Beth - Week 10 - Exam 4 Flashcards
what is urolithiasis?
formation of calculi in the kidney, bladder, urinary tract
what is nephrolithiasis?
calculi in the kidneys
what is hydronephrosis?
unilateral swelling of one kidney or stones
what are the risk factors for urinary obstruction problems?
- 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)
T/F the most common causes of urinary obstruction problems differs by age
TRUE
what is the common causes of urinary obstruction problems in children?
- Anatomic abnormalities (including
posterior urethral valves or stricture and
stenosis at the ureterovesical or ureteropelvic
junction)
what are the common causes of urinary obstruction problems in young adults?
calculi (not hydrated)
what are the common causes of urinary obstruction problems in older adults?
BPH or prostate cancer, retroperitoneal or pelvic tumors, metastatic cancer and calculi
what are the three steps in the pathology of obstructive nephropathy?
- Urinary stasis (causes: calculus formation)
- Frequent UTI (causes: local ischemia)
a. obstruction results in renal
insufficiency
b. dilation of the collecting ducts & distal
tubules
c. chronic tubular atrophy - Increased intratubular pressure
*Dilation takes 3 days from the onset of
obstructive uropathy to develop.
what are the nursing assessment/sxs of stones in the bladder?
UTI
hematuria
urinary retention
less painful to no pain
what are the nursing assessment/sxs of stones in the ureters?
pain is described as agonizing
frequent desire to urinate but little urine output
what are the nursing assessment/sxs of stones in the renal pelvis?
pain localized inc voiding inc RBC inc WBC in urine distention of renal pelvis colic pain is described as costavertebral raidating downward
what are the different types of urinary tract calculi and how often do they occur?
- 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)
what are the diagnostics for obstructive nephropathy?
- CT (usually IV contract)
- Ultrasound
- UA (if positive culture and sensitivity)
- Gout (Hyperuricemia (high uric acid level))
Uric acid test isn’t considered a definitive test for gout. only testing a person’s ______ for _____ is absolute
joint fluid; monosodium urate
what are the clinical manifestations for urinary obstruction?
- 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
what is hydronephrosis?
enlarged kidney; complication of renal obstruction
- stones or enlarged prostate that cause backup of the urine in one or both kidneys
- kidneys retain urine
what can untreated hydronephrosis lead to?
kidney damage
what are the diagnostics for hydronephrosis lead to?
UA
ultrasound
CT
voiding cystourethrogram
what is nephrolithiasis?
stone formation in kidney; stones or enlarged prostate that cause backup of the urine in one or both kidneys
what is bladder cancer?
- rare type of cancer
- more frequent than kidney cancer
- grows within the bladder
- more common in men > 60 years
what are the sxs of bladder cancer?
- often asymptomatic
- chronic or intermittent hematuria, gross hematuria, dysuria, frequency, urgency
what are the diagnostics used for bladder cancer?
- ultrasound
- CT
- MRI
- Cystoscopy with biopsy
what is the tx for bladder cancer?
immunotherapy, molecularly targeted therapies, or localized radiation therapy
- TURP, laser photocoagulation, cystectomy
what is kidney cancer?
rare type of cancer
- starts in the lining of small tubules of kidneys
- more common in men age greater than 60 years
what are the sxs of kidney cancer?
often asymptomatic
- flank pain, hematuria, palpable abdomen mass
what is the tx for kidney cancer?
- Immunotherapy, molecularly targeted therapies, or localized radiation therapy
- Nephrectomy
- Partial or radical with removal of adrenal gland
what are the risk factors for bladder and kidney cancer?
- Smoking
- Environmental factors
- Exposure to Asbestos, cadmium, gasoline, dyes (used in rubber & paint)
- Obesity
- HTN
- Cystic kidney disease
- Renal Calculi
- Drugs: Cyclophosphamide & Actos
what is the pt education for those with urolithiasis?
- 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)
what dietary changes are used for calcium stones?
- low protein diet to decrease excretion of calcium in the urine
what dietary changes are used for oxalate stones?
- low oxalic acid diet: limit dark greens, chocolate, strawberies and peanuts
what are the dietary changes used for uric acid stones?
low purine diet: limit shell fish, mussels, asparagus, mushrooms, organ meat - keep urine basic and reduce uric acid
what is the invasive/surgical interventions for urolithiasis?
- 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)
what are the characteristics of lithotripsy ESWL?
- 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.
what are the nursing responsibilities for lithotripsy ESWL?
- 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)
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
TRUE
what are ureteral stents?
tube (soft silicone) device place within the ureter d/t obstruction to restore renal function (temporary or permanent)
what are the different types of ureteral stents?
- internal or external (right or left)
- insertion by cystoscopy or open procedure
- self-retaining (coils in kidney and extends to bladder)
TEST what are the nursing assessement and care for a urinary drain/stent?
- 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
what are suprapubic catheters?
- usually temporary catheter
what are suprapubic catheters used for?
patients who have
- prostate surgery
- urethral surgery
- bladder surgery
what is the nursing care for suprapubic catheter?
- nursing care is same as all drains and stents except
- temporary
- caution w/ the catheters placement (sutured in place)
- complications - poor drainage
what are the indications for a nephrostomy?
- renal tumor
- polycystic kidney
- trauma
what are the 2 ways to perform a nephrostomy?
- laparoscopic (preferred) or open
what are the characteristics of laparoscopic nephrostomy?
- five puncture sites
- pt recovery quicker
- reduced complications
what are the characteristics of open nephrostomy?
- large incision 6 - 10 in
- pt recover is longer
- increased complications
what are the complications with nephrectomies?
• 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
how are continent/incontinent urinary diversions chosen for patients?
- pt age
- condition of bladder
- obesity
- degree of ureteral dilatation
- kidney function
- pt’s ability to learn and willingness to participate
what are the two types of simple conduits for incontinent urinary diversions?
- ileal conduit (implanting ureter into a loop of ikleum and pulled through the abd wall
- colon is the conduit
what are the 6 characteristics of the colon conduit?
- 6 - 8 inches
- isolated from the intestinal tracck
- NO valve
- NO voluntary control
- urine flows constantly
- requires an external xollection device (bag)
what are the 6 types of continent urinary diversions?
- Kock’s Pouch
- Mainz Pouch
- Indiana Pouch
- Florida Pouch
- Neobladder (ureters implanted into new bladder)
- intraabdominal reservoir
T/F names of the continent urinary diversion depend on the segment of bowel used
TRU
what are the characteristics of an intraabdominal reservoir?
- 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
what are the nursing assessment/interventions for someone with a urinary diversion?
- 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
what are the assessment/teaching for a person with an incontent urinary diversion?
- 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
