NUR 114 - Concept of Elimination EXAM IV Flashcards
_____ ______ are small, hard deposits of minerals and acid salts
kidney stones
stones in urinary tract
urolithiasis
stones in kidney
nephrolithiasis
stones in the ureter
ureterolithiasis
stones in the urethra
urethrolithiais
diets high in what leads to kidney stones?
calcium, vitamin D, and high does of vitamin C
type of stone that is associated with high concentrations of calcium in the blood or urine; absorbed in the intestinal tract. Most stones have a calcium component (80 % of kidney stones are from this type.)
RISK FACTORS: increase in intestinal calcium absorption, prolonged immobility, bone disease, vitamin D intoxication, renal tubular acidosis, prolonged steroid use, alkaline urine, dehydration, IBD
MANAGEMENT: diet low in oxalate while maintaining adequate calcium intake, limit foods high in sodium and protein, increase foods that acidify urine.
-increase hydration and exercise. thiazide diuretics and phosphates.
Hyercalcemia (oxalate, phosphate)
type of stone that develops when the urine concentration of uric acid is high. Common in men.
RISK FACTORS: gout, pourine intake, acidic urine
MANAGEMENT: avoid foods high in purine. increase hydration. potassium citrate and allopurinol (gout management)
hyperuricemia
type of stone associated with an UTI caused by urease-producing bacteria. Stones can grow very large filling the renal pelvis and calyces. May be called staghorn stones because of their shape. (more common in women than men)
RISK FACTORS: UTIs, especially proteus infections
MANAGEMENT: surgery for the removal of stones. antibiotic for infection
struvite
type of stone that is rare, associated with genetic defect of amino acid metabolism that precipitates insoluable cystine crystals.
RISK FACTORS: genetic defect, acid urine
MANAGEMENT: diet restricting sodium intake. increase hydration, and penicillamine, and sodium bicarb
Cystine
- Severe pain that was sudden onset (often described as a corkscrew feeling)
- Nausea, vomiting, high blood pressure, diaphoresis.
- Elevated temperature, BP, and respirations
- Hematuria
- Persistent urge to void
- Oliguria, Anuria,Dysuria (persistent urge to void and painful urination)
- Foul smelling urine
- Hydronephrosis
clinical manifestations of kidney stones
complication of a kidney stone occurs when a blockage persists. the stone is in a place where it is completely blocking urinal flow. so organ goes on to swell. main symptom will be pain (on either side of back, abdominal, or groin pain) increased urge and frequency to void. upon using the restroom they incompletely void. symptoms depends on the severity of the blockage
hydronephrosis
what type of test would be recommended for children and pregnant women to reduce the risk of radiation exposure.
ultrasound
___% of kidney stones can be spontaneously passed but there are some who have infections or complications and need other measures to treat the stone. often time NSAIDS are prescribed to help alleviate pain.
50
ketorolac (Toradol)
ketoprofen (Nexcede)
NSAIDs
Oxybutynin chloride (ditropan) Tamsulosin (Flomax) used to help relax the muscles in the bladder to help pass the stone.
Spasmolytics
what is the key preventative measure in regards to kidney stones?
ensuring that the client is hydrated with water and citrus juices. (citrate is a stone inhibitor)
____ as often as possible prevents calcium buildup in the bloodstream.
walking
_____ the urine in order to catch and study the stone.
strain
asparagus beer and colas beets cabbage celery spinach chocolate and cocoa fruits green beans nuts tea tomatoes rhubarb coffee wheat/bran
food highs in oxalate `
goose organ meats sardines, herring, salmon venison moderate in beef chicken crab pork veal
purine rich foods (should be avoided if they have a kidney stone)
surgical removal of a stone through an incision in the back
lithotomy
if larger than 10 mm, the pain is not managed, and the nausea and vomiting is severe then…
- extra corporeal shock wave lithotripsy
- retrograde ureteroscopy
- laser lithotripsy
treatment for kidney stones
as the stone moves the pain will ______.
increase
what are you evaluating in the duration of the treatment of kidney stones?
patient’s pain is managed
infection is controlled
diet is appropriate
fluid intake is appropriate
infection urinary stasis and retention immobility dehydration increase in uric acid increase in urinary oxalate
risk factors for kidney stones
prostate problems are no _______ ?
F frequency U urgency N nocturia - hematuria - increase infections - decrease urinary streams - increase in residual urine
gives strength to micturition and squeezes fluid to the urthera.
function of the prostate gland
age family history obesity DM Testosterone decreased activity
risk factors for benign prostatic hypertrophy
half of the men after age __ have BPH.
60
- Hesitancy ~ Frequency ~ Diminished force of urinary stream ~ Increased urge to urinate ~ Sensation of incomplete emptying ~ Nocturia ~ Straining to begin urination ~ Post void dribbling
manifestations of benign prostatic hypertrophy
light red to red: normal day of surgery and first post op day
very dark red: may indicate increased venous bleeding or inadequate dilution. catheter at risk for occlusion. increase the flow rate and notify physician.
bright red: may indicate arterial bleeding. increase flow rate, monitor VS, and notify physician.
contains blood clots: occasional blood clots are normal. frequent indicated the catheter may be obstructed. increase the flow rate.
clear to light pink: normal through hospitalization.
nursing implications in regard to urine characteristics after surgery.
what is the goal of continuous bower irrigation
promotion of the outflow of urine.
gold standard for the treatment of BPH.
Transurethral Resection of the Prostate (TURP)
