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Questions and Answers
What is a primary cause of chronic renal failure (CRF)?
Which stage of chronic renal failure is characterized by less than 10% of nephron function remaining?
How should infections be managed in order to prevent chronic renal failure?
What can excessive retention of urea and nitrogenous wastes in the blood lead to?
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What is essential to monitor in critically ill patients to detect renal failure early?
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What is a recommended action to ensure safe blood transfusions?
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What is NOT a common complication associated with chronic renal failure?
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What can be done to prevent the progression of chronic renal failure?
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Which of the following compounds can lead to the classification of chronic renal failure?
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Which condition is typically NOT associated with chronic renal failure?
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What renal treatment is usually considered when conservative treatment fails to improve a patient's quality of life?
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What major risk factor commonly leads to postrenal acute renal failure?
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What term describes an elevated concentration of urea in blood?
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Which of the following is NOT classified as a type of acute renal failure?
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Which cause is identified primarily with intrarenal acute renal failure?
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What laboratory results would most likely indicate renal failure?
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What is the primary hormone affected by kidney failure that leads to anemia?
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Which condition is a major complication of end-stage renal disease (ESRD)?
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Which electrolyte imbalance is most common in patients with renal failure?
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Which of the following clinical signs is associated with the late stage of chronic renal failure?
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Which diagnostic test is most commonly used to assess kidney function in patients with renal failure?
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Which complication should be monitored in patients undergoing hemodialysis?
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Which of the following can contribute to the development of chronic renal failure?
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What is NOT a prevention strategy for acute renal failure?
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What is the primary function of erythropoietin in patients with renal failure?
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Why are phosphate binders prescribed in the management of chronic renal failure?
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What is a key feature of Stage 3 chronic renal failure (end-stage renal disease)?
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Which nursing intervention is essential for managing fluid volume excess in patients with renal failure?
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Which condition can lead to postrenal acute renal failure?
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What is the main purpose of dialysis in renal failure patients?
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Which nursing diagnosis is most appropriate for a patient with chronic renal failure and anemia?
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Which stage of chronic renal failure is characterized by a 75% to 90% loss of nephron function?
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What action is not recommended for the arm with a fistula?
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Which dietary modification is essential for managing high serum potassium levels?
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Which symptom is most indicative of fluid overload in renal failure patients?
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What characterizes acute renal failure (ARF)?
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Which condition is considered a prerenal cause of acute renal failure?
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What type of acute renal failure is associated with direct damage to kidney tissue?
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Which test accurately estimates the kidney's filtration rate?
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In chronic renal failure, which hormone is crucial for red blood cell production?
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Study Notes
Acute Renal Failure (ARF)
- ARF is a sudden loss of kidney function, impacting the body's ability to regulate fluids and electrolytes.
- ARF can be caused by factors that affect blood flow to the kidneys (prerenal), direct damage to the kidneys (intrarenal), or obstruction of the urinary tract (postrenal).
- Prerenal ARF can be triggered by conditions like dehydration, heart failure, or hemorrhage.
- Intrarenal ARF can be caused by conditions like burns, crush injuries, or nephrotoxic drugs (medications that harm the kidneys).
- Postrenal ARF can be caused by conditions like prostate enlargement, kidney stones, or tumors.
- Monitor central venous and arterial pressure alongside hourly urine output to identify renal failure early.
- Treat hypotension promptly.
- Ensure correct blood transfusions to avoid transfusion reactions that might trigger renal failure.
- Promptly manage and prevent infections, particularly those related to wounds, burns, and potential sepsis.
Chronic Renal Failure (CRF)
- CRF or ESRD (End-Stage Renal Disease) is a progressive, irreversible deterioration of kidney function.
- The body's ability to maintain fluid, electrolyte, and metabolic balance diminishes, impacting the elimination of waste products.
- CRF leads to an accumulation of urea and other nitrogenous waste products in the blood, causing uremia and azotemia.
Causes of CRF
-
Systemic diseases:
- Diabetes Mellitus
- Hypertension
- Chronic glomerulonephritis (inflammation of the glomeruli)
- Pyelonephritis (infection of the kidneys)
- Obstruction of the urinary tract (blockage in the urinary system)
- Hereditary lesions
- Polycystic kidney disease
-
Vascular disorders:
- Infections
- Medications or toxic substances
-
Environmental & Occupational agents:
- Lead
- Mercury
- Chromium
Prevention of CRF
- Promptly treat underlying causes like diabetes and hypertension.
- Prevent acute renal failure (ARF) to support long-term kidney health.
Pathophysiology of CRF
- Renal function declines progressively.
- The body's ability to filter waste products diminishes.
- Protein metabolism byproducts accumulate in the blood, leading to uremia.
- Uremia impacts all body systems, contributing to the progression of CRF.
- Urinary protein excretion and hypertension contribute to worsening renal function and the progression of CRF.
Stages of CRF
-
Stage 1 (Reduced renal reserve):
- 40% to 75% loss of nephron function (functional kidney units)
- Usually asymptomatic
-
Stage 2 (Renal insufficiency):
- 75% to 90% loss of nephron function
- Elevated serum creatinine levels (waste product in the blood)
- Elevated blood urea nitrogen (waste product in the blood)
- Diluted urine
- Anemia
- Polyuria (excessive urination)
- Nocturia (frequent urination at night)
-
Stage 3 (ESRD), Final stage:
- Less than 10% nephron function remaining
- Very high creatinine levels
- Very high BUN levels
- Severe electrolyte imbalances
Clinical Manifestations of CRF
- Severity of symptoms depends on the degree of renal impairment, underlying health conditions, and the patient's age.
-
Common signs and symptoms include:
- Fatigue and weakness
- Nausea and vomiting
- Shortness of breath
- Edema (swelling)
- Seizures
- Heart problems
- High blood pressure
- Bone disease
- Anemia
- Electrolyte imbalances, like high potassium (hyperkalemia) and low calcium (hypocalcemia)
Management of CRF
-
Conservative treatment:
- Medication therapy (blood pressure meds, diuretics, etc.)
- Nutritional Therapy (restricted protein, low potassium and sodium, maintaining fluid balance)
-
When conservative treatment is insufficient:
- Dialysis (hemodialysis or peritoneal dialysis) - helps remove waste products, excess fluid, and balance electrolytes.
- Kidney transplant -- considered for certain patients when it's a viable option.
Key Points about CRF Management
- Erythropoietin: Key hormone for red blood cell production; levels are often reduced in renal failure, leading to anemia.
- Phosphate binders: Prescribed to reduce phosphorus absorption, which can be elevated in renal failure and contribute to bone disease.
- Fluid Management: Critical aspect, often with fluid restrictions to prevent overload.
- Cardiovascular Complications: Common; hypertension is frequent and can be managed with medications.
- Electrolyte Imbalances: Common; particularly hyperkalemia (high potassium) which can lead to heart rhythm problems.
- Anemia: Due to decreased erythropoietin; managed with synthetic erythropoietin (given as medication).
- Bone Disease: Mineral and bone metabolism problems are common in CRF due to imbalances in calcium and phosphorus.
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Description
This quiz offers an overview of Acute Renal Failure (ARF), including its causes, types, and management strategies. Understand the distinctions between prerenal, intrarenal, and postrenal factors, as well as the importance of early detection and treatment. Test your knowledge on key concepts related to kidney function and failure.
