Exam 18 - Disorders of the Kidney

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Questions and Answers

Following a nephrostomy procedure, what volume of sterile saline is recommended for irrigation at one time to avoid renal damage?

5 mL (correct)

15 mL

20 mL

10 mL

A patient has a nephrostomy and post-operatively has a urinary output of 40 mL/hr. According to protocol, what is the most appropriate first action?

Immediately notify the physician.

Increase the frequency of pain medication.

Administer IV fluids.

Check the drainage system for proper placement and function. (correct)

What is the primary risk if a nephrostomy catheter is not draining correctly?

Pulmonary edema

Urinary tract infection

Hydronephrosis. (correct)

Hypokalemia.

What is the recommended daily fluid intake for a patient with a nephrostomy, unless contraindicated?

2000 ml Signup and view all the answers

What is the most common type of renal tumor?

Malignant adenocarcinoma Signup and view all the answers

Which of the following is NOT typically associated with early-stage renal cell carcinoma?

Gross hematuria Signup and view all the answers

A patient presents with painless, intermittent hematuria, a palpable flank mass, and dull flank pain. These symptoms are considered:

Classic triad of symptoms for renal tumors Signup and view all the answers

Which genetic/hereditary condition is significantly associated with an increased risk of renal adenocarcinomas?

Von Hippel-Lindau disease Signup and view all the answers

What is the primary surgical treatment for a localized renal adenocarcinoma?

Radical nephrectomy with removal of adjacent lymph nodes and tissue. Signup and view all the answers

Which of these factors is LEAST associated with the development of renal tumors?

High cholesterol Signup and view all the answers

Which physiological process is most directly responsible for the removal of waste products during peritoneal dialysis?

Diffusion and osmosis between blood and dialysate Signup and view all the answers

A client undergoing continuous ambulatory peritoneal dialysis (CAPD) performs exchanges 4 times a day. Approximately how much time is typically required for a single exchange cycle?

30-40 minutes Signup and view all the answers

What is the primary reason dialysate is typically kept at body temperature during peritoneal dialysis?

To minimize patient discomfort Signup and view all the answers

A nurse is monitoring a patient undergoing peritoneal dialysis. Which of the following findings would be most indicative of peritonitis?

Cloudy dialysate output, accompanied by fever Signup and view all the answers

Which of the following is a key nursing intervention performed during peritoneal dialysis?

Monitoring the patient's weight before and after dialysis Signup and view all the answers

What is a key nursing intervention for a patient experiencing impaired coping following a cancer diagnosis?

Encouraging the patient to express feelings and identify personal strengths. Signup and view all the answers

What is the correct action to take regarding drainage catheters after a nephrectomy?

Keeping drainage catheters unkinked and below the insertion point Signup and view all the answers

What does the presence of a thrill indicate in a patient with an arteriovenous fistula?

A normal flow of blood through the fistula Signup and view all the answers

A patient with polycystic kidney disease (PKD) is experiencing pain. Which intervention would be most appropriate initially?

Applying heat and administering analgesics. Signup and view all the answers

Which of the following laboratory tests would be important and monitored before starting peritoneal dialysis?

BUN, Creatinine, CBC and electrolytes Signup and view all the answers

A patient undergoing a nephrectomy requires post-operative care. What is a key nursing action?

Encouraging the patient to express their fears and concerns related to the diagnosis. Signup and view all the answers

If a patient with polycystic kidney disease and flank pain experiences bleeding, what nursing intervention is most important?

Discontinue heat therapy and place patient on bed rest. Signup and view all the answers

A patient with nephrotic syndrome exhibits severe edema and low serum albumin. What pathophysiological process is primarily responsible for these findings?

Loss of protein through the kidneys, decreasing serum osmotic pressure. Signup and view all the answers

A patient with nephrotic syndrome has decreased urine output (oliguria) and is experiencing fatigue. What is the most likely underlying cause of these symptoms?

Reduced kidney function and fluid retention. Signup and view all the answers

A patient with chronic renal failure develops polycystic kidney disease (PKD). What is the primary mechanism through which PKD affects kidney function in this case?

Kidney function is compromised due to pressure of cysts. Signup and view all the answers

Which finding is most indicative of nephrotic syndrome during an assessment?

Severe, generalized edema (anasarca). Signup and view all the answers

What is the significance of monitoring BUN and creatinine levels through a renal function panel (RFP) in patients with kidney disease?

To evaluate the degree of kidney damage and function. Signup and view all the answers

What is the primary purpose of a dialysate fluid during dialysis?

To facilitate the diffusion of waste, drugs and electrolytes out of the blood and to control water movement. Signup and view all the answers

A patient with a Quinton catheter has been admitted. What precautions should the nurse implement regarding this type of catheter?

Inspect the catheter site for signs/symptoms of infection and bleeding and avoid use for routine blood draws. Signup and view all the answers

What nursing intervention is crucial for assessing a patient's arteriovenous fistula (AV fistula)?

Auscultate for a bruit and palpate for a thrill over the fistula. Signup and view all the answers

What is the most appropriate response to a patient’s question about the expected duration of their hemodialysis treatment?

Dialysis is typically indefinite unless a kidney transplant becomes available. Signup and view all the answers

Which dietary adjustment would be MOST appropriate for a patient with end-stage renal disease undergoing dialysis?

Increase caloric and fat intake with a focus on polyunsaturated fats. Signup and view all the answers

What is a critical nursing intervention to prevent complications related to hemodialysis vascular access?

Place a sign over the patient's bed indicating 'No IV or BP in (R or L) arm'. Signup and view all the answers

What does the administration of epoietin alfa (Epogen) require in patients with iron-deficiency anemia?

Pretreatment with ferrous sulfate or iron dextran. Signup and view all the answers

What is the primary rationale for maintaining strict intake and output (I&O) records for a patient with renal failure?

To monitor the patient for signs of fluid overload or dehydration. Signup and view all the answers

A patient post-dialysis presents with diaphoresis and anxiety. Which of the following complications should the nurse suspect?

Hypotension due to rapid fluid removal. Signup and view all the answers

Which intervention might a nurse implement to promote comfort and emotional support for a patient with renal failure?

Provide a quiet environment and cluster care activities. Signup and view all the answers

Study Notes

Renal Tumors

Etiology/Pathophysiology: Malignant adenocarcinomas (renal cell carcinomas) are most common. They often develop unilaterally and are large when detected. Develop in proximal convoluted tubules.
Increased Risk Factors: Smoking, obesity, genetics/heredity (especially conditions like hypertension and horseshoe kidney), and specific multi-organ syndromes (like von Hippel-Lindau disease).
Clinical Manifestations (late signs): Painless, intermittent hematuria; palpable flank mass; dull flank pain.
Clinical Manifestations (early signs): Hypercalcemia, fever, anemia, weakness, erythrocytosis, gross hematuria (rare until advanced).
Clinical Manifestations (metastatic): Respiratory distress, bone pain.
Assessment (subjective): Hematuria (without pain), weight loss, fatigue, dull flank pain.
Assessment (objective): Palpable flank mass, hematuria (check for anticoagulant use), signs of metastasis.
Diagnostics: Urinalysis (hematuria), cystoscopy with IVP/tomography (detect mass), CT scan (with/without contrast), chest X-ray, bone scan (staging). Biopsies are uncommon.
Medical Management: Radical nephrectomy (with lymph nodes) for localized disease. Partial nephrectomy for solitary kidney or renal insufficiency. Radiation and chemotherapy are not usually very effective.
Nursing Interventions: Post-operative care for nephrectomy; encourage patient expression of fears and concerns regarding poor prognosis; teach coping skills; support realistic hope; answer questions honestly.

Polycystic Kidney Disease (PKD)

Etiology/Pathophysiology: Fluid-filled sacs (cysts) on kidneys, increase with age; Many are discovered through imaging tests.
Increased Risk Factors for Cancer:
- Common in patients with chronic renal failure
- Causes are unknown but may be related to compensatory hyperplasia.
Diagnosis: More than 4 cysts per kidney, visible during ultrasound or CT scans.
Clinical Manifestations: Cysts on renal structures, frequently in collecting ducts (urine/blood fill the cysts).
Bosniak Classification: Used to classify cysts, with classes I-IV; Class I are benign; Class II are minimally complicated; Class III have irregular thickened walls and need investigation; Class IV are malignant and require nephrectomy
Assessment (subjective): Abdominal/flank pain, headache, GI issues, voiding problems, history of recurrent UTIs.
Assessment (objective): Hypertension, hematuria.
Diagnostics: Family history, physical exam, IVP and sonogram, renal function panel (BUN, creatinine).
Medical Management: No specific treatment exists, pain management (heat/analgesics), maintaining blood pressure control (antihypertensives, diuretics, dietary modifications), managing infections. Dialysis/transplant may be needed.
Nursing Interventions: Manage patient symptoms and severity; provide genetic counseling; address emotional concerns; monitor renal function; strict I&O.

Nephrotic Syndrome

Etiology/Pathophysiology: Characterized by the following: marked proteinuria, hyperlipidemia, hypoalbuminemia (low albumin levels), and edema; this occurs due to glomerulus damage interfering with its permeability.
Etiology/Pathophysiology (cont.): Protein loss reduces serum osmotic pressure, allowing fluid to enter interstitial spaces causing edema and decreased intravascular volume; immune responses (humoral and cellular) are suppressed, increasing risk of infection.
Clinical Manifestations: Severe generalized edema (anasarca), anorexia, weight loss, activity intolerance, fatigue, foamy urine (proteinuria).
Assessment (subjective): Anorexia, fatigue, foamy urine, decreased urine output (oliguria).
Assessment (objective): May include electrolyte imbalances like decreased bicarbonate and magnesium, and increased potassium, sodium, and phosphatase.
Diagnostics: Kidney function studies; blood tests.
Medical Management: Primary goal is to conserve renal function, initiate dialysis, prepare for transplant; drug therapies include anticonvulsants, anti-anemics, vitamin supplements, antiemetics, anti-pruritics, biological response modifiers such as epoietin alfa (but iron replacement may be necessary first).
Nursing Interventions: Maintaining fluid & electrolyte balance (strict I&Os, weights, hydration monitoring); nutritional therapy (high calories, high fat, protein, potassium restriction); addressing emotional support, safety; maintaining asepsis, documentation and reporting.

Dialysis

Definition: Removing wastes, drugs, electrolytes, and controlling water balance by utilizing a semipermeable membrane.
Hemodialysis: For acute/irreversible renal failure and fluid/electrolyte imbalances. Blood is circulated through an artificial kidney (dialyzer) to remove wastes while returning cleaned blood. Requires vascular access (temporary or permanent).
Vascular Access (temporary): Quinton catheter (subclavian or femoral), two ports.
Vascular Access (permanent): AV fistula (preferred, artery/vein sewn together), or AV graft (synthetic tube between artery/vein).
Procedure: Patient connected to dialysis machine via AV fistula or graft; performed by trained technician; treatments are scheduled multiple time per week.
Complications: Cardiovascular issues (heart failure, stroke), hypotension, muscle cramps, dysrhythmias, headaches, nausea/vomiting, rapid changes in electrolytes.
Medical Management: Monitor drug levels; adjust medications to avoid toxicity; instruct patients to not take OTC medications without approval; monitor GFR, dialysis, vomiting, and missed medications.
Peritoneal Dialysis: Utilizes the peritoneum as a semi-permeable membrane to remove waste and excess fluids. Types include CAPD (continuous ambulatory), CCPD (continuous cycling), and NIPD (nocturnal intermittent).
Peritoneal Dialysis Considerations: Patient preference; less rapid treatment needed; no need for blood vessel access; more freedom for the patient, severe cardiovascular issues.
Complications (Peritoneal): Peritonitis, hypotension, pain, and hemorrhage.
Patient Teaching: Explain procedure, signs of complications, diet/fluid restrictions, medication scheduling.

Nephrectomy

Procedure: Removal of all or part of a kidney.
Types: Partial (diseased tissue), Radical (kidney, ureter, adrenal gland, and surrounding fatty tissue).
Post-op Management: Monitor vital signs, look for bleeding, identify GI problems (nausea, vomiting, distention), record I&O. Keep drainage tubes clear. Monitor output, change dressings.
Patient Teaching: Avoid heavy lifting, drink sufficient fluids (unless contraindicated), monitor output, avoid alcohol, infections, and hazardous activities (that could hurt the remaining kidney).

Nephrostomy

Procedure: Surgical insertion of a catheter into the renal pelvis for urine drainage.
Post-op Management: Maintain catheter patency; prevent hemorrhage, monitor I&O; careful skin care. Irrigate catheter as prescribed, avoiding catheter displacement. Note drainage, observe for obstruction. Change dressings regularly. Maintain drainage below the kidney.

Kidney Transplantation

Recipient Selection: Based on medical, immunological, and psychosocial evaluation of the patient's status. General guideline based on age.

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Description

This quiz covers the etiology, pathophysiology, and clinical manifestations of renal tumors, focusing on renal cell carcinomas. It explores risk factors, diagnostic criteria, and assessment techniques associated with the condition. Perfect for medical students and healthcare professionals looking to enhance their knowledge of renal tumors.