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Adult Health 2 > GU/Renal Disorders > Flashcards

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
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2
Q

antibacterial features of the urinary tract

A
  • acidic pH (<6)
  • high urea concentration
  • glycoproteins interfering w/ bacterial growth
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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)
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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
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5
Q

clinical manifestations of upper UTIs

A
  • all sxs of lower UTI
  • fever
  • chills
  • flank pain
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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
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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)
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8
Q

T/F: the need for a urine specimen is a reason to catheterize someone

A

False; do a clean catch when possible

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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
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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)
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11
Q

inflammation of kidneys and ureters w/ bacterial infection being most common cause; most start as lower UTIs

A

acute pyelonephritis

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12
Q

what preexisting factors are often present w/ acute pyelonephritis

A
  • vesicoureteral reflex
  • calculi
  • obstruction
  • catheters
  • pregnancy
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13
Q

clinical manifestations of acute pyelonephritis

A
  • fatigue
  • fever
  • chills
  • N/V
  • flank pain
  • lower UTI sxs
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14
Q

diagnostic tests for acute pyelonephritis

A
  • UA
  • urine C & S
  • CBC and blood cultures (sepsis)
  • renal US and CT
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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)
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16
Q

recurring pyelonephritis

A

chronic pyelonephritis

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17
Q

what can chronic pyelonephritis lead to

A
  • renal atrophy
  • fibrosis
  • loss of renal function
  • can progress to ESRD
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18
Q

diagnostic tests for chronic pyelonephritis

A
  • US
  • CT
  • renal biopsy
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19
Q

chronic inflammatory and painful bladder disease with unknown cause

A

interstitial cystitis

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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
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21
Q

diagnostic test for interstitial cystitis

A

diagnosed by ruling out UTI

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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
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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
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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
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25
Q

types of renal calculi

A
  • 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
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26
Q

clinical manifestations of neprholithiasis

A
  • 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
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27
Q

diagnostic tests for neprholithiasis

A
  • CT
  • US
  • UA
  • electrolytes
  • stone analysis
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28
Q

collaborative care for neprholithiasis

A
  • 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
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29
Q

types of procedures done to remove renal calculi

A
  • 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)
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30
Q

T/F: hematuria is common after a lithotripsy

A

True

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31
Q

How to watch for hemorrhage after renal surgery

A
  • monitor VS frequently
  • serial CBCs
  • bleeding/hematoma at flank site
  • gross hematuria
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32
Q

reasons to use an indwelling (Foley) catheter

A
  • accurate urine output for critically ill pts
  • urinary obstruction
  • pressure ulcers (especially if incontinent)
  • surgical considerations
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33
Q

reasons to use an intermittent (straight) catheter

A
  • urinary retention
  • sterile sample collection
  • checking for post-void residual
  • testing/instillation of medications
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34
Q

How to prevent CAUTIs

A
  • 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
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35
Q

indications for continued catheter use -> remove catheter if no indications met

A

HOUDINI protocol

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36
Q

list HOUDINI protocol

A
  • hematuria
  • obstruction
  • urinary surgery
  • decubitus ulcer
  • input and output measurement
  • nursing end of life care
  • immobility
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37
Q

catheter that goes through the skin of the suprapubic area

A

suprapubic catheter

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38
Q

nursing considerations for suprapubic catheters

A
  • temporary - usually bladder or urethral surgery
  • sometimes long term (spinal cord injury)
  • bladder spasms may be present
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39
Q

caring for a suprapubic catheter

A
  • prevent kinking
  • maintain gravity drainage
  • daily skin care and dressing change
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40
Q

nursing considerations for a nephrostomy tube

A
  • 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
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41
Q

caring for a nephrostomy tube

A
  • prevent kinking
  • do NOT clamp
  • may need to irrigate (no more than 5 mL)
  • dressing changes (sterile for irrigation and dressing)
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42
Q

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)

A

ileal conduit

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43
Q

nursing considerations for ileal conduit

A
  • connected to mesentery for support but does not drain into bowel
  • external stoma and urinary bag
  • assess for stoma signs and sxs
44
Q

caring for an ileal conduit

A
  • 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
Q

benign enlargement of the prostate gland w/ gradual urethral obstruction; approx 50% of males will develop this

A

benign prostate hyperplasia (BPH)

46
Q

risk factors for BPH

A
  • age related hormonal changes (decreased testosterone -> leads to higher estrogen -> prostate growth)
  • obesity, sedentary lifestyle
  • alcohol, smoking
  • DM
  • erectile dysfunction
  • family Hx
47
Q

clinical manifestations of BPH

A
  • gradual onset
  • nocturne (usually first sx)
  • dysuria and bladder pain
  • urinary retention
  • difficulty initiating urination, intermittency
  • dribbling at end of voiding
48
Q

complications of BPH

A
  • UTIs
  • pyelonephritis
  • acute urinary retention
  • bladder damage
  • renal failure (from hydronephrosis)
49
Q

diagnostic tests for BPH

A
  • digital rectal exam (DRE)
  • prostate specific antigen (PSA) may be elevated
  • UA and culture
  • creatinine
  • transrectal ultrasound (TRUS)
50
Q

collaborative care for BPH

A
  • 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
Q

drugs used for BPH

A
  • 5a-reductase inhibitors: finasteride (Proscar)

- alpha-adrenergic receptor blockers: tamsulosin (Flomax)

52
Q

considerations for finasteride (Proscar)

A
  • reduce prostate size
  • monitor PSA levels (will decrease them)
  • may take 6 months to show effectiveness
  • must take consistently
53
Q

considerations for tamsulosin (Flomax)

A
  • helps relieve urinary sxs (prostate smooth muscle relaxation)
  • improvement in 2-3 weeks
54
Q

care for pt after TURP

A
  • 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
Q

pt teaching after TURP

A
  • avoid increased ABD pressure (prevent constipation and heavy lifting)
  • no sex 4-6 weeks
  • avoid bladder irritants
56
Q

post op care for open prostatectomy

A
  • 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
Q

characteristics of acute kidney injury (AKI)

A
  • rapid onset (hours to days)
  • high mortality rate
  • potentially reversible
  • older adults more susceptible (dehydration, diuretics, hypotension, other illnesses)
58
Q

clinical manifestations of acute kidney injury

A
  • increased creatinine and/or decreased urine output
  • azotemia (incresce BUN)
  • hyperkalemia
59
Q

3 types of acute kidney injury

A
  • prerenal
  • intrarenal
  • post renal
60
Q

caused by reduced systemic circulation -> oliguria; can be reversible but if untreated leads to intrarenal

A

prerenal kidney injury

61
Q

causes of prerenal kidney injury

A
  • 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
Q

direct kidney tissue damage; acute tubular necrosis (ATN) most common cause

A

infrarenal kidney injury

63
Q

causes of infrarenal kidney injury

A
  • 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
Q

obstruction outside of kidney -> hydronephrosis -> kidney damage; reversible if obstruction addressed within 48 hours

A

post renal kidney injury

65
Q

causes of post renal kidney injury

A
  • BPH
  • prostate cancer
  • bladder cancer
  • renal calculi
  • trauma (back, pelvis, perineum)
  • ureteral strictures
  • spinal cord injury
66
Q

3 phases of AKI

A
  • oliguric phase
  • diuretic phase
  • recovery phase
67
Q

describe the oliguric phase of AKI

A
  • 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
Q

describe the diuretic phase of AKI

A
  • 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
Q

describe the recover phase of AKI

A
  • 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
Q

diagnostic tests for AKI

A
  • BUN
  • Cr
  • electrolytes
  • UA
  • renal US
  • CT
71
Q

collaborative care for AKI

A
  • 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
Q

how to decrease K levels

A
  • regular insulin IV (give w/ glucose)
  • sodium bicarbonate
  • sodium polystyrene sulfonate (Kayexalate) -> PO or enema
  • hemodialysis
73
Q

characteristics of chronic kidney disease (CKD)

A
  • 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
Q

causes of CKD

A
  • DM (50% of cases)
  • HTN (25% of cases)
  • glomerulonephritis
  • polycystic kidney disease
  • urologic diseases
  • unresolved AKI
75
Q

lab changes in CKD

A
  • 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
Q

clinical manifestations of CKD

A
  • 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
Q

diagnostic tests for CKD

A
  • BUN and Cr
  • creatinine clearance and GFR
  • electrolytes
  • UA
  • BCB
  • lipid profile
  • renal US
  • CT (contrast is nephrotoxic)
  • renal biopsy
78
Q

collaborative care for CKD

A
  • 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
Q

foods high in K

A
  • avocado, banana, cantaloupe, oranges, prunes, and raisins
  • beans, broccoli, potatoes, carrots, tomatoes
  • bran products, chocolate, granola, milk, nuts/seeds, peanut butter, yogurt
80
Q

types of dialysis

A
  • peritoneal dialysis

- hemodialysis

81
Q

characteristics of peritoneal dialysis

A
  • 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
Q

2 types of peritoneal dialysis

A
  • 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
Q

characteristics of hemodialysis

A
  • done at outpatient center
84
Q

3 types of access to hemodialysis

A
  • AV fistula: surgically joining vein and artery in arm
  • AV graft: graft joints vein and artery in arm
  • HD catheter (temporary access)
85
Q

T/F: the only person who is going to access a dialysis access point is someone who is specialized in dialysis

A

True

86
Q

what to assess in someone w/ AV fistula or graft

A
  • listen for bruit and palpate thrill at site (normal)

- neuromuscular assessment distal to fistula/graft

87
Q

What to never do with a patient’s arm that has an AV graft/fistula

A

limb alert

  • never draw blood
  • never place IV
  • never check BP
88
Q

What to do with a HD catheter

A
  • check dressing is CDI
  • if dressing needs to be changed, call dialysis
  • don’t do anything w/ catheter
89
Q

How often is dialysis done

A

3 times per week for 3-4 hours at a time

90
Q

how to care for pt in hospital getting dialysis

A
  • 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
Q

characteristics of leiomyomas

A
  • 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
Q

clinical manifestations of leiomyomas

A
  • pelvic pain
  • pelvic pressure
  • abnormal uterine bleeding
93
Q

diagnostic testing for leiomyomas

A

pelvic/transvaginal US

94
Q

collaborative care for leiomyomas

A
  • 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
Q

when uterus displaces downward into vaginal canal

A

uterine prolapse

96
Q

clinical manifestations of uterine prolapse

A
  • dyspareunia
  • heavy feeling in pelvis
  • feeling that something is in vagina
  • backache
  • bowel/bladder problems (if rectocele and cystocele present)
97
Q

when cervix is in lower part of vagina

A

1st degree uterine prolapse

98
Q

when cervix is at the vaginal opening

A

2nd degree uterine prolapse

99
Q

when the uterus protrudes out of the body

A

3rd degree uterine prolapse

100
Q

collaborative care for uterine prolapse

A
  • Kegel exercise (starting and stopping flow of urine)
  • pessary (vaginal device to support uterus)
  • surgery (vaginal hysterectomy and vaginal and underlying fascia repair)
101
Q

weakened support between bladder and vagina

A

cystocele

102
Q

weakened support between rectum and vagina

A

rectocele

103
Q

clinical manifestations of cystocele

A
  • many are asymptomatic

- if large, incomplete bladder emptying and UTIs

104
Q

clinical manifestations rectocele

A
  • many are asymptomatic

- if large, incomplete emptying of stool upon defection

105
Q

collaborative care for cystocele and rectocele

A
  • Kegel exercises
  • pessary (for cystocele)
  • surgery: anterior colporrhaphy (cystocele); posterior colporrhaphy (rectocele) -> tightens vaginal wall
106
Q

how to care for pessary

A
  • 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
Q

post op care for anterior/posterior colporrhaphy

A
  • maintain clean incision site
  • foley care (anterior)
  • prevent constipation (posterior)
  • no intercourse
  • no heavy lifting
  • limited sitting/standing

Adult Health 2 (8 decks)

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