GU/Renal Disorders Flashcards
1
Q
bacteria found in UTI
A
- E. coli (most common)
- staph
- pseudomonas
- candidas
- can be used by fungus or parasite
2
Q
antibacterial features of the urinary tract
A
- acidic pH (<6)
- high urea concentration
- glycoproteins interfering w/ bacterial growth
3
Q
risk factors for UTIs
A
- obstruction (tumor, stone, stricture, BPH)
- urinary retention
- renal impairment
- female
- pregnancy, aging, HIV, DM
- sexual intercourse
- catheters (foley, nephrostomy tube)
- instrumentation (cystoscopy, surgery)
4
Q
clinical manifestations of lower UTIs
A
- dysuria, frequency (more than every 2 hours) , urgency
- suprapubic discomfort or pain
- cloudy urine, hematuria, sediment
- incomplete emptying of bladder
- incontinence and nocturia
- some are asymptomatic
5
Q
clinical manifestations of upper UTIs
A
- all sxs of lower UTI
- fever
- chills
- flank pain
6
Q
clinical manifestations of UTI found in older adults
A
- often asymptomatic, non localized ABD discomfort
- cognitive impairment
- general clinical deterioration, can progress to urosepsis
7
Q
diagnostic tests for UTI
A
- urinalysis (UA): bacteria, WBC, RBC, leukocyte esterase
- urine culture and sensitivity (clean catch)
- CT and US (only if obstruction or other problem suspected and for recurrent UTIs)
8
Q
T/F: the need for a urine specimen is a reason to catheterize someone
A
False; do a clean catch when possible
9
Q
collaborative care for UTIs
A
- antibiotics (must finish whole course!)
- adequate fluid intake
- avoid unnecessary catheterization
- early removal of Foleys
- aseptic technique when inserting catheters
- hand hygiene, gloves, perineal hygiene
10
Q
pt teaching for UTIs
A
- adequate fluid intake
- wipe from front to back
- urinate frequently (every 3-4 hours)
- urinate before and after intercourse
- avoid bladder irritants (caffeine, alcohol, citrus, spicy foods, chocolate, nuts)
11
Q
inflammation of kidneys and ureters w/ bacterial infection being most common cause; most start as lower UTIs
A
acute pyelonephritis
12
Q
what preexisting factors are often present w/ acute pyelonephritis
A
- vesicoureteral reflex
- calculi
- obstruction
- catheters
- pregnancy
13
Q
clinical manifestations of acute pyelonephritis
A
- fatigue
- fever
- chills
- N/V
- flank pain
- lower UTI sxs
14
Q
diagnostic tests for acute pyelonephritis
A
- UA
- urine C & S
- CBC and blood cultures (sepsis)
- renal US and CT
15
Q
collaborative care for acute pyelonephritis
A
- antibiotics (PO or IV)
- analgesics
- follow-up UA and urine culture
- monitor for subtle changes in VS (usually first sign of sepsis)
16
Q
recurring pyelonephritis
A
chronic pyelonephritis
17
Q
what can chronic pyelonephritis lead to
A
- renal atrophy
- fibrosis
- loss of renal function
- can progress to ESRD
18
Q
diagnostic tests for chronic pyelonephritis
A
- US
- CT
- renal biopsy
19
Q
chronic inflammatory and painful bladder disease with unknown cause
A
interstitial cystitis
20
Q
clinical manifestations of interstitial cystitis
A
- lower UTI sxs
- pain: suprapubic, vagina, perineum, rectum
- irritation, inflammation, and scarring of bladder wall
- remission and exacerbations
- stress and premenstrual time lead to exacerbations
21
Q
diagnostic test for interstitial cystitis
A
diagnosed by ruling out UTI
22
Q
collaborative care for interstitial cystitis
A
- avoid bladder irritants (caffeine, alcohol, citrus, spicy foods, chocolate, nuts)
- stress management
- pain management
- tricyclic antidepressant -amitriptyline (Elavil) -> reduces burning pain and frequency
23
Q
characteristics of nephrolithiasis
A
- more common in males
- most between 20-55 years of age
- higher incidence in Caucasians
- recurrence in up to 50% of pts
24
Q
risk factors for nephrolithiasis
A
- hot climate, dehydration, low fluid intake
- large intake of calcium
- large intake of protein (uric acid)
- family Hx
- sedentary lifestyle, immobility
25
types of renal calculi
- calcium oxalate (most common) -> oxalate from fruit juice or tea
- calcium phosphate - high oxalate foods and protein
- uric acid -> gout
- cystine - usually due to cystinuria
- struvite - usually due to infections due to alkaline environment
26
clinical manifestations of neprholithiasis
- sudden onset of severe pain (flank, lower ABD, back, groin)
- men -> testicular pain
- women -> labial pain
- dysuria, fever and chills (if UTI present)
- nonobstructive stone may have no pain
27
diagnostic tests for neprholithiasis
- CT
- US
- UA
- electrolytes
- stone analysis
28
collaborative care for neprholithiasis
- pain management
- antibiotics (if infection present)
- surgery if stones too large to pass (>7mm) or causing complications -> watch for signs of hemorrhage w/ kidney procedures
- identify type and cause
- adequate hydration
- avoid soda, coffee, tea
- low Na, avoid too much Ca and purine
29
types of procedures done to remove renal calculi
- cystoscopy, cystoscopic lithotripsy, ureterscope
- percutaneous nephrolithotomy w/ nephrostomy tube
- lithotripsy (laser, shock wave, percutaneous) -> stent left in ureter for 2 weeks to allow stones to pass
- surgery (very large obstructive stones)
30
T/F: hematuria is common after a lithotripsy
True
31
How to watch for hemorrhage after renal surgery
- monitor VS frequently
- serial CBCs
- bleeding/hematoma at flank site
- gross hematuria
32
reasons to use an indwelling (Foley) catheter
- accurate urine output for critically ill pts
- urinary obstruction
- pressure ulcers (especially if incontinent)
- surgical considerations
33
reasons to use an intermittent (straight) catheter
- urinary retention
- sterile sample collection
- checking for post-void residual
- testing/instillation of medications
34
How to prevent CAUTIs
- maintain closed system
- keep drainage bag below level of bladder and empty often
- perineal care (depends on facility but usually q shift)
- remove as soon as possible
- assess for device related breakdown at urethral meatus
35
indications for continued catheter use -> remove catheter if no indications met
HOUDINI protocol
36
list HOUDINI protocol
- hematuria
- obstruction
- urinary surgery
- decubitus ulcer
- input and output measurement
- nursing end of life care
- immobility
37
catheter that goes through the skin of the suprapubic area
suprapubic catheter
38
nursing considerations for suprapubic catheters
- temporary - usually bladder or urethral surgery
- sometimes long term (spinal cord injury)
- bladder spasms may be present
39
caring for a suprapubic catheter
- prevent kinking
- maintain gravity drainage
- daily skin care and dressing change
40
nursing considerations for a nephrostomy tube
- temporary - ureteral obstruction
- sometimes permanent - palliative care
- directly into kidney (high risk for infection)
- hematuria common after initial placement -> should clear up but monitor
- may need to be changed every month
41
caring for a nephrostomy tube
- prevent kinking
- do NOT clamp
- may need to irrigate (no more than 5 mL)
- dressing changes (sterile for irrigation and dressing)
42
6-8 inch segment of ileum is used as a conduit -> attached to the ureters to bring urine to the outside of the body (stoma)
ileal conduit
43
nursing considerations for ileal conduit
- connected to mesentery for support but does not drain into bowel
- external stoma and urinary bag
- assess for stoma signs and sxs
44
caring for an ileal conduit
- stoma care
- S&S to report: stoma sunk in, macerated skin (wet/raw)
- opening of pouch 1/8 inch larger than stoma
- urinary bag can be connected to tubing and gravity during hospitalization or at night if desired
45
benign enlargement of the prostate gland w/ gradual urethral obstruction; approx 50% of males will develop this
benign prostate hyperplasia (BPH)
46
risk factors for BPH
- age related hormonal changes (decreased testosterone -> leads to higher estrogen -> prostate growth)
- obesity, sedentary lifestyle
- alcohol, smoking
- DM
- erectile dysfunction
- family Hx
47
clinical manifestations of BPH
- gradual onset
- nocturne (usually first sx)
- dysuria and bladder pain
- urinary retention
- difficulty initiating urination, intermittency
- dribbling at end of voiding
48
complications of BPH
- UTIs
- pyelonephritis
- acute urinary retention
- bladder damage
- renal failure (from hydronephrosis)
49
diagnostic tests for BPH
- digital rectal exam (DRE)
- prostate specific antigen (PSA) may be elevated
- UA and culture
- creatinine
- transrectal ultrasound (TRUS)
50
collaborative care for BPH
- watchful waiting if mild or no sxs
- drug therapy
- reduce modifiable risk factors
- transurethral resection of prostate (TURP): removal and cauterization of prostate tissue through urethra (gold standard of tx)
- open prostatectomy -> if too large for TURP
51
drugs used for BPH
- 5a-reductase inhibitors: finasteride (Proscar)
| - alpha-adrenergic receptor blockers: tamsulosin (Flomax)
52
considerations for finasteride (Proscar)
- reduce prostate size
- monitor PSA levels (will decrease them)
- may take 6 months to show effectiveness
- must take consistently
53
considerations for tamsulosin (Flomax)
- helps relieve urinary sxs (prostate smooth muscle relaxation)
- improvement in 2-3 weeks
54
care for pt after TURP
- bleeding common after surgery
- large 3-way Foley and CBI (prevent clots)
- subtract irritation amount from Foley bag to measure urine output
- monitor signs of hyponatremia (confusion, N/V, bradycardia) -> due to large amount of irrigation
55
pt teaching after TURP
- avoid increased ABD pressure (prevent constipation and heavy lifting)
- no sex 4-6 weeks
- avoid bladder irritants
56
post op care for open prostatectomy
- catheter removed 2-4 days
- drains (JP)
- urinary incontinence or dribbling may last several weeks -> Kegel exercises (start/stop stream of urine)
- ED and retrograde ejaculation (goes into bladder and urine will look cloudy)
- incision care
- stool softeners and avoid heavy lifting (no ABD pressure)
- drink 2-3 L of fluid
- showers ok; NO tub baths
57
characteristics of acute kidney injury (AKI)
- rapid onset (hours to days)
- high mortality rate
- potentially reversible
- older adults more susceptible (dehydration, diuretics, hypotension, other illnesses)
58
clinical manifestations of acute kidney injury
- increased creatinine and/or decreased urine output
- azotemia (incresce BUN)
- hyperkalemia
59
3 types of acute kidney injury
- prerenal
- intrarenal
- post renal
60
caused by reduced systemic circulation -> oliguria; can be reversible but if untreated leads to intrarenal
prerenal kidney injury
61
causes of prerenal kidney injury
- hypovolemia (dehydration, hemorrhage, burns)
- decreased cardiac output (dysrhythmias, cardiogenic shock, CHF, MI)
- decreased peripheral vascular resistance (anaphylaxis, septic shock, neurologic injury)
- decreased renovascular flow (renal thrombosis)
62
direct kidney tissue damage; acute tubular necrosis (ATN) most common cause
infrarenal kidney injury
63
causes of infrarenal kidney injury
- ATN due to sepsis, ischemia, or nephrotoxicity
- nephrotoxic injury (gentamicin, vancomycin, amphotericin B, contrast dye, crush injury)
- interstitial nephritis (bacterial pyelonephritis, CMV, candidiasis)
- other causes (prolonged prerenal ischemia, acute glomerulonephritis, eclampsia, malignant HTN, SLE)
64
obstruction outside of kidney -> hydronephrosis -> kidney damage; reversible if obstruction addressed within 48 hours
post renal kidney injury
65
causes of post renal kidney injury
- BPH
- prostate cancer
- bladder cancer
- renal calculi
- trauma (back, pelvis, perineum)
- ureteral strictures
- spinal cord injury
66
3 phases of AKI
- oliguric phase
- diuretic phase
- recovery phase
67
describe the oliguric phase of AKI
- oliguria (<400 mL/day)
- starts 1-7 days of cause; lasts 10-14 days
- more common w/ prerenal causes
- UA -> casts, RBCs, WBCs, proteinuria
- fluid overload -> edema, HTN, HF, pulmonary edema
- metabolic acidosis
- decreased Na, Hgb, Hct, and Ca
- increased K, BUN, creatinine, phosphate, and WBC
- pt may have fatigue, seizures, or coma
68
describe the diuretic phase of AKI
- urine output 1-3 L/day; may reach 5 L or more/day
- nephrons still not functional
- osmotic diuresis; kidneys excreting waste but unable to concentrate urine
- hypovolemia, hypotension, hyponatremia, and hypokalemia
- may last 1-3 weeks
69
describe the recover phase of AKI
- GFR increases and BUN and Cr decrease back to normal
- significant improvement in 1-2 weeks; up to 12 months to fully stabilize
- some don't recover and progress to chronic renal failure
- older adults have decreased change of recovery
70
diagnostic tests for AKI
- BUN
- Cr
- electrolytes
- UA
- renal US
- CT
71
collaborative care for AKI
- treat the cause
- fluid restriction in oliguric phase
- renal diet (decreased K, decreased phosphate, adequate protein intake)
- Ca supplementation and phosphate binders
- decrease K levels
72
how to decrease K levels
- regular insulin IV (give w/ glucose)
- sodium bicarbonate
- sodium polystyrene sulfonate (Kayexalate) -> PO or enema
- hemodialysis
73
characteristics of chronic kidney disease (CKD)
- progressive loss of kidney function; irreversible
- more common than AKI
- higher incidence among AA, NA, and Hispanics
- high mortality rate
- may be asymptomatic until advanced
- 5 stages
- if ESRD, eligible for Medicare
74
causes of CKD
- DM (50% of cases)
- HTN (25% of cases)
- glomerulonephritis
- polycystic kidney disease
- urologic diseases
- unresolved AKI
75
lab changes in CKD
- may be asymptomatic in early stages
- increased BUN and Cr
- decreased Cr clearance (decrease GFR)
- altered carbs and lipids metabolism -> hyperglycemia, hyperinsulinemia, increased triglycerides and LDL, decreased HDL
- metabolic acidosis
- hyperkalemia
- altered Na (normal, increased or decreased)
- decreased Ca and increased Pi
- decreased Hgb and Hct (due to decreased EPO)
76
clinical manifestations of CKD
- risk for infection
- CV disease (most common cause of death in CKD)
- fluid overload, pulmonary edema, and PNA
- N/V, lethargy, fatigue, HA, seizure, coma
- risk for fractures
- infertility and decreased libido
- anxiety and depression
77
diagnostic tests for CKD
- BUN and Cr
- creatinine clearance and GFR
- electrolytes
- UA
- BCB
- lipid profile
- renal US
- CT (contrast is nephrotoxic)
- renal biopsy
78
collaborative care for CKD
- address fluid and electrolyte imbalances
- renal diet (low K)
- dialysis
- manage DM, HTN, and HLD if present
- EPO therapy -> epoetin alfa (Epogen)
- Ca supplements and phosphate binders (taken w/ meal -> bind to Pi and excrete it)
- adjust med dosages according to renal function
- kidney transplant
79
foods high in K
- avocado, banana, cantaloupe, oranges, prunes, and raisins
- beans, broccoli, potatoes, carrots, tomatoes
- bran products, chocolate, granola, milk, nuts/seeds, peanut butter, yogurt
80
types of dialysis
- peritoneal dialysis
| - hemodialysis
81
characteristics of peritoneal dialysis
- dialysis solution enters the peritoneum and is drained out
- can be done at home
- less dietary restriction (dialysis done throughout the day)
- continuous ambulatory peritoneal dialysis (CAPD) - throughout the day
- automated peritoneal dialysis (APD) - machine that cycles at night
82
2 types of peritoneal dialysis
- continuous ambulatory peritoneal dialysis (CAPD) - 4-5 bags of solution filtered throughout the day
- automated peritoneal dialysis (APD) - machine that cycles at night; may still need 1-2 bags during day
83
characteristics of hemodialysis
- done at outpatient center
84
3 types of access to hemodialysis
- AV fistula: surgically joining vein and artery in arm
- AV graft: graft joints vein and artery in arm
- HD catheter (temporary access)
85
T/F: the only person who is going to access a dialysis access point is someone who is specialized in dialysis
True
86
what to assess in someone w/ AV fistula or graft
- listen for bruit and palpate thrill at site (normal)
| - neuromuscular assessment distal to fistula/graft
87
What to never do with a patient's arm that has an AV graft/fistula
limb alert
- never draw blood
- never place IV
- never check BP
88
What to do with a HD catheter
- check dressing is CDI
- if dressing needs to be changed, call dialysis
- don't do anything w/ catheter
89
How often is dialysis done
3 times per week for 3-4 hours at a time
90
how to care for pt in hospital getting dialysis
- pt may be exhausted when they return
- need weight before going to dialysis -> compare weight after to see how much fluid was taking off
- check what medications to give before going to dialysis (some meds may be dialyzed out and shouldn't be given before)
91
characteristics of leiomyomas
- uterine fibroids -> benign smooth muscle tumors of uterus
- 60% of women have at least 1 by age 50
- grow slowly during reproductive years then atrophy after menopause
- unknown cause and most asymptomatic
92
clinical manifestations of leiomyomas
- pelvic pain
- pelvic pressure
- abnormal uterine bleeding
93
diagnostic testing for leiomyomas
pelvic/transvaginal US
94
collaborative care for leiomyomas
- minimal sxs -> monitor pt closely overtime
- oral contraceptives
- if heavy menstrual bleeding, fast growing tumor, or very large tumor -> surgery (hysterectomy or myomectomy)
- uterine A. embolization (cuts off blood supply to tumor and causes them to shrink -> by femoral access)
95
when uterus displaces downward into vaginal canal
uterine prolapse
96
clinical manifestations of uterine prolapse
- dyspareunia
- heavy feeling in pelvis
- feeling that something is in vagina
- backache
- bowel/bladder problems (if rectocele and cystocele present)
97
when cervix is in lower part of vagina
1st degree uterine prolapse
98
when cervix is at the vaginal opening
2nd degree uterine prolapse
99
when the uterus protrudes out of the body
3rd degree uterine prolapse
100
collaborative care for uterine prolapse
- Kegel exercise (starting and stopping flow of urine)
- pessary (vaginal device to support uterus)
- surgery (vaginal hysterectomy and vaginal and underlying fascia repair)
101
weakened support between bladder and vagina
cystocele
102
weakened support between rectum and vagina
rectocele
103
clinical manifestations of cystocele
- many are asymptomatic
| - if large, incomplete bladder emptying and UTIs
104
clinical manifestations rectocele
- many are asymptomatic
| - if large, incomplete emptying of stool upon defection
105
collaborative care for cystocele and rectocele
- Kegel exercises
- pessary (for cystocele)
- surgery: anterior colporrhaphy (cystocele); posterior colporrhaphy (rectocele) -> tightens vaginal wall
106
how to care for pessary
- instructions how to clean it and how to place it
- must be taken out at least every 2 weeks, cleaned, and left out overnight
- if left in place for too long -> erosion can cause fistula or vaginal cancer
107
post op care for anterior/posterior colporrhaphy
- maintain clean incision site
- foley care (anterior)
- prevent constipation (posterior)
- no intercourse
- no heavy lifting
- limited sitting/standing
