Module 3 and Module 4 Flashcards
major role of the urinary system
MAINTAIN HOMEOSTASIS BY MAINTAINING FLUID COMPOSITION AND VOLUME
components of the urinary system (KUUU)
○ Kidneys
○ Ureters
○ Urinary bladder
○ Urethra
Functions of kidneys
○ Maintaining overall fluid balance
○ Regulating and filtering minerals from the blood
○ Filtering food and waste materials and toxic substances
○ Creation of hormones that helps in the production of red blood cells
○ Promote bone health
○ Regulate blood pressure
functional units of kidneys
nephrons
what nephrons do in the kidneys
Nephrons aid in the formation of urine
Amount of blood flows in the kidneys and its percentage in the cardiac output
About 1200 ml of blood flows to the kidney per minute, which is 20-25% of the cardiac output
Through the formation of urine, what kidneys do?
Through the formation of urine, the kidneys remove waste products from the blood, regulate fluid volume, maintain electrolyte concentration, blood pressure, and pH within the body
Paired muscular docks with narrow lumina which carry the urine from the kidneys to the bladder
URETERS
Measurement of two small tubes in the ureters
Two small tubes about 25 cm long
Enumerate the three layers in the ureters
○ Outer layer (Fibrous coat)
○ Middle layer (Muscular coat)
○ Inner layer (Mucosa)
supporting layer of fibrous connective
tissue
Outer layer (Fibrous coat)
inner circular and outer longitudinal smooth
muscle
Middle layer (Muscular coat)
Define Inner layer (Mucosa)
made up transitional epithelium that is continuous
with the lining of the renal pelvis and
urinary bladder
Main function of the middle layer (muscular coat)
Main function is peristalsis which
helps in propelling in the release
of the urine
Purpose of mucus that secretes in the inner layer (mucosa)
This layer secretes mucus which
coats and protects the surface
the cells
Transport the urine from the _____ to the urinary
bladder
pelvis
this structure prevents the reflux of urine as the
bladder contracts
ureters
Serves as temporary storage reservoir for urine
THE URINARY BLADDER
Location of the urinary bladder
Located in the pelvic cavity
Size of urinary bladder
Its size varies with the amount of urine it contains
and with the pressure it receives from the
surrounding organ
Amount of urine that urinary bladder can hold
Can hold up to 1000 ml of urine
Tube that drains the urine from the bladder out of
the body
THE URETHRA
The passageway of the urine into the external
environment
THE URETHRA
Size of the urethra
● Female: 1 ½ ( cm long) to 2 ½ inches, ending at
the vulva or the external female genital organ
● Male: 5 ½ to 6 ½ inches up to 8 inches (20 cm) in
length , ending at the tip of the penis
three steps of urine formation by the kidneys
GTT
Glomerular filtration
Tubular reabsorption
Tubular secretion
Glomerular filtration process
The water or solute go to the
glomerular capsule and
becomes glomerular filtrate
Tubular reabsorption process
The glomerular filtrate goes into the kidney tubules, then into peritubular capillaries where 1% stays in the tubules and becomes urine
Tubular secretion process
- Substances from the blood are transported into the renal tubules
- There is an elimination of potassium ion, hydrogen, ammonia and uric acid
- Usually only few substances are secreted and typically these are waste products
- Urine is the substance left over inthe collecting dock, following
secretion and reabsorption
DIAGNOSTIC TESTS OF GENITOURINARY DISORDERS
ROUTINE URINALYSIS
CREATININE CLEARANCE AND BLOOD STUDIES
SERUM ELECTROLYTES
CYSTOSCOPY
KUB X ray
EXCRETORY UROGRAM/INTRAVENOUS
PYELOGRAPHY
RETROGRADE PYELOGRAM (RPG)
VOIDING CYSTOURETHROGRAM
CYSTOMETROGRAM
RENAL ARTERIOGRAM
UTZ OF KIDNEYS, URETERS, AND BLADDER
RENAL BIOPSY
Also known as routine analysis
ROUTINE URINALYSIS
What is the simple test that looks at the simple sample of the urine?
URINE ANALYSIS
It can help find problems that need treatment
including infection or kidney problems
URINE ANALYSIS
ROUTINE URINALYSIS helps find serious diseases in early stages like ___________
kidney disease, diabetes or liver disease
ROUTINE URINALYSIS is often used prior to surgery as?
as a pre-emptive screening during a pregnancy check up and as part of routine medical or physical examination
ROUTINE URINALYSIS NORMAL FINDINGS IN URINE COLOR
Amber Yellow/Straw
ROUTINE URINALYSIS NORMAL FINDINGS IN pH level
4.5 to 8.00 (Average is 6, slightly
acidic)
ROUTINE URINALYSIS NORMAL FINDINGS IN specific gravity
1.010-1.025
TRUE OR FALSE
Normal urine has protein positive (+)
False. Protein negative (-), if positive, it means that thempatient is consuming too much protein rich foods or there already an entry in the kidney tissues that may cause leakage of protein that thereby mixes in the urine of the patient
Normal range of RBC and WBC in urinalysis
(0-5/hpf) hpf- high power
field
Indication of exceeding levels in RBC and WBC in urinalysis
urinary tract infection
TRUE OR FALSE
Normal urine has absence of pus
TRUE. Pus should be absent, if positive, it can be a sign of bacterial urinary tract infection. Usually happens in people with sepsis or older people with pneumonia
TRUE OR FALSE
Normal urine has absence of glucose and ketones
TRUE
■ If positive in glucose, there can
be diabetes mellitus
■ If positive in ketones, may
indicate diabetic ketoacidosis
best indicator of glomerular function
Creatinine
Indication of decrease creatinine levels
renal function impairment
Normal range of creatinine
74.3 to 107 micromoles per liter
(But vary from lab to lab between men
and women and by age)
ENUMERATE BLOOD STUDIES AND THEIR NORMAL VALUES
BUN (blood urea nitrogen) - 10-20 mg/dl
Serum uric acid – 2.5-8mg/dl
Albumin – 3.2-5.5 mg/dl
RBC (red blood cells) – 4.5-5
million/cubic.mm of blood volume
Hct (Hematocrit Measurement) - 41-50% (Male); 36-48% (Female)
What happens if there is a high BUN level?
it may indicate that kidneys are not working well, urinary tract obstruction, congestive heart failure or recent heart attack, GI bleeding, dehydration which resulted from shock, severe burns, not drinking enough fluid, certain medications such as antibiotics and high-protein diet
What happens if there is a high uric acid?
kidneys don’t eliminate uric acid efficiently
Causes of a slow down in the removal of uric acid
overweight, having diabetes, taking certain diuretics (water pills), too much alcohol
Other less common causes are diet high in purine containing items or your body is producing too much uric acid
a protein found in the blood
Albumin
TRUE OR FALSE
A healthy kidney doesn’t let albumin pass from the blood in the urine
TRUE
_, _, _ commonly accompanying illness which means
it’s not a disease itself but a clinical manifestation
of another underlying condition.
Fluid, electrolyte, and acid-base imbalances
TRUE OR FALSE
A damage kidney let some albumin pass into the urine
TRUE
TRUE OR FALSE
The more albumin in the urine, the better
FALSE; more-less
What is the purpose of measuring albumin in the urine?
Measuring the albumin in the
urine is a toll for diagnosing
kidney disease as well as in
monitoring progression of a
kidney disease
A genitourinary disorders that covers a lot of problems that can result eventually to kidney failure. It usually happens when the kidney does not get enough blood to filter; happens also perked by disease, like high blood sugar, high blood pressure glomerulonephritis, and polycystic kidney disease. It also happens when kidney is blocked by a kidney stone or scar tissue.
RENAL FAILURE
What would the nurse should do if the high count of RBC were detected and the patient is a female?
If a high count of red blood cells
were detected and the patient
is a female, it is important to ask
them if they are having
menstruation. The nurse must
also assess the genitalia for
possible trauma due to bladder
catheterization
Indication of high presence of RBC? KIT
infection, tumors or kidney stones
Renal failure is perked by what diseases?
High blood sugar, high blood pressure, glomerulonephritis, and polycystic kidney disease
What does it mean if RBC is seen under microscopy and look distorted?
they suggest kidney is the possible
source and may arise to kidney
inflammation
(glomerulonephritis)
2 Types of Renal Failure
Acute Renal Failure and Chronic Renal Failure
Without water, we cannot promote
______ and it will be
hard for our body to _______________.
cellular chemical function, maintain normal
body temperature
It can help in the promotion of neuromuscular
irritability.
Electrolytes
It can also help our body to distribute body water
fluid compartments.
Electrolytes
TRUE OR FALSE
Small amounts in the urine is
sometimes seen in young people
and usually not indicative of any
disease
TRUE
Refers to the percentage of red
blood cells in your blood
Hct (Hematocrit Measurement)
It is essential in maintaining blood volume
or plasma.
water
Identify which type of renal failure:
1) It happens due to sudden loss of renal function
2) Gradual progressive loss of renal function
Answer Key
1) Acute Renal Failure
2) Chronic Renal Failure
It is helpful in the transportation of gases,nutrients, and other substances to the cells.
water
Identify which type of renal failure:
1) Irreversible
2) Potentially reversible
Answer Key
1) Chronic Kidney Failure
2) Acute Kidney Failure
water is considered a way of ___________________.
eliminating waste products from our cells.
Identify which type of renal failure:
Glomeruli is totally damaged
Chronic Renal Failure
Electrolytes can also help our body to distribute _________________________.
body water fluid compartments.
Identify which type of renal failure:
Renal tubules are damaged, however, the glomeruli remain intact
Acute Renal Failure
Three Stages of Acute Renal Failure
ODR
Oliguric Phase
Diuretic Phase
Recovery Phase
Electrolytes can help in the regulation of ________________.
acid-base
balance.
Oliguric Phase
Decreased Urine Output
Increased BUN, serum creatinine
Edema
Hypertension
Hyperkalemia
Hypermagnesemia
Hyperphosphatemia
Hyponatremia
Metabolic Acidosis (last 1-3 weeks)
Without electrolytes, these essential functions will
not be possible and our ___________ will be compromised.
homeostasis
Diuretic Phase
Kidneys starting to regain function
Increase urine output (3-5 L per day)
Excessive potassium loss
Recovery Phase
Takes 3-12 months for kidney to recover
Pt should avoid nephrotoxic drugs
4 Stages of Chronic Renal Failure
Renal Impairment
Renal Insufficiency
Renal Failure
ESRD (End Stage Renal Disease)
What are the 2 BODY FLUID COMPARTMENTS?
ICF (intracellular fluid), ECF (extracellular fluid)
Which stage of chronic renal failure has a 40-50% remaining GFR?
Renal Impairment
fluid inside the cells
ICF (intracellular fluid)
Which stage of chronic renal failure has a 10-20% remaining GFR?
Renal Failure
fluid found outside the
cells
ECF (extracellular fluid)
Which stage of chronic renal failure has a 20-40% remaining GFR?
Renal Insufficiency
ICF (intracellular fluid) comprises _______ of the body fluid
2/3 or 70%
Which stage of chronic renal failure has a less than 10% remaining GFR and has a presence of uremia?
ESRD
What does uremia mean?
Having urine in the blood
ECF (extracellular fluid) comprises _______ of the body fluid
1/3 or 30%
Clinical Manifestations of Chronic Renal Failure
1) Inability of the kidney to excrete metabolic waste products through urine formation
2) Inability of the kidney to secrete erythropoietin
3) Inability of the kidney to maintain fluid-electrolyte acid-base balance
4) Inability of the kidney to metabolize Vitamin D
5) Altered biochemical environment
What does oliguria mean?
Having a less than 400 ml of urine output per day
WHAT ARE THE CONSTITUENTS OF EXTRACELLULAR FLUIDS?
Interstitial fluid (ISF), Intravascular fluid (plasma), Transcellular water (TSW)
An increased BUN and serum creatinine is a condition we call as
Azotemia
spaces between cells
Interstitial fluid (ISF)
Interstitial fluid (ISF) comprising ___ of total body fluid
15%
4% of the total body fluid
Intravascular fluid (plasma)
1-2% of total body fluids
Transcellular water (TSW)
How does urineferous odor of breath happen?
It happens when elevated concentration of UREA IN BLOOD is associated with FLUID ELECTROLYTE, HORMONE IMBALANCES, AND METABOLIC ABNORMALITIES
specifically it’s 75 mL/kg of body weight
Intravascular fluid (plasma)
It is due to conversion of urea back to ammonia, which irritates mucous membranes, including that of GI tract
Stomatitis and GI bleeding
no electrical charge
Nonelectrolytes
have an electrical charge
Electrolytes
(+) charged electrolytes
Cations
(-) charged electrolytes
Anions
Examples of Cations
sodium, potassium, calcium, magnesium, and hydrogen ions
Based on the premise that a reduced RBC lifespan in renal disease is primarily caused by the
Toxic Uremic Milleu
Examples of Anions
chloride, bicarbonate, phosphate, and sulfate
major cation in the ECF
Sodium
major cation in the ICF
Potassium
A reduced RBC lifespan continues to contribute to
Renal anemia
Electrolytes combine in solutions based on the
__________ they are producing
electrical charge
Measurement of solute concentration in body
fluid is based on the fluid’s __________.
osmotic pressure
pressure exerted by a solution necessary to
prevent osmosis; minimum pressure required to
prevent the inward flow of a solution’s pure
solvent through a semipermeable membrane
osmotic pressure
It occurs in patients with CKF and it happens when the brain tissue is damaged due to HIGH UREA AND NITROGEN
Renal encephalopathy
It is due to the accumulation of HIGH URATES IN THE SKIN, causing severe pruritus and skin dryness
Uremic frost
the number of osmoles per kilogram of solution
Osmolality
Solution that have the same solute concentration as another solution
Isotonic Solution
the number of osmoles per liter of solution
Osmolarity
Solution that have a lower solute concentration than another solution
Hypotonic Solution
Solution that have a higher solute concentration than another solution
Hypertonic Solution
Hypertonic Solution: Cell Shrinking
_______________: Cell Swelling
Isotonic Solution: ______________
Hypotonic Solution : Cell Swelling
Isotonic Solution: No Particular Effect on cell
What are the other clinical manifestations of CRF in worst cases?
Decreased libido, impotence and infertility
What are the sources of fluid intake?
Water in food, Water from oxidation, Water taken as liquid
Water in ____ - 1000 mL
food
Water from ______ - 300 mL
oxidation
Water taken as _____ - 1200 mL
liquid
Water in food - ____ mL
1000 mL
Water from oxidation -_____ mL
300 mL
Water taken as liquid -________ mL
1200 mL
The inability of the kidneys to secrete erythropoietin results in
Severe anemia and reducing RBC production by bone marrow
What are the sources of fluid output?
Skin, Lungs, Feces, Kidneys
Skin - ___ mL
500mL
Inability of the kidney to maintain fluid-electrolyte, acid-base balance causes the manifestation of:
Edema
Hyperkalemia
Hypermagnesemia
Hypo/Hypernatremia
Metabolic Acidosis
Lungs - ___ mL
300 mL
Feces- ___ mL
150 mL
Kidneys- _____ mL
1500 mL
It is due to CRF and due to inability of the kidneys to BUFFER HYDROGEN IONS that regenerate HCO3 (bicarbonate), and their failure to excrete waste products, which are mostly ACIDIC in nature.
Metabolic Acidosis
Inability of the kidneys to metabolize Vitamin D due to decrease calcium absorption
Hypocalcemia
Inability of the kidneys to metabolize Vitamin D due to decrease serum calcium levels
Hyperphosphatemia
Inability of the kidneys to metabolize Vitamin D due to lack of calcemia and in this case, the bone become weak and brittle
Renal osteodystrophy
the major control of actual fluid intake
THIRST
Inability of the kidneys to metabolize Vitamin D due to calcemia that triggers the parathyroid glands to increase secretion of parathyroid hormone
Hyperparathyroidism
Normal values of K in serum electrolyte
3.5 to 5.5 mEq/L
Normal values of Na in serum electrolyte
135-145 mEq/L
It is the feeling of needing to
drink something.
THIRST
Thirst occurs whenever the body is ______ for
any reason.
dehydrated
What are the collaborative management for clients with RENAL FAILURE? (2 Conservative Management)
Fluid control and Electrolyte control
Normal values of Ca in serum electrolyte
4.5-5.5 mEq/L
Thirst is the major control of ________.
actual fluid intake
Normal values of Mg in serum electrolyte
1.5-2.5 mEq/L
Respiratory Acidosis is also known as
Carbonic Acid Excess
Normal values of Phosphorus in serum electrolyte
2.5-4.5 mg/dl
Normal values of chloride in serum electrolyte
98-108 mEq/L
Any condition that can result in a _________ can lead to thirst or excessive thirst.
loss of body water
Caused by the failure of the respiratory system to
remove CO2 from the body fluid
Respiratory Acidosis
Thirst can be a characteristic symptom of certain medical conditions most notably __________.
diabetes mellitus
major organs controlling output
KIDNEYS
Kidneys helps the body in eliminating fluid waste such as
____.
urine
Blood ph in renal failure
metabolic acidosis
Fill in the blanks: (In respiratory acidosis)
________ can also occur because of this
problem and usually this visual disturbances is
accompanied by _________.
Visual Disturbances, Headaches
Kidneys are also helpful in performing many crucial functions such as maintaining the __________.
overall fluid balance
What is the meaning of ADH?
antidiuretic hormone
What structures are being visualized using cystoscopy?
urethra, bladder wall,
trigone, urethral opening
What is cystocope?
a hollow tube equipped with the
lens which is inserted into your urethra and then
slowly advance into the bladder
What is the meaning of RAAS?
Renin-Angiotensin-Aldosterone System
retains water in the renal tubules
ADH (antidiuretic hormone)
Where cystoscopy is being done and their respective anesthesia given?
-testing room using a local anesthetic jelly that numbs the urethra
-outpatient procedure using sedation
-in the hospital during general anesthesia
ADH (antidiuretic hormone) prevents diuresis or urination so its tendency is to _________.
retain water instead of releasing through urination
Electrolyte Control in Renal Failure:
Hyperkalemia
Ensure that Pt is:
- In LOW POTASSIUM DIET
- Given with GLUCOSE 10% with INSULIN administered INTRAVENEOUSLY
- Given with RESIN KAYEXALATE
What is the meaning of the acronym ESRD?
End Stage Renal Disease
Why doctors recommending cystoscopy?
-to investigate causes of signs and symptoms
manifested by the patient such as having blood
in the urine, having urinary incontinence,
overactive bladder, and painful urination
-to diagnose bladder diseases and condition such
as bladder cancer and cystitis
-to treat bladder diseases and condition so special tools can be passed through cystoscope to treat certain condition
○ For example a very small bladder tumor
might be removed
-To diagnose an enlarged prostate, this can
reveal a narrowing the urethra where it passes
through the prostate gland
_______ retains sodium and water
Aldosterone
It happens when the angiotensinogen which is secreted by the liver is converted by ____, a hormone produced by kidneys into Angiotensin I.
renin
Give the nursing interventions before cystoscopy
- Secure informed written consent
● It is the duty of the nurse to secure that the written consent will be signed by the patient or the legal representative of the patient - Done under local/general anesthesia
- Force fluids (if under local anesthesia) to prevent ascending UTI
● If the patient is administered with local anesthesia, the proper nursing action is to force fluid or to hydrate the patient.This is done to prevent the occurence of ascending UTI - NPO if under GA
● If the patient was given general anesthesia, the nurse must do a nothing per orem status or NPO to prevent episode of aspiration pneumonia - Inform client that the desire to void is felt as cystoscope is inserted
● They must be informed to gain better control while the procedure is being done - Place client in lithotomy position during the procedure
● This position is commonly used for a variety of open and endoscopic neurologic procedures
The presence of ______________ will lead to the conversion of Angiotensin I into Angiotensin II.
Angiotensin-converting enzyme (ACE)
This Angiotensin II can lead to the
secretion of two substances: (1) ____________ (2) _________
(1)antidiuretic hormone (2) release of
aldosterone.
Electrolyte Control in Renal Failure:
Hypocalcemia
Ensure that CALCIUM SALTS and VITAMIN D supplements are administered
If the Angiotensin II will trigger the
release of antidiuretic hormone, then
there will be an _______________.
increase in the water reabsorption
if the Angiotensin II will release aldosterone, our body will experience ______ and if there is constriction of blood vessels, chances are there will be _________.
vasoconstriction, high blood pressure
What are the clinical manifestations of respiratory acidosis? HVHVK
> Hyperpnea/Hyperventilation
Visual Disturbances
Headaches
Ventricular Fibrillation
K+ Excess
Electrolyte Control in Renal Failure:
Hyperphosphatemia
AMPHOGEL is given
Diet is: HIGH CALORIE, HIGH CARBOHYDRATES, LOW PROTEIN, LOW POTASSIUM, LOW SODIUM
Potassium regulation is relevant to ______ because
aldosterone retains ___ and excretes _______.
aldosterone, ion, potassium
relevant to aldosterone because aldosterone retains ion and excretes potassium.
Give the nursing interventions after cystoscopy
- Bed rest until V/S are stable
● Done to prevent orthostatic hypotension - Pink-tinged urine is normal 24-48 hrs after the
procedure
● Happens due to irritation of mucous
membrane upon insertion of the cystoscope - Expect Dysuria (difficulty in urination), urine
frequency, hematuria (blood in the urine) due to
irritation and these signs and symptoms must be
informed the patient to prevent anxiety - Observe for urine retention, signs of infection,
and excessive hematuria
● Notify the physician if these are
manifested - Monitor intake, output and V/S
- Hot sitz bath to relieve pelvic discomfort
- Advice warm, moist soak in the pt.’s legs to
promote relief and comfort due to prolonged
lithotomy position - Force fluids to prevent ascending UTI
True or False
Weeping Edema is characterized by swelling of feet, ankle, and sacrum part of the body
False
Dependent Edema instead Weeping
Increased aldosterone
hypokalemia
What is common between KUB (kidney, ureters, bladders) Xray and excretory urogram?
Both of them performed X-ray visualization of the kidney, ureters, bladder
Decrease aldosterone
hyperkalemia
A painless procedure that performed to assess the abdominal area for causes of abdominal pain or to assess the organ and structures of the urinary or gastrointestinal system.
KUB (kidney, ureters, bladders) Xray
low potassium levels in the blood
hypokalemia
high levels of potassium in the blood
hyperkalemia
True or False
Abdominal Effusion is the accumulation of fluid in the abdomen
False
Ascites instead Abdominal Effusion
Collaborative Management for Clients with Renal Failure - for Metabolic Acidosis
Give NaHCO3 (Sodium Bicarbonate)
increases K+ excretion that results to
hypokalemia
Alkalosis
Collaborative Management for Clients with Renal Failure - for Anemia
Administer hormonal drugs, such as EPOGEN, PROCRIT/EPOIETIN ALFA
decreases K+ excretion that results to
hyperkalemia
Acidosis
It helps the doctor determine the size and
position of your bladder, kidneys, as well as ureters
KUB (kidney, ureters, bladders) Xray
Who could be the candidate for KUB (kidney, ureters, bladders) Xray?
People who have symptoms of gallstones or kidney
stones
conditions that can be diagnosed through KUB (kidney, ureters, bladders) Xray?
intestinal blockage, foreign objects in the stomach, certain tumors and kidney stones and other
types of gallstones.
Potassium is the major cation found in the
intracellular fluid and this is very important because it
helps in the conduction of ________ as well as the
promotion of skeletal and cardiac activity.
nerve impulses
Give the bowel preparation in KUB (kidney, ureters, bladders) Xray
Bowel preparation: laxative in the evening and enema
in the morning as ordered
-This is done to prevent gas or feces from
interference during visualizations of the organs that are
being examined.
What is the meaning of PTH?
Parathormone
These three regulate calcium levels
Parathormone (PTH), thyrocalcitonin, and Vitamin D
Parathormone is made by your ________.
parathyroid glands
What is the contrast medium being used in excretory urogram/intravenous pyelography?
iodine dye
In PTH, if there is an increase in parathyroid hormone,
there is also an increase in ________.
serum calcium
In PTH, if there is a decrease in ____________,
there is a decrease in serum calcium.
parathyroid hormone
It deposits calcium to the bones
Thyrocalcitonin
In Thyrocalcitonin, if there is increased ________, there is decreased serum calcium.
calcitonin
In Hyponatremia, we have to check the _______________ because the patient can develop coma
patient’s level of consciousness
When hormonal drugs are being administered, the nurse must observe for patients’ what?
BLOOD PRESSURE
It is because hormonal drugs such as Epogen, Procrit/Epoietin alfa cause HYPERTENSION
How iodine dye is being used in excretory urogram/intravenous pyelography?
an iodine dye which is injected into the vein of the patient’s arm.
The dye flows into the kidneys ureters and bladders which outline each of these structures. X-ray pictures are then taken at specific times during the examination for the attending physician to clearly see the urinary tract and assess how well it is working.
In Thyrocalcitonin, if there is decreased calcitonin, there is ______ serum calcium.
increased
What are the collaborative managements for Respiratory Acidosis? APS
> Administer bronchodilators as prescribed
Perform Postural drainage as ordered
Sodium bicarbonate per IV is prescribed
Nursing interventions before excretory urogram/intravenous pyelography
- Written consent
>Prior to the procedure, the nurse must ensure
that an informed written consent was secured. - NPO 6-8 hrs
>NPO for 6 to 8 hours as instructed by the doctor. - Bowel preparation
>Bowel preparation, which is giving laxatives as
prescribed, must also be practiced. - Assess allergy to iodine and seafoods
>Because the contrast medium to be used
contains Iodine. - Prepare Epinephrine at bedside
>due to the possibility of anaphylaxis which can
be caused by the contrast medium.
What diet is Suggested to patient with Hyponatremia
Sodium-rich food diet
It promotes calcium absorption
Vitamin D
Nursing interventions after excretory urogram/intravenous pyelography
- Monitor V/S
- Increase fluid intake to excrete the dye
- Burning sensation on voiding may be experienced
>So the duty of the nurse is to inform the patient
about this manifestation. - Observe for s/sx of delayed reaction
>because not all allergic reactions are
manifested after a certain period of time
Collaborative Management for Clients with Renal Failure - for GI Disorders
Administer ANTACIDS, H2 BLOCKERS as prescribed
Example of Plasma expanders
gelofusine
eCART meaning
electronic Cardiac Arrest Risk Triage
Causes of hypernatremia
● Hyperventilation
● Diarrhea
● High sodium intake
● Intake of sodium tablet
● Water deprivation
Opposite of hyponatremia
Hypernatremia (Sodium excess)
A diagnostic test that outlines pelvis and ureters
RETROGRADE PYELOGRAM (RPG)
Nursing Management for Clients with CRF
1) Maintain fluid and electrolyte balance
2) Provide adequate nutrition
3) Prevent infection and injury
4) Provide comfort
Nursing Management for Clients with CRF: Maintaining fluid and electrolyte balance
1) Weigh the Pt before eating anything
2) Measure I and O record accurately
3) Assess presence and extent of edema
4) Auscultate breath sounds to assess for CRACKLES, indicating PULMONARY EDEMA
5) Restrict fluids as indicated since the kidney is having a hard time to do its filtration process
6) Monitor cardiac rhythm
7) Avoid OTC drugs, such as MILK OF MAGNESIA as it may cause MAGNESIUM TOXICITY
increasing evidence indicates that
the reason for disturbed calcium balance with
age is inadequate _______ levels in the elderly
Vitamin D
In Hypernatremia, we _______ sodium diet
restrict
It is a good component of bronchial hygiene theraphy and this bronchial hygiene therapy is very vital because it helps in reducing the effects of acidosis in the lungs.
Postural Drainage
Fluids are escaping the cells so the tendency of the cells is to ____.
shrink
A diagnostic test which can typically be done even if you are allergic to the contrast dye. Provided that you will be administered with anti hypersensitivity and anti-inflammatory agents prior to the injection of the contrast medium
RETROGRADE PYELOGRAM (RPG)
True or False
If you are urinating, along with that urination is the elimination of sodium resulting to increased sodium in the blood stream.
False.
decreased sodium in bloodstream
Fluids shift from ICF to ECF
DEHYDRATION
IN DEHYDRATION All V/S are increased, except ___
BP (Blood pressure)
PURPOSES OF RETROGRADE PYELOGRAM (RPG)
to find the possible cause of blood in your urine. This may be a tumor, stone, blood clots or narrowing structures.
to check the placement of the catheter or a
urethral stent. The test can also be done if you have a
poor kidney function.
If there is hyponatremia, then there is an increase in the intracellular fluid volume so, the tendency of the cells _______.
swells
Nursing Management for Clients with CRF: Provide adequate nutrition
High CHO (carbohydrate)
Low CHON (protein)
Low Na (sodium)
Low K+ (potassium)
What is the meaning of DHN?
Dehydration
if there is hypernatremia, there is a decrease in the extracellular fluid volume so, the tendency of the cell is to __________
shrink or shrivel
GIVE THE NURSING INTERVENTIONS BEFORE RETROGRADE PYELOGRAM (RPG)
- Written consent
- Check for allergy to the dye
>or contrast medium to be used. - Inform on the discomfort of the procedure
- Prepare Epinephrine at the bedside
>The nurse must also prepare for epinephrine in
case of anaphylactic reactions. Aside from epinephrine,
the nurse must also anticipate the use of corticosteroids,
particularly hydrocortisone to be used as an
anti-inflammatory agent which can help in relieving the
effects of hypersensitivity reactions.
What is the meaning of S/Sx?
Signs and Symptoms
This diet for clients with chronic renal failure is helpful in reducing urea and nitrogenous waste products in the human body system
Low Protein
This diet for clients with chronic renal failure is helpful in preventing further water retention and edema
Low Sodium
This diet for clients with chronic renal failure is helpful in resolving hyperkalemia
Low Potassium
GIVE THE NURSING INTERVENTIONS AFTER RETROGRADE PYELOGRAM (RPG)
- Monitor V/S
- Observe urinary retention, infection, and
prolonged hematuria.
>If the signs and symptoms have manifested in
the patient, the nurse must immediately notify the
attending physician. - Increase fluid intake
>In order to prevent urinary tract infection and to
eliminate the dye through urination.
Other S/Sx of DHN
● Dry mouth and throat
● Warm flushed skin
● Soft, sunken eyeballs
● Dark, concentrated urine
● Altered LOC (assess their mental health
status)
● Increased HCT, BUN, and serum
electrolyte levels (laboratory tests)
LOC means
Level of consciousness
In voiding cystourethrogram, why films are being taken before voiding?
to outline the bladder wall.
Common causes of hypokalemia are
decreased food and fluid intake (foods rich in potassium)
HCT means
hematocrit test
In voiding cystourethrogram, why films are being taken during voiding?
to outline the urethra and reflux of urine into the
ureters
The obstruction of the intestine due to paralysis of the intestinal muscles.
Paralytic Ileus
In voiding cystourethrogram, why films are being taken after voiding?
to demonstrate if the bladder is emptied
completely
BUN means
blood urea nitrogen
Nursing Management for Clients with CRF: Prevent infection and injury
1) Maintain ASEPSIS during treatments and procedures
2) Avoid ASPIRIN to prevent BLEEDING EPISODES
encourage the client to use SOFT-BRISTLED TOOTHBRUSH due to possibility of bleeding
Collaborative Management for Dehydration
Fluid replacement, Oral care, Safety measures, Identify and treat underlying cause
TRUE OR FALSE
In voiding cystourethrogram, contrast medium is instilled into the bladder through a cystoscope
TRUE
Clinical manifestations of hypokalemia related to mental status
Lethargy, diminished Deep tendon reflexes (DTR), confusion, mental depression
Nursing Management for Clients with CRF: Provide comfort
1) Relieve pain
2) Relieve pruritus due to uremic frost
It is a clinical syndrome characterized by rapid onset of weakness including weakness of the muscles of respiration and swallowing
Flaccid paralysis
Why are voiding in cystourethrogram being
done?
This is done to check for problems in the structure
or function of the urinary system. It can check the bladder’s size and shape and look for problems such as
blockage along the path of the urine.
This flaccid paralysis is happening if the patient has very _______ potassium levels
low
the most effective way to treat of DHN
Identify and treat underlying cause
Give the normal direction of urine
Normally, the urine flows from the kidneys down to the
bladder through the ureters.
what does hypokalemic patients experience?
Hypotension or decreased in blood pressure
TRUE OR FALSE:
To relieve pain, pain medications are prescribed as ordered, however, Pt with CRF, NSAIDs are usually prescribed for the Pt pain relief.
FALSE
They are not usually prescribed.
What is the meaning of the acronym NSAIDs?
Non-Steroidal Anti-Inflammatory Drugs
Most of the time the patient is given ______ as a form of fluid replacement in order to combat DHN
IV fluid
What happens if the urine goes to the wrong direction?
if it goes in the wrong direction, it goes back up toward the kidneys and this is called vesicoureteral reflux or VUR.
Water intoxication/ dilutional hyponatremia
HYPOSMOLAR IMBALANCE
Medical Management for Client with CRF
1) DIALYSIS as prescribed
2) RENAL TRANSPLANTATION as indicated
Causes shifting of fluid from ECF to ICF; there is
cell swelling
HYPOSMOLAR IMBALANCE
How many minutes does voiding cystourethrogram to accomplish?
30 to 60 minutes
In hyposmolar imbalance, there is _______________
sodium deficit or water excess
Most dangerous effect of hyposmolar imbalance is ______
increased ICP ( increased intracranial pressure)
What are the two types of dialysis?
Hemodialysis and Peritoneal Dialysis
The patient’s heart is also experiencing difficulties in terms of its pumping action. It experiences a lot of pressure because the lack of potassium so the tendency is that this patient having hypokalemic condition will manifest (name 3)
dysrhythmias, myocardial damage, cardiac arrest
what specifically happens during voiding cystourethrogram?
So this is done in a special room
with an x-ray or ultrasound machine. After performing the sterile technique, the physician will insert a catheter into the bladder through the small opening of the urethra
where the urine usually comes out. This might feel
uncomfortable but when the catheter is in place, the rest
of the test is usually painless. The catheter is used to fill the bladder with a contrast material and as the bladder fills, it is viewed on the screen and pictures are taken. The patient will start to feel the need to urinate as the bladder gets full. Even though that kind of sensation takes place, then the patient is still expected to hold it in until the bladder is full, then, afterwards the patient is asked to urinate. The movement of the contrast material in the urinary system is seen on the screen and pictures are taken. When the bladder is empty, the catheter is then removed
ICP means
increased intracranial pressure
A diagnostic test where most of the nursing considerations for this procedure is similar to that of retrograde pyelogram?
VOIDING CYSTOURETHROGRAM
Assess the S/Sx of increased ICP for a Pt
diagnosed with Hyposmolar Imbalance
■Changes in LOC
■ Eyes have edema, pupillary changes, and impaired eye
movement
■ Headache
■ Seizures (leads to impaired sensory and motor function)
■ Increase in the systolic BP but decrease in patient’s pulse (if you assess VS)
■ Altered respiratory pattern
■ Vomiting
■ Speech changes
■ Decrease in motor function
Another procedure used for diagnosing
problems in the genitourinary tract. It records pressure exerted at varying phases of filling of the bladder.
CYSTOMETROGRAM
a condition that affects the spine and is usually apparent at birth-It is a type of neural tube defect
spina bifida
hyposmolar imbalance is also called
dilutional hyponatremia.
In this procedure, a retention
catheter is inserted and residual volume is measured.
CYSTOMETROGRAM
Drinking too much water — causes the
sodium in your body to become
diluted
Hypokalemia diet
> Include K+ rich foods in the diet (fresh fruit in general except __________
Apple is considered as high glucose fruit that has very low potassium
Hypokalemia diet
> Include K+ rich foods in the diet (fresh fruit in general except __________
Apple is considered as high glucose fruit that has very low potassium
A diagnostic test that helps evaluate neurosensory status and tonicity
CYSTOMETROGRAM
Clinical Manifestations of Hyposmolar Imbalance
● Changes in mental status
● Sudden weight gain
● Peripheral edema
A diagnostic test that assess time to initiate stream, degree of hesitance, intermittence of voiding, presence of terminal dribbling
CYSTOMETROGRAM
So if there’s
hyponatremia in a patient, one of your nursing
actions is
monitor the patient’s lab results especially the serum electrolyt
A diagnostic test that assess time to initiate stream, degree of hesitance,
intermittence of voiding, presence of terminal dribbling
CYSTOMETROGRAM
A diagnostic test that amounts of bladder volume and pressures are recorded at intervals
CYSTOMETROGRAM
True or False
In, Hypokalemia, Administer KCl per slow drip. It must not be given in an IV push or direct IV because it may cause dysrhythmias and cardiac arrest
True
Collaborative Management of Water Intoxication
● Fluid restriction
● Administration of diuretics as prescibed
● Infusion of hypertonic saline per IV
● Promotion of safety
● Assess neuro status
● Identify and treat the underlying cause
X-ray visualization of renal circulation as contrast
medium is injected into the renal artery through a catheter
RENAL ARTERIOGRAM
Why hypertonic saline and not give
another IV fluid which is hypotonic or
isotonic?
hypotonic solution, there will be cell
swelling we can’t do this in a Pt with
water intoxication because there is
already cell swelling in hyposmolar
imbalance
isotonic solution
to a Pt with hyposmolar imbalance,
there will be NO PARTICULAR EFFECT
hypertonic solution,tendency of the cell is to shrink
Who may be the recipient of renal arteriogram?
this exam is useful for patients who have high blood pressure that may be caused by a kidney problem. It is also helpful for patients who may have a kidney artery that is closed or whose arteries are inflamed
How renal aretriogram is being done?
This procedure is performed by a doctor-radiologist who is assisted by specially-trained nurses and technologists. So, using a needle, the doctor inserts a thin wire into the large artery in the groin area.
This wire is used to guide the catheter into the large artery leading to the kidneys, and once the catheter is in place, the x-ray dye is injected through the catheter and x-rays of the arteries are taken.
numbness and tingling is also called
paresthesia
TYPES OF SOLUTION
ISOTONIC SOLUTIONS, HYPOTONIC SOLUTIONS, HYPERTONIC SOLUTIONS
Solutions that have the same solute
concentration as another solution
ISOTONIC SOLUTIONS
There is diarrhea in hyperkalemia because?
your body feels that there is a high level of potassium and it responds to this kind of condition by eliminating this excess potassium through defecation.
If you place the cell here, it will have no
particular effect on the cell
If a normal cell is placed here, it will still remain
normal
ISOTONIC SOLUTIONS
Ventricular fibrillation can be seen on ?
ECG
Solutions that have a lower solute concentration
than another solution.
HYPOTONIC SOLUTIONS
If you place a cell here, there will be cell swelling
because the fluids will be going inside the cell.
HYPOTONIC SOLUTIONS
Solutions that have higher solute concentration
than another solution.
HYPERTONIC SOLUTIONS
There will be cell shrinkage because the fluid
instead of going inside the cell, the fluids are
escaping outside the cell
HYPERTONIC SOLUTIONS
What is the major route of potassium excretion?
Kidneys
Also known as the extracellular fluid volume
deficit.
ISOTONIC FLUID VOLUME DEFICIT
There is water and electrolyte loss just like in DHN
ISOTONIC FLUID VOLUME DEFICIT
Nursing care before renal arteriogram
- Cleanse the bowel
>So the nursing care prior to this procedure is
cleansing the bowels, so for this, laxative will be given as ordered - Shave catheter insertion site
>The nurse must also shave the catheter insertion
site, usually this is the lumbar femoral area. - Locate and mark distal pulses
-NPO after midnight, the night before the
procedure except when taking your usual medications.
Respiratory Alkalosis is also known as
Carbonic acid deficit or Carbon acid deficit
A plasma expander given to patient who is sodium deficit
Gelofusine
Clinical Manifestations of Isotonic Fluid Volume
Deficit
● Weight loss –
● Oliguria –
● Dry mouth
● Poor skin turgor
● Postural HTN
● Tachycardia and tachypnea
Nursing care after renal arteriogram
- V/S until stable
- Apply cold compress on puncture site
>Cold compresses are also applied on puncture
sites to prevent bleeding. The nurse must also check for
swelling and hematoma - Sandbag over catheter insertion site
>sandbag over the insertion site should also be
applied to prevent further bleeding - Palpate peripheral pulses
>The nurse must also palpate peripheral pulses to
assess adequacy of circulation in the involved extremity. - Check color and temperature of extremity
>for adequacy of circulation - Bed rest for 24 hours; no sitting
- Measure urine output
>based on the timeline ordered by the physician.
Carbonic acid deficit or Carbon acid deficit also known as
Respiratory Alkalosis
A diagnostic test that detects tumors, cysts, obstruction, abscesses
UTZ (ultrasound) OF KIDNEYS, URETERS, AND BLADDER
Recommended Diet for pt diagnosed w/ hyponatremia
Sodium-rich foods diet
Caused by loss of CO2 on the lungs at a faster rate than it is produced in the tissues
Respiratory Alkalosis
IFVD means
Isotonic Fluid Volume
Deficit
Collaborative Management of Hypokalemia (Potassium Deficit)
● Include K+ rich foods in the diet (fresh fruit in general except apple)
* Administer KCl per slow drip.
* Administer K+ sparing diuretics as prescribed
Collaborative Management for ECF Volume Deficit
● Administer fluids with sodium
● Meticulous oral care
● Safety
● Identify and correct underlying cause
Nursing care in ultrasound of kidneys, ureters, and bladders
- Cleanse the bowel
-laxative must be given as ordered by the
physician. - Distend the bladder (give 2 glasses of H20).
- Withhold voiding
-during the procedure, please remind the patient
to control the urge to urinate.
Carbon dioxide is released at an abnormally faster rate
Respiratory Alkalosis
Respiratory alkalosis can result in a disease known as
Hyperventilation
Why it is needed to give 2 glasses of H20 in a distended bladder in ultrasound of Kidneys, Ureters, and Bladder?
the primary reason for this is
that a distended bladder permits better imaging of the
bladder structures.
Collaborative Management of Hyperkalemia (Potassium Excess)
● low K+ diet
● Dextrose 10% in water with regular insulin per IV
● Polystyrene sulfonate (kayexalate) by mouth or enema as prescribed
● Calcium gluconate per IV.
● Dialysis as indicated
True or False: Sodium is hydrophilic or water-loving which means wherever there is sodium, there is water
True
Examining a sample of renal tissue for possible
malignancy
RENAL BIOPSY
Very similar to hyposmolar imbalance because it
also manifest edema or overhydration
ISOTONIC VOLUME EXCESS
Polystyrene sulfonate sample medication
Kayexalate
Nursing care before renal biopsy
- NPO for 6-8 hrs
- Check PTT, PT
>Partial Thromboplastin Time, Prothrombin Time,
because commonly, bleeding is a possible complication
in this procedure. - Mild sedation is done
- Pt. should be in prone position due to retroperitoneal placement of the kidneys
- UTZ and X-ray of the kidney should be readily available to have more means of locating the
kidney. - Local anesthesia is administered
- Instruct client to hold breath and remain still during
needle insertion to prevent trauma
Antidote for hyperkalemia
Calcium gluconate
Calcium gluconate is a medication used to manage hypocalcemia, cardiac arrest, and cardiotoxicity due to hyperkalemia or hypermagnesemia.
ISOTONIC VOLUME EXCESS occurs due to:
Increase capillary hydrostatic pressure
Increase capillary hydrostatic pressure
Increased capillary permeability
Lymphatic obstruction
Sodium and water excess
This usually happens to patients whose blood vessels are
damaged due to burns. It can also happen if the patient is experiencing vasodilation due to an inflammatory process.
Increased capillary permeability
causes impaired circulation and to the system therefore affecting
how our body retains water
Lymphatic obstruction
Decreased colloidal or oncotic pressure which
then results to a condition _
hypoalbuminemia
What are the clinical manifestations of respiratory alkalosis? LNTTSK+
> Lightheadedness
Numbness
Tingling of fingers and toes (Twitching)
Tetany
Seizures
K+ Deficit
Causes of Hypernatremia (Select all that apply)
Hyperventilation
Diarrhea
Low sodium intake
Intake of sodium tablet
Water deprivation
Hyperventilation
Diarrhea
Intake of sodium tablet
Water deprivation
(It should be High sodium intake)
Clinical Manifestations of Edema
Weight gain
Tight, smooth, shiny skin
Cool, pale skin
Neck vein engorgement
Clothings and shoes feels tight
Pleural effusion, pericardial effusion, ascites
Nursing interventions after renal biopsy
- Bedrest for 24 hrs to prevent bleeding
- Monitor V/S as it is indicators of possible internal
bleeding. - Check for pain, N/V
- Provide fluids up to 3000ml to prevent infection.
- Hct (hematocrit) and Hgb (hemoglobin) done in 8 hours to detect bleeding, low levels can indicate
bleeding - Avoid strenuous activities for 2 weeks
- Notify the physician for: bleeding, hematoma, and
infection
Abnormally decrease calcium levels
Hypocalcemia
accumulation of fluid into the pleural space
pleural effusion
Serum calcium value of Hypocalcemia
lower than 8.6 mg/dL [2.15 mmol/L]
which is an abnormal accumulation of fluid in the pericardial
cavity particularly in the sac-like structure around the heart which is the pericardium
Pericardial effusion
which is a condition of fluid accumulation in the abdominal area;
ascites
a problem where fluid collects in spaces within your abdomen
Ascites
2 TYPES OF EDEMA
- Dependent Edema
- Weeping Edema
Causes of Hypocalcemia
- Decreased ionized calcium because of high volume of blood transfusion containing saturated blood
- Excess loss of Calcium due to renal disease sometimes due to draining fistulas
- Low calcium diet
- Decreased calcium absorption
Seen on sacral areas as well as ankles and feet
Dependent Edema
Fluid is leaking out of the pores especially
when the skin is pressed
Weeping Edema
Collaborative Management for Edema
Sodium and fluid restriction
High protein diet
Elevate edematous body parts
Prevent edematous body parts from prolonged
pressure
Keep the skin dry and well-lubricated
Administer diuretics as ordered
Regulate IVF accurately
What are the collaborative managements for respiratory alkalosis? IT
> Instruct the client to breathe into a plastic bag or brown bag
Treat the underlying cause
Metabolic Acidosis is also known as
Bicarbonate Deficit
Have a high protein diet for edema EXCEPT if the patient has _
renal failure
Clinical Manifestations of Hypocalcemia in muscular system
1.
2.
- Muscle spasm
- Tetany (Chvostek’s sign and Trousseau’s sign)
Bicarbonate Deficit is also known as
Metabolic Acidosis
2 classic signs of tetany
Chvostek’s sign and Trousseau’s sign
In edema, elevate edematous body parts to promote
venous return. EXCEPT patients with _
because it can cause an increase in their
preload.
Congestive Heart Failure
CHF means
Congestive Heart Failure
It results from the abnormal accumulation of fixed acids or loss of base
Metabolic Acidosis
what vitamin and supplements are prescribed to patients with hypocalcemia?
vitamin D
Parathormone supplements
What are the clinical manifestations of metabolic acidosis? HKP
> Headache
Kussmaul’s Breathing
Potassium Excess
Collaborative Management of Hypocalcemia
● _______ calcium diet
* Oral calcium salts as prescribed (calcium supplement)
* _______ ____ and ______ _________ as ordered (it can help in absorption of calcium in the bloodstream)
* Amphogel as prescribed. (Phosphate binder which can lower phosphate levels so is the calcium levels)
* Calcium gluconate _______ as prescribed (given to hypocalcemia patient as therapeutic regimen) Take note that this is only given to severe hypocalcemia
* Promote safety due to possibility of seizures (at risk for seizures and trauma)
* Protect from trauma
* Monitor _________
- high
- Vitamin D and PTH supplements
- 10%
- breathing
having abnormally high calcium levels in the blood.
Hypercalcemia
Difference and similarity between Hyponatremia and Hypernatremia
Difference
Hyponatremia = sodium deficit
Hypernatremia = sodium excess
Similarity
Both = water excess
Causes of Hypercalcemia
1.
2.
3.
- Calcium loss from bones
Usually, this happens due to calcium loss in the bones. This calcium loss is triggered due to immobilization. It is also happening due to carcinoma from bone metastasis.
- Excessive intake of calcium
It is also occurring because of excessive intake of calcium(i.e. If you have a high calcium diet or if you’re having an intake of calcium-containing antacids. Those who are having hyperacidity and were prescribed antacids containing a high level of calcium are at risk for hypercalcemia
- Hyperparathyroidism, hypervitaminosis D, steroid therapy
what is DTR
Deep Tendon Reflexes
The practice of low sodium diet is commonly recommended to pt. diagnosed of what medical conditions?
Hypertension
Kidney disorders
what is Hypotonia
abnormally low level of muscle tone
_______________ and _________ may also happen in hypercalcemia not just in hypocalcemia.
Osteoporosis and fractures
Collaborative Management for Hypercalcemia
- Increase fluid intake
-About ______ L/day to help kidneys remove excess calcium and to prevent stone formation caused by accumulation of calcium deposits in the kidney. - Provide acid-ash fruit juices (_________ what juices?_____)
Helping acidifying urine and prevent stone formation - Protect the client from injury
Because they are at risk of having osteoporosis as well as fractures. - Administer normal saline (__________).
Why do we give this? Because it promotes calcium excretion. - Administer Mithracin (_________) as prescribed.
Helping in reduction of serum calcium levels
- 3-4 liters
- Cranberry and Prune Juice
- NaCl 0.9%
- Mithramycin
True or false
Hypomagnesemia with secondary hypocalcemia is an inherited condition caused by the body’s inability to absorb and retain calcium that is taken in through the diet.
false.
inability to absorb and retain magnesium
Common Causes of Hypomagnesemia are
(5)
-Prolonged Malnutrition or Starvation
(Common with patient who are severely malnurished or to those who are practicig fasting, particularly to those wo are anorexic).
-Malabsorption Syndrome are also a causative factor for Hypomagnesemia
(Those who are having problems as regards to their nutrients absorption are also experiencing hypomagnesemia, because their having difficulties in the absorption and metabolism of magnesium).
- Hypercalcemia is another condition which can lead to a complication of hypomagnesemia
-Alcohol Withdrawal syndromes
-Draining Fistulas
a problem of our nervous system in which our body manifest disorders that affects coordination, balance, and speech.
Ataxia
Clinical manifestation of Hypomagnesia
- Tachycardia, Hypertension, Dysrhythmia
As a nurse, we must be monitoring the px cardiac condition by checking the ______, _________, and __________.
pulse rate, respiration, and oxygen saturation.
why should we Monitor client for laryngeal stridor in Hypomagnesemia?
-Because this can indicate airway obstruction.
what route can we administer Mg supplement
oral and parenteral
Disease caused by excessive intake of magnesium containing acids.
Hypermagnesia
It can be also cause by renal failure as well as diabetic ketoacidosis
Hypermagnesia
having at normally high levels of magnesium in the blood and this is usually manifested by decreased blood pressure.
Hypermagnesemia
hypermagnesemia is usually caused by a ?
kidney failure
Most objective indicator of dehydration
Weight loss
True or False
So hypermagnesemia is also treated through the use of calcium gluconate, this is given by a intramuscular route.
false.
intravenous
Principal factor of maintaining calcium homeostasis
Vitamin D
So why are we giving calcium gluconate?
Because it antagonizes magnesium so as you know in maternal and child health nursing if the patient is experiencing magnesium toxicity we have to prepare calcium gluconate as an antidote.
dialysis is done in px with hypermagnesemia because it is caused by
renal failure or kidney failure
True or False
Flaccid paralysis is a gradual onset of weakness
False
Rapid onset
Hypermagnesemia is a serum magnesium concentration of what value?
> 2.6 mg/dL (> 1.05 mmol/L).
higher than 2.6 mg/dL (> 1.05 mmol/L).
Clinical manifestations of Hypermagnesemia
Clinical manifestations:
- Decreased BP
- Thirst, N/V
- Drowsiness
- Diminished or loss of DTR
Collaborative Management for Hypermagnesemia
(3)
- Ca Gluconate per IV as prescribed
- Dialysis
- Monitor serum electrolytes
Difference of K+ sparring and K+ wasting diuretics
K+ sparring diuretics = no release of potassium along urination
K+ wasting diuretics = release of potassium along urination
Early Sign of Hyperkalemia
Late Sign of Hyperkalemia
ES = Irritability
LS = Weakness, Flaccid Paralysis
Metabolic alkalosis also known as
Bicarbonate Excess
Bicarbonate Excess also known as
Metabolic alkalosis
Nursing Care for Hemodialysis
1) Arm precaution (No BP Taking or puncturing of the affected arm)
2) Assess for patency of AV fistula
3) Blood transfusion should be administered
4) Anti-HPN (hypertensive) meds are omitted to prevent hypotension
5) Promote comfort because hemodialysis may take 3 to 4 hours per session
6) Maintain activity and nutrition
7) Prevent disequilibrium syndrome
It results from the loss of hydrogen ions or addition of
base to body fluids
Metabolic alkalosis
What are the clinical manifestations of metabolic alkalosis? HMDNMS
- Hypoventilation
- Mental confusion
- Dizziness
- Numbness and tingling of fingers and toes
- Muscle twitching, tetany
- Seizures
It is caused by more rapid removal of waste products from the blood than from the brain, which happens due to blood brain barrier
Disequillibrium syndrome
Metabolic alkalosis is often manifested by _______
Hypoventilation
Common signs and symptoms of disequillibrium syndrome
Restlesness, Headache, Dizziness, Nausea and Vomiting, Hypertension
In metabolic alkalosis, in terms of
neurological manifestations we can observe that the
patient is exhibiting _____ and ______
mental confusion and dizziness.
What are the Collaborative Management for Metabolic Alkalosis?
- Maintain good respiratory function
- Protect the client from injury
- NaCl or Ammonium chloride oral or IV
- Diamox
- Identify and treat underlying cause
How to prevent disequillibrium syndrome from happening?
The initial dialysis must be 30 mins only. Duration of the procedure will be increased gradually. Usual time is 3-4 hours and then 2-3 times a week.
TRUE OR FALSE
Nursing Care: Peritoneal Dialysis
The dialysate solution should be warmed at body temperature. It is done to increase permeability and enhance the removal of waste products.
TRUE
What is the infusion time in peritoneal dialysis?
10 mins
A type of cancer that is more common among males
Carcinoma (Bladder Cancer)
What is the dwell time or equillibration time in peritoneal dialysis?
20 mins
What is the drainage time in peritoneal dialysis?
30 mins
Nursing Care: Peritoneal Dialysis
If the drainage stops, you have to turn the client to the sides. The Pt should be in what position?
Semi-Fowler’s position
This contains having blood in the urine with no painful sensation at all.
Painless Hematuria
Nursing Care: Peritoneal Dialysis
Cloudy dialysate indicates what?
Peritonitis
If the cancer cells are contained inside the lining of the bladder
Non-Muscle invasive bladder cancer
TRUE OR FALSE
Nursing Care: Peritoneal Dialysis
the nurse must monitor the urine and blood glucose levels because the dialysate solution contains glucose; small doses of insulin may be required in this case, especially if hyperglycemia occurs.
TRUE
TRUE OR FALSE
Nursing Care: Peritoneal Dialysis
Renal transplantation may be indicated in ESRD.
TRUE
When the cancerous cell spreads beyond the lining going to the surrounding bladder muscle
Muscle Invasive bladder cancer
Nursing Care: Peritoneal Dialysis
What are the medications to be administered to prevent GVHD (Graft-Versus-Host-Disease) or rejection reaction?
Imuran (Azanthiopine)
Sandimmune, Neoral (Cyclosporin)
Prograf (Tacrolimus)
CellCept (Mycophenolate mofetil)
Deltasone (Prednisone)
If bladder cancer spreads to the other parts of the body
Advanced or metastatic bladder cancer
What does the acronym GVHD mean?
Graft-Versus-Host-Disease
Risk Factors for Bladder Cancer
Cigarette Smoking, Chronic Cytitis, Large Phenacitin Intake, Bladder Calculi, Pelvic Radiation, Use of Cycophospamide, Schistosomiais
Imuran (Azanthiopine)
Sandimmune, Neoral (Cyclosporin)
Prograf (Tacrolimus)
CellCept (Mycophenolate mofetil)
Deltasone (Prednisone)
The medications above are considered as what type of drugs?
Immunosuppressants
An infection caused by Escherichia. Coli
Urinary Tract Infection
Parasitic infection which can trigger the development of bladder cancer
Schistosomiais
It can also be caused by Klebsiella pneumonia, Protes mirabilis, and Pseudomonas species
Urinary Tract Infection
The chemical buffers of our body arethe lungs
and our kidneys. So they work together to
maintain acid-base balance and then for
potassium if the level is below 2.5mEq/L or above
7mEq/L then it can result to ________
Cardiac Arrest
Common type of analgesic used for medication in bladder cancer
Phenacetin
__________ should be given with the glass of
water to prevent GI irritation. Please remember
this fact because it will help in your effective
nursing care.
Oral potassium
Urinary tract Infection is more common to?
A. Males
B. Females
B. Females
What are the clinical manifestations for Bladder cancer?
Dysuria, Gross Hematuria, Urine Flow Obstruction, Development of Fistula
We have to monitor renal function before giving
potassium supplements. We must make sure that
urine output is adequate to prevent renal
damage. So what we are remembering here is
the term “No Pee, No K”, if there is no urination
then _______
we must not give additional potassium
supplements
Major route for potassium excretion
Kidneys
What are the Clinical Managements for Clients with bladder Cancer?
Ileal Conduit, Koch Pouch, Indianca Pouch, Ureterostomy, Vesicostomy, Percutaneous Nephrostomy, TURB (Transurethral resection and fulguration of the bladder).
T or F: For calcium which is to be given for intravenous route it should be mixed with plain nss or normal saline.
FALSE ( It should be mixed with D5 water and not plain nss or normal saline.)
It can also be caused by Klebsiella pneumonia, Proteus mirabilis, and Pseudomonas species
Urinary Tract Infection
T or F: calcium enhances the effect of digoxin.
TRUE
Who tends to have more UTI?
A. Sexually Active Women
B. Not Sexually Active Women
A. Sexually Active Women
Other term for Urinary Calculi
Urolithiasis
T or F: Calcium supplements should be taken before meals because it can help in preventing GI irritation
FALSE (It should be taken with meals or after meals)
It is the most common cause of UTI that leads to urinary stasis
Urinary Calculi
____ is required to enhance calcium
absorption
Vitamin D
This causes obstruction of urine flow
Urinary Calculi
It is a process of forming stones in the kidney, bladder, and urethra or urinary tract
Urolithiasis
T or F: If you are administering magnesium in solution
form you must give it as fast as you can to prevent hot or
flushed feeling.
FALSE (you must slowly give it)
-Actually we are giving it for at least 30 minutes, if
we are going to inject it to the mother it requires
30 minutes of slow injection and we are not
giving it as quick as other iv medications that we
are giving to other patients.
A type of pain that originates from the lumbar area and radiates to the lower abdomen
Colicky Pain
It is common to px who have urinary calculi and it is manifested by nausea and vomiting, diarrhea or constipation.
GI Upset/ Gastrointestinal Upset
Don’t forget that digitalis toxicity can also
happen if digoxin will be given along with a
condition known as ______.
Hypomagnesemia.
The antidote for hypermagnesemia is ______.
Calcium gluconate
Other companion symptoms for urolithiasis
Hematuria, Dysuria and Urinary frequency
For continuous enteral feeding, check residual feeding
every _______
2-4 hours
It may happen because px with urolithiasis is at risk to develop UTI
Fever, chills
For TPN, teach client to do ____ when
changing infusion bags and tubing
Valsalva maneuver
Rationale: to prevent air embolism.
The calculi or stones found in the kidney are made up of _____,______
alkaline substances, acidic substances
What type of birth control is used by women and puts them at high risk for urinary tract infection?
Diaphragm and spermicidal agents
Fluid intake of a person with Urinary Calculi should be at least _____ per day
3 liters/ 3000ml
T or F : Change TPN solution and tubing every 18 hours
FALSE (24 hours)
After menopause, a decline in circulating _____ causes changes in the urinary tract making women vulnerable to infection.
A. Progesterone
B. Estrogen
C. Testosterone
B. Estrogen
It is a medication prescribed for uric acid stone
Allopurinol
Why administering D10W if TPN infusion is interrupted for 12-24 hours after TPN is discontinued is important?
to prevent hypoglycemia.
Surgical intervention for Urinary Calculi
Nephrolithotomy, Pyelolithotomy, Ureterolithotomy
ESWL
Extracorporeal Shock Wave Lithotripsy
What are the Clinical Manifestation for Urinary Tract Infection?
-Urgency
-Dysuria (difficulty in urinating)
-Foul-smelling urine
-Suprapubic pain
-Malaise, fever, chill, nausea and vomiting
-Lower back pain
In UTI under clinical manifestation ________ and _________ are being ordered.
Routine Analysis and C and S Test
It is also a collaborative management for clients with stone formation. The crushing of the stone is done in this procedure using high frequency ultrasonic waves while the body is half immersed in water.
ESWL / Extracorporeal Shock Wave Lithotripsy
It is done for patient with kidney stones wherein a guide is inserted under fluoroscopy near the area of the stone and then the ultrasonic wave breaks the stones into fragments followed by the placement of a nephrostomy tube.
Percutaneous Lithotripsy
Most common type of cancer among males
Prostate Cancer
To determine the drug to which the bacteria is resistant, C and S after antibiotic should be done.
TRUE or FALSE
FALSE
Answer:
C AND S BEFORE ANTIBIOTIC THERAPY
It is an androgen-dependent carcinoma
Prostate Cancer
Increasing fluid intake by 3-4 liters per day helps in facilitating urination
TRUE and FALSE
TRUE
To acidify urine encourage the px to drink cranberry or prune juice
TRUE or FALSE
TRUE
It is the blood in the urine
Hematuria
It is done to relieve pelvic discomfort
Hot Sitz Bath
Common complaints of the patient with prostate cancer
Pain radiating down the hips and legs
Provide the following pt teachings:3Ws
W: Wash hands before and after using the toilet
W: Wear cotton underwear
W: Wipe perineum front to back
TRUE or FALSE
TRUE
It is the protein produced by normal as well as malignant cells of the prostate glands
PSA (Prostate Specific Antigen)
The test that measures the level of PSA in the men’s blood
PSA test
is the single most effective practice to prevent the spread of microorganisms
Hand Washing
Clinical manifestations for Prostate Cancer
the patient can be seen in the UTZ to have hard, enlarged prostate, Hematuria, Pain radiating down the hips and legs, Elevated PSA, Elevated phosphate, Urinary obstruction, UTI
Empty the bladder every 2-3 hours to prevent ________
Urinary Statis
Empty the bladder before and immediately after sexual intercourse
TRUE or FALSE
TRUE
Colllaborataive Management for clients with prostate cancer
Hormone therapy, Surgery(Postatectomy), Chemotherapy, Radiation therapy
A Urinary Tract Analgesic
Pyridium (Phenazopyridine HCI)
Does the drug Pyridium cause urine discoloration?
TRUE or FALSE
TRUE
Site Urinary Antiseptics drug administer as prescribed to treat UTI
-Cinobac (Cinoxacin)
-Mandelamine (Menthenamine)
-Hiprex (Methenamine Hippurate)
-Negram (Nalidixic Acid)
-Furadantin, Macrodantin, Macrobid (Nitrofurantoin)
Mandelamine (Menthenamine) is a drug for UTI and should not be combined with Sulfonamides to prevent ______?
Crsytalluria (the excretion of crystals in the urine, causing irritation of the kidney.)
Site Fluoroquinolones drug administer as prescribed to treat UTI
-Cipro (Ciprofloxacin)
-Penetrex (Enoxacin)
-Tequin (Gatifloxacin)
-Levaquin (Levoflaxacin)
-Maxaquin (Lomefloxacin)
- Avelox (Moxifloxacin)
- Noroxin (Norfloxacin)
-Floxin (Ofloxacin)
- Zagam (Sparfloxacin)
- Trovam (Trovafloxacin)
_____________ should be adminste with a full galss of water and ensure adeqequate urine output to prevent crystalluria
Fluoroquinolones
Fluoroquinolones may cause neurotoxicity, hepatic and renal toxicity
TRUE or FALSE
TRUE
Does the sulfonamides medication should be taken with a half glass of water to increase fluid intake to prevent crystalluria?
FALSE
It should be taken with a full glass of water to increase fluid intake to prevent crystalluria
Site Sulfonamides medications administer as prescribed to treat UTI
-Sulfadiazine
- Thiosulfil forte (Sulfamethizole)
-Gantanol ( Sulfamethoxazole)
-Gantrisin (Sulfisoxazole)
-Bactrim ( Trimethopin-sulfamethoxazole)- AVOID SUN EXPOSURE, may cause fever, rash and sensitivity
May cause Steven-Johnson Syndrome , most severe hypersensitive response, produces widespread lesions of the skin and mucous membrane, fever, malaise, and toxemia
Sulfonamides
Site a Cholinergic Agent medication administer as prescribed for a patient with UTI
Urecholine (Bethanecol Chloride)
A drug used to treat urinary retention and neurogenic bladder, promotes contraction of the bladder and relaxation of the sphincter, which allows emptying of the urine from the bladder
Urecholine (Bethanecol Chloride)
What is the antidote for the cholinergic drug Urecholine (Bethanecol Chloride)?
AtSO4 (Atropine Sulfate)
What are the antispasmodics drug that administers medication as prescribed?
-Ditropan ( Oxybutynin)
- Pro- Banthine (Propantheline Bromide)
Antispasmodics drug is used to treat urinary frequency (promotes relaxation of the bladder and contraction of the sphincter)
TRUE or FALSE
TRUE
Do not Administer these medication among clients with glaucoma because it dilates pupis and obstruct aqeous humor flow)
Antispasmodics drug
Gradual enlargement of the prostate gland with hypertrophy and hyperplasia commonly happens due to more estrogen rather than androgen hormones of normal tissues among male — the cause is unknown for this condition
Benign Prostatic Hyperplasia
BPH usually occurs among ____ over 50 years of age
A. men
B. women
A. men
In UTI, Enlargement causes compression of the urethra and base of the bladder and it can also lead to the urinary obstruction which can complicate renal failure.
FALSE
It is in Benign Prostatic Hyperplasia not in UTI
Urinating at night hours is called
Nocturia
Clinical Manifestation for Benign Prostatic Hyperplasia are:
-Nocturia
-Frequency, Urgency, and hesitancy form of urination
- Increased residual urine
- Hematuria
- UTI
Different Surgical procedures for the patient with the condition called Benign Prostatic Hyperplasia are:
- TURP (transurethral resection of the prostate)
- CBI (continuous bladder irrigation)
- Suprapubic Prostatectomy
- Retropubic Prostatectomy
- Perineal Prostatectomy
Post-Op Care of the Client Who Had Undergone Prostatectomy
FOR those who have Continuous Bladder Irrigation should:
- Maintain patency of the catheter
- Always practice aseptic technique
- Monitor the client for hemorrhage
- Monitor urinary output
FOR those who have Continuous Bladder Irrigation, the nurse must expect ______ urine for the first 24 hrs (which is expected to become amber 3 days after the procedure).
red to light pink
FOR those who have Continuous Bladder Irrigation, The nurse must prevent the occurrence of thrombophlebitis because this can lead to ______
Embolism
What neurologic problem is manifestated in Hypercalcemia?
Clue: sunod sa letter f
E di lethargy
Diffirentiate how a constrast medium is administered in Excretory Urogram, RPG, Voiding Cystourethrogram, & Renal Arteriogram
Excretory Urogram = Contrast medium is injected in the vein of the pt.’s through IV
RPG = Contrast medium is inserted in the ureters through cystoscope
Voiding Cystourethrogram = Contrast medium is instilled into the bladder through cystoscope
Renal Arteriogram = Contrast medium is injected into the renal artery through a catheter
