exam 2 Flashcards
uti is often caused by
gram negative bacteria e. coli
kidney functions
filter, regulate, remove waste products (urea), balance glucose/electrolytes, water levels in blood
urinary system
kidneys, ureters, bladder, urethra
generally ascending
uti
first line of treatment for uti
bactrim and macrodantin
helps sooth discomfort of painful urination; uti
pyridium; turns urine dark orange
if UTI is fungal what med do you give
diflucan
hall mark sign of acute pyelonephritis
fever, flank pain, high wbc
causes include bacterial, viral, trichomonas, chlamydia, gonorrhea
urethritis
what does HOUDINI stand for
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
less than 100 ml in a day
anuria
someone 300-500 ml of urine in 24 hours
oliguria
promotes kidneys to reabsorb water
ADH - antidiuretic hormone
lack of ADH
large amounts of diluted urine
when is adh produced
when patient is dehydrated, high sodium intake, decrease in blood volume
increase in potassium leads to
increase in aldosterone
pulls potassium in the gut so patient can have a BM
Kayexalate
normal BUN
8-25
Evaluates how well the kidneys are working to remove creatinine from the blood
creatinine clearance
what is the best estimate of GFR
creatinine clearance
The most common cause of intrarenal AKI?
Acute tubular necrosis (ATN)
Shock waves are delivered to break up renal calculi?
Lithotripsy
Priority intervention with a patient with a kidney stone?
pain
single most important risk factors for UTI in hospitalized patients?
catheter use
Indicative of a patient with AKI is in recovery phase?
decrease bun and decrease creatinine
Patient has a K level of 7. What is your priority?
heart rate and rhythm
Urine is cloudy with WBC, nitrates, and a PH of 8.2?
uti
What does erythropoietin secretion do?
Increase RBC production
which foods should be avoided in renal patients
high potassium, high sodium
Strep throat may proceed which kidney issue?
Glomerulonephritis
Chemical waste that is generated from muscle metabolism?
creatinine
Assessment finding that indicates a urinary tract infection has ascended to the kidneys?
Costovertebral angle tenderness
Enlargement of prostate gland resulting from increase in number of epithelial cells and connective tissue
bph
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
Urinary frequency and urgency Dysuria Bladder pain Nocturia Incontinence
irritation
appropriate treatment option for individuals who have moderate to severe symptom scores on the AUA symptom index.; decreases the size of the prostate
Finasteride
risks with Finasteride
othro hypotension and pregnant women should not touch the drugs, decrease libido
decreased prostate size but can also be used for kidney stones in male or female
tamsulosin (Flomax)
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)
side effect of tamsulosin (Flomax)
doxazosin (Cardura)
silodosin (Rapaflo)
orthostatic hypotension
effectively reduces symptoms of both BPH and ED.
cialis
ED drug taken daily, ED drug taken prn before sex
cialis; viagra
what can obstruction lead to
Hydronephrosis- swelling and damage to one or both kidney d/t retention.
golden standard to treat obstructing BPH
TURP
biggest complication with TURP
bleeding
post op care
CBI - flushes sterile fluid through cath and into the bladder to prevent blood clots
administer antispasmodics
teach kegel exercises
diagnostics for prostatitis
UA and culture
CBC
PSA
tightening or constriction off the foreskin; cause by poor hygiene. Ice pack for edema, topical corticosteroid 2-3 x day.
Phimosis
tightening of the foreskin in the retracted position. Warm soaks, cleaning glans and foreskin, antibiotics, and possible circumcision
paraPhimosis
A painful erection that lasts more than 6 hours.
Is a medical emergency
priapism
Curved or crooked penis cause by plaque formation of the cavernosa of the penis or possible trauma. May have pain.
Peyronie’s disease
tx for Peyronie’s disease
collagenase Clostridium histolyticum to break down collagen
Men under 40 cause often gonorrhea or chlamydial infection; older men often UTI and prostatitis
epididymitis
tx for epididymitis
Tx: Elevate scrotum, ice packs, and analgesics.
Acute inflammation of the testis. Can be bacterial or viral infection (mumps, pneumonia, TB, syphilis. Also trauma, influenza, complicate UTI, and catheterization
orchitis
Non-tender, fluid filled mass. Lumph interference
hydrocele
tx for hydrocele
nothing unless scrotum becomes large and uncomfortable then aspiration or surgical drainage
Sperm filled cyst in epididymis
spermatocele
tx for Spermatocele
surgical removal
Twisting of the spermatic cord that supplies blood to testes and epididytimis
testicular torsion
tx for testicular torsion
Surgical emergency within 4-6 hours or ischemia to testes
what are you going to tell patient who had a vasectomy
Total of 10 ejaculations or 6 weeks to evacuate sperm. Advise contraception
Gradual decline in male hormone with aging
andropause
labs to draw for andropause
testosterone. 280-1000 is normal; replace at 200
dysuria, increased frequency >q2 hrs, urgency, suprapubic pain, hematuria, cloudy urine
UTI
used in complicated UTIs but has a risk of tendon rupture
Fluroquinolines
if UTI is fungal
Diflucan
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
tx for pyelonephritis
Place pt on broad spectrum abx until culture sensitivity is back from lab (24+ hours maybe)
result of obstruction and rupture of the periurethral glands
urethral diverticula
dysuria, post void dribbling; urinary frequency and urgency, suprapubic discomfort, feeling of incomplete bladder emptying,
urethral diverticula
symptoms of a UTI without the presence of a positive urine culture, bacteremia, or pyuria.
Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)
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
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
to assess for renal trauma
IVP- contrast with X-ray to see where the blockage is
a life-threatening genetic disease. It is characterized by cysts that enlarge and destroy surrounding tissue by compression.
Polycystic kidney disease (PKD)
what can we do for Polycystic kidney disease (PKD)
no treatment. may need Nephrectomy may be necessary with dialysis or kidney transplant
accumulation of waste products in blood
azotemia
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
why drugs could be toxic to the kidneys, causing intrarenal damage
Antibiotics, aminoglyo, NSAIDS, vanco, ace inhibitor
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.
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
what is ERSD
GFR is less than 15 and this patient needs dialysis
causes of CKD
diabetes and hypertension
foods high in potassium
bananas, avocado, potato, spinach, beans, citrus juices, fish
foods high in phosphorus
meat, fast food, cheese, soda, seeds, canned fish, milk
with bph we are really worried about
urinary retention
nurses role for CBI
titrating to the color of urinary output
monitoring output so we dont rupture the bladder
if the bag for CBI is dark red what will we do
increase the flow
shrinks the prostate tissue for BPH
finasteride
uti ascending can cause
pyelonephritis
someone with lithotripsy what do we want to do
sprain their urine so we can catch the calculi and send it to the lab
in the diuretic phase of aki what are we worried about
dehydration because they are putting out a lot of urine
know prerenal, intra, and post
who is at risk for each
GFR and CKD stages
know
hemodialysis
prevent central line infections
dont do bp or sticks in that arm
assessment for hemodialysis
palpate for a thrill - blood flow
biggest risk for hemodialysis
hypotension
peritoneal dialysis
CAPD- stays at home patient can be up and about; pretty independent; hanging bags
APD- automated overnight
biggest thing with peritoneal dialysis
peritonitis
in the peritoneal dialysis what are we looking for in the bag
fibrin and cloudiness- signs of infection
if you think the urine is infected
send for cell count and culture
anemia med for CKD
erythropoietin - stimulates the bone marrow to produce rbc
what to do if patient is on erythropoietin
monitor rbc, hgb, hct because they could have too much
biggest side effect of binders
GI upset
when should binders be taken
with food otherwise they aren’t doing anything
with albumin what are we worried about
htn and volume overload because albumin brings fluid back into the cells
best determines what stage of CKD
GFR
influenced by fluid volume status and by the amount of protein in the diet
bun
if creatinine rises over time what are we thinking
kidney damage
what is considered a low oxalate diet
avoid spinach, dark roughage, asparagus, cabbage, tomatoes, rhubarb tea, chocolate
ca phosphate calculi
no ca or phosphate foods; animal meat, dairy, dark sodas, broccoli
ca oxalate
no ca or oxalate foods; spinach, bran, nuts
uric acid
no red meat, organ meat, shellfish
cysteine
drink plenty of water, limit sodium
draws potassium out through bowel and can treat hyperkalemia
kayexalate
shifts potassium into cells
insulin
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
