Chapter_051 Renal and Urologic Problems

Question 1

What is the most common cause of renal and urologic infections?

Answer 1

Bacteria such as E. coli, Proteus, Klebsiella, or Enterobacter from the intestinal tract

Other causes can include fungi, protozoa, or viruses.

Question 2

What is urosepsis?

Answer 2

Systemic infection from a urologic source

It can lead to severe complications if not treated promptly.

Question 3

What are classic symptoms of acute pyelonephritis?

Answer 3

Fever, chills, nausea, vomiting, malaise, flank pain

Other symptoms may include dysuria, urgency, and frequency.

Question 4

What diagnostic tests are used for acute pyelonephritis?

Answer 4

• Urinalysis: pyuria, bacteriuria, hematuria
• Urine cultures and sensitivities
• Blood cultures
• Ultrasound
• CT scan

CT scan is the preferred imaging study.

Question 5

What is the treatment for mild symptoms of acute pyelonephritis?

Answer 5

• Fluids
• NSAIDs
• Follow-up cultures and imaging
• Antibiotics: oral for 7 to 14 days; IV to oral for 14 to 21 days

Treatment should be guided by sensitivity results.

Question 6

What are the expected nursing diagnoses for a patient with acute pyelonephritis?

Answer 6

• Impaired urinary system function
• Acute pain
• Lack of knowledge

Goals include normal renal function and no recurrence of symptoms.

Question 7

True or False: Chronic pyelonephritis can lead to end-stage renal disease (ESRD).

Answer 7

True

Chronic pyelonephritis is characterized by inflammation of the kidneys that can result in irreversible renal failure.

Question 8

What is urethritis?

Answer 8

Inflammation of the urethra due to bacterial or viral infection

Common causes include Trichomonas, chlamydia, or gonorrhea.

Question 9

What are symptoms of urethral diverticula?

Answer 9

• Dysuria
• Post void dribbling
• Frequency
• Urgency
• Suprapubic discomfort
• Incontinence

Symptoms can vary significantly between males and females.

Question 10

How is interstitial cystitis (IC) characterized?

Answer 10

Chronic, painful, inflammatory disease of the bladder

IC causes painful bladder syndrome (PBS) and is associated with urgency and frequency.

Question 11

What are common clinical manifestations of acute poststreptococcal glomerulonephritis (APSGN)?

Answer 11

• Generalized edema
• Hypertension
• Oliguria
• Hematuria
• Proteinuria

Smoky urine may indicate bleeding in the upper urinary tract.

Question 12

What is the management for APSGN?

Answer 12

• Symptom relief
• Rest
• Restrict Na+ and fluids
• Administer diuretics
• Antibiotics if streptococcal infection is present

95% recover completely or improve with conservative treatment.

Question 13

What are the manifestations of chronic glomerulonephritis?

Answer 13

• Hematuria
• Proteinuria
• Increased BUN and creatinine

Symptoms develop slowly and may go unnoticed until routine tests reveal abnormalities.

Question 14

What is Goodpasture syndrome?

Answer 14

Autoimmune disease where antibodies attack glomerular and basement membranes

It can lead to kidney and lung damage.

Question 15

What are the treatments for nephrotic syndrome?

Answer 15

• Corticosteroids
• Immunosuppressive drugs
• Diuretics
• Dietary changes

Management focuses on relieving symptoms and preventing complications.

Question 16

Fill in the blank: The primary clinical manifestations of interstitial cystitis are _______ and bothersome LUTS.

Answer 16

pain

LUTS stands for lower urinary tract symptoms.

Question 17

What is edema?

Answer 17

Accumulation of fluid in tissues

Can be caused by various conditions including systemic diseases.

Question 18

What are the clinical manifestations of nephrotic syndrome?

Answer 18

Peripheral edema, massive proteinuria, hypertension, hyperlipidemia, hypoalbuminemia, foamy urine

Severe hypoalbuminemia can lead to ascites and anasarca.

Question 19

What is a common treatment approach for nephrotic syndrome?

Answer 19

Corticosteroids, cyclophosphamide, manage diabetes, ACE inhibitors, ARBs, diuretics, antihyperlipidemic drugs, anticoagulants

Dietary modifications include a low-sodium, moderate protein diet with small, frequent meals.

Question 20

What is urinary obstruction?

Answer 20

An anatomic or functional condition that blocks or impedes the flow of urine

Can be congenital or acquired.

Question 21

What factors determine the severity of urinary obstruction?

Answer 21

Location, duration, amount of pressure or dilation, presence of urinary stasis or infection

Question 22

What is hydronephrosis?

Answer 22

Swelling of a kidney due to a build-up of urine

Can occur with urinary obstruction.

Question 23

What are common causes of renal trauma?

Answer 23

Blunt trauma (abdominal, flank, back injuries), penetrating trauma (gunshot, stabbing)

Clinical manifestation often includes hematuria.

Question 24

What treatments are available for renal trauma?

Answer 24

Bed rest, fluids, analgesia, exploratory surgery, nephrectomy

Question 25

What causes renal artery stenosis?

Answer 25

Partial occlusion due to atherosclerosis or fibromuscular hyperplasia

Question 26

What are the manifestations of renal artery stenosis?

Answer 26

Sudden hypertension ## Footnote Common in ages less than 30 and more than 50 years.

Question 27

What treatments are used for renal artery stenosis?

Answer 27

Control BP, restore renal perfusion, percutaneous transluminal renal angioplasty, surgical revascularization, nephrectomy

Question 28

What is renal vein thrombosis?

Answer 28

Thrombosis of the renal vein that may be unilateral or bilateral ## Footnote Causes include trauma, compression, renal cell cancer, and nephrotic syndrome.

Question 29

What is nephrosclerosis?

Answer 29

Sclerosis of small arteries and arterioles of the kidney leading to reduced blood flow and ischemia

Question 30

What is the difference between benign and malignant nephrosclerosis?

Answer 30

Benign is age-related changes due to hypertension and atherosclerosis; malignant is a medical emergency with severe hypertension

Question 31

What is polycystic kidney disease (PKD)?

Answer 31

A hereditary disease characterized by the growth of numerous cysts in the kidneys

Question 32

What are the clinical manifestations of adult PKD?

Answer 32

Hypertension, hematuria, pain in back or abdomen, UTI, urinary stones

Question 33

What is the treatment for adult PKD?

Answer 33

No cure, manage UTIs, nephrectomy, dialysis, kidney transplant

Question 34

What is medullary cystic disease?

Answer 34

A hereditary disorder in older adults characterized by cysts in the medulla

Question 35

What are the clinical manifestations of Alport Syndrome?

Answer 35

Hematuria, progressive hearing loss, deformities in lens ## Footnote It is a chronic hereditary nephritis.

Question 36

What is urinary incontinence (UI)?

Answer 36

Involuntary leakage of urine ## Footnote More prevalent in older adults, particularly women.

Question 37

What are the types of urinary incontinence?

Answer 37

Stress, urge, overflow, reflex, functional ## Footnote Patients may have more than one type.

Question 38

What is the basic evaluation method for urinary incontinence?

Answer 38

Bladder log or voiding record for 1 to 7 days, physical exam, diagnostic studies like urinalysis and ultrasound

Question 39

What are some interventions for urinary incontinence?

Answer 39

Lifestyle modifications, scheduled voiding regimens, pelvic floor muscle rehabilitation, drug therapy, surgical therapy

Question 40

What is urinary retention?

Answer 40

Inability to empty bladder or accumulation of urine due to inability to void

Question 41

What are the diagnostic studies for urinary retention?

Answer 41

Urinalysis, post void residual, urodynamic studies, ultrasound

Question 42

What is acute urinary retention?

Answer 42

Inability to pass urine; considered a medical emergency

Question 43

What surgical techniques are used for urinary tract surgery?

Answer 43

Open nephrectomy, laparoscopic nephrectomy, procedures for obstructing stones, congenital abnormalities, urinary diversion

Question 44

What should be monitored postoperatively after urinary tract surgery?

Answer 44

Urine output, respiratory status, abdominal distention, bowel sounds, pain management

Question 45

What are some methods of urinary diversion?

Answer 45

Ureterostomy, ileal conduit, nephrostomy ## Footnote Surgical procedures to redirect urine flow.

Question 46

What conditions can cause urine flow blockage?

Answer 46

Bladder cancer, neurogenic bladder, congenital anomalies, strictures, bladder trauma, and chronic bladder inflammation

Question 47

What is the most common type of incontinent urinary diversion?

Answer 47

Ileal conduit (ileal loop)

Question 48

What is the main characteristic of incontinent urinary diversion?

Answer 48

No valve = no voluntary control

Question 49

How is urine collected in incontinent urinary diversion?

Answer 49

Urine drips into an external collection device

Question 50

What is a key feature of continent urinary diversion?

Answer 50

Intraabdominal urinary reservoir that can be catheterized

Question 51

What materials can be used to construct a continent urinary reservoir?

Answer 51

* Ileum * Ileocecal segment * Ascending colon

Question 52

What is a common method of patient self-catheterization frequency for continent urinary diversion?

Answer 52

Every 4 to 6 hours

Question 53

What are examples of continent urinary diversions?

Answer 53

* Kock * Mainz * Indiana * Florida

Question 54

What is the primary goal of orthotopic bladder reconstruction?

Answer 54

Construction of a new bladder in correct anatomical position to discharge urine through the urethra

Question 55

What are some common segments of intestine used to create a neobladder?

Answer 55

* Distal ileum * Various segments of intestines

Question 56

What are the candidate criteria for orthotopic bladder reconstruction?

Answer 56

* Normal renal and liver function * 1 to 2 year life expectancy * Adequate motor skills * No inflammatory bowel disease or colon cancer * Not obese

Question 57

What is a potential postoperative issue for patients with a neobladder?

Answer 57

Incontinence may occur; may need intermittent catheterization

Question 58

What is essential in preoperative management for urinary diversion?

Answer 58

Patient/family education and psychosocial support

Question 59

What complications should be prevented in postoperative management?

Answer 59

* Atelectasis * Shock * Thrombophlebitis * Small bowel obstruction * Paralytic ileus * UTI

Question 60

What is a common postoperative care instruction regarding fluid intake?

Answer 60

Encourage high fluid intake

Question 61

What is important for skin care in patients with an ileal conduit?

Answer 61

Meticulous skin care to avoid dermatitis and yeast infections

Question 62

What is a key teaching point for patients with continent diversion?

Answer 62

How and when to catheterize and irrigate

Question 63

How long may bladder control take after orthotopic bladder reconstruction?

Answer 63

Up to 6 months

Question 64

What is a critical aspect of discharge teaching for patients post-surgery?

Answer 64

Symptoms of obstruction or infection

Question 65

What should patients know about ostomy care post-surgery?

Answer 65

Stoma may shrink as it heals

Question 66

What is important regarding the fit of ostomy appliances?

Answer 66

Proper fit is important

Question 67

What should patients be informed about purchasing ostomy supplies?

Answer 67

Where to buy supplies, emergency contact numbers, and location of ostomy clubs