Page 414 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 399

CORRECT ANSWERS AND RATIONALES

1. A, E, and F. A patient in ARF can develop right- and left-sided heart failure. Failure to ex-
crete excess fluid can result in crackles as fluid backs up into the lungs from the heart’s
inability to pump the extra fluid load. Pericarditis develops due to uremic poisons, which
affect the heart and can lead to cardiac tamponade. Lethargy can be due to hypoxemia
when the excess fluid interferes with O and CO exchange in the lungs and heart.
2 2
2. This patient is in an acidosis as the pH is less than 7.35. The acidosis is not caused by the
respiratory system as the pCO indicates a respiratory alkalosis as a secondary problem, not
2
the primary one. The HCO is less than 22 mEq/L, which shows that the kidneys are giving
3
up base or retaining acid, leading to an acidosis. Since the pH will always tell the primary
problem, linked with the HCO3, this is a metabolic acidosis. The nurse needs to look at the
clinical situation to find the metabolic acidosis. In the renal patient, it is because the kidneys
cannot maintain pH balance and acid is retained. The lungs are compensating by excret-
ing CO . Since the pH is not normal, we have a partially compensated metabolic acidosis. It
2
would be fully compensated if the pH were less than 7.40 but in the normal range.
3. B. High, peaked T waves are indicative of early hyperkalemia. The others are late signs
of hyperkalemia.
4. True. All dialysis types look at how much weight via fluid loss (wet weight minus dry
weight) occurs during each treatment. Weight gain or loss is the number one indicator
of fluid balance, and it should be confirmed with the intake and output, serum sodium, Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
and hematocrit.
5. A. Prerenal failure is due to decreased blood flow to the kidney, so dehydration lowers
BP, therefore lowering GFR. Fluid overload is a symptom of ARF and CRF. Kidney stones
(postrenal) and nephrotoxic medications (intrarenal) can cause other types of ARF.
6. B. A bruit is a swishing sound like a heart murmur but heard peripherally over the fis-
tula site. A thrill is a vibration like a pulsating water hose felt over the insertion site. If
these are not present, call the nephrologist right away!
7. D. Peritonitis is the most common complication of PD. The patient is febrile, tachycardic,
and tachypneic—all signs of possible infection. The abdominal insertion site is red and
the patient states that it is swollen—all confirming the possible problem.
8. D. Calcium gluconate IV is needed to stimulate the heart to contract and prevent sus-
tained ventricular fibrillation or asystole. This is an abnormally high potassium level
as it is greater than 5.1 mEq/L. Sodium bicarbonate is given to correct a metabolic
acidosis, and there is no evidence that this patient has this in the information provided.
Sodium polystyrene is given with sorbitol in situations of mild hypokalemia. The level
ventricular fibrillation and symptoms in the patient indicate an emergency!
9. A. Patients with CRF cannot excrete magnesium-containing compounds; so MOM would
be contraindicated in the care of this patient. The other medications are used to treat CRF.
10. C. New-onset twitching, positive Trousseau’s and Chvostek’s signs, and cramping can
all indicate disequilibrium syndrome. There is no information to support a pericarditis
(temperature or friction rub), infection (elevated temperature, pulse, or infected HD
site), or hyperkalemia (high-peaked T waves).