Exam #7 Flashcards
Common GU Symptoms
Pain
Changes in voiding
Gastrointestinal symptoms
Unexplained anemia
Glomerular Filtration Rate
Amount of plasma filtered through the glomeruli per unit of time
125-200 mL/hour
BUN
10-20 mg/dL
Creatinine
Waste product of skeletal muscles
0.7–1.4 mg/dL
Anuria
Urine less than 50 mL in 24 hours
Oliguria
Urine less than 0.5 mL/kg/hour
GU Diagnostic Exams
UA/Urine culture Specific gravity Osmolality BUN/Creatinine KUB Ultrasonography CT/MRI Nuclear scans Intravenous urography Renal angiography Cystoscopy Biopsies
Cystoscopy Nursing Care
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
Kidney Biopsy
Percutaneous or open biopsy
Check coags before procedure
Pre-op urine specimen
NPO/IV
Post-op: IV to keep urine clear, pain control
Gerontological Considerations
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
Chronic Kidney Disease
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
S/S of CKD
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
Treatment of CKD
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
Primary Glomerular Diseases
Acute nephritic syndrome
Chronic glomerulonephritis
Major Clinical Manifestations of Primary Glomerular Diseases
Proteinuria, hematuria
Decreased GFR
Decreased excretion of sodium, edema
Hypertension
Acute Nephritic Syndrome
Acute glomerulonephritis
Caused by immune respone
Signs/Symptoms of Acute Nephritic Syndrome
Hematuria, edema
Azotemia, proteinuria
Oliguria, hypoalbuminemia, hyperlipidemia, urinary casts, BUN and CRE increased, urine output decreases, Hgb and Hct decreased, hypertension
Treatment of Acute Nephritic Syndrome
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
Complications of Acute Nephritic Syndrome
Hypertensive encephalopathy
Heart failure
Pulmonary edema
Chronic Glomerulonephritis
Kidneys decrease in size and increase in fibrous content
Glomeruli and tubules are scarred
Renal arteries are thickened
Leads to stage 5 CKD
Cause of Chronic Glomerulonephritis
Repeated episodes of acute nephritic syndrome, hypertensive nephrosclerosis, glomerular sclerosis
Secondary: lupus
Signs/Symptoms of Chronic Glomerulonephritis
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
Treatment of Chronic Glomerulonephritis
Treat symptoms
Sodium/water restriction
Antihypertensives
Daily weight and diuretic medications
Careful protein with a high biologic value
Dialysis
Nephrotic Syndrome
Type of renal failure with increased glomerular permeability
Caused by damage to glomerular capillary membrane
Signs/Symptoms of Nephrotic Syndrome
Massive proteinuria
Edema
Hypoalbuminemia
Hyperlipidemia
Treatment of Nephrotic Syndrome
ACE inhibitors
Diuretics
Lipid lowering agents
Polycystic Kidney Disease
Genetic, numerous cysts in the kidney
Signs/Symptoms of Polycystic Kidney Disease
Hematuria, polyuria, hypertension, renal calculi, UTI, proteinuria
Abdominal fullness and flank pain as cysts grow
Renal Cancer Risk Factors
Men
Occupational chemical exposure
Tobacco use, obesity
Estrogen therapy, polycystic kidney disease
Signs/Symptoms of Renal Cancer
Hematuria
Abdominal Mass may present
Metastasis to lungs, bone, liver, brain, contralateral kidney
Nephrectomy
Treatment if a renal tumor can be removed
Laparoscopic method is preferred
Nursing Interventions after Nephrectomy
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
Renal Failure
Results when kidney cannot remove the body’s metabolic wastes or perform their regulatory function
Affects endocrine, metabolic functions
Acute Kidney Injury
Rapid loss of renal function
Potentially reversible, may not necessarily lead to failure
Cause of Acute Kidney Injury
Damage to the kidneys
Reduced blood flow to the kidneys
Decreased perfusion related to heart failure
Obstruction
May be prerenal, intrarenal, or postrenal
Hyperkalemia
Can kill a patient in ESRD
ECG changes present with a tall tented or peaked T-wave
Signs/Symptoms of Hyperkalemia
Irritability, abdominal cramps, diarrhea, paresthesia, general muscle weakness, slurred speech, difficulty breathing, paralysis
Treatment of Hyperkalemia
Kayexalate retention enema
IV dextrose (50%), insulin and calcium may shift potassium back into cells temporarily
End Stage Renal Disease
Final stage (stage 5) of chronic kidney disease
Retained uremic waste
Need for renal replacement therapies, dialysis, or kidney transplants
Risk Factors for End Stage Renal Disease
CV disease
Diabetes
HTN
Obesity
Renal Replacement Therapies
Dialysis (hemodialysis, continuous renal replacement therapies, peritoneal dialysis)
Kidney transplantation
Protection of AV Fistula
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
Lower UTI
Caused by pathogens in the system
May be cystitis, prostatitis, urethritis
Upper UTI
Less common
May be pyelonephritis, nephritis, renal and perirenal abscess
Risk Factors for UTI
Failure to empty bladder
Obstructed urinary flow
Decreased defenses
Instrumentation/inflammation or abrasion
Reflux (urethrovesical or ureterovesical)
Female, diabetes, pregnancy, neurological disorders, gout
Uncomplicated UTI
Community-acquired
Burning with urination, frequency, urgency, incontinence, hematuria
Complicated UTI
Could be related to urological condition or healthcare-acquired
Can lead to shock or urosepsis
Gerontologic Considerations of UTI
More likely to have UTI that leads to sepsis
Lack the typical symptoms
Pyelonephritis
Bacterial infection of the renal pelvis
May be in one or both kidneys
Caused by spread of infection from the bladder or systemic infection
Acute Pyelonephritis
Chills, fever, leukocytosis, bacteriuria, pyuria, low back/flank pain, N/V, headache, malaise, painful urination
If it comes back frequently, more testing is warranted
Chronic Pyelonephritis
No symptoms of infection/fatigue
Headache, anorexia, weight loss, polyuria, thirst
End stage renal disease
Kidneys become scarred and nonfunctional
Stress Incontinence
Involuntary loss of urine; more common in women, especially after vaginal birth
Urge Incontinence
Strong urge that cannot be suppressed and cannot reach the toilet in time; related to neurological dysfunction
Functional Incontinence
Cognitive impairment (Alzheimer’s); no signals to the brain telling them they need to go
Overflow Incontinence
Related to chronic retention, overflows and causes incontinence
Iatrogenic Incontinence
Due to medical factors, medications
Pharmacologic Therapy for Incontinence
Anticholinergics, tricyclic antidepressants
Pseudo-ephedrine: caution with prostate hyperplasia and HTN
Assessments for Incontinence
Develop and use a voiding log or diary
Diagnostic exams: residual urine, UA, culture and sensitivity
Behavioral Interventions for Incontinence
Kegel exercises, voiding schedule, physical therapy
Surgical Interventions for Incontinence
Bladder sling, bladder tac, Botox injections
Urinary Retention
When the bladder does not empty completely
Common in people older than 60 years old
Residual urine is 50-100 mL commonly
Causes of Urinary Retention
Surgery, general anesthesia, diabetes, prostate enlargement, pathology in the urethra, tumors, trauma, neurological disorders such as multiple sclerosis
Assessment of Urinary Retention
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
Nursing Measures to Promote Voiding
Provide privacy, position patient in normal way that they should void, warmth, hot tea, turn on the faucet, stroking the abdomen, Creed’s maneuver
Urolithiasis and Nephrolithiasis
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
S/S of Urolithiasis and Nephrolithiasis
Pain, infection, swelling, blood in the urine, difficulty urinating, incontinence, hesitancy, nocturia
Diagnosis of Urolithiasis and Nephrolithiasis
X-ray, blood chemistries, and stone analysis; strain all urine and save stones
Calcium Stone Types
Liberal fluid, restrict protein and sodium, thiazide diuretics
Uric Acid Stone Types
Low purine diet
Allopurinol to prevent recurrence
Cystine Stone Types
Low protein diet
Increase fluid intake
Oxalate Stone Types
Limit oxalate in diet –spinach, strawberries, chocolate, peanuts
Medical Management of Stones
Stone may pass spontaneously
Ureteroscopy ESWL (extracorporeal shock wave lithotripsy): breaking up the stone Endourologic (percutaneous)-stone removal
Bladder Cancer
More common over age of 55, more common in men
Risk Factors for Bladder Cancer
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
S/S of Bladder Cancer
Hematuria, infection, alterations in urine function, changes in color of urine, pelvic and back pain
Diagnosis and Treatment of Bladder Cancer
DX: ureteroscopy, biopsy, cytologic exam of urine
TX: Surgery, chemotherapy, radiation
Urinary Diversion
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)
Types of Urinary Diversions
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
Assessment after Urinary Diversions
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
Prostatitis
Inflammation of the prostate gland related to infection, urethral stricture, benign prostatic hypertrophy
S/S of Prostatitis
Onset of fever, pain, dysuria
Treatment of Prostatitis
Antibiotics, anti-inflammatory, alpha adrenergic blockers
Sitz baths, comfort measures
Diagnostic Tests of Prostatitis
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
Benign Prostatic Hypertrophy
Noncancerous enlargement of prostate
Common in aging men
Leads to incomplete emptying of bladder, which leads to urinary retention
Risk Factors for BPH
Smoking, alcohol, obesity, reduced activity, HTN, heart disease
Western diet: high in animal fat and protein, refined carbs, low in fiber
Risk Factors for Prostate Cancer
Family history, genetic link, diet high in red meat or dairy products high in fat
Prostate Cancer
Second most common cancer for men
Early stages rarely has symptoms
Diagnosis of Prostate Cancer
DRE - digital rectal exam
PSA
Treatment of Prostate Cancer
Treatment may include prostatectomy, radiation therapy, hormonal therapy, and/or chemotherapy
Radical Prostatectomy
Removal of seminal vesicles, tips of vas deferens and surround fat, nerves and blood vessels
TURP
No incision from the outside, done all through the urethra
Prostatectomy Complications
Depends on type of prostatectomy
Hemorrhage, clot formation, catheter obstruction and sexual dysfunction
Relief of Pain after Prostatectomy
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
