Module 10 - Start of Final Exam Flashcards
Renal
Kidney
Retroperitoneal
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
Ureters can do ___ movement
Peristalsis
Urine leaves in ___
drips (not a flow)
Detrusor Muscle
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
CV Angle
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
Where are the kidneys located?
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
Renal Cortex
Outer layer of the renal capsule
It has cortical nephrons
Renal Medulla
Middle part of the kidney surrounded by the renal cortex
Has medullary nephrons
Parenchymal Tissue of the Kidneys
Nephrons
Cortical Nephrons
Shorter nephrons not penetrating the kidneys as deeply
part of the renal cortex
less concentrating power on filtrate than the medullary nephrons
Medullary Nephrons
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
Functions of the Kidneys
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
Low flow states to the kidney causes …
renin secretion
Angiotensin II is a potent…
vasoconstrictor (increasing preload and afterload as a result)
What part of the kidney does aldosterone work on?
the distal convoluted tubule to control sodium (which water then follows)
Nephron
Parenchymal functional renal unit
Made up of glomerulus and tubules
The filtering system of the kidneys
Nephrons
What determines the amount of filtering done in the nephrons?
The amount of pressure coming into the system (increase = increase)
Proximal Convoluted Tubule
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
Should there be glucose in urine?
No, not normally
Diabetic ketoacidosis and other issues can lead to this being in the urine
Loop of Henle
Concentrating mechanism of the nephron
Has differential permeability to urea in water
One of the more fragile parts of the nephron
Nocturia
Nocturnal voiding without reason for it
Isosthenuria
isotonic urine where urine has the same tenacity as blood
If there is an insult to the nephron, which area is most likely to go and lead to loss of concentrating ability?
the loop of henle
Concentrating Mechanism of the Nephron
Loop of Henle
Distal Convoluted Tubule
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
Vasa Recta
blood supply along the loop of Henle
Venous flow from the nephrons go to …
the Renal Vein
Collecting Duct
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
What glands sit on top of the kidneys
The Adrenal Glands
Glomerulus
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
If there is RBC or Plasma Proteins in the urine what might this give a picture of?
Inflammation because the glomerulus cells must be inflamed/enlarged and spread out enough to allow outflow
Post Streptococcal Glomerulonephritis
Inflammation in the glomerulus because of a strep infection, which leads to RBC and plasma proteins in the urine that should not be there
Tubules
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
Filtrate
fluid , before conversion to urine by the tubules
Order of tubule filtration movement?
Renal Corpuscle –> Proximal Tubule – Loop of Henle –> Distal Tubule –> Collecting Duct
Urine Production
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
Prostate Gland
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
Secretion
moving something from one place to another but it stays in the body
Excretion
moving something from one place to another but it leaves the body
The kidneys __ what we need and ___ what we dont
keep what we need and void what we dont
Risk Factors for Renal Disorder
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
Why can frequent UTIs cause renal disorders
they can cause scarring
How can high Na diets lead to renal disorders
the kidneys have to do more fine tuning to get rid of all the salt we do not need
Renal disorders can occur when there is injury/trauma to the ….
flank area
How can HTN lead to renal disorderss
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
How can medicines cause renal disorders
Things like chemotherapy drugs can be nephrotoxic
BUN Renal Function Test
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
Serum Creatinine Renal Function Tests
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
Creatinine Clearance Renal Function Tests
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
Uric Acid Serum and Uric Acid Urine Renal Function Tests
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
Both creatinine and uric acid test are done …
over 24 hours to check the urine
Uric acid buildup can lead to ….
gout
Purines are found in what foods?
Beer
Liver
Beans
Anchovies
Peas
(So eating more of these can lead to higher uric acid levels)
Urinalysis
the main way to test for renal system function and look for renal disease progression/existence
ex: Used when suspected UTI
What could cause false positive blood in the urinalyses?
menstruation
Implementation of Urinalsysi
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
2 Main Components of urinalysis
Physical Examination
Chemical Examination
Physical Examination of Urinalysis involves…
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)
Chemical Examination of Urinalysis involves…
Urine pH Proteins Glucose Ketones Blood Bilirubin Urobilinogen WBCs Nitrites Leukocyte Esterase
pH of urine should be…
slightly acidic (4 to 6) since more alkaline urine increases rate of infection
If there is proteins, RBC, or glucose in urine what might it indicate?
Inflammation or High Blood Sugar
Ketone Presence in urine
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
Bilirubin Presence in urine
Byproduct of RBC breakdown after 120 days and needs to be conjugated by the liver to be in the urine
Urobilinogen
Byproduct of conjugation of the bilirubin
Half of all of it should be excreted by the kidneys
What does WBC in urine indicate?
infection
Nitrite Presence in Urine
Indicates bacterial infection since the bacteria may have an enzyme that converts nitrates to nitrites
Leukocyte Esterase presence in urine
Enzyme secreted by WBC
Is a value that can help detect WBC in urine
Specific Gravity
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
High Specific Gravity Indicates…
Concentrated Urine (Dehydration)
Low Specific Gravity Indicates…
Dilute Urine (Overhydration)
Diabetes Insipidus may do what to urine specific gravity?
Have too much water (low gravity) due to not enough ADH
Syndrome of Inappropriate ADH may do what to urine specific gravity?
Too much ADH pulls more water into the body causing things like bounding pulses and concentrated urine (higher gravity)
Application of Specific Gravity in Practice
Chronic Renal Disease are Assoc. with low specific gravity of urine
Knowledge of specific gravity helps in the interpretation of a urinalysis
Urine C & S (Culture and Sensitivity) Test
A urine test that identifies the presence of microorganisms and determines the specific antibiotics that will appropriately treat the existing microorganism
Implementation of urine c & S Test
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
Urine from clients who force fluids may be …
too dilute to provide a positive culture
When on antibiotics, what is more likely to occur ?
Vaginal yeast infections and diarrhea since both good and bad bacteria are killed via their cell walls
What is the creatinine clearance test?
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
Urine for a C&S test should be taken from ___ rather than ___
Folly Tubing rather than the bag
The best estimation of glomerular filtration rate comes from which test…
The creatinine clearance test (tells us how well the kidney is working!)
Creatinine test on ice…
aint it nice!
If any dumping occurs during a 24 hour test…
the test is void and must be restarted
Implementation of the Creatinine Clearance Test
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
Creatinine Clearance
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
VMA Test
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+)
Implementation of the VMA Test
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
Uric Acid Test
a 24 hour urine collection to diagnose gout and kidney disease
Uric Acid and Gout
can precipitate out into crystals in joint leading to pain (usually in the feet due to the coolness) and inflammation (gout)
Implementation of the Uric Acid Test
encourage fluids and a regular diet during testing
place specimen on ice/refrigerate, and check with the lab regarding adding a preservative
Renal Biopsy
invasive needle procedure for when renal cancer is suspected to take some renal tissue
Looks for dysplasia and cell development
KUB Test
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
Implementation of KUB Test
There is no specific preparation for this test since it is an x ray
IVP Test
Intravenous Pyelogram
Injection of radiopaque dye outlines the renal system
Performed to ID abnormalities in the system
Important Education for the IVP Test
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
Renal Angiography
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
Implementation of Renal Angiography
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
Renal Scan
An IV injection of a radioisotope for visual imaging of renal blood flow (can see all veins, capillaries, arteries, etc)
Implementation of the Renal Scan
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
What is important to keep in mind for urinary incontinence on linens following a renal scan or other radiopaque dye test?
Linens and soiled items must be double bagged since the dye is radioactive
CT Scan (Renal)
Computed tomography
Better than a KUB test to see structure
Can visualize kidney tumors
Voiding Cystourethrogram
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
Cystitis
Inflammation of the bladder from infection or obstruction of the urethra
commonly used as a term with UTI
Urinary Tract Infection (UTI)
Inflammation of anywhere from the urethra to the bladder
Most common causative organisms for Cystitis/UTI
E Coli
Enterobacter
Pseudomonas
Serratia
In what gender is UTI more common and why
Women because of a shorter urethra and location of the urethra near the rectum
Who is most vulnerable to cystitis?
Sexually active and pregnant women
Causes of cystitis
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
Calculus/Calculi
stones
Why is good catheter technique very important for hospitals to avoid UTIs?
Compensation from medicare will not occur when a catheter UTI occurs
Prevention of Cystitis
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
Urosepsis
Gram negative bacteremia originating in the urinary tract
The bacteria make toxins that cause illness and are highly resistant/virulent
Most common organism responsible for urosepsis is ..
E Coli
Most common cause of urosepsis is …
presence of indwelling catheter or an untreated UTI in a client who is medically compromised
The major problem of urosepsis is …
the ability of this bacterium to develop resistant strains
Urosepsis can lead to ..
septic shock and a high mortality rate when not treated aggressively
The most common and earliest manifestation of urosepsis?
Fever (but it does not diagnose this, it just is an indicator)
Management of urosepsis includes what?
Urine C&S
IV Antibiotics until client is afebrile for 3-5 days, and then oral antibiotics
Urethritis
An inflammation of the urethra commonly associated with STD, but may also be seen with cystitis
(Urethra Inflammation)
Urethritis in men is most commonly due to …
gonorrhea and chlamydial infection
Urethritis in women is most commonly due to ..
feminine hygiene sprays, perfumed toilet paper, sanitary napkins, spermicidal jellies, UTIs, changes in vaginal mucosal lining
When inspecting/diagnosing the renal system always look …
UP (move from urethra toward the kidneys up)
Signs and Symptoms of Urethritis in Men
Burning on urination Frequency Urgency Nocturia Difficulty Voiding Penis Discharge
Signs and Symptoms of Urethritis in Women
Frequency Urgency Nocturia Painful urination Difficulty Voiding Lower Abdominal Discomfort
Ways to treat urethritis?
Encourage fluids
STI testing
Avoiding intercourse until treatment is complete
Taking all antibiotics
Avoiding bad hygiene supplies
Ureteritis
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
Pyelonephritis
an inflammation of the renal pelvis and the parenchyma (nephrons), commonly caused by bacterial invasion of E COLI
can cause urinary backup
When does Acute Pyelonephritis occur…
most often after bacterial contamination of the urethra or following an invasive procedure of the urinary tract
When does Chronic Pyelonephritis occur…
most commonly following chronic obstruction with reflux or other chronic disorders
The most common bacterial causative organism of Pyelonephriotis?
E coli
Acute Pyelonephritis
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
S/S of Acute Pyelonephritis
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
Chronic Pyelonephritis
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
S/S of Pyelonephritis
Frequently diagnosed incidentally when a client is being evaluated for HTN
Poor urine concentrating ability
Pyuria
Azotemia
Proteinuria
Anemia
Acuidosis
Azotemia
Higher creatinine/urea nitrogenous wastes
Pyuria
pus in urine
Proteinuria
Protein in urine
Why does anemia occur with chronic pyelonephritis
Erythropoietin cannot be released
Why does acidosis occur with chronic pyelonephritis
Kidneys may not be able to control acid base balance
Nephrolithiasis
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
What are good tests for diagnosing urolithiasis/nephrolithiasis?
KUB, but its not good for soft tissues
IVp
CT Scan
Renal Ultrasonography
(These all can determine stone location)
When looking at nephrolithiasis it is important to …
know what the stones are made of !
Calculi or stones can form anywhere in the urinary tract, but the most frequent site is ..
the kidneys (ex: in ureter connection to kidney)
Problems that can occur as a result of calculi?
pain
obstruction
tissue trauma with secondary hemorrhaging and infection
It is very important to do when looking at uro/nephrolithiasis
Strain the urine and collect the stone for analysis to determine type and assist in determining treatment
Urolithiasis refers to the formation of ____ stones, which are formed in the ____
urinary stones; ureter
Nephrolithiasis refers to the formation of ___ stones, which are formed in the ___ ___
kidney; renal parenchyma
Hydroureter
Ureter dilation when a calculus occludes it and blocks urine flow
If calculus obstruction is not removed…
urinary stasis can result in infection, impairment of renal function on the side of the blockage, and resultant hydro nephrosis and irreversible kidney damage
Causes of urolithiasis and nephrolithiasis
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
S/S of Urolithiasis and Nephrolithiasis
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
Types/Compositions of Urolithiasis and nephrolithiasis stones
Calcium Oxalate Stones
Calcium Phosphate Stones
Struvite Stones
Uric Acid Stones
Cystine Stones
Calcium Phosphate Stones
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
Calcium Oxalate Stones
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
Oxalate Rich Food Sources include…
Tea Almonds Cashews Chocolate Cocoa Beans Spinach rhubarb
Struvite Stones
“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
Uric Acid Stones
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
Allopurinol (Zyloprim)
Medication that may be prescribed to lower uric acid levels
Cysteine Stones
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
Alkaline Forming Stones
Struvite Stones
Calcium Stones
Acidic Forming Stones
Uric Acid Stones
Cysteine Stones
Alkaline Ash Diet
Increases the pH to decrease acidity of urine
works against uric acid and cysteine stones
Ash means what is left
Foods to include in the alkaline ash diet
Milk
Fruits, BUT NOT Cranberries Plums and Prunes
rhubarb
Most vegetables
Small amounts of beef, halibut, veal, trout, and salmon are allowed
Acid Ash Diet
Decreased the pH to increase acidity of urine
Works against struvite and calcium stones
Foods to include in acid ash diet
Cheese Eggs Meat fish Oysters Poultry Bread Cereal Whole Grains Pastries CPP and Tomatoes Corn and Legumes
Foods to avoid in acid ash diet
Carbonated Beverages Baking soda or power all vegetables except corn and legumes Olives Pickles Nuts other than peanuts
CPP
Cranberries Prunes and Plumes
Triad of fruits for an acid ash diet, but not alkaline ash
Cystoscopy
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
ESWL
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
Percutaneous Lithotripsy
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
Important considerations for a percutaneous lithotripsy?
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
Ureterolithotomy
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
Pyelolithotomny
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
Nephrolithotomy
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
Partial or Total Nephrectomy
performed if there is extensive kidney damage, renal infection, or severe obstruction - and to prevent stone reoccurrence
surgical removal of kidney(s)
very extreme
