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NURS351-Pathophysiology I > Module 10 - Start of Final Exam > Flashcards

Module 10 - Start of Final Exam Flashcards

1
Q

Renal

A

Kidney

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2
Q

Retroperitoneal

A

location of the kidneys behind the peritoneal area

Because the kidneys are outside the peritoneal sac, peritoneal cancer does not spread as easily to them

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3
Q

Ureters can do ___ movement

A

Peristalsis

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4
Q

Urine leaves in ___

A

drips (not a flow)

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5
Q

Detrusor Muscle

A

Muscle of the bladder that can stretch for holding more urine or constrict/hang on to urine during a fight or flight response until a stressor is resolved

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6
Q

CV Angle

A

costovertebral angle

90 degree angle below the 12th rib that is over each kidney

tenderness ion this area can infer that there is a kidney infection ocurring

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7
Q

Where are the kidneys located?

A

Attached to the ab wall at the level of the last thoracic and first three lumbar vertebrae

it is enclosed in a renal capsule in this retroperitoneal area

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8
Q

Renal Cortex

A

Outer layer of the renal capsule

It has cortical nephrons

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9
Q

Renal Medulla

A

Middle part of the kidney surrounded by the renal cortex

Has medullary nephrons

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10
Q

Parenchymal Tissue of the Kidneys

A

Nephrons

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11
Q

Cortical Nephrons

A

Shorter nephrons not penetrating the kidneys as deeply

part of the renal cortex

less concentrating power on filtrate than the medullary nephrons

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12
Q

Medullary Nephrons

A

Nephrons going deeper into the kidney with stronger concentrating power on filtrate than the cortical nephrons

Consequently, if these nephrons are damaged there will be more H ion, water, electrolyte loss than if the cortical ones were damaged

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13
Q

Functions of the Kidneys

A

Maintain blood homeostasis

Excrete body metabolism end products

Control fluid and electrolyte balance

Excrete bacterial toxins, water soluble drugs, and drug metabolites

Secrete Renin and erythropoietin

Play a role in the function of the parathyroid hormones and vitamin D

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14
Q

Low flow states to the kidney causes …

A

renin secretion

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15
Q

Angiotensin II is a potent…

A

vasoconstrictor (increasing preload and afterload as a result)

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16
Q

What part of the kidney does aldosterone work on?

A

the distal convoluted tubule to control sodium (which water then follows)

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17
Q

Nephron

A

Parenchymal functional renal unit

Made up of glomerulus and tubules

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18
Q

The filtering system of the kidneys

A

Nephrons

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19
Q

What determines the amount of filtering done in the nephrons?

A

The amount of pressure coming into the system (increase = increase)

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20
Q

Proximal Convoluted Tubule

A

part of the nephron

Afferent and Efferent flow - arterial/pressure associated in nature

Mechanisms of flow here help the glomerulus do filtering while reclaiming things like water and glucose

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21
Q

Should there be glucose in urine?

A

No, not normally

Diabetic ketoacidosis and other issues can lead to this being in the urine

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22
Q

Loop of Henle

A

Concentrating mechanism of the nephron

Has differential permeability to urea in water

One of the more fragile parts of the nephron

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23
Q

Nocturia

A

Nocturnal voiding without reason for it

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24
Q

Isosthenuria

A

isotonic urine where urine has the same tenacity as blood

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25
Q

If there is an insult to the nephron, which area is most likely to go and lead to loss of concentrating ability?

A

the loop of henle

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26
Q

Concentrating Mechanism of the Nephron

A

Loop of Henle

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27
Q

Distal Convoluted Tubule

A

Area of the nephron where aldosterone acts to retain sodium and water (passively)

This is an area where more fine tuning is done in exchanging of things

Acid Base of Electrolyte Balance has its fine tuning done here

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28
Q

Vasa Recta

A

blood supply along the loop of Henle

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29
Q

Venous flow from the nephrons go to …

A

the Renal Vein

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30
Q

Collecting Duct

A

part of the nephron where ADH works - posterior pituitary with high blood osmolarity causes ADH release, which waters down the blood. The collecting duct will be worked on to prevent water from leaving the body and the ADH controls the water not the sodium

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31
Q

What glands sit on top of the kidneys

A

The Adrenal Glands

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32
Q

Glomerulus

A

In the nephron

Filtering part of the nephron

Encased in a bowmans capsule

Filters fluid, glucose, and tiny things - not large things like plasma proteins and RBC

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33
Q

If there is RBC or Plasma Proteins in the urine what might this give a picture of?

A

Inflammation because the glomerulus cells must be inflamed/enlarged and spread out enough to allow outflow

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34
Q

Post Streptococcal Glomerulonephritis

A

Inflammation in the glomerulus because of a strep infection, which leads to RBC and plasma proteins in the urine that should not be there

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35
Q

Tubules

A

Proximal, Distal, and Henle’s Loops areas of the kidney

Fluid is converted into urine at the tubules –> Urine moves to the Kidney Pelvis –> Urine flows from kidney pelvis to ureter –> Bladder –> Void

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36
Q

Filtrate

A

fluid , before conversion to urine by the tubules

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37
Q

Order of tubule filtration movement?

A

Renal Corpuscle –> Proximal Tubule – Loop of Henle –> Distal Tubule –> Collecting Duct

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38
Q

Urine Production

A

Fluid flows through the proximal tubules which leads to water and solute reabsorption

Whatever is not reabsorbed becomes urine and the process of selective reabsorption determines the amount of water and solutes to be secreted each time

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39
Q

Prostate Gland

A

Not a renal part, but has an effect on it in males

Surrounds the male urethra

Has a duct that opens into the prostatic portion of the urethra and secretes the alkaline part of seminal fluid

Enlarges with age and can put pressure on the urethra which can cause issues with voiding and thus increased UTI chance

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40
Q

Secretion

A

moving something from one place to another but it stays in the body

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41
Q

Excretion

A

moving something from one place to another but it leaves the body

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42
Q

The kidneys __ what we need and ___ what we dont

A

keep what we need and void what we dont

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43
Q

Risk Factors for Renal Disorder

A

Frequent UTI

High Na Diet

Contact Sports

Trauma and Injury

History of HTN

Family History of Renal Disease

Medication Use

Associated Medical Conditions like Diabetes

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44
Q

Why can frequent UTIs cause renal disorders

A

they can cause scarring

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45
Q

How can high Na diets lead to renal disorders

A

the kidneys have to do more fine tuning to get rid of all the salt we do not need

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46
Q

Renal disorders can occur when there is injury/trauma to the ….

A

flank area

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47
Q

How can HTN lead to renal disorderss

A

HTN, CAD, stroke, etc - HTN effects the whole body and since the flow state is important in this system, HTN can be a deterrent to glomerular filtration

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48
Q

How can medicines cause renal disorders

A

Things like chemotherapy drugs can be nephrotoxic

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49
Q

BUN Renal Function Test

A

Blood urea Nitrogen (mg/dL)

Measures how much nitrogen is coming from urea, and urea is a waste product of the liver when proteins are broken down

Decreased solvent in blood will increase BUN (decreases in water) SO THIS IS USED TO MEASURE DEHYDRATION

  • not a good measure of kidney function on its own
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50
Q

Serum Creatinine Renal Function Tests

A

Serum Creatinine is waste products of the muscle (mg/dL)

a MUCH better indicator of renal function than BUN

Measures the creatinine content in serum (blood) and urine, and creatinine should not be reabsorbed so it SHOULD BE IN THE URINE

If there is high blood value, then filtering is not working

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51
Q

Creatinine Clearance Renal Function Tests

A

This is the amount of blood cleaned of creatinine by the kidneys (mL/min)

This value will greatly increase as kidney glomerulus filtration ability decreasesw

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52
Q

Uric Acid Serum and Uric Acid Urine Renal Function Tests

A

Waste product of purine breakdown seen in blood and urine (mg/dL for serum and mg/24 hours for urine)

Most uric acid is dissolved and secreted by the kidney, but it can buildup and cause gout, so it should be in urine

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53
Q

Both creatinine and uric acid test are done …

A

over 24 hours to check the urine

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54
Q

Uric acid buildup can lead to ….

A

gout

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55
Q

Purines are found in what foods?

A

Beer

Liver

Beans

Anchovies

Peas

(So eating more of these can lead to higher uric acid levels)

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56
Q

Urinalysis

A

the main way to test for renal system function and look for renal disease progression/existence

ex: Used when suspected UTI

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57
Q

What could cause false positive blood in the urinalyses?

A

menstruation

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58
Q

Implementation of Urinalsysi

A

Wash the perineal area

Use a clean container

Obtain 10-15 mL of first morning sample

  • Refrigerated samples may alter specific gravity
  • If menstruating, indicate so on lab form
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59
Q

2 Main Components of urinalysis

A

Physical Examination

Chemical Examination

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60
Q

Physical Examination of Urinalysis involves…

A

Color
Clarity
Specific Gravity

*water has a sg of 1, dilute urine is 1.002 and higher levels mean more dehydration (range is 1 to 1.030)

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61
Q

Chemical Examination of Urinalysis involves…

A 
Urine pH
Proteins
Glucose
Ketones
Blood 
Bilirubin
Urobilinogen
WBCs
Nitrites
Leukocyte Esterase
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62
Q

pH of urine should be…

A

slightly acidic (4 to 6) since more alkaline urine increases rate of infection

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63
Q

If there is proteins, RBC, or glucose in urine what might it indicate?

A

Inflammation or High Blood Sugar

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64
Q

Ketone Presence in urine

A

Byproduct of fat metabolism that builds up in urine

Usually abnormal unless they are doing the Atkins Diet which WANTS ketotic urine

High ketones could indicate diabetic ketoacidosis

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65
Q

Bilirubin Presence in urine

A

Byproduct of RBC breakdown after 120 days and needs to be conjugated by the liver to be in the urine

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66
Q

Urobilinogen

A

Byproduct of conjugation of the bilirubin

Half of all of it should be excreted by the kidneys

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67
Q

What does WBC in urine indicate?

A

infection

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68
Q

Nitrite Presence in Urine

A

Indicates bacterial infection since the bacteria may have an enzyme that converts nitrates to nitrites

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69
Q

Leukocyte Esterase presence in urine

A

Enzyme secreted by WBC

Is a value that can help detect WBC in urine

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70
Q

Specific Gravity

A

A urine test that measures the specific gravity of the urine - which is the weight of urine in comparison to distilled water (1)

It evaluates concentrating and excretory abilities of the kidneys and hydration status

Essentially, measures amount of solutes in the fluid and a thicker fluid has a higher osmolarity and gravity

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71
Q

High Specific Gravity Indicates…

A

Concentrated Urine (Dehydration)

72
Q

Low Specific Gravity Indicates…

A

Dilute Urine (Overhydration)

73
Q

Diabetes Insipidus may do what to urine specific gravity?

A

Have too much water (low gravity) due to not enough ADH

74
Q

Syndrome of Inappropriate ADH may do what to urine specific gravity?

A

Too much ADH pulls more water into the body causing things like bounding pulses and concentrated urine (higher gravity)

75
Q

Application of Specific Gravity in Practice

A

Chronic Renal Disease are Assoc. with low specific gravity of urine

Knowledge of specific gravity helps in the interpretation of a urinalysis

76
Q

Urine C & S (Culture and Sensitivity) Test

A

A urine test that identifies the presence of microorganisms and determines the specific antibiotics that will appropriately treat the existing microorganism

77
Q

Implementation of urine c & S Test

A

Clean perineal area and urinary meatus with bacteriostatic solution

collect a midstream sample in a sterile container

Send specimen to lab immediately

ID any sources of potential contaminants during collection like hands, skin, clothing, hair, vaginal secretion, rectal secretions

78
Q

Urine from clients who force fluids may be …

A

too dilute to provide a positive culture

79
Q

When on antibiotics, what is more likely to occur ?

A

Vaginal yeast infections and diarrhea since both good and bad bacteria are killed via their cell walls

80
Q

What is the creatinine clearance test?

A

A blood and timed urine specimen that evaluates kidney function

Blood is drawn at the start of the test and the morning of the day the 24 hour specimen collection is completed - compares how much was in the blood versus what was collected

81
Q

Urine for a C&S test should be taken from ___ rather than ___

A

Folly Tubing rather than the bag

82
Q

The best estimation of glomerular filtration rate comes from which test…

A

The creatinine clearance test (tells us how well the kidney is working!)

83
Q

Creatinine test on ice…

A

aint it nice!

84
Q

If any dumping occurs during a 24 hour test…

A

the test is void and must be restarted

85
Q

Implementation of the Creatinine Clearance Test

A

Encourage adequate fluids before and during

Instruct client as prescribed to avoid TEA, COFFEE, MEDICATIONS during testing

If the client is taking ACTH, CORTISONE, or THYROXINE, check with the physician regarding administration of these during testing

Maintain the urine specimen on ice or refrigerate and check with the lab in regard to adding a preservative

86
Q

Creatinine Clearance

A

How much creatinine is filtered through the glomerulus

It goes through all the tubules and collecting ducts, and the filtrate moves into urine and it is at that point when none of it can be reclaimed anymore

87
Q

VMA Test

A

Vanillylmandelic Acid Test

A 24 hour urine collection to diagnose pheochromocytoma, a tumor of the adrenal gland –> this can cause constant fight or flight / NEP and EP release

ID’s an assay of urinary catecholamines in the urine ()should be 2-7 mg/24 hours in people 15+)

88
Q

Implementation of the VMA Test

A

Avoid: Cocoa, Caffeine, Vanilla, Cheese, Gelatin, Licorice and Fruits for 2 days prior to start, during collection, and avoid medications for 2-3 days prior to start

Avoid stress

Maintain adequate food and fluids during test

89
Q

Uric Acid Test

A

a 24 hour urine collection to diagnose gout and kidney disease

90
Q

Uric Acid and Gout

A

can precipitate out into crystals in joint leading to pain (usually in the feet due to the coolness) and inflammation (gout)

91
Q

Implementation of the Uric Acid Test

A

encourage fluids and a regular diet during testing

place specimen on ice/refrigerate, and check with the lab regarding adding a preservative

92
Q

Renal Biopsy

A

invasive needle procedure for when renal cancer is suspected to take some renal tissue

Looks for dysplasia and cell development

93
Q

KUB Test

A

Kidneys, Ureters, and Bladder Test

An x ray film that views the urinary system and adjacent structures

Used to detect urinary calculi

This exposes people to ionizing radiation, so some people - like pregnant women - cannot do it

CT Scan is a better picture but this is still used

94
Q

Implementation of KUB Test

A

There is no specific preparation for this test since it is an x ray

95
Q

IVP Test

A

Intravenous Pyelogram

Injection of radiopaque dye outlines the renal system

Performed to ID abnormalities in the system

96
Q

Important Education for the IVP Test

A

Informed consent

Asses client for seafood, iodine, radiopaque dye allergies

Inform client about possible throat irritation, flushing of face, warmth, salty taste that could be experienced, but is not harmful

97
Q

Renal Angiography

A

An injection of a radiopaque dye through a catheter for examination of the renal arterial supply

Looks for renal artery stenosis, which is hard and small lumens of arterial supply leading to increased BP and can damage nephrons

98
Q

Implementation of Renal Angiography

A

Need to know about allergies to iodine, seafood, and radiopaque dyes

Dye may cause burning feelings or feelings of heat along the vessel after injection

Need to assess and mark peripheral pulses

can cause a lot of bleeding since it is a femoral artery poke with a catheter

99
Q

Renal Scan

A

An IV injection of a radioisotope for visual imaging of renal blood flow (can see all veins, capillaries, arteries, etc)

100
Q

Implementation of the Renal Scan

A

Assess for allergies to dye

Instruct clients that they will be required to remain motionless

Instruct client that imaging may be repeated at various intervals before the test is done

Radioactive material will clear in 24 hours

101
Q

What is important to keep in mind for urinary incontinence on linens following a renal scan or other radiopaque dye test?

A

Linens and soiled items must be double bagged since the dye is radioactive

102
Q

CT Scan (Renal)

A

Computed tomography

Better than a KUB test to see structure

Can visualize kidney tumors

103
Q

Voiding Cystourethrogram

A

Foley Catheter injects dye into the bladder and the flow of urine is watched to make sure there is no urinary reflux back into the kidney leading to infection or nephron edamage

Looks also at how well the bladder empties

104
Q

Cystitis

A

Inflammation of the bladder from infection or obstruction of the urethra

commonly used as a term with UTI

105
Q

Urinary Tract Infection (UTI)

A

Inflammation of anywhere from the urethra to the bladder

106
Q

Most common causative organisms for Cystitis/UTI

A

E Coli
Enterobacter
Pseudomonas
Serratia

107
Q

In what gender is UTI more common and why

A

Women because of a shorter urethra and location of the urethra near the rectum

108
Q

Who is most vulnerable to cystitis?

A

Sexually active and pregnant women

109
Q

Causes of cystitis

A

Hormonal Changes influencing alterations in vaginal flora

Loss of bactericidal properties of prostatic secretions in men

Sexual intercourse

poor fitting diaphragms

Use of spermicides

Synthetic underwear and pantyhose

Wet bathing suits

Allergens or irritants: Soap, sprays, bubble baths, perfumed sanitary napkins

Invasive urinary tract procedures

Bladder distention

urinary stasis

calculus

110
Q

Calculus/Calculi

A

stones

111
Q

Why is good catheter technique very important for hospitals to avoid UTIs?

A

Compensation from medicare will not occur when a catheter UTI occurs

112
Q

Prevention of Cystitis

A

Teach females good perineal care and to wipe front to back

Instruct client to avoid bubble baths, tub baths, and vaginal deodorants

Instruct voiding every 2 to 3 hours

Instruct voiding and drinking a glass of water after intercourse

Instruct females to wear cotton pants and avoid wearing pantyhose with slacks, tight clothes, and sitting around in a wet bathing suit

teach pregnant women to void every 2 hours

Encourage menopausal women to use estrogen vaginal creams to restore pH

Instruct women to use water soluble lubricants for coitus, especially after menopause

113
Q

Urosepsis

A

Gram negative bacteremia originating in the urinary tract

The bacteria make toxins that cause illness and are highly resistant/virulent

114
Q

Most common organism responsible for urosepsis is ..

A

E Coli

115
Q

Most common cause of urosepsis is …

A

presence of indwelling catheter or an untreated UTI in a client who is medically compromised

116
Q

The major problem of urosepsis is …

A

the ability of this bacterium to develop resistant strains

117
Q

Urosepsis can lead to ..

A

septic shock and a high mortality rate when not treated aggressively

118
Q

The most common and earliest manifestation of urosepsis?

A

Fever (but it does not diagnose this, it just is an indicator)

119
Q

Management of urosepsis includes what?

A

Urine C&S

IV Antibiotics until client is afebrile for 3-5 days, and then oral antibiotics

120
Q

Urethritis

A

An inflammation of the urethra commonly associated with STD, but may also be seen with cystitis

(Urethra Inflammation)

121
Q

Urethritis in men is most commonly due to …

A

gonorrhea and chlamydial infection

122
Q

Urethritis in women is most commonly due to ..

A

feminine hygiene sprays, perfumed toilet paper, sanitary napkins, spermicidal jellies, UTIs, changes in vaginal mucosal lining

123
Q

When inspecting/diagnosing the renal system always look …

A

UP (move from urethra toward the kidneys up)

124
Q

Signs and Symptoms of Urethritis in Men

A 
Burning on urination
Frequency
Urgency
Nocturia
Difficulty Voiding
Penis Discharge
125
Q

Signs and Symptoms of Urethritis in Women

A 
Frequency
Urgency
Nocturia
Painful urination
Difficulty Voiding
Lower Abdominal Discomfort
126
Q

Ways to treat urethritis?

A

Encourage fluids

STI testing

Avoiding intercourse until treatment is complete

Taking all antibiotics

Avoiding bad hygiene supplies

127
Q

Ureteritis

A

Inflammation of the ureter that is commonly associated with pyelonephritis

Chronic pyelonephritis causes the ureter to become fibrotic and narrowed by strictures

can cause urinary backup

128
Q

Pyelonephritis

A

an inflammation of the renal pelvis and the parenchyma (nephrons), commonly caused by bacterial invasion of E COLI

can cause urinary backup

129
Q

When does Acute Pyelonephritis occur…

A

most often after bacterial contamination of the urethra or following an invasive procedure of the urinary tract

130
Q

When does Chronic Pyelonephritis occur…

A

most commonly following chronic obstruction with reflux or other chronic disorders

131
Q

The most common bacterial causative organism of Pyelonephriotis?

A

E coli

132
Q

Acute Pyelonephritis

A

Usually a short course that recurs as a relapse of a previous infection or as a new infection

Can progress to bacteremia or chronic pyelonephritis

133
Q

S/S of Acute Pyelonephritis

A

Fevers and Chills

Nausea

Flank pain of affected side

CVA tenderness

headache

muscular pain

dysuria

frequency and urgency

cloudy, bloody, or foul smelling urine

increased WBC in the urine

134
Q

Chronic Pyelonephritis

A

A slow progressive disease that is usually associated with recurrent acute attacks

Causes contraction of the kidneys and dysfunction of the nephrons, which are replaced by scar tissue

particularly troublesome as it leads to loss of balance abilities or possible renal failure

135
Q

S/S of Pyelonephritis

A

Frequently diagnosed incidentally when a client is being evaluated for HTN

Poor urine concentrating ability

Pyuria

Azotemia

Proteinuria

Anemia

Acuidosis

136
Q

Azotemia

A

Higher creatinine/urea nitrogenous wastes

137
Q

Pyuria

A

pus in urine

138
Q

Proteinuria

A

Protein in urine

139
Q

Why does anemia occur with chronic pyelonephritis

A

Erythropoietin cannot be released

140
Q

Why does acidosis occur with chronic pyelonephritis

A

Kidneys may not be able to control acid base balance

141
Q

Nephrolithiasis

A

Kidney Stones in the minor or major calyces of the kidney

Lime stone like - causes excruciating pain, obstructs urine flow, and can cause secondary damage to kidney structures

142
Q

What are good tests for diagnosing urolithiasis/nephrolithiasis?

A

KUB, but its not good for soft tissues

IVp

CT Scan

Renal Ultrasonography

(These all can determine stone location)

143
Q

When looking at nephrolithiasis it is important to …

A

know what the stones are made of !

144
Q

Calculi or stones can form anywhere in the urinary tract, but the most frequent site is ..

A

the kidneys (ex: in ureter connection to kidney)

145
Q

Problems that can occur as a result of calculi?

A

pain

obstruction

tissue trauma with secondary hemorrhaging and infection

146
Q

It is very important to do when looking at uro/nephrolithiasis

A

Strain the urine and collect the stone for analysis to determine type and assist in determining treatment

147
Q

Urolithiasis refers to the formation of ____ stones, which are formed in the ____

A

urinary stones; ureter

148
Q

Nephrolithiasis refers to the formation of ___ stones, which are formed in the ___ ___

A

kidney; renal parenchyma

149
Q

Hydroureter

A

Ureter dilation when a calculus occludes it and blocks urine flow

150
Q

If calculus obstruction is not removed…

A

urinary stasis can result in infection, impairment of renal function on the side of the blockage, and resultant hydro nephrosis and irreversible kidney damage

151
Q

Causes of urolithiasis and nephrolithiasis

A

Family history

Diet high in calcium, vitD, milk, protein, oxalate, purines, or alkali

high intake of purine rich food

obstruction and unrinary stasis

dehydration

use of diuretics, which can cause volume depletion

UTIs and prolonged urinary catheterization

immobilization

Hypercalcemia and hyperparathyroidism

Elevated uric acid levels, like in gout

152
Q

S/S of Urolithiasis and Nephrolithiasis

A

Renal colic originates in lumbar region and radiates around the side and down toward the testicle in men and the the bladder in women

Ureteral colic radiates toward the genitalia and thigh

sharp, severe pain of sudden onset

Dull aching kidney(s)

Nausea and vomiting, pallor, diaphoresis during acute pain

Urinary frequency with alternating retention

Signs of UTI

low grade fever

RBC, WBC and bacteria in urinalysis

Hematuria

153
Q

Types/Compositions of Urolithiasis and nephrolithiasis stones

A

Calcium Oxalate Stones

Calcium Phosphate Stones

Struvite Stones

Uric Acid Stones

Cystine Stones

154
Q

Calcium Phosphate Stones

A

Eat less calcium and phosphate and excess vitD which will absorb calcium

Calcium stones are alkaline, so we need to acidify the urine to help

155
Q

Calcium Oxalate Stones

A

Supersaturation of urine with calcium and oxalate

Diet should be acid ash foods since calcium stones are alkaline

Decrease intakes of high calcium foods, and avoid oxalate foods

156
Q

Oxalate Rich Food Sources include…

A 
Tea
Almonds
Cashews
Chocolate
Cocoa
Beans
Spinach
rhubarb
157
Q

Struvite Stones

A

“Triple Phosphate” stones composed of magnesium and ammonium phosphate

Caused by UREA SPLITTING BACTZERIA

form in alkaline urine, so have an acid ash diet

Dietary prescription includes limiting high phosphate foods like dairy, red and organ meats, and whole grains to reduce phosphate content in urine

158
Q

Uric Acid Stones

A

Caused by excess dietary purine OR gout

Tend to form in acidic urine so have an alkaline ash diet

Decrease purine intake in foods like organ meats, gravies, red wines, and sardines

159
Q

Allopurinol (Zyloprim)

A

Medication that may be prescribed to lower uric acid levels

160
Q

Cysteine Stones

A

Caused by cystine crystal formation

tend to form in acidic urine, therefore alkaline ash diet

low intake of methionine, an essential AA that makes cysteine, and avoiding meat/milk/cheese/eggs is prescribed

Also, encourage 3L of fluid a day unless contraindicated to help dilute urine and prevent cysteine crystal formation

161
Q

Alkaline Forming Stones

A

Struvite Stones

Calcium Stones

162
Q

Acidic Forming Stones

A

Uric Acid Stones

Cysteine Stones

163
Q

Alkaline Ash Diet

A

Increases the pH to decrease acidity of urine

works against uric acid and cysteine stones

Ash means what is left

164
Q

Foods to include in the alkaline ash diet

A

Milk

Fruits, BUT NOT Cranberries Plums and Prunes

rhubarb

Most vegetables

Small amounts of beef, halibut, veal, trout, and salmon are allowed

165
Q

Acid Ash Diet

A

Decreased the pH to increase acidity of urine

Works against struvite and calcium stones

166
Q

Foods to include in acid ash diet

A 
Cheese
Eggs
Meat 
fish
Oysters
Poultry
Bread
Cereal
Whole Grains
Pastries
CPP and Tomatoes
Corn and Legumes
167
Q

Foods to avoid in acid ash diet

A 
Carbonated Beverages
Baking soda or power
all vegetables except corn and legumes
Olives
Pickles
Nuts other than peanuts
168
Q

CPP

A

Cranberries Prunes and Plumes

Triad of fruits for an acid ash diet, but not alkaline ash

169
Q

Cystoscopy

A

Surgical management method of kidney stones

For stones in bladder or lower ureter

no incision needed

1/2 ureteral catheters are inserted past the stone and it is manipulated, dislodged, and mechanically moved via the procedure where catheters mechanically guide it downward for removal

Catheters are left in place for 24 hours to drain the urine trapped proximal to the stone and to dilate the ureter

Continuous chem irrigation may be prescribed to dissolve the stone too

170
Q

ESWL

A

Extracorporeal Shock Wave Lithotriopsy

Noninvasive mechanical procedure for breaking up stones in the kidney or upper ureter so they can pass spontaneously or be removed by other methods

Fluoroscopy visualizes the stones

no incisions or drains

ultrasonic waves are delivered through a bath of warm water

Stones are passed in urine within a few days

171
Q

Percutaneous Lithotripsy

A

For stones in the bladder, ureter, or kidneys

Invasive

fluoroscopy guide inserted near the area of the stone, and an ultrasonic wave is then aimed at the stone ti break it up

Performed via cystoscopy or nephrostomy

No incision needed for cystoscopy, but a small flank incision is needed for nephrostomy

172
Q

Important considerations for a percutaneous lithotripsy?

A

Client may already have an indwelling catheter

Nephrostomy tube may be placed to administer chemical irrigations to break up the stone and may remain in place for 1-5 days

Encourage client to drink 3000-4000 mL of fluid per day following procedure

Monitor for an instruct client to monitor for complications of infection, hemorrhage, and extravasation of fluid into the retroperitoneal cavity

NEVER FLUSH THE NEPHROSTOMY TUBE AS PRESSURE CAN HARM THE NEPHRON

173
Q

Ureterolithotomy

A

Open surgical procedure if the stone is in the ureter and the lithotripsy is not effective

Incision into the ureter is made through a lower ab or flank incision to remove the stone

Client may have a penrose drain, ureteral stent catheter, and an indwelling bladder catheter

174
Q

Pyelolithotomny

A

flank incision into the kidney is made to remove stones from the renal pelvis

LARGE INCISION in flank area is needed

Client will have a penrose drain and an indwelling catheter

175
Q

Nephrolithotomy

A

Incision into the kidney to remove the stone from the renal calyx

LARGE INCISION in flank area is needed

client may have a nephrostomy tube and an indwelling catheter

176
Q

Partial or Total Nephrectomy

A

performed if there is extensive kidney damage, renal infection, or severe obstruction - and to prevent stone reoccurrence

surgical removal of kidney(s)

very extreme

NURS351-Pathophysiology I (11 decks)

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