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Urinary System
Chapter 45&46-Urinary System/Renal & Urologic Problems
| Question | Answer |
|---|---|
| 3 Functions of Kidneys | Controls electrolytes, release erythropoitein, acid/base balance-produce bi-carb |
| Kidneys extract what % of cardiac output | kidneys extract 20-25% of cardiac output |
| What should NOT be found in urine? should not get through semi-permeable membrane of glomerulus | sugar, protein (ketones), WBC, RBC |
| What is GFR | Glomerular function rate: decreased GFR=decrease kidney function. If dehydrated, GFR decreased--alone does NOT indicate kidney failure |
| What is hydronephrosis? | Fluid builds up around the renal pelvis; is a symptom of something, does not indicate kidney failure |
| What is the normal concentration of urine? | specific gravity=1.003-1.03 |
| What is fixed specific gravity? | 1.010=same as plasma, indicates kidneys are not filtrating |
| What are serum renal labs? | BUN/Creatine electrolytes: Na, K, Ca, Phos Bicarb: venous CO2 |
| What is a KUB: Kidneys, Ureter, Bladder? | x-ray; can show stones |
| What is an Intravenous Pyelogram (IVP)? | IV injection of dye, then take x-ray *must be NPO for 8 hrs prior *no allergies to iodine or shellfish *with dye,will feel warm sensation expected, feel like peeing themselves *push fluids after; hard on kidneys, need to flush |
| What is a Retrograde Pyelogram? | Done when can't give IV dye. Scope thru urethra into bladder, then inject dye into ureter *NPO 8 hours prior *push fluids after |
| What does an ultrasound of the kidneys show? | Shows possible mass(es) or size of kidney |
| Does a CT scan or MRI reveal more info about the kidney | CT gives more detail of kidney tissue than MRI |
| What is a renal biopsy? | Give info about the kidney tissue; large needle CT or ultrasound guided *Type & cross for blood ahead of time Contraindications: uncontrolled HTN (risk for bleed), only have one kidney, d/c coumadin; INR <1.5 |
| What are some pt teachings for after a renal biopsy procedure? | After procedure keep on affected side (to apply pressure) for 30-60 min, bedrest for 24 hours, no heavy lifting 5-7 days |
| What is a cystoscopy? | Pt in lythotomy position; scope thru urethra to bladder. Visualization of bladder to see cancer, see stones, do biopsies *NPO before procedure |
| What should a pt expect after a cystoscopy? | *burning, frequency, pink-tinged urine *soreness *bright red urine NOT expected or normal *warm sitz bathes help *apply heat and/or take mild analgesics |
| What is the normal pH of urine? | normal urine pH=4-8, average of 6 |
| What is pyelonephritis? | UTI, has worked its way up and now affects the kidney |
| What is cystitis? | UTI, affecting bladder |
| What is urethritis? | UTI, affecting urethra; puss coming out of urethra |
| What is urosepsis? | UTI, now into blood; common in elderly pts |
| What is Complicated UTI? | Other things/issues are involved with UTI--diabetes, Foley stones |
| What is recurrent UTI? | antibiotics not working on UTI, keeps coming back; if long term--only treat if symptomatic; it's a chronic issue |
| Who's at risk for UTIs? | *ppl w/urinary retention issues *women w/multiple partners *post-menapausal women, decrease in normal flora *ppl with instrumentation (Foley) *chg in urine pH |
| How will an elderly person present with UTI? | abdominal pain, confusion |
| How do you dx UTI? | UA w/ C&S |
| What is the tx for UTI? | antibiotics, increase fluids, prevention |
| What is the most common microorganism to cause UTI? | E. coli |
| What is acute pyelonephritis? | inflammation of the renal parenchyma (tissue) |
| What are causes of pyelonephritis? | UTI moved upped ureter, kidney reflux, urine back up ureter, BPH, obstruction, stone |
| What are S&S of pyelonephritis? | Lower Urinary Tract Symptoms (LUTS)-urgency, frequency; fatigue, chills, fever, flank pain, costal vertebral tenderness |
| What is Tx & care of pyelonephritis? | Aggressive antibiotics 2-3 wks; S&S should resolve in 48-72 hours. If relapse, will treat for at least 6 weeks w/diff antibiotic |
| How to Dx pyelonephritis? | Symptoms, labs (inc. WBC), urinalysis=positive nitrates, WBC, and casts (tissue cells in urine), C&S |
| What is chronic pyelonephritis? | Recurrent, not getting better--kidneys begin to shrink & lose function, if affects both kidneys can result in chronic kidney failure, ESRD |
| What is Urethritis? | Inflammation of urethra, caused by bacteria or virus; typically an STD In men, gonorrhea (tx w/doxycyclin); purulent drainage Clear discharge: trychomonus, tx w/Flagyl In women, can be a yeast inf. (Nystatin & Diflucan) *Need to treat partners if STD |
| What is Urethral Diverticula? | Typically occurs in women. Result of obs. of skenes glands; affects bottom 1/3 of uretha |
| What are S&S of urethral diverticula? | LUTS, post-void dribbling, urinary incontinence |
| How is urethral diverticula dx? | sediment or hematuria in urine or anterior wall mass, will be tender, can express puss with manual exam; if mass large, may send to CT-Treatment is surgery for removal |
| What is interstitial cystitis? | AKA-Painful bladder syndrome. Chronic, painful inflamm. disease of bladder S&S: urgency, frequency; most freq in women |
| How is painful bladder syndrome dx? | R/O everything else; no single treatment. Avoid bladder irritants; avoid stress; will affect sex life, chg positions |
| What are tx options for painful bladder syndrome? | Elevil & Aventil--used to decrease pain and frequency; may need opiate analgesics--Norco, Vicodin |
| What is glomerulonephritis? | bilateral; third leading cause of renal failure; anti-glomerial basement membrane (anti-GBM)antibodies attack basement membrane; have immune complexes deposited in glomerulus (clogs membrane; causes compl activation, leads to inflamm in membrane, damages |
| What are S&S of glomerulonephritis? | Hematuria, WBC, RBC, casts & protein in urine, increase BUN & Creatinine Goal: to eval for infections & autoimmune diseases; treat for infection, then check ESR, RA |
| What is post-streptococcal glomerulonephritis? | Immune complexes too big to get through glomerular basement; clogs |
| Who does post-streptococcal glomerulonephritis affect? | Affects children & young adults; 5-21 days after strep infection (group-A beta hemolytic strep) |
| What are S&S of post-streptococcal glomerulonephritis? | Generalized edema, HTN, oliguria (less than 400mL in 24 h), smoky, rusty urine, periorbital edema (eyes) |
| How to Dx post-streptococcal glomerulonephritis? | Protein in urine; not enough pull in vascular space, low serum protein=edema Lab: Anti-streptolysin-O (aka, ASO titer): blood test, may do renal biopsy |
| How to Tx post-streptococcal glomerulonephritis? | Rest, steriods to decrease inflamm (solumederol), diuretics to decrease edema, low Na, fluid restrict diet, treat w/antibiotic for recurrent strep infection; if HTN, treat w/meds |
| What is Good Pasture Syndrome? What are S&S? | A cytotoxic, autoimmune disease in (Immune complexes too big to get through glomerular basement); inflammatory reaction S&S: flu-like symp w/cough; hemoctysis (coughing blood), crackles in lungs, hematuria, anemia |
| How is Good Pasture Syndrome Dx: | Based on symptoms & anti GBM antibodies |
| What is Tx for Good Pasture Syndrome? | Corticosteriods, Immune suppression=drugs: cytoxin or Imuran; Plasma Foresis=plasma exchange to remove auto immune complexes; similar to dialysis |
| Who's at risk for Good Pasture Syndrome? | young males, smokers death results from respiratory failure |
| What is Nephrotic Syndrome? | Glomerulas is excessively passive to proteins; massive overflow of protein in urine *infection leading cause of death; chronic, no cure |
| What are S&S of Nephrotic Syndrome? | serum albumin very low; results in massive edema; elevated cholesterol & triglycerides b/c lack of protein; fatty casts in urine |
| What is Tx of Nephrotic Syndrome? | Based on symptom management: low Na diet, 2-3g/day; mod to low protein diet; daily wts; measure circum. of extremeties; small freq meals; infection prevention **skin care is crucial for these pts b/c of pitting edema; must keep clean, dry |
| What's a big risk for Nephrotic Syndrome? | In a hyper-coaguable state; need to watch for renal vein thrombosis; if occurs, will have 6mos anti coagulation |
| Why do kidney stones occur? | elevated Ca levels; concentration of urine; incr. pH, Ca & Phos precipitate out; decreased pH, uric acid (found in ppl w/gout) & cysteine precipitate out |
| What are kidney stones made of? what they are made of helps decipher how to treat | Calcium Oxylate, Calcium Phosphate, Uric Acid, Cysteine & Struvite struvite assoc w/ UTI; large & staghorn, occupy renal pelvis |
| What are S&S of kidney stones? | abd or flank pain, renal colic (as stone passes), cool, moist skin, pain in testicles or groin area |
| What are diagnostics to find kidney stones? | ultrasound, CT, IVP, UA for pH & to decide how to treat, Urine culture-UTI |
| How do you tx kidney stones? | pain control, as stone passes; strain urine-->4mm will not pass; urethral stents (dilates ureter); change diet |
| What is a cystolitholapaxy? | Crushes stones thru cystoscope |
| What is cystoscopic lithotripsy? | ultrasound to pulverize stone; to make passing easier |
| What is a uteroscope? | used to go up thru ureter and try to get stone out |
| What is percutaneous nephrolithotomy? | nephrostomy tube, bringing ureter to surface & leave it there. Risks: bleeding & infection |
| What is lithotripsy? | Breaking up of the stone; diff ways to do it--typically ultrasound; uretal stent may be put in place for 1-2 weeks; may be a string hanging out of urethra to help pull out S&S: hematuria, pink, NOT bright red |
| What's the most common surgical complication of surgery for stones? | May have flank or lateral incision; hemorrhage most common complication |
| What is nutrition concerns for ppl with stones? | push fluids, about 3L/day after removal; limit caffeine; limit purines for uric acid |
| What is a ureteral stricture? | narrowing of ureter; most common w/surgical, scar tissue S&S: mild/mod colic Tx: stent, dilate where stricture is located; nephostomy tube (last resort) |
| What is urethral stricture? | narrowing of urethra; result of fibrosis, scar tissue, previous trama; can create voiding obstruction |
| What are S&S of urethral stricture? | decreased force of urine, dribble, may have to strain to void, may have sprayed stream, may have urinary retention |
| What is Tx for urethral stricture? | dilation to open up; stents; or surgically repair |
| What is Nephrosclerosis? | narrowing of small arteries of kidney; leads to decreased blood flow & necrosis of kidney S&S: HTN, then decreased renal funtion...kidney failure |
| What is Renal Artery Stenosis? | Hx of athlerosclerois; CAD--makes more prone for renal artery stenosis; not adequate blood flow |
| What are possible tx for artery stenosis? | angioplasty to try to stent renal artery (ballon); if kidney not getting enough blood flow-keeps sending out RENIN which causes vasocontriction, inc BP; if adeq blood supply cannot be supplied, may lose kidney |
| What is renal vein thrombosis? vein not leaving kidney | Due to trauma, cancer or pregnancy. S&S: Flank pain, hematuria, r/t nephrotic syndrome Tx:anti-coagulation, may go in to surg. remove clot & save kidney Tx: |
| What is Polycystic Kidney Disease? | autosomal dominant condition; bilateral; ppl 30-40y/o, Kidneys become overrun with cysts; blood, serous fluid or puss-filled |
| What are S&S of polycystic kidney disease? | HTN, hematuria, feeling of heaviness in back, side or abdomen; can palpate kidney, it can affect heart, liver, intestines; gradual loss of kidney function |
| What is the care & tx for polycystic kidney disease? | Take the kidneys out if pain, bleeding or infection; leave in as long as possible; Tx: antihypertensives, genetic counseling--eventually will need transplant or dialysis |
| Who does kidney cancer affect: | Men more than women; 50-70y/o; smokers-#1 risk factor |
| What are S&S of kidney cancer? | Hematuria, flank pain, palpable mass, weight loss, HTN, & anemia; no early symptoms, by the time it's diagnosed usually in advanced stages--mets in lungs, liver & long bones |
| What are diagnostic studies for kidney cancer? | ultrasound, CT, IVP |
| What are treatments for kidney cancer? | Stage 1 or 2=radical nephrectomy; also includes adrenal glands, ureter and lymph nodes Stage 3 or greater=radiation for pallative care; chemo doesn't work-no good chemo agent |
| What is survival rate with nephroctomy? | 60% have five year survival rate |
| What is survival rate of stage 3 or greater? | 3-10% five year survival rate |
| Who does bladder cancer affect and what are risks and S&S? | Affects men more than women, 60-70y/o Risks: smoking, recurrent calculi, chronic UTIs S&S: painless hematuria, frequency & urgency |
| What are diagnostics for bladder cancer? | UA & check for neoplastic cells, CT, ultrasound. Confirming dx=cystoscopy with biopsy |
| How is bladder cancer classified? | Superficial Invasive Metastatic |
| What are treatments for bladder cancer? | *intravesicular chemo-inside bladder *resect the bladder & take portion out *Systemic chemo drugs: Cysplatin, adriamycin & methotrexate |
| What is Transurethral resection with fulguration? | go in w/scope & resect tumor out w/cauderizing & blade For more superficial lesions |
| What is laser photocoagulation? | destruction of bladder tumor w/laser; burning it off |
| Nursing care for after bladder cancer procedures... | push fluids, no alcohol, pink urine expected, bright red=NO, no clots 7-10 days post may have dark red, rust in urine=scabs, healing give stool softeners analgesics; 3-6 mos f/u cystoscopy |
| What is a partial cystectomy? | removal of part of the bladder; some left in tact |
| What is a radical cystectomy with urinary diversion? | Male: removal of bladder, prostate and seminal vesicles Female: removal of bladder, urethra, cervix, ovaries & uterus |
| What is urinary incontinence? | unintentional leaking of urine; not normal, not expected with aging Stress incontinence, overflow or urge incontinence |
| What is urinary retention? | Bladder does not empty completely; 50-75mL normal post-void residual; not normal, not expected with aging |
| What is a retropubic colpa suspension? | muscles that attach to bladder are loose; surgery not 100% Complications: voiding dysfunction, vaginal prolapse |
| What is pubal vaginal sling? | muscles that attach to bladder are loose; surgery not 100% Complications: voiding dysfunction, vaginal prolapse |
| Nursing Care for urinary incontinence & retention... | Kegel exercises, avoid bladder irritants, alcohol, caffeine, stop smoking, void q 2-3 h |
| What is a ileal conduit? | After radical cystectomy, portion of ilium brought to surface; ureters attached to ilium |
| What is a continent urinary diversion? | No bag. Create a bladder made of bowel, attach to surface; small stoma that does not continuously leak; straight cath q 4-6 h |
| What is orthotopic bladder reconstruction? | bowel used to construct bladder, attach ureters, urethra still connected; may straight cath--no innervation between "fake" bladder & brain; may have to straight cath in meatus |
| What must a pt have for continent urinary diversion or orthotopic bladder reconstruction? | normal renal function, no IBS, >2yr life expectancy; obesity is an issue |
| What are some pt teachings pre-surgery for UTI surgery? | adequate fluid volume; flank incision or lower abdominal incision; 12th rib may have to be removed depending on incision |
| What are some pt teachings and things to look for post-surgery for UTI surgery? | watch urine output q 1-2 h, daily weights; respiratory-DB & C, IS; splinting lower abdominal incision; NPO until bowel sound return, stool softener after BS return |
| What are ways to help someone with urinary retention? | run water, peeing in shower, sitz bath |
Created by:
divelmama
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