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severe generalized edema
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urine output less than 100ml per day
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68WM6 Ph 2 GU
Urinary System
| Question | Answer |
|---|---|
| severe generalized edema | anasarca |
| urine output less than 100ml per day | anuria |
| a general feeling of tiredness or listlessness | asthenia |
| the buildup of nitrogenous waste products in the blood | azotemia |
| a medical procedure for the removal of elements from the blood through an external semipermeable membrane or the peritoneum | dialysis |
| painful or difficult urination | dyruria |
| blood in the urine | hematuria |
| dilation of the renal pelvis and calyces | hydronephrosis |
| a substance that causes destruction of the kidney | nephrotoxin |
| excessive urination at night | nocturia |
| low urine output less than 400ml per day | oliguria |
| pus in the urine | pyuria |
| the volume of urine remaining in the bladder after a pt voids | residual urine |
| normal volume of residual urine | less than 50ml |
| What are the 4 functions of the urinary system? | excrete waste products, regulate fluid and electrolytes, maintain acid base balance, secrete erythropoietin |
| hormones secreted by the kidneys to stimulate the production of red blood cells | erythropoietin |
| Which kidney is located anatomically lower than the other kidney? | right kidney |
| the kidneys are surrounded by a layer of this kind of tissue | adipose |
| a notch found near the center of the medial border where the ureter blood vessels and nerves enter and exit the kidney | hilus |
| outer covering of the kidney made of strong connective tissue | renal capsule |
| just beneath the capsule and contains 1.25 million renal tubules | renal cortex |
| lies beneath the cortex and is darker in color; contains the triangular pyramids | renal medulla |
| narrow points of the pyramids that drain into the calyces | palilla |
| what is the functional unit of the kidney? | nephron |
| lightly bound network of capillaries | glomerulus |
| blood enters the glomerulus via which arteriole | afferent |
| blood exits the glomerulus via which areteriole | efferent |
| cuplike structure that collects the glomerular filtrate | bowman's capsule |
| secreted water and electrolyes and waste products travel through the collecting duct and out of the kidney as this | urine |
| between the ages of 40 and 70, the filtering mechanism of the kidneys becomes ____ _______ | less efficient |
| weakened musculature in the bladder and urethra, diminished neurological sensation, and decreased bladder capacity are effects of this on the urinary system | aging |
| females be come more prone to this urinary issue with aging | UTI's |
| urinary retention or hesitancy in males is frequently caused by this | benign prostatic hypertropy |
| men become more prone to UTI's with aging because of this | decreased bactericidal secretion from the prostate |
| most commonly used urinary diagnostic test | routine urinalysis |
| routine urinalysis can be used to test these things | color, clarity, odor, pH, specific gravity, protein, glucose, ketones, RBC's and WBC's |
| what is the normal pH range of urine | 4.6-8.0 |
| what is the normal specific gravity of urine? | 1.005 -1.030 |
| measurement of excreted substances by the kidney during a 24 hour period | 24 hour urine |
| substances commonly measured in a 24 hour urine | protein, creatinine, urea, uric acid, catecholamines |
| used to confirm suspected infections, identify causative organisms, determine appropriate antimicrobial therapy, and periodically screen urine for infection | culture and sensitivity |
| this portion of the culture and sensitivity can reliably differentiate between infection and contamination of a clean catch | colony count |
| this test is an excellent indicator of renal function and determines efficiency of kidneys clearing creatinine from blood | urine creatinine clearance |
| what kind of specimen is required for a urine creatinine clearance | 24 hour |
| this test measures creatinine levels in blood | serum creatinine |
| this test determines the kidney's ability to rid the blood of urea | BUN |
| normal creatinine clearance | 80-139 ml per minute |
| normal serum creatinine | 0.5 to 1.2 mg per dl |
| normal BUN | 10-20 mg per dl |
| an organ specific glycoprotein produced by normal prostate tissue | PSA |
| false positive PSA can be caused by | tissue manipulation |
| normal PSA | 4 mg per dl |
| measurement of the weight of the solvent compared with the weight of the solute | osmolality |
| provides information regarding the ability of the kidneys to concentrate urine | osmolality |
| radiological procedure to evaluate the size, structure and position of the urinary tract structures | KUB (kidney ureter bladder) |
| before IVP (intravenous pyelogram) the nurse should determine if a patient has an allergy to | iodine, saltwater fish, vegetables |
| common side effect of contrast injection | flushing, metallic taste |
| examination of the lower urinaty tract with a sterile cystoscope | retrograde pyelography |
| patient may be asked to void during this procedure | voiding cystourethrography |
| noninvasive procedure used to identify the kidney's shape, size, location, collecting systems, and adjacent tissues | ultrasound |
| visual examination to inspect, treat, evaluate, or diagnose disorders of the urinary bladder and proximal structures | cystoscopy |
| following cystoscopy, what should the nurse encourage? | increased oral hydration |
| performed with a nylon brush via a urethral catheter during a cystoscopy | brush biopsy |
| performed through the skin to directly visualize the upper urinary structures | nephroscopy |
| evaluates blood supply to the kidneys, evaluates masses and detects potential complications after renal transplant | renal angioogram |
| rectangular area created from ligaments that suspends and anchors the bladder within the pelvic and pubic bones | trigone |
| a continuous layer of cells that line the renal pelvis, ureters, and urinary bladder | transitional epithelium |
| contains layer of smooth and involuntary muscle that contracts to expel bladder contents through the urethra | bladder wall |
| extends from the urinary bladder to the exterior | urethra |
| surrounds the male urethra | prostate |
| provides involuntary control over the discharge of urine from the bladder | internal sphincter |
| a circular band of skeletal muscle that is under voluntary control located at the end of the urethra | external sphincter |
| composed of the kidneys, renal pelvis, and ureters | upper urinary tract |
| bladder, urethra, pelvis floor muscles | lower urinary tract |
| how much does the normal bladder hold? | 750 to 1000 mL of urine |
| average hourly output of urine for an adult | 30cc |
| voiding occurs more often than normal | frequency |
| conditions that can result in urinary frequency | infection, disease of urinary tract, metabolic disease, hypertension, medications |
| conditions that can result in dysuria | infection of lower urinary tract, irritation following intercourse, bath and feminine hygiene products |
| bed wetting | enuresis |
| strong desire to urinate | urgency |
| conditions that can result in urgency | inflammatory lesions, bacterial infections, chronic prostatitis |
| excessive urination at night | nocturia |
| conditions that can result in nocturia | decrease renal concentration ability, heart failure, diabetes mellitus |
| large volumes of urine voided in a given time | polyuria |
| passage of gas in urine during voiding | pneumaturia |
| conditions that can result in urinary hesitancy | urethral compression, outlet obstruction, neurogenic bladder (trauma) UTI |
| conditions that can result in urinary incontinence | infection, sphincter damage, spinal damage, congenital defects, bladder trauma |
| four types of urinary incontinence | stress, urge, overflow, functional |
| medications usued in the treatment of urinary incontinence | ditropan, dibenzaline, urecholine, detrol |
| exercises that can be helpful in mitigating incontinence in female patients | kegels |
| signs/symptoms of bladder or urinary tract infection | urinary discomfort, rash, lower abdominal pain, fever/chills, cloudy or foul smelling urine |
| causes of urinary retention in males | benign prostatic hypertrophy, strictures, foreign bodies, phimosis, urethritis |
| causes of urinary retention in both males and females | obstruction, postoperative, trauma, medication side effect, fecal impaction, infection |
| cause of urinary retention seen only in females | retroverted uterus |
| residual urinary retention greater than 50mL indicates | urinary retention |
| urinary analgesics | pyridium, prosed DS |
| antispasmodics used for patients with urinary retention | uroxatol, ditropan, detrol, detro LA |
| loss of voluntary bladder control resulting in urinary retention or incontinence | neurogenic bladder |
| conditions that can result in neurogenic bladder | congenital anomaly, neurological disease, trauma |
| caused by a lesion above the voiding reflex arc resulting in bladder wall atrophy and decreased capacity | spastic bladder |
| caused by a lesion of a lower motor neuron resulting in distension with urine stasis and incomplete emptying, and loss of urge to foid | flaccid bladder |
| diaphoresis, flushing, and nausea followed by episodes of urinary incontinence would be indicative of | spastic bladder |
| medications used to enhance urinary output | diuretics |
| carbonic anhydrase inhibitor diuretic | acetazolamide |
| loop diuretics | bumetanide (bumex), furosemide (lasix), toresemide (demadex) |
| osmotic diuretic | mannitol (osmitrol, resectisol) |
| potassium sparing diuretics | amiloride (midamor), spironolactone (aldactone), triamterene (dyrenium) |
| thiazide diuretics | chlorothiazide (diuril), hydrochlorothiazide (esidrex) |
| thiazide like diuretics | chlorthalidone (hygroton, thalitone), indapamide (lozol), metolazone (mykrox, zaroxolyn) |
| this electrolyte imbalance can cause enhanced digitalis glycoside toxicity | hypokalemia |
| signs and symptoms of hypokalemia | weakness, numbness, tingling, parasthesia, confusion, excessive thirst |
| patients on diuretics should have these lab values monitored frequently | potassium, blood glucose, BUN, serum uric levels |
| oral diuretics should be administered at what time of day | morning |
| potassium replacement should be administered if levels are below | 3mg/dL |
| desired effects of diuretics | decreased blood pressure, increased urine output, decreased edema, decreased intracranial pressure |
| these diuretics are appropriate for the prevention of renal calculi composed of uric acid or cystine, prevention of altitude sickness, treatment of increased intraocular pressure, and to decrease the frequency of seizures | carbonic anhydrase inhibitor diuretics |
| these diuretics are appropriate for use in the treatment of hypertensions, edema from CHF, or from hepatic or renal disease | loop (high ceiling) diuretics |
| loop diuretics are contraindicated | uncorrected electrolyte imbalance, hepatic coma, anuria |
| Loop diuretics can generally decrease blood concentration of ____________ and increase blood concentration of ___________ ______________ such as BUN, serum glucose, creatinine, uric acid, and cholesterol | electrolytes, metablolic byproducts |
| these diuretics are used as ADJUNCTS in the treatment of oliguric renal failure, edema, increased intracranial pressure, and toxic overdose | osmotic diuretics |
| osmotic diuretics are contraindicated | anuria, dehydration, ACTIVE INTRACRANIAL BLEEDING |
| osmotic diuretics can be given to treat this electrolyte deficiency | hypomagnesemia |
| these diuretics are given to control pregnancy related seizures | osmotic diuretics |
| these diuretics counteract potassium loss caused by thiazide and loop diuretics | potassium sparing diuretics |
| these diuretics cause loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions at the distal tubule | potassium sparing |
| potassium sparing diuretics are contraindicated | hyperkalemia |
| strange side effect of potassium sparing diuretics | bluish urine |
| these diuretics are used alone or in combination in the treatment of hypertension and edema due to CHF, renal dysfunction, cirrhosis, corticosteroid therapy, and estrogen therapy | thiazide diuretics |
| these diuretics increase the kidney's filtration of sodium and water and promote the excretion of chloride, potassium, magnesium, and bicarbonate | thizide diuretics |
| thiazide diuretics are contraindicated | anuria, lactation |
| common adverse side effect of thiazide diuretics in diabetics | hyperglycemia |
| a patient taking thiazide diuretics is experiencing the desired effects of the medication if | blood pressure decreases, edema decreases, urine output increases |
| these diuretics increase excreation of sodium and water by inhibiting sodium reabsorption in the distal tubule | thiazide like diuretics |
| these medications provide relief from pain, itching, burning, urgency, and frequency associated with infection or urologic procedures | urinary tract analgesics |
| pyridium is contraindicated | glomerulonephritis, hepatitis, uremia, renal failure, G6PD deficiency |
| patients taking pyridium should be warned about this odd side effect | bright orange urine |
| these medications are used to treat frequent urination, urgency, nocturia, incontinence, and overactive bladder | urinary tract antispasmodics (anticholinergics) |
| commonly used urinary tract antispasmodics | oxybutynin oral or transdermal |
| oxybutynin is contraindicated | glaucoma, intestinal obstruction, toxic megacolon, paralytic ileus, myasthenia gravis, hemorrhage/shock, obstructive uropathy |
| side effect of ocybutynin that males specifically should be warned about | impotence |
| these medications are used to treat urinary retention (nonobstructive) | urinary tract stimulants |
| these medications for urinary retention mimic the effects of the parasympathetic nervous system to stimulate gastric motility and micturation | urinary tract stimulants (cholinergics) |
| commonly used urinary tract stimulants | bethanechol chloride (urecholine); neostigmine (prostigmin) |
| urinary tract stimulants are contraindicated | mechanical obstruction of GI or GU tract |
| antidote for cholinergics | atropine |
| bacteria in the urine | bacteriuria |
| commmon cause of nonsocomial urinary tract infections | catheters |
| chronic conditions that increase a patient's risk of urinary tract infections | diabetes, MS, spinal cord injuries, hypertension, kidney disease |
| infection/inflammation of the urethra | urethritis |
| infection/inflammation of the urinary bladder | cystitis |
| infection/inflammation of the kidney | pyelonephritis |
| infection/inflammation of the prostate | prostatitis |
| what type of organism most commonly causes UTI's | gram negative bacteria |
| methods for preventing urinary tract infections | increased fluid intake, avoid coffee, tea, colas, and alcohol, shower rather than bathe, wipe from front to back, avoid irritating substances, wear cotton underwear, void every 2 to 3 hours |
| how is urethritis classified | by presence or absence of gonorrhea |
| most common cause of nonspecific urethritis | chalmydia |
| signs and symptoms of urethritis | dysuria, frequency, pruritis, urethral discharge, NO FEVER |
| causes of cystitis | urethral reflux, diagnostic studies, fecal contamination (e. coli), catheters, sexual intercourse |
| signs and symptoms of cystitis | urgency, frequency, dysuria, perineal and suprapubic pain, nocturia, hematuria, chills and fever |
| antibiotics commonly used for treatment of cystitis | septra, bactrim, macrodantin |
| most common cause of pyelonephritis | e. coli |
| chronic pyelonephritis is most commonly associated with | recurrent infections or chronic obstruction |
| kidney failure develops when large numbers of ________________ are destroyed | nephrons |
| pain in this area is a key sign of pyelonephritis | costovertebral angle |
| urinary antiseptic used to treat gram negative microbes only; common side effects include vertico, weakness, nausea, and vomiting | quinolone (nalidixic acid) |
| urinary antiseptic used to treat gram positive and negative microbes, common side effects include, loss of apppetite and nausesa/vomiting | nitrofuratoin |
| urinary antiseptic used to suppress fungi and gram positive or negative organisms; used to prevent reinfection after antibiotic use and rarely causes side effects | methenamine (mandelamine) |
| urinary antiseptic; broad strectrum effective against gram positive or negative organisms | fluoroquinolone |
| signs of super infection | black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul smelling stools; allergic reaction |
| methenamine is converted to ___________ in the urine | formaldehyde |
| this supplement can help to acidify urine | vitamin C |
| mouth should be rinsed following administration of nitrofurantoin to prevent this | teeth staining |
| a patient with UTI should be encouraged to __________ oral fluid intake | increase |
| nonbacterial prostatitis results from _______ of the urethra | occlusion |
| signs and symptoms of prostatitis | burning, perineum discomfort, dysuria, frequency and urgency, URINARY RETENTION |
| how long are antibiotic administered for prostatitis? | 4 to 12 weeks |
| these activities should be avoided in acute prostatitis | arousal, sexual intercourse |
| possible complications of urinary obstruction | electrolyte imbalance, infection (from urine stasis), ischemia (due to compression), atrophy of renal tissue |
| causes of urinary obstruction | strictures, kinks, cysts, tumors, calculi, BPH |
| catheter choice of urinary obstruction is dependent on | location of obstruction |
| mesh like tube or coil inserted via cystoscopy to regain patency of ureter | ureteral stent |
| possible complications of ureteral stent placement | diabetes insipidus, dehydration |
| cause of hydronephrosis | obstruction |
| prolonged pressure associated with hydronephrosis can result in | renal fibrosis and loss of function |
| signs and symptoms of hydronephrosis | flank pain, nausea and vomiting related to pain |
| factors that increase risk for renal calculi | immobility, hyperparathyroid (overproduction of calcium), recurrent UTI, dehydration, excessive vitamin D intake, osteoporosis |
| age group and gender in which renal calculi are most common | 20-30 year old males |
| stones in the kidney | nephrolithiasis |
| stones in the ureter | ureterolithiasis |
| stones in the bladder | cystolithiasis |
| signs and symptoms of urolithiasis | flank pain, hematuria, pyuria, vomiting, hydronephrosis |
| removal of stone from ureter | ureterolithotomy |
| removal of stone from renal pevis | pyelolithotomy |
| removal of ston from renal parenchyma (tissue) | nephrolithotomy |
| alkylating or acidifying agents instilled to dissolve stone | chemolysis |
| to verify passsage of stone, what must be done to urine? | straining |
| loss of voluntary voiding control resulting in urinary retention | neurogenic bladder |
| factors that increase the risk of renal tumors | gender, smoking, family history, preexisting renal disorders |
| signs and symptoms of renal tumors | intermittent hematuria, weight loss, dull flank pain, mass in flank, fatigue |
| treatment for renal tumors includes | surgery (nephrectomy), radiation, chemotherapy |
| most common site of cancer in the urinary tract | bladder |
| genetic disorder where multiple fluid filled cysts slowly replace much of the kidney | polycystic kidney disease |
| renal function compromise in polycystic kidney disease is caused by | pressure, secondary infection, tissue scarring from cyst rupture |
| most common site of cysts in polycystic kidney disease | collecting ducts |
| signs and symptoms of polycystic kidney disease | flank pain, HEADACHE, GI upset, voiding disturbances, recurrent uti's, hypertension |
| what is the treatment for polycystic kidney disease | relief of pain and symptoms, no cure |
| secretes alkaline fluid that helps neutralize seminal fluid and increases sperm motility | prostate |
| signs and symptoms of BPH | urinary retention, hematuria, oliguria, renal insufficiency |
| to avoid rapid decompression of bladder, drainage should be stopped at | 1000 mL |
| most common procedure for relief of BPH | transurethral resection of prostate |
| antihypertensive used in the treatment of BPH | terazosin hydrochloride (Hytrin) |
| androgen inhibitor used in the treatment of BPH | finasteride (proscar) |
| proscar (finasteride) is contraindicated | women |
| side effects of androgen inhibitors that the patient should understand | decreased libido, decreased ejaculate volume, impotence |
| urinary tract antispasmodic used in the treatment of BPH | alfuzosin (uroxatral) |
| alfuzosin (uroxatral) is contraindicated | hepatic impairment, alpha blockers, renal impairment, women or children |
| possible sytemic side effect of alfuzosin (uroxatral) | hypotension |
| at risk age group for prostate cancer | over 50 |
| by the time prostate cancer causes urinary symptoms, this has usually already occurred | metastasis |
| the key objective difference between BPH and prostate cancer | feeling of prostate, boggy and enlarged with BPH, firm and possible nodules, with cancer |
| which prostatectomy procedure provides access to pelvic lymph nodes? | retropubic prostatectomy |
| in this prostatectomy the approach is through the bladder | suprapubic prostatectomy |
| in this prostatectomy the prostate is removed via the urethra | tranurethral prostatectomy |
| this prostatectomy is one of the most effective ways of curing cancer | radical perineal prostatectomy |
| trauma to the urethra can result in | strictures |
| in this prostatectomy the approach is low on the abdomen and leaves the bladder intact | retropubic prostatectomy |
| general term the encompasses all urinary calculi | urolithiasis |
| proteinuria, hypoalbuminemia, and edema along with anorexia, fatigue, and alteration of renal function would be indicative of | nephrotic syndrome (nephrosis) |
| urine with protein in it can appear | foamy |
| diet for nephrotic syndrome | low sodium, high protein |
| signs and symptoms of glomerulonephritis | periorbital edema, visual disturbanses, nausea, anorexia, anemia, nosebleeds, headache, irritability, malaise, edema, dyspnea, hematuria, oliguria, anuria, nocturia, flank pain/tenderness |
| glomerulonephritis can cause this, which can lead to cerebral and cardiac complications | hypertension |
| glomerulonephritis is usually treated with | antibiotics (to prevent infection), diuretics, antihypertensives, vitamins, iron supplements, corticosteroids |
| diet for glomerulonephritis | low protein, low sodium |
| clinical manifestations of chronic glomerulonephritis | anasarca, headaches (in morning), hypertension, visual disturbances, cerebral edema, heart failure, dyspnea, nocturia, proteinuria, anemia |
| urea in the blood can cause this uncomfortable side effect | pruritis (itching) |
| causes of acute renal failure | thrombosis in renal arteries, sever hypotension, burns, sepsis, blood transfusion reactions |
| these two heavy metals are nephrotixic | lead, mercury |
| recovery from acute renal failure may take this long | one year |
| a patient with chronic renal failure may have lost this percentage of function before symptoms develop | 80 |
| terminal stage of renal failure | uremia |
| causes of chronic renal failure | chronic kidney disease, urinary tract obstruction, diabetes mellitus, congenital abnormalities, lupus, hypertension |
| a patient with chronic renal failure will smell like | urine |
| indications for hemodialysis | severe renal failure, acute poisoning, metabolic acidosis, sever volume overload |
| peritoneal dialysis is contraindicated | systemic inflammatory disease, previous abdominal surgery, chronic back pain |
| surgical removal of kidney | nephrectomy |
| a catheter inserted into the kidney pelvis for drainage | nephrostomy |
| how much fluid can safely be used for irrigation of a nephrostomy tube | 5mL |
| most common urinary diversion following cystectomy | ileal conduit |
| continent urinary diversion technique | ileal urinary resoirvoir |
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