exam 2 Flashcards
1
Q
uti is often caused by
A
gram negative bacteria e. coli
2
Q
kidney functions
A
filter, regulate, remove waste products (urea), balance glucose/electrolytes, water levels in blood
3
Q
urinary system
A
kidneys, ureters, bladder, urethra
4
Q
generally ascending
A
uti
5
Q
first line of treatment for uti
A
bactrim and macrodantin
6
Q
helps sooth discomfort of painful urination; uti
A
pyridium; turns urine dark orange
7
Q
if UTI is fungal what med do you give
A
diflucan
8
Q
hall mark sign of acute pyelonephritis
A
fever, flank pain, high wbc
9
Q
causes include bacterial, viral, trichomonas, chlamydia, gonorrhea
A
urethritis
10
Q
what does HOUDINI stand for
A
hematuria obstruction- urinary uro, gyn or perineal surgery decubitus ulcer - open wound with incontinence I and O- hourly management No code/ comfort/ hospice immobility due to physical limitations
11
Q
less than 100 ml in a day
A
anuria
12
Q
someone 300-500 ml of urine in 24 hours
A
oliguria
13
Q
promotes kidneys to reabsorb water
A
ADH - antidiuretic hormone
14
Q
lack of ADH
A
large amounts of diluted urine
15
Q
when is adh produced
A
when patient is dehydrated, high sodium intake, decrease in blood volume
16
Q
increase in potassium leads to
A
increase in aldosterone
17
Q
pulls potassium in the gut so patient can have a BM
A
Kayexalate
18
Q
normal BUN
A
8-25
19
Q
Evaluates how well the kidneys are working to remove creatinine from the blood
A
creatinine clearance
20
Q
what is the best estimate of GFR
A
creatinine clearance
21
Q
The most common cause of intrarenal AKI?
A
Acute tubular necrosis (ATN)
22
Q
Shock waves are delivered to break up renal calculi?
A
Lithotripsy
23
Q
Priority intervention with a patient with a kidney stone?
A
pain
24
Q
single most important risk factors for UTI in hospitalized patients?
A
catheter use
25
Indicative of a patient with AKI is in recovery phase?
decrease bun and decrease creatinine
26
Patient has a K level of 7. What is your priority?
heart rate and rhythm
27
Urine is cloudy with WBC, nitrates, and a PH of 8.2?
uti
28
What does erythropoietin secretion do?
Increase RBC production
29
which foods should be avoided in renal patients
high potassium, high sodium
30
Strep throat may proceed which kidney issue?
Glomerulonephritis
31
Chemical waste that is generated from muscle metabolism?
creatinine
32
Assessment finding that indicates a urinary tract infection has ascended to the kidneys?
Costovertebral angle tenderness
33
Enlargement of prostate gland resulting from increase in number of epithelial cells and connective tissue
bph
34
Symptoms due to urinary retention
Decrease in caliber and force of urinary stream
Difficulty in initiating urination
Intermittency
Starting and stopping stream several times while voiding
Dribbling at end of urinating
obstructive symptoms
35
```
Urinary frequency and urgency
Dysuria
Bladder pain
Nocturia
Incontinence
```
irritation
36
appropriate treatment option for individuals who have moderate to severe symptom scores on the AUA symptom index.; decreases the size of the prostate
Finasteride
37
risks with Finasteride
othro hypotension and pregnant women should not touch the drugs, decrease libido
38
decreased prostate size but can also be used for kidney stones in male or female
tamsulosin (Flomax)
39
Promotes smooth muscle relaxation in prostate, facilitates urinary flow
Improvement in 2 to 3 weeks
Offer symptomatic relief but do not treat hyperplasia
tamsulosin (Flomax)
doxazosin (Cardura)
silodosin (Rapaflo)
40
side effect of tamsulosin (Flomax)
doxazosin (Cardura)
silodosin (Rapaflo)
orthostatic hypotension
41
effectively reduces symptoms of both BPH and ED.
cialis
42
ED drug taken daily, ED drug taken prn before sex
cialis; viagra
43
what can obstruction lead to
Hydronephrosis- swelling and damage to one or both kidney d/t retention.
44
golden standard to treat obstructing BPH
TURP
45
biggest complication with TURP
bleeding
46
post op care
CBI - flushes sterile fluid through cath and into the bladder to prevent blood clots
administer antispasmodics
teach kegel exercises
47
diagnostics for prostatitis
UA and culture
CBC
PSA
48
tightening or constriction off the foreskin; cause by poor hygiene. Ice pack for edema, topical corticosteroid 2-3 x day.
Phimosis
49
tightening of the foreskin in the retracted position. Warm soaks, cleaning glans and foreskin, antibiotics, and possible circumcision
paraPhimosis
50
A painful erection that lasts more than 6 hours.
| Is a medical emergency
priapism
51
Curved or crooked penis cause by plaque formation of the cavernosa of the penis or possible trauma. May have pain.
Peyronie’s disease
52
tx for Peyronie’s disease
collagenase Clostridium histolyticum to break down collagen
53
Men under 40 cause often gonorrhea or chlamydial infection; older men often UTI and prostatitis
epididymitis
54
tx for epididymitis
Tx: Elevate scrotum, ice packs, and analgesics.
55
Acute inflammation of the testis. Can be bacterial or viral infection (mumps, pneumonia, TB, syphilis. Also trauma, influenza, complicate UTI, and catheterization
orchitis
56
Non-tender, fluid filled mass. Lumph interference
hydrocele
57
tx for hydrocele
nothing unless scrotum becomes large and uncomfortable then aspiration or surgical drainage
58
Sperm filled cyst in epididymis
spermatocele
59
tx for Spermatocele
surgical removal
60
Twisting of the spermatic cord that supplies blood to testes and epididytimis
testicular torsion
61
tx for testicular torsion
Surgical emergency within 4-6 hours or ischemia to testes
62
what are you going to tell patient who had a vasectomy
Total of 10 ejaculations or 6 weeks to evacuate sperm. Advise contraception
63
Gradual decline in male hormone with aging
andropause
64
labs to draw for andropause
testosterone. 280-1000 is normal; replace at 200
65
dysuria, increased frequency >q2 hrs, urgency, suprapubic pain, hematuria, cloudy urine
UTI
66
used in complicated UTIs but has a risk of tendon rupture
Fluroquinolines
67
if UTI is fungal
Diflucan
68
Begins in lower urinary track and ascends the urethra; unresolved bacterial infection can cause bacteremia that can lead to urosepsis (can be fatal)
acute pyelonephritis
69
tx for pyelonephritis
Place pt on broad spectrum abx until culture sensitivity is back from lab (24+ hours maybe)
70
result of obstruction and rupture of the periurethral glands
urethral diverticula
71
dysuria, post void dribbling; urinary frequency and urgency, suprapubic discomfort, feeling of incomplete bladder emptying,
urethral diverticula
72
symptoms of a UTI without the presence of a positive urine culture, bacteremia, or pyuria.
Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)
73
what to suggest for a person who has Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)
keep a food diary when voids and when pain comes on; eliminate bladder irritating foods i.e.- caffeine, alcohol, citrus, aged cheese, foods with vinegar, hot peppers and curry ; avoid high-potency vitamins as they irritate the bladder
74
generalized body edema, periorbital edema, hypertension, oliguria, hematuria with a smoky or rusty appearance, and proteinuria; fluid retention d/t decreased glomerular filtration.
Acute Post Streptococcal Glomerulonephritis
75
to assess for renal trauma
IVP- contrast with X-ray to see where the blockage is
76
a life-threatening genetic disease. It is characterized by cysts that enlarge and destroy surrounding tissue by compression.
Polycystic kidney disease (PKD)
77
what can we do for Polycystic kidney disease (PKD)
no treatment. may need Nephrectomy may be necessary with dialysis or kidney transplant
78
accumulation of waste products in blood
azotemia
79
difference between acute injury and chronic kidney injury
rapid onset of injury, whereas chronic kidney disease comes on over time and is linked to CV disease
80
why drugs could be toxic to the kidneys, causing intrarenal damage
Antibiotics, aminoglyo, NSAIDS, vanco, ace inhibitor
81
phases of AKI
oliguria
diuretic phase- kidneys are starting to recover. Diuretic: 1-3 L and up to 5 L per day of output from osmotic diuresis, where the tubules can’t concentrate urine. This can cause hypovolemia and hypotension! This can last 2-6 weeks
recovery- phase continues until the kidney is fully recovered and could take up to a year.
82
how to treat hyperkalemia
Regular Insulin IV- Helps to move K+ into cells
Sodium bicarb IV- corrects acidosis and moves K+ into cells
Calcium gluconate IV- raises the threshold for excitation from K+
Hemodialysis- Most effective way to remove K+
Sodium Polystyrene Sulfonate (Kayexalate)- Exchange of Na for K+; oral or retention enema creates diarrhea and removes K+
Dietary restriction- limit intake to 40 mEq day of potassium rich foods and drink
83
what is ERSD
GFR is less than 15 and this patient needs dialysis
84
causes of CKD
diabetes and hypertension
85
foods high in potassium
bananas, avocado, potato, spinach, beans, citrus juices, fish
86
foods high in phosphorus
meat, fast food, cheese, soda, seeds, canned fish, milk
87
with bph we are really worried about
urinary retention
88
nurses role for CBI
titrating to the color of urinary output
| monitoring output so we dont rupture the bladder
89
if the bag for CBI is dark red what will we do
increase the flow
90
shrinks the prostate tissue for BPH
finasteride
91
uti ascending can cause
pyelonephritis
92
someone with lithotripsy what do we want to do
sprain their urine so we can catch the calculi and send it to the lab
93
in the diuretic phase of aki what are we worried about
dehydration because they are putting out a lot of urine
94
know prerenal, intra, and post
who is at risk for each
95
GFR and CKD stages
know
96
hemodialysis
prevent central line infections
| dont do bp or sticks in that arm
97
assessment for hemodialysis
palpate for a thrill - blood flow
98
biggest risk for hemodialysis
hypotension
99
peritoneal dialysis
CAPD- stays at home patient can be up and about; pretty independent; hanging bags
APD- automated overnight
100
biggest thing with peritoneal dialysis
peritonitis
101
in the peritoneal dialysis what are we looking for in the bag
fibrin and cloudiness- signs of infection
102
if you think the urine is infected
send for cell count and culture
103
anemia med for CKD
erythropoietin - stimulates the bone marrow to produce rbc
104
what to do if patient is on erythropoietin
monitor rbc, hgb, hct because they could have too much
105
biggest side effect of binders
GI upset
106
when should binders be taken
with food otherwise they aren't doing anything
107
with albumin what are we worried about
htn and volume overload because albumin brings fluid back into the cells
108
best determines what stage of CKD
GFR
109
influenced by fluid volume status and by the amount of protein in the diet
bun
110
if creatinine rises over time what are we thinking
kidney damage
111
what is considered a low oxalate diet
avoid spinach, dark roughage, asparagus, cabbage, tomatoes, rhubarb tea, chocolate
112
ca phosphate calculi
no ca or phosphate foods; animal meat, dairy, dark sodas, broccoli
113
ca oxalate
no ca or oxalate foods; spinach, bran, nuts
114
uric acid
no red meat, organ meat, shellfish
115
cysteine
drink plenty of water, limit sodium
116
draws potassium out through bowel and can treat hyperkalemia
kayexalate
117
shifts potassium into cells
insulin
118
measures how much is in the blood; product of protein and muscle metabolism
creatinine; normal could be different for everyone so you need to trend the patient before jumping to conclusions
