Kidney Function Recovery Quiz

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Questions and Answers

What is the primary reason diabetes type II is most often associated with older age?

Increased insulin sensitivity with age

Lower physical activity levels often seen in older adults (correct)

Higher prevalence of autoimmune diseases in older populations

Increased genetic mutations in older individuals

Which factor is NOT typically associated with an increased risk of developing diabetes type II?

Family history of diabetes

Increased physical activity (correct)

Excess weight

Gestational diabetes history

What initial condition typically characterizes the development of diabetes type II?

Increased absorption of glucose in the intestines

Increased production of glycogen in the liver

Insulin resistance in the body's cells (correct)

Decreased insulin secretion from the pancreas

Which statement best describes the function of insulin in the body?

Insulin facilitates the diffusion of glucose into cells for energy usage Signup and view all the answers

Which of the following symptoms is NOT associated with Type 2 diabetes?

Bedwetting Signup and view all the answers

Which of the following statements about diabetes type II is correct?

Insulin requirements are initially high due to insulin resistance. Signup and view all the answers

What is a characteristic feature of metabolic syndrome?

Abdominal obesity Signup and view all the answers

Which condition is primarily associated with excessive thirst due to dehydration?

Polydipsia Signup and view all the answers

Which medication is known to improve insulin sensitivity in Type 2 diabetic patients?

Metformin Signup and view all the answers

Which symptom indicates a potential state of metabolic acidosis in diabetic patients?

Increased respiratory rate & depth Signup and view all the answers

What is a common complication seen in noncompliant diabetic patients?

Slow healing of wounds Signup and view all the answers

Which combination of factors qualifies as metabolic syndrome?

Hyperlipidemia, hyperglycemia, and high blood pressure Signup and view all the answers

What can excessive hunger and eating in diabetic patients indicate?

Insufficient cellular uptake of glucose Signup and view all the answers

What symptom is often caused by the body's use of protein and fat for energy in diabetes?

Acetone/fruity breath odor Signup and view all the answers

Which factor is commonly associated with the risk of developing Type 2 diabetes?

Family history Signup and view all the answers

What is the primary function of glucagon?

Prevents hypoglycemia by releasing glucose Signup and view all the answers

Which cells in the pancreas are responsible for producing insulin?

Beta cells Signup and view all the answers

What happens to blood glucose levels when insulin is secreted?

Blood glucose levels decrease Signup and view all the answers

What is the role of somatostatin in glucose regulation?

Inhibits insulin and glucagon to maintain stable blood glucose Signup and view all the answers

Which test is used to assess long-term glycemic control over the previous 120 days?

Hemoglobin A1C test Signup and view all the answers

When is it recommended to perform a Hemoglobin A1C test for someone who has stable blood glucose control?

At least twice yearly Signup and view all the answers

What physiological response does glucagon initiate in response to low blood glucose levels?

Glycogenolysis in the liver Signup and view all the answers

Which of the following best describes the secretion control of insulin?

Stimulated by high blood glucose levels Signup and view all the answers

What is considered the expected reference range for Hemoglobin A1C?

4%-6% Signup and view all the answers

What is the significance of the Oral Glucose Tolerance Test (OGTT)?

Primarily used to diagnose gestational diabetes during pregnancy Signup and view all the answers

What is the blood creatinine level indicative of Stage 1 acute kidney injury?

1.5-1.9 times baseline Signup and view all the answers

Which stage of acute kidney injury is characterized by a urine output of less than 0.5 mL/kg/hr for 12 hours or more?

Stage 2 Signup and view all the answers

What best describes prerenal acute kidney injury?

Volume depletion and prolonged reduction of blood flow to the kidneys Signup and view all the answers

What is a common laboratory finding in acute kidney injury?

Blood urea nitrogen (BUN) increased to 80-100 mg/dL Signup and view all the answers

What urine specific gravity level is typically seen in prerenal acute kidney injury?

1.030 Signup and view all the answers

Which imaging assessment provides 3-dimensional imaging of the renal/urinary system?

CT scan Signup and view all the answers

What is a primary nursing action before performing a CT scan involving contrast?

Check for iodine allergy Signup and view all the answers

What is a potential complication of a kidney biopsy?

Hemorrhage Signup and view all the answers

What is NOT a characteristic of intrarenal acute kidney injury?

Results from prolonged reduction of blood flow to kidneys Signup and view all the answers

During the recovery phase of acute kidney injury, how long can it take for kidney function to be fully restored?

Up to 12 months Signup and view all the answers

Which nursing action is essential before a client undergoes abdominal imaging?

Ensure client is NPO for 4 hours Signup and view all the answers

What electrolyte imbalance is common in intrarenal azotemia?

Hyperkalemia Signup and view all the answers

What is the expected initial urine output for a patient experiencing Stage 3 acute kidney injury?

Less than 0.3 mL/kg/hr Signup and view all the answers

What finding in a urinalysis suggests acute kidney injury?

Presence of casts and red blood cells (RBCs) Signup and view all the answers

What should be consumed to meet carbohydrate needs if solid food is not an option?

Liquids equal to usual carbohydrate content Signup and view all the answers

What is the recommended frequency for testing urine for ketones if blood glucose exceeds 240 mg/dL?

Every 3-4 hours Signup and view all the answers

Which symptom indicates a need to call the provider immediately?

Rapid breathing Signup and view all the answers

What is a major risk factor for the development of myocardial infarction related to diabetes?

Coronary artery disease Signup and view all the answers

Which complication results from prolonged hyperglycemia and can lead to foot ulcers?

Neuropathy Signup and view all the answers

What is a common gastrointestinal issue associated with diabetic autonomic neuropathy?

Constipation Signup and view all the answers

Which test result is typical in Diabetic Ketoacidosis (DKA)?

Presence of ketones in the urine Signup and view all the answers

Which of the following is NOT a characteristic of Hyperglycemic Hyperosmolar State (HHS)?

Presence of ketones in blood and urine Signup and view all the answers

What is a common cause for the development of neonvascularization in diabetic retinopathy?

Retinal cell hypoxia Signup and view all the answers

In the context of diabetes complications, what does microalbuminuria indicate?

Presence of abnormal albumin levels in urine Signup and view all the answers

What initial action should be taken if a patient experiences mild hypoglycemia?

Give 15g of a rapid-acting sugar Signup and view all the answers

In the case of diabetic peripheral neuropathy, what is one of the first symptoms reported?

Pain leading to loss of sensation Signup and view all the answers

Which treatment option should be considered when potassium levels fall below 5.0 after hyperglycemic treatment?

Intravenous potassium replacement Signup and view all the answers

Study Notes

Acute Kidney Injury (AKI)

Diuresis occurs when kidneys start recovering, leading to significant fluid loss that can last 2-6 weeks.
Complete kidney function recovery can take up to 12 months after initiating treatment.

Classes of AKI

Stage 1 (Risk Stage):
- Blood creatinine levels 1.5-1.9 times baseline.
- Urine output < 0.5 mL/kg/hr for 6 hours or more.
Stage 2 (Injury Stage):
- Blood creatinine levels 2-2.9 times baseline.
- Urine output < 0.5 mL/kg/hr for 12 hours or more.
Stage 3 (Failure Stage):
- Blood creatinine levels 3 times baseline.
- Urine output < 0.3 mL/kg/hr for 12 hours or more.

Types of AKI

Prerenal AKI:
- Caused by volume depletion or reduced blood flow to kidneys leading to nephron ischemia.
- Early intervention can reverse AKI and prevent chronic kidney disease (CKD).
Intrarenal AKI:
- Direct kidney damage from lack of oxygen affecting glomeruli, nephrons, or tubules.
Postrenal AKI:
- Resulting from bilateral obstruction of structures leaving the kidney.

Laboratory Findings

Blood creatinine levels may rise by 1-2 mg/dL every 24-48 hours, or by 1-6 mg/dL in a week.
Blood urea nitrogen (BUN) may increase to 80-100 mg/dL within a week.
Urine specific gravity can vary; elevated in prerenal, and diluted in intrarenal AKI.
Electrolyte changes: sodium levels may decrease or increase, along with hyperkalemia and hyperphosphatemia.
Decreased hematocrit levels and presence of sediment in urinalysis indicate AKI.
Arterial blood gas (ABG) analysis may show metabolic acidosis.

Imaging Assessments

MAG3 and standard X-rays (KUB):
- Visualizes renal structures and detects obstructions or stones without contrast media.
CT Scan:
- Offers detailed 3D imaging to assess kidney size and possible obstructions, using iodine-based contrast.
Ultrasound (US):
- Assesses kidney size and evaluates lower urinary tract for obstructions and calculi.

Other Diagnostic Assessments

Kidney Biopsy:
- Tissue samples can be taken to examine for complications such as hemorrhage, infection, urinary retention, or liver/bowel puncture.
- Nursing Actions: NPO for 4 hours before procedure, client positioned prone, monitor hemoglobin levels.

Diabetes Mellitus (DM) Overview

Pancreas Function: Regulates digestion and glucose metabolism via hormone secretion.
Alpha Cells: Secrete glucagon to raise blood sugar during fasting.
Beta Cells: Produce insulin, which manages blood sugar levels post-meals.

Glucagon and Insulin Functions

Glucagon:
- Stimulates glycogenolysis and gluconeogenesis to prevent hypoglycemia.
Insulin:
- Facilitates glucose uptake, promotes glycogenesis, and prevents hyperglycemia.

Diabetes Mellitus Type II

Progressive condition often beginning with insulin resistance and leading to decreased insulin secretion.
Common in obese individuals; linked to genetics, metabolic syndrome, and lifestyle factors.
Symptoms include increased thirst, frequent urination, dark patches on skin, and fatigue.

Metabolic Syndrome

Defined by the presence of 3+ risk factors including abdominal obesity and hypertension, increasing the likelihood of DM2 and cardiovascular events.

Diabetes Management and Medications

Medications such as Metformin enhance insulin sensitivity, reduce liver glucose production, and may lead to lactic acidosis in certain patients.
Regular monitoring of blood glucose levels and HbA1c is necessary for maintaining glycemic control.
Aspirin therapy recommended for heart disease prevention in at-risk patients.### Hydration and Nutrition Management
Consume sugar-free, non-caffeinated liquids hourly to prevent dehydration.
If blood glucose is below the target, fluids containing sugar are permitted.
Meet carbohydrate needs through soft foods (custard, cream soup, gelatin, graham crackers) six to eight times daily or replace with liquids equivalent to the usual carb content.
Test urine for ketones every 3-4 hours or if blood glucose exceeds 240 mg/dL, and report values outside the expected range.
Seek medical assistance for:
- Moderate to large urine ketones persisting over 24 hours.
- Persistent blood glucose above 250 mg/dL despite treatment.
- Persistent fever over 101.5°F unresponsive to acetaminophen.
- Symptoms of disorientation, rapid breathing, or persistent gastrointestinal upset.
- Illness lasting longer than 2 days.

Complications of Diabetes Mellitus

Macrovascular Complications:
- Coronary artery disease is a leading risk factor for myocardial infarction.
- Hypertension affects 75% of people with diabetes.
- Stroke risk increases 2-4 times in individuals with diabetes.
- Peripheral vascular disease primarily affects lower extremities with potential gangrene due to hyperglycemia.
Neuropathy (Microvascular Complication):
- Caused by microvascular disease, leading to conditions like microalbuminuria and nerve dysfunction.
- Risks include mood alterations and increased susceptibility to infections.
- Diabetic Peripheral Neuropathy:
  - Progressive nerve function deterioration, causing sensory loss with slow onset.
  - Can lead to fallen ulcers and deformities.
Diabetic Autonomic Neuropathy:
- Affects heart and blood vessel nerves, causing orthostatic hypotension and potential for falls.
- Can disrupt gastrointestinal functioning, leading to issues like gastroparesis and constipation.
Retinopathy:
- Leading cause of blindness related to retinal microvascular damage.
- Nearly all diabetics exhibit some level of diabetic retinopathy, which usually presents few symptoms until vision loss occurs.

Diabetic Ketoacidosis (DKA)

Caused by insufficient insulin or interruptions in treatment, often triggered by infections, stress, or illness.
Commonly presents with:
- Hyperglycemia (blood glucose >300 mg/dL).
- Elevated ketones in blood and urine.
- High blood osmolarity and signs of metabolic acidosis.
- Dehydration indicated by high BUN (>30 mg/dL) and creatinine (>1.5 mg/dL).

Hyperglycemic Hyperosmolar State (HHS)

Results from poorly managed diabetes, often in older adults, leading to severe hyperglycemia (>600 mg/dL) without ketoacidosis.
Occurs due to inadequate fluid intake or compromised kidney function.
Presents with high blood osmolarity (>320 mOsm/L) and elevated BUN and creatinine.

Hypoglycemia

Defined as blood sugar below 70 mg/dL.
Symptoms range from mild (hunger, headache, sweating) to severe (confusion, seizures, coma).
Treatment includes 15g of fast-acting sugar for mild hypoglycemia; severe cases may require hospitalization and glucagon administration.
Position the unconscious client laterally to prevent aspiration and administer glucagon as needed.

Prevention and Management Recommendations

Regular monitoring of blood glucose and ketone levels.
Control of blood pressure and lipid levels to prevent complications.
Frequent visits to healthcare providers for routine eye exams to monitor for retinopathy and other complications.
Education on recognizing hypoglycemia symptoms and effective baked countermeasures.

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Description

Test your knowledge on kidney function recovery stages and diuresis processes. This quiz explores the phases of recovery, including variations with or without diuretics, duration, and the risk stages as indicated by blood creatinine levels. Brush up on your understanding of nephrology topics and their implications.