Chapter 33/34

Question 1

what factors influence urinary elimination?

Answer 1

developmental factors
psychosocial factors
fluid and food intake
medications
muscle tone
pathologic conditions
surgical procedures

Question 2

some causes of urologic disorders?

Answer 2

minimum fluid intake of 2-3L per day
minimum output 30mL/hr
bladder health
controlling blood pressure
nephrotoxicity and medications

Question 3

examples of potential nephrotoxicity substances

Answer 3

• contrast media dye
  heavy metals like lithium
  pesticides. snake venom

Question 4

age-related changes in urinary system

Answer 4

-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

Question 5

important assessment aspects of urinary system?

Answer 5

normal urine output should equal fluid intake
- approximately 60mL/hr
- minimum 30mL/hr or 0.5 mL/Kg per hour

Question 6

important aspects of px health hx

Answer 6

• 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!!!!

Question 7

diagnostic tests and procedures?

Answer 7

• urinalysis and culture and sensitivity
• cbc
• blood urea nitrogen
• BUN: creatinine ratio
• KUB
  -angioplasty
• serum creatinine, creatinine clearance

Question 8

what do you look at when examining urine?

Answer 8

• volume
• color, clarity
• odor
• sterility
• pH
• specific gravity
• glucose, ketone, proteins
• measure residual urine

Question 9

what is urge incontinence?

Answer 9

involuntary loss of urine when there is strong urge to urinate

Question 10

what is stress incontinence?

Answer 10

when urethral sphincter fails caused by coughing sneezing laughing and exercise

Question 11

what is mixed incontinence?

Answer 11

combination of different types of incontinence

Question 12

what is overflow incontinence?

Answer 12

poor contractility of muscle or obstruction of the urethra

Question 13

what is functional incontinence?

Answer 13

-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

Question 14

what is neurologic incontinence?

Answer 14

caused by disorders of the neurologic system like sclerosis or spinal cord injury

Question 15

symptoms of cystitis?

Answer 15

• urgency, frequency, dysuria
  -hematuria, nocturia
• bladder spasms, incontinence
  -low-grade fever
• dark urine
  fatigue
• pelvic discomfort

Question 16

what can cystitis be caused by ?

Answer 16

• renal calculi
• urinary diversion
• indwelling catheters
• prolonged immobility
  -inflammation due to infection ( usually bacterial)

Question 17

what us cystitis diagnosed by and treated by?

Answer 17

urinalysis and antibiotics

Question 18

what is urethritis caused by?

Answer 18

• infection
• trauma
• hypersensitivity to products like bubble baths and sperm jellies

Question 19

symptoms of urethritis?

Answer 19

-dysuria, frequency, urgency, and bladder spasms
- urethral discharge

Question 20

how do you diagnosis and treat urethritis?

Answer 20

antibiotics and urinalysis test

Question 21

health teachings regarding urinary infections

Answer 21

• cotton underwear
• clean front-to-back
• urinate before and after sex
  -void every 4 hours
  -advise to take medications
  -drink plenty of water

Question 22

what can cause acute pyelonephritis?

Answer 22

• bacterial infection
• infection in kidneys
• mostly in women 20’s-30’s
• can be acute or chronic
  -can be due to uti that spread

Question 23

symptoms of acute pyelonephritis

Answer 23

• fever, chills
• increased wbc
• fatigue, nausea, vomiting
• flank pain, nocturia, dysuria, bacteriura, pyuria
• edema, fluid overload

Question 24

symptoms of pyelonephritis

Answer 24

• chills
• nausea, vomiting
• headache
• flank pain
• high fever

Question 25

diagnostic tests of pyelonephritis?

Answer 25

- KUB OR CT - urinalysis, BUN, creatinine, GFR, - blood cultures, WBC count - kidney biopsy

Question 26

treatment for pyelonephritis

Answer 26

-antibiotics - hygiene - encourage fluid intake - meds watch sodium intake - hospitalize if they are septic

Question 27

symptoms of acute glomerulonephritis ?

Answer 27

- fever, chills - nausea, vomiting - fatigue - flank pain - nocturia, pyuria, bacteriuria - hypertension ( late indicator)

Question 28

what is acute glomerulonephritis?

Answer 28

occurs after strep-throat or in response to bacterial, viral, or parasitic infection

Question 29

what is acute pyelonephritis?

Answer 29

infection of the kidney from bacteria traveling from the bladder up to ureters to the kidney

Question 30

what to assess for in acute glomerulonephritis?

Answer 30

recent infections, surgeries signs of edema compare blood pressure baseline inspect skin for lesions, incisions -kidney biopsy - urinalysis, BUN and creatinine, GFR

Question 31

interventions of acute glomerulonephritis?

Answer 31

daily weight is taken and vital signs input and output diet therapy drug therapy cardiac management urinary assessment possible dialysis

Question 32

what causes renal calculi? what is it?

Answer 32

- stones in the urinary tract - cause: dehydration, urinary stasis, result in obstruction in the urinary tract, immobility - infection, or genetic -

Question 33

symptoms of renal calculi? diagnostic tests? treatment?

Answer 33

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

Question 34

what is acute renal failure ?

Answer 34

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

Question 35

what are the three types of acute renal failure? description/example?

Answer 35

prerenal: issue prior to the kidney like hemorrhage intrarenal: issue inside the kidney post-renal: issue after kidney like renal calculi

Question 36

acute renal failure diagnostic tests?

Answer 36

i/o's azotemia - abg elevated creatinine, increased k - ultrasound of kidneys ct of abdomen and pelvis without contrast dye KUB cytoscopy kidney biopsy

Question 37

4 phases of acute kidney injury? describe what happens in each

Answer 37

1. onset phase: starts with the prior event, and continues until oliguric development 2. oliguric phase: lasts 1-3 weeks, longer the phase lasts poorer the prognosis, dialysis may be required during this phase 3. diuretic phase: urine output may be 1,000-2,000 ml/day 4. recovery phase: 3-12 months

Question 38

how to manage acute kidney failure? (medical management)

Answer 38

1. prevent renal failure with adequate hydration 2. maintain fluid and electrolyte balance (monitor serum and urine electrolytes) 3. replace renal function with dialysis 4. prevent infection: a significant cause of death in px with ARF, avoid indwelling catheters \ 5. avoid protein foods, contrast media, and nephrotoxic medications, decrease fluid volume overload, monitor skin integrity, monitor for s/s of infection