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VN 147: Finals
| Question | Answer |
|---|---|
| Physiology of Urinary System | Urine production, urine elimination, regulation of serum calcium and phosphate, regulation of blood pressure & hormonal stimulation of RBC production |
| Erythropoietin | RBC production hormone; made by cells in kidney which releases the hormone when oxygne levels are low |
| age related changes in the Urinary system | loss of nephrons, creatinine clearance decrase w age, nocturia, bladder muscles weaken, incontinence, urethral obstruction (prostate) |
| URETHRITIS | inflammation of the urethra. By microoranisms, trauma or hypersensitivity to chemicals in products such as vaginal deodorants, spermicidal jellies or bubble baths |
| URETHRITIS - S/S | dysuria, frequency, urgency and bladder spasms. Urethral discharge may be noted |
| URETHRITIS - MEDICAL DIAGNOSIS | based on pt s/s, urinalysis and urethral smear |
| URETHRITIS - MEDICAL TREATMENT | antimicrobials |
| URETHRITIS - ASSESSMENT | comfort, possible causative factors, and understanding of treatment and prevention |
| URETHRITIS - INTERVENTIONS | sitz baths, instruct female pts to wipe from front to back after toileting; void before and after sexual intercourse. Discourage bubble baths & vaginal deodorants; instruct uncircumcised male pts to clean penis under foreskin regularly |
| CYSTITIS | inflammation of the urinary bladder. Common cause is bacterial contramination; prolonged immobility, renal calculi, urinary diversion and indwelling catheters |
| CYSTITIS - S/S | urgency, frequency, dysuria, hematuria, nocturia, bladder spasms, incontinence and low grade fever; urine may be dark or cloudy, fever, fatigue & pelvic or abdominal discomfort |
| CYSTITIS - MEDICAL DIAGNOSIS | urinalysis, culture and sensitivity, WBCs |
| CYSTITIS - MEDICAL TREATMENT | antibiotics, mild analgesic, hyoscyamine (Cystospaz) and flavoxate (Urispas) ANTISPASMODICS |
| CYSTITIS - ASSESSMENT | pt symptoms, causative factors and understanding of treatment and prevention |
| CYSTITIS - INTERVENTION | pt teaching regarding meds, fluids and prevention - no kink on foley cath. When cath needs to get out, take it out. Usually 48 hrs after operation |
| INTERSTITIAL CYSTITIS | inflammatory disease of the bladder, usualy chronic; cause is unknown; bladder/pelvic pain; urinary frequency & urgency |
| INTERSTITIAL CYSTITIS - MEDICAL DIAGNOSIS | cystoscopy |
| INTERSTITIAL CYSTITIS - MEDICAL TREATMENT | symptom management; attempts to treat causes |
| INTERSTITIAL CYSTITIS - NURSING CARE | primary role is teaching and support |
| PYELONEPHRITIS | inflammation of the renal pelvis |
| PYELONEPHRITIS - ACUTE | Most often caused by ascending bacterial infection, but it may be bloodborn |
| PYELONEPHRITIS - CHRONIC | often the result of reflux of urine from inadequate closure of the ureterovesical junction during voiding |
| PYELONEPHRITIS - S/S - ACUTE | ALWAYS have high fever!, chills, nausea, vomiting & dysuria; severe pain or a constant dull ache occurs in the flank area |
| PYELONEPHRITIS - S/S - CHRONIC | bladder irritation, chronic fatigue and slight aching over one or both kidneys. CHRONIC FATIGUE - puts a lot of stress on kidneys (anemia due to Erythropoietin |
| PYELONEPHRITIS -MEDICAL TREATMENT | antibiotics, urinary tract antiseptics, analgesics, and antispasmodics. Drink at least 8 ounce glasses of fluids daily. IV fluids may be ordered if nausea & vomitting. Dietary salt & protein restriction for pt w chronic disease |
| PYELONEPHRITIS -ASSESSMENT | related s/s, history of UTI disorders, predisposing factors and effects of the infection on daily activities. |
| PYELONEPHRITIS - INTERVENTIONS | acute pain; activity intolerance (start slow); deficient fluid volume & imbalanced nutrition (due to nausea & vomitting - antiemetics; hydrate w IV); ineffective management of therapeutic regimen |
| POLYCYSTIC KIDNEY DISEASE | hereditary disorder; 2 types: childhood & adult; in adults usually manifested by age 40 yrs; grapelike cysts in place of normal kidney tissue; cysts enlarge, compress functional renal tissue & result in renal failure. |
| POLYCYSTIC KIDNEY DISEASE - S/S | dull, aching abdominal, lower back or flank pain, or colicky pain that begins abruptly |
| POLYCYSTIC KIDNEY DISEASE - MEDICAL TREATMENT | supportive treatment is recommended to preserve kidney function, treat UTI & control hypertension; infections treated promptly w antibiotics; dialysis, nephrectomy & transplantation once end stage renal disease develops |
| ACUTE GLOMERULONEPHRITIS | immunologic disease; inflammation of the capillary loops in the glomeruli |
| ACUTE GLOMERULONEPHRITIS - S/S | urine becomes tea colored as output decreases; peripheral & periorbital edema; as glomerular filtration decreases, mild to severe hypertension occurs & hypervolema results |
| ACUTE GLOMERULONEPHRITIS - MEDICAL DIAGNOSIS | pt assessment & lab tests. Urinalysis, BUN, creatinine & albumin. Renal ultrasound, renal biopsy, or both |
| ACUTE GLOMERULONEPHRITIS - MEDICAL TREATMENT | diuretics, antihypertensive meds & antibiotics; bed rest; activity restriction; fluids, sodium, potassium & protein may be restricted; if renal failure develops, dialysis is necessary |
| ACUTE GLOMERULONEPHRITIS - ASSESSMENT | s/s, recent infections and changes in urine |
| ACUTE GLOMERULONEPHRITIS - INTERVENTIONS | excess fluid volume, activity tolerance, self-care deficit, anxiety |
| RENAL CALCULI | STONES; urinary tract obstruction; precipitations of calcium salts (calcium phosphate or calcium oxalate) uric & magnesium ammonium phosphate or cystine; normally found in urine |
| FACTORS FOR DEVELOPMENT OF CALCULI | concentrated urine; excessive intake of ca, vit D, protein, oxalate, ca-based antacids; familial tendency; hyperparathyroidism; immobility; urinary stasis; sedentary lifestyle; altered urine pH; lack of kidney substance that inhibits calculi formation |
| RENAL CALCULI - S/S | pain, dull flank pain; a calculus in the renal pelvis or stretching of the renal capsule from urine retention (hydronephrosis); if calculus lodges in ureter, excruciating pain in abs that radiates from groin or the perineum; nausea, vomittin, hematuria |
| RENAL CALCULI - MEDICAL DIAGNOSIS | KUB, IBP, retrograde pyelogram, or ultrasound |
| RENAL CALCULI - MEDICAL TREATMENT | most calculi are passed spontaneously; ambulation & adequate hydration facilitate passage; opioid analgesics/antispasmodics relieve pain; lithotripsy (shatters calculi); endourologic procedures; neph, pyelo, uretero |
| RENAL CALCULI - PREVENTION | high fluid intake to keep urine dilute, dietary restrictions for specific elements (ie calcium and purines), regular exercise, meds to alter urine ph (normal = acidic) |
| RENAL CALCULI - ASSESSMENT | pt's usual fluid intake & diet, including vit & mineral supplements; location, severity & nature of the pain; changes in urine amt of characteristics |
| RENAL CALCULI - INTERVENTIONS | acute pain (drugs); impaired urine elimination; risk for deficient fluid volume (monitor fluid intake); risk for infection; decreased cardiac output (kidneys regulates blood); ineffective breating patterns (due to pain) |
| UROLOGIC TRAUMA | penetrating injuries most often from knives or guns; blunt trauma; a force is applied to the abdominal wall and the energy is diffused into the abdominal cavity |
| UROLOGIC TRAUMA | when trauma is suspected, observe for bruising or abdomen or in the flank area; assess for signs of shock, pain & palpable abdominal mass (hematoma) |
| UROLOGIC TRAUMA - GREY TURNER'S SIGN | bruising over the flank and lower back; occurs with retroperitonial bleeding |
| UROLOGIC TRAUMA - MEDICAL DIAGNOSIS | KUB, urography, CT or ultrasound to determine extent of injury |
| UROLOGIC TRAUMA - S/S | hematuria |
| RENAL CANCER | 80% of malignancies: adenocarcinomas; primarily affect men 55-60 yrs of age; less common squamous cell carcinomas of the renal pelvis affect men & women equally |
| RENAL CANCER | tumor may be large before it is detected. Renal malignancies metastacize to the liver, lungs, long bones & other kidney. |
| RENAL CANCER - S/S | anemia, weakness, weight loss; painless, gross hematuria classic sign, but usually occurs in the advanced stage. A dull ache in the flank area also is a late area |
| RENAL CANCER - MEDICAL DIAGNOSIS | excretory urography, IVP, retrograde pyelography, ultrasound, arteriography, computed tomography, MRI, & renal biopsy |
| RENAL CANCER - MEDICAL TREATMENT | radical nephrectomy; in general, renal tumors are not responsive to radiation or chemotherapy; radiation is sometimes used as a palliative measure for inoperable cancer; biotherapy with alpha-interferon & interleukin-2 for metastatic disease |
| RENAL CANCER - ASSESSMENT | weakness, fatigue & changes in the urine; pt's emotional state, usual coping strategies, & support systems |
| RENAL CANCER - PREOPERATIVE CARE | ineffective coping r/t potentially fatal disease (provide support, talk to them, refer to counselor); deficient knowledge of tests, procedures & effects of nephrectomy |
| RENAL CANCER - POSTOPERATIVE CARE | monitor VS, record I&O, routinely check drains & tubes; monitor dressings for drainage; auscultate breath sounds & bowel sounds |
| RENAL CANCER - INTERVENTIONS | acute pain, risk for deficient fluid volume, ineffective breathing pattern; risk for injury, risk for infection, ineffective coping, deficient knowledge |
| BLADDER CANCER | most common malignancy of urinary tract; ureteral orifices and bladder neck are the most common sites. |
| BLADDER CANCER - cause | tars in smoking tobacco, aniline dyes in industrial compounds, and tryptophan have been implicated in development of bladder cancer. |
| BLADDER CANCER - S/S | painless, intermittent hematuria; other s/s: bladder irritability; infection w dysuria, frequency & urgency & decreased stream of urine |
| BLADDER CANCER - MEDICAL DIAGNOSIS | urinalysis, IVP, CT scan, and cystoscopy |
| BLADDER CANCER - MEDICAL TREATMENT | surgery is the treatment of choice. Cystoscopic resection & fulguration or laser photocoagulation; segmental bladder resection & radical cystectomy; URINARY DIVERSION |
| BLADDER CANCER - ASSESSMENT | description of urinary s/s; fatigue & wt loss; health history may reveal use of tobacco or exposure to carcinogenic chemicals; pt's emotional state, coping strategies & sources of support |
| BLADDER CANCER - INTERVENTIONS | acute pain, impaired urinary elimination; impaired skin integrity; risk for infection; risk for injury; deficient knowledge |
| ACUTE RENAL FAILURE - PRERENAL FAILURE | decreased blood flow to glomeruli |
| ACUTE RENAL FAILURE - INTRARENAL FAILURE | nephrotoxic agents, kidney infections, occlusion of intra renal arteries, hypertension, diabetis mellitus, direct trauma to the kidney |
| ACUTE RENAL FAILURE - POST RENAL FAILURE | obstructions beyond the kidneys that cause urine to back up. |
| ACUTE RENAL FAILURE STAGE - ONSET STAGE | short (1-3 days); increasing BUN and serum creatinine with normal to decreased urine output |
| ACUTE RENAL FAILURE STAGE - OLIGURIC STAGE | the urine output decrease to 400 ml/day or less. Serum values for BUN, creatinine, K, and phosphorus increase. Serum calcium & bicarbonate decrease. Follows onset stage and continues for up to 14 days. |
| what are the stages of acute renal failure | ONSET, OLIGURIC, DIURETIC, AND RECOVERY STAGE |
| ACUTE RENAL FAILURE STAGE - DIURETIC STAGE | urine output exceeds 400 ml/da; may rise above 4L/day. Kidneys exceed BUN, creatinine, K and phosphorus and retain Ca and bicarbonate |
| ACUTE RENAL FAILURE STAGE - RECOVERY STAGE | as renal tissue recovers, serum electrolytes, BUN, and creatinine return to normal. This stage lasts 1 to 12 months |
| ACUTE RENAL FAILURE STAGE - MEDICAL TREATMENT | fluid & dietary restrictions, restoration of electrolyte imbalance & dialysis; drug therapy, diet (LOW K & PROTEIN), fluids (LIMITED), hemodialysis & peritoneal dialysis; continious renal replacement therapy |
| ACUTE RENAL FAILURE STAGE - ASSESSMENT | monitoring fluid status is critical; s/s of electrolyte imbalance (pressure ulcer); s/s r/t immobility; impaired circulation, constipation & atelectasis; fears, anxiety, copy strategies sources of support |
| ACUTE RENAL FAILURE STAGE - INTERVENTIONS | excess fluid volume, decreased cardiac output, anxiety, disuse syndrome, deficient knowledge |
| CHRONIC KIDNEY DISEASE | progressive nephron destruction of both kidneys; creatinine clearance: important measure of renal function (<15 mL/min, dialysis or transplantation necessary) |
| CHRONIC KIDNEY DISEASE | uremia: when kidneys unable to maintain fluid and electrolyte or acid-base balance (also called end-stage renal disease) |
| CHRONIC KIDNEY DISEASE - CAUSES | HTN, diabetis mellitus, atherosclerosis |
| CHRONIC KIDNEY DISEASE - SIGNS & SYMPTOMS | azotemia, hyper & hypo kalemia, metabolic acidosis, fluid imbalance (hyper & hypo volemia), insulin resistance, anemia, suppressed immunologic function, CHF & Dysrhythmias |
| CHRONIC KIDNEY DISEASE - SIGNS & SYMPTOMS | neurologic system, integ system, GI system, musculoskeletal system, reproductive system, endocrine function, emotional & psychological effects |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT hyperkalemia | IV glucose & insulin, calcium carbonate, calcium acetate or sodium polystyrene sulfonate |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT hypocalcemia | calcium, active vit D, phosphate binders |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT hypervolemia | fluid restriction & diuretics |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT HTN | diuretics, beta blockers, calcium channel blocker and ACE inhibitors |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT Anemia | iron supplements, folic acid, synthetic erythropoietin |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT Disquilibrium syndrome | hypertonic glucose |
| CHRONIC KIDNEY DISEASE - MEDICAL TREATMENT excess urea | high-carbohydrate, low protein diet |
| CHRONIC KIDNEY DISEASE - DIALYSIS | passage of molecules through semipermeable membrane into special solution called dialysate solution. It operates like a kidney. Small molecules (urea, creatinine, electrolytes) pass out of the blood, across a membrane, and into a solution |
| goals of dialysis | remove end products of protein metabolism from blood; maintain safe concentrations of serum electrolytes; correct acidosis & replenish the body's bicarbonate buffer system; remove excess fluid from blood |
| DIALYSIS - HEMODIALYSIS | blood is removed & circulated through an "artificial kidney" to remove excess fluid, electrolytes, wastes; dialyzed blood then returned to the pt. |
| DIALYSIS - HEMODIALYSIS requirements | catheter, cannula, graft or fistula; subclavian or femoral catheters for temp access for dialysis during acute renal failure while a graft or fistula matures (dilates & toughens) or for peritoneal dialysis who need immediate access for hemodialysis |
| DIALYSIS - PERITONEAL | uses the pt's own peritoneum as a semipermeable dialyzing membrane. Fluid instilled into peritoneal cavity. Waste products drawn into the fluid; w/c is drained from peritoneal cavity. |
| DIALYSIS - PERITONEAL TEMP | cathether inserted into the peritoneal cavity through the abdominal wall |
| DIALYSIS - PERITONEAL LONG TERM | catheter is implanted into the peritoneal cavity |
| DIALYSIS - PERITONEAL advantages | less anemia, reduced cost, fewer dietary and fluid restrictions, independence, closer to normal kidney function |
| DIALYSIS - PERITONEAL disadvantages | risk for peritonitis (major complication) and catheter site infection, hyperglycemia, elevated serum lipids and body image disturbances |
| DIALYSIS - PERITONEAL 3 phases | inflow, dwell and drain |
| CHRONIC KIDNEY DISEASE - ASSESSMENT | frequent monitoring for changes important; fluid imbalance evaluated closely, accurate i/o records, s/s of fluid volume excess that can lead to cardiac failure: increase edema, dyspnea, tachycardia, bounding pulse, rising bp |
| CHRONIC KIDNEY DISEASE - ASSESSMENT | s/s electrolyte imbalances; apetite, usual daily intake, weight gain or loss pattern and prescribed diet |
| CHRONIC KIDNEY DISEASE - INTERVENTIONS | excess fluid volume, imbalanced nutrition, distrurbed sensory perception, ineffective coping, situational low esteem, risk for infection & injury, constipation, diarrhea, sexual dysfuntion, self care deficit |
| RENAL TRANSPLANTATION | kidney donation - healthy kidney from live donor or cadaver; tissues must match or recipient will reject new kidney; matching based on ABO blood groups & human leukocyte antigens |
| RENAL TRANSPLANTATION | crossmatching reveals any cytotoxics preformed antibodies will result in organ rejection; kidney donors must be at least 18 yrs of age, free of systemic disease or infection |
| RENAL TRANSPLANTATION - PREOPERATIVE NURSING CARE | pt must be prepared mentally & physically. Recipient & live donor have complete diagnostic workups to rule out other medical problems & evaluate function of the urinary tract. |
| RENAL TRANSPLANTATION - PREOPERATIVE NURSING CARE | recipient must be give meds to bring bp within normal limits; immunosuppresants to control the body's response to foreign tissue |
| RENAL TRANSPLANTATION - INTERVENTIONS | encourage pt to discuss concerns; factual info helps pt copy by reducing the fear of the unknown; when pts are active participants in their care, they feel less helpless & less anxious, preoperative teaching begins when pt is id'd as candidate |
| RENAL TRANSPLANTATION - SURGICAL PROCEDURE | donor kidney removed from live donor in OR. Taken to adjacent room where receipient has been prepared. Cadaver kidney removed under sterile conditions and transported to receipient. Donor kidney placed in recipient's abdomen |
| RENAL TRANSPLANTATION - COMPLICATIONS | acute tubular necrosis, rejection, renal artery stenosis, hematomas, abscesses and leakage of ureteral or vascular anastomoses |
| RENAL TRANSPLANTATION - POSTOPEATIVE NURSING CARE | ASSESSMENT: fluid intake, urine output, wt changes & VS |
| KIDNEY DONOR | physical care of the donor similar to that for a nephrectomy; it may be conventional or laparoscopic; pain worse with conventional approach |
| KIDNEY DONOR | conventional approach: pt hospitalized 4 to 7 days & return to work in 6 to 8 wks. |
| KIDNEY DONOR | laparascopic approach: donor hospitalized 2 to 4 days and can return to work 4 to 8 wks. |
Created by:
jekjes
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