Deep Vein Thrombosis (DVT) EXAM LATEST UPDATED 2025 WITH COMPLETE
SOLUTIONS
Chronic Renal Failure
Definition: progressive, irreversible destruction of the nephrons in both kidneys. Last
stage of renal failure is ESRD [when the GFR is < 15 ml/min, normal is 85-135ml/min]. Pt
can survive without dialysis until 90% of nephrons are loss [during loss, the remaining
nephrons hypertrophy to compensate for the loss]. In ESRD, pt needs dialysis or renal
transplant [difficult, because pt needs a donor])
Causes: primary causes is DM, HTN, glomerulonephritis and cystic kidney disease
Stages of CRF: Decreased renal reserve (25 – 30%), Renal insufficiency, End stage renal
disease [ESRD]
Signs & Symptoms: Anxiety, depression, CHF, anorexia, nausea & vomiting, gastritis, gout,
anemia, infection, fatigue, headache, lethargy, seizure, confusion, dyspnea, pneumonia,
pallor, dry scaly skin, pruritis, restless leg syndrome, canker sore, impotence
Dx Tests: Hx & PE, Identification of reversible renal disease, Renal US, Renal Scan, Renal
Biopsy, BUN, creatinine, & creatinine clearance, Serum electrolytes, Protein: Creatinine
ration in first morning void, Urinalysis for [RBC, glucose, C & S], CBC [emphasize Hb &
Hct]
Management: Correction of ECF volume overload or deficit (restrict fluid, dialysis);
Nutritional therapy (protein restrictions until pt starts dialysis then intake is adjusted to
replace loss during dialysis], multivits [H20 soluble], low phosphorus diet, adequate CHO
& fat to minimize protein catabolism, fluid restriction [depends on urine output] foods
liquid at room temp [gelatin & ice cream] should be counted as fluids [same as in ARF],
Na & K restrictions depending on HTN I edema, foods high in Na are [cured meats,
1
,pickled foods, can soups & stews, cold cuts, soy sauce & salad dressings]. If pt requires
K restrictions, foods high in K are [oranges, bananas, melons, tomatoes, prunes, raisons,
deep green & yellow veggies, beans, legumes], restrict phosphate intake, foods high in
phosphate are [dairy products, milk, ice cream, cheese, yogurt, puddings] NOTE: these
foods are also high in Ca which is needed therefore Ca supplements are given);
Erythropoietin therapy (Epogen - Recormin); Calcium supplementation , phosphate
binders or both; AntiHTN; Measures to lower K; Adjustment to drug dosage [renal doses].
Nursing Mx: Assessment (Hx [existing familial diseases, infections, meds, dietary habits,
symptoms, support systems, family relations, self-image, work I& home activities], PE &
lab tests).
Nursing Dxs (Excess fluid volume r/t inability to excrete fluid, inadequate dialysis,
excessive fluid intake; Impaired skin integrity r/t decrease oil & sweat gland activity,
hyperphosphatemia, deposition of Ca-phosphate precipitates, capillary fragility, excess
fluid, & neuropathy; Risk for injury (fracture) r/t altered absorption of Ca & altered
excretion of phosphate, alt vit D metabolism; Activity intolerance r/t anemia and
neuropathy; Imbalanced nutrition: less than body requirements r/t restricted intake of
nutrients [protein], nausea, vomiting, anorexia, stomatitis; Anticipatory grieving r/t loss
of kidney function; Risk for infection r/t suppressed immune system, access sites,
malnutrition; Potential complications (HTN} related to Na & H20 retention & altered
renin-angiotensin system; Potential complication (hyperkalemia) r/t decreased renal
function, increased tissue catabolism & k shift into ECF; Potential complication
(peripheral neuropathy) r/t effects of uremia on peripheral nerves).
Goals (pt will demonstrate knowledge & ability to adhere to therapeutic regimen,
participate in decision making for plan of care & future modality, effective copying
strategies, continue with ADL within physiologic limitations).
Interventions (educate pt & family [drugs, diet, follow-up care, pts responsibility, daily
wt, check bp, S&S of fluid overload, high K & other electrolyte imbalances, importance of
strict dietary & drug adherence, OTC to avoid [nephrotoxic & laxatives & antacids that
2
,are mag based, dialysis, home care, activity, work, sex; assess edema, strict I & O daily
wt, assess skin, give good skin care, moisturize dry skin, adm antihistamines if
prescribed for itching apply creams or ointments [aquaphor], keep pt safe from injury,
provide adequate period of rest, monitor Hb & Hct, adm iron tabs & Epogen as
prescribed, teach pt to avoid fatigue, ensure pt receives prescribed diet with
restrictions [Na, K, phosphate], listen to pt & family concerns, allow pt to grieve, identify
ways of coping, offer support, assess access sites for inflammation [pain, redness,
drainage, temp], uses asepsis with invasive procedures & dressing change, adm other
meds as ordered [antihypertensive, ca supplements, multivits, Kayexalate to decrease K
level], ensure physiotherapy, assess pt for decreased sensations, prepare for dialysis
or renal transplant)
The reason why a person in renal failure can end up with anemia: Kidneys are
responsible for production of erythropoietin – hormone, which goes to the bone marrow
to cause production of RBC. If kidneys are damaged, there will be decreased
erythropoietin, therefore decreased RBC production, causing anemia.
Definition: Thrombus/blood clot in a vein not near to the skin’s surface, but in the deep
veins such as iliac and femoral veins.
Causes: Stasis of blood, vessel wall injury, altered blood coagulation (over-coagulation of
the blood).
S/S: Many DVTs do not produce any symptoms; others may cause changes in skin color -
redness, swelling, pain, feeling of heat in the area, cool extremity, superficial veins, calf
pain, stasis ulcer. Severe chest pain of difficultly breathing – clot in lungs
Risk Factors: Trauma, prolonged bedrest, surgery, obesity, advanced age, pregnancy,
cancer, oral contraceptives, hx of DVT
3
, Complications: Chronic venous insufficiency, increased venous pressure, varicosities,
venous ulcers, fluid stasis, edema, venous gangrene.
Dx Tests: History & physical exam, circumference of affected & non-affected limb, calf
pain.
Management: Thrombectomy, vena cava filter, Anticoagulant therapy (heparin)
Nursing Mx: Monitor PTT, PT, Hb, hematocrit, platelet count; assess for bleeding (due to
therapy), administer medications as prescribed (anticoagulant, analgesics), monitor for
bleeding, thrombocytopenia, drug interactions; Provide comfort (bed rest, elevate
extremity above the level of the heart, elastic compression stocking, analgesics, warm
compresses); patient teaching - shift weight, avoid high heels, elevation, medications,
signs of complications, etc.)
Prevention: Elastic compression stockings, proper body alignment, exercise,
anticoagulation therapy, do not cross legs at the ankle when sitting, prevent constipation
or straining, regularly change leg positions, move and stretch legs and feet while seated,
drink adequate, non-diuretic fluids such as water, juice and milk, minimize alcohol &
caffeine intake, loose clothing.
Sickle Cell Disease (SCD)
4
SOLUTIONS
Chronic Renal Failure
Definition: progressive, irreversible destruction of the nephrons in both kidneys. Last
stage of renal failure is ESRD [when the GFR is < 15 ml/min, normal is 85-135ml/min]. Pt
can survive without dialysis until 90% of nephrons are loss [during loss, the remaining
nephrons hypertrophy to compensate for the loss]. In ESRD, pt needs dialysis or renal
transplant [difficult, because pt needs a donor])
Causes: primary causes is DM, HTN, glomerulonephritis and cystic kidney disease
Stages of CRF: Decreased renal reserve (25 – 30%), Renal insufficiency, End stage renal
disease [ESRD]
Signs & Symptoms: Anxiety, depression, CHF, anorexia, nausea & vomiting, gastritis, gout,
anemia, infection, fatigue, headache, lethargy, seizure, confusion, dyspnea, pneumonia,
pallor, dry scaly skin, pruritis, restless leg syndrome, canker sore, impotence
Dx Tests: Hx & PE, Identification of reversible renal disease, Renal US, Renal Scan, Renal
Biopsy, BUN, creatinine, & creatinine clearance, Serum electrolytes, Protein: Creatinine
ration in first morning void, Urinalysis for [RBC, glucose, C & S], CBC [emphasize Hb &
Hct]
Management: Correction of ECF volume overload or deficit (restrict fluid, dialysis);
Nutritional therapy (protein restrictions until pt starts dialysis then intake is adjusted to
replace loss during dialysis], multivits [H20 soluble], low phosphorus diet, adequate CHO
& fat to minimize protein catabolism, fluid restriction [depends on urine output] foods
liquid at room temp [gelatin & ice cream] should be counted as fluids [same as in ARF],
Na & K restrictions depending on HTN I edema, foods high in Na are [cured meats,
1
,pickled foods, can soups & stews, cold cuts, soy sauce & salad dressings]. If pt requires
K restrictions, foods high in K are [oranges, bananas, melons, tomatoes, prunes, raisons,
deep green & yellow veggies, beans, legumes], restrict phosphate intake, foods high in
phosphate are [dairy products, milk, ice cream, cheese, yogurt, puddings] NOTE: these
foods are also high in Ca which is needed therefore Ca supplements are given);
Erythropoietin therapy (Epogen - Recormin); Calcium supplementation , phosphate
binders or both; AntiHTN; Measures to lower K; Adjustment to drug dosage [renal doses].
Nursing Mx: Assessment (Hx [existing familial diseases, infections, meds, dietary habits,
symptoms, support systems, family relations, self-image, work I& home activities], PE &
lab tests).
Nursing Dxs (Excess fluid volume r/t inability to excrete fluid, inadequate dialysis,
excessive fluid intake; Impaired skin integrity r/t decrease oil & sweat gland activity,
hyperphosphatemia, deposition of Ca-phosphate precipitates, capillary fragility, excess
fluid, & neuropathy; Risk for injury (fracture) r/t altered absorption of Ca & altered
excretion of phosphate, alt vit D metabolism; Activity intolerance r/t anemia and
neuropathy; Imbalanced nutrition: less than body requirements r/t restricted intake of
nutrients [protein], nausea, vomiting, anorexia, stomatitis; Anticipatory grieving r/t loss
of kidney function; Risk for infection r/t suppressed immune system, access sites,
malnutrition; Potential complications (HTN} related to Na & H20 retention & altered
renin-angiotensin system; Potential complication (hyperkalemia) r/t decreased renal
function, increased tissue catabolism & k shift into ECF; Potential complication
(peripheral neuropathy) r/t effects of uremia on peripheral nerves).
Goals (pt will demonstrate knowledge & ability to adhere to therapeutic regimen,
participate in decision making for plan of care & future modality, effective copying
strategies, continue with ADL within physiologic limitations).
Interventions (educate pt & family [drugs, diet, follow-up care, pts responsibility, daily
wt, check bp, S&S of fluid overload, high K & other electrolyte imbalances, importance of
strict dietary & drug adherence, OTC to avoid [nephrotoxic & laxatives & antacids that
2
,are mag based, dialysis, home care, activity, work, sex; assess edema, strict I & O daily
wt, assess skin, give good skin care, moisturize dry skin, adm antihistamines if
prescribed for itching apply creams or ointments [aquaphor], keep pt safe from injury,
provide adequate period of rest, monitor Hb & Hct, adm iron tabs & Epogen as
prescribed, teach pt to avoid fatigue, ensure pt receives prescribed diet with
restrictions [Na, K, phosphate], listen to pt & family concerns, allow pt to grieve, identify
ways of coping, offer support, assess access sites for inflammation [pain, redness,
drainage, temp], uses asepsis with invasive procedures & dressing change, adm other
meds as ordered [antihypertensive, ca supplements, multivits, Kayexalate to decrease K
level], ensure physiotherapy, assess pt for decreased sensations, prepare for dialysis
or renal transplant)
The reason why a person in renal failure can end up with anemia: Kidneys are
responsible for production of erythropoietin – hormone, which goes to the bone marrow
to cause production of RBC. If kidneys are damaged, there will be decreased
erythropoietin, therefore decreased RBC production, causing anemia.
Definition: Thrombus/blood clot in a vein not near to the skin’s surface, but in the deep
veins such as iliac and femoral veins.
Causes: Stasis of blood, vessel wall injury, altered blood coagulation (over-coagulation of
the blood).
S/S: Many DVTs do not produce any symptoms; others may cause changes in skin color -
redness, swelling, pain, feeling of heat in the area, cool extremity, superficial veins, calf
pain, stasis ulcer. Severe chest pain of difficultly breathing – clot in lungs
Risk Factors: Trauma, prolonged bedrest, surgery, obesity, advanced age, pregnancy,
cancer, oral contraceptives, hx of DVT
3
, Complications: Chronic venous insufficiency, increased venous pressure, varicosities,
venous ulcers, fluid stasis, edema, venous gangrene.
Dx Tests: History & physical exam, circumference of affected & non-affected limb, calf
pain.
Management: Thrombectomy, vena cava filter, Anticoagulant therapy (heparin)
Nursing Mx: Monitor PTT, PT, Hb, hematocrit, platelet count; assess for bleeding (due to
therapy), administer medications as prescribed (anticoagulant, analgesics), monitor for
bleeding, thrombocytopenia, drug interactions; Provide comfort (bed rest, elevate
extremity above the level of the heart, elastic compression stocking, analgesics, warm
compresses); patient teaching - shift weight, avoid high heels, elevation, medications,
signs of complications, etc.)
Prevention: Elastic compression stockings, proper body alignment, exercise,
anticoagulation therapy, do not cross legs at the ankle when sitting, prevent constipation
or straining, regularly change leg positions, move and stretch legs and feet while seated,
drink adequate, non-diuretic fluids such as water, juice and milk, minimize alcohol &
caffeine intake, loose clothing.
Sickle Cell Disease (SCD)
4
