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NUR 131 > Class 4 Renal/Urinary elimination adult > Flashcards

Class 4 Renal/Urinary elimination adult Flashcards

1
Q

Define: Anuria

A

Failure of kidney to produce urine

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2
Q

Define: Oliguria

A

Small amount of urine production (less than 400mL/24 hour)

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3
Q

Define: Polyuria

A

Passing abnormal large amount of urine (over 3L/24 hour)

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4
Q

Define: Frequency

A

Voiding more than 8x during waking hours (the feeling of having to void all the time)

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5
Q

Define: Urgency

A

Sudden need to urinate

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6
Q

Define: Dysuria

A

Pain with urination

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7
Q

Define: Hesitancy

A

decrease in force of urine or difficulty starting flow

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8
Q

Define: incontinence

A

involuntary loss of urine

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9
Q

Retention
ACUTE?
CHRONIC?

A

Acute: suddenly unable to void when bladder is full
Chronic: bladder does not empty completely

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10
Q

Define: proteinura

A

excess of protein in urine

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11
Q

Define: glycosuria

A

excreation of glucose in urine

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12
Q

Define: Hematuria

A

Blood in urine

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13
Q

Define: Pyuria

A

Pus or WBC in urine

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14
Q

Define: Calculi

A

Stones in urine

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15
Q

Define: casts

A

Tube shape particles containing WBC, RBC, kidney cells or substances such as protein or fat

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16
Q

Define: CCMS

A

Clean catch midstream sample. patient must clean perineal area, start to void, then collect urine sample during voiding stream

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17
Q

Define: C&S

A

Culture (identify the pathogen) and Sensitivity (identify which antibiotic will work)

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18
Q

Define: UA

A

Urinalysis, to get a baseline, diagnosis, and whether the therapy is working.

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19
Q

Define: PVR

A

Post Void residual. <50mL is considered residual after voiding

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20
Q

24 hour urine collection

A

Patient voids at 7am and dumps 1st void. Collects all voids for remaining 24 hours, put on ice. If one void is not collected during that 24 hours the process must start over

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21
Q

Urinalysis info, color, appearance etc

A 
Color: light straw to amber
Appearance: clear
odor: aromatic
pH: 4.5-8
spec. gravity: 1.005-1.030
Protein: 0-5mg/dL
Glucose: neg
Ketones: neg
Nitrites: neg
RBC: rare
WBC: 3-4
Casts: occasional hyaline
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22
Q

What could be the cause of ketones in the urine?

A

high protein diet

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23
Q

What could be the cause of RBC in the urine?

A

Kidney stones

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24
Q

What could be the cause of WBC in the urine?

A

UTI, fever

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25
Q

What could be the cause of casts in the urine?

A

fever, heart failure

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26
Q

what would cause the pH to be under 4.5

A

metabolic or respiratory acidosis

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27
Q

What would cause the pH to be over 8

A

Bacteria, UTI

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28
Q

What would cause the specific gravity to be under 1.005

A

Diabetes insidious, over hydration

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29
Q

What would cause the specific gravity to be over 1.030

A

Dehydration, vomiting, fever

30
Q

Urine diagnostic Tests

What is PSA (blood)

A

Prostate-specific antigen
protein produced by prostate and released into blood
Increases with prostate cancer

31
Q

Urine diagnostic Tests

What is KUB?

A

Xray of the anteroposterior film of kidneys, ureters and bladder
Looks for urinary calculi and masses

32
Q

Urine diagnostic Tests

What is IVP

A

Intravenous phylogram
Xrays after IV injection of contrast.
Looks for stones, masses, hematuria, obstruction
**ask pt is they are allergic to seafood, iodine or contrast
**done before KUB if both are ordered
Pre-procedure: bowel prep, NPO 8 hr (water ok)
Post-procedure: V/S, when to contact provider

33
Q

Blood test

A

BUN (10-20 norm): increased= impaired renal function, sepsis, increased protein intake, starvation, dehydration, heart failure
Creatinine (0.6-1.2 norm): increased= impaired renal function
GFR (>60) or (90-100): <15 is considered end stage renal failure

34
Q

Urine diagnostic Tests

Radiology: retrograde pyelogram

A

Used for clients who are allergic to iodine-based contrast
Contrast admin directly into urinary tract during cystoscopy.
Evaluates: Ureters, renal pelvis, calyces

35
Q

Urine diagnostic Tests

Radiology: Cystogram

A

Contrast instilled into bladder via catheter.

Evaluates: UTI’s, reflux, hematuria, trauma, surgical healing, stress incontinence

36
Q

Urine diagnostic Tests

Radiography: voiding cystogram

A

Similar to cystogram but films taken while client is voiding.
Evaluates urethral stricture, fistula, trauma, diverticulum or tumor
CT scan, MRI, Renal angiography

37
Q

Urine diagnostic Tests

Ultrasonography

A

Evaluates: kidneys, ureters, bladder, prostate, testes and penis.
Bladder scan
Prostate scan: performed transrectally, pre-procedure prep: enema

38
Q

Diagnostic Tests

Surgical: Endoscopy

A

Cystourethroscopy and Urethroscopy

Preop: UA, permits, IV fluids

Intra-op: anesthesia, lithotomy position

Post-op education: increase fluids, assess bleeding, monitor for infection, warm baths, NSAIDS’s, cath for retention, B&O (Belladonna and opioids) for bladder spams

39
Q

Diagnostic Tests

Surgical: Endoscopy

A

Ureteroscopy, Nephroscopy, Ureterorenoscopy
Preop: UA, antibiotics, NPO, permits
Intra-op: anesthesia, Trendelenburg position
Postop: observation for perforation and urinary extravasation into abdomen, infection, renal colic, bleeding.
Unilateral stents may be left in for at least 48 hours
increase fluids
continue antibiotics

40
Q

Diagnostic Tests

Surgical: Biopsy

A

Transurethral bladder
Transrectal Prostate
Percutaneous and Open Renal

41
Q

Obstructive Disorders
Bladder cancer: surgical treatment
What is TUR?

A

Transurethral resection. used to diagnose cancer and remove cancerous tissue from bladder

  • for low grade superficial tumors
  • palliative for inoperable tumors
  • often followed with intravesical BCG (bacillus Calmette-Guérin) or chemo
42
Q

Obstructive Disorders
Bladder cancer: surgical treatment
What is Fulguration?

A

Uses heat from electricity current to destroy abnormal tissue

  • for low grade superficial tumors
  • palliative for inoperable tumors
  • often followed with intravesical BCG or chemo
43
Q

What is partial Cystectomy?

A

Partial bladder removal

  • clients who can’t tolerate a radical cystectomy
  • isolated tumors that can’t be treated with TUR
44
Q

Obstructive Disorders
Bladder cancer: surgical treatment
What is radical cystectomy and urinary Diversion?

A

Requires urinary diversion
Also done for Neurogenic Bladder, Radiation Induced Cystitis and Congenital defects
Used for when tumors have invaded the bladder wall

45
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
What is Ileal Conduit?

A

ureteroileostomy, ileal bladder or Bricker’s procedure

  • portion of intestine used to form stoma
  • ureters implanted into this portion of intestine
  • continuous urine flow
  • incontinent diversion
46
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
What is Cutaneous Ureterostomy?

A
  • each ureter brought to surface of ab to form a stoma
  • continuous drainage
  • incontinent diversion
47
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
What is Indiana Pouch?

A
  • improved/larger version of Kock Pouch
  • reservoir created from ascending colon and terminal ileum
  • ureters implanted into side of diversion
  • special nipple valve, used to attach reservoir to skin
  • internal storage 800mL
  • no drainage devise needed
  • must be drained every 3-4 hours
  • continent diversion
48
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
Guidelines for patients for Indiana Pouch?

A
  • > 2 years of life expectancy
  • 1-3 hours surgery
  • creatinine 2.5 or less
  • fine motor skills needed
  • electrolyte re-absorption is minimal if urine is drained regularly
  • no severe bowel history
49
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
Orthotopic neobladder?

A 
Must have normal liver/renal function
Good motor skills
1-2 years life expectancy
May need to cath but might be able to void normally
May have incontinence
50
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
Total Cystectomy with Urinary Diversion Pre op

A
  • bowel prep (clear liquids 1-3 days, laxatives/enemas night before, antibiotics, NPO night before)
  • Enterostomal nurse visitation
  • potential sexual dysfunction
  • informed consent
51
Q

Obstructive Disorders
Bladder cancer: Urinary Diversion
Total cystectomy with Urinary diversion Post op

A
  • usual post op assessments
  • assess stoma (q 2hr x 24 hr, q 4hr x 48-72 hrs, q 8hr for color and patency) report if dusky color, could be necrosis.
  • NPO until peristalsis resumes or bowel sounds
  • I/O q 1 hour
  • assess urine
  • monitor for complications
52
Q

What is minimum urine output per hour?

A

30mL/hr x 24 hour OR 720mL a day

53
Q

Obstructive Disorders

Ureteral Tumors info

A

Primary tumors are rare
Gross hematuria is usually 1st symptom
Treatment: surgical incision and resection

54
Q

Obstructive Disorders:
What is Urolithiasis?
Etiology?
Pathophysiology?

A

Urinary Calculi

Etiology: 2 primary causes, Urinary stasis or supersaturation of urine with poorly soluble crystalloids r/t fluid depletion or increased solutes, family history

Pathophysiology:
Types of calculi:
calcium phosphorus or oxalate (most common)
uric acid
struvite (stones), cystine (genetic defect)

55
Q

Obstructive Disorders:

urolithiasis potential damage?

A
  • obstruction with possible hydronephrosis
  • tissue trauma with hemorrhage
  • infection
56
Q

Obstructive Disorders:

Urolithiasis (kidney stones) clinical manifestations and Diagnosis

A

Manifestation: sharp, severe, sudden pain (renal or ureteral colic)
N/V, pallor, diaphoresis and anxiety
Gross hematuria
Elevated temp and WBC

Diagnosis: UA, KUB, IVP, Cystoscopy used to diagnosis calculi

57
Q

Obstructive Disorders:

Urolithiasis treatment

A

Relieve acute manifestations
Facilitate passage of stone
Increase fluids
Decrease pain

58
Q

Obstructive Disorders:
Urolithiasis preventing stone recurrence
FLUID, MEDICATION, DIETARY

A

Increase fluids- 2.5-3L per day

Medications:
Calcium and oxalate stone- thiazide diuretic
Uric and cystine stone- potassium citrate

Dietary modifications
Calcium stone- reduce calcium/sodium/protein
Calcium oxalate- reduce spinach, nuts, chocolate, beer, pop, beets
Uric stones- need purine diet of increase organ meats, venison, sardines

59
Q

Obstructive Disorders:
Urolithiasis Surgical Management
3 types?

A

Laser Lithotripsy- lasers and ureteroscopy remove or loosen impacted stones

Extracorporeal Shock Wave Lithotripsy (ESWL)- external sound waves break up stones

Percutaneous Nephrolithotomy- guide inserted through skin under fluoroscopy near stone and an ultrasonic wave is used to break up stone

60
Q

Obstructive Disorders:

Urinary Reflux causes and pathophysiology

A

-backward flow of urine
-severity ranges from Grade I to Grade V
Causes: congenital abnormality, chronic bladder infections, outlet obstruction in bladder neck

Pathophysiology: continuous presence of residual urine, leads to chronic UTI’s, renal damage and/or pyelonephritis (kidney infection)

61
Q

Obstructive Disorders:

Urinary Reflux surgical management

A
  • usually involves re-implantation of ureters
  • post op: urethral or suprapubic catheter
  • advantages of ureteral catheter: splints ureter to facilitate healing, prevents obstruction due to post op/trauma edema, drain urine
62
Q

Voiding Disorders:

Urinary Retention

A
  • inability of bladder to empty partially or completely
  • PVR (post void residual >50 mL)
  • patient dribbling (voiding 25-50 mL at a time)

Causes: detrusor muscle failure, decreased sensory input to bladder (anesthesia), BPH (benign prostatic hyperplasia), rectocile (rectal) or enterocele (vaginal) prolaps, poor bladder muscle tone

63
Q

Urinary Retention Medical treatment

A

Identify and remove cause
cholinergic medication (increases peristalsis)
urethral dilation

64
Q

Voiding Disorders:

Urinary Retention Surgical Management

A
  • done if structural defect is found
  • removal of enlarged prostate or urethral stricture
  • correction of structural abnormality
  • bladder neck repair
  • suprapubic cystotomy (done when urethral cath is diff, inserted through ab into bladder, used for bladder training
65
Q

Prostate Disorders:

BPH (benign prostatic hyperplasia)

A
  • abnormal increase in the number of normal cells (hyperplasia) in prostate
  • excessive smooth muscle contraction
66
Q

Prostate Disorders:
BPH (benign prostatic hyperplasia)
clinical manifestations?

A
  • usually develops slowly
  • decreases in size and force of urine stream
  • hesitancy, urgency, nocturia
  • incomplete emptying
  • urine leaking
67
Q

Prostate Disorders:
BPH (benign prostatic hyperplasia)
Medical Management?

A
  • slow prostate growth (Proscar med, takes 6-12 months)
  • relax prostate muscle (Flomax)
  • relieve retention, catheterization
68
Q

Prostate Disorders:
BPH (benign prostatic hyperplasia)
Surgical management?

A
  • TURP (transurethral resection of prostate), most common, “gold standard”
  • TUIP (transurethral incision of prostate)
  • open prostatectomy
69
Q

Prostate Disorders:
BPH (benign prostatic hyperplasia)
Post Op Care

A
  • Prevention of injury (no straining during defecation, prevent constipation, avoid bladder irritants)
  • Monitor for bleeding/bladder irrigation
  • Strict I/O
  • Pain medication
  • Pelvic exercises
  • Erectile dysfunction (rare), Viagra, sexual counseling
  • Arrange follow-up
70
Q

Urinary Drainage Systems:

Maintenance

A
  • Uro-meter (little plastic measure on bag)
  • I/O for continuous/intermittent bladder irrigation
  • *total output - amount of irrigation admin = urine output
71
Q

What are the 2 highest diseases that cause renal insufficiency/failure?

A

Diabetes

Hypertension

NUR 131 (38 decks)

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