1. The nurse recognized that NG had decreased filtration rate based on the finding of A....

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1. The nurse recognized that NG had decreased filtration rate based on the finding of A. hematuria B. proteinuria C. elevated BUN and creatinine D. periorbital and peripheral edema 2. When planning care for N.G. the nurse considers the collaborative management indicated for patients with acute post streptococcal glomerulonephritis Select all that apply administration of antibiotics administration of antihypertensive agents administration of corticosteroids administration of diuretics daily weights intake and output moderate low protein diet sodium and fluid restriction &bull; The nurse plans to promote rest for N.G. but when she walks into the room she finds him pacing because he is worried about missing his classes. He asks why he has to stay in bed when he doesn't feel bad. The best response by the nurse is A. lying down will help relieve the edema B. his hypertension will become worse with activity C. activity and exercise will increase the stress on the kidneys D. activity increase his metabolic rate which is already increase with his infection 4. Three days after his admission N.G. experiences increased edema and his BP rises to 182/102. His BUN and Creatinine elevate to 42 and 1.8 respectively and he continues to have marked hematuria and proteinuria. He is placed on strict bedrest and antihypertensive drugs are started in addition to corticosteroids and increased diuretic doses. His health care provider is concerned that he may be developing rapidly progressive glomerulonephritis and orders a creatinine clearance test. The nurse knows that the creatinine test A. requires a collection of a urine specimen every 6 hours for 24 hours B. reflects the GFR and reflects the amount of functioning renal tissue C. is a 24 hour collection of urine used to evaluate the kidneys' ability to concentrate urine D. is a measurement of urea and creatinine in the blood at hourly intervals after administration of a measured amount of protein. N.G.'s kidney function continues to deteriorate. The nurse recognizes that the Tollowing manifestations are the effects of chronic kidney disease on other body systems. Match the cause to the findings CAUSES CLINICAL FINDINGS Failure of excretory ability of kidneys GI mucosal inflammation High urea content of blood Hyperkalemia Sodium and fluid retention hypertension anemia Absorption and retention of urinary Chromogens Decreased production of erythropoietin fixed urine specific gravity Decreased renal concentrating ability hypocalcemia Lack of activation of Vit D yellowish discoloration of skin 7 a. A decreased activation of vitamin D leads to _hypocalcemia/ is released in response to hypocalcemia. c. Parathyroid hormone causes and increased serum phosphate through d. The effect of parathyroid hormone on the bones leads to a condition of increasing softness of the bones. e. Hypercalcemia and hyperphosphatemia result in calcium phosphate deposits in soft tissues of the body, a condition known as 8. Calcium Carbonate (Tums) is ordered for N.G. The nurse explains the nate (Tums) is ordered for N.G. The nurse explains that this drug is used to A. prevent osteoporosis inactivate potassium in the GI tract decrease the risk of gastric ulcer formation bind phosphorus in the bowel, preventing its absorption 9. The nurse identifies that dietary modifications are needed for the management of N.Gs renal failure. Select 5 substances that must be restricted and 2 that must be Supplemented. Restricted Supplemented Phosphorus Calcium Potassium Protein Folic acid Sodium Water 10. The health care provider determines that dialysis is needed when he fails to respond to conservative treatment. A temporary vascular access device is placed in his chest wall to be used for hemodialysis. When he returns from his first dialysis treatment, the nurse assesses him for disequilibrium syndrome that may accompany initial dialysis by assessing him for A. c. D. nausea and vomiting headache and hypertension muscle weakness and paralysis hypotension and cardiac dysrhythmias Overview of Glomerulonephritis Glomerulonephritis is a bilateral inflammation of renal glomeruli resulting from 2 different types of immunologie injury. In the first type an unknown mechanism stimulates antibodies specific for antigens within the glomerular basement membrane. In the second type of immune process antibodies react with circulating non-glomerular antigens, such as bacterial products or viral agents, and are randomly deposited as immune complexes around the glomerular basement membrane. All forms of immune complex diseases are characterized by an accumulation of antigen antibody, and complement in the glomeruli, which can result in tissue injury and inflammation. In most cases recovery from the acute illness is complete. If progressive involvement occurs the result is destruction of renal tissue and marked renal insufficiency. ents, and are random u ne complex disease which can result in tissue Overview of Chronic Kidney Disease Chronic kidney disease involves progressive irreversible loss of kidney function. It is defined as either the presence of kidney damage or glomerular filtration rate (GFR) less than 60 ml/min for more than 3 months. Although there are many different causes of chronic kidney disease the end result is a systemic disease involving every body organ. Disease staging is based on GFR; the last stage of kidney failure (end stage renal disease (ESRD) occurs when GFR is less than 15 ml/min. Conservative management directed toward preserving existing renal function, treating symptoms, preventing complications and providing for patient comfort is attempted before maintenance Case Study N.G. is a 21 year old college student who is admitted to the hospital with a diagnosis of acute post streptococcal glomerulonephritis. He was seen at the college's student health center because of swelling around his eyes and rusty colored urine. His history from the health student center states that he had a sore throat several weeks ago and he ignored because it resolved in 4-5 days. He has been in excellent health and has no medical problems except for his usual childhood illnesses and minor injuries. Before caring for N.G. the nurse reviews his initial laboratory findings, which reveal gross hematuria, moderate proteinuria and RBC cast in the urine a BUN of 28 ml/dl, and a creatinine of 1.4 mg/dl. An ASO (antistreptolysin-O) titer was 240 Todd unit. During the morning assessment of N.G. the nurse finds his vital signs as follows: BP 142/92, heart rate: 86, ting edema of his respiratory rate: 16, and temperature 98.8. He has periorbital edema and 2+ pitting cuma ankles and he denies any pain. His urinary output from the last 8 hours is 800 ml.

 · Answer

1.Decreased filtration rate refers to decrease in the amount of urine produced. In these cases the creatinine and blood urea nitrogen levels increases.

Hematuria refers to passage of blood in urine

Proteinuria refers to presence of protein in the urine

Periorbital edema and peripheral edema refers to increase in the fluid volume of the body

Ans:elevated BUN and creatinine

2.Antibiotics are ne essary to reduce and prevent infection

Antihypertensive drugs to reduce the increased blood pressure

Corticosteroid are not beneficial in this condition

Diuretics to reduce swelling,maintaining intake and output chart

Weight monitoring can be done to add sess for any fluid retention

Diet should have less fluid ,salt ,potassium and less protein

Ans:administration of antibiotics

Administration of antihypertensive agents

Administration of diuretics

Daily weight

Intake and output chart

Sodium and fluid restrictions

3.Bed rest is needed to decrease the signs and symptoms .There is an evidence it can decrease hematuria and high blood pressure Lying down does not have any effect in decreasing edema

It does not affect the kidney directly or metabolism

Ans:his hypertension will become worse with activity

4.Creatinine clearance test is needed to assess the filtration rate.It can be done either through blood or in urine test

6 hour or 24 hour urine is not necessary

It does not measures hourly the creatinine and urea rate

Ans:reflects the GFR and the functioning 9frenal tissue

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1. The nurse recognized that NG had decreased filtration rate based on the finding of A....

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