Nephrosclerosis and Glomerular Diseases Quiz
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Questions and Answers

What is a common late manifestation of nephrosclerosis?

  • Renal insufficiency (correct)
  • Edema
  • Proteinuria
  • Frequent urination

    • Which class of medication is primarily used in the aggressive medical management of nephrosclerosis?

  • Diuretics
  • Calcium channel blockers
  • Beta blockers
  • Angiotensin-converting enzyme (ACE) inhibitors (correct)

    • What is the primary mechanism of injury in primary glomerular diseases?

  • Calcification of renal tubules
  • Infection of the renal pelvis
  • Ischemia of the kidney
  • Antigen-antibody complexes trapping in the glomerular capillaries (correct)

    • Which symptom is NOT typically associated with acute nephritic syndrome?

    <p>Hyperkalemia</p> Signup and view all the answers

    What can indicate glomerular injury in the urine?

    <p>RBC casts</p> Signup and view all the answers

    Which type of glomerulonephritis can occur following a group A beta-hemolytic streptococcal throat infection?

    <p>Post infectious glomerulonephritis</p> Signup and view all the answers

    What is a major clinical manifestation of glomerular injury?

    <p>Decreased GFR</p> Signup and view all the answers

    Which statement regarding urine appearance in glomerular injury is true?

    <p>It can appear cola-colored due to red blood cells</p> Signup and view all the answers

    What is a common cardiovascular complication that may occur in patients on dialysis?

    <p>Coronary heart disease</p> Signup and view all the answers

    Which of the following conditions may exacerbate the effects of hemodialysis, particularly regarding fluid shifts?

    <p>Hypotension</p> Signup and view all the answers

    What is a common sign of hypotension experienced during hemodialysis treatment?

    <p>Tachycardia</p> Signup and view all the answers

    What complication can arise from worsening calcium metabolism in dialysis patients?

    <p>Bone pain and fractures</p> Signup and view all the answers

    Which symptom is commonly associated with the rapid removal of fluid and electrolytes during dialysis?

    <p>Muscle cramping</p> Signup and view all the answers

    Which vascular access issue is particularly crucial for nursing management during dialysis?

    <p>Maintenance of the access device</p> Signup and view all the answers

    During dialysis treatment, how often should the patient and the equipment be monitored?

    <p>Constantly</p> Signup and view all the answers

    What is a rare but serious risk associated with the vascular system during hemodialysis?

    <p>Air embolism</p> Signup and view all the answers

    What characterizes high-biologic-value proteins?

    <p>They supply essential amino acids.</p> Signup and view all the answers

    What is the typical fluid allowance for a patient per day compared to the previous day’s urine output?

    <p>500 mL to 600 mL more.</p> Signup and view all the answers

    Why is vitamin supplementation necessary for patients on a protein-restricted diet?

    <p>Their diet may lack necessary vitamins.</p> Signup and view all the answers

    What should nursing care primarily focus on for a patient with end-stage renal disease (ESRD)?

    <p>Assessing fluid status and implementing a dietary program.</p> Signup and view all the answers

    What is an important aspect of teaching patients self-care in the context of dialysis?

    <p>They should report any signs of infection or access problems.</p> Signup and view all the answers

    Which symptom may indicate a worsening condition in a patient with renal failure?

    <p>Nausea or vomiting.</p> Signup and view all the answers

    What may indicate a need to alter the dialysis prescription?

    <p>Increasing BUN and serum creatinine levels.</p> Signup and view all the answers

    What is a common emotional response from patients dealing with end-stage renal disease?

    <p>Stress and anxiety related to their illness.</p> Signup and view all the answers

    What is a primary advantage of peritoneal dialysis (PD) compared to hemodialysis?

    <p>Gradual change in fluid volume status</p> Signup and view all the answers

    Which of the following statements is true regarding the nursing management of patients on PD?

    <p>Fluid volume and electrolytes need to be monitored regularly.</p> Signup and view all the answers

    What complication must nurses actively monitor for in patients undergoing peritoneal dialysis?

    <p>Peritonitis</p> Signup and view all the answers

    How long does training typically take for patients learning to perform peritoneal dialysis?

    <p>5 days to 2 weeks</p> Signup and view all the answers

    A patient undergoing PD may experience changes in which physical characteristic?

    <p>Increased waist size</p> Signup and view all the answers

    What dietary adjustments should a patient on continuous PD consider?

    <p>High-protein, well-balanced diet</p> Signup and view all the answers

    What is a method nurses can use to facilitate drainage when the peritoneal fluid does not drain properly?

    <p>Turning the patient from side to side</p> Signup and view all the answers

    Which statement regarding the PD catheter is accurate?

    <p>The catheter dressing should remain dry.</p> Signup and view all the answers

    What is a critical indicator of the overall success of a kidney transplant procedure?

    <p>The production of urine after the kidney is transplanted</p> Signup and view all the answers

    Why must a patient be free of infection before undergoing renal transplantation?

    <p>To avoid complications due to immunosuppression</p> Signup and view all the answers

    Which aspect is NOT typically included in the psychosocial evaluation before a kidney transplant?

    <p>History of allergic reactions</p> Signup and view all the answers

    What is the purpose of tissue and blood typing during kidney transplantation preparation?

    <p>To determine compatibility between donor and recipient</p> Signup and view all the answers

    How soon can rejection and failure occur after a kidney transplant?

    <p>Within 24 hours, 3 to 14 days, or even years later</p> Signup and view all the answers

    What kind of medications are prescribed after a kidney transplant?

    <p>Immunosuppressants to prevent transplant rejection</p> Signup and view all the answers

    What is the objective of performing hemodialysis the day before a scheduled kidney transplant?

    <p>To optimize the patient’s physical status</p> Signup and view all the answers

    Which of the following is a common concern for patients receiving a kidney from a living related donor?

    <p>Concern about the donor's recovery from the surgical procedure</p> Signup and view all the answers

    Study Notes

    Nephrosclerosis

    • Symptoms are rare in early stages, urine may contain protein and casts
    • Renal insufficiency and associated symptoms occur late in the disease
    • Treatment is aggressive antihypertensive therapy, ACE inhibitors, alone or in combination with other antihypertensive medications

    Primary Glomerular Diseases

    • Primary glomerular diseases are a cause of stage 5 CKD
    • Glomerular capillaries are primarily involved
    • Antigen-antibody complexes form in the blood and get trapped in glomerular capillaries, causing inflammation
    • Immunoglobulin G (IgG) is detected in glomerular capillary walls
    • Clinical manifestations include proteinuria, hematuria, decreased GFR, decreased sodium excretion, edema, and hypertension

    Acute Nephritic Syndrome

    • It is the clinical manifestation of glomerular inflammation
    • Glomerulonephritis is an inflammation of glomerular capillaries, occurring in acute and chronic forms
    • Post infectious causes are group A beta-hemolytic streptococcal infections of the throat, preceding the onset of glomerulonephritis by 2 to 3 weeks
    • May also follow skin infections and acute viral infections (upper respiratory tract infections, varicella zoster virus, Epstein-Barr virus, hepatitis B, and HIV infection)
    • Presenting features include hematuria, edema, azotemia, proteinuria
    • Hematuria may be microscopic or macroscopic
    • Urine may appear cola-colored due to RBCs and protein plugs or casts
    • High-biologic-value proteins are complete proteins and provide essential amino acids for growth and cell repair
    • Fluid allowance is usually 500 mL to 600 mL more than previous day's urine output
    • Calories are supplied by carbohydrates and fat to prevent wasting
    • Vitamin supplements are necessary due to protein restriction and potential loss during dialysis

    Nursing Management of ESRD

    • The patient requires careful assessment of fluid status and identification of potential imbalances
    • Implement a dietary program for proper nutrition within treatment regimen
    • Promote positive feelings through increased self-care and independence
    • Provide emotional support to patient and family

    Teaching Patients Self-Care

    • Referral to a nutritionist is necessary due to dietary changes
    • Teach the patient how to check vascular access device for patency and appropriate precautions
    • Patients and families should know what to report to their healthcare provider:
      • Worsening signs and symptoms of renal failure
      • Signs and symptoms of hyperkalemia
      • Signs and symptoms of access problems
    • Increasing BUN and creatinine levels may indicate a need to alter dialysis prescription

    Complications of Dialysis

    • Disturbances of lipid metabolism (hypertriglyceridemia) contribute to cardiovascular complications
    • Cardiovascular disease is the leading cause of death in patients receiving dialysis
    • Anemia is compounded by blood lost during hemodialysis
    • Gastric ulcers may result from stress, medication, and pre-existing conditions
    • Vomiting may occur during hemodialysis due to rapid fluid shifts and hypotension
    • Worsening calcium metabolism and renal osteodystrophy can cause bone pain and fractures
    • Calcification of major blood vessels is linked to hypertension and other vascular complications
    • Phosphorus deposits in the skin can cause itching
    • Shortness of breath may occur as fluid accumulates between dialysis treatments
    • Hypotension may occur during treatment as fluid is removed
    • Painful muscle cramping may occur late in dialysis
    • Dysrhythmias may result from electrolyte and pH changes
    • Air embolism is rare but can occur
    • Chest pain may occur in patients with anemia or arteriosclerotic heart disease

    Nursing Management During Dialysis

    • The patient, dialyzer, and dialysate bath require constant monitoring
    • Nursing care of the patient and the vascular access device are important
    • Excess manipulation should be avoided, and meticulous care of the catheter entry site is provided using a standardized protocol

    Peritoneal Dialysis (PD)

    • PD is less efficient than hemodialysis in removing solute and fluid
    • It allows for a more gradual change in the patient's fluid volume status and waste product removal
    • It may be the treatment of choice for hemodynamically unstable patients
    • Exchange times range from 30 minutes to 2 hours

    Nursing Management of PD

    • Patients may experience altered body image due to the presence of the abdominal catheter, bag, tubing, and cycler
    • Patients may experience depression due to the responsibility of self-care
    • Training for self-care usually takes 5 to 14 days
    • Vital signs, weight, I&O, laboratory values, and patient status are frequently monitored
    • The nurse uses a flow sheet to document each exchange
    • Skin turgor and mucous membranes are assessed to evaluate fluid status and monitor for edema
    • If peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient or raising the head of the bed
    • The nurse monitors for complications such as peritonitis, bleeding, respiratory difficulty, and leakage of peritoneal fluid
    • Abdominal girth may be measured periodically to assess fluid retention
    • The nurse ensures that the PD catheter remains secure and the dressing remains dry
    • The patient and family are educated about the procedure and kept informed of progress
    • The patient is instructed to eat a high-protein, well-balanced diet
    • The patient is encouraged to increase daily fiber intake to prevent constipation
    • Potassium, sodium, and fluid restrictions are not usually needed
    • Patients commonly lose 2 to 3 L of fluid over and above the volume of dialysate infused into the abdomen during a 24-hour period

    Kidney Transplantation

    • If the conditions are met, the donor should remain healthy and have a normal lifespan after donation
    • Once the blood supply has been reestablished to the transplanted kidney in the operating room, urine should begin to flow
    • Production of urine at this stage is an important indicator of the success of the procedure

    Medical Management of Kidney Transplantation

    • A complete physical examination is performed to detect and treat any complications
    • Tissue typing, blood typing, and antibody screening are performed to determine compatibility
    • The patient must be free of infection at the time of transplantation
    • A psychosocial evaluation is conducted
    • A history of psychiatric illness is important to obtain
    • Hemodialysis may be performed the day before the transplantation

    Nursing Management Post Transplantation

    • Patient teaching addresses postoperative care, pain management options, dietary restrictions, IV and arterial lines, tubes, and early ambulation
    • The patient receiving a kidney from a living related donor may be concerned about the donor
    • The goal is to maintain homeostasis until the transplanted kidney is functioning well

    Rejection and Failure

    • Rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years

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    Description

    Test your knowledge on nephrosclerosis and primary glomerular diseases. This quiz covers symptoms, causes, and treatments associated with kidney diseases. Understand the implications of acute nephritic syndrome and the roles of various medications used in treatment.

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