephrotoxic agents, kidney infections, occlusion of intrarenal arteries,
hypertension, diabetes mellitus, or direct trauma to the kidney
▪ Reflects injury to the glomeruli, nephrons or tubules
▪ Conditions that contribute: glomerulonephritis, bleeding in the kidney, sepsis, lupus,
TTP, drugs, multiple myeloma, scleroderma, vasculitis
o Post-renal: caused by backward pressure on the kidney from an obstruction somewhere lower
in the urinary system (Effects normal urine flow)
▪ Conditions that contribute: Kidney stones, cancers (bladder, cervical, colon,
prostate), enlarged prostate, nerve damage, blood clots in the urinary tract
Table 68-4 Conditions Contribute to AKI
• Prerenal (Perfusion Reduction)
o Blood or fluid loss (surgery, trauma, sepsis, shock, hypovolemic shock)
o BP drugs resulting in hypotension
o MI or heart failure
o Infection
o Liver failure
o Use of aspirin, ibuprofen, Naproxen, NSAIDS
o Severe allergic reaction
o Severe burns
o Severe dehydration
o Renal artery stenosis
o Bleeding or clotting in kidney blood vessels
o Atherosclerosis or cholesterol deposits that block blood flow
• Intrarenal (Kidney Damage)
o Glomerulonephritis or inflammation
o Bleeding in kidney
o Thrombi or emboli
o Hemolytic uremic syndrome (premature destruction of RBC’s)
Solution
EXAM #1: CONTENT REVIEW
Unit 1: Care of Patients with Complex Renal & Gastrointestinal Problems
Renal A & P
• What do the kidneys do?
o Kidneys receive 20-25% of cardiac output under resting conditions – more than 1L blood/min
o Kidneys are controller of fluid & electrolyte homeostasis in the body
o Kidneys secrete erythropoietin that inc. RBC synthesis in bone marrow
o Kidneys convert Vitamin D into its active form
o Loop of Henle concentrates urine and allows water reabsorption into bloodstream
Question: The nurse is explaining to a group of nursing students that when there is a decrease in the secretion
of renin, and aldosterone it can cause
▪ (Select all that apply.)
• A. an excretion of sodium.
• B. dilution of urine.
• C. increased intestinal absorption of calcium.
• D. increased bone density.
• E. a decreased thirst.
Physical Examination
• Skin color (ashen, yellow); crystals on skin (uremic frost)
• Tissue turgor: to detect dehydration or edema
• Periorbital edema: suggests fluid retention. Inspect the mouth for moisture and odor
• Observe respiratory rate, pattern, and effort
• Auscultate the lungs for crackles or rhonchi
• Inspect the abdomen for scars and contours, and palpate for tenderness and bladder distention
• Edema
• Inspect the genitalia
Nephrotic Syndrome
• Patho:
o A condition of increased glomerular permeability that allows large molecules to pass through the
membrane into the urine and then be excreted.
o This process causes severe proteinuria, high serum lipid levels, fats in the urine, edema and
, hypertension.
o Identified by kidney biopsy
, • Risk Factors: allergic reactions, reactions to medications, renal vein disease, sickle cell disease, HF
• Clinical Manifestations
o Massive proteinuria (Increased protein) >3.5g/day in a 24-hour urine sample
o Hypoalbuminemia (Decreased albumin (serum)) <3g/dL
o Hypertension
o Edema (esp. facial and periorbital)
o Hyperlipidemia (due to low albumin)
o Fat bodies in urine
o Delayed clotting or increased bleeding with higher-than-normal values of serum activated
partial thromboplastin time (aPTT), coagulation or internation normalized ration for
prothrombin (INR, PT)
o Reduced kidney function with elevated BUN and serum creatinine and decreased GFR
• Nursing Interventions: management varies, depending on which process is causing the disorder!
o Maintain fluid (NS) & electrolyte balance
o Monitor labs daily
o Monitor and record I&O daily
o Assess daily weight
o Restrict sodium & potassium intake (diet changes)
o Monitor skin due to edema
o Protein intake restriction with decreased GFR; normal GFR dietary intake of protein is needed!
o Medications:
▪ Administer steroids if needed for inflammation
▪ ACE inhibitors: Can decrease protein loss in the urine
▪ Cholesterol-lowering drugs can improve blood lipid levels
• NOTE! NS may progress to end stage kidney disease (ESKD) but can be prevented with
treatment!!
Kidney Injury
• Acute (AKI) vs Chronic (CRF)
o Acute develops in a few hours to days with abrupt disruption in kidney function
o Chronic is progressive deterioration over years with slow loss of kidney function
o AKI affects MANY body systems. Chronic kidney disease affects EVRY body system.
AKI
• What is it?
o Rapid reduction in kidney function resulting in a failure to maintain fluid &
electrolyte balance, and acid-base balance.
o Develops abruptly within hours to days
o If AKI occurs in patients with decreased kidney function already ESKD
o Increase in serum creatinine by 0.3mg/dL or more within 48 hours; OR increase in
serum creatinine to 1.5 times or more from baseline
▪ Occurred in previous 7 days; or a urine volume less than 0.5 mL/kg/hr for 6 hours
o GFR is not accurate acute or critical illness although best overall indicator of kidney function!
o HYPOPERFUSION (reduction in blood flow)
▪ Kidney compensates by constricting blood vessels and by activating renin-angiotension-
aldosterone which RELEASES ADH
▪ ADH- increase blood volume increasing perfusion BUT will decrease UOP causing:
• OLIGURIA = <400ml/24hour period
o Less than 0.5mL/kg/hr for 2 or more hours
o Min. UOP Q24 hours=720mL or 30mL/hr
, ▪ Symptoms of reduced blood volume MAP <65, tachycardia, thread peripheral pulses,
decreasing cognition
o Timely interventions to remove the cause of AKI may prevent progression to ESKD and the
need for lifelong renal replacement therapy or a renal transplant
• S/S: same as fluid overload Hypertension, dec. O2, high HR
• AKI Causes
o Reduced perfusion to the kidneys, damage to kidney tissue and obstruction of urine outflow
o Pre-renal: decreased perfusion to glomeruli
▪ Reduced perfusion with a sustained mean arterial pressure (MAP) of less than 65mm Hg
▪ Conditions that contribute: Blood or fluid loss, BP drugs, heart attack/HF, infection,
liver failure, use of aspirin/ibuprofen/NSAIDS, dehydration, burns, atherosclerosis
o Intra-renal: nephrotoxic agents, kidney infections, occlusion of intrarenal arteries,
hypertension, diabetes mellitus, or direct trauma to the kidney
▪ Reflects injury to the glomeruli, nephrons or tubules
▪ Conditions that contribute: glomerulonephritis, bleeding in the kidney, sepsis, lupus,
TTP, drugs, multiple myeloma, scleroderma, vasculitis
o Post-renal: caused by backward pressure on the kidney from an obstruction somewhere lower
in the urinary system (Effects normal urine flow)
▪ Conditions that contribute: Kidney stones, cancers (bladder, cervical, colon,
prostate), enlarged prostate, nerve damage, blood clots in the urinary tract
Table 68-4 Conditions Contribute to AKI
• Prerenal (Perfusion Reduction)
o Blood or fluid loss (surgery, trauma, sepsis, shock, hypovolemic shock)
o BP drugs resulting in hypotension
o MI or heart failure
o Infection
o Liver failure
o Use of aspirin, ibuprofen, Naproxen, NSAIDS
o Severe allergic reaction
o Severe burns
o Severe dehydration
o Renal artery stenosis
o Bleeding or clotting in kidney blood vessels
o Atherosclerosis or cholesterol deposits that block blood flow
• Intrarenal (Kidney Damage)
o Glomerulonephritis or inflammation
o Bleeding in kidney
o Thrombi or emboli
o Hemolytic uremic syndrome (premature destruction of RBC’s)
