Class 4 Renal/Urinary elimination adult Flashcards
1
Q
Define: Anuria
A
Failure of kidney to produce urine
2
Q
Define: Oliguria
A
Small amount of urine production (less than 400mL/24 hour)
3
Q
Define: Polyuria
A
Passing abnormal large amount of urine (over 3L/24 hour)
4
Q
Define: Frequency
A
Voiding more than 8x during waking hours (the feeling of having to void all the time)
5
Q
Define: Urgency
A
Sudden need to urinate
6
Q
Define: Dysuria
A
Pain with urination
7
Q
Define: Hesitancy
A
decrease in force of urine or difficulty starting flow
8
Q
Define: incontinence
A
involuntary loss of urine
9
Q
Retention
ACUTE?
CHRONIC?
A
Acute: suddenly unable to void when bladder is full
Chronic: bladder does not empty completely
10
Q
Define: proteinura
A
excess of protein in urine
11
Q
Define: glycosuria
A
excreation of glucose in urine
12
Q
Define: Hematuria
A
Blood in urine
13
Q
Define: Pyuria
A
Pus or WBC in urine
14
Q
Define: Calculi
A
Stones in urine
15
Q
Define: casts
A
Tube shape particles containing WBC, RBC, kidney cells or substances such as protein or fat
16
Q
Define: CCMS
A
Clean catch midstream sample. patient must clean perineal area, start to void, then collect urine sample during voiding stream
17
Q
Define: C&S
A
Culture (identify the pathogen) and Sensitivity (identify which antibiotic will work)
18
Q
Define: UA
A
Urinalysis, to get a baseline, diagnosis, and whether the therapy is working.
19
Q
Define: PVR
A
Post Void residual. <50mL is considered residual after voiding
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
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
22
Q
What could be the cause of ketones in the urine?
A
high protein diet
23
Q
What could be the cause of RBC in the urine?
A
Kidney stones
24
Q
What could be the cause of WBC in the urine?
A
UTI, fever
25
What could be the cause of casts in the urine?
fever, heart failure
26
what would cause the pH to be under 4.5
metabolic or respiratory acidosis
27
What would cause the pH to be over 8
Bacteria, UTI
28
What would cause the specific gravity to be under 1.005
Diabetes insidious, over hydration
29
What would cause the specific gravity to be over 1.030
Dehydration, vomiting, fever
30
Urine diagnostic Tests
| What is PSA (blood)
Prostate-specific antigen
protein produced by prostate and released into blood
Increases with prostate cancer
31
Urine diagnostic Tests
| What is KUB?
Xray of the anteroposterior film of kidneys, ureters and bladder
Looks for urinary calculi and masses
32
Urine diagnostic Tests
| What is IVP
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
Blood test
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
Urine diagnostic Tests
| Radiology: retrograde pyelogram
Used for clients who are allergic to iodine-based contrast
Contrast admin directly into urinary tract during cystoscopy.
Evaluates: Ureters, renal pelvis, calyces
35
Urine diagnostic Tests
| Radiology: Cystogram
Contrast instilled into bladder via catheter.
| Evaluates: UTI's, reflux, hematuria, trauma, surgical healing, stress incontinence
36
Urine diagnostic Tests
| Radiography: voiding cystogram
Similar to cystogram but films taken while client is voiding.
Evaluates urethral stricture, fistula, trauma, diverticulum or tumor
CT scan, MRI, Renal angiography
37
Urine diagnostic Tests
| Ultrasonography
Evaluates: kidneys, ureters, bladder, prostate, testes and penis.
Bladder scan
Prostate scan: performed transrectally, pre-procedure prep: enema
38
Diagnostic Tests
| Surgical: Endoscopy
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
Diagnostic Tests
| Surgical: Endoscopy
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
Diagnostic Tests
| Surgical: Biopsy
Transurethral bladder
Transrectal Prostate
Percutaneous and Open Renal
41
Obstructive Disorders
Bladder cancer: surgical treatment
What is TUR?
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
Obstructive Disorders
Bladder cancer: surgical treatment
What is Fulguration?
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
What is partial Cystectomy?
Partial bladder removal
- clients who can't tolerate a radical cystectomy
- isolated tumors that can't be treated with TUR
44
Obstructive Disorders
Bladder cancer: surgical treatment
What is radical cystectomy and urinary Diversion?
Requires urinary diversion
Also done for Neurogenic Bladder, Radiation Induced Cystitis and Congenital defects
Used for when tumors have invaded the bladder wall
45
Obstructive Disorders
Bladder cancer: Urinary Diversion
What is Ileal Conduit?
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
Obstructive Disorders
Bladder cancer: Urinary Diversion
What is Cutaneous Ureterostomy?
- each ureter brought to surface of ab to form a stoma
- continuous drainage
- incontinent diversion
47
Obstructive Disorders
Bladder cancer: Urinary Diversion
What is Indiana Pouch?
- 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
Obstructive Disorders
Bladder cancer: Urinary Diversion
Guidelines for patients for Indiana Pouch?
- >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
Obstructive Disorders
Bladder cancer: Urinary Diversion
Orthotopic neobladder?
```
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
Obstructive Disorders
Bladder cancer: Urinary Diversion
Total Cystectomy with Urinary Diversion Pre op
- bowel prep (clear liquids 1-3 days, laxatives/enemas night before, antibiotics, NPO night before)
- Enterostomal nurse visitation
- potential sexual dysfunction
- informed consent
51
Obstructive Disorders
Bladder cancer: Urinary Diversion
Total cystectomy with Urinary diversion Post op
- 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
What is minimum urine output per hour?
30mL/hr x 24 hour OR 720mL a day
53
Obstructive Disorders
| Ureteral Tumors info
Primary tumors are rare
Gross hematuria is usually 1st symptom
Treatment: surgical incision and resection
54
Obstructive Disorders:
What is Urolithiasis?
Etiology?
Pathophysiology?
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
Obstructive Disorders:
| urolithiasis potential damage?
- obstruction with possible hydronephrosis
- tissue trauma with hemorrhage
- infection
56
Obstructive Disorders:
| Urolithiasis (kidney stones) clinical manifestations and Diagnosis
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
Obstructive Disorders:
| Urolithiasis treatment
Relieve acute manifestations
Facilitate passage of stone
Increase fluids
Decrease pain
58
Obstructive Disorders:
Urolithiasis preventing stone recurrence
FLUID, MEDICATION, DIETARY
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
Obstructive Disorders:
Urolithiasis Surgical Management
3 types?
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
Obstructive Disorders:
| Urinary Reflux causes and pathophysiology
-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
Obstructive Disorders:
| Urinary Reflux surgical management
- 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
Voiding Disorders:
| Urinary Retention
- 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
Urinary Retention Medical treatment
Identify and remove cause
cholinergic medication (increases peristalsis)
urethral dilation
64
Voiding Disorders:
| Urinary Retention Surgical Management
- 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
Prostate Disorders:
| BPH (benign prostatic hyperplasia)
- abnormal increase in the number of normal cells (hyperplasia) in prostate
- excessive smooth muscle contraction
66
Prostate Disorders:
BPH (benign prostatic hyperplasia)
clinical manifestations?
- usually develops slowly
- decreases in size and force of urine stream
- hesitancy, urgency, nocturia
- incomplete emptying
- urine leaking
67
Prostate Disorders:
BPH (benign prostatic hyperplasia)
Medical Management?
- slow prostate growth (Proscar med, takes 6-12 months)
- relax prostate muscle (Flomax)
- relieve retention, catheterization
68
Prostate Disorders:
BPH (benign prostatic hyperplasia)
Surgical management?
- TURP (transurethral resection of prostate), most common, "gold standard"
- TUIP (transurethral incision of prostate)
- open prostatectomy
69
Prostate Disorders:
BPH (benign prostatic hyperplasia)
Post Op Care
- 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
Urinary Drainage Systems:
| Maintenance
- Uro-meter (little plastic measure on bag)
- I/O for continuous/intermittent bladder irrigation
* *total output - amount of irrigation admin = urine output
71
What are the 2 highest diseases that cause renal insufficiency/failure?
Diabetes
| Hypertension
