exam 3 detailed Flashcards
what does a 24 hour urine collection measure
creatinine clearance, urea nitrogen, sodium, chloride, calcium, and proteins
Lithotripsy
breaks stone into smaller pieces
Percutaneous nephrolithotomy
a surgical procedure to remove kidney stones that are too large to pass on their own or don’t respond to other treatments
go in through the skin
Open ureterolithotomy
Removes a stone from the ureter
Open nephrolithotomy
Removes a stone from within the kidney
nephrostomy tube
a thin, flexible tube that drains urine directly from the kidney into a bag outside the body.
SIgns and Symptoms of UTI
pain, fatigue, fever, confusion, frequency, urgency, dysuria, nocturia,
hematuria, retention, feeling of incomplete bladder emptying
Dx of UTI
history, physical exam, urinalysis, CBC, cystoscopy if
recurrent
UTI treatment
antibiotic therapy, phenazopyridine (urinary analgesic), antipyretic,
increased fluid intake, warm sitz bath 2-3 times a week can relieve pain
UTI PT education
full abx course, drink 2-3 L/day, wipe front to back, do not
hold urine, phenazopyridine (urinary analgesic) will turn urine orange
UTI Labs
urinalysis–>expect positive WBCs, Nitrite, bacteria, leukocyte esterase, casts; Urine culture and sensitivity; CBC-> elevated WBCs
Renal calculi s/s
lank pain, fluctuating pain (depending on location of stone), oliguria,
anuria, dysuria, hematuria, bladder distention.
Renal Calculi Dx
x-ray KUB, CT KUB, Ultrasound KUB
Renal Calculi Treatment
NSAIDs, Antiemetics, Antibiotics, increase fluid intake (to aid in
passing stone and prevent further stone formation), watchful waiting (for
stones to pass), straining of urine
Renal Calculi- Calcium pt education
avoid milk and other dairy products
Renal Calculi- Oxalate
avoid spinach, black tea, and rhubarb
Renal Calculi- Uric Acid
decrease purine intake–> poultry, fish, gravies, red
wines, sardines
Renal Calculi- Struvite
results after a bacterial infection.
Avoid high
phosphate foods (dairy, red or organ meats, whole grains)
Renal Calculi Labs
urinalysis–> rule out infections, may be positive for RBCs,
Hyperkalemia, Hyperphosphatemia
Polycystic Kidney Disease s/s
weight gain (due to cyst formation and increased kidney size), flank pain, headache (stroke risk r/t hypertension), hematuria, hypertension (r/t decreased kidney perfusion and initiation of the RAAS system), dysuria, nocturia, constipation (enlarged kidney compresses bowels), enlarged abdominal girth (r/t enlargement of kidneys), kidney stones
Polycystic Kidney Disease treatment
blood pressure control (typically with ACEs or ARBs because they
work directly on the RAAS system), pain management (typically acetaminophen and nonpharmacologic interventions), interventions to slow progression of kidney damage (surgical cyst drainage, dialysis, smoking cessation), infection prevention, Pt will inevitably need a kidney transplant (if they live that long)
Polycystic Kidney Disease Dx
ultrasound, family history/genetic testing
Polycystic Kidney Disease pt education
importance of diet (decrease sodium intake), importance of smoking cessation (hypertension risk),
Polycystic Kidney Disease labs
urinalysis: + proteinuria, + hematuria; decreased GFR; elevated BUN and creatinine levels, fluctuation in sodium level (can be wasted or retained)
Hydronephrosis
The dilation of the renal pelvis and calyces, which can affect one or both kidneys.
Hydroureter
The dilation of the ureter
Hydronephrosis/Hydroureter s/s
flank pain, anuria, abdominal asymmetry (may indicate kidney mass),
abdominal tendernes
Hydronephrosis/Hydroureter Dx
renal ultrasonography (1st choice), UA, CBC, CT or X-Ray
KUB
Pyelonephritis
kidney infection
Pyelonephritis Dx
urinalysis, culture and sensitivity, Imaging (X-ray KUB, CT)
Pyelonephritis treatment
antibiotics, increase fluid intake, pain interventions, antipyretic
Pyelonephritis labs
BUN may be elevated (but creatinine will not), urinalysis- + WBC,
+ nitrite, + bacteria, cloudy, foul odor
Voiding Cystourethrogram
an X-ray exam that uses a contrast material to image the bladder, urethra, and kidneys while the bladder is filling and emptying
Glomerulonephritis
a term for a group of kidney diseases that damage the glomeruli, the tiny filters in the kidneys
ACute Glomerulonephritis
strep infection after 10 days
Chronic Glomerulonephritis
occurs 20-30 year
s/s Glomerulonephritis
Proteinuria, hematuria, hypertension, edema (especially in the face and hands), Pulmonary edema (dyspnea, shortness of breath, crackles), neck vein distension, weight gain
Stages of bone healing
Hematoma formation within 24-72 hours of fracture
Granulation tissue invades hematoma to form fibrocartilage within 3 days-
2 weeks
Fracture site is surrounded by new vascular tissue known as a callus
within 3-6 weeks
Callus is gradually resorbed and transformed into bone within 3-8 weeks
Consolidation and remodeling of bone can continue for up to 1 year after
External Fixation
assess pin sites every 8-
12 hours for s/s of infection
elective amputation
surgical removal r/t chronic disease –> more commonly the lower extremities
traumatic amputation
result of an injury/trauma –> more commonly the upper extremities
Phalen’s maneuver
wrist flexion for 1 minute (numbness in hands indicates positive test),
Tinel’s sign
repetitive tapping of the transverse ligament (results in paresthesia indicates positive test)
