Genitourinary Flashcards
Considerations for Elderly Pts with Incontinence
Medications - opioids and diuretics
Disease - stroke and parkinson
Depression
Inadequate resources
Labs, Radiographic and Urodynamic studies for Incontinence
-UA
-Voiding cystourethrogram (VCUG)
-Post-void residual
-Urodynamic evaluation
= cystometrogram
= ultrasonography
= electromyogram
Nursing Assessment for Pts with Incontinence
-HISTORY (get a voiding history)
-Palpate and percuss for distension
-post-void residual, if ordered
-Pelvic ultrasonographic scanner
-Inspect female genitalia
=urethra or uterine prolapse
=cystocele (when bladder prolapses)
=rectocele (when bladder prolapses)
Risk factors for Kidney Stones
- Urinary stasis (not emptying bladder completely)
- Supersaturation of urine (caused by dehydration)
= calcium crystals - infection
- presence of foreign body or urinary diversion
=obstruction - family history
- metabolic disease
=intake of excessive calcium, uric acid, medications or Vit. D - males > females
- recur at rate of 35-50%
- hyperparathyroidism
- diuretics
Types of Calculi
- Calcium oxalate or Calcium phosphate: 80%
- Struvite: 10-15%
- Uric acid: 5-8%
- Cystine: 1-2%
Uremia Skeletal Effects
- Osteomalacia (Rickets)…aka weak bones
- -Bone pain…arthritic symptoms
- Spontaneous fractures
- -Bone demineralization
- -Hypocalcemia/hyperphosphatemia…leads to prolonged QT interval, bradycardia, decreased contractility, hypotension, weakness and tetany
Uremia Cardiopulmonary Effects
- -HTN
- -Pericarditis…with fever
- Pulmonary edema, CHF
- Chest pain
- Pericardial friction rub
- -Kussmal respirations
- -Hyperlipidemia
Treatment of Cardiopulmonary complications
- control HTN with fluid restrictions and low Na diet
- give hypertensive medications: usually multi drug regimen
- antihyperlipidemic medications
- monitor I&Os and daily weights
- ONLY use diuretics in EARLY stages
- dialysis
Uremia Neurological Effects
- -Encephalopathy….fatigue, decreased attention and problem solving
- -Peripheral neuropathy…. pain, burning and loss of protective sensation. use GABAPENTIN or PREGABALIN
- -Seizures ….loss of motor coordination, twitching, stupor and coma
Uremia Hematological Effects
- -decreased erythropoietin production by kidneys leads to anemia. use IRON for minor; use EPOETIN ALFA for major
- -decreased RBC survival time….caused by uremic toxins, iron and folic acid deficiencies
- -impaired platelet function and increased bleeding times…caused by uremic function
Uremia Gastrointestinal Effects
- -Nausea/Vomiting
- -Anorexia, hiccups
- -Diarrhea/constipation
- -Stomatits/mouth ulcers
- Gastritis, peptic ulcers and GI bleeding
- *-Changes in taste and uremia fetor (ruinous breath)
use…PROTON PUMP INHIBITORS or PEPSID
Uremia Integumentary Effects
- -Pruritus…effects 15-50% of CRF pts and 50-75% of dialysis pts
- dry, yellow skin
- -decrease in skin turgor
- -Ecchymosis
- soft tissue calcifications
- *-uremic frost (urea crystals on the skin)…when BUN is 250/300, the body puts out urea in sweat…this is morbid stage
Uremia Immunological Effects
*-increased risk of infection…can lead to sepsis and death d/t suppression of cell-mediated immunity, reduced number and fx of lymphocytes and phagocytes
Uremia Reproductive Effects
- -sexual dysfunction
- menorrhagia
- amenorrhea
- infertility
- decreased libido
use…SSRI meds like SERTRALINE
Nutrition and Renal Diet
- increase calories and carbs
- decrease protein intake until dialysis begins
- increase calcium and iron intake
- decrease sodium and phosphorus intake
SUPPLEMENTATION
- daily multiple vitamin
- med to reduce phosphorus (called Renagel)
- iron supplements
- nutrition shakes for pts with anorexia
