A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments?
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Solution
Low-protein diet with a prescribed amount of water
The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs.
Option C: Salt substitutes shouldn’t be used without a doctor’s order because it may contain potassium, which could make the patient hyperkalemic.
Option D: Fluid and protein restrictions are needed.
Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
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Solution
Taking a blood pressure reading on the affected arm can cause clotting of the fistula
Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.
Which sign indicated the second phase of acute renal failure?
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Solution
Daily doubling of urine output (4 to 5 L/day)
Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.
Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is priority?
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Solution
Fluid volume deficit related to inability to conserve water
A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care?
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Solution
Apply pressure to the needle site upon discontinuing hemodialysis
Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.
What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?
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Solution
Fluid volume excess
Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other diagnoses may apply, but they don’t take priority.
Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
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Solution
Hypertension, oliguria, and fatigue
Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.
You’re planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include?
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Solution
“Your urine might turn bright orange.”
The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.
A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?
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Solution
Drink 8 to 10 eight-oz glasses of water daily
Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.
A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys and I’m still young. If I stick to my insulin schedule, I don’t have to worry about kidney damage, right?” Which of the following statements is the best response?
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Solution
“Even with insulin, kidney damage is still a concern.”
Kidney damage is still a concern. Microvascular changes occur in both of the patient’s kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.