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N4- Test 3 > Adult Urinary, Renal, Bladder disorder > Flashcards

Adult Urinary, Renal, Bladder disorder Flashcards

1
Q

List 4 urinary, renal, and bladder disorders in ADULTS?

A
  • Polycystic Kidney Disease
  • Kidney cancer
  • Bladder cancer
  • Bladder trauma
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2
Q

Disorder:

genetic disorder where multiple cysts form in the kidneys, leading to kidney enlargement and possible kidney failure.

A

Polycystic Kidney Disease (PKD)

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3
Q

Disorder:

Injury to the bladder from external forces

A

Bladder Trauma

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4
Q

There are 2 forms of Polycystic Kidney Disease (PKD)

A
  1. Childhood (Recessive) PKD
  2. Adult (Dominant) PKD (ADPKD):
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5
Q

PKD that is Inherited in a recessive manner.

(inherrited from both parents)

A

Childhood (Recessive) PKD

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6
Q

PKD that is Inherited in a dominant manner.

(inherrited from one parent)

A

Adult (Dominant) Polycystic Kidney Disease (ADPKD)

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7
Q

S/S of PKD typically appear when cysts in the kidneys begin to ____.

A

enlarge.

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8
Q

PKD EARLY symptoms

List 8

A
  • Nausea/vomiting
  • Pruritus (itching)
  • Fatigue
  • Palpable bilateral enlarged kidneys (felt during a physical exam).
  • Hematuria (blood in the urine) from cyst rupture.
  • Urinary tract infections (UTI).
  • Uremia (elevated BUN levels, indicating kidney dysfunction).
  • Hypertension: decreased kidney function
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9
Q

Q: What are some associated complications of Polycystic Kidney Disease (PKD)?

A
  • Liver cysts – Cysts can develop in the liver, affecting its function.
  • Heart valve abnormalities – PKD can cause issues with heart valves, such as mitral valve prolapse.
  • Diverticulosis – The development of small pouches in the walls of the intestines, which can become inflamed or infected.
  • Aneurysms – Weakening of the blood vessel walls, particularly in the brain, which can lead to an increased risk of rupture and hemorrhage.
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10
Q

5 PKD Diagnosis include:

A
  • DNA Testing: genetic mutation
  • Family History: important for dominant form
  • Clinical Manifestations
  • **Ultrasound/CT scan
  • IVP (Intravenous pyelogram)- detailed images of kidneys and urinary tract
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11
Q

Can patients with PKD progress to End Stage REnal Disease (ESRD)?

A

Yes!
About 50% of patients progress to ESRD by age 60.

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12
Q

What is the percent and age that patients with PKD progress to End stage Renal FAILURE

Renal disease and renal failure are diff- keep an eye!

A

70% by age 70

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13
Q

Is there a cure for PKD?

A

No. Treatment mainly focuses on managing symptoms and preventing complications

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14
Q

Collaborative Care for PKD

2 main ones

A
  1. Genetic Counseling: understand the risks of inheritance and potential implications for future generations
  2. Supportive Prevention/Treatment
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15
Q

Tx for ESRD and ESRF

List 3

A
  • Nephrectomy (removal of kidneys) in some cases.
  • Dialysis to filter waste and fluids from the body.
  • Kidney Transplant as a potential long-term solution.
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16
Q

New Topic: Kidney Cancer

Most common type of malignant kidney tumor

A

adenocarcinoma

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17
Q

Q: What are the early symptoms of kidney cancer?

A

No “specific” early symptoms
- Makes early detection challenging

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18
Q

Risk factors for kidney Cancer

A
  • Risk factors
  • Smoking
  • Family Hx
  • Obesity
  • HTN
  • Exposure to asbestos, cadmium, gasoline
  • Males > Females
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19
Q

Q: What are the classic manifestations of ADVANCED kidney cancer?

A
  • gross hematuria: Blood in the urine
  • flank pain: Pain in the side or back- tumor pressing on surrounding tissues.
  • palpable mass
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20
Q

Kidney cancer spreads beyond kidneys to nearby structures such as

A
  • Renal Vein
  • Vena Cava
  • lungs
  • liver
  • long bones
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21
Q

DX studies for Kidney Cancer

A
  • Intravenous Pyelogram (IVP) with Nephrotomography – Detects most kidney masses.
  • Ultrasound – Helps differentiate between a tumor and a cyst.
  • Angiography, percutaneous needle aspiration, CT scan, and MRI
  • Cystoscopy with a renal biopsy
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22
Q

What labs are needed PRIOR to Intravenous Pyelogram (IVP)

A

baseline BUN/Creatinine
- due to contrast dye used

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23
Q

What should you monitor post dx studies

A

Bleeding- procedures can cause bleeding.

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24
Q

What is a RADICAL NEPHRECTOMY surgery

A
  • Entire kidney is removed.
  • Removal of adrenal gland, surrounding fascia, part of ureter, & draining lymph nodes
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25
Q

How is Radical Nephrectomy performed?

A
  • via laparoscopy (minimally invasive)
  • or through an open approach, where an incision is made, usually around the 12th rib, to access the kidney.
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26
Q

What are the key** post-operative care** considerations for a patient following a radical nephrectomy?

A
  • Pain control: PCA pump-patient controlled
  • Maintain airway / C&DB / IS
  • Monitor for S/S of infection / bleeding
  • Position of comfort
  • I&O, Indwelling catheter
    -mild (pink) hematuria several days post-op is common
  • Electrolyte, BUN/Creat: assess function of remianing kidney
  • Activity /driving restrictions 2 weeks minimum
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27
Q

Tx of choice for Kidney cancer

A

Partial or radical nephrectomy.

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28
Q

kidney cancer:

Radiation therapy is used ____

A

Palliatively

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29
Q

Q: Is chemotherapy an effective treatment for metastatic kidney cancer?

A

No, chemotherapy is not an effective treatment for metastatic kidney cancer

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30
Q

Type of ‘targeted therapy’ used for metastatic kidney cancer

A

kinase inhibitors (potent anti-neoplastics)

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31
Q

How do Kinase inhibitors work?

A
  • work by blocking certain enzymes that help cancer cells grow.
  • This helps slow down or stop the cancer from spreading.
  • It’s a more focused treatment with fewer side effects compared to traditional chemotherapy.
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32
Q

Moving on to: Bladder Cancer

Risk factors for Bladder Cancer

A
  • Cigarette smoking
  • Exposure to dyes used in rubber & other industries
  • Radiation for cervical cancer
  • Cyclophosphamide (Cytoxan®) / Pioglitazone (Actos®)
33
Q

Hallmark sign of Bladder cancer- often 1ST sign!

A

Painless Hematuria
(blood in urine w/o pain)

34
Q

Besides painless hematuria, what other urinary symptoms are associated with bladder cancer?

A
  • Frequency
  • urgency
  • dysuria
35
Q

Q: What is the most reliable DX TEST for DETECTING BLADDER tumors?

A

Cystoscopy

36
Q

Q: What DX test confirms a bladder cancer diagnosis?

A

Bladder biopsy

37
Q

Is Chemotherapy possible with Bladder cancer?

A

Yes. Sometimes radiation is used with it.

38
Q

2 types of treatments for Bladder Cancer

A
  1. Chemotherapy
  2. Surgery
39
Q

List 2 ways Chemotherapy is administered.

A
  1. Systemic Infusion
  2. Intravesical Instillation
40
Q

Chemo administration type:

chemotherapy drugs are given through an IV (PIV - Peripheral Intravenous Line), allowing them to circulate throughout the body.

A

Systemic Infusion

41
Q

#1 thing to monitor for Systemic Infusion

A

Systemic Infusion

42
Q

Chemo Administration Type:

  • method involves placing chemotherapy drugs directly into the bladder through a catheter.
  • Medication contacts the entire bladder wall and targets cancer cells locally.
A

Intravesical Instillation

43
Q

Q: What are the 4 surgical treatment options for bladder cancer?

A
  1. Transurethral resection of bladder tumor (TURBT) with fulguration (electrocautery)
  2. Photocoagulation/Open loop resection with fulguration
  3. Partial cystectomy
  4. Cystectomy (bladder removal)
44
Q

Which bladder surgical tx am I?

A

TURBT: Transurethral resection of bladder tumor with fulguration (electrocautery)

45
Q

No. 1 Assessment POST TURBT

A

Assess for DVT post-op due to immobility.

46
Q

Which bladder surgical tx am I?

A

Photocoagulation/ open loop resection with fulguration

47
Q

Which bladder surgical tx am I?

A

Partial cystectomy
- Removes a portion of the bladder while preserving function.

48
Q

Which bladder surgical tx am I?

A

Cystectomy (bladder removal)
– Requires urinary diversion to reroute urine since the bladder is no longer present.

49
Q

Post-OP Bladder Cancer Surgery:

What is the desired urinary output range to monitor in a post-op urology patient?

A

A: 30-60 mL/hr.

50
Q

Post-OP Bladder Cancer Surgery:

If catheter present post bladder surgery, what should you perform on this catheter?

A

irrigate a catheter gently with 60 mL of NS

51
Q

Post-OP Bladder Cancer Surgery:

What complications should be monitored for in a patient with a urinary catheter?

A
  • Hematuria (blood in urine)
  • peritonitis
  • bladder distention
  • shock
  • hemorrhage: excessive bleeding due to blood vessel damage
  • thrombophlebitis.
52
Q

Post-OP Bladder Cancer Surgery:

What is used after bladder surgery to collect urine when normal bladder emptying is not possible?

A

Urinary drainage pouch

53
Q

What 2 important things should be monitored Post bladder cancer surgery.

A
  • Monitor the urinary drainage pouch.
  • Monitor the pH of the urine – keep acidic.
54
Q

Q: Why should the pH of urine be monitored and kept acidic?

A

A: To reduce the risk of infection and stone formation.

55
Q

3 Types of Urinary Diversion Techniques

A
  1. Indiana Pouch Reservoir
  2. Kock Pouch Reservoir
  3. Neobladder to Urethra Diversion
56
Q

1st type of Urincary Diversion:

What type of urinary diversion uses tissue from the LARGE intestine to create a pouch and the small intestine for the outlet?

A

A continent urinary diversion called Indiana pouch

57
Q

What does CONTINENT urinary diversion mean?

A
  • the ability to control the release of urine or stool
  • urine is stored internally in a pouch and can be emptied voluntarily with a catheter, rather than continuously draining into an external bag
58
Q

How is urine drained in an Indiana Pouch?

A

By inserting a catheter through the stoma 3 to 6 times daily

59
Q

2nd type of Urinary Diversion:

A type of urinary diversion that uses the SMALL intestine to make the pouch, valves, and outlet.

A

Kock Pouch Reservoir

60
Q

What part of the small intestine is used in Kock Pouch Reservoir?

A

Terminal ileum

61
Q

Is the Kock pouch considered a continent urinary diversion?

A

Yes!
catheter is also placed in stoma 3 to 6 times daily to drain urine.

62
Q

3rd type of Urinary DIversion:

A segment of the intestine is made into a new bladder (reservoir) and connected to the urethra, allowing urine to be expelled naturally.

A

Neobladder to Urethra Diversion

Neobladder = “new bladder”

63
Q

Is Neobladder + urthra considered a ‘continent diversion’?

A

Yes bc urine collects internally and emptied VOLUNTARILY, and not continuous into a urine bag.

64
Q

What must a patient relearn to do with a Neobladder to Urethra diversion?

A

Relearn to urinate since the neobladder cannot contract or squeeze out urine like a bladder.

  • Use abdominal muscles to create pressure and push urine out.
  • Practice timed voiding (urinating at set intervals Q2-4 hrs.) to prevent overfilling, since they may not feel the usual urge to urinate.
65
Q

Which one am I?

A

Kock Pouch Resorvoir

66
Q

Which one am I?

A

Indiana Pouch Reservoir

67
Q

Which one am I?

A

Neobladder to Urethra Diversion

(new bladder is made from the small intestine and connected to the urethras)

68
Q

What are the 3 important pre-operative assessments for a patient undergoing urinary diversion surgery?

A
  • Cardiopulmonary assessment: heart & lung fuction.
  • Nutritional assessment: healing and recovery, more fiber.
  • Evaluation of readiness to learn : assessing anxiety and knowledge deficit.
69
Q

What are the pre-operative goals for a patient undergoing urinary diversion surgery?

A
  1. Relief of anxiety through education and support.
  2. Adequate nutrition for optimal healing.
  3. Understanding the procedure, including the stoma’s appearance and care after surgery.
70
Q

Why is it important to educate the patient about stoma appearance and care preoperatively?

A

To reduce anxiety, promote self-care, and prepare the patient for life after surgery.

71
Q

11 Key Assessments for KIDNEY & BLADDER Trauma

A
  • History of Injury
  • Anuria (no urine)
  • Hematuria (blood in urine)
  • Flank / Pelvic Pain
  • Suprapubic Pain
  • Guarding
  • Dysuria (painful urination)
  • Difficulty / Inability to Void
  • Nausea and vomiting
  • Abdominal Distention
  • Rebound Tenderness (pain upon releasing pressure from abdomen-indicate bladder rupture or internal bleeding)
72
Q

6 Diagnosis to detect Kidney & Bladder Trauma

A
  • Hematuria (UA)
  • Ultrasound
  • CT (with barium contrast)
  • MRI
  • IVP with cystography
  • Renal arteriography

CT & MRI done before IVP

73
Q

Kidney/Bladder DX:

Q: Why is renal trauma often associated with bowel trauma?

A

The kidneys and bowel are in close proximity within the abdomen, so trauma (blunt or penetrating) can affect both organs simultaneously

74
Q

Kidney/Bladder DX:

Q: What imaging tests are used to assess BOTH renal and bowel injury?

A

Abdominal CT and X-ray with contrast (barium)

75
Q

How is Barium administered?

A

Oraly (barium swallow)
or
Rectally (barium enema)

76
Q

Kidney/Bladder DX:

What does Barium Contrast do?

A

Barium contrast helps highlight the GI tract BUT blocks visualization of other organs like the kidneys.

77
Q

Kidney/Bladder DX:

When should barium contrast be administered/scheduled?

A

Barium contrast should be scheduled AFTER THE IVP IS COMPLETE because it obstructs the kidney’s visualization during the imaging process.

IVP done 1st, Barium done 2nd.- KNOW THIS!!!!

78
Q

What is most commonly used the most:

IV contrast or Barium?

A

IV contrast bc its doesnt obstruct views like barium does.

N4- Test 3 (7 decks)

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