Exam 2 MS study guide
RENAL – Chapter 61, 62, 63/ ATI Nursing. Ch. 56, 59-61
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Glomerulonephritis
o Patho
Inflamed glomeruli
o Risk factors
Infection, autoimmune disease, Family Hx, systemic disease(vasculitis, HTN, diabetes)
o Clinical manifestations
Protien/blood/WBC/casts in urine, lower urine output, HTN, raised BUN/creatinine, edema
o Patient teachings (think infection prevention)
Avoid infection, diet restrictions, prescribed meds,
o Diet restrictions/ lifestyle interventions
Low-moderate protein, sodium/fluid restriction,
o Medications for treatment
Diuretics for sodium/fluid, corticosteroids for inflammation

Pyelonephritis
o Patho
Parenchyma/urinary collection system inflammation
o Risk factors
Multiple Utis, pregnancy
o s/s
fever, chills, nausea, vomit, back/flank pain, large kidney, costovertebral tenderness,
nocturia, hematuria, painful urine
o diagnostics
Urinalyses, CT scan, ultrasound, KUB X-ray (kidney, ureter, bladder)
o Septic shock d/t pyelonephritis- what s/s do you expect to see and what is the
patho behind this advancement to septic shock? And what is the definition of
sepsis?
Bacteria enters blood stream shown by Mental change, fever, tachycardia, hypotension,
oliguria, leukopenia
o Plan of care- goals appropriate before discharge
Free of symptoms (fever/vomit end of shift), avoid complications
o Nursing interventions
Avoid UTI, 2L per day, call if fever returns, empty bladder fully, complete Abx regimen
o Tx options
Antibiotics, pain management, hydration, surgery pain > 48H
o Complications
Burn/pain urine, frequency, hesitancy, urgency, nocturia, hematuria
o Patient teaching / discharge education
2L per day, call if fever returns, empty bladder fully, complete Antibiotic regimen
o Prevention teachings
Safe sex
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Polycystic kidney disease
o Patho
Cysts develop, separate & grows compressing surrounders & destroy renal tubule
o Clinical manifestations
HTN, Hematuria, back/flank pain, headache, ab pain
o Priority nursing interventions
First, Control BP. Diet change (low potassium/phosphorous/protein/sodium), fluid restrict,
antibiotics, analgesics. Manage UTI, pain, HTN
o Evaluating disease progress/ how do you know they are getting better? What
happens to bp specifically?
BP under control, prevent complications
o Diet modifications
low potassium/phosphorous/protein/sodium), fluid restrict
o Expected outcomes
BP under control, prevent complications

Nephrotoxic medications (refer to table in PPT)
Acetaminophen/NSAIDs, Acyclovir/foscarnet, adefovir/tenofovir, aminoglycosides,
amphotericin B, ACE inhibitors, carboplatin/cisplatin, cyclosporine/tacrolimus, pentamidine,
Radigrapghic IV contrast agents

Urine gravity levels- interventions & mechanism of action for low and high gravity

AKI
o Patho
Rapid loss of renal function
o Risk factors
CVD, diabetes, sepsis, nephrotoxin exposure, age, contrast media administration
o S/s
o Oliguric/anuric phase- pt teaching,
<400mL/day is oliguric. <100mL/day is anuric.
o urine ouput per hour and per 24 hours
30mL/hr and 400mL/day
o Pt teachings
Cause/treatment, fluid/sodium/protein restriction, monitor urine output, avoid nephrotoxic,
and dialysis
o Diagnostic
Labs values, vein distention, edema, bound pulse, HTN
o RN interventions
Manage fluid balance, diuretics, potassium, position, ambulation, cough, breath exercises,
skin care, monitor food intake, avoid nephrotoxic drugs
o Know the 3 different types (prerenal, intrarenal, postrenal) and be able to
differentiate between the 3 and what causes each of them
Pre- external factors lowing renal blood flow by injury or illness. Intra- renal damage by
inflame, toxins, drugs, infection, or low blood supply. Post- obstruction of low Urinary tract
by large prostate/kidney stones/tumor/injury
o Post op s/s that pts may exhibit that would lead an RN to think they’ve
developed AKI
Dehydration severe

CKD
o Causes/ etiology
Diabetes, HTN, hyperlipidemia, smoking, obesity, NSAIDs, glomerulonephritis, PKD, lupus,
atherosclerosis
o Dx
Protein/albumin in urine, uremia, renal ultrasound, CT scan, renal biopsy, elevated serum
creatinine, decreased creatinine clearance, renal biopsy
o Interventions
. Restrict fluid/sodium/potassium, weight patient, cardiac monitor, antihypertensives,
phosphate binders, calcium supplement, synthetic erythropoietin, folic acid/ ferrous sulfate,
stool softeners
o Treatment options
Renal replacement therapy, prevent complications, renal transplant, treat symptoms, support
remaining function
o ESRD pt teachings
Renal transplant an option. Can remove dialysis, diet/fluid restriction reduced, lifelong
immunosuppressant and vigilant treatment for HTN, diabetes& heart disease
o Lifestyle interventions (diet, fluid restrictions)
Restrict fluids/sodium/potassium, manage hyperkalemia,anemia, dyslipidemia, renal
osteodystrophies
o Contraindications
o Fistulas- RN interventions for these (bruit vs thrill- what does each mean? And
how do you asses each one?)
Palpate thrill, auscultate bruit
o Rn actions if a pt missed dialysis
Don’t miss them. May result in hyperkalemia so lower kalemia

Patho behind the kidney’s responsibility for RBC production and effects on anemia
Erythropoietin production, activates vitamin D

Renal caliculi (kidney stone, urolithiasis)
o Risks for developing kidney stones? Avoid dehydration
Family Hx, Caucasian, male, high sodium,

Renal Cancer
o Pt education after radial nephrectomy (what should pts expect vs report?)
Give pain med, IV hydration, encourage respiratory exercises, appropriate care
(catheter/stents/nephrostomy tube/drains), perform wound care, turn to prevent
pneumonia,vital for internal bleed (tachy/low BP), assess urine
o Rn interventions
Vitals, monitor I&O, pain, proper care,
o Renal biopsy- post op interventions/ things to watch out for
Hypotension/tachycardia=dehyrdation, high temp= surgery site infection, Low SPo2=
atelectasis

What medications do you give to reverse hyperkalemia in the hospital?
IV calcium, diuretics, insulin, sodium bicarbonate, albuterol

What is the minimal urine output by kidneys in this form URINE ml/kg/hour?

Nephrolithiasis and urolithiasis
o Patho
Crystals joining together creating a stone
o Risk factors
Family hx, Caucasian, male, dehydration, high sodium diet
o Treatment- how does each component help with urolithiasis?
Narcotics/NSAIDs w/ antiemetics help small pass spontaneously. Alpha adrenergic blockers
relax ureter muscle to help pass stone. Surgery after 4-6 weeks.
o Cystoscopy procedure and care after
Scope exam of bladder followed with biopsy of any. Lesions found.
o Teachings
Strain urine, call for fever/ uncontrolled pain/ vomit
o Prevention
Hydration, low sodium, citrate increase, oxalate decrease
HEMATOLOGY - Chapter 33 and 34/ ATI Ch 39-42

Sickle cell resources on Canvas -> pre-class work

Know potassium, sodium, phosphate, calcium levels

Know wbc, rbc, hct, hbg, platelet, vit b12, folate

Anemia
o Goals
o
Precautions
o
s/s
o
teachings and preventions
o
discharge teachings
o
compensatory mechansisms
o
iron supplements- what do you expect?
o
rn dx
o
rn actions and interventions
o
iron def anemia- clinical manifestations
Hypoxia, fatigue, pallor, tachycardia, tachypnea
o
what blood levels would you expect? Think hemoglobin!
Low hemoglobin
o
Where does one obtain iron from? (in diet?)
Meat, leafy green, beets, dry beans, cream of wheat, iron fortified, vitamin c in oranges and
grapefruits may help also
o
Anemia r/t blood loss- what rn interventions are priority?
Increase iron/vitamin c diet, minimize blood loss


What will need to be monitored if having a blood transfusion because of
anema?
folic acid anemia
o if pregnant- what do you need to teach them?
At least 400mcg daily, reduce defects/ abnormalities in infants
o
Know folic acid norm levels
o
Where does folate come from?
Green leafy vegetables, bran, yeast, legumes, nuts
o
Difference between folic acid anemia vs vit b12 anemia
Neuro manifestations of BB12 don’t show in folic acid deficiency
o
Teachings
Diet sources, prenatal teaching, anticonvulsants/ oral contraceptives/ metformin/ chemo agents
interfer with absorption.

Vitamin b12 anemia
o Know vitamin b12 levels
o
Where does it come from?
Found in animal protein
o
Teachings
Supplement for vegans, report fatigue, sob, confusion, paresthesias
o
Specific s/s and how to assess them
Lhermitte’s sign- electric neck shock w/ flex, peripheral neuropathy,


aplastic anemia
o patho
o
teachings
o
complications
o
What lab values would you expect in a pt dx’ed w this?
sickle cell
o teachings about genetic disposition
Inherited, cells shaped wrong, no cure
o
Priority rn interventions
Administer oxygen, hydration, pain meds, antipyretics, supportive measures
o
Sickle cell crisis
 what increases risk for crisis? What teaching do you give to avoid these?
Low O2, avoid infection, dehydration, hypoxia, high altitudes, hemorrhage, strenous exercise, sports

What does a crisis look like? What interventions would rn do?
Give O2

shift to left on cbc, what does it mean

thrombocytopenia
o platelet levels
Less than 150,000/mm^3
o
risks/complications
Malignancy, infection, meds, autoimmune conditions, DIC, African, obese, 2 to1 female to male
o
how to prevent ^^^
o
what does bleeding precautions consist of? / teaching
Direct pressure and/or ice on bleed, avoid injections, rectal temp, enemas, suppositories, douches,
safe area, minimal inflation on BP cuff, minimize blood draws, stool soft, soft diet
o
How do you determine evaluation of care?
Prevent hemorrhage, minimize bleed risk
o
Priority actions for a patient undergoing sx who has thrombocytopenia- post op
priority interventions for sx site
Solve condition, immediate antibiotic for sepsis, give blood to maintain homeostasis, stop heparin
administration,

Leukemia
o Labs
ANC < 1000 mm^3
o
n/v w chemo- how to combat it? RN driven actions
Chemotherapy,
o
Dx tests
Bone Marrow Biopsy
o
Risk factors
Genetic anomalies, Down’s syndrome, radiation/benzene exposure
o
Evaluation factors, how do you know their condition is improving/worsening?
Decreased anemia, infection, bleeding, minimize/prevent complications

Malignant lymphoma
o s/s
Painless lymph node swelling, low fever, night sweats, rapid weight loss

Multiple Myeloma
o s/s and complications
S/s: Fatigue, weakness, bone pain, weight loss, paresthesia, repeat infections
Comp:anemia, bone marrow failure, bleed, infection, hypercalcemia, spinal cord compression,
pathological fractures,

Clotting studies- know ptt, inr, pt, platelets (what does a high or low value mean?)

What labs should be done pre op?

Blood transfusion- what do you check/actions before? Allergies, consent, vitals, verify orders
Med math x5
Jeopardy
1. What is a priority RN intervention preventing complications in pt w/ polycystic kidney disease
a. Controlling BP & keeping up w parameters
2. 2 key factors of iron deficiency anemia & explain what they present
a. Glossitis
i. Red, swollen, beefy tongue
b. Koilonychias
i. Spoon shaped nails
3. Name a dietary item that are high in iron
a. Meat
b. DARK LEAFY GREENS
c. Beets
d. Fortified cereals & breads
4. Name dietary items that are high in B12
a. MEAT ONLY
5. Those are vegans & vegetarians, how do they get B12?
a. B12 supplements
6. 3 different categorical causes of acute renal injury & give example
a. Pre:
i. B4 kidney, sudden & severe drop in BP
b. Intra:
i. Direct damage to kidney by inflammation, toxins, drugs, infections àcontrast dye
c. Post:
i. Injury (can be due to UTI’s)
7. An RN needs to assess these 2 items b4 a pt can undergo hemodialysis w/ a pt who has a fistula &
how to assess each one
a. Bruit
i. Auscultate
b. Thrill
i. Palpate
1. Why is there a thrill in hemo pt a normal finding?
a. Connections between vein & artery is working
8. 4 risk factors for glomerulonephritis
a. Recent travel
b. Recent infections
c. Autoimmune disease
d. Family hx of kidney diseases
e. Presences of systemic disease:
i. Vasculitis
ii. Hypertension
iii. Diabetes
9. 4 causes of CKD
a. Malnutrition
b. Uncontrolled HTN
c. Diabetes
d. Polycystic kidney disease
10. What is a compensatory mechanisms for iron deficiency anemia
a. Increased in RR bc lungs try to compensate for the decreased O2 to body tissues
b. Why?
i. Low hemo & low O2
11. Lab values for indicating low in aplastic anemia
a. Platelets
b. WBC
c. RBC
12. What are 2 main RN interventions needed for a pt who is actively in a sickle cells crisis
a. Apply O2 & opioids for pain management
13. This activity should be reduced in pt w/ sickle cell anemia to prevent crisis
a. Interactive physical sports (soccer)
14. Key factors for glomerulonephritis (think vascular)
a. Edema
15. Name dietary restrictions for a pt w/ CKD
a. Restrict sodium & potassium
16. Name a dietary restriction for a pt w/ polycystic kidney disease
a. Restrict potassium & phosphorus
17. 3 teachings to provide pt w/ glomerulonephritis
a. Infection control à wash hands
b. Low protein & salt
c. Take diuretics
18. Key diagnostics for leukemia
a. Bone marrow biopsy
19. What gender is associated w/ leukemia
a. Male
20. What S&S would you expect w/ pt with hemoglobin level at 8
a. Fatigue
b. Pallor
c. Dyspnea on exertion
21. Monitor what after blood transfusion of packed RBC (what type of lab)
a. CBC à Hemoglobin
22. What S&S would you include in your d/c teaching for pt to report if their hemoglobin level is low
a. Increased fatigue
b. Space out ADLs
i. Why?
1. Bc hemoglobin is low again
23. Urine color expected for post radial nephrectomy
a. Pink tingy color
24. How can adrenergic blocker help w urolithiasis
a. Dilate lower ureters to help the ease of passing the stones
25. 4 RN interventions for pt w iron deficit anemia
a. Monitor: VS & O2
b. Teach risk of anemia
c. Take iron w Vit. C
d. Report increases fatigue
e. Space out ADLs
26. 4 teachings for pt w sickle cell anemia
a. Infection precautions
b. Genetic consoling
c. Stay hydrated
d. No cure
e. Avoid cold temps & overexertion
f. How to live a normal life
27. 3 different areas od teaching to provide to pt to prevent urolithiasis/neprolititis
a. Increase fluids à H2O
b. Low sodium diet
c. Avoid foods high in oxalate
i. Chocolate
ii. Tea
iii. Coffee nuts
28. 3 interventions for pt w thrombocytopenia
a. Stool softner
b. Bleeding precautions
c. Soft diet
29. Oliguria – how many mL in 24 hrs
a. 400mL
30. Anuria – how many mL in 24 hrs
a. 100 mL
31. 4 interventions b4 hanging a blood transfusion
a. Obtaining consent
b. Verify order w provider
c. Obtain allergy & reaction hx
d. Full VS assessment
32. 4 risks for developing nephrolithiasis
a. Male
b. Caucasians
c. High diet of protein
d. Family hx of kidney stones
33. 4 S&S of multiple myeloma à CARB pic
a. Renal insufficiency/failure
b. Anemia & bone lytic can include w weight loss & paresthesia
c. C – calcium
i. HYPERcalemia
d. R – renal failure
i. Renal insufficiency
e. A – Anemia
f. B – bone lesions
i. Punched out osteolytic
34. Disease causes rapid weight loss
a. Lymphoma due to swelling
35. Labs for Pre-Op
a. RBC
b. CBC
c. Coagulation studies