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Adult Health Nursing II > Exam #7 > Flashcards

Exam #7 Flashcards

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1
Q

Common GU Symptoms

A

Pain

Changes in voiding

Gastrointestinal symptoms

Unexplained anemia

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2
Q

Glomerular Filtration Rate

A

Amount of plasma filtered through the glomeruli per unit of time

125-200 mL/hour

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3
Q

BUN

A

10-20 mg/dL

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4
Q

Creatinine

A

Waste product of skeletal muscles

0.7–1.4 mg/dL

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5
Q

Anuria

A

Urine less than 50 mL in 24 hours

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6
Q

Oliguria

A

Urine less than 0.5 mL/kg/hour

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7
Q

GU Diagnostic Exams

A 
UA/Urine culture
Specific gravity
Osmolality
BUN/Creatinine
KUB
Ultrasonography
CT/MRI
Nuclear scans
Intravenous urography
Renal angiography
Cystoscopy
Biopsies
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8
Q

Cystoscopy Nursing Care

A

NPO Status

Post procedure: tell them to expect burning with urination, hematuria, polyuria, high risk for UTI, monitor for urinary retention

Treat with sitz bath, antispasmodics, intermittent catheter

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9
Q

Kidney Biopsy

A

Percutaneous or open biopsy

Check coags before procedure

Pre-op urine specimen

NPO/IV

Post-op: IV to keep urine clear, pain control

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10
Q

Gerontological Considerations

A

GFR decreases
More susceptible to ARF and CRF due to sclerosis of glomeruli and renal vasculature
Renal reserve is decreased
Higher risk for adverse drug effects/interactions
Prone to hypernatremia and fluid volume deficit
Decreased bladder wall contractility

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11
Q

Chronic Kidney Disease

A

Damage to kidneys without signs/symptoms, related to acute inflammation

5 is end-stage renal failure

Screening and early intervention is important; prevent progression by decreasing risk, help eliminate HTN, treat anemia, decrease hyperglycemia

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12
Q

S/S of CKD

A

Elevated creatinine
Anemia
Metabolic acidosis, abnormal calcium and phosphorus levels
Fluid retention, edema, S/S of CHF, increase in potassium
Electrolyte imbalances
Difficult to control HTN

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13
Q

Treatment of CKD

A

Find the cause and eliminate it

Keep BP below 130/80

Prevent complications by controlling hyperglycemia, managing anemias, decreasing salt intake

Diet: low protein, low sodium, low potassium, low phosphate

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14
Q

Primary Glomerular Diseases

A

Acute nephritic syndrome

Chronic glomerulonephritis

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15
Q

Major Clinical Manifestations of Primary Glomerular Diseases

A

Proteinuria, hematuria

Decreased GFR

Decreased excretion of sodium, edema

Hypertension

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16
Q

Acute Nephritic Syndrome

A

Acute glomerulonephritis

Caused by immune respone

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17
Q

Signs/Symptoms of Acute Nephritic Syndrome

A

Hematuria, edema

Azotemia, proteinuria

Oliguria, hypoalbuminemia, hyperlipidemia, urinary casts, BUN and CRE increased, urine output decreases, Hgb and Hct decreased, hypertension

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18
Q

Treatment of Acute Nephritic Syndrome

A

Biopsy of kidney

Prognosis is excellent

Some need dialysis if it becomes a chronic problem

Treat the symptoms, steroids to help with inflammatory process, low sodium diet, keep track of intake and output, antibiotics

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19
Q

Complications of Acute Nephritic Syndrome

A

Hypertensive encephalopathy

Heart failure

Pulmonary edema

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20
Q

Chronic Glomerulonephritis

A

Kidneys decrease in size and increase in fibrous content

Glomeruli and tubules are scarred

Renal arteries are thickened

Leads to stage 5 CKD

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21
Q

Cause of Chronic Glomerulonephritis

A

Repeated episodes of acute nephritic syndrome, hypertensive nephrosclerosis, glomerular sclerosis

Secondary: lupus

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22
Q

Signs/Symptoms of Chronic Glomerulonephritis

A

May not have any at first

Increased irritability, increased nocturia, headache, dizziness, digestive problems, look chronically ill/poorly nourished, yellow-gray pigmentation, retinal hemorrhage, heart failure

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23
Q

Treatment of Chronic Glomerulonephritis

A

Treat symptoms

Sodium/water restriction

Antihypertensives

Daily weight and diuretic medications

Careful protein with a high biologic value

Dialysis

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24
Q

Nephrotic Syndrome

A

Type of renal failure with increased glomerular permeability

Caused by damage to glomerular capillary membrane

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25
Q

Signs/Symptoms of Nephrotic Syndrome

A

Massive proteinuria

Edema

Hypoalbuminemia

Hyperlipidemia

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26
Q

Treatment of Nephrotic Syndrome

A

ACE inhibitors

Diuretics

Lipid lowering agents

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27
Q

Polycystic Kidney Disease

A

Genetic, numerous cysts in the kidney

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28
Q

Signs/Symptoms of Polycystic Kidney Disease

A

Hematuria, polyuria, hypertension, renal calculi, UTI, proteinuria

Abdominal fullness and flank pain as cysts grow

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29
Q

Renal Cancer Risk Factors

A

Men

Occupational chemical exposure

Tobacco use, obesity

Estrogen therapy, polycystic kidney disease

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30
Q

Signs/Symptoms of Renal Cancer

A

Hematuria

Abdominal Mass may present

Metastasis to lungs, bone, liver, brain, contralateral kidney

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31
Q

Nephrectomy

A

Treatment if a renal tumor can be removed

Laparoscopic method is preferred

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32
Q

Nursing Interventions after Nephrectomy

A

Pain relief

Promote airway clearance by encouraging TCDB

Monitor UO and maintain patency of urinary drainage systems

Use strict asepsis

Monitor for bleeding

Teach leg exercises

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33
Q

Renal Failure

A

Results when kidney cannot remove the body’s metabolic wastes or perform their regulatory function

Affects endocrine, metabolic functions

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34
Q

Acute Kidney Injury

A

Rapid loss of renal function

Potentially reversible, may not necessarily lead to failure

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35
Q

Cause of Acute Kidney Injury

A

Damage to the kidneys

Reduced blood flow to the kidneys

Decreased perfusion related to heart failure

Obstruction

May be prerenal, intrarenal, or postrenal

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36
Q

Hyperkalemia

A

Can kill a patient in ESRD

ECG changes present with a tall tented or peaked T-wave

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37
Q

Signs/Symptoms of Hyperkalemia

A

Irritability, abdominal cramps, diarrhea, paresthesia, general muscle weakness, slurred speech, difficulty breathing, paralysis

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38
Q

Treatment of Hyperkalemia

A

Kayexalate retention enema

IV dextrose (50%), insulin and calcium may shift potassium back into cells temporarily

39
Q

End Stage Renal Disease

A

Final stage (stage 5) of chronic kidney disease

Retained uremic waste

Need for renal replacement therapies, dialysis, or kidney transplants

40
Q

Risk Factors for End Stage Renal Disease

A

CV disease

Diabetes

HTN

Obesity

41
Q

Renal Replacement Therapies

A

Dialysis (hemodialysis, continuous renal replacement therapies, peritoneal dialysis)

Kidney transplantation

42
Q

Protection of AV Fistula

A

No BP, lab draws, or IV on extremity

Palpate for thrill and bruit q4h

Do not carry objects or sleep on side of access

Monitor for bleeding and infection

Assess pulses distal to access

43
Q

Lower UTI

A

Caused by pathogens in the system

May be cystitis, prostatitis, urethritis

44
Q

Upper UTI

A

Less common

May be pyelonephritis, nephritis, renal and perirenal abscess

45
Q

Risk Factors for UTI

A

Failure to empty bladder
Obstructed urinary flow
Decreased defenses
Instrumentation/inflammation or abrasion
Reflux (urethrovesical or ureterovesical)
Female, diabetes, pregnancy, neurological disorders, gout

46
Q

Uncomplicated UTI

A

Community-acquired

Burning with urination, frequency, urgency, incontinence, hematuria

47
Q

Complicated UTI

A

Could be related to urological condition or healthcare-acquired

Can lead to shock or urosepsis

48
Q

Gerontologic Considerations of UTI

A

More likely to have UTI that leads to sepsis

Lack the typical symptoms

49
Q

Pyelonephritis

A

Bacterial infection of the renal pelvis

May be in one or both kidneys

Caused by spread of infection from the bladder or systemic infection

50
Q

Acute Pyelonephritis

A

Chills, fever, leukocytosis, bacteriuria, pyuria, low back/flank pain, N/V, headache, malaise, painful urination

If it comes back frequently, more testing is warranted

51
Q

Chronic Pyelonephritis

A

No symptoms of infection/fatigue

Headache, anorexia, weight loss, polyuria, thirst

End stage renal disease

Kidneys become scarred and nonfunctional

52
Q

Stress Incontinence

A

Involuntary loss of urine; more common in women, especially after vaginal birth

53
Q

Urge Incontinence

A

Strong urge that cannot be suppressed and cannot reach the toilet in time; related to neurological dysfunction

54
Q

Functional Incontinence

A

Cognitive impairment (Alzheimer’s); no signals to the brain telling them they need to go

55
Q

Overflow Incontinence

A

Related to chronic retention, overflows and causes incontinence

56
Q

Iatrogenic Incontinence

A

Due to medical factors, medications

57
Q

Pharmacologic Therapy for Incontinence

A

Anticholinergics, tricyclic antidepressants

Pseudo-ephedrine: caution with prostate hyperplasia and HTN

58
Q

Assessments for Incontinence

A

Develop and use a voiding log or diary

Diagnostic exams: residual urine, UA, culture and sensitivity

59
Q

Behavioral Interventions for Incontinence

A

Kegel exercises, voiding schedule, physical therapy

60
Q

Surgical Interventions for Incontinence

A

Bladder sling, bladder tac, Botox injections

61
Q

Urinary Retention

A

When the bladder does not empty completely

Common in people older than 60 years old

Residual urine is 50-100 mL commonly

62
Q

Causes of Urinary Retention

A

Surgery, general anesthesia, diabetes, prostate enlargement, pathology in the urethra, tumors, trauma, neurological disorders such as multiple sclerosis

63
Q

Assessment of Urinary Retention

A

Last time they voided, how much did they go, how frequently did they go, do they have dribbling in between, pain, feel bladder distention, restlessness/agitation, checking residual

64
Q

Nursing Measures to Promote Voiding

A

Provide privacy, position patient in normal way that they should void, warmth, hot tea, turn on the faucet, stroking the abdomen, Creed’s maneuver

65
Q

Urolithiasis and Nephrolithiasis

A

Calculi (stones) in the urinary tract or kidney where there is a concentration of substance such as calcium and uric acid (75% are calcium)

Risk factors include dehydration, infection, urinary stasis, immobility

66
Q

S/S of Urolithiasis and Nephrolithiasis

A

Pain, infection, swelling, blood in the urine, difficulty urinating, incontinence, hesitancy, nocturia

67
Q

Diagnosis of Urolithiasis and Nephrolithiasis

A

X-ray, blood chemistries, and stone analysis; strain all urine and save stones

68
Q

Calcium Stone Types

A

Liberal fluid, restrict protein and sodium, thiazide diuretics

69
Q

Uric Acid Stone Types

A

Low purine diet

Allopurinol to prevent recurrence

70
Q

Cystine Stone Types

A

Low protein diet

Increase fluid intake

71
Q

Oxalate Stone Types

A

Limit oxalate in diet –spinach, strawberries, chocolate, peanuts

72
Q

Medical Management of Stones

A

Stone may pass spontaneously

Ureteroscopy
ESWL (extracorporeal shock wave lithotripsy): breaking up the stone
Endourologic (percutaneous)-stone removal
73
Q

Bladder Cancer

A

More common over age of 55, more common in men

74
Q

Risk Factors for Bladder Cancer

A

Cigarette smoking

Exposure to carcinogens: rubber, leather, ink, paint, dyes

Recurrent bacterial UTI, bladder stones, high urinary pH, high cholesterol intake, pelvic radiation therapy

Cancers: prostate, colon and rectum

75
Q

S/S of Bladder Cancer

A

Hematuria, infection, alterations in urine function, changes in color of urine, pelvic and back pain

76
Q

Diagnosis and Treatment of Bladder Cancer

A

DX: ureteroscopy, biopsy, cytologic exam of urine

TX: Surgery, chemotherapy, radiation

77
Q

Urinary Diversion

A

Procedure to divert urine from bladder to a new exit site

Reasons: bladder is permanently removed, partially resected, pelvic malignancies, birth defects, trauma-induced problems

Technique dependent on patient (age, bladder condition, body build, renal status, independence, willingness to participate)

78
Q

Types of Urinary Diversions

A

Cutaneous urinary diversion: ileal conduit (oldest and most common)—ureters are placed into loop of ileum and have a stoma

Continent urinary diversion: catheterize through a stoma, no need for a bag

79
Q

Assessment after Urinary Diversions

A

Post-Op: hourly urine output

Monitor for signs of complications: wound infection, skin irritation, dehiscence, leakage, obstruction, small bowel obstruction, ileus, gangrene of the stoma, chronic reflux, pyelonephritis, stones

Hematuria may be normal for 48 hours/urine with mucus—normal due to the ileum

Stoma inspection, skin inspection, anxiety

80
Q

Prostatitis

A

Inflammation of the prostate gland related to infection, urethral stricture, benign prostatic hypertrophy

81
Q

S/S of Prostatitis

A

Onset of fever, pain, dysuria

82
Q

Treatment of Prostatitis

A

Antibiotics, anti-inflammatory, alpha adrenergic blockers

Sitz baths, comfort measures

83
Q

Diagnostic Tests of Prostatitis

A

Prostate specific antigen (PSA)
(N < 4 ng/ml, > 4 ng/ml = may indicate prostate cancer)

Recommend: Baseline level 40-50 yo.

Transrectal ultrasound: ask for sedation/pain medicine before procedure

Prostate fluid or tissue analysis

Tests of male sexual function

84
Q

Benign Prostatic Hypertrophy

A

Noncancerous enlargement of prostate

Common in aging men

Leads to incomplete emptying of bladder, which leads to urinary retention

85
Q

Risk Factors for BPH

A

Smoking, alcohol, obesity, reduced activity, HTN, heart disease

Western diet: high in animal fat and protein, refined carbs, low in fiber

86
Q

Risk Factors for Prostate Cancer

A

Family history, genetic link, diet high in red meat or dairy products high in fat

87
Q

Prostate Cancer

A

Second most common cancer for men

Early stages rarely has symptoms

88
Q

Diagnosis of Prostate Cancer

A

DRE - digital rectal exam

PSA

89
Q

Treatment of Prostate Cancer

A

Treatment may include prostatectomy, radiation therapy, hormonal therapy, and/or chemotherapy

90
Q

Radical Prostatectomy

A

Removal of seminal vesicles, tips of vas deferens and surround fat, nerves and blood vessels

91
Q

TURP

A

No incision from the outside, done all through the urethra

92
Q

Prostatectomy Complications

A

Depends on type of prostatectomy

Hemorrhage, clot formation, catheter obstruction and sexual dysfunction

93
Q

Relief of Pain after Prostatectomy

A

Urine: needs to be monitored after prostatectomy; foley will be inserted, monitor urine output, difficult with continuous bladder irrigation

Assessment of pain

Bladder spasms: lead to pain, leads to feelings of pressure, fullness, urgency

Medication and warm compresses or sitz baths

Analgesics and antispasmodics

Ambulation; avoid sitting

Prevent constipation

Irrigate catheter as prescribed

Adult Health Nursing II (22 decks)

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