Fluid and electrolytes
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Questions and Answers

What is the primary function of the kidneys in regulating fluid and electrolyte balance?

  • Adjusting urine volume to maintain water balance (correct)
  • Filtering plasma volume to remove waste products
  • Regulating blood pressure
  • Secreting hormones to regulate electrolyte balance

    • What is the term used to describe the abrupt decrease in kidney function, resulting in the retention of urea and other nitrogenous waste products?

  • End-Stage Renal Disease (ESRD)
  • Chronic Kidney Disease (CKD)
  • Acute Kidney Injury (AKI) (correct)
  • Acute Renal Failure (ARF)

    • What is the percentage of filtrate that is reabsorbed by the kidneys in an average adult?

  • 99% (correct)
  • 90%
  • 98%
  • 95%

    • What is the term used to describe the accumulation of nitrogen waste products in the blood?

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

    What is the term used to describe the classification system for AKI that uses serum creatinine, glomerular filtration rate (GFR), and urine output?

    <p>RIFLE criteria</p> Signup and view all the answers

    What is the age-related change that increases the risk of developing AKI in older persons?

    <p>Decrease in number of functioning nephrons</p> Signup and view all the answers

    What is the term used to describe the type of AKI that is due to inadequate renal perfusion?

    <p>Prerenal AKI</p> Signup and view all the answers

    What is the percentage of critical care unit (CCU) patients that develop severe AKI?

    <p>70-80%</p> Signup and view all the answers

    What is the term used to describe the process that aids in maintaining normal plasma osmolality, electrolyte balance, blood volume, and acid-base balance?

    <p>Filtration and reabsorption</p> Signup and view all the answers

    What is the typical range of urine output per day during the oliguric phase of acute kidney injury?

    <p>50-500 mL</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of uremia in acute kidney injury?

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

    Which of the following is a possible physical finding in a patient with uremic pericarditis?

    <p>Pericardial friction rub</p> Signup and view all the answers

    What is the primary cause of decreased renal blood flow within 3 to 4 hours after an obstruction of the urinary tract?

    <p>Increased renal vasculature resistance</p> Signup and view all the answers

    What is the typical urine output in the prodromal phase of acute kidney injury?

    <p>Normal urine output</p> Signup and view all the answers

    What is a characteristic of the postoliguric phase in acute kidney injury?

    <p>Urine output gradually returns to normal, but serum creatinine and urea levels may not fall for several more days</p> Signup and view all the answers

    Which of the following situations is likely to cause significant acute kidney injury?

    <p>Bilateral ureteral obstruction</p> Signup and view all the answers

    What is an important part of the diagnosis of acute kidney injury?

    <p>Medication review, including all OTC/herbal remedies</p> Signup and view all the answers

    What is the most common cause of sudden cessation of urinary output in men?

    <p>Enlarged prostate</p> Signup and view all the answers

    What may be a complication of acute kidney injury?

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

    Which of the following is a possible manifestation of fluid accumulation in the lungs due to acute kidney injury?

    <p>Crackles on auscultation</p> Signup and view all the answers

    What is a priority when determining the cause of acute kidney injury?

    <p>Ruling out reversible causes first</p> Signup and view all the answers

    What is a characteristic of prerenal acute kidney injury?

    <p>Often clinically apparent</p> Signup and view all the answers

    What is a treatment for prerenal acute kidney injury?

    <p>Volume infusion</p> Signup and view all the answers

    What is a laboratory test used to diagnose acute kidney injury?

    <p>Blood Urea Nitrogen (BUN) and serum creatinine</p> Signup and view all the answers

    What is a physical finding that may be seen in acute kidney injury?

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

    A patient presents with anuria, peripheral edema, and a history of an enlarged prostate. Which of the following is the most likely cause of the patient's acute kidney injury?

    <p>Post-renal AKI</p> Signup and view all the answers

    A patient with acute kidney injury (AKI) is in the oliguric phase. What is the typical range of urine output per day in this phase?

    <p>50-500 mL/day</p> Signup and view all the answers

    Which of the following is a potential complication of AKI that can cause chest pain, pericardial friction rub, and findings of pericardial tamponade?

    <p>Uremic pericarditis</p> Signup and view all the answers

    A patient with AKI presents with asterixis and hyperreflexia. These findings are most likely indicative of:

    <p>Neurological complications of uremia</p> Signup and view all the answers

    A patient with AKI has a urine output of 200 mL/day. What phase of AKI is the patient most likely in?

    <p>Oliguric phase</p> Signup and view all the answers

    A patient with bilateral ureteral obstruction is at risk for which type of AKI?

    <p>Post-renal AKI</p> Signup and view all the answers

    Which of the following is a common symptom of uremia in AKI?

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

    What is the typical duration of the oliguric phase of AKI?

    <p>Unpredictable and varies depending on etiology and treatment</p> Signup and view all the answers

    How is the postoliguric phase characterized in patients with acute kidney injury?

    <p>Gradual return of urine output to normal</p> Signup and view all the answers

    What is a common laboratory finding in acute kidney injury related to electrolytes?

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

    Which of the following is a reversible cause of acute kidney injury that should be prioritized in diagnosis?

    <p>Obstruction of urinary tract</p> Signup and view all the answers

    Which treatment approach is typically appropriate for prerenal acute kidney injury caused by hypovolemia?

    <p>Fluid volume expansion</p> Signup and view all the answers

    What physical finding is commonly associated with acute kidney injury and may indicate fluid overload?

    <p>Peripheral edema</p> Signup and view all the answers

    Which of the following electrolyte imbalances is typically seen with acute kidney injury due to renal dysfunction?

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

    Which assessment is crucial in diagnosing the cause of acute kidney injury?

    <p>Review of medication history</p> Signup and view all the answers

    What laboratory test would be least helpful in diagnosing acute kidney injury?

    <p>Complete blood count</p> Signup and view all the answers

    Which of the following is a classification system used to determine the severity of acute kidney injury (AKI)?

    <p>The RIFLE criteria</p> Signup and view all the answers

    Which of the following is a common cause of prerenal acute kidney injury?

    <p>Severe dehydration</p> Signup and view all the answers

    Which of the following is a hallmark sign of acute kidney injury (AKI)?

    <p>Elevated blood urea nitrogen (BUN)</p> Signup and view all the answers

    Which of the following is a possible complication of acute kidney injury (AKI)?

    <p>Metabolic acidosis</p> Signup and view all the answers

    Which of the following is a nursing intervention for a patient with acute kidney injury (AKI)?

    <p>Monitoring blood pressure closely</p> Signup and view all the answers

    Which of the following is a nursing assessment finding that may indicate acute kidney injury (AKI)?

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

    Which of the following is a classification of burns based on depth of tissue involvement?

    <p>Superficial, partial-thickness, full-thickness</p> Signup and view all the answers

    Which of the following is the most common type of burn?

    <p>Thermal burns</p> Signup and view all the answers

    Which of the following is a nursing intervention for a patient with a burn?

    <p>Removing clothing from the burn area</p> Signup and view all the answers

    According to the rule of nines, what percentage of the body surface area is affected by a burn that covers the entire right arm?

    <p>9%</p> Signup and view all the answers

    Study Notes

    Acute Kidney Injury (AKI)

    • Defined as a rapid decline in kidney function leading to nitrogenous waste retention and electrolyte imbalance.
    • Replaced the term acute renal failure (ARF) to emphasize smaller declines in function that increase morbidity and mortality.
    • Essential kidneys functions include regulating fluid and electrolytes and maintaining water balance through urine volume adjustments.

    Kidney Function

    • Adult kidneys filter total plasma volume multiple times daily, reabsorbing approximately 99% of filtrate, resulting in about 1.5 liters of urine daily.
    • Urine formation occurs in renal tubules involving selective reabsorption and secretion of water and electrolytes.
    • Plays a critical role in maintaining plasma osmolality, electrolyte balance, blood volume, and acid-base homeostasis, influenced by ADH and aldosterone.

    Diagnostic Criteria for AKI

    • Diagnosis involves assessing acute reductions in urine output and elevations in serum creatinine, potentially leading to azotemia.
    • Untreated AKI can result in fluid overload, electrolyte imbalances, metabolic acidosis, and increased mortality risk from infections.

    Causes and Risk Factors

    • Severe AKI may arise from prolonged hypotension, hypovolemia, or nephrotoxic agents, developing over hours or days.
    • Critically ill patients exhibit severe AKI in over 60% of cases with mortality rates reaching 70-80%.
    • Classification of AKI includes prerenal, renal, and postrenal causes.

    Age and Susceptibility

    • Older adults are more vulnerable to AKI due to a natural decline in functional nephrons and concurrent organ system impairments.
    • Aging kidneys are less capable of handling changes in fluid volume and cardiac output.

    Classification of AKI Causes

    • Prerenal AKI leads to inadequate renal perfusion; patients often experience lower morbidity and mortality.
    • Nonoliguric patients may develop a postoliguric phase, gradually returning urine output to normal while serum creatinine levels may remain elevated temporarily.

    Diagnostic Approaches

    • Diagnostic evaluations include clinical assessments, medication reviews, and laboratory tests such as CBC, BUN, serum creatinine, and urinalysis.
    • Imaging studies like renal ultrasound may be used for suspected postrenal causes.

    Laboratory Results in AKI

    • Common findings include acidosis, hyperkalemia, hyponatremia, anemia, hyperphosphatemia, and hypocalcemia.

    Management and Treatment

    • Immediate focus involves identifying and reversing treatable causes like volume depletion or obstruction.
    • Prerenal AKI management may include volume infusion in cases of hypovolemia, while obstructive causes require resolution of the underlying obstruction.
    • Initial observations may indicate weight gain and edemas, with symptoms of uremia such as anorexia, nausea, weakness, and confusion developing later.

    Phases of Urine Output in AKI

    • The prodromal phase usually has normal urine output of variable duration based on underlying factors.
    • The oliguric phase is characterized by urine output between 50-500 mL/day; its duration is highly variable, contingent on the AKI's cause and treatment timeline.

    Acute Kidney Injury (AKI)

    • Defined as a rapid decline in kidney function leading to nitrogenous waste retention and electrolyte imbalance.
    • Replaced the term acute renal failure (ARF) to emphasize smaller declines in function that increase morbidity and mortality.
    • Essential kidneys functions include regulating fluid and electrolytes and maintaining water balance through urine volume adjustments.

    Kidney Function

    • Adult kidneys filter total plasma volume multiple times daily, reabsorbing approximately 99% of filtrate, resulting in about 1.5 liters of urine daily.
    • Urine formation occurs in renal tubules involving selective reabsorption and secretion of water and electrolytes.
    • Plays a critical role in maintaining plasma osmolality, electrolyte balance, blood volume, and acid-base homeostasis, influenced by ADH and aldosterone.

    Diagnostic Criteria for AKI

    • Diagnosis involves assessing acute reductions in urine output and elevations in serum creatinine, potentially leading to azotemia.
    • Untreated AKI can result in fluid overload, electrolyte imbalances, metabolic acidosis, and increased mortality risk from infections.

    Causes and Risk Factors

    • Severe AKI may arise from prolonged hypotension, hypovolemia, or nephrotoxic agents, developing over hours or days.
    • Critically ill patients exhibit severe AKI in over 60% of cases with mortality rates reaching 70-80%.
    • Classification of AKI includes prerenal, renal, and postrenal causes.

    Age and Susceptibility

    • Older adults are more vulnerable to AKI due to a natural decline in functional nephrons and concurrent organ system impairments.
    • Aging kidneys are less capable of handling changes in fluid volume and cardiac output.

    Classification of AKI Causes

    • Prerenal AKI leads to inadequate renal perfusion; patients often experience lower morbidity and mortality.
    • Nonoliguric patients may develop a postoliguric phase, gradually returning urine output to normal while serum creatinine levels may remain elevated temporarily.

    Diagnostic Approaches

    • Diagnostic evaluations include clinical assessments, medication reviews, and laboratory tests such as CBC, BUN, serum creatinine, and urinalysis.
    • Imaging studies like renal ultrasound may be used for suspected postrenal causes.

    Laboratory Results in AKI

    • Common findings include acidosis, hyperkalemia, hyponatremia, anemia, hyperphosphatemia, and hypocalcemia.

    Management and Treatment

    • Immediate focus involves identifying and reversing treatable causes like volume depletion or obstruction.
    • Prerenal AKI management may include volume infusion in cases of hypovolemia, while obstructive causes require resolution of the underlying obstruction.
    • Initial observations may indicate weight gain and edemas, with symptoms of uremia such as anorexia, nausea, weakness, and confusion developing later.

    Phases of Urine Output in AKI

    • The prodromal phase usually has normal urine output of variable duration based on underlying factors.
    • The oliguric phase is characterized by urine output between 50-500 mL/day; its duration is highly variable, contingent on the AKI's cause and treatment timeline.

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    Description

    Test your knowledge of kidney function, fluid and electrolyte balance, and kidney diseases. This quiz covers key concepts in renal physiology and pathology.

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