Genitourinal & Renal

Question 1

Acute kidney injury

Answer 1

Life threatening, clinical syndrome that results from a sudden, significant decrease in filtration through the glomeruli, causing buildup of high levels of uremic toxins in the blood

Occurs when kidneys cannot excrete the daily load of toxins in the urine. Patients are divided into two groups:
-Oliguric – excrete less than 500 mL/d
-Nonoliguric – excrete greater than 500 mL/d

*Causes:
-Trauma
-Shock
-Infection
-Urinary obstruction
-Multisystem diseases

Question 2

Prerenal AKI

Answer 2

-Patients are critically ill and may have preexisting medical conditions
-Perfusion is poor in many organs, which may lead to multiple organ failure

S/S:
-Dizziness
-Dry mouth
-Thirst
-Hypotension

Question 3

Intrarenal AKI

Answer 3

Results from conditions that damage or injure one or both kidneys (e.g., tubular diseases)

-90% of cases are caused by:
-Ischemia or toxins (can lead to acute tubular necrosis)
-Antibiotics
-Nonsteroidal ant-inflammatory drugs
-Alcohol
-Hypertension
-Autoimmune diseases
-Pyelonephritis

S/S:
-Fever
-Flank and joint pain
-Headache
-Hypertension

Question 4

Postrenal AKI

Answer 4

Caused by ureteral and urethral obstruction and obstructs the urine flow from both kidneys. Can result from obstruction of a urinary catheter also

S/S:
–Urine retention
-Distended bladder
-Gross hematuria
-Lower back pain
-Pain in abdomen, groin or genitalia

Question 5

Chronic kidney failure

Answer 5

-Anorexia
-Vomiting
-Metallic taste in the mouth
-Hypertension
-Pericarditis
-Pulmonary edema
-Anxiety, delirium, hallucinations
-Fatigue, mental dullness, confusion
-Tremors or seizures
-Glucose intolerance
-Anemia

*Signs of uremia:
-Uremic frost
-Pasty
-Yellow skin
-Thin extremities

Question 6

-Chest pain
-Hypotension
-Hypoxemia
-Headache/Dizziness

HX:
-Actively receiving Dialysis

Answer 6

TX:
-O2
-Fluids
-Antianginal meds

Dysrhythmias may be associated w/ myocardial ischemia

TX:
-Stop if dialysis is in progress
-Contact Medical direction

Question 7

-Weakness
-Paralysis
-Dyspnea
-Often asymptomatic
-EKG findings

HX:
-Dialysis Pt

Answer 7

Dialysis severe hyperkalemia

Life-threatening emergency resulting from poor dietary regulation and missed dialysis;

(Any patient with renal failure in cardiac arrest should be suspected of having severe hyperkalemia)

TX:
-Calcium
-High-dose nebulized albuterol
-Glucose plus Insulin

Question 8

-Headache
-Fatigue
-Confusion
-Coma

HX:
-Dialysis Pt

Answer 8

Dialysis disequilibrium syndrome

Osmotic gradient between the blood and the brain, causing water to move into the brain leading to cerebral edema and intracranial pressure;

Due to:
Disproportionate decrease in the osmolality of the extracellular fluid compared with that of the intracellular compartment in the brain or cerebrospinal fluid

Question 9

Dialysis hypotension problems

Answer 9

Occurs with hemodialysis due to:
-Rapid reduction of intravascular volume
-Abrupt changes in electrolyte concentrations
-Vascular instability

TX:
-Cautiously administer hypotonic fluids (monitor to prevent hypertension & signs of heart failure)

Question 10

Dialysis hemorrhage problems

Answer 10

Dialysis patients are at higher risk because of their exposure to anticoagulants during hemodialysis and decreased platelet function

*watch for signs of hypovolemia

Question 11

Hyperkalemia EKG Findings

Answer 11

-Tall or tented T-wave

Conduction slows causing:
-A prolonged PR interval
-Depressed ST segments
-Loss of P waves (not always)

Patterns may be followed by:
-Widened QRS complex
-Deep S waves
-Blended S and T waves
-Delayed conduction in the interventricular conducting system

Question 12

Dialysis emergencies

Answer 12

-Vascular access problems
-Hemorrhage
-Hypotension
-Chest pain
-Severe hyperkalemia
-Disequilibrium syndrome
-Air embolism

Question 13

Dialysis vascular access problems

Answer 13

-Bleeding at the site of puncture
-Dialysis thrombosis
-Infection

*Bleeding from graft or fistula is minimal but excessive pressure can cause thrombosis
*Occluded fistulas and grafts due to thrombus formation

Question 14

-Fever
-Chills
-Flank pain
-Nausea/vomiting

*left untreated can lead to a chronic condition lasting months or years, scarring and possible loss of kidney function

HX:
-UTI’s
-Bacterial Infection

Answer 14

Pyelonephritis

Inflammation of the kidney parenchyma occurring as a result of a lower UTI infection;
Bacterial infection, backflow of infected urine from the bladder into the ureters or kidney pelvis

Question 15

-Acute, excruciating pain originates in the flank area and radiates to the right or left lower abdominal quadrant, groin, and testes

*Pain may be accompanied by:
-Restlessness
-Nausea/vomiting

HX:
-20-50 yrs
-Dehydration
-CNS disorders
-Drug use
-Surgery

Answer 15

Urinary calculus

TX:
-IV fluids
-Transport in a comfortable position
-Antiemetics
-Pain management

Question 16

-Gradual onset of unilateral scrotum pain radiating to spermatic cord
-Tender swelling of the scrotum and testicle = inflammation of one or both testes
-Fever
-Malaise
-Urethral discharge

Answer 16

Epididymitis

Inflammation of the epididymitis, the structure that carries sperm from the testicle to the seminal vesicles

Question 17

-Tender epididymis and painful swelling of the scrotal sac; pain is sudden and severe; preceded by vigorous physical activity
-Associated with nausea and vomiting

HX:
-Blunt trauma to the scrotal area
-More often it occurs spontaneously

Answer 17

Testicular torsion

Urologic emergency; a testicle twists on its spermatic cord, disrupting blood supply

*Two peak periods for this to occur: first year of life and puberty (average age, 14 years)