Exam 2 (Ch. 49, 50, & 51) PPT Flashcards

Question

# Diagnostic Studies What is a nurses responsibilty before and after a cystoscopy?

Answer 1

Before: Give IV fluids if general anesthesia is to be used. Ensure consent form is signed. Explain procedure to patient. Give preoperative medication. After: Explain that burning on urination, pink-tinged urine, and urinary frequency are expected effects. Observe for bright red bleeding, which is not normal. Help with ambulation because orthostatic hypotension may occur. Offer warm sitz baths, heat, mild analgesics to relieve discomfort.

Answer 2

Visualizes bladder and evaluates vesicoureteral reflux. Evaluates patients with neurogenic bladder and recurrent UTIs. Can delineate abnormalities of bladder (e.g., diverticula, stones, tumors). Contrast media instilled into bladder via cystoscope or catheter.

Answer 3

Before: Explain procedure to patient. During: If done via cystoscope, follow nursing care related to cystoscopy.

Answer 4

X-ray examination of abdomen and pelvis. Delineates size, shape, and position of kidneys, ureter, and bladder. Can see radiopaque stones and foreign bodies.

Answer 5

Can visualize the structures and identify abnormalities like kidney stones, tumors, or blockages. Detects renal or perirenal masses (tumors, cysts) and obstructions. Computer interprets tissue density based on sound waves and displays it in picture form. Safe for patients with renal failure.

Answer 6

Before: Explain procedure to patient. No bowel preparation needed. During: Because radiation exposure is avoided, can obtain repeated images over a brief period.

Answer 7

A procedure in which a small sample of kidney tissue is removed and examined under a microscope. ## Footnote Usually done as a skin (percutaneous) biopsy through needle insertion into lower lobe of kidney under CT or ultrasound guidance.

Answer 8

* Diagnose kidney disease * Evaluate the severity of kidney damage * Monitor the progression of kidney disease * Assess the function of a transplanted kidney * Investigate unexplained kidney problems ## Footnote Obtains renal tissue for examination to determine type of kidney disease or to follow progress of kidney disease. Absolute contraindications are bleeding disorders, single kidney, and uncontrolled hypertension. Relative contraindications include suspected renal infection, hydronephrosis, and possible vascular lesions.

Answer 9

Before: Type and crossmatch patient for blood. Ensure consent form is signed. Assess coagulation status through patient history, medication history, CBC, hematocrit, prothrombin time, and bleeding and clotting time. Patient should not be taking aspirin or warfarin. After: Apply pressure dressing and keep patient on affected side for 30–60 min. Bed rest for 24 hr. Vital signs every 5–10 min, first hour. Assess for flank pain, hypotension, decreasing hematocrit, fever, chills, urinary frequency, dysuria, and gross or microscopic hematuria. Inspect biopsy site for bleeding. Teach patient to avoid lifting heavy objects for 5–7 days and to not take anticoagulant drugs until allowed by HCP

Answer 10

Imparied Urinary System Function - Assessment: Monitor for changes in urinary frequency, urgency, hesitancy, dysuria (painful urination), hematuria (blood in urine), or cloudy/foul-smelling urine. Assess for bladder distention. Acute Pain - Assessment: Assess pain level using a pain scale. Note location, character, and duration of pain. Knowledge Deficit - Assessment: Assess the patient's understanding of UTIs, risk factors, treatment, and prevention strategies.

Answer 11

Relief from bothersome symptoms - Assessment: Identify specific symptoms (dysuria, frequency, urgency, nocturia, hematuria, etc.) Assess their severity and impact on the patient's quality of life. No upper urinary tract involvement - Assessment: Monitor for signs and symptoms of upper UTI (fever, chills, flank pain, nausea, vomiting). Assess urine for casts (indicating kidney involvement). Non recurrence - Assessment: Identify risk factors for recurrent UTIs (female sex, history of UTIs, sexual activity, urinary retention, etc.). ## Footnote Follow-up: Encourage regular follow-up appointments with the healthcare provider to monitor for recurrence and address any concerns.

Answer 12

C Rationale: While options A and B are helpful in managing and preventing UTIs, option C directly addresses a known risk factor for recurrent UTIs in some women – sexual activity. If a healthcare provider deems it appropriate, post-coital antibiotic prophylaxis can be a very effective strategy in preventing recurrences. Option D is incorrect as scented feminine hygiene products can irritate the urethra and increase the risk of UTIs.

Answer 13

A, C, E Rationale: Obtaining a urine specimen (A) is essential for diagnosis. Assessing for flank pain/CVA tenderness (E) helps determine if the infection has spread to the kidneys. Increasing fluid intake (C) helps dilute the urine and flush out bacteria. While pain relief (B) and patient education (D) are important, they are not the immediate priorities. Antibiotics (F) are essential but cannot be administered until a culture is obtained (unless it is a standing order for suspected UTI).

Answer 14

F Rationale: Douching disrupts the natural flora of the vagina and can increase the risk of UTIs.

Answer 15

These factors specifically increase the risk of UTIs in older adults

Answer 16

These factors specifically increase the risk of UTIs in older adults

Answer 17

Aging kidneys process and eliminate drugs more slowly. This can lead to higher drug levels in the body, increasing the risk of side effects and toxicity. Older adults often take multiple medications for various conditions. Reduced kidney function can exacerbate the risk of interactions between these drugs, potentially leading to serious adverse events.

Answer 18

That urinary incontinence is a normal part of aging. While some older adults experience incontinence, it is not an inevitable consequence of aging. ## Footnote It often results from underlying medical conditions, such as: - Urinary tract infections - Weak pelvic floor muscles - Enlarged prostate (in men) - Neurological disorders - Medications

Answer 19

A & C Rationale: Age and female sex are significant risk factors for UTIs. While hypertension and osteoarthritis are medical conditions, they are not directly linked to increased UTI risk. Cognitive impairment might indirectly contribute if it affects hygiene or fluid intake, but age and sex are the primary risk factors here.

Answer 20

C, F Rationale: Older adults may not present with classic UTI symptoms like high fever. New-onset confusion (C) and increased falls (F) can be subtle signs of a UTI in this age group and are more concerning than a low-grade fever.

Answer 21

May be associated with leakage or post void dribbling—overflow UI - Overflow incontinence can occur with urinary retention. Because the bladder is full, urine can leak out involuntarily.

Answer 22

A sudden inability to urinate. It's a medical emergency because it can cause significant discomfort and potentially lead to bladder damage or kidney problems. Intervention: Bladder Scan - A non-invasive ultrasound that measures the amount of urine in the bladder. It's crucial for diagnosing urinary retention and guiding further treatment.

Answer 23

Incomplete emptying of the bladder despite voiding. It may or may not be symptomatic.

Answer 24

PVR refers to the amount of urine left in the bladder after urination. A small amount is normal (50 to 75 mL) More than 100 mL - repeat or further evaluation with UTIs: A More than 100 mL is considered abnormal. It may warrant repeating the measurement or investigating for urinary tract infections (UTIs), as retained urine can increase the risk of infection. More than 200 mL - Requires further evaluation to determine the cause and appropriate treatment.

Answer 25

A, C, D, F Rationale: Palpating for bladder distention (A) directly assesses for urine retention. Checking the perineal area (C) identifies potential skin breakdown from leakage or prolonged wetness. Fluid intake (D) is relevant to urine production and elimination. A history of UTIs (F) can contribute to recurrent retention. While bowel sounds (B) and vital signs (E) are part of a general assessment, they are not the most directly related to urinary retention.

Answer 26

* Relief of urinary retention * Bladder decompression preop or postop * Facilitate surgery * Facilitate healing * Accurate I & O—critical care * Stage III or IV pressure ulcer * Terminal illness—comfort

Answer 27

* Relief of urinary retention * Diagnostic study * Urodynamic testing * Sterile specimen * Medication instillation * Measure PVR

Answer 28

Sterile Technique: Prevent UTIs Proper Insertion Technique: To minimize trauma to the urethra. Catheter Care: Prevent infection. Monitoring Urine Output: Regularly checking the amount, color, and characteristics of urine. Patient Comfort: Ensuring the catheter is secure and not causing discomfort. Removal: Minimize discomfort and trauma. Documentation: Accurate recording of the procedure, including the type and size of catheter inserted, the amount and characteristics of urine drained, and the patient's response.

Answer 29

Catheter Associated Urinary Tract Infection (CAUTI): The most common complication. Bladder Spasms: Can cause discomfort or pain. Periurethral abscess: Occurs around the urethra, often due to infection introduced by the catheter. It can cause pain, swelling, and discharge. Chronic pyelonephritis: A long-term kidney infection Urosepsis: A severe, life-threatening infection of the urinary tract that has spread to the bloodstream. Urethral trauma or erosion: The catheter can irritate and damage the urethra, especially with long-term use. This can lead to inflammation, erosion (wearing away of tissue), and pain. Fistula: An abnormal connection between two body parts Stricture formation: A narrowing of the urethra Stones: Urinary catheters can increase the risk of urinary stones forming. This is because they can introduce bacteria and create a surface for minerals in the urine to deposit on. Catheter Obstruction: Due to sediment or blood clots. ## Footnote Long-term catheterization carries significant risks. It's crucial to use catheters only when necessary and for the shortest duration possible to minimize these complications. Proper catheter care and hygiene are also essential.

Answer 30

1. Don sterile gloves. 2. Lubricate the catheter tip. 3. Cleanse the perineal area with antiseptic solution. 4. Insert the catheter through the urethra into the bladder. 5. Inflate the catheter balloon. Rationale: Sterile technique is paramount. Lubrication facilitates insertion. Cleansing reduces infection risk. Insertion precedes balloon inflation to secure the catheter.

Answer 31

A, E Rationale: Urine output less than 30 mL/hr can indicate kidney issues or catheter obstruction and requires prompt attention. Fever and chills are signs of a potential UTI, a common complication of catheterization. Blood in the urine and discomfort are possible but not as immediately concerning as low urine output and signs of infection. Leakage might indicate a catheter issue but is not as urgent as infection or kidney compromise.

Answer 32

1. Use sterile technique if need to open system; consider triple-lumen catheter for continuous irrigations 2. Catheter change not necessary if less than 2 weeks; for long-term, determine necessity based on assessment, not routine 3. Use catheter sampling port for urine culture; prepare puncture site with antiseptic solution

Answer 33

Ensure UAP: - Maintains unobstructed downhill flow of urine - Empties collecting bag regularly; records output - Provides perineal care 1 to 2 x/day and PRN - Does not use lotion or powder near catheter - Uses a securement device to prevent catheter movement and urethral tension

Answer 34

Anatomic or functional condition that blocks or impedes the flow of urine | Can be congential or acquired

Answer 35

Congenital: The obstruction is present at birth. This usually involves a structural abnormality in the urinary tract's development. Acquired: The obstruction develops sometime after birth. This is caused by factors like those listed in the "anatomic" section above (kidney stones, tumors, etc.).

Answer 36

A, C, D, F Rationale: Palpating for bladder distention (A) directly assesses for urine retention. Checking the perineal area (C) identifies potential skin breakdown from leakage or prolonged wetness. Fluid intake (D) is relevant to urine production and elimination. A history of UTIs (F) can contribute to recurrent retention. While bowel sounds (B) and vital signs (E) are part of a general assessment, they are not the most directly related to urinary retention due to suspected BPH.

Answer 37

Nephrolithiasis is the formation and presence of kidney stones (calculi) in the urinary system.

Answer 38

Metabolic: Conditions like hyperparathyroidism, renal tubular acidosis, cystinuria, and others can alter the composition of urine and increase stone formation risk. Climate: Hot climates can lead to dehydration, concentrating urine and increasing the risk. Dietary: High sodium, high protein, high oxalate (spinach, rhubarb), and excessive sugar intake can contribute. Inadequate fluid intake is a major risk factor. Genetic: Family history can increase the risk of developing kidney stones. Lifestyle: Sedentary lifestyle, obesity, and certain medications can also increase risk.

Answer 39

Formation: Kidney stones form when the concentration of dissolved substances (crystals) in the urine becomes too high. These crystals precipitate (come out of solution) and clump together, forming a stone. Prevention: The key to preventing kidney stones is to keep the urine dilute (by drinking plenty of fluids) and free-flowing (preventing stasis).

Answer 40

First symptom—sudden, severe pain (renal colic) * Flank area, back, or lower abdomen * Ureter stretches, dilates, and spasms * May see nausea and vomiting; “kidney stone dance;” dysuria, fever, chills; moist, cool skin

Answer 41

Ureteropelvic Junction (UPJ): Obstruction at the UPJ (where the ureter joins the kidney) typically causes dull costovertebral (flank) pain or renal colic. Ureterovesical Junction (UVJ): Obstruction at the UVJ (where the ureter joins the bladder) often causes lower abdominal pain, and the pain may radiate to the testicles or labia.

Answer 42

C Rationale: While managing pain and nausea are important, the highest priority is to monitor urine output and strain the urine. This is crucial to assess for complete obstruction and to retrieve the stone for analysis if it passes.

Answer 43

D Rationale: While all instructions are important, emphasizing post-procedure hydration is the most critical. Adequate fluid intake helps to flush out the fragmented stone particles and prevent further stone formation. Bruising is common but not the most crucial instruction. SWL typically does not require fasting or general anesthesia (it's usually done under conscious sedation).

Answer 44

- Are too large (more than 7 mm) to pass spontaneously - Are associated with bacteriuria or symptomatic infection - Impair renal function - Cause persistent pain, nausea, or paralytic ileus - The pt can't be treated medically or only has one kidney | Stones less than/equal to 4 mm may pass spontaneously (may take weeks)

Answer 45

Endourologic procedures: These are minimally invasive procedures that involve inserting instruments into the urinary tract to remove or break up the stone. Examples include: * Ureteroscopy: A thin scope is passed through the urethra, bladder, and into the ureter to visualize and remove or fragment the stone. * Percutaneous nephrolithotomy (PCNL): A small incision is made in the back, and a needle is inserted into the kidney. The stone is then removed or broken up using instruments. This is typically used for larger stones in the kidney. Lithotripsy: This is a non-invasive procedure that uses shock waves to break the stone into smaller pieces that can then be passed in the urine. The most common type is extracorporeal shock wave lithotripsy (ESWL).

Answer 46

1. Pain: intractable pain that is not relieved by conservative measures. 2. Infection: If a patient develops a kidney infection (pyelonephritis) in conjunction with a kidney stone, and the infection is severe or doesn't respond to antibiotics, surgery may be needed to remove the stone and drain any abscesses. This is particularly true if the infection is threatening kidney function or spreading to the bloodstream (sepsis). 3. Obstruction: If the obstruction is severe or prolonged, surgery may be required to remove the stone and restore urine flow. This is an emergency if both kidneys are obstructed.

Answer 47

Nephrolithotomy—kidney (involves making an incision into the kidney to remove a stone located within the kidney itself.) Pyelolithotomy—renal pelvis (involves making an incision into the renal pelvis to remove a stone that is lodged there.) Ureterolithotomy—ureter (involves making an incision into the ureter to remove a stone that is stuck in the ureter.) Cystotomy—bladder (involves making an incision into the bladder to remove a stone that has passed from the ureter and is lodged in the bladder.)

Answer 48

Hemorrhage

Answer 49

1. Monitor urine output and characteristics. 2. Assess the incision site for bleeding and signs of infection. 3. Administer pain medication as needed. 4. Encourage oral fluid intake. Rationale: Urine output is the MOST critical immediate assessment to ensure kidney function and identify potential complications like obstruction or bleeding. Assessing the incision site is next to check for local complications. Pain management follows assessment, and fluids are important but not the immediate priority.

Answer 50

B Rationale: Urine output of 15 mL/hr indicates potential kidney compromise and requires immediate intervention. Some bloody drainage (A) and pain (C) are expected initially. Nausea/vomiting (D) are possible post-operatively but not as immediately life-threatening as low urine output.

Answer 51

Adequate fluids to avoid dehydration - Facilitate stone passage: More dilute urine can help flush the stone down the urinary tract. - Reduce the risk of further stone growth: Diluted urine is less likely to become supersaturated with minerals, reducing the chance of the existing stone growing or new stones forming. | Forcing fluids not recommended; increased pain

Answer 52

High intake (~3 L/day) to produce 2.5 L urine/day: This is the cornerstone of prevention. Increasing fluid intake dilutes your urine. When your urine is dilute, minerals are less likely to clump together and form stones. * Water is best! * Prevents supersaturation of minerals * Reduce risk of dehydration * Limit colas, coffee, and tea—increased stone formation Low-sodium diet: High sodium intake can increase calcium excretion in the urine, which can contribute to calcium-based stones. Dietary restrictions according to the type of stone * Oxalate: Found in foods like spinach, rhubarb, almonds, and chocolate. * Purine: Found in red meat, organ meats, and some seafood. * Calcium: While calcium is important for bone health, excessive calcium intake can be a factor in some cases.

Answer 53

Renal cell carcinoma Risk factors: cigarette smoking, ACKD, obesity, HTN, exposure to asbestos, cadmium, and gasoline Increased incidence—First-degree relatives | Males more than females; average age 64 years old

Answer 54

Renal vein, vena cava, lungs, liver, and long bones

Answer 55

Hematuria, flank pain, palpable mass in flank or abdomen Other: weight loss, fever, HTN, anemia

Answer 56

CT scan: Provides detailed images of the kidneys and surrounding structures. Ultrasound: Can help visualize kidney masses. Angiography: Examines the blood vessels supplying the kidneys. Biopsy: A tissue sample is taken for examination under a microscope to confirm the diagnosis. MRI: May be used for further evaluation or staging. Radionuclide isotope scan: Can help detect metastasis to the bones.

Answer 57

1. Assess the patient's understanding of the surgical procedure. 2. Monitor for signs and symptoms of bleeding. 3. Administer pain medication as ordered. 4. Encourage deep breathing and coughing exercises. Rationale: Understanding (teaching) should ideally come before the procedure. Monitoring for bleeding is the priority post-op concern. Pain management and respiratory exercises are important but secondary to identifying potential hemorrhage.

Answer 58

1. Kidney Cancer 2. Diseased Kidney 3. Kidney Transplantation

Answer 59

The surgical removal of a kidney

Answer 60

A, E Rationale: Partial nephrectomy aims to preserve as much kidney function as possible (E), thus reducing the long-term risk of chronic kidney disease (A). While some patients may experience shorter stays or faster recovery, this is not guaranteed and depends on individual factors. Pain management needs are similar, and complication risks can vary.

Answer 61

A, E Rationale: Urine leak (A) is a risk due to the surgical manipulation of the kidney's collecting system. Decreased overall kidney function (E) can occur if a significant portion of the kidney is removed. Bleeding (B) and infection (C) are general surgical risks. Pneumonia (D) is a risk for any surgery, not specific to partial nephrectomy. Hypertension (F) is more associated with chronic kidney disease, not specifically partial nephrectomy.

Answer 62

"Most patients do not need dialysis after a partial nephrectomy, as the remaining kidney portion should be able to function adequately. However, we will closely monitor your kidney function after surgery, and long-term follow-up is essential." Rationale: This provides reassurance and emphasizes the importance of ongoing monitoring.

Answer 63

A hereditary disorder characterized by the growth of numerous cysts in the kidneys.

Answer 64

Abdominal and flank pain: The enlarged, cyst-filled kidneys can cause pain in the abdomen and flank (side/back). Hematuria: Blood in the urine, which can be caused by cyst rupture or bleeding from the enlarged kidneys. Hypertension: High blood pressure is a common complication of PKD, often due to the disrupted kidney function. Frequent UTI: Urinary tract infections are more common in people with PKD, possibly due to the structural changes in the kidneys and the presence of cysts. Kidney stones: The altered kidney structure and urine flow can increase the risk of kidney stone formation. Enlarged kidneys: The kidneys become enlarged due to the numerous cysts, which can sometimes be felt during a physical exam.

Answer 65

End-stage renal disease (ESRD): This is a serious complication. Over time, the cysts progressively damage the kidneys, leading to kidney failure. Many people with PKD will eventually require dialysis or a kidney transplant. Liver cysts: As mentioned earlier, cysts can also develop in the liver. While usually not as problematic as kidney cysts, they can sometimes cause pain or other symptoms. Cerebral aneurysms: These are weak spots in the blood vessels of the brain that can bulge out and potentially rupture, causing bleeding. People with PKD have an increased risk of cerebral aneurysms. Mitral valve prolapse: A heart valve problem that can sometimes occur in people with PKD.

Answer 66

CT scan or MRI: These imaging studies provide detailed pictures of the kidneys and can reveal the presence of cysts. Ultrasound: A less invasive imaging technique that can also detect kidney cysts. Genetic testing: Can be used to confirm the diagnosis of PKD, especially in individuals with a family history of the disease.

Answer 67

The surgical removal of a kidney from a living donor for transplantation Donor's surgery begins 1-2 hrs prior to recipient's surgery - Ensure the kidney is ready for immediate transplantation once the recipient's surgery is underway.

Answer 68

Kidneys are preserved up to 72 hours prior to transplant surgery

Answer 69

This refers to the time the kidney is without a blood supply (outside the donor's body and before it's transplanted into the recipient). Minimizing cold ischemic time is important for good graft function (how well the kidney works after transplant).

Answer 70

Urine output: Tracking urine output is essential. Initially, there might be a large volume of urine as the kidney starts functioning. Lab values: Monitoring BUN (Blood Urea Nitrogen) and creatinine levels to assess kidney function. Electrolytes: Monitoring and managing electrolyte balance, as the new kidney may take time to regulate them effectively. ## Footnote You may see a large increase of urine output due to the kidney being re-established and will normalize once BUN and Creatine return to normal - A sudden decrease in urine output is a cause of concern (leak, obstruction or rejection

Answer 71

Kidney Transplant | Reverse's pathophysiology of ESRD

Answer 72

Eliminates dialysis (and dietary & lifestyle restrictions) Less expensive than dialysis after first year

Answer 73

Emotional and physical preparation - Stress that dialysis may be required - Review need for immunosuppressive drugs and prevention of infection ECG, Chest x-ray, lab studies, possibly dialysis ## Footnote Preoperative care focuses on preparing the patient emotionally and physically for the transplant, including education and necessary testing.

Answer 74

Kidney transplant recipient * Maintenance of fluid and electrolyte balance is first priority * Immunosuppressant therapy to prevent rejection * Meticulous infection control practices ## Footnote Postoperative care prioritizes maintaining fluid and electrolyte balance, preventing rejection and infection, and ongoing patient education.

Answer 75

A, B, E Rationale: Urine output (A) is paramount to assess graft function. Incision site (B) checks for local complications. Monitoring for rejection (E) is critical due to the risk of transplant failure. Lung sounds (C) and pain management (D) are important, but less immediate than graft function and rejection. Long-term education (F) is important but not the immediate priority.

Answer 76

Rejection Infection Cardiovascular disease - Transplant recipients have increased incidence of atherosclerotic vascular disease - Immunosuppressants can worsen hypertension and hyperlipidemia - Patients need to adhere to antihypertensive regimen Cancer: Immunosuppression increases the risk of certain cancers Recurrence of original kidney disease

Answer 77

A, B, D, F Rationale: Sudden weight gain (A) can indicate fluid retention, a sign of rejection or other issues. Fever/chills (B) suggest infection. Pain at the transplant site (D) is concerning for rejection or other problems. High blood pressure (F) can be a sign of graft dysfunction or medication side effects. Increased energy/appetite (C) are positive signs. Urine output of 30 mL/hr (E) is within normal limits.

Answer 78

B, D, E Rationale: Decreased urine output (B), weight gain (D), and transplant site pain (E) are more indicative of rejection. Fever (A) and elevated WBC (F) can occur in both rejection and infection. Hypertension (C) is less specific and can have multiple causes.

Answer 79

Bladder Cancer - More common in men than women

Answer 80

About 1/2 related to cigarette smoking Other risk factors - Exposure to dyes used in rubber and other industries - Indwelling catheters use for a long period of time - Chronic recurrent urinary tract stones (often in the bladder) and chronic UTIs - Women treated with radiation for cervical cancer - Patients who receive cyclophosphamide, docetaxel, or gemcitabine: These are chemotherapy drugs that, while used to treat cancer, can increase the risk of bladder cancer as a side effect

Answer 81

Cystoscopy with biopsy Cystoscopy with biopsy allows direct visualization and tissue sampling for definitive diagnosis.

Answer 82

This procedure targets superficial lesions within the bladder. It utilizes a cystoscope, a thin tube inserted into the urethra, to visualize and remove the tumor. This is a minimally invasive approach often used for early-stage cancers.

Answer 83

This involves the surgical removal of a portion of the bladder wall affected by cancer. It is employed for larger tumors confined to a single area of the bladder. A margin of healthy tissue surrounding the tumor is also removed to ensure complete eradication of cancerous cells.

Answer 84

This is a more extensive surgery involving the complete removal of the bladder. It is typically recommended for invasive cancers or those located in the trigone area (the base of the bladder near the urethra) but no metastasis beyond pelvic area. Because the bladder is removed, a urinary diversion procedure is necessary to create a new pathway for urine elimination. Radical cystectomy is appropriate when there is no metastasis beyond the pelvic area. ## Footnote In men, it may also involve removal of the prostate and seminal vesicles, while in women, it may include removal of the uterus, ovaries, and part of the vagina.

Answer 85

Surgical site infection (SSI)

Answer 86

Transurethral resection with fulguration - Transurethral resection means a surgical procedure done through the urethra (the tube that carries urine out of the body) without the need for an external incision. - Fulguration refers to the use of an electric current to destroy tissue, often used to stop bleeding or remove small growths. Laser photocoagulation: Can be used to treat superficial bladder tumors. The laser energy is delivered through a cystoscope (a thin tube inserted into the urethra) to destroy the tumor cells while minimizing damage to surrounding healthy tissue. Open loop resection with fulguration - Open Loop Resection: This indicates a surgical procedure where a loop-shaped instrument is used to cut away tissue. The term "open" suggests it might involve a traditional surgical incision, although it can also refer to techniques using scopes where the loop is manipulated externally. - Fulguration: As discussed earlier, this is the use of an electric current to destroy tissue (often to stop bleeding or remove small growths). Cystectomy (segmental, partial, or radical) (Surgical removal of the bladder.) - Segmental Cystectomy: Removal of a portion of the bladder wall. - Partial Cystectomy: Removal of a larger portion of the bladder, but not the entire organ. - Radical Cystectomy: Removal of the entire bladder, as well as surrounding tissues and organs. In men, this often includes the prostate and seminal vesicles. In women, it may involve removal of the uterus, ovaries, and part of the vagina. Lymph nodes in the pelvis are also usually removed during a radical cystectomy.

Answer 87

Bacille Calmette-Guérin (BCG) α-interferon (Intron A)

Answer 88

doxorubicin epirubicin gemcitabine mitomycin thiotepa valrubicin (Valstar)

Answer 89

C. Assess the patient for signs of urinary tract infection. Rationale: Intravesical chemotherapy can irritate the bladder lining. Administering it in the presence of a UTI could worsen the infection.

Answer 90

B. "This method delivers the medication directly to the bladder cancer cells, reducing side effects to the rest of your body." Rationale: This response provides an accurate and patient-centered explanation for the use of intravesical chemotherapy.

Answer 91

Continuous bladder irrigation is used to flush out blood clots and debris from the bladder, often after urologic surgery (e.g., transurethral resection of the prostate - TURP) or in cases of hematuria (blood in the urine).

Answer 92

Assess Bleeding and Clots (Some bleeding is expected after certain procedures, but it should gradually decrease) Assess Catheter Patency: - Intake and Output (I&O) - Bladder Spasms Manual Irrigation Medication Administration: Administer antispasmodics (to reduce bladder spasms) and analgesics (for pain) as needed and as prescribed. Monitor Catheter Drainage: Monitor for increased blood clots Discontinue CBI and Notify HCP: If obstruction occurs and cannot be resolved with manual irrigation, stop the CBI and immediately notify the healthcare provider (HCP). Post-Catheter Removal Care: Teach patients Kegel exercises after the catheter is removed to strengthen the pelvic floor muscles and improve urinary control. Discharge Instructions: Provide thorough care instructions to patients discharged with an indwelling catheter, including catheter care, signs of infection, and when to seek medical attention.

Answer 93

A, B, D, F Rationale: These are all key nursing responsibilities in CBI management. Antipyretics are for fever, which is not directly related to CBI. Valsalva maneuver is contraindicated as it can increase intra-abdominal pressure and lead to bleeding after certain procedures.

Answer 94

B Rationale: The decreased output and bladder spasms suggest a potential blockage. Manual irrigation is the first step to attempt to restore patency. If irrigation is unsuccessful, then the HCP should be notified.

Answer 95

Urinary diversions are surgical procedures performed when urine flow is blocked or impaired. They reroute urine away from the bladder and out of the body. Common Causes of Urinary Flow Blockage Requiring Diversion: Bladder Cancer Congenital Anomalies (birth defects) Strictures (narrowing of the urethra or ureters) Trauma to the Bladder Chronic Bladder Inflammation

Answer 96

Incontinent Urinary Diversion: Urine drains continuously into a pouch or bag worn outside the body. The patient has no control over urine flow. Continent Urinary Diversion: A pouch is created inside the body to hold urine. The patient learns to self-catheterize to empty the pouch periodically, or in some cases, can void naturally. This provides more control over urinary elimination.

Answer 97

"Diversion to skin; must wear appliance" "Ureters anastomosed to conduit; bowel brought to abdominal wall to form stoma" "No valve = no voluntary control": This emphasizes the lack of continence, meaning the urine flow is continuous and not controlled by the patient. "Urine drips into external collection device": Reinforces the need for a pouch to collect the continuously draining urine.

Answer 98

An ileal conduit is an incontinent urinary diversion. This means urine drains continuously from a stoma (an opening) on the abdomen into an external collection bag or pouch. How it's created: A piece of the ileum (small intestine) is surgically removed and formed into a tube or channel. The ureters (tubes carrying urine from the kidneys) are attached to this ileal segment. The open end of the ileum is then brought to the surface of the abdomen, creating the stoma. Why it's done: It's performed when the bladder is either removed (cystectomy) due to conditions like bladder cancer, or if it's not functioning properly.

Answer 99

Stoma complications: Necrosis, retraction, prolapse, stenosis. Skin irritation: Around the stoma due to urine leakage or pouch adhesive. Infection: Urinary tract infections or infection at the stoma site. Obstruction: Blockage of urine flow within the conduit. Electrolyte imbalances: Due to urine loss.

Answer 100

Intra-abdominal urinary reservoir that can be catheterized; has internal pouch - Internal Pouch: A portion of the intestine is used to create a pouch or reservoir inside the abdomen. - Continence Mechanism: A valve or other mechanism is constructed to prevent urine from leaking involuntarily. - Self-Catheterization: Patients must regularly catheterize themselves to drain the urine from the internal pouch. This is a crucial aspect of managing this type of diversion.

Answer 101

Kock Pouch: This type of continent diversion involves creating a pouch from a section of the ileum (small intestine). What makes the Kock Pouch unique is the presence of a special valve mechanism. This valve prevents urine from leaking out of the stoma (the opening on the abdomen) until a catheter is inserted to drain the pouch. Mainz Pouch: Similar to the Kock Pouch, the Mainz Pouch is also constructed from a portion of the ileum. However, the specific configuration and surgical technique may differ slightly. It also features a valve mechanism to ensure continence. Indiana Pouch: The Indiana Pouch is another type of continent diversion, but in this case, it's typically made from a combination of the ileum and the ascending colon (part of the large intestine). Like the others, it also has a valve mechanism to prevent leakage. Florida Pouch: The Florida Pouch is another variation of a continent urinary diversion, and it's also constructed from a portion of the intestines. The specific design and surgical approach may vary.

Answer 102

A, B, C, D Rationale: Urine output (A) is paramount to ensure kidney function. Incision site (B) checks for complications. Diversion function (C) assesses its patency. Bowel sounds (D) indicate return of function. While emotional support (E) and pain management (F) are important, they are not the immediate priorities.

Answer 103

Description: A catheter inserted surgically through an incision in the abdomen directly into the bladder. Use: Used when urethral catheterization is not possible or appropriate (e.g., urethral injury, prostate enlargement obstructing the urethra). Can be used for long-term bladder drainage.

Answer 104

Description: A tube inserted percutaneously (through the skin) into the renal pelvis (part of the kidney where urine collects) and connected to a drainage bag. Use: Used to drain urine directly from the kidneys when there is a blockage or other issue preventing urine flow from the kidneys to the bladder (e.g., kidney stones, tumors).

Answer 105

Description: Insertion of a catheter through the urethra into the bladder to drain urine, followed by immediate removal of the catheter. Use: Used for patients who are unable to empty their bladder effectively on their own (e.g., due to neurological conditions or spinal cord injury) but do not require continuous drainage. Helps prevent urinary retention and associated complications.

Answer 106

Description: A flexible tube inserted through the urethra into the bladder, with a balloon inflated to hold it in place for continuous urine drainage. Use: Used to continuously drain urine from the bladder when patients are unable to void or when it's necessary to monitor urine output closely (e.g., after surgery, in critical care).

Answer 107

Atelectasis: Collapsed lung tissue, prevented by deep breathing and coughing exercises. Shock: Related to fluid/blood loss, requiring monitoring of vital signs and fluid replacement. Thrombophlebitis: Blood clots in veins, prevented by early ambulation and leg exercises. Small bowel obstruction: Blockage in the small intestine, requiring monitoring of bowel sounds and function. Paralytic ileus: Temporary loss of bowel function, also requiring monitoring of bowel sounds and function. UTI (Urinary Tract Infection): Prevented by maintaining catheter patency and hygiene.

Answer 108

Prevent stoma injury & maintain urine output - Mucus in urine is expected - Encourage high fluid intake | Nurses need to preform stoma assessment

Answer 109

A, B, D Rationale: Maintaining pulmonary function (A), stoma viability (B), and ensuring urine drainage (D) are the immediate priorities in the early post-operative period. While pain management (C) and ambulation (E) are important, they are not the highest priorities at this moment. Emotional support (F) is crucial but not in the immediate moment.

Answer 110

C. There may be a blockage in the ileal conduit or ureter. Rationale: A steadily declining urine output suggests a potential obstruction, requiring prompt investigation.

Answer 111

Meticulous skin care: Essential to prevent complications related to urine contact with the skin. Avoid: alkaline encrustations with dermatitis and yeast infections, product allergies, and shearing effect excoriations Changing appliances: See Table 45-22 in the textbook Continent diversion Patient teaching * How to catheterize: Clean technique, catheter insertion and removal. * When to catheterize: Frequency, how to recognize fullness. * How to irrigate: Maintaining patency of the reservoir. Body Image: emotional impact, provide support

Answer 112

A surgically constructed neobladder, created from a section of the intestine, that is connected to the urethra, allowing the patient to void through their urethra.

Answer 113

Catheterize for postoperative urinary retention Bladder control may take up to 6 months Empty bladder every 2 to 4 hours by relaxing outlet sphincter and bearing down with abdominal muscles; does not feel need to void Follow-up pouchogram in 3 to 4 weeks

Answer 114

Symptoms of obstruction or infection - Obstruction (e.g., decreased urine output, abdominal pain). - Infection (e.g., fever, chills, cloudy urine, back pain). Ostomy care - Stoma Changes: Explain that the stoma may shrink in size as it heals. - Skin Care: Teach how to keep the peristomal skin clean and healthy. Appliances - Components: Faceplate (skin barrier), pouch, drainage opening. - Proper Fit: Emphasize the importance of a proper fit to prevent leaks and skin irritation. - Changing: Provide detailed instructions on how to change the appliance. Need to know: where to buy supplies, emergency contact numbers, location of ostomy clubs Follow-up visits with WOCN (Wound, Ostomy, Continence Nurse) and HCP

Answer 115

C. Bowel obstruction. Rationale: Nausea, lack of bowel movement, decreased ostomy output, and darker urine are concerning signs of a potential bowel obstruction.

Answer 116

Partial or complete impairment of kidney function that results in inability to excrete metabolic waste products and water - Affects all body systems - Treatment & dietary changes are challenging - Impacts lifestyle, occupation, family relationships, and self-image Causes: Common causes of CKD include diabetes, high blood pressure, glomerulonephritis (kidney inflammation), and polycystic kidney disease.

Answer 117

C Rationale: GFR is the BEST indicator as it directly measures kidney's filtering capacity. While BUN and creatinine are also indicators, they are less specific than GFR. Urinalysis provides information about the urine but not the filtration rate.

Answer 118

Onset: Sudden Most common causes: Acute tubular necrosis Diagnostic criteria: Acute reducation in urine output and/or elevation in serum creatinine Reversibility: Potentially Cause of death: Infection

Answer 119

Onset: Gradual, over years Most common causes: Diabetic nephropathy Diagnostic criteria: GFR <60 mL/min/1.73 m2 for >3 months AND/OR Kidney damage >3 months Reversibility: Progressive and irreversible Cause of death: Cardiovascular disease

Answer 120

Used to correct fluid and electrolyte imbalances and removes waste products in kidney failure Can be used to treat drug overdoses

Answer 121

Peritoneal Dialysis (PD): This method uses the lining of the abdomen (peritoneum) as a natural filter. A solution is instilled into the abdomen, and waste products and excess fluids pass from the blood into the solution. The solution is then drained from the abdomen. Hemodialysis (HD): This is the more common type. Blood is pumped out of the body through tubes to a dialysis machine, where it's filtered through a special membrane (dialyzer) to remove waste and excess fluids. The cleaned blood is then returned to the body.

Answer 122

Started when patient’s uremia (buildup of waste products in the blood) can no longer be adequately treated conservatively; GFR < 15 mL/min/1.73 m2

Answer 123

Peritoneal access is obtained by inserting a catheter through anterior abdominal wall Technique for catheter placement varies; usually done via surgery PD may start right away or bed delayed until site healed Aseptic technique important to avoid peritonitis

Answer 124

B. Peritonitis. Rationale: Cloudy dialysate and abdominal pain are classic signs of peritonitis, a serious complication of peritoneal dialysis.

Answer 125

Arteriovenous (AV) fistulas and grafts: These are considered the preferred long-term access options. - Fistula: A surgical connection between an artery and a vein, creating a large, strong vessel for needle insertion. Allows arterial blood flow through vein (becomes arterialized). - Graft: A synthetic tube is used to connect an artery and a vein if the patient's own veins are not suitable for a fistula. Temporary vascular access: This refers to catheters, usually inserted into a large vein in the neck or chest, used for temporary access until a fistula or graft matures or in emergency situations.

Answer 126

Hypotension Blood loss Infection

Answer 127

Forearm or upper arm ↑ vein size and wall thickness Placed 3 months before HD; needs to mature ## Footnote "Feel 'thrill' or hear 'bruit' due to high velocity of blood flow"

Answer 128

A piece of plastic tubing – very similar to a jugular catheter – and is used inexactly the same way for your haemodialysis. The permacath has a cuff that holds the catheter in place and acts as a barrier to infection. The cuff is underneath the skin and cannot be seen.

Answer 129

Distal ischemia (steal syndrome): Occurs when too much blood is "stolen" from the distal extremity by the fistula or graft, leading to inadequate blood supply to the hand and fingers. - Pain distal to access site - Numbness or tingling of fingers - Poor capillary refill Aneurysms: Weakening and bulging of the vessel wall, can occur at the access site.

Answer 130

No BP, venipunctures, or IV lines - Post signs in room or labeled arm band Prevent infection and clotting

Answer 131

Lower Infection Risk (compared to catheters, because they are created using the patient's own tissue and do not involve a foreign object) Long-Term Use: With proper care, AV fistulas can last for many years, providing reliable access for hemodialysis. Better Blood Flow: AV fistulas provide excellent blood flow, which is essential for effective hemodialysis treatments.

Answer 132

Not Always Possible: Some patients may have damaged or unsuitable veins. Maturation Time: The waiting period for fistula maturation can be challenging for patients who need immediate dialysis. Potential Complications: While generally safe, AV fistulas can develop complications such as infection, clotting (thrombosis), narrowing (stenosis), or aneurysm formation.