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68WM6 Phs2 test 7
68WM6 Phase 2 test 7 Urinary System
| Question | Answer |
|---|---|
| Define anasarca | Severe, generalized edema |
| Define anuria | urine output less than 100 ml/day |
| General feeling of tiredness and listlessness | asthenia |
| Azotemia | build up of nitrogenous waste products in the blood |
| dysuria | painful or difficult urination |
| hydronephrosis | dialation of the renal pelvis and calyces |
| nocturia | excessive urination at night |
| pyuria | pus in urine |
| residual urine | volume left in bladder after voiding. usually less than 50 ml |
| which kidney is slightly lower and why? | Right kidney is lower due to the Liver |
| outer covering of kidney; made of strong connective tissue | renal capsule |
| lies beneath the cortex and is darker in color | renal medulla |
| functional unit of the kidney | nephron |
| 3 functions of the nephron | maintain water balance maintain pH levels in blood removes toxins from the blood stream |
| Afferent | Going INTO the kidney |
| Efferent | Going OUT of kidney |
| Cup-like structure that collects the glomerular filtrate | Bowman's Capsule |
| The renal tubule contains what? | Proximal convoluted tubule, Lood of Henle, distal convoluted tubule, and collecting ducts |
| what two hormones help kidney maintain fluid and electrolyte balance | ADH (anti-diuretic hormone), and aldosterone |
| stress incontinence | bladder tone loss and perineal muscle relaxation - sneeze=pee risk of UTI |
| Enlargement of prostate that leads to constriction of urethra | BPH - Benign Prostate Hypertrophy |
| what is not normally found in urine | protein, glucose, ketones, RBC, WBC, and crystals |
| True / False - Urine culture and sensitivity requires a clean catch | True |
| urine creatinine clearance | levels related to muscle mass, do not exercise during test period. excellent renal function indicator |
| Abnormal elevation in creatinine levels are caused by what? | Glomerulonephritis, polynephritis, acute tubular necrosis, urinary obstruction |
| Blood tests for renal function | Serum clearance, BUN, PSA, Osmolality |
| Elevated PSA results from: | prostate cancer, BPH, Prostatitis Do not manipulate prostate prior to blood draw, can give false positive |
| Osmolality provides: | info on kidney's ability to concentrate urine |
| Kidney-Ureter-Bladder is a what? | X-Ray to evaluate size, structure and position of urinary tract structures |
| IVP - Intravenous Pyleography is: | contrast & radiographs to monitor kidney function - metallic taste / warm flushing sensation |
| Abnormal finding in a IVP | structural deviations, hydronephrosis, calculi within urinary tract, polycystic kidney disease, tumors |
| retrograde pyleography is: | exam of lower urinary tract; contrast injected into ureters to visualize upper tract |
| visual exam to inspect, treat, evaluate, or diagnose d/o of urniary bladder and proximal structures | Cystoscopy |
| Performed through the skin and provides direct visualization of upper urinary structures | nephroscopy |
| Multiple cross-section pictures obtained at several different sites creates a 3D "map" of kidney structres | CT Scan |
| Evaluates blood supply to kidneys, evaluates masses and detects potential complications after renal transplant | Renal Angiogram |
| male urethra female urethra | 18-20cm 2.5-3.0cm |
| Difference between internal and external sphincter | internal provides involuntary control while the external is under voluntary control |
| Upper urinary tract: | kidneys, renal pelvis, ureters |
| lower urinary tract | bladder urethra, pelvis floor muscles |
| physiology of urination | bladder holds 750-1000ml, urge hits at approx 250ml of urine, stretch receptors in bladder wall stimulate urge=involuntary contraction of bladder, internal and external sphincters relax=urination |
| kidneys for about how much urnie each day? | 1-2 Liters |
| what are some alterations in voiding pattern? | Dysuria, frequency, urgency, burning, enuresis, nocturia, polyuria, oliguria, anuria, pneumaturia, hesitancy |
| Dysuria can be r/t: | lower UTI, irritation after sex, use of bath or feminine products, pathological conditions |
| frequency can be r/t: | disease of urinary tract, metabolic disease(DM), HTN, medications |
| Urgency r/t: | acute bacterial infections, chronic prostatitis, and inflammatory lesions in bladder, prostate, and urethra |
| what is enuresis? | no control over flow of urine |
| Nocturia r/t: | heart failure, DM, poor bladder emptying, decreased renal concentrating ability |
| pneumaturia r/t: | rectosigmoid cancer, regional ileitis, sigmoid diverticulitis, gas-forming UTI, fistula between bowel and bladder |
| Hesitancy r/t: | compression of urethra, outlet obstruction, neurogenic bladder, UTI |
| Upon initial assessment of urinary incontinence, what would the objective data comprise of? | Inspect abd for scars, symmetry, and pulsations Examine the back for bulging, bruising, scars Percuss for fullness of bladder-dullness? Palpation of suprapubic area Assess kidney of pain or tenderness |
| pathophysiology of urinary incontinence? | reduced stimuli to bladder sphincters r/t age, unconscious, anesthesia, infection, damaged sphincters, spinal nerve damage, defects |
| 4 clinical manifestations of urinary incontinence: | stress, urge, overflow, and functional incontinence |
| 4 pharmacologic agents for urinary incontinence | Ditropan, Dibenzaline, Urecholine, Detrol |
| Nursing interventions for urinary incontinence | Develope schedule, encourage adequate fluid intake, bladder training exercises (Kegel exercise) |
| etiology of urinary retention in males | BPH, foreign body in urethra, phimosis, urethritis |
| a lesion of the nervous system that interfers with normal nerve conduction to the urinary bladder | neurogenic bladder |
| Carbonic Anhydrase inhibitors | Dazamide, Diamox, Storzolamide |
| Loop Diuretics | Bumex, Lasix, Demadex |
| Osmotic Diuretics | Osmitrol, Resectisol |
| Thiazide Diuretics | Diuril, HCTZ, Esidrex, Hydrodiuril |
| K+ Sparing Diuretics | Midamor, Aldactone, Dyrenium |
| Thiazide-like diuretics | Hygroton, Lozol, Mykrox |
| Diuretic Nursing Implications: | Weigh Daily, I&O, edema?, lung sounds, turgor, mucous membranes |
| Diuretics: Assess for: | Anorexia, numbness, tingling, confusion, excessive thirst, parethesia, electrolyte imbalance |
| When would you administer oral diuretics? | in the morning |
| Diuretics & pt/family teaching: | orthostatic hypotension is at risk; change position slowly, decrease alcohol, exercise in hot weather. use sunscreen, ask before taking OTC meds. Routine follow-up=impt! |
| Diuretic evaluation includes what? | Decreased BP, Increased Urine, decreased edema, reduced intracranial pressure, prevent hypokalemia, tx hyperaldosteronism |
| Action of Carbonic anhydrase inhibitor diuretics? | Increase Na+ excretion through renal tubule, decrease secretion of aqueous humor in eye= decreased ICP |
| Noteable side affects of carbonic anhydrase inhibitors | metallic taste, kidney stones, hypokalemia VERY painful if given IM |
| Carbonic anhydrase evaluation includes | decreased intraocular pressure, decreased seizures, prevent altitude sickness, prevent uric acid/cystine stones in urinary tract |
| Where in the nephron do carbonic anhydrase diuretics work? | proximal convoluted tubule |
| Where in nephron do Osmotic diuretics work? | Descending Loop of Henle |
| Where in nephron do Loop Diuretics work? | Ascending Loop of Henle |
| Where in nephron do Thiazide Diuretics work? | Distal convoluted tubule |
| Where in nephron do K+ Sparing Diuretics work? | Distal convoluted tubule and collecting duct |
| What is the action of Loop Diuretics? | inhibits the reabsorption of Na and Cl, increases renal excretion of water, Na, Cl, Mg, H, and Ca. |
| What are Loop diuretics used for? | tx HTN, or edema r/t CHF, and renal and hepatic disease |
| noted pt/family teaching for Loop diuretics | in being tx for HTN, continue meds even if feeling better. Reinforce need to continue additional therapies for HTN. |
| Uses for Osmotic diuretics | Acute oliguric renal failure, edema, increased intracranial or intraocular pressure |
| Action of Osmotic diuretics | excrete water, sodium, and chloride |
| What are 3 uses of K+ Sparing Diuretics? | tx edema, manage CHF, tx HTN, counteract K+ loss caused by loop or thiazide diuretics |
| Action of K+ Sparing diuretics: | causes loss of sodium bicarbonate and Ca while saving K+ and H+ ions at Distal Conv. tubule. |
| What are three K+ Sparing diuretics? | Midamor, Aldactone, Dyrenium |
| What are 4 side effects of K+ sparing diuretics? | arrhythymias, consitpation, bluish urine, hyperkalemia, hyponatremia |
| nursing implications for K+ Sparing diuretics | I&O's, daily weight, BP, s/s for hypokalemia (arrhythmias, U wave on ECG, polyuria / polydipsia), periodic ECG's |
| Pt/family teaching for K+ Sparing diuretics | avoid salt substitutes and food high in K+, take even if feeling better, no driving, no OTC meds w/o ok from Dr, bluish colored urine, correct way to take BP |
| Evaluation / expected outcomes with K+ Sparing Diuretics | decreased edema, decreased BP, prevent hypokalemia, tx hyperaldosteronism |
| What are the uses for Thiazide Diuretics? | use alone or with other meds to tx HTN. Tx edema r/t CHF, Renal dysfunctino, cirrhosis, estrogen therapy |
| What do Thiazide diuretics do? | increase kidney's flitration of Na and water. promotes excretion of Cl, K, Mg, and Bicarbonate |
| Examples of Thiazide diuretics | diuril, HCTZ, HydroDIURIL |
| May increase serum cholesterol, LDL, and triglyceride concentration? | Thiazide Diuretics |
| Desired outcomes for Thiazide Diuretics? | Decreased BP, Decreased edema, increased urine output |
| Thiazide-like diuretic use and action? | Mild to moderate HTN and edema r/t CHF increase excretion of Na and water; inhibits Na reabsorption in distal tubule |
| Examples of Thiazide-like diuretics | Hygroton, Lozol, Mykrox, Zaroxolyn |
| Pt/family teaching for Thiazide-like diuretics | encourage pt to comply with HTN control measures - low sodium diet, exercise, stop smoking, low alcohol consumption, stress mngt |
| Pyridium is what kind of urinary medication? | urinary tract analgesic |
| What is one noteable side effect of Pyridium? | Bright orange or reddish-orange urine |
| What urinary medication would you find as a transdermal patch that you apply to hip, abd, or buttock? | Oxybutynin - apply same two days each week to a dry, clean, non-irritated area. |
| Which urinary medication would you instruct pt to rinse mouth frequently, use good oral hygiene and sugarless gum to decrease dry mouth. This also causes a decrease in perspiration. | Oxybutynin |
| What are the desired effects of Oxybutynin? | Relief of bladder spasms and associated symptoms in pts with nuerogenic bladder |
| Why are urinary tract stimulants (cholinergics) used? | Stimulate micturation - relieve urinary retention |
| name 5 types of urinary catheters | Foley, Coude, Malecot & Pezzer, Robinson & Whistle-tip, ureteral, Suprapubic, External (Texas and Condom) |
| Wear a ______ catheter during the day and a _____ at night. | leg bag, larger closed drainage system |
| Clean pt with ___ and _____ rinse collection bag with ___ and ___ | soap and water vinegar and water |
| What are warning signs of infection around catheter? | change in skin color, general weakness, N/V, Abd Pain, flank pain |
| how much should a pt drink per day with a catheter? | 2-3 Liters |
| What is Kegel exercises? | Tighten and hold perineal floor muscles for 10 sec, relax for 10 sec...repeat x 10, 4 x p/day |
| What are some nursing interventions with pts that have a catheter? | develope urination schedule teach Kegel exercises teach proper skin care teach importance of adequate fluid intake |
| what are causes of infections that are common in elderly pts due to bladder obstructions, insufficient bladder emptying, and increased perineal soiling in females? | gram-positive microorganisms and yeast |
| what conditions contribute to urinary stasis? | urinary obstruction, neurogenic bladder, ureteral or urethral reflux, sexual intercourse |
| what chronic conditions are r/t urinary tract complications? | DM, multiple sclerosis, spinal cord injuries, HTN, kidney diseases |
| why are females more prone to UTI's then males? | Females have a shorter urethra and it is closer to rectum. |
| What is the most common organism that causes a UTI? | Gram Negative bacteria |
| what are the diagnostic tests for urethritis in males and females? | men:urethral smear - C&S women: Clean catch UA |
| What are some S/S of urethritis? | urinary frequency, urethral discharge, urethral pruritis, vulvar irritation, (FEVER NOT COMMON) |
| what is cystitis? | inflammation of the bladder |
| urethritis is often caused by: | Gonorrhea |
| what is pyelonephritis? | inflammation of the structures of the kidney, renal pelvis, renal tubules, and interstitial tissue |
| what are some S/S of pyelonephritis? | pain in costovertebral angle, chills, fever, frequency in urination, N/V, stones could form |
| what are the 4 groups of urinary antiseptics? | Quinolones (gram -), Nitrofurantoin(gram - & +), Methenamines(gram - & +), Fluoroquinolones(gram - & +) |
| Urinary anti-infectives include: | Cephalosporins, Pencillins, extended spectrum penicillins, sulfonamides, fluoroquinolones, and other misc... |
| If pt is on long term anti-infective meds, what should you monitor and how often? | AST, ALT, CBC, HCT, Bilirubin - monthly |
| how long are anti-infectives taken to prevent a superinfection? | 10-14 days |
| what are signs of a superinfection? | black, furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools, allergic reaction. |
| Methenamine is used to tx what? | UTI (bladder or kidney) |
| examples of a Methenamine? | Hiprex, Mandelamine, Urex |
| Directions for missed dose of Methenamine: | if twice daily-take missed dose and next dose 5-6 hours apart If three x p/day: take missed dose and next dose 2-4 hrs apart |
| What is a use of Nitrofurantoin? | chronic suppressive therapy for UTI's. |
| What decreases effectiveness of anti-infectives? | milk or antacids |
| This medication can cause rust-yellow to brown colored urine? | Nitrofurantoin |
| What can cause pain in the lower back, perineum, or rectum? | Prostatitis |
| how long do you expect a pt with prostatitis to be on antibiotic therapy? | 4-12 weeks |
| what are some major things to teach your pt with UTI's or other related infections? | Signs and symptoms of infections, take full course of meds, how to prevent infections |
| what are some causes of Urinary obstructions? | Structures/kinks, cysts/tumors, calculi, BPH |
| Diagnostic tests for Urinary obstructions; | KUB, Renal ultrasound, IVP, BUN/Creatinine |
| what is hydronephrosis? | swelling/dialation of renal pelvis & calyces |
| what is the eitology of hydronephrosis? | an obstructrion forms in urinary tract and pressure builds behind it causing potential damage to renal system. |
| what types of conditions predispose you to renal calculi? | Immobility, hyperparathyoid, recurring UTI, dehydration, excessive Vit D intake, osteoporosis |
| How would you describe pain of a calculi in the urinary system? | Pain is often inversely proportionate to size of calculus. Small-big pain! Big-small pain. |
| what are some nursing interventions r/t urolithiasis? | encourage ambulation even with pain, maintain hydration, strain all urine, assess renal function |
| what is polycystic kidney disease? | genetic disorder characterized by the growth of several fluid-filled cysts which can slowly replace much of the kidney |
| what is the eitiology of a renal tumor? | more common in men, primarily carcinomas that develope unilaterally, large when detected due to vague symptoms, cells from proximal convoluted tubule |
| A palpable mass in the flank, hematuria, and signs of metestsis are signs of what? | renal tumor |
| where is the most common site of urinary cancer? | Bladder tumor |
| fulguration, laser ablation, chemotherapy, and radiation therapy are all tx for what? | Bladder tumor |
| the most common site for this cystic disease is in the collecting ducts? | Polycystic kidney disease |
| Abd pain, headache, GI complaints, voiding disturbances, and a hx of UTI's are all things a pt with what, might tell you? | Polycystic kidney disease |
| List 3 causes of renal function compromise r/t polycystic kidney disease | pressure of cyst on kidney, secondary infection, scarring from ruptured cysts |
| What is: prostate encircles the male urethra at the base of urinary bladder? | BPH |
| What is the most common procedure for relief of BPH? | TURP (TranUrethral Resection of the Prostate) |
| What procedure to relieve BPH uses a laser to ablate the prostate and blood loss is minimal? | TULIP (TransUrethral, Ultrasound-guided, Laser-induced Prostatecotomy |
| What would you teach your pt after a TURP or TULIP? | Urine may be bloody for a few days, avoid voiding around catheter-may cause bladder spasms, may have frequent voiding with small amounts, understand meds. |
| What type of drug is Terazosin hydrochloride and what is it used for? | Antihypertensive. decrease contractions in smooth muscles of prostatic capsule/decrease symptoms of prostatic hyperplasia |
| What kind of medication is Finasteride and what is it used for? | Androgen Inhibitor, decrease s/s of BPH |
| What unique side effects can Finasteride cause? | decreased libido, decreased volume of ejaculate, impotence |
| What lab test can Finasteride effect? | PSA - Prostate Specific Antigen |
| What can the serum PSA be used to screen for? | Prostate Cancer |
| What does alfuzosin do and what kind of medication is it? | Urinary tract antispasmodic, relax smooth muscles in bladder neck and prostate & decrease s/s of BPH |
| what is a unique side effect of alfuzosin? | bronchitis, sinusitis, dizziness, headache, and lethargy |
| What are common sites r/t prostate cancer? | pelvic lymph nodes, hips, lower spine |
| what are three goals of a prostatectomy? | remove tumor, preserve urine control, and preserve sexual function |
| what are nursing goals postoperative for a prostate cancer pt? | DO NOT MOVE FOLEY, maintain patency of catheter, avoid clot formation, DO NOT remove tape until told to do so by Dr. |
| what are 4 techniques for a prostatectomy? | TURP, Suprapubic prostatectomy,radical perineal, and retropubic prostatectomy |
| Of the 4 techniques for a prostatectomy, which is used first because it provides access to pelvic lymph nodes? | Retropubic prostatectomy |
| what is the force which holds fluid in the vascular space? | Osmotic pressure |
| Marked proteinuria, low albumin levels, and edema are all signs of what? | Nephrotic syndrome (nephrosis) |
| What are two diagnostic tests for Nephrosis? | Albumin level, Renal biopsy |
| Low sodium and high protein diet, with loop diuretics are indicators of what? | tx for Nephrosis |
| what kidney d/o is usually preceded by a sore throat or skin infection? | Acute glomerulonephritis |
| distended neck veins, dyspnea with exertion, crackles are all signs of what? | glomerulonephritis |
| what kinds of medications can you expect to be taking while treating glomerulonephritis? | Antibiotics, antihypertensives, diuretics, Vitamins - iron, corticosteriods-immunosuppressives |
| What are the phases of renal failure? | Oliguric, Diuretic, Recovery |
| Urine output exceeds 2 L p/day, hypokalemia, hypocalcemia and hyperphospatemia are signs of what phase of renal failure? | Diuretic phase |
| Increased BUN and creatinine levels, decreased urine, metabolic acidosis, lasts days to 4-6 weeks is what phase of renal failure? | Oliguric phase |
| the terminal stage of renal failure is called | Uremia |
| uremic encephalopathy, respiratory alterations, pulmonary edema, uremic frost, cardiac dysrthythmias, and electrolyte inbalance = | chronic renal failure |
| how often are hemodialysis tx scheduled? | 3 x p/wk for 3-6 hours each |
| peritoneal dialysis works by what? | diffusion and osmosis |
| what are the stages of peritoneal dialysis? | Installation stage, equilibration stage, drainage stage |
Created by:
jrstrader
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