{"id":120416,"date":"2023-09-22T12:09:32","date_gmt":"2023-09-22T12:09:32","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=120416"},"modified":"2023-09-22T12:09:34","modified_gmt":"2023-09-22T12:09:34","slug":"nur-265-advanced-exam-1-a-guide-latest-updated","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/09\/22\/nur-265-advanced-exam-1-a-guide-latest-updated\/","title":{"rendered":"NUR 265 Advanced Exam 1: A+ Guide: Latest updated"},"content":{"rendered":"\n<p>Exam 1 review<br>Anatomy of the Kidney:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The nephron is the functional unit of the kidney.<\/li>\n\n\n\n<li>Normal GFR is 120-125.<\/li>\n\n\n\n<li>If 75% of nephrons quit = renal insufficiency.<\/li>\n\n\n\n<li>Kidneys are sensitive to changes in cardiac output. VOLUME DEPENDENT. A decrease in<br>urine output indicates a decrease in cardiac output.<\/li>\n\n\n\n<li>If the SBP is below 70 for over 40 minutes, the kidney will become hypo then ischemic.<\/li>\n\n\n\n<li>If the SBP drops, the arterioles dilate. If the SBP elevate, arterioles constrict.<br>Normal Functions of the Kidney:<\/li>\n\n\n\n<li>Regulation of Water: Thirst regulates body fluid. Aldosterone- excretes K and reabsorbed<br>NA. ADH- reabsorbs water, is water conserving. ANP- inhibits NA and reabsorbs water. A<br>decrease in volume causes as increase in aldosterone.<br>\uf0e8 When encouraging the patient to drink, provide a GOAL.<\/li>\n\n\n\n<li>Excretion of Metabolic Waste: Reabsorbed = water and electrolytes. NOT reabsorbed =<br>creatinine, urea, lactic acid, and ketones. Check creatinine and BUN to assess kidney<br>function<br>\uf0e8 Lactic acid is a byproduct of metabolism. When the lactic acid is high in decrease<br>kidney function, these patients have soreness everywhere. *give them water.<\/li>\n\n\n\n<li>Regulation of Acid-Base Balance: The kidneys are 2nd place after the lungs. They excrete<br>hydrogen and reabsorb bicarb.<\/li>\n\n\n\n<li>Regulation of Blood Pressure: Maintain VOLUME. Renin-Angiotensin- vasoconstricts then<br>releases aldosterone. Aldosterone. Prostaglandins- vasodilatation. Bradykininsvasodilation and vascular permeability.<\/li>\n\n\n\n<li>RBC Synthesis: Renal Erythropoietin Factor stimulates bone marrow to make RBCs.<br>\uf0e8 A dialysis patient is often anemic.<\/li>\n\n\n\n<li>Regulation of Electrolytes: effecting neuro, cardiac, mental, and GI.<br>Electrolytes:<\/li>\n\n\n\n<li>Sodium NA: 135-145. Hypo = change in LOC, seizures, and vascular collapse. Hyper =<br>dehydration. Treat hyper with diuretics, D5W because glucose pulls NA out. Correct the<br>problem slowly to avoid cerebral edema. 48 hours or more.<\/li>\n\n\n\n<li>Potassium K: 3.5-5.2. Hyper = MI, chemo, autotransfusion (we did it), crushing injuries.<br>Hypo = diuretics, diarrhea, and GI suctioning. <em>CARDIAC DYSRHYTHMIAS<\/em><br>\uf0e8 No K to renal patients, if the kidney is not working correctly, they\u2019re not regulating<br>levels causing build up. Monitor closely, and give slowly. Pt should be on monitor.<br>Cardiac patients should have an increase K to support cardiac functioning. NO PUSH.<br>NUR 265 Advanced Exam 1<\/li>\n\n\n\n<li>Calcium Ca: 8.5-10.2. Needed for nerve impulses, cardiac contraction, blood clotting,<br>and bones and teeth growth. Hypo = laryngospasm (AIRWAY), and respiratory collapse.<br>Transfusions decrease Ca. Basic Metabolic Panel is not accurate. A decrease in Ca<br>indicates a decrease in albumin.<br>\uf0e8 Chovskeys-<br>\uf0e8 Trouvosels-<\/li>\n\n\n\n<li>Magnesium Mg: 1.8-2.4. Hyper = decease reflexes, hypertension, and cardiac<br>dysrhythmias. Hypo = increase in muscular and CNS activity.<br>\uf0e8 K needs Mg. Give Mg first so K can be transported into the cells.<\/li>\n\n\n\n<li>Phosphorus: 2.5- 4.9. Where Ca is\u2026 Phos is NOT! Opposite s\/s as Ca.<br>Ask our Patient: current problem, what\u2019s their normal, how much fluid do you drink daily, what<br>meds do you take, other health issues, and family history.<br>Nephrotic Syndrome: (pg. 1379 chart 67-3 sudden onset of sxs)<\/li>\n\n\n\n<li>Pathophysiology \u2013 immunologic kidney disorder where the glomerular permeability<br>increases so larger molecules pass through the membrane into the urine and are then<br>excreted. This causes a massive loss of protein into the urine, edema formation, and<br>decreased plasma albumin levels. Many agents and disorders are possible causes of NS.<br>All glomerulonephritis diseases have features of nephrosis.<\/li>\n\n\n\n<li>Causes \u2013 most common is glomerular membrane changes is altered immunity with<br>inflammation. Defects in glomerular filtration can also occur as a result of genetic<br>defects of the filtering system, like Fabry disease. glomerulonephritis, glomerular injury,<br>neoplastic disease, diabetes, and altered liver function (can also occur with NS, resulting<br>in increased lipid production and hyperlipidemia).<\/li>\n\n\n\n<li>Symptoms \u2013 Severe proteinuria, hypoalbuminemia causing EDEMA, weight gain,<br>dyspnea, HTN, orthostatic, ascites, decrease output.<\/li>\n\n\n\n<li>ACUTE = related to medications. CHRONIC = related to processes of disorders over time.<\/li>\n\n\n\n<li>Interventions &#8211; Tx of the underlining cause related to meds. 24-hour urine catch daily<br>weights, abdominal girths, I&amp;O, monitor electrolytes. ORDERS \u2013 diuretics, steroids, low<br>NA and protein diet, replace albumin.<\/li>\n\n\n\n<li>Management varies, depending on which process is causing the disorder (identified by a<br>kidney biopsy). Excess immunity can improve with suppressive therapy using steroids<br>and cytotoxic or immunosuppressive agents. Angiotensin-converting enzyme inhibitors<br>(ACEIs) can decrease protein loss in the urine and cholesterol-lowering drugs can<br>improve blood lipid levels. Heparin may reduce vascular defects and improve kidney<br>function. Diet changes are also prescribed \u2013 if glomerular filtration rate (GFR) is normal,<br>dietary intake of proteins is needed. If GFR is decreased, protein intake needs to be<br>decreased. Mild diuretics and sodium restriction may be needed to control the edema<br>and hypertension. Assess the patient\u2019s hydration status because vascular dehydration is<\/li>\n<\/ul>\n\n\n\n<p>common. If plasma volume is depleted, kidney problems worsen. Acute kidney injury<br>(AKI) may be avoided if adequate blood flow to the kidney is maintained.<br>Acute Kidney Injury: (pg. 1391 table 68-1, 68-2, 68-3, 68-4)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pathophysiology \u2013 rapid reduction in kidney function resulting in a failure to maintain<br>waste elimination, fluid &amp; electrolyte imbalance, and acid-base balance. Occurs over a<br>few hours or days. Reversible if diagnosed and treated early. Retaining waste, and causes<br>a rise in creatinine by more than 0.3 mg\/dl or more within 48 hours; or an increase in<br>serum creatinine to 1.5 times or more from baseline, which is known or presumed to<br>have occurred in the previous 7 days; or a urine volume of less than 0.5 ml\/kg\/hr for 6<br>hours (pg. 1391)<\/li>\n\n\n\n<li>Although GFR is accepted as the best overall indicator of kidney function, it\u2019s not<br>accurate during an acute or critical illness.<\/li>\n\n\n\n<li>AKI also causes systemic effects and complications and can increase discomfort and risk<br>for death.<\/li>\n\n\n\n<li>AKI causes an increase in magnesium, phosphorus and potassium. Patient needs to<br>decrease this in their diet and increase protein.<\/li>\n\n\n\n<li>Classification:<\/li>\n\n\n\n<li>Prerenal failure: #1 cause of AKI in acute care. Impaired renal perfusion with a<br>sustained mean arterial pressure (MAP) of less than 65 mm Hg. Causes =<br>Hypovolemia &#8211; SHOCK, blood loss, diabetes, and misuse of diuretics.<\/li>\n\n\n\n<li>Hypotension\/Perfusion &#8211; CHF, decreased cardiac output, or clamping of renal<br>artery (during abdominal aneurysm surgery)<\/li>\n\n\n\n<li>Intrarenal or intrinsic renal failure: damage to kidney tissue and reflects injury<br>to glomeruli, nephrons, or tubules. Causes = SEPSIS, trauma, inflammation,<br>glomerulonephritis, and vascular disease.<br>&#8211;&gt;amikacin for sepsis patients.<br>&#8211;&gt;Going to CT? Are you on dialysis? <strong>Contrast<\/strong><\/li>\n\n\n\n<li>Postrenal failure: RARE! Obstruction of urine flow. Clots, stones, crystals,<br>malignancy, endometriosis, prostate disease, bladder mass, and urethral<br>stricture.<\/li>\n\n\n\n<li>Symptoms: findings aren\u2019t bad until renal dysfunction gets severe. Malaise, n\/v, weakness,<br>altered LOC, dyspnea, chest pain, oliguria, metallic taste, HA, weight gain, itchy dry skin.<\/li>\n\n\n\n<li>Phases of AKI:<br>Onset: Onset to develop of oliguria (hours-days)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Exam 1 reviewAnatomy of the Kidney: common. If plasma volume is depleted, kidney problems worsen. Acute kidney injury(AKI) may be avoided if adequate blood flow to the kidney is maintained.Acute Kidney Injury: (pg. 1391 table 68-1, 68-2, 68-3, 68-4)<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-120416","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/120416","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=120416"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/120416\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=120416"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=120416"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=120416"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}