Deck 11_GU

Question 1

Identify measures to prevent UTI, pyelonephritis & CAUTI

Tip:

• Discontinue Catheter
• Date urine bag

Answer 1

• UTI prevention:
  
  • good bowel habits (pee when you have to pee)
  • cranberry juice
  • wipe front to back
• Pyelonephritis
  
  • same as UTI prevention
• CAUTI
  
  • take that catheter out ASAP
  • if you cant take out the catheter, fix it to the patient’s thigh

Question 2

What are the signs and symptoms of urolithiasis? What is the priority for nursing care?

Answer 2

Signs and Symptoms

• severe, colicky pain w/ concomitant N&V
• based on location of stone
• Diaphoresis
• Obstructed urinary flow
• Hematuria

Priority for nursing care is managing acute pain, administering meds, teach pt to strain urine

• Control Pain
• Keep well hydrated
• Low Na Diet
• Avoid oxalate

Question 3

What are the classifications of acute kidney (AKI) injury and what causes each classification of renal failure? ​

Answer 3

• Pre-renal
  
  • Blood or fluid loss
  • Reduced Renal bloodflow
  • Hypotension
  • Sepsis/septic shock
  • Liver failure
  • Severe burns
• Intrarenal
  
  • Direct damage to renal system
  • Ischemia from emboli
  • Bleeding in the kidney
  • Glomerulonephritis or inflammation
  • Lupus
  • Pyelonephritis
  • Meds (NSAIDS)
• Post-renal
  
  • BPH
  • Kidney stones
  • neurogenic bladder
  • Mechanical obstruction in the lower urinary tract

Question 4

What are the signs and symptoms of AKI? How is AKI managed?

Answer 4

• Signs and symptoms of AKI
  
  • Loss of Urinary output (Oliguria <400ml/24hrs)​
  • Proteinuria
  • Fluid retention
  • Edema
  • Third spacing
  • Abnormal Electrolytes (Potassium and Cr are elevated in blood)
  • Can result in life-threatening cardiac arrythmias
• AKI managed through management of fluid balance
  
  • Medications – diuretics
  • Treat hyperkalemia
  • Continuous renal replacement therapy
  • Assess daily weight
  • Dialysis

Question 5

What are the signs and symptoms of chronic kidney disease?

Answer 5

• in stage 1, nothing really. As CKD gets worse though, you get stuff like:
• anemia b/c of decreased erythropoietin production
• Uremia
• Hyperkalemia
• Hypertension
• pulmonary edema b/c of fluid overload
• bone breakdown/osteodystrophoies
• metabolic acidosis (b/c of decreased acid clearance)
• HF
• Decreased GFR
• Itchy Skin

Question 6

What is the difference between the time commitments of hemodialysis versus peritoneal dialysis?

Answer 6

Much less time commitment for hemodialysis compared to peritoneal dialysis

Hemodialysis

• Done in within the vasculature (blood)
• 2-4hours a day
• 3x a week

Peritoneal dialysis

• 4-6hrs a day

Question 7

What types of hemodialysis access devices are available? How do these devices differ?

Answer 7

• Arteriovenous graft
  
  • synthetic, self-sealing graft
  • Increased clotting/infection with this type
  • Used with poor vessels. For diabetics/IV drug abuse
• Arteriovenous fistula: PREFERRED TYPE
  
  • surgical anastomosis of artery/vein
  • preferred access: lasts longest/least compilcations
  • Must mature for 2-3 months. Use permacath until AV fistula is ready for use
  • Lasts long
• central venous double lumen catheter: double Lumen Hemodialysis Catheter (Permecath)
  
  • special large-volume high-flow catheters
  • complications = site infection/septicemia
  • Infections with this device
  • • Do not flush

Question 8

What care is needed for each type of hemodialysis access device?

Answer 8

Hemodialysis (HD):

• Do not use BP cuff or needles in the HD arm

PD (Peritoneal dialysis):

• Prevent infection.
• Patients are taught sterile technique)

• Arteriovenous graft
  
  • Assess for infection?
• Arteriovenous fistula
  
  • palpate for thrills and listen for bruits to make sure that it’s still functional
• central venous double lumen catheter
  
  • Unless you’re a dialysis nurse, don’t touch it!!