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Lecture Block II Final Exam > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Urethra
cm? female and male

A

Urethra
* Females: 3-4 cm
* Males: 20 cm

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2
Q

functional capacity for bladder to empty the urine

A

functional capacity 400-500ml

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3
Q
  • Oliguria:
  • Anuria
  • Normal
A

Oliguria: daily urine volume of less than 400 mL
* Anuria urine output of less than 100 mL/day
* Normal urine production is 0.5mL/kg/hr

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4
Q

GFR - glomerular filtration rate

A

GFR - glomerular filtration rate
* < 90 mL/min/1.73 m2 considered chronic kidney damage
< 60 mL/min/1.73 m2 considered irreversible kidney damag

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5
Q

Acute kidney injury Vs Chronic Kidney Failure

A

Acute kidney injury is a reversible syndrome that results in
decreased glomerular filtration rate and oliguria

  • Chronic renal failure (ESRD) is a progressive, irreversible
    deterioration of renal function that results in azotemia
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6
Q

Acute kidney injury cause
Prerenal
Intra-renal
Post-renal

A

Prerenal
*Hypoperfusion of kidney
* Hypovolemia
* Reduced cardiac output
* Vasodilation

Intrarenal
* Prolonged renal ischemia
* Nephrotoxic agents
* Infectious processes

Postrenal
* Urinary tract obstruction

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7
Q

Four Phases of Acute Kidney Injury

A
  • Initiation
  • Begins with the initial insult

Oliguria
* Increase in serum urea, creatinine, uric acid, organic acids, K+,
mag

Diuresis
* Increase in urine output

Recovery
* Renal function continues to improve

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8
Q

Urinalysis and urine culture:

Renal function tests:

Ultrasonography:

A

Urinalysis and urine culture
* Specific gravity, CYU, pH, protein,
glucose, ketones

Renal function tests
* GFR

Ultrasonography
* Bladder should be ful

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9
Q

What is the difference between Prerenal and
Intrarenal failure?

A
  • Prerenal acute renal failure is characterized by diminished renal
    blood flow (60 to 70 percent of cases).
  • In intrinsic acute renal failure, there is damage to the renal
    parenchyma (25 to 40 percent of cases).
  • Postrenal acute renal failure occurs because of urinary tract
    obstruction (5 to 10 percent of cases)
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10
Q

Acute Kidney Injury: clinical manifestations in oliguric phase
( Hint more like right-side heart failure symptoms)

A
  • Peripheral edema, pulmonary edema, JVD, HTN
  • Fatigue
  • N/V
  • SOB
  • Confusion
  • Seizures or coma
  • Chest pain
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11
Q

Azotemia

A

abnormally high levels of nitroge

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12
Q

Initial diagnostic test for Acute kidney injury

A

Ultrasound

then CBC -
* Hemoglobin

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13
Q

Acute Kidney Injury: Tx medications for hyperkalemia especially
K+ is the most life-threatening in AKI

A

Hyperkalemia

  • Sodium polystyrene sulfonate (PO, PR)
  • Sorbitol
  • IV insulin/D50
  • IV bicarbonate
  • Dialysis
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14
Q

Monitor nephrotoxic medications
example?

A

Contrast, biguanides, etc

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15
Q

Collaborative Problems and Complications

A

Hyperkalemia
* Pericarditis
* Pericardial effusion
* Pericardial tamponade (extra fluid builds up in the space around the
heart)
* Hypertension
* Anemia - lower production of erythropoietin production of RBCs
* Bone disease and metastatic calcifications (calcium salts in normal
tissue)

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16
Q

Stages of Chronic Kidney Disease
stage 1-5

A

Stages of Chronic Kidney Disease
* Stage 1
* Kidney damage with normal or increased GFR
* Stage 2
* Mild decrease in GFR
* Stage 3
* Moderate decrease in GFR
* Stage 4
* Severe decrease in GFR
* Stage 5
* End-stage kidney disease or chronic kidney disease

17
Q

End Stage Kidney Disease: Diagnostics

A
  • GFR decreases
  • Increased creatinine & BUN
  • Na & H2O balance
  • Potassium balance
  • Metabolic Acidosis
  • Calcium decreases
  • Phosphorous increases
  • Anemia
18
Q

Kidney Disease Diet Considerations

A
  • 4 to 5 small meals
  • Read food labels (no salt added, low sodium)
  • Low in sodium and potassium (lemon, spices)
  • Avoid salt substitutes
  • Avoid foods high in phosphorus (dairy, lentils, beans)
  • High-quality protein (lean meat, poultry, fish, eggs)
  • Monitor fluids carefully (anything liquid at room temp counts)
19
Q

Kidney Transplant:
Donor contraindications:
Sucess rate:

A
  • Treatment of choice for patients with ESRD
  • Elective surgery with many requirements

Donor contraindications
* HTN
* DM

Success rate
* Living-donor 97% after one year; 86% after five years
* Cadaver-donor 96% after one year; 79% after five years
* Second kidney transplant if the first fail

20
Q

Hemodialysis:

A

Hemodialysis: used when patient is acutely ill until kidneys resume
function and for long-term replacement therapy in CKD and ESKD

  • Objective is to extract toxic nitrogenous substances from the blood
    and to remove excess fluid:
  • Diffusion, osmosis, and ultrafiltration

Vascular access
* Arteriovenous fistula
* Arteriovenous graft

21
Q

Peritoneal Dialysis:

Complications:

A

Goals are to remove toxic substances and metabolic wastes and to
reestablish normal fluid and electrolyte balance
* Peritoneal membrane serves as semipermeable membrane
* Ultrafiltration
* Peritoneal catheter
* Acute intermittent, continuous ambulatory, continuous cyclic

Complications:
peritonitis, leakage, bleeding
* bowel or bladder perforation
* Peritonitis
* Loss of protein
* Hyperglycemia
* Effluent assessment
* Color
* Clarity

22
Q

Recipient Contraindications to surgery for kidney transplant

A
  • Recent cancer
  • Chronic or active infection (HIV, hepatitis B, and C)
  • Cardiac disease, chronic lung disease, severe peripheral vascular disease
  • Class II obesity (body mass index greater than 35 kg/m2)
  • Current substance abuse
  • Inability to give informed consent
  • History of nonadherence to treatment regimen
23
Q

Pre-operative Nursing Management

A
  • Both donors and recipients should be in the best possible health and
    have the ability to remain so.
  • Both patients must be free of infection
  • Recipient anti-rejection medications suppress the immune response
  • Psychosocial evaluation
  • Motivation
  • Psychiatric illness
24
Q

Postoperative Nursing Management
and intervention

A
  • Assessment: include all body systems, pain, fluid and electrolyte
    status, and patency and adequacy of urinary drainage system
  • Complications: bleeding , pneumonia, infection, and DV

Pain relief measures, analgesic medications
* Promote airway clearance and effective breathing pattern, turn,
cough, deep breathe, incentive spirometry, positioning
* Monitor UOP and maintain patency of urinary drainage systems
* Use strict asepsis with catheter
* Monitor for signs and symptoms of bleeding
* Encourage leg exercises, early ambulation, and monitor for signs of
DVT

25
Q

Assessing the Patient for Transplant
Rejection

A

Urine out put decreases main sign for rejection
* Oliguria
* Edema
* Fever
* Increasing blood pressure
* Weight gain
* Swelling or tenderness over the transplanted kidney or graft.

Lecture Block II Final Exam (8 decks)

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