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7th Semester > 400 Exam 1 > Flashcards

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

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2
Q

other fxns of the kidneys

A

Regulates body fluid volume,

osmolality,

electrolytes,

acid-base balance

excretes wastes

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3
Q

which kidney is lower?

A

right

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4
Q

kidney is surrounded by ____ and held together by ___.

A

renal capsule & renal fascia

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5
Q

o connective tissue that provides protection from trauma

A

renal fascia

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6
Q

o Patient with severe coronary artery disease could also get ?

A

renal disease

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7
Q

are approximately 30cm long in average adult and extend from the renal pelvis down to the bladder

A

o Ureters

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8
Q

inner tissue of bladder is made of

A

rugae

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9
Q

elastic tissue that allows the bladder to stretch

A

rugae

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10
Q

involuntary control of flow

A

internal urethral orifice

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11
Q

voluntary flow control

A

external urethral orifice

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12
Q

who’s urethra is shorter?

A

females

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13
Q

o male reproductive gland that surrounds the urethra

A

prostate gland

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14
Q

ϖ The process by which urine is made

A

ultrafiltration

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15
Q

ϖ Average adult urine output

A

1-2 L/day

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16
Q

ultrafiltration is measured by?

A

GFR

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17
Q

Amt of glomerular filtrate formed in 1 min

A

GFR

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18
Q

ϖ Kidneys maintain stability by balancing fluid & solute composition of the blood using three processes?

A

Filtration, Resorption, Secretion

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19
Q

ϖ Final refinement of urine is regulated by ?

A

Aldosterone and ADH/ vasopressin

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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

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21
Q

if water loss is too high?

A

ADH is released & kidneys retain water

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22
Q

is a steroid secreted by the adrenal cortex assists in the resorption of sodium

A

aldosterone

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23
Q

As the filtrate moves from proximal to distal tubules it becomes ?

A

more concentrated and more acidic

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24
Q

ϖ Final pH of urine is usually

A

5-6

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25
Q

ϖ A major function of kidney is ?

A

conservation of water and electrolyte

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26
Q

Electrolytes are filtered out in ?

A

Bowman’s capsule

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27
Q

Electrolyte concentration is adjusted in the distal nephron by ?

A

ADH and aldosterone

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28
Q

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

A

blood bicarbonate to carbon dioxide ratio

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29
Q

ϖ Normal plasma pH for arterial blood is

A

7.35-7.45

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30
Q

ϖ Blood bicarbonate/carbon dioxide ratio

A

20:1

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31
Q

Lungs vary the rate of ___ by breathing and kidneys secrete or retain ______

A

CO2; bicarbonate

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32
Q

ϖ This is the process by which red blood cells are produced

A

Erythropoiesis

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33
Q

what triggers increased production of erythropoietin

A

Hypoxia and anemia

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34
Q

Erythropoiesis cannot occur In pts w/

A

anemia associated with renal failure, renal insufficiency, or cancer

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35
Q

generically engineered erythropoietin

A

epogen and procrit injections

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36
Q

ϖ Calcium is crucial for ??

A

bone formation,

cell growth,

blood coagulation,

hormone response and

cellular electrical activity

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37
Q

ϖ Phosphate is necessary for?

A

glucose metabolism

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38
Q

If the kidney is not functioning properly the body will draw calcium from somewhere, often the ____.

A

bones

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39
Q

renal patients are at high risk for developing ____.

A

fractures

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40
Q

BP is maniputlated through the kidney by?

A

ADH
renin-angiotension system
aldosterone

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41
Q

causes kidneys to resorb water

A

ADH response

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42
Q

is a hormone that stimulates the conversion of angiotensinogen to angiotensin I

A

renin

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43
Q

renin also causes a release of angiotensin converting enzyme (ACE) from the lungs causing?

A

vasoconstriction and a release of aldosterone to help increase BP

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44
Q

contained in the glomerular filtrate & is excreted unchanged into the urine

A

Creatinine

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45
Q

a byproduct of muscle metabolism and it is excreted by the kidneys at a constant rate and amount

A

Creatinine

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46
Q

creatinine excreted by the kidneys at a constant rate & amount

A

creatinine clearance

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47
Q

A rise in creatinine means ?

A

kidneys aren’t filtering & excreting as they should

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48
Q

is the best indicator of renal func.

A

creatinine

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49
Q

most drugs are either ?

A

excreted directly by the kidneys or first metabolized by the liver, then excreted by the kidneys

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50
Q

____-____ of urine fills in bladder prior to getting the urge to urinate

A

200-300ml

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51
Q

physiologic changes with aging

A

arteriosclerotic changes

prostatic hypertrophy

stress incontinence

fluid & electrolyte imbalance

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52
Q

Untreated _____ can accelerate arteriosclerosis and lead to kidney failure

A

hypertension

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53
Q

o People with known arteriosclerosis should have frequent evaluations of their ?

A

kidney function

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54
Q

common in older men & if left untreated can obstruct the flow of urine

A

prostatic hypertrophy

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55
Q

prostatic hypertrophy patients are often placed on what kind of meds?

A

antibiotics/steroids or meds like Flomax to help decrease the size of the prostate

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56
Q

o Common in aging women and even men as a result of weakened muscle tone

A

stress incontinence

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57
Q

ex of stress incontinence

A

sudden movement

sneezing

stretching

exercising

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58
Q

GFR decreases around age ___.

A

40

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59
Q

as a person ages the ____ stimulation decreases

A

thirst

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60
Q

elderly patients can become ____ and dehydrated without realizing they are thirsty

A

hypernatremic

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61
Q

how is a 24 hour urine collected

A

very first urine discarded and the clock starts after the first urine

jug is kept on ice

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62
Q

mid stream clean catch instructions

A

wipe first

pee a little bit

stop

finish peeing in cup

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63
Q

o how to prevent infection with a foley catheter

A
  • 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

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64
Q

− A normal ratio with an elevated BUN and creatinine is seen with

A

intrinsic renal disease

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65
Q

− An elevated BUN-creatinine ratio is seen in

A

hypovolemia

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66
Q

• 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

A

Intravenous Pyelography (IVP)

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67
Q

must do what before IVP

A

check BUN-creatinine ratio

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68
Q

why check ratio before IVP?

A

it can cause renal failure

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69
Q

• Direct visualization going through the meatus and into the structures of the renal system into the bladder

A

o Cystoscopy/ Endoscopy

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70
Q

After endoscopic procedures patient will have some

A

burning and urge to void without being able to and some bladder retention

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71
Q

what to observe for after endoscopy/cystoscopy?

A

Blood in the urine (NOT normal)

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72
Q

what to monitor for after Renal/ Kidney Biopsy

A

bleeding

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73
Q

patients are on bedrest for how long after renal/kidney biopsy

A

24 hours

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74
Q

Painful or difficult voiding

A

ϖ Dysuria

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75
Q

Frequent voiding—more than every 3 hours

A

ϖ Frequency

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76
Q

Strong desire to void

A

ϖ Urgency

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77
Q

excessive urination at night

A

nocturia

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78
Q

delay, difficulty in initaiting voiding

A

hesitancy

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79
Q

involuntary loss of urine

A

incontinence

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80
Q

increased volume of urine voided

A

polyuria

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81
Q

polyuria = > ____ ml

A

3,000ml in 24 hours

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82
Q

urine output less than 500 ml/day

A

oliguria

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83
Q

urine output less than 50ml/day

A

anuria

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84
Q

Muscle or tissue break down

A

ϖ Myoglobinuria

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85
Q

Myoglobinuria looks like?

A

coco colored

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86
Q

Myoglobinuria is seen with conditions such as?

A

glomerulonephritis

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87
Q

Red blood cells in the urine

A

hematuria

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88
Q

ϖ Second most common bacterial disease

A

UTI

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89
Q

who is at greatest risk for UTI

A

females

elderly

catheter patients

anyone with invasive procedure

diabetics

anyone with obstruction from prostate or kidney stone

women that use spermicidal agents and diaphragms

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90
Q

ϖ Most common site of nosocomial infection (hospital acquired infection)

A

UTI

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91
Q

most common bacteria with UTI

A

E. Coli

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92
Q

lower UTI locations

A

bladder and structures below the bladder

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93
Q

upper UTI locations

A

kidneys and ureters

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94
Q

lower UTIs

A

urethritis

cystitis

bacterial prostatitis

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95
Q

♣ Inflammation in urethra

A

urethritis

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96
Q

inflammation of the bladder (bladder infection)

A

cystitis

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97
Q

Enlarged, inflamed prostate that becomes infected because they have urinary stasis because they cannot urinate frequently and they get an infection

A

Bacterial prostatitis

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98
Q

upper UTIs

A

pyleonephritis

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99
Q

infection moved up the urinary tract to the kidneys—More serious

A

pyleonephritis

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100
Q

common sx of lower UTI (cystitis)

A

Pain—suprapubic or pelvic

Itching or burning on urination

Urinary Urgency

Urinary

Frequency

Discharge

Nocturne

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101
Q

1st sign of infection in elderly —->

A

altered mental status

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102
Q

how to collect a MSCC UA?

A
  • 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
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103
Q

MSCC UA from a foley?

A

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

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104
Q

anti-infective, urinary tract

A

nitrofurantoin (Macrodantin)

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105
Q

bactericidal

A

cephalexin (Keflex)

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106
Q

cephalosporin

A

cefadroxil (Duricef, Ultracef)

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107
Q

Fluroquinolone

A

ciprofloxacin (Cipro)

levofloxacin (Levaquin)

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108
Q

Penicillin

A

ampicillin

amoxicillin

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109
Q

Trimethoprim-sulfamethoxazole combo

A

co-trimoxazole (Bactrim))

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110
Q

education for bactrim

A

sun sensitivity & photosensitivity

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111
Q

Urinary analgesic agent

A

Phenazopyridine (Pyridium)

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112
Q

education with pyridium

A

will turn your pee orange

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113
Q

sx of acute pyelonephritis

A 
chills 
fever
CVA pain
tenderness
flank pain
lower back pain
pyuria
hematuria
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114
Q

tx of acute pyelonephritis

A

2 week course of ATB

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115
Q

difference between acute pyelonephritis and chronic pyelonephritis

A

chronic is recurring

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116
Q

sx of chronic pyelonephritis

A

don’t have constant pain, but pain is increased in acute exacerbations

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117
Q

who’s at increased risk of urosepsis with chronic pyelonephritis?

A

elderly & children

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118
Q

ϖ Infection spreads from urinary system to blood stream

A

urosepsis

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119
Q

common population with urosepsis?

A

elderly women,

immunocompromised people,

diabetics,

severe UTI,

indwelling catheters,

kidney stones

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120
Q

tx of urosepsis

A

ϖ culture urine and blood, broad spectrum antibiotics until culture and sensitivity is complete, life support measures if patient is in septic shock

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121
Q

normal WBCs in urine =

A

0-5

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122
Q

involuntary/unpredictable expulsion of urine

A

urinary incontinence

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123
Q

types of urinary incontinence

A 
urge
stress incontinence
functional
mixed
overflow
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124
Q

• strong urge to void that cannot be suppressed

A

urge

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125
Q

• Loss of urine through intact urethra d/t sneezing, coughing, or changing position

A

stress incontinence

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126
Q

• physical impairments make it difficult/impossible for pt to reach the toilet in time.

A

functional

127
Q

Encompasses several types of urinary incontinence

A

mixed

128
Q

associated with urine retention

bladder fills up really big, can’t fully empty it —> has dribbling

A

overflow

129
Q

common people with overflow incontinence?

A

males with prostate problems

130
Q

types of treatment for urinary incontinence

A

behavioral
medications
surgery

131
Q

encourage habit training by doing what?

A

bringing patient to the restroom q 2 hours

132
Q

what kind of exercise do prevent urinary incontinence?

A

kegals

133
Q

diet changes for urinary incontinence?

A

slack off fluids around 4-6 pm

134
Q

what type of meds to prevent urinary incontinence?

A

anticholinergics
TCAs
sudofedrine

135
Q

side effects of anticholinergic drugs?

A

dry mouth, dry eyes, constipation.

136
Q

education when patient is taking anticholinergic?

A

chew gum
increase fluids
increase fiber for constipation

137
Q

how to TCAs prevent urinary incontinence?

A

help decrease bladder contractions

138
Q

watch for ___ ___ with sudofedrine?

A

urinary retention

139
Q

surgeries to prevent urinary incontinence?

A

bladder lifts

bladder neck suspension

prostatectomy

140
Q

if patient is on vancomycin check for ?

A

renal function

141
Q

ϖ Inability to completely empty bladder

A

urinary retention

142
Q

urine that is still left in bladder after voiding

A

Residual urine

143
Q

Shouldn’t have more than _____ left in bladder after voiding in elderly pt; younger pts should have even less than that

A

100ml

144
Q

ϖ Causes of urinary retention

A

enlarged prostate,

surgery and medications cause lazy bladder,

bashful bladder

145
Q

o Assess patient for urinary retention by:

A

palpate bladder

catheter

146
Q

if there is functional retention use ____ _____ to make the bladder contract.

A

cholinergic medications

147
Q

ex of cholinergic meds

A

urocholine

148
Q

• If an obstruction is occurring the patient may need a surgically inserted _____ _______, may be temporary or permanent

A

suprapubic catheter

149
Q

risk for _____ with urinary retention

A

infection due to stasis of urine

150
Q

ϖ Results from a dysfunction of the nervous system that causes bladder to not work correctly

A

neurogenic bladder

151
Q

neurogenic bladder is often caused by?

A

spina bifida,

spinal injury,

severe diabetic

neuropathy,

MS,

neuropathy

152
Q

common complication of neurogenic bladder

A

ϖ Common complication infection due to stasis of urine

153
Q

treatment of neurogenic bladder

A

patients are taught to self cath or do intermittent cats several times a day

154
Q

is home cath sterile or clean?

A

clean

155
Q

how much urine per cath?

A

300-500ml

156
Q

if they have more than 500 ml per cath what should you instruct patient to do?

A

cath more frequently

157
Q

when are patients due to void after removal of cath

A

within 6-8 hours

158
Q

ϖ Commonly called renal calculi or kidney stones

A

URINARY CALCULI

159
Q

ϖ Urinary stones (urolithiasis) may develop where in the urinary system?

A

at any level in the urinary system

160
Q

ϖ Stones are most frequently found in the _____.

A

kidney

161
Q

“kidney stones”

A

(nephrolithiasis)

162
Q

ϖ Formed from urine that is supersaturated with a stone forming salt (calcium, phosphate, uric acid)

A

urinary calculi

163
Q

o Those with gout and uric acid stones are placed on a special diet such as?

A

avoid red meat and seafood

164
Q

______ can also can precipitate stone formation

A

Dehydration

165
Q

renal calculi are common in ?

A

males over 40

166
Q

common complaints with renal calculi

A

sharp sudden severe pain

may be intermittent depending on stone movement

167
Q

why is the pain intermittent with renal calculi?

A

renal colic (due to stretching of ureters)

168
Q

diagnosis of renal calculi by what tests?

A

UA
IVP
CAT scan

169
Q

risk factors for renal calculi

A
  • Infection
  • Urinary stasis
  • Immobility
  • Hyper calcemia
  • Increased uric acid
  • Increased urinary oxalate level
170
Q

goal of renal calculi

A

PAIN, STRAIN, PREVENT COMPLICATIONS

171
Q

Renal calculi can lead to _______ if severe.

A

hydronephrosis

172
Q

immediate goal for renal calculi

A

RELIEVE PAIN

173
Q

if a patient has bladder stones they have what type of sxs?

A

UTI like symptoms

frequency, burning, NOT flank pain

174
Q

why might BP be low with a pt. who has renal calculi?

A

Stimulates SNS and they get a vagal response

175
Q

vagal response symptoms?

A

vasoconstriction: pale, sweaty, low BP, tachycardia

176
Q

o Should we consider IV fluids for renal calculi? and WHY?

A

YES, to stabilize BP and flush out bacteria and promote fluid movement through kidneys

177
Q

o Urine flow cannot go anywhere.

Backflow of urine into kidney

o May be unilateral or bilateral

A

hydronephrosis

178
Q

hydronephrosis is usually from what happening?

A

kidney stones or prostate issues

179
Q

goal for hydronephrosis

A

manage or eradicate the stone all together and prevent nephron damage in the kidney

180
Q

surgery for hydronephrosis?

A

stents

lithotripsy

nephroscomy tubes

181
Q

o Done if stone is over 5mm or too big to pass

A

lithotripsy

182
Q

o May go in with a scope through the urethra and grab fragments or patient may just pass fragments on their own

A

lithotripsy

183
Q
  • 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
A

Extracorporeal Shock Wave Lithotripsy (ESWL)

184
Q

what should you teach patients receiving ESWL treatment?

A

they will see bruising

NO anticoagulants or aspirin

185
Q

what will patients be given during ESWL?

A

anesthesia to remain still

186
Q

• Stints may be placed into ureters after ESWL and what will remain inside the patient?

A

string will go all the way out and string is used to pull them out after swelling is down

187
Q

• Put probe into renal pelvis

sends ultrasonic waves

A

Percutaneous nephrolithotomy ultrasound

188
Q

• Most of the time a ______ tube will be placed to help with swelling after a Percutaneous nephrolithotomy ultrasound

A

nephrostomy

189
Q

used for larger stones

A

o Percutaneous nephrolithotomy ultrasound

190
Q

PRE-OP instructions

A

NPO & Bowl prep

191
Q

POST-OP most important

A

pain control

192
Q

urine should be ___ post op?

A

pink tinged and should not be cloudy

193
Q

what is usually used for pain control post-op?

A

tordol

194
Q

goal of patient with renal calculi?

A

relieve PAIN

195
Q

client is undergoing ESWL. what would you report?

A

arrhythmia on ECG.

196
Q

what can you delegate to an LPN

A

48 year old with cystitis who is taking oral ATB

197
Q

risk factors for renal tumors

A

tobacco use and hypertension

198
Q

treatment for renal tumors

A

remove tumor or nephrectomy

NO pharmacologic treatment

199
Q

bladder tumors are more common in who?

A

males older than 55 who smoke

200
Q

manifestations of bladder tumors

A

PAINLESS HEMATURIA

201
Q

affects of tumor or urinary system

A

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
Q

what to instruct patient who has bladder cancer and is scared of chemo

A

BCG acts directly on bladder tissue (won’t have many side effects of chemo)

203
Q

how is BCG therapy administered?

A

through a foley

204
Q

stimulates immune system to fight off cancer cells in the bladder

A

BCG therapy

205
Q

why must you change positions q 15 minutes after BCG therapy

A

to get the medicine on all sides of the bladder

206
Q

what symptoms to experience during the weeks of treatment

A

frequency
urgency
bladder spasms
hematuria

207
Q

how often is BCG therapy done?

A

Usually given once a week for about 6 weeks break few months do it for about 3 weeks

208
Q

during BCG therapy a patient may experience __-___ symptoms

A

flu-like

209
Q

BCG therapy Stimulates the ____ ____ rather than directly destroying cancer cells.

A

immune system

210
Q

main complaint during BCG therapy

A

malaise
burning on urination
hematuria

211
Q

how to prevent tumors

A

quit smoking

prevent industrial exposure and chronic inflammation or infection of bladder mucosa

212
Q

bladder cancer often metastasizes to the ____ tissue.

A

lung

213
Q

if someone has back pain, hip pain, pelvic or rib pain suspect _____.

A

metastasis.

214
Q

what treatment for bladder cancer if chemo is not effective

A

cystectomy with urinary diversion

215
Q

bladder removal

A

cystectomy

216
Q

total radical for men includes:

A

prostate, seminal vessels

217
Q

total radical for women

A

total hysterectomy and removal of tubes and ovaries

218
Q

2 types of urinary diversions

A

incontinent and continent

219
Q

most common incontinent diversion

A

illeal conduit

220
Q

uses the ileum or colon to prepare opening for ureters to drain

A

ileal conduit

221
Q

♣ Ureters are directed through the abdominal wall and attached to an opening in the skin

A

Cutaneous Urostomy

222
Q

examples of continent pouches

A

kock/indiana pouch

223
Q

♣ Must be drained at regular intervals by a catheter

patient self caths

A

kock pouch

224
Q

pre op for urinary diversion

A

liquid diet for several days

225
Q

teaching for stomas

A

no straining and no heavy lifting

226
Q

color of stoma should be?

A

rose, brick red

227
Q

what should urine output be per hour with stoma

A

30 ml hour

228
Q

bowels have mucous build up. what do we do?

A

flush with 5-10 ml NS

229
Q

urine is very acidic so we need to teach our patients what?

A

to apply barrier 1/8 inch around the stoma

230
Q

after ill conduit, patient may have ____ for 48 hours

A

hematuria

231
Q

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

A

nephrostomy

232
Q

post op education after nephrostomy tube?

A

make sure the tubes are draining and have no kinks, or clogs

233
Q

odor control for nephrostomy tube

A

vinegar or detergent drops

234
Q

o Caused by a reflux of urine

A

prostatitis

235
Q

prostatitis is caused by?

A

E. coli

236
Q

acute prostatitis symptoms

A

Sudden onset of fever, dysuria, perineal prostatic pain, severe lower urinary tract symptoms dysuria, frequency, urgency, hesitancy, nocturia

237
Q

chronic prostatitis symptoms

A

asymptomatic

238
Q

chronic prostatitis occurs with patients who have recurrent _____.

A

UTIs

239
Q

treatment of prostatitis

A

antibiotics

240
Q

ex of ATB used for prostatitis

A

fluoroquinolone drugs (cipro)

and

Bactrim (trimethoquin sulfamethazole )

241
Q

may be prescribed to promote bladder and prostate relaxation to increase urine outflow

A

alpha-adrenergic blocker

242
Q

example of alpha-adrenergic blocker

A

flomax

243
Q

what to monitor for with alpha-adrenergic blockers like flomax?

A

orthostatic hypotension

244
Q

prostatitis can be very painful in the acute phase. how would you instruct the patient to promote comfort?

A

warm sitz bath, avoid food and drinks that stimulate the bladder

245
Q

NO _____ or _____ during acute inflammation phase to prevent prostatic secretions

A

intercourse or arousal

246
Q

o No exact known cause, but family history, smoking, age, diet high in meat and fats are risk factors

A

ϖ Benign Prostatic Hypertrophy (BPH)

247
Q

BPH is an _____ process; not an infection.

A

inflammatory

248
Q

BPH does not predispose men to ____.

A

cancer.

249
Q

BPH complaints

A 
•	Straining to urinate
•	Difficulty starting stream
•	Dribbling even after urinating
•	Nocturia
•	Hematuria
•	Dysuria
•	Urgency, frequency
Unable to empty bladder
250
Q

diagnosis of BPH

A

digital rectal exam

UA

creatinine

PSA

post-void residual urine

IVP

H & P (dripping of urine)

251
Q

− 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

A

prostate specific antigen (PSA)

252
Q

using a catheter, voiding, or CT scan to see urine in the bladder after voiding

A

post-void residual urine

253
Q

how much urine should be in bladder after voiding

A

50 ml or less

254
Q

− Specific questionnaire for the physician to ask the patient
− Used in conjunction with other tests to get a diagnosis

A

• The American Urological Society Symptom Questionaire

255
Q

non surgical options for BPH

A

alpha 1 blockers

anti-androgen agents (5 alpha reductase inhibitors)

256
Q
  • 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
A

alpha 1 blockers

257
Q

example of alpha 1 blockers

A

Tamsulosin/Flomax

Terazosin/Hytrin

Doxazoxin/Cardura

Alfuzosin/Uroxatral

258
Q

side effect of alpha 1 blockers

A

orthostatic hypotension

259
Q
  • Shrink (decrease) prostate size

- Prevents conversion of testosterone to DHT

A

anti-adrogen agents (5 alpha reductase inhibitors)

260
Q

example of anti-adrogen agents (5 alpha reductase inhibitors)

A

Finasteride/Proscar

Dutasteride/Avodart

261
Q

side effects of anti-adrogen agents (5 alpha reductase inhibitors)

A

impotence
gynecomastia
decreased libio

262
Q

important information for anti-adrogen agents (5 alpha reductase inhibitors)

A

women of childbearing age CAN’T handle this medication

263
Q

• Most common cancer in American men

A

cancer of the prostate

264
Q

risk factors for cancer of the prostate

A

genetic disposition

265
Q

how does cancer of the prostate start?

A

in a discrete nodule then spreads

266
Q

when the patient with cancer of the prostate start having urinary problems what does that mean?

A

the tumor has grown outside the prostate

267
Q

a test useful both in diagnosis and follow-up of prostate CA

A

PSA

268
Q

normal PSA level

A

0-2.5

269
Q

any man over age 50 needs annual

A

DRE

270
Q

most definite way to diagnose cancer of the prostate?

A

biopsy

271
Q

ranks the severity of the cancer

A

gleason score

272
Q

medications for cancer of the prostate?

A

hormone manipulations

Lupron, zoladex, eulexin, casodex, degralix

273
Q

why do they give hormone medications for cancer of the prostate?

A

the cancer is testosterone dependent

274
Q

radiologic seeds inserted into prostate

A

brachytherapy

275
Q

education for brachytherapy?

A

use condoms

stay away from PG women and babies and strain all urine

276
Q

3 ways for prostate surgery

A

retropubic approach

superpubic approach

peroneal approach

277
Q

go behind the bladder (bladder is not injured at all, should have no urine on dressing!)

A

retropubic approach

278
Q

♣ 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.

A

superpubic approach

279
Q

♣ incision by rectum, look for signs of infections (dirty location), no rectal temp or enemas, good cleaning after bowel movement; no straining bowel movements

A

peroneal approach

280
Q

post op prostatectomy

A

irrigation to prevent clots
incontinence and sexual problems
avoid constipation

281
Q

surgical options for BPH and prostate cancer

A

TUMT
TUNA
TURP
TUIP

282
Q
  • Heat up prostate and destroy cells

* Outpatient procedure

A

o Transurethral microwave heat treatment (TUMT)

283
Q

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

A

o Transurethral needle ablation (TUNA)

284
Q

• No incision—all done through urethra
• Most common procedure done
• May use a laser, can also do a biopsy
Continuous bladder irrigation

A

Transurethral resection of the prostate (TURP)—

285
Q

• No prostate tissue is removed, go make an incision in the prostate to relieve pressure

A

o Transurethral incision of the prostate (TUIP)

286
Q

• Usually used to rid the prostate cancer completely when it is located to that area

A

o Open prostatectomy

287
Q

pre-op TURP

A

assess NO anti-coagulants

bowel prep

pain management

3-way foley catheter

288
Q

post-op TURP

A
  • 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
Q

o Can be acute or chronic

Inflammation of the glomerulus

A

Glomerulonephritis

290
Q

Glomerulonephritis is caused by?

A

o immunologic abnormalities, diabetes, toxins (antibiotics), vascular disorders, systemic lupus

291
Q

most common cause of Glomerulonephritis

A

strep infection

292
Q

o Characterized by an accumulation of antigen and antibody that accumulate in the glomeruli, which results in tissue injury

A

Glomerulonephritis

293
Q

Glomerulonephritis damage results in?

A

proteinuria,
hematuria,
changes in GFR (trouble filtrating) d/t changes in capillary wall structure

294
Q

o Labs with glomerulonephritis show:

A
  • High BUN and creatinine (high in serum)

* Reduced creatinine clearance (low in urine)

295
Q

manifestations for glomerulonephritis

A

•

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
Q

building up too many toxins in the blood

A

azotemia

297
Q

used to diagnose glomerulonephritis?

A

RBC and cast cells

298
Q

treatment of glomerulonephritis

A

ATB

steroid therapy

299
Q

chronic glomerulonephritis is treated the same as acute; except it will persist to ___ ____.

A

renal failure

300
Q

nursing care of chronic glomerulonephritis

A 
♣	Sodium restriction
♣	IO
♣	Listen for crackles
♣	Diuretics
♣	Cardiac monitoring—esp if K is elevated
Normally need dialysis

daily weights

301
Q

chronic glomerulonephritis have problems with ____ because the EPO cycle is off.

A

anemia

302
Q

Type of acute renal failure

o serious damage the glomerular capillary membrane

A

nephrotic syndrome

303
Q

nephrotic syndrome happens as a result of a ____….it is not a disease itself.

A

disease

304
Q

symptoms of nephrotic syndrome

A 
•	Increased glomerular permeability
•	Proteinuria (>3.5 grams per/day)  
•	Hypoalbuminemia
•	Diffuse edema
•	High serum cholesterol
Hyperlipidemia
305
Q

2 hallmark signs of nephrotic syndrome

A

proteinuria and edema

306
Q

the goal of nephrotic syndrome is to slow the progression of CRF by??

A

− Rest
− Diuretics
− ACE Inhibitors to reduce proteinuria and control BP
Lipid-lowering agents

307
Q

diet for nephrotic syndrome

A

− Low protein and low sodium diet

308
Q

ϖ Genetic disorder
ϖ Destroys nephrons
ϖ Can lead to kidney failure
ϖ Can develop cysts on other organs

A

POLYCYSTIC KIDNEY DISEASE

309
Q

sx of POLYCYSTIC KIDNEY DISEASE

A

enlarged kidneys,

impaired renal labs,

hematuria from kidney damage,

polyuria,

HTN,

flank pain

310
Q

if patient has polycystic kidney disease, we can improve their renal function by?

A

kidney transplant

311
Q

pre-op kidney surgery. ____ is important

A

hydration

312
Q

if donating a kidney, may be placed on ____ temporarily or permanently after surgery.

A

dialysis

313
Q

post-op kidney surgery

A

breathing will hurt

watch for bleeding! (Kidneys are vascular)

7th Semester (14 decks)

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