GU Flashcards
Questions to assess when a pt has kidney/urinary issues
OPQRST pain
frequency
amount
hematuria
dysurea (pain)
change in color or odor
anuria vs. oliguria vs. polyuria
anuria - no urine
oliguria - little urine
polyuria - lots of urine
ideally, when should urinalysis sample be collected?
1st catch in the morning
what is KUB test
kidney, ureter, bladder x-ray
what is IVP test
intravenous pyelogram which uses contrast dye to view kidneys, ureters, bladder, and urethra
what is cystoscopy
examine the bladder lining and urethra
how does the GU change with age
- kidney size decrease
- decreased renal blood flow, GFR
- decreased ability to conserve Na, excrete acid, dilute/con. urine
- increased prostates
- decreased bladder elasticity
how does change in bladder elasticity affect urine output
increased residual volume
cause of nocturia
change in dilution and concentration of urine
what is vesicoureteral reflux
blockage or failure of bladder muscle and leading to urine flowing backward into ureters and kidneys
signs of an elderly pt having GU issues
- mental confusion or frequent unexplained falls
- sudden onset of incontinence
- fever, tachycardia, tachypnea, hypotension (without urinary symptoms)
- loss of appetite, nocturia/dysuria
causes of cystitis
- not emptying bladder completely
- damage or irritation around urethra
- bacteria transfer to urethra
signs of cystitis
- increased frequency/urgency with burning urination
- hematuria
- cloudy/smelly urine
- pelvic discomfort
- pressure in lower abdomen
- low-grade fever
treatment of cystitis
antibiotics and pain meds
encourage fluids
what can pyelonephritis lead to
sudden severe kidney infection
leading to kidneys swelling
can cause permanent kidney damage
cause of chronic pyelonephritis
pts with urinary obstructions
upper vs. lower UTI symptoms
upper - fever, chills, flank pain
lower - dysuria, urgency, hesitancy
bacteria that cause most UTIs
E. coli
pyelonephritis meaning
inflamed renal parenchyma & collecting system
cystitis meaning
inflammation of bladder
urethritis meaning
urethra inflammation
name 1 urinary tract analgesic
pyridium (Phenazopyridine)
what does cranberry juice do
prevents attachment of pathogens to bladder wall
what is renal colic
sudden acute pain in kidneys from obstruction of urine flow from kidneys to bladder
signs of renal colic
sharp, severe pain in lower back and can radiate to groin
can have hematuria
how does urine pH help diagnose renal calculi
acidic - uric acid/cystine stones
alkaline - calcium phosphate stones
treatment of renal calculi
3-4 L water a day minimum (ideally want 2L urine output per day)
most will pass unless larger than 4mm
teaching for post-op lithotripsy (stent)
hematuria for several days, bruising or discomfort to back/abdomen
avoid aspirin or anti-coagulant drugs
will have discomfort from more stones passing
nurse interventions for any post-operation
encourage fluids, movement
strain all urine & check urine pH
pain management
change in diet
what foods to avoid for renal calculi
avoid high purine foods such as red meat, organ meats, alcohol, sardines/anchovies/shellfish
3 phases of acute renal failure
- oliguric-anuric
- diuretic
- recovery
causes of prerenal failure
hypotension or poor blood flow to kidneys secondary to other source
causes of intrarenal failure
inflammation, drugs, infection, decreased blood flow to kidneys
causes of postrenal failure
sudden urine obstruction from enlarged prostate
kidney stones
bladder tumor
or injury
what labs can be expected from oliguric-anuric stage of ARF (acute renal failure)
- 1-7 days
- increased BUN, creatinine
- decreased urine output, possible fluid overload (hypervolemia) leading to decreased Hgb, Hct, RBC count
- changes in electrolytes: hyperkalemia, hyponatremia
- metabolic acidosis
- fatigue/malaise
what precautions should oliguric stage of acute renal failure should a pt be placed on
seizure precautions - low Na
pulmonary edema - hypervolemia
risk for growth disturbance - lack of appetite, disturbance to diet
what is happening anatomically during oliguric-anuric stage of ARF
- renal tubule damage leading to decreased urine output
what happens anatomically during diuretic phase of ARF
- kidneys attempt to heal but results in damage or scarring
- increased GFR, daily urine ideally over 400ml, poss electrolyte imbalance still
- creatinine/BUN still elevated
- poss anemia: kidneys make erythropoietin
- dehydration/hypovolemia
what happens anatomically during recovery phase of ARF
- can take months to yrs
- decreased edema
- renal fxn improves
signs and symptoms of ARF
fluid build up/edema
chest pain
muscle weakness
interventions for ARF
surgery
meds
nutrition
dialysis
what is differential diagnosis?
other diagnosis besides the first thing you can think of/relate it to
what 3 factors are the most important to look at for a urine dipstick
nitrates
blood
leukocyte esterase
what is normal GFR
less than 60
what abx to use for UTI
fluoroquinolone - ciprofloxacin
sulfonamide - TMP-SMX (septra)
nitrofurantoin
bactrim
contraindication for hemodialysis
hemophilia (major bleed risk)
what to do when a kidney pt has hyperkalemia
infuse regular insulin with D10W or D20W to get K into cells and sugar to prevent hypoglycemia
normal urine pH
4.5 -8.0 okay
WBC normal range
4,000 - 12,000
normal Hct range
35-50
when is shockwave delivered with extracorporeal shock wave lithotripsy (ESWL)
ECG placed and shockwave synced to R wave
rapid decrease in fluid post hemodialysis can cause what
seizures from cerebral edema, and increased intracranial pressure
