400 Exam 1 Flashcards
1
Q
the kidneys Produce and secrete hormones and enzymes that help regulate?
A
RBC production,
BP,
metabolism of calcium and phosphate
2
Q
other fxns of the kidneys
A
Regulates body fluid volume,
osmolality,
electrolytes,
acid-base balance
excretes wastes
3
Q
which kidney is lower?
A
right
4
Q
kidney is surrounded by ____ and held together by ___.
A
renal capsule & renal fascia
5
Q
o connective tissue that provides protection from trauma
A
renal fascia
6
Q
o Patient with severe coronary artery disease could also get ?
A
renal disease
7
Q
are approximately 30cm long in average adult and extend from the renal pelvis down to the bladder
A
o Ureters
8
Q
inner tissue of bladder is made of
A
rugae
9
Q
elastic tissue that allows the bladder to stretch
A
rugae
10
Q
involuntary control of flow
A
internal urethral orifice
11
Q
voluntary flow control
A
external urethral orifice
12
Q
who’s urethra is shorter?
A
females
13
Q
o male reproductive gland that surrounds the urethra
A
prostate gland
14
Q
ϖ The process by which urine is made
A
ultrafiltration
15
Q
ϖ Average adult urine output
A
1-2 L/day
16
Q
ultrafiltration is measured by?
A
GFR
17
Q
Amt of glomerular filtrate formed in 1 min
A
GFR
18
Q
ϖ Kidneys maintain stability by balancing fluid & solute composition of the blood using three processes?
A
Filtration, Resorption, Secretion
19
Q
ϖ Final refinement of urine is regulated by ?
A
Aldosterone and ADH/ vasopressin
20
Q
exerts hormonal regulation of salt and water balance and is produced in the hypothalamus and stored in the pituitary gland, and it responds to changes in the plasma osmolarity
A
ADH
21
Q
if water loss is too high?
A
ADH is released & kidneys retain water
22
Q
is a steroid secreted by the adrenal cortex assists in the resorption of sodium
A
aldosterone
23
Q
As the filtrate moves from proximal to distal tubules it becomes ?
A
more concentrated and more acidic
24
Q
ϖ Final pH of urine is usually
A
5-6
25
ϖ A major function of kidney is ?
conservation of water and electrolyte
26
Electrolytes are filtered out in ?
Bowman’s capsule
27
Electrolyte concentration is adjusted in the distal nephron by ?
ADH and aldosterone
28
ϖ In order for the body to maintain normal acid-base balance to achieve normal cell function the kidneys need to work together with the lungs to maintain a ___ to ____ ratio
blood bicarbonate to carbon dioxide ratio
29
ϖ Normal plasma pH for arterial blood is
7.35-7.45
30
ϖ Blood bicarbonate/carbon dioxide ratio
20:1
31
Lungs vary the rate of ___ by breathing and kidneys secrete or retain ______
CO2; bicarbonate
32
ϖ This is the process by which red blood cells are produced
Erythropoiesis
33
what triggers increased production of erythropoietin
Hypoxia and anemia
34
Erythropoiesis cannot occur In pts w/
anemia associated with renal failure, renal insufficiency, or cancer
35
generically engineered erythropoietin
epogen and procrit injections
36
ϖ Calcium is crucial for ??
bone formation,
cell growth,
blood coagulation,
hormone response and
cellular electrical activity
37
ϖ Phosphate is necessary for?
glucose metabolism
38
If the kidney is not functioning properly the body will draw calcium from somewhere, often the ____.
bones
39
renal patients are at high risk for developing ____.
fractures
40
BP is maniputlated through the kidney by?
ADH
renin-angiotension system
aldosterone
41
causes kidneys to resorb water
ADH response
42
is a hormone that stimulates the conversion of angiotensinogen to angiotensin I
renin
43
renin also causes a release of angiotensin converting enzyme (ACE) from the lungs causing?
vasoconstriction and a release of aldosterone to help increase BP
44
contained in the glomerular filtrate & is excreted unchanged into the urine
Creatinine
45
a byproduct of muscle metabolism and it is excreted by the kidneys at a constant rate and amount
Creatinine
46
creatinine excreted by the kidneys at a constant rate & amount
creatinine clearance
47
A rise in creatinine means ?
kidneys aren’t filtering & excreting as they should
48
is the best indicator of renal func.
creatinine
49
most drugs are either ?
excreted directly by the kidneys or first metabolized by the liver, then excreted by the kidneys
50
____-____ of urine fills in bladder prior to getting the urge to urinate
200-300ml
51
physiologic changes with aging
arteriosclerotic changes
prostatic hypertrophy
stress incontinence
fluid & electrolyte imbalance
52
Untreated _____ can accelerate arteriosclerosis and lead to kidney failure
hypertension
53
o People with known arteriosclerosis should have frequent evaluations of their ?
kidney function
54
common in older men & if left untreated can obstruct the flow of urine
prostatic hypertrophy
55
prostatic hypertrophy patients are often placed on what kind of meds?
antibiotics/steroids or meds like Flomax to help decrease the size of the prostate
56
o Common in aging women and even men as a result of weakened muscle tone
stress incontinence
57
ex of stress incontinence
sudden movement
sneezing
stretching
exercising
58
GFR decreases around age ___.
40
59
as a person ages the ____ stimulation decreases
thirst
60
elderly patients can become ____ and dehydrated without realizing they are thirsty
hypernatremic
61
how is a 24 hour urine collected
very first urine discarded and the clock starts after the first urine
jug is kept on ice
62
mid stream clean catch instructions
wipe first
pee a little bit
stop
finish peeing in cup
63
o how to prevent infection with a foley catheter
* Empty the bag at least every 8 hours
* Clean the tube around the peri area with soapy water every shift and as needed
* Keep bag below the patient to prevent the backflow of urine
Change the catheter out if it is in for a prolonged period
64
− A normal ratio with an elevated BUN and creatinine is seen with
intrinsic renal disease
65
− An elevated BUN-creatinine ratio is seen in
hypovolemia
66
• Dye is put into the vein and goes through the renal system and radiologic pictures are taken so you can see the structure and excretory function
Intravenous Pyelography (IVP)
67
must do what before IVP
check BUN-creatinine ratio
68
why check ratio before IVP?
it can cause renal failure
69
• Direct visualization going through the meatus and into the structures of the renal system into the bladder
o Cystoscopy/ Endoscopy
70
After endoscopic procedures patient will have some
burning and urge to void without being able to and some bladder retention
71
what to observe for after endoscopy/cystoscopy?
Blood in the urine (NOT normal)
72
what to monitor for after Renal/ Kidney Biopsy
bleeding
73
patients are on bedrest for how long after renal/kidney biopsy
24 hours
74
Painful or difficult voiding
ϖ Dysuria
75
Frequent voiding—more than every 3 hours
ϖ Frequency
76
Strong desire to void
ϖ Urgency
77
excessive urination at night
nocturia
78
delay, difficulty in initaiting voiding
hesitancy
79
involuntary loss of urine
incontinence
80
increased volume of urine voided
polyuria
81
polyuria = > ____ ml
3,000ml in 24 hours
82
urine output less than 500 ml/day
oliguria
83
urine output less than 50ml/day
anuria
84
Muscle or tissue break down
ϖ Myoglobinuria
85
Myoglobinuria looks like?
coco colored
86
Myoglobinuria is seen with conditions such as?
glomerulonephritis
87
Red blood cells in the urine
hematuria
88
ϖ Second most common bacterial disease
UTI
89
who is at greatest risk for UTI
females
elderly
catheter patients
anyone with invasive procedure
diabetics
anyone with obstruction from prostate or kidney stone
women that use spermicidal agents and diaphragms
90
ϖ Most common site of nosocomial infection (hospital acquired infection)
UTI
91
most common bacteria with UTI
E. Coli
92
lower UTI locations
bladder and structures below the bladder
93
upper UTI locations
kidneys and ureters
94
lower UTIs
urethritis
cystitis
bacterial prostatitis
95
♣ Inflammation in urethra
urethritis
96
inflammation of the bladder (bladder infection)
cystitis
97
Enlarged, inflamed prostate that becomes infected because they have urinary stasis because they cannot urinate frequently and they get an infection
Bacterial prostatitis
98
upper UTIs
pyleonephritis
99
infection moved up the urinary tract to the kidneys—More serious
pyleonephritis
100
common sx of lower UTI (cystitis)
Pain—suprapubic or pelvic
Itching or burning on urination
Urinary Urgency
Urinary
Frequency
Discharge
Nocturne
101
1st sign of infection in elderly ---->
altered mental status
102
how to collect a MSCC UA?
* Wash hands
* Clean from front to back (or tip of penis)
* Let urine flow for a little while when you first urinate
* Pee in the cup
103
MSCC UA from a foley?
o Collect it in the bag the first time if still sterile
o If it has been in there a while—clamp tubing for few mins, scrub port, w/draw urine with a syringe
104
anti-infective, urinary tract
nitrofurantoin (Macrodantin)
105
bactericidal
cephalexin (Keflex)
106
cephalosporin
cefadroxil (Duricef, Ultracef)
107
Fluroquinolone
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
108
Penicillin
ampicillin
amoxicillin
109
Trimethoprim-sulfamethoxazole combo
co-trimoxazole (Bactrim))
110
education for bactrim
sun sensitivity & photosensitivity
111
Urinary analgesic agent
Phenazopyridine (Pyridium)
112
education with pyridium
will turn your pee orange
113
sx of acute pyelonephritis
```
chills
fever
CVA pain
tenderness
flank pain
lower back pain
pyuria
hematuria
```
114
tx of acute pyelonephritis
2 week course of ATB
115
difference between acute pyelonephritis and chronic pyelonephritis
chronic is recurring
116
sx of chronic pyelonephritis
don't have constant pain, but pain is increased in acute exacerbations
117
who's at increased risk of urosepsis with chronic pyelonephritis?
elderly & children
118
ϖ Infection spreads from urinary system to blood stream
urosepsis
119
common population with urosepsis?
elderly women,
immunocompromised people,
diabetics,
severe UTI,
indwelling catheters,
kidney stones
120
tx of urosepsis
ϖ culture urine and blood, broad spectrum antibiotics until culture and sensitivity is complete, life support measures if patient is in septic shock
121
normal WBCs in urine =
0-5
122
involuntary/unpredictable expulsion of urine
urinary incontinence
123
types of urinary incontinence
```
urge
stress incontinence
functional
mixed
overflow
```
124
• strong urge to void that cannot be suppressed
urge
125
• Loss of urine through intact urethra d/t sneezing, coughing, or changing position
stress incontinence
126
• physical impairments make it difficult/impossible for pt to reach the toilet in time.
functional
127
Encompasses several types of urinary incontinence
mixed
128
associated with urine retention
bladder fills up really big, can't fully empty it ---> has dribbling
overflow
129
common people with overflow incontinence?
males with prostate problems
130
types of treatment for urinary incontinence
behavioral
medications
surgery
131
encourage habit training by doing what?
bringing patient to the restroom q 2 hours
132
what kind of exercise do prevent urinary incontinence?
kegals
133
diet changes for urinary incontinence?
slack off fluids around 4-6 pm
134
what type of meds to prevent urinary incontinence?
anticholinergics
TCAs
sudofedrine
135
side effects of anticholinergic drugs?
dry mouth, dry eyes, constipation.
136
education when patient is taking anticholinergic?
chew gum
increase fluids
increase fiber for constipation
137
how to TCAs prevent urinary incontinence?
help decrease bladder contractions
138
watch for ___ ___ with sudofedrine?
urinary retention
139
surgeries to prevent urinary incontinence?
bladder lifts
bladder neck suspension
prostatectomy
140
if patient is on vancomycin check for ?
renal function
141
ϖ Inability to completely empty bladder
urinary retention
142
urine that is still left in bladder after voiding
Residual urine
143
Shouldn’t have more than _____ left in bladder after voiding in elderly pt; younger pts should have even less than that
100ml
144
ϖ Causes of urinary retention
enlarged prostate,
surgery and medications cause lazy bladder,
bashful bladder
145
o Assess patient for urinary retention by:
palpate bladder
catheter
146
if there is functional retention use ____ _____ to make the bladder contract.
cholinergic medications
147
ex of cholinergic meds
urocholine
148
• If an obstruction is occurring the patient may need a surgically inserted _____ _______, may be temporary or permanent
suprapubic catheter
149
risk for _____ with urinary retention
infection due to stasis of urine
150
ϖ Results from a dysfunction of the nervous system that causes bladder to not work correctly
neurogenic bladder
151
neurogenic bladder is often caused by?
spina bifida,
spinal injury,
severe diabetic
neuropathy,
MS,
neuropathy
152
common complication of neurogenic bladder
ϖ Common complication infection due to stasis of urine
153
treatment of neurogenic bladder
patients are taught to self cath or do intermittent cats several times a day
154
is home cath sterile or clean?
clean
155
how much urine per cath?
300-500ml
156
if they have more than 500 ml per cath what should you instruct patient to do?
cath more frequently
157
when are patients due to void after removal of cath
within 6-8 hours
158
ϖ Commonly called renal calculi or kidney stones
URINARY CALCULI
159
ϖ Urinary stones (urolithiasis) may develop where in the urinary system?
at any level in the urinary system
160
ϖ Stones are most frequently found in the _____.
kidney
161
"kidney stones"
(nephrolithiasis)
162
ϖ Formed from urine that is supersaturated with a stone forming salt (calcium, phosphate, uric acid)
urinary calculi
163
o Those with gout and uric acid stones are placed on a special diet such as?
avoid red meat and seafood
164
______ can also can precipitate stone formation
Dehydration
165
renal calculi are common in ?
males over 40
166
common complaints with renal calculi
sharp sudden severe pain
| may be intermittent depending on stone movement
167
why is the pain intermittent with renal calculi?
renal colic (due to stretching of ureters)
168
diagnosis of renal calculi by what tests?
UA
IVP
CAT scan
169
risk factors for renal calculi
* Infection
* Urinary stasis
* Immobility
* Hyper calcemia
* Increased uric acid
* Increased urinary oxalate level
170
goal of renal calculi
PAIN, STRAIN, PREVENT COMPLICATIONS
171
Renal calculi can lead to _______ if severe.
hydronephrosis
172
immediate goal for renal calculi
RELIEVE PAIN
173
if a patient has bladder stones they have what type of sxs?
UTI like symptoms
| frequency, burning, NOT flank pain
174
why might BP be low with a pt. who has renal calculi?
Stimulates SNS and they get a vagal response
175
vagal response symptoms?
vasoconstriction: pale, sweaty, low BP, tachycardia
176
o Should we consider IV fluids for renal calculi? and WHY?
YES, to stabilize BP and flush out bacteria and promote fluid movement through kidneys
177
o Urine flow cannot go anywhere.
Backflow of urine into kidney
o May be unilateral or bilateral
hydronephrosis
178
hydronephrosis is usually from what happening?
kidney stones or prostate issues
179
goal for hydronephrosis
manage or eradicate the stone all together and prevent nephron damage in the kidney
180
surgery for hydronephrosis?
stents
lithotripsy
nephroscomy tubes
181
o Done if stone is over 5mm or too big to pass
lithotripsy
182
o May go in with a scope through the urethra and grab fragments or patient may just pass fragments on their own
lithotripsy
183
* Non invasive
* 90% effective
* A high-energy amplitude of pressure, or shock wave, is generated by the abrupt release of energy and transmitted through water and soft tissues ---> causes stone to shatter ----> pieces of stone are excreted in urine
Extracorporeal Shock Wave Lithotripsy (ESWL)
184
what should you teach patients receiving ESWL treatment?
they will see bruising
NO anticoagulants or aspirin
185
what will patients be given during ESWL?
anesthesia to remain still
186
• Stints may be placed into ureters after ESWL and what will remain inside the patient?
string will go all the way out and string is used to pull them out after swelling is down
187
• Put probe into renal pelvis
sends ultrasonic waves
Percutaneous nephrolithotomy ultrasound
188
• Most of the time a ______ tube will be placed to help with swelling after a Percutaneous nephrolithotomy ultrasound
nephrostomy
189
used for larger stones
o Percutaneous nephrolithotomy ultrasound
190
PRE-OP instructions
NPO & Bowl prep
191
POST-OP most important
pain control
192
urine should be ___ post op?
pink tinged and should not be cloudy
193
what is usually used for pain control post-op?
tordol
194
goal of patient with renal calculi?
relieve PAIN
195
client is undergoing ESWL. what would you report?
arrhythmia on ECG.
196
what can you delegate to an LPN
48 year old with cystitis who is taking oral ATB
197
risk factors for renal tumors
tobacco use and hypertension
198
treatment for renal tumors
remove tumor or nephrectomy
| NO pharmacologic treatment
199
bladder tumors are more common in who?
males older than 55 who smoke
200
manifestations of bladder tumors
PAINLESS HEMATURIA
201
affects of tumor or urinary system
o Obstruction
o Resultant Renal Failure because of the obstruction
o Hemorrhage
o Tissue Destruction problems with hemorrhage
o All the above can lead to renal failure if progression continues
202
what to instruct patient who has bladder cancer and is scared of chemo
BCG acts directly on bladder tissue (won’t have many side effects of chemo)
203
how is BCG therapy administered?
through a foley
204
stimulates immune system to fight off cancer cells in the bladder
BCG therapy
205
why must you change positions q 15 minutes after BCG therapy
to get the medicine on all sides of the bladder
206
what symptoms to experience during the weeks of treatment
frequency
urgency
bladder spasms
hematuria
207
how often is BCG therapy done?
Usually given once a week for about 6 weeks break few months do it for about 3 weeks
208
during BCG therapy a patient may experience __-___ symptoms
flu-like
209
BCG therapy Stimulates the ____ ____ rather than directly destroying cancer cells.
immune system
210
main complaint during BCG therapy
malaise
burning on urination
hematuria
211
how to prevent tumors
quit smoking
prevent industrial exposure and chronic inflammation or infection of bladder mucosa
212
bladder cancer often metastasizes to the ____ tissue.
lung
213
if someone has back pain, hip pain, pelvic or rib pain suspect _____.
metastasis.
214
what treatment for bladder cancer if chemo is not effective
cystectomy with urinary diversion
215
bladder removal
cystectomy
216
total radical for men includes:
prostate, seminal vessels
217
total radical for women
total hysterectomy and removal of tubes and ovaries
218
2 types of urinary diversions
incontinent and continent
219
most common incontinent diversion
illeal conduit
220
uses the ileum or colon to prepare opening for ureters to drain
ileal conduit
221
♣ Ureters are directed through the abdominal wall and attached to an opening in the skin
Cutaneous Urostomy
222
examples of continent pouches
kock/indiana pouch
223
♣ Must be drained at regular intervals by a catheter
| patient self caths
kock pouch
224
pre op for urinary diversion
liquid diet for several days
225
teaching for stomas
no straining and no heavy lifting
226
color of stoma should be?
rose, brick red
227
what should urine output be per hour with stoma
30 ml hour
228
bowels have mucous build up. what do we do?
flush with 5-10 ml NS
229
urine is very acidic so we need to teach our patients what?
to apply barrier 1/8 inch around the stoma
230
after ill conduit, patient may have ____ for 48 hours
hematuria
231
a temporary ______ tube may be used to decrease stress on renal tubule until kidneys are working properly so they don't get backed up into kidney and get hydronephrosis
nephrostomy
232
post op education after nephrostomy tube?
make sure the tubes are draining and have no kinks, or clogs
233
odor control for nephrostomy tube
vinegar or detergent drops
234
o Caused by a reflux of urine
prostatitis
235
prostatitis is caused by?
E. coli
236
acute prostatitis symptoms
Sudden onset of fever, dysuria, perineal prostatic pain, severe lower urinary tract symptoms dysuria, frequency, urgency, hesitancy, nocturia
237
chronic prostatitis symptoms
asymptomatic
238
chronic prostatitis occurs with patients who have recurrent _____.
UTIs
239
treatment of prostatitis
antibiotics
240
ex of ATB used for prostatitis
fluoroquinolone drugs (cipro)
and
Bactrim (trimethoquin sulfamethazole )
241
may be prescribed to promote bladder and prostate relaxation to increase urine outflow
alpha-adrenergic blocker
242
example of alpha-adrenergic blocker
flomax
243
what to monitor for with alpha-adrenergic blockers like flomax?
orthostatic hypotension
244
prostatitis can be very painful in the acute phase. how would you instruct the patient to promote comfort?
warm sitz bath, avoid food and drinks that stimulate the bladder
245
NO _____ or _____ during acute inflammation phase to prevent prostatic secretions
intercourse or arousal
246
o No exact known cause, but family history, smoking, age, diet high in meat and fats are risk factors
ϖ Benign Prostatic Hypertrophy (BPH)
247
BPH is an _____ process; not an infection.
inflammatory
248
BPH does not predispose men to ____.
cancer.
249
BPH complaints
```
• Straining to urinate
• Difficulty starting stream
• Dribbling even after urinating
• Nocturia
• Hematuria
• Dysuria
• Urgency, frequency
Unable to empty bladder
```
250
diagnosis of BPH
digital rectal exam
UA
creatinine
PSA
post-void residual urine
IVP
H & P (dripping of urine)
251
− Screening to make sure patient doesn’t have a risk factor for cancer…not a test to see if they actually have cancer, just a high risk for cancer
prostate specific antigen (PSA)
252
using a catheter, voiding, or CT scan to see urine in the bladder after voiding
post-void residual urine
253
how much urine should be in bladder after voiding
50 ml or less
254
− Specific questionnaire for the physician to ask the patient
− Used in conjunction with other tests to get a diagnosis
• The American Urological Society Symptom Questionaire
255
non surgical options for BPH
alpha 1 blockers
anti-androgen agents (5 alpha reductase inhibitors)
256
- Relieve obstruction and increase urine flow d/t excessive smooth muscle contraction
- Relax smooth muscle of bladder neck and prostate—improves urine flow and relieves symptoms
alpha 1 blockers
257
example of alpha 1 blockers
Tamsulosin/Flomax
Terazosin/Hytrin
Doxazoxin/Cardura
Alfuzosin/Uroxatral
258
side effect of alpha 1 blockers
orthostatic hypotension
259
- Shrink (decrease) prostate size
| - Prevents conversion of testosterone to DHT
anti-adrogen agents (5 alpha reductase inhibitors)
260
example of anti-adrogen agents (5 alpha reductase inhibitors)
Finasteride/Proscar
Dutasteride/Avodart
261
side effects of anti-adrogen agents (5 alpha reductase inhibitors)
impotence
gynecomastia
decreased libio
262
important information for anti-adrogen agents (5 alpha reductase inhibitors)
women of childbearing age CAN'T handle this medication
263
• Most common cancer in American men
cancer of the prostate
264
risk factors for cancer of the prostate
genetic disposition
265
how does cancer of the prostate start?
in a discrete nodule then spreads
266
when the patient with cancer of the prostate start having urinary problems what does that mean?
the tumor has grown outside the prostate
267
a test useful both in diagnosis and follow-up of prostate CA
PSA
268
normal PSA level
0-2.5
269
any man over age 50 needs annual
DRE
270
most definite way to diagnose cancer of the prostate?
biopsy
271
ranks the severity of the cancer
gleason score
272
medications for cancer of the prostate?
hormone manipulations
| Lupron, zoladex, eulexin, casodex, degralix
273
why do they give hormone medications for cancer of the prostate?
the cancer is testosterone dependent
274
radiologic seeds inserted into prostate
brachytherapy
275
education for brachytherapy?
use condoms
| stay away from PG women and babies and strain all urine
276
3 ways for prostate surgery
retropubic approach
superpubic approach
peroneal approach
277
go behind the bladder (bladder is not injured at all, should have no urine on dressing!)
retropubic approach
278
♣ go through bladder come back with urethrocatheter and superpubic catheter (temporary suprapubic cath and foley cath) Assess for urine leakage around dressing; 2-4 days after surgery urethral catheter may be removed and then a few days later the supra pubic will come out.
superpubic approach
279
♣ incision by rectum, look for signs of infections (dirty location), no rectal temp or enemas, good cleaning after bowel movement; no straining bowel movements
peroneal approach
280
post op prostatectomy
irrigation to prevent clots
incontinence and sexual problems
avoid constipation
281
surgical options for BPH and prostate cancer
TUMT
TUNA
TURP
TUIP
282
* Heat up prostate and destroy cells
| * Outpatient procedure
o Transurethral microwave heat treatment (TUMT)
283
Outpatient procedure
• Uses low-level radiofrequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues body resorbs the dead tissue
o Transurethral needle ablation (TUNA)
284
• No incision—all done through urethra
• Most common procedure done
• May use a laser, can also do a biopsy
Continuous bladder irrigation
Transurethral resection of the prostate (TURP)—
285
• No prostate tissue is removed, go make an incision in the prostate to relieve pressure
o Transurethral incision of the prostate (TUIP)
286
• Usually used to rid the prostate cancer completely when it is located to that area
o Open prostatectomy
287
pre-op TURP
assess NO anti-coagulants
bowel prep
pain management
3-way foley catheter
288
post-op TURP
* May or may not have continuous bladder irrigation
* If patient is voiding, monitor output very closely
* Make sure they do not have bright red bleeding—pinkish urine with with small clots can be expected, large blood clots can cause an obstruction
* Dribbling may be common after surgery but usually resolves
289
o Can be acute or chronic
| Inflammation of the glomerulus
Glomerulonephritis
290
Glomerulonephritis is caused by?
o immunologic abnormalities, diabetes, toxins (antibiotics), vascular disorders, systemic lupus
291
most common cause of Glomerulonephritis
strep infection
292
o Characterized by an accumulation of antigen and antibody that accumulate in the glomeruli, which results in tissue injury
Glomerulonephritis
293
Glomerulonephritis damage results in?
proteinuria,
hematuria,
changes in GFR (trouble filtrating) d/t changes in capillary wall structure
294
o Labs with glomerulonephritis show:
* High BUN and creatinine (high in serum)
| * Reduced creatinine clearance (low in urine)
295
manifestations for glomerulonephritis
•
Hematuria from tissue break down cocoa colored urine
• Proteinuria
Salt & water retention d/t decreased filtration
• Hypertension
• Azotemia
• Fatigue
• Anorexia (poor appetite), nausea, and vomiting
• Headache
296
building up too many toxins in the blood
azotemia
297
used to diagnose glomerulonephritis?
RBC and cast cells
298
treatment of glomerulonephritis
ATB
steroid therapy
299
chronic glomerulonephritis is treated the same as acute; except it will persist to ___ ____.
renal failure
300
nursing care of chronic glomerulonephritis
```
♣ Sodium restriction
♣ IO
♣ Listen for crackles
♣ Diuretics
♣ Cardiac monitoring—esp if K is elevated
Normally need dialysis
```
daily weights
301
chronic glomerulonephritis have problems with ____ because the EPO cycle is off.
anemia
302
Type of acute renal failure
o serious damage the glomerular capillary membrane
nephrotic syndrome
303
nephrotic syndrome happens as a result of a ____....it is not a disease itself.
disease
304
symptoms of nephrotic syndrome
```
• Increased glomerular permeability
• Proteinuria (>3.5 grams per/day)
• Hypoalbuminemia
• Diffuse edema
• High serum cholesterol
Hyperlipidemia
```
305
2 hallmark signs of nephrotic syndrome
proteinuria and edema
306
the goal of nephrotic syndrome is to slow the progression of CRF by??
− Rest
− Diuretics
− ACE Inhibitors to reduce proteinuria and control BP
Lipid-lowering agents
307
diet for nephrotic syndrome
− Low protein and low sodium diet
308
ϖ Genetic disorder
ϖ Destroys nephrons
ϖ Can lead to kidney failure
ϖ Can develop cysts on other organs
POLYCYSTIC KIDNEY DISEASE
309
sx of POLYCYSTIC KIDNEY DISEASE
enlarged kidneys,
impaired renal labs,
hematuria from kidney damage,
polyuria,
HTN,
flank pain
310
if patient has polycystic kidney disease, we can improve their renal function by?
kidney transplant
311
pre-op kidney surgery. ____ is important
hydration
312
if donating a kidney, may be placed on ____ temporarily or permanently after surgery.
dialysis
313
post-op kidney surgery
breathing will hurt
watch for bleeding! (Kidneys are vascular)
