CoC for Patients With Urinary Problems & Renal Calculi

Question 1

Answer 1

• Urine formation & excretion of wastes occurs in the nephron

Question 2

Kidney Physiology

• Urine formation & excretion of wastes
• Regulator of electrolyte & water excretion
• Acid-base balance

Answer 2

• Erythropoietin production
• Renin-Angiotensin BP control
• Vit D conversion to active form

Question 3

Renal Calculi

• Urolithiasis - stones anywhere in the urinary system

Answer 3

• Renal calculi are usually within the kidneys but can be anywhere in the urinary system

Question 4

Hydronephrosis/Hydroureter

• Obstructive uropathies occur either when there’s a stricture or a stone that’s blocking the urine flow from the kidney to the bladder & out through the urethra

Answer 4

• If there’s a backup, pt may end up w/hydronephrosis and/or hydroureter

Question 5

Calculus Formation

• Calcium oxalate
• Calcium phosphate
• Uric acid

Answer 5

• Struvite
• Cystine

Question 6

Risk Factors

• Dehydration/warm climates
  > Dehydration leads to more solutes being circulated & the kidneys have a more difficult time getting rid of them (“solution to pollution is dilution”)
• Immobility
• Stasis of urine & infection
• Urine pH
• Supersaturation/crystallization

Answer 6

Renal Calculi Sx’s

• Pain (flank/anxiety)
• Renal colic
• Ureteral colic
• Hematuria [presence of blood in the urine]
• Pyuria (pus in urine [typically from bacterial infection])
• Urgency/frequency
• Infection
• Dec u/o

Question 7

Diagnostics

• KUB, CT scan, US
• IV urography
• Retrograde pyelography
• Serum chemistry, 24 hr urine, stone analysis

Question 8

Medical treatment - calcium ___

• Inc hydration
• Reduce dietary ___ - spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, Ovaltine, tea, Worcestershire sauce
• Cellulose phosphate, cholestyramine [reduces high blood cholesterol lvls]
• Calcium lactate, reduce sodium intake

Answer 8

oxalate

oxalate

Question 9

Medical treatment: calcium ___

• Treat hyperparathyroid disorder
• Treat other stones
• Inc hydration

Answer 9

phosphate

Question 10

Medical treatment: ___ (NH4MgPO4)

• Antimicrobial agents (! these are usually created in the environment of bacteria)
• Acetohydroxamic acid
• Surgery for staghorn calculi
• Inc hydration

Answer 10

struvite

Question 11

Medical treatment: ___

• Alkalinize urine w/potassium citrate
• Allopurinol (a xanthine oxidase inhibitor)
• Reduce dietary __ - sardines, herring, mussels, liver, kidney, goose, venison, meat soups, chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
• Inc hydration

Answer 11

uric acid

uric acid

Question 12

Medical treatment: ___

• Inc hydration
• Penicillamine
• Tiopronin
• Potassium citrate to maintain alkaline urine

Answer 12

cystine

Question 13

Treatments

Answer 13

Ureteroscopy

Question 14

Extracorporeal shock wave lithotripsy

Answer 14

Percutaneous nephrolithotomy

Question 15

Complications

! Obstruction (stone/edema/clot)

! Infection (UTI/pyelonephritis/urosepsis)

! Hemorrhage

Answer 15

Nursing Interventions & Patient Teaching

• Pain assessment & management
• Straining all urine
• Monitor hematuria, u/o, VS
• S/S of infection

Question 16

Patient Teaching

• Rx teaching as needed
• Periodic urine C&S
• Urine pH monitoring

Answer 16

Bladder Cancer - Risk Factors

• Smoking
• Environmental carcinogen exposure
• Recurrent bacterial infections, bladder stones
• High urinary pH
• High cholesterol intake
• Pelvic radiation therapy
• Cancer from prostate, colon, rectum

Question 17

1 sign is ?

Bladder Cancer Symptoms

• UTI common complication; frequency, urgency, dysuria
• Change in flow of urine
• Pelvic or back pain

Answer 17

(visible, painless) hematuria

Question 18

Diagnostics

• Cytology of fresh urine
• CT scan
• Cystoscopy w/bx
• US

Answer 18

Urinary Diversion

Reasons
> Bladder cancer or other pelvic malignancies
> Birth defects, trauma, strictures
> Neurogenic bladder, chronic infection or intractable cystitis
- Used as a last resort for incontinence

Question 19

Types

• Cutaneous urinary diversion
  > ileal conduit
  > cutaneous ureterostomy
  > vesicostomy
  > nephrostomy

Answer 19

• Continent urinary diversion
  > Indiana pouch, Kock pouch
  > ureterosigmoidostomy

Question 20

Care of an Ostomy Bag

• Typically lasts 3-5 days before leakage; never tape down a leaking appliance
• Empty >1/3 full to prevent bag from separating from skin

Answer 20

• Cleanse w/sterile saline, skin prep, wick w/gauze on stoma to prevent leak while cleaning, measure wafer to widest section of stoma & create hole 1/8th in or greater
  > Apply around stoma, may use karaya powder for skin protection
  > Apply bag (if 2 piece) may have cover or corn starch

Question 21

• Control odor w/ascorbic acid which helps to acidify urine & decrease odor & skin irritation

> Avoid asparagus, cheese, eggs; add a few drops of white vinegar or deodorant into bottom of bag

Answer 21

• If reusable bag, have 2. 1 to wear while the other is being cleaned w/3:1 sol’n of water & white vinegar for 30 min, rinsed w/tepid water & air dried away from direct sunlight
• Sleep w/attachment to drainage bag

Question 22

Postop Complications

• Peritonitis
• Stoma ischemia & necrosis

Answer 22

• Stoma retraction & separation
  > anti-reflux valve appliance
  > karaya powder, stoma adhesive, properly fitting wafer
• Dec kidney function

Question 23

Nursing Interventions

• Monitor labs & u/o
• Hourly basis monitoring w/minimum output 30 cc/hr in urine collection system (i.e., Foley); urometer to measure

Question 24

Preop Nursing Diagnoses

• Anxiety
• Imbalanced nutrition
• Deficient knowledge

Answer 24

Postop Nursing Diagnoses

• Risk for impaired skin integrity
• Acute pain
• Disturbed body image
• Potential for sexual dysfunction
• Deficient knowledge