Chapter 33/34 Flashcards
Exam 1 content: urinary system
what factors influence urinary elimination?
developmental factors
psychosocial factors
fluid and food intake
medications
muscle tone
pathologic conditions
surgical procedures
some causes of urologic disorders?
minimum fluid intake of 2-3L per day
minimum output 30mL/hr
bladder health
controlling blood pressure
nephrotoxicity and medications
examples of potential nephrotoxicity substances
- contrast media dye
heavy metals like lithium
pesticides. snake venom
age-related changes in urinary system
-kidney function decreases
-The prostate gland can block the flow of urine in men
-hormones secreted by kidneys decrease
-bladder tone decreases
-bladder capacity decreases
-nocturia becomes more common
-decrease in estrogen levels causes the tone to decrease in women so they become more common to infection and incontinence
important assessment aspects of urinary system?
normal urine output should equal fluid intake
- approximately 60mL/hr
- minimum 30mL/hr or 0.5 mL/Kg per hour
important aspects of px health hx
- changes in urine quality or quantity, pain
- px normal urine patterns
- pain or discomfort
- problem initiating or controlling urination
- review all modifiable and non-modifiable risk factors!!!!
diagnostic tests and procedures?
- urinalysis and culture and sensitivity
- cbc
- blood urea nitrogen
- BUN: creatinine ratio
- KUB
-angioplasty - serum creatinine, creatinine clearance
what do you look at when examining urine?
- volume
- color, clarity
- odor
- sterility
- pH
- specific gravity
- glucose, ketone, proteins
- measure residual urine
what is urge incontinence?
involuntary loss of urine when there is strong urge to urinate
what is stress incontinence?
when urethral sphincter fails caused by coughing sneezing laughing and exercise
what is mixed incontinence?
combination of different types of incontinence
what is overflow incontinence?
poor contractility of muscle or obstruction of the urethra
what is functional incontinence?
-cognitive inability to recognize the need to urinate
-self-care deficit extreme depression
-also can be the inability to reach the bathroom because of restraints or out-of-reach walker
what is neurologic incontinence?
caused by disorders of the neurologic system like sclerosis or spinal cord injury
symptoms of cystitis?
- urgency, frequency, dysuria
-hematuria, nocturia - bladder spasms, incontinence
-low-grade fever - dark urine
fatigue - pelvic discomfort
what can cystitis be caused by ?
- renal calculi
- urinary diversion
- indwelling catheters
- prolonged immobility
-inflammation due to infection ( usually bacterial)
what us cystitis diagnosed by and treated by?
urinalysis and antibiotics
what is urethritis caused by?
- infection
- trauma
- hypersensitivity to products like bubble baths and sperm jellies
symptoms of urethritis?
-dysuria, frequency, urgency, and bladder spasms
- urethral discharge
how do you diagnosis and treat urethritis?
antibiotics and urinalysis test
health teachings regarding urinary infections
- cotton underwear
- clean front-to-back
- urinate before and after sex
-void every 4 hours
-advise to take medications
-drink plenty of water
what can cause acute pyelonephritis?
- bacterial infection
- infection in kidneys
- mostly in women 20’s-30’s
- can be acute or chronic
-can be due to uti that spread
symptoms of acute pyelonephritis
- fever, chills
- increased wbc
- fatigue, nausea, vomiting
- flank pain, nocturia, dysuria, bacteriura, pyuria
- edema, fluid overload
symptoms of pyelonephritis
- chills
- nausea, vomiting
- headache
- flank pain
- high fever
diagnostic tests of pyelonephritis?
- KUB OR CT
- urinalysis, BUN, creatinine, GFR,
- blood cultures, WBC count
- kidney biopsy
treatment for pyelonephritis
-antibiotics
- hygiene
- encourage fluid intake
- meds
watch sodium intake
- hospitalize if they are septic
symptoms of acute glomerulonephritis ?
- fever, chills
- nausea, vomiting
- fatigue
- flank pain
- nocturia, pyuria, bacteriuria
- hypertension ( late indicator)
what is acute glomerulonephritis?
occurs after strep-throat or in response to bacterial, viral, or parasitic infection
what is acute pyelonephritis?
infection of the kidney from bacteria traveling from the bladder up to ureters to the kidney
what to assess for in acute glomerulonephritis?
recent infections, surgeries
signs of edema
compare blood pressure baseline
inspect skin for lesions, incisions
-kidney biopsy
- urinalysis, BUN and creatinine, GFR
interventions of acute glomerulonephritis?
daily weight is taken and vital signs
input and output
diet therapy
drug therapy
cardiac management
urinary assessment
possible dialysis
what causes renal calculi? what is it?
- stones in the urinary tract
- cause: dehydration, urinary stasis, result in obstruction in the urinary tract, immobility
- ## infection, or genetic
symptoms of renal calculi? diagnostic tests? treatment?
symptoms: bladder distention, hematuria, flank pain
dx: urinalysis, urine specific gravity, 24-hour urine, CT, KUB, IVP
tx: pain management, ketorolac (Toradol), strain urine, a thiazide diuretic, ambulation. i/o, increase fluid intake
- lithotripsy, stent
what is acute renal failure ?
abrupt loss of kidney function
- GRF decreases
- can happen in hours to days
- creatinine and bun will increase
- fluid and electrolyte imbalances
- acid-base imbalances occur
what are the three types of acute renal failure? description/example?
prerenal: issue prior to the kidney like hemorrhage
intrarenal: issue inside the kidney
post-renal: issue after kidney like renal calculi
acute renal failure diagnostic tests?
i/o’s azotemia
- abg elevated creatinine, increased k
- ultrasound of kidneys
ct of abdomen and pelvis without contrast dye
KUB
cytoscopy
kidney biopsy
4 phases of acute kidney injury? describe what happens in each
- onset phase: starts with the prior event, and continues until oliguric development
- oliguric phase: lasts 1-3 weeks, longer the phase lasts poorer the prognosis, dialysis may be required during this phase
- diuretic phase: urine output may be 1,000-2,000 ml/day
- recovery phase: 3-12 months
how to manage acute kidney failure? (medical management)
- prevent renal failure with adequate hydration
- maintain fluid and electrolyte balance (monitor serum and urine electrolytes)
- replace renal function with dialysis
- prevent infection: a significant cause of death in px with ARF, avoid indwelling catheters \
- avoid protein foods, contrast media, and nephrotoxic medications, decrease fluid volume overload, monitor skin integrity, monitor for s/s of infection
