Med-Surg 2: Urinary, Prostate, Diabetes Flashcards
0
Q
The most common type of UTI that is an inflammation of the bladder wall =
A
Cystitis.
1
Q
What is the most common bacteria that causes UTI’s?
A
E coli.
2
Q
Diagnosis of a UTI is with >___organisms/mL.
A
100,000
3
Q
When are men most at risk for a UTI?
A
Catheters & during older years when prostate is changing (fluid in the prostate is normally beneficial for prevention).
4
Q
Etiology/Risk Factors for UTI’s?
A
E coli, Sexually active females, chemical irritants, moisture, pregnancy (changes in pH of vagina), stasis of urine, HAI’s (Healthcare Associated Infections), Age (incontinence, changes in pH, change in prostate), Immunocompromised, Co-morbidities (DM–glucose in urine, neurogenic bladders).
5
Q
Clinical Manifestations of UTI’s?
A
Dysuria, Hematuria, Frequency, Urgency, Pain, CVA Tenderness, Cloudy/Foul-smelling urine, Fever, chills, N/V, Malaise; geriatrics may be asymptomatic or with altered LOC.
6
Q
Diagnostic Tests for UTI’s?
A
Urine specimen, C&S, Imaging Studies (IVP, Cystoscopy, Ultrasound).
7
Q
Name three common antibiotics used for UTI’s.
A
Sulfonamides (Bactrim, Septra, Macrobid).
8
Q
What are three things you need to remember about taking antibiotics?
A
Decrease effectiveness of oral birth control, photosensitivity, yeast infections (if on them for a while).
9
Q
What is a urinary analgesic commonly used for UTI’s?
A
Pyridium (phenazopyridine hydrochloride)
10
Q
What is a side effect of Pyridium that you need to warn patients about?
A
Turns urine orange/red color.
11
Q
Name some bladder irritants.
A
Caffeine, tomatoes, chocolate, alcohol.
12
Q
What are two things you can take/drink when you have a UTI?
A
Sugar-free Cranberry Juice, Ascorbic Acid (Vitamin C).
13
Q
How much should you increase your fluid intake when you have a UTI?
A
15 mL per pound per day.
14
Q
What are some complications that cause UTI’s or follow UTI’s?
A
Overgrowth of bacteria (ie yeast), Urolithiasis, Pyelonephritis, & CAUTI (catheter associated urinary tract infections).
15
Q
Urolithiasis=? Nephrolithiasis=?
A
Urinary calculi (stones) in the urinary system; Ones primarily in the kidney = Nephrolithiasis
16
Q
What are some dietary items that can cause urinary calculi (stones)?
A
High intake of cereal, tea, instant coffee, tomatoes, cola
17
Q
Clinical manifestations of Urinary Calculi (kidney stones)?
A
Severe, intermittent pain (occurs when the stone is moving)–renal colic or ureteral colic (renal originates in lumbar region & radiates around the side and down toward testicle in male or bladder in female; Ureteral radiates toward the genitalia and thigh); N/V from pain; CVA tenderness; Tachycardia & HTN; Sometimes shock-like symptoms (clammy, pale, almost pass out, BP & HR down); Fever and elevated WBC due to inflammation.
18
Q
An IVP (intravenous pyelogram) is contraindicated in whom?
A
Those with kidney dysfunction because they can’t flush the dye out.
19
Q
What labs are important to monitor in someone with a UTI?
A
BUN and Creatinine (Creatinine being more important. May need to worry at a level of 1.5-2.0)
20
Q
What is Ditropan (oxybutynin chloride)?
A
Anticholinergic & GU antispasmodic that can be used to help with overactive bladder, postoperative pain related to an indwelling catheter - radical prostatectomy
21
Q
What diuretics can be used with kidney stones?
A
Thiazide (HCTZ0; decrease calcium load in urine.
22
Q
What can be used for a calcium oxalate kidney stone?
A
Vitamin B6 will decrease the amount of calcium in the urine.
23
Q
What is a medicine used for Gout?
A
Allopurinol.
24
How does the nurse handle suprapubic/urethral catheters?
It is a very sterile technique that the doctor uses; need to monitor positioning of catheters (twisting, kinking, dislodgement), May need to irrigate them but it has to be ordered by an MD!! (will be a very small amount of fluid); Usually don't do much with urethral catheters except monitor the site and Urine output
25
What is a Lithotripsy?
Procedure using a laser or shockwaves to loosen or remove impacted kidney stones
26
What should you worry about with the patient after a Lithotripsy?
Patient will be in pain and can have flank bruising.
27
How long will it take after a Lithotripsy for the stone fragments to pass?
May take up to 3 months.
28
May need open surgical removal of a kidney stone if it is bigger than ____
4-5 mm
29
Etiology/Risk Factors of Bladder Cancer:
Cigarette Smoking!, Industrial chemical exposure (dyes used in rubber and cable industry), Catheters, recurrent stones, Artificial sweeteners?, coffee?, low fluid intake
30
What is the classic sign of bladder cancer?
Painless hematuria
31
What are the clinical manifestations of bladder cancer?
PAINLESS HEMATURIA = classic sign; dysuria, frequency, urgency, most tumors are superficial.
32
What should you have the patient do when they are getting intravesical therapy?
Have them move side-to-side every 15-30 mins.
33
What are three types of Urinary Diversion?
Ileal Conduit (most common); Continent Pouch (Indiana Pouch); Neobladder
34
With which type of Urinary Diversion type do you have to wear a bag?
Ileal Conduit
35
What are some disadvantages and possible complications with the Ileal Conduit?
Have to wear bag, skin irritation, peritonitis (s/s=distention, fever, chills, pain!, abdominal guarding)
36
What do you have to teach your patients with the Indiana Pouch?
They will have to learn to self-cath the nipple valve when they feel fullness in their abdomen. May take a few weeks to control continence.
37
What is the advantage of having a Neobladder?
You can still pee thru your urethra. Just have to "bear down" to do it.
38
After a person has Urinary Diversion, when should you report a low amount of urine?
<5.0 mL/kg/hr or no output for 15 minutes
39
What are some side effects of Ditropan (anticholinergic)?
Dry mouth/eyes, Increased BP/HR
40
What are some clinical manifestations of Pyelonephritis?
CVA Tenderness, Acute distress, fever, chills, nausea, dysuria, frequency, urgency, hematuria, foul-smelling urine, WBC's in urine
41
What type of drugs will be given for Acute Pyelonephritis?
Antibiotics (possibly IV), Pyridium (urinary analgesic)
42
What are you concerned about if pyelonephritis becomes chronic?
HTN, renal failure, fluid volume excess/decreased urine output, electrolyte imbalances
43
Clinical manifestations of Glomerulonephritis:
Hematuria, proteinuria, low serum albumin, edema, fever, chills, n/v, ascites, HTN, abdominal or flank pain, Oliguria or anuria
44
What are some ways to manage Glomerulonephritis?
Plasmapheresis (to remove antibodies from blood), steroids, anti-rejection meds, antibiotics if infection present, low-to-moderate protein and high calories, daily weights, Manage HTN, rest!
45
Risk factors for BPH:
Risk factors not well defined; Increasing age; Smoking/ETOH; cirrhosis; Obesity; family history (asian americans have a LOWER risk)
46
What food ingredient may possibly have a role in reducing prostate problems?
Lycopene (red-colored fruits and veggies--tomatoes, watermelon, etc).
47
Clinical Manifestations of BPH:
Nocturia, frequency, decreased force of stream, difficulty starting stream, hematuria, bladder diverticuli (which can rupture), urine may dribble.
48
A PSA over __ may be significant.
2.0
49
What are some meds given for BPH?
Alpha-adrenergic blockers (Cardura, Flomax); Proscar; Avodart
50
When should you take the alpha-adrenergic blockers (ie Cardura, Flomax)?
At nighttime because they may make you lethargic or dizzy.
51
Which BPH drugs may cause sexual dysfunction (dec. libido, abnormal ejaculation, etc)?
Proscar, Avodart, Flomax.
52
What is an herbal therapy that may help with BPH? How should you take it?
Saw palmetto; with food because it may cause n/v
53
What is the most common type of surgery for BPH?
TURP (Transurethral resection of Prostate)
54
At what age is TURP usually performed?
Not usually til later in life because it usually has to be redone in about 5 years.
55
What meds may be given after a TURP?
Anticholinergics/Antispasmodics; stool softener; narcotic analgesics; B&O suppository
56
Etiology/Risk Factors for Prostate Cancer?
Age (2/3 after age 65); Race (most common in AA's); Family hx; diet high in red meat/fat dairy products
57
Clinical Manifestations of Prostate Cancer:
Similar to BPH; feels fixed, hard, enlarged, asymmetrical
58
What are the recommendations for getting a DRE and testing PSA?
*DRE annually after 50
*PSA “regularly” between 50-70 (want <2.6)
–Beginning at age 40 for Af. Amer. & other high risk men
–New recommendations based on initial PSA levels
*PSA < 1 retest every 5 years, PSA=1-2 (undergo annual testing)
59
Which prostate surgery has the greater chance for ED (erectile dysfunction) and bowel incontinence?
Perineal approach.
60
Which prostate surgery approach has a lesser chance of causing ED?
Retropubic approach.
61
What do you need to worry about after prostate surgeries?
Incontinence (30% wear pads for 5 years post-op), Impotence, Lymphedema, Pain in shoulder/not breathe as deeply because of CO2 from surgery spreading up thru body--worry about atelectasis and pneumonia
62
What is the type of radiation where they put radioactive seeds into the prostate?
Brachytherapy
63
After Brachytherapy, how long does the man have to wait to have sex, have kids on his lap, etc?
1-2 months.
64
What is a med used for advanced prostate cancer (won't cure it--palliative)?
Lupron
65
What are three side effects of Lupron?
Hot flashes, ED, decreased libido
66
Pre-Diabetes is diagnosed with an impaired fasting glucose of ___ after 8 hours NPO.
100-125
67
An impaired OGTT (Oral Glucose Tolerance Test) level after 2 hours is ______
140-199
68
Etiology/Risk Factors for Type 1 DM:
An inherited multigenic trait; viruses/stressors trigger an autoimmune process that destroys beta cells which causes ICA's (islet cell antibodies) to appear, increasing over months/years as beta cells are destroyed
69
Etiology and Risk factors for Type 2 DM:
Inc. risk in AA's, Nat. Americans, and His. Americans; CAD; Obesity; Heredity; Sedentary lifestyle; unhealthy diet; Polycystic Ovary Syndrome (often seen in obese women); had baby greater than 9 lb; Hyperlipidemia
70
Clinical Manifestations of Diabetes Mellitus:
Symptoms at Diagnosis of DM: Polyuria, Polydipsia, Polyphagia; Type 1's may lose weight; blurred vision; pruritis/skin infections/vaginitis; ketonuria; weakness & fatigue; dizziness; often asymptomatic
71
What is a desirable HbA1c level?
<7%
72
Things that can affect the HbA1c result?
bleeding disorders, Alcohol ingestion, uremia, heparin, pregnancy, asplenia (absence of spleen), high ASA doses
73
How often should HbA1c be tested?
twice a year in those under control (<7%); quarterly in those who haven't met goal.
74
Test that indicates the amount of endogenous insulin production =
C-Peptide level (Connecting Peptide)
75
Should test for ketonuria if the blood sugar is over ___
240
76
Urine should be tested in those with DM for ___ annually because it may detect progression of kidney disease.
Protein (proteinuria).
77
Who and when should you take Diabinese, Glucotrol, and/or Diabeta?
Type 2 diabetics; 1-2 times a day with meals.
78
When should you take Prandin (repaglinide)?
3 times a day, RIGHT BEFORE MEALS (10-15 mins before); it acts in the presence of food. Way to remember= Prandial means of or relating to meals (ie Post-prandial).
79
How often and when do you take Metformin (Glucophage)?
twice a day with meals.
80
What are two side effects of Metformin (Glucophage)?
GI upset & diarrhea
81
When is Metformin (Glucophage) contraindicated?
Renal disease; 2 days before and after IV contrast!
82
What do you need to monitor when someone is taking Avandia?
hepatotoxicity (monitor LFT's)
83
When should you take Precose?
with the first bite of the meal.
84
What is Precose contraindicated with?
Inflammatory Bowel Disease
85
What are some side effects of Precose?
abdominal bloating, discomfort, flatulence.
86
When do you give Byetta injection?
60 minutes before meal
87
Byetta has a risk of hypoglycemia if used with what?
sulfonylureas or metformin
88
Symlin should be taken with what?
CHO because it can cause n/v
89
When is Symlin contraindicated?
–h/o hypoglycemia, peds, pregnancy, gastroparesis
90
Name 3 rapid-acting insulins:
Humalog (insulin lispro) & Novolog (insulin aspart) (***remember: A log is floating down the rapids) & Apidra (**has rapid in it)
91
Name 3 regular insulins:
Humulin R, Novolin R, & ReliOn R (**remember=Regular people are short)
92
Name 5 Intermediate-acting insulins:
NPH: Humulin N, Novolin N, ReliOn N; Humulin L (Lente), Humulin 70/30 (70% NPH, 30% regular)
93
Name 3 long-acting insulins:
Humulin U (Ultralente) & Lantus (insluin glargine) & Levemir (**Levemir's lance is Ultra long)
94
Which insulins are cloudy?
Intermediate-acting (Humulin N (NPH), Humulin L (Lente), & Humulin 70/30).
95
What are the onsets of rapid-acting insulin?
15 min
96
What is the peak of Rapid-acting insulin?
60-90 min
97
What is the duration of rapid-acting?
3-4
98
What is the onset of short-acting insulin?
30-1hr
99
What is the peak of short-acting?
2-3 hours
100
What is the duration of short-acting insulin?
3-6hr
101
What is the onset, peak, and duration of Intermediate-acting insulin?
Humulin N & L, Novolin N, ReliOn N: Onset=2-4; Peak=4-10; Duration=10-16; Humulin 70/30: Onset=30-1hr; Peak=Dual; Duration=10-16hr
102
What is the onset, peak, and duration of Humulin U?
Onset=6-10 hr; Peak= None; Duration=18-20hr
103
What is the onset, peak, and duration of Lantus (insulin glargine) & Levemir (detemir)?
Onset=1-2 hr; Peak=None; Duration=24 hours
104
When should you give rapid-acting insulin?
when food is going to be there asap.
105
When should you give short-acting insulin?
30 mins before meal.
106
How do you draw up cloudy and clear insulin?
Inject air into cloudy, then air into clear, then draw up clear, then draw up cloudy. (**Clear to cloudy-alphabetical order)
107
When is the time of administration for Intermediate-acting insulin?
within 30 minutes
108
When is the patient most susceptible for a hypoglycemic reaction?
During the peak of the insulin
109
When do you usually give long-acting insulins?
around bedtime
110
What are two important things to remember about long-acting insulins?
don't mix with other insulins; expiration date is only 14 days.
111
What is the expiration date for most insulins (minus long-acting)?
30 days; long-acting is about 14 days
112
Do you need to refrigerate insulin?
Actually no, even though it often is. It is actually more absorbable when room temp. It just can't be exposed to extreme heat/cold.
113
What would the ABG values look like during DKA (Diabetic Ketoacidosis)?
They would all be low.
114
Clinical Manifestations of DKA (Diabetic Ketoacidosis)?
Dehydration, polydipsia, polyuria, warm/dry skin, anorexia/n/v, Electrolyte imbalances (labs would look hyperkalemic because K+ moved out of cell and into bloodstream), Fruity odor of breath, Kussmaul's respirations, hypotension, tachycardia, ketonuria, decreased LOC, abnormal ABG, somnolence, thirst, visual disturbances, weakness, weight loss
115
What should you remember about giving IV Potassium?
NEVER PUSH IT!!!; will be diluted; can burn patient if given peripherally (may give slowly, have lidocaine around area, or may need PICC line)
116
During DKA, once the BS gets back down to around 250, you may start to infuse ____ so they don't bottom out.
D5W
117
If someone with DM is sick, what should they do?
```
•Call health care provider if:
–Fever for 2 days, not getting better
–Vomiting or diarrhea for >6 hours
–Large amount of ketones in urine
–BS >240 – if on insulin or pills
–Symptoms of DKA or dehydration
•Prevent DKA
–Monitor BS & ketonuria
–Don’t stop insulin even if not eating – why?
–10-15 Gm. CHO Q 1-2H & fluids Q 30minutes
```
118
A variant of DKA, but in Type 2 diabetics =
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
119
Clinical Manifestations of HHNS?
```
–Severe hyperglycemia
–Osmotic diuresis
–Severe dehydration
–Hyperosmolality
•Increased BUN
```
120
S/S of hypoglycemia:
•Adrenergic (autonomic)
–Shaky, irritable, nervous, tachycardic, hungry, diaphoretic, pale, paresthesias ** Can self-treat
•Neuroglycopenic (< glucose to brain!!)
–H/A, confusion, lethargy, slurred speech, coma, seizure, death
121
How do you manage hypoglycemia?
•Mild (defined by symptoms, not by BS): will ask what foods to give on test (not exact amounts)
–15-20 Gm. CHO
•4 -6 oz. juice OR 4 tsp. sugar – not both!
•8 oz. low fat milk
•4-6 oz. regular soda
–Recheck in 15-30 minutes & retreat if BS <100
•Moderate
–needs 20-30 Gm CHO or Glucagon 1mg. SQ or IM
–Glucagon (be aware of adverse effect): can cause n/v (risk for aspiration because they were passed out before)--put them on side!
•Severe
–Unresponsiveness
–D50W (25 Gm) IV push fast, or Glucagon 1 mg. IV or IM
122
```
• Which of the following is the most common reported symptom of hypoglycemia?
A. Anorexia
B. Kussmaul’s respirations
C. Bradycardia
D. Nervousness
```
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