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Nursing Semester 3 > Beth - Week 10 - Exam 4 > Flashcards

Beth - Week 10 - Exam 4 Flashcards

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1
Q

what is urolithiasis?

A

formation of calculi in the kidney, bladder, urinary tract

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2
Q

what is nephrolithiasis?

A

calculi in the kidneys

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3
Q

what is hydronephrosis?

A

unilateral swelling of one kidney or stones

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4
Q

what are the risk factors for urinary obstruction problems?

A
  • infectious (frequent UTI)
  • cancers (obstructive tumors)
  • metabolic (↑ in calcium, phosphate, oxalate, uric acid, cysteine, struvite (Mg ammonium phosphate)
  • environment (hot/warm climate)
  • dietary (↑ protein, ↑ caffeine, ↓ fluid intake)
  • genetics (family hx of stone)
  • lifestyle (lack of exercise_
  • immobility (bloods not circulating)
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5
Q

T/F the most common causes of urinary obstruction problems differs by age

A

TRUE

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6
Q

what is the common causes of urinary obstruction problems in children?

A
  • Anatomic abnormalities (including
    posterior urethral valves or stricture and
    stenosis at the ureterovesical or ureteropelvic
    junction)
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7
Q

what are the common causes of urinary obstruction problems in young adults?

A

calculi (not hydrated)

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8
Q

what are the common causes of urinary obstruction problems in older adults?

A

BPH or prostate cancer, retroperitoneal or pelvic tumors, metastatic cancer and calculi

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9
Q

what are the three steps in the pathology of obstructive nephropathy?

A
  1. Urinary stasis (causes: calculus formation)
  2. Frequent UTI (causes: local ischemia)
    a. obstruction results in renal
    insufficiency
    b. dilation of the collecting ducts & distal
    tubules
    c. chronic tubular atrophy
  3. Increased intratubular pressure
    *Dilation takes 3 days from the onset of
    obstructive uropathy to develop.
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10
Q

what are the nursing assessment/sxs of stones in the bladder?

A

UTI
hematuria
urinary retention
less painful to no pain

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11
Q

what are the nursing assessment/sxs of stones in the ureters?

A

pain is described as agonizing

frequent desire to urinate but little urine output

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12
Q

what are the nursing assessment/sxs of stones in the renal pelvis?

A 
pain localized
inc voiding
inc RBC
inc WBC in urine
distention of renal pelvis 
colic pain is described as costavertebral raidating downward
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13
Q

what are the different types of urinary tract calculi and how often do they occur?

A
  • Calcium Oxalate (occurs 40% in population)
  • Calcium Phosphate (occurs10% in population)
  • Struvite Staghorn type (Mg Ammonium Phosphate)
    (occurs15% in population) - UTI usually Proteus
  • Uric Acid (occurs 8% in population)
  • Cystine (occurs 2% in population)
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14
Q

what are the diagnostics for obstructive nephropathy?

A
  • CT (usually IV contract)
  • Ultrasound
  • UA (if positive culture and sensitivity)
  • Gout (Hyperuricemia (high uric acid level))
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15
Q

Uric acid test isn’t considered a definitive test for gout. only testing a person’s ______ for _____ is absolute

A

joint fluid; monosodium urate

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16
Q

what are the clinical manifestations for urinary obstruction?

A
  • severe pain (sudden/sharp in lower abd, flank or back or groin)
  • caused by the stones stretching dilating and cutting d/t spasms of the ureters
  • symptoms of mild shock (cool, clammy, tachycardia, fever, chills)
  • men have pain in testicle
  • women have pain in labia
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17
Q

what is hydronephrosis?

A

enlarged kidney; complication of renal obstruction

  • stones or enlarged prostate that cause backup of the urine in one or both kidneys
  • kidneys retain urine
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18
Q

what can untreated hydronephrosis lead to?

A

kidney damage

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19
Q

what are the diagnostics for hydronephrosis lead to?

A

UA
ultrasound
CT
voiding cystourethrogram

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20
Q

what is nephrolithiasis?

A

stone formation in kidney; stones or enlarged prostate that cause backup of the urine in one or both kidneys

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21
Q

what is bladder cancer?

A
  • rare type of cancer
  • more frequent than kidney cancer
  • grows within the bladder
  • more common in men > 60 years
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22
Q

what are the sxs of bladder cancer?

A
  • often asymptomatic

- chronic or intermittent hematuria, gross hematuria, dysuria, frequency, urgency

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23
Q

what are the diagnostics used for bladder cancer?

A
  • ultrasound
  • CT
  • MRI
  • Cystoscopy with biopsy
24
Q

what is the tx for bladder cancer?

A

immunotherapy, molecularly targeted therapies, or localized radiation therapy
- TURP, laser photocoagulation, cystectomy

25
Q

what is kidney cancer?

A

rare type of cancer

  • starts in the lining of small tubules of kidneys
  • more common in men age greater than 60 years
26
Q

what are the sxs of kidney cancer?

A

often asymptomatic

- flank pain, hematuria, palpable abdomen mass

27
Q

what is the tx for kidney cancer?

A
  • Immunotherapy, molecularly targeted therapies, or localized radiation therapy
  • Nephrectomy
  • Partial or radical with removal of adrenal gland
28
Q

what are the risk factors for bladder and kidney cancer?

A
  • Smoking
  • Environmental factors
  • Exposure to Asbestos, cadmium, gasoline, dyes (used in rubber & paint)
  • Obesity
  • HTN
  • Cystic kidney disease
  • Renal Calculi
  • Drugs: Cyclophosphamide & Actos
29
Q

what is the pt education for those with urolithiasis?

A
  • prevention of risk factors is best
  • dietary changes for types of stones
  • infectious sxs
  • hydration
  • mobility
  • voiding education (don’t hold urine; women - empty bladder)
  • lifestyle (exercise → circulation)
30
Q

what dietary changes are used for calcium stones?

A
  • low protein diet to decrease excretion of calcium in the urine
31
Q

what dietary changes are used for oxalate stones?

A
  • low oxalic acid diet: limit dark greens, chocolate, strawberies and peanuts
32
Q

what are the dietary changes used for uric acid stones?

A

low purine diet: limit shell fish, mussels, asparagus, mushrooms, organ meat - keep urine basic and reduce uric acid

33
Q

what is the invasive/surgical interventions for urolithiasis?

A
  • Lithotripsy
  • Ureteral Catheters or Stents (Interventional radiology)
  • Nephrostomy Drains (Interventional radiology)
  • Nephrectomy (Surgery)
  • Urinary Diversions-continent & Incontinent
    systems (Surgery)
  • lithotripsy - ESWL (extracorporeal shock wave lithotripsy)
34
Q

what are the characteristics of lithotripsy ESWL?

A
  • sound/shock waves
  • impulse to area of stone
  • lasts 45-1 hr
  • anesthesia (local, regional, or general)
  • success is higher than 90% for stone clearance
  • if unsuccessful invasive interventions are required.
35
Q

what are the nursing responsibilities for lithotripsy ESWL?

A
  • explain tx (ESWL)
  • pt education (conscious sedation - can be local or general)
  • assessment pre-procedure (no anticoags (ASA/NSAID)
  • post procedure (pain, bruising at site, expected hematuria, monitor urine output and strain for stones)
36
Q

T/F: all diversions divert urine away from the bladder or kidney. Nephrostomy drain or tube directly in the kidney connected to a bag of some type

A

TRUE

37
Q

what are ureteral stents?

A

tube (soft silicone) device place within the ureter d/t obstruction to restore renal function (temporary or permanent)

38
Q

what are the different types of ureteral stents?

A
  • internal or external (right or left)
  • insertion by cystoscopy or open procedure
  • self-retaining (coils in kidney and extends to bladder)
39
Q

TEST what are the nursing assessement and care for a urinary drain/stent?

A
  • assess position/placement
  • assess ureteral flow/I+O (q 1-2 hr)
  • **notify MD if ↓ U/O
  • assess characteristic of urine and drain site
  • assess for bleeding at the site
  • assure non-obstruction drainage
  • **if dislodged, cal MD immediately
  • **never clamp
  • **rarely irrigated - must have orders if do it it sterile
    • report sxs of infection
40
Q

what are suprapubic catheters?

A
  • usually temporary catheter
41
Q

what are suprapubic catheters used for?

A

patients who have

  • prostate surgery
  • urethral surgery
  • bladder surgery
42
Q

what is the nursing care for suprapubic catheter?

A
  • nursing care is same as all drains and stents except
  • temporary
  • caution w/ the catheters placement (sutured in place)
  • complications - poor drainage
43
Q

what are the indications for a nephrostomy?

A
  • renal tumor
  • polycystic kidney
  • trauma
44
Q

what are the 2 ways to perform a nephrostomy?

A
  • laparoscopic (preferred) or open
45
Q

what are the characteristics of laparoscopic nephrostomy?

A
  • five puncture sites
  • pt recovery quicker
  • reduced complications
46
Q

what are the characteristics of open nephrostomy?

A
  • large incision 6 - 10 in
  • pt recover is longer
  • increased complications
47
Q

what are the complications with nephrectomies?

A 
• ABCs
- nephrectomy is close  to diaphragm
- nerve can be injuried
- pain prevents deep breaths
- implement IS
- pneumonia
• abdominal distention
- common paralytic ileus d/t manipulation
48
Q

how are continent/incontinent urinary diversions chosen for patients?

A
  • pt age
  • condition of bladder
  • obesity
  • degree of ureteral dilatation
  • kidney function
  • pt’s ability to learn and willingness to participate
49
Q

what are the two types of simple conduits for incontinent urinary diversions?

A
  • ileal conduit (implanting ureter into a loop of ikleum and pulled through the abd wall
  • colon is the conduit
50
Q

what are the 6 characteristics of the colon conduit?

A
  • 6 - 8 inches
  • isolated from the intestinal tracck
  • NO valve
  • NO voluntary control
  • urine flows constantly
  • requires an external xollection device (bag)
51
Q

what are the 6 types of continent urinary diversions?

A
  • Kock’s Pouch
  • Mainz Pouch
  • Indiana Pouch
  • Florida Pouch
  • Neobladder (ureters implanted into new bladder)
  • intraabdominal reservoir
52
Q

T/F names of the continent urinary diversion depend on the segment of bowel used

A

TRU

53
Q

what are the characteristics of an intraabdominal reservoir?

A
  • Requires catheterization or outlet (anal sphincter)
  • Similar to Ileal conduit
  • Continence mechanism is used THIS TIME A
    VALVE IS PRESENT
  • Intussusception of the bowel
  • Self-catheterization (4-6 hrs)
  • No external collection devise
  • Patients can wear bandage to cover stoma
54
Q

what are the nursing assessment/interventions for someone with a urinary diversion?

A
  • assess I+O (measure U/O if <30cc call MD)
  • assess skin (keep urine pH < 6.5 because of alkaline encrustation ↑ skin irritation; ensure pt appliance is connected properly, check tube is in stoma, connect to bag)
  • assess odor (foul? alkaline? concentrated? educate pt on foods that cause strong odors: asparagus, cheese, eggs; reduce odors with ↑ fluid, PO ascorbic acid, deodorizers, white vinegar)
  • educate the pt that mucous maybe normal; they need to increase fluids
55
Q

what are the assessment/teaching for a person with an incontent urinary diversion?

A
  • bag usually lasts 3-5 days
  • empty when 1/3 to 1/2 full
  • watch for leakage
  • better to change the appliance in AM
  • use something absorbent while cleaning stoma
  • can use a collection bag at NOC
  • maintain clear dry skin

Nursing Semester 3 (29 decks)

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