Nursing 107 Exam #4 Flashcards
1
Q
What are normal components of urine?
A
Water, sodium, chloride, potassium, calcium, bicarbonate, urea, creatinine
2
Q
What components should not be in urine?
A
Glucose, protein, blood
3
Q
What does very pale yellow urine represent?
A
Diluted urine
4
Q
What does dark amber urine represent?
A
Concentrated urine
5
Q
What does Dark red/brown urine represent?
A
Blood in urine
6
Q
What does tea brown colored urine represent?
A
Bilirubin in urine
7
Q
What does green colored urine represent?
A
Gentimycin (antibiotic)
8
Q
What does orange colored urine represent?
A
pyridium
9
Q
What does red urine represent?
A
rifampin & myoglobin
10
Q
What does smokey colored urine represent?
A
Red blood cells
11
Q
What does cloudy turbidity of urine mean?
A
infection, high levels of urinary protein
12
Q
What is the normal urine specific gravity?
A
1.005-1.030
13
Q
What causes a specific gravity of less than 1.005 (diluted urine) mean?
A
Diuretics, fluid overload, diabetes insipidus
14
Q
What causes a specific gravity of more than 1.030 (concentrated urine)
A
Dehydration, SIADH, decreased renal perfusion
15
Q
What is the average and normal pH of urine?
A
Average = 6 Normal range (4.6-8)
16
Q
Why do changes occur in the pH of urine?
A
Diet, medications, acid base imbalance, altered renal function
17
Q
What does the positive finding of protein in urine mean?
A
Renal disease, stress, infection, and strenuous exercise
18
Q
What does glucose in urine mean?
A
Reflects hyperglycemia in the blood
19
Q
What happens when the blood sugar >180?
A
The renal threshold for what kidneys can save has been exceeded
20
Q
What does urine that is positive for ketones mean?
A
Incomplete metabolism of fatty acids
21
Q
What causes ketones in urine?
A
DKA, prolonged fasting, anorexia nervosa, adkins diet (high protein that causes the body to breakdown fats for fuel)
22
Q
What causes the urine to test positive for nitrites?
A
Presence of nitrite-forming bacteria including E. coli, Citrobacter, Enterobacter, Klebsiella, Proteus, Pseudomonas, Salmonella & some species of staphylococcus
23
Q
What is the normal reading of RBC in urine?
A
0-2 per high power field
24
Q
What causes a increased reading of RBC in urine?
A
catheterization, menses, abnormal tumors, stones, trauma, glomerular disorders, cystitis, or bleeding disorders
25
What is the normal reading of WBC in urine?
0-3 in males
| 0-5 in females
26
What causes increased numbers of WBC in the Urine
Infection or inflammation anywhere in the renal/urinary tract, renal transplant rejection, fever, or exercise
27
What is the normal reading of Casts in urine?
few or none
28
What causes an increase in Casts in urine?
renal disease, infections, transplant rejection
29
What is the normal reading of crystals in the urine?
none
30
What are crystals?
Crystals are salts that precipitate in the urine.
31
Large number of crystals are common in what patients?
urolithiasis (kidney stone), gout, high dietary intake of foods rich in purines, or receiving chemotherapy
32
What is the normal count of bacteria found in the urine?
Normal is less than 1000 colonies/ml
33
What is the normal reading of parasites in the urine?
none
34
What does the presence of Trichomonas vaginalis indicate?
infection, usually of the urethera, prostate or vagina
| Considered STI
35
What is the most common organism in community acquired infection from fecal organism?
E. Coli
36
What organisms cause infection in hospitalized patients?
Staph, Klebsiella, Proteus, Enterobacter
37
What are the risk factors in UTI development?
Age, altered immunity, DM, obstruction of urine flow, (BPH, kidney stone) sexual activity (diaphragm use), pregnancy, urinary stasis, catheterization
38
What are the s/s for a UTI?
Frequency, urgency, dysuria
39
What are the nonspecific s/s for UTI in the elderly?
Lethargy, altered sensorium (LOC), low grade fever, anorexia, new onset of incontinence
40
What are some common drug treatments for UTI?
Antibiotics, Urinary Antiseptics, and Bladder Analgesics
41
What is are two lower UTI's names?
Cystitis and Urethritis
42
Describe Cystitis
Bladder inflammation
Acute or chronic
Urgency, frequency, pain, spasms
43
Describe s/s of Urethritis
Painful urination
Discharge
Neisseria gonorrhea
44
Describe an upper UTI?
Inflammation of renal pelvis and kidney
Usually results from bacterial infection ascended from bladder
Sudden onset of fever & chills, dull flank pain
45
What are some complications of Pyelonephritis (Upper UTI)?
Chronic renal failure
Inflamed pelvis
Dilated ureter
Scar tissue
46
What is Glomerulonephritis?
Acute nephritic syndrome
47
How is Glomerulonephritis contracted?
Usually follows upper respiratory infection caused by Streptococci
48
What are the s/s of Glomerulonephritis?
Hematuria, proteinuria, red cell casts, oliguria, edema, pruritus, nausea, constipation, hypertension, increasing BUN & Creatinine.
49
What is BUN?
Blood Urea Nitrogen
| Urea=nitrogen compound formed in the liver from ammonia as an end product of protein metabolism.
50
What does BUN tell us?
Reflects both protein intake and renal excretion function.
51
What are the normal levels of BUN?
Newborn: 5-17 mgdL
Youth: 7-17 mg/dL
14 yo - adult: 8-21 mg/dL
Adult >90 yo: 10-31 mg/dL
52
What are some reasons for abnormal high BUN?
Acute renal failure, chronic glomerulonephritis, HF, decreased renal perfusion, excess protein intake, GI bleeding, muscle wasting from starvation, dehydration.
53
What are some reasons for abnormal low BUN?
Inadequate dietary protein intake, malabsorption syndrome, pregnancy, overhydration, severe liver disease
54
What is Serum (blood) Creatinine?
End product of creatine metabolism
55
What are normal levels of Serum (blood) creatinine?
1-5 yo: 0.3-0.5 mg/dL
6-10 yo: 0.5-0.8 mg/dL
Adult male: 0.6-1.2 mg/dL
Adult female: 0.5-1.1 mg/dL
56
What are some reasons for high creatinine levels?
Increased muscle mass, decreased renal blood flow (HF, shock), decreased renal excretion, released from damaged muscle
57
What are some reasons for low creatinine levels?
Decreased muscle mass (increasing age, muscular dystrophy, small stature, inadequate protein intake), increased GFR (Hyperthyroidism)
58
What is Creatinine Clearance?
Ideal substance for determining renal clearance
| Measures a blood sample with urine sample to determine rate at which the kidneys are clearing creatinine from the blood.
59
What is Glomerular Filtration Rate (GFR)?
Best indication of overall kidney function based on 24hr urine collection. Shows how well the renal system clears creatinine
60
What is the normal BUN/Creatinine ratio?
10:1 and 20:1
61
A ratio > than 20:1 indicates what in BUN/Creatinine ratio?
decreased renal perfusion
62
A ration < than 10:1 indicates what in BUN/Creatinine ratio?
diminished protein intake or liver dysfunction
63
Ratio of BUN/Creatinine can remain normal with intra-renal failure? T or F
True
64
Which is drawn up first in a Peak & Trough level test?
Trough is drawn 1st, then Peak 2nd
65
What drugs require peak/trough testing?
Aminoglycosides, Amphotericin B, Antibiotics, Systemic antifungals, ACE inhibitors, NSAIDS, Radiographic contrast agents
66
A quantitative analysis of a composite urine sample for levels of creatinine, urea nitrogen, sodium, chloride, calcium or catecholamine is called?
24 hour urine test
67
X-ray of the kidneys, ureters, and bladder to screen for presence of 2 kidneys, measure kidney size, and to detect gross obstruction is called what?
KUB
68
Uses sound waves to identify the size of the kidneys, obstruction, tumor, or cysts. Minimal risk to the client. This is called?
Ultrasound
69
This procedure has a radiopaque dye the is injected intravenously. The dye circulates into the kidney blood vessels and excreted in the urine. A series of x-rays are taken at various times after injection. Helps evaluate kidney function, renal calculi, and trauma is called?
IVP
70
Blood test that provides information about renal impairment is?
BUN, CR
71
This is performed under general anesthesia or local anesthesia with sedation. Scope goes through the urethra and into the bladder to examine for trauma, obstruction, tumor, or enlarged prostate gland?
Cystoscopy
72
The catheter is inserted into the femoral artery and threaded into the renal arteries. Radiopaque dye is injected into vessel and x-rays taken to determine areas of narrowing or obstruction. Bleeding from the insertion site is the most common complication.
Renal angiogram
73
This provides information on components present in urine sample. Abnormal results include blood, protein, glucose, white blood cells.
UA
74
This analyzes presence of bacteria and determines which drugs are effective at killing or stopping growth of the bacteria?
C & S
75
A decrease in this occurs with increased fluid intake, diuretic administration, and diabetes inspidus. An increase occurs with dehydration, ADH, and decreased renal perfusion.
Specific gravity
76
Provides 3-dimentional information about the kidneys, ureters, bladder, and surrounding tissues. May be performed with contrast medium.
CT Scan
77
Urine test used to screen for urinary tract infection?
UA
78
Most common type of this problem. Associated with childbirth?
Stress Incontinence
79
Blood test used to evaluate hydration status & kidney function?
BUN
80
Abnormal substance found in urine with diabetes mellitus?
Glucose
81
Spread of infection from the urinary tract to the bloodstream?
Urosepsis
82
Involuntary loss of urine assocated with strong desire to urinate?
Urge Incontinence
83
Definitive lab used to diagnosis renal function. Associated with amount of muscle mass?
Creatinine
84
Abnormal finding in urine. Passes thru damaged glomerular membranes?
Protein
85
Type of exercise used to strengthen pelvic floor muscles?
Kegel
86
Detrusor muscle fails to contract and bladder becomes overdistended?
Overflow incontinence
87
Density of urine compared with water. Increased amount occurs with dehydration?
Specific Gravity
88
Presence of this substance indicates incomplete metabolism of fatty acids?
Ketones
89
Plural form of calculus. Another name for kidney stone?
Calculi
90
Decline in cognitive function contributes to this disorder rather than bladder or urethra problems?
Functional Incontinence
91
Used for diagnostic or treatment of bladder problems. Requires OR permit?
Cystoscopy
92
Abnormal finding in UA that indicates presence of bacteria that form this substance?
Nitrite
93
Term that means blood in urine?
Hematuria
94
Condition that develops after infectious & autoimmune diseases cause intra-renal damage. Classic symptom is morning facial edema?
Glomerulonephritis
95
Diagnostic exam where dye is injected into the kidney. Contrast dye can cause kidney damage?
IVP
96
Rare to find this substance in fresh urine sample. Can form into kidney stones?
Crystals
97
Painful symptom assoc with movment of kidney stones through ureters?
Colic
98
Presence of active organisms in kidney or effects of kidney infections?
Pyelonephritis
99
Test that requires a full bladder to allow visualization of GU organs. Test can identify obstructions, tumors, cysts, and other masses with contrast dye?
Ultrasound
100
Increased # of this substance in urine indicates need for culture to determine infection?
Bacteria
101
Increased # of cells and enlargement of prostate leads to urine flow problems?
BPH
102
Most common type of cancer in men. Only diagnosed by biopsy?
Prostate CA
103
May be the only symptom elderly patients who have UTI present with?
Confusion
104
"Plain film" of the abdomen that can show anatomic features, stones, strictures, calcifications in urinary tract?
KUB x-ray
105
Inflammation of the prostate gland. May be bacterial, viral, STD, or autoimmune?
Prostatitis
106
Most common cause of this inflammation is bacterial infection or complication of STD. Symptoms of pain along injuinal canal & along vas deferens. Untreated it can cause abscess that requires orchiectomy.
Epididymitis
107
Most common cause of hospital acquired infection?
CAUTI
108
AKA impotence. 2 main classifications: organic and functional?
ED
109
What three drugs are commonly used for treating a UTI?
Macrodantin
Septra DS
Ciprofloxin
110
What are the nursing considerations for Macrodantin?
```
Take with food to avoid GI upset
Avoid taking with antacid
Encourage fluids
Monitor i/o
Check urine culture and sensitivity results
```
111
What is low dose Macrodantin prescribed for?
bacteriostatic for chronic UTI
112
What is high dose Macrodantin prescribed for?
bactericidal
113
What are the adverse effects for Macrodantin?
GI disturbances, N/V, diarrhea, abdominal pain, dyspnea, chest pain, fever and cough.
In long term use peripheral Neuropathy
114
This commonly prescribed drug for UTI is usually given in double strength due to resistance and has been around for nearly forever. Can be in the first line treatment, for 3 days. Need to be careful of sun exposure. Also causes increased risk of SJS?
Septra DS
115
This drug commonly given for UTI can be used for other infections such as penumonia?
Quinolones: example are ciprofloxacin "Cipro"
116
This drug has been on the market for over 40 yrs. Used to treat the pain, urgency and frequency of a UTI. May cause GI upset, Nausea. May also cause nephrotoxicity and hepatotoxicity. It does not treat the infection. Urine becomes reddish orange?
Pyridium = Urinary Analgesics
117
What type of drug would be prescribed for bladder function decreased due to neurogenic bladder due to spinal cord injury, head injury, or other CNS lesion?
Bladder Stimulants
118
This drug type can be used to stimulate micturition; it is a direct acting parasympathomimetic; it increases the tone of the detrusor urinary muscle, which produces a contraction strong enough to stimulate urination.
Urecholine
119
Give two examples of Urinary antispasmodics?
Ditropan and Detrol
120
These drugs decrease the urge urinary incontinence and is used to control overactive bladder?
Ditropan and Detrol
121
Urinary antispasmodics have anticholinergic side effects, what are they?
Hot flashes, mouth drys out, blurred vision, confusion, redness, urinary retention.
122
Who is contraindicated in urinary antispasmodics?
Cardiac, renal hepatic and patients with prostate problems
123
Problems of BPH are?
Bladder fullness, frequency, nocturia, and erectile dysfunction
124
How is BPH treated?
5 Alpha-Reductase Inhibitors (Proscar)
| Alpha-Adrenergic Blocking Agents (Flomax)
125
This 5 Alpha-reductase inhibitors lowers the levels of DHT (testosterone) with the goal of shrinking the prostate gland. May take 6 months?
Proscar
126
What are the side effects of Proscar (5-Alpha-Reductase Inhibitor)?
decreased libido, erectile dysfunction. Not recommended for women.
127
What are some off label use for Propecia?
promotes hair regrowth in patients with male pattern baldness. Much lower doses (5 times lower)
128
What is the generic name for Alpha-Adrenergic Blockers?
Flomax
129
What are some side effects of Flomax?
first dose hypotension, syncope, dizziness, avoid alcohol and activities requiring alertness until effects are known.
130
This gland enlarges under the influence of testosterone in males. Enlarged gland creates physical obstruction of urethra?
Prostate gland
131
This interferes with testosterone metabolism?
Alpha-reductase inhibitors
132
This prevents the activation of alpha receptors? Which causes the smooth muscle in the urethra and neck of bladder to relax and open the lumen?
Alpha-adrenergic blockers
133
What is the prototype drug for Androgen Hormones?
Testosterone
134
This may be use for hypogonadism - failure of the testes to produce androgen, sperm or both? It can result in defective primary or secondary sexual development which may result in infertility. It is usually started with a six month trial, then rest and reevaluate. If long term therapy is needed either injections or a patch can be used.
Testosterone
135
This drug can be given for growth delay: may be due to an androgen deficiency or a deficiency of growth hormone. Therapy will be initiated after age 14, but before growth plates are closed.
Testosterone
136
What are the side effects of Androgen (Testosterone)?
Abdominal pain, nausea, insomnia, diarrhea and constipation. May cause an increase in blood cholesterol levels.
137
This increases protein synthesis within cells, resulting in buildup of cellular tissue = larger muscles
Anabolic androgenic steroids
138
What are some of the side effects of AAS?
Can cause sudden increase in weight and size, mood changes, person can become more aggressive and physical. Excessive intake can cause increase in cholesterol levels, acne, high blood pressure, liver damage and changes in the left ventricle of the heart. Effects may not be seen until years later.
139
What are Anti androgens used for?
Treatment of prostate cancer
140
What do Anti androgens do?
block conversion of testosterone to its active form. By blocking androgens, the drugs prevent androgens from encouraging the cancer to grow.
141
What are some examples of Anti-androgens?
Eulexin
Cyproterone Acetate
Proscar
142
What are the side effects of Anti-androgen?
Mood and cognitive changes (especially depression), muscle strength, loss of libido, gynecomastia (male breasts that enlarge and become tender).
143
This drug relaxes smooth muscle, allowing for increased blood flow to the penis?
Viagra
144
What are the side effects and contraindications?
Hypotension
| Contraindicated with nitrates due to unsafe drop in BP.
145
What is orchitis?
Testicle inflammation in males
146
What are some s/s of STD?
Urethral discharge, and & swelling in scrotum & groin, pain on ejaculation, blood in semen and risk for sterility.
147
Define Hypercalcuria?
Hypercalciuria, or excessive urinary calcium excretion, is the most common identifiable cause of calcium kidney stone disease.
148
What is Nephrotic Syndrome?
A kidney disease where the protein is found in the urine
149
What are some s/s of Nephrotic Syndrome?
Severe edema around the eyes, ankles and feet, foamy urine caused by excess protein in urine, and weight gain due to excess fluid retention.
150
What is Vesicoureteral reflux in pediatrics?
Backflow of urine from the bladder into the ureters during voiding.
151
What are the s/s of a UTI in children?
Newborn: non specific, may have fever or hypothermia, FTT, poor feeding, vomiting, diarrhea, strong-smelling urine, irritability.
Toddle years begin classic s/s
152
What is myelomeningocele in a pediatrics?
When the spinal cord does not develop normally and it interrupts to nerve supply to the bladder resulting in a neurogenic bladder.
153
What is Enuresis in pediatrics?
Repeated involuntary voiding by a child old enough that bladder control is expected ~5-6
154
What are some risk factors for Enuresis in pediatrics?
Family hx of bedwetting, smaller functional capacity of bladder, children are harder to arouse, lack of circadian rhythm of vaspressin, obstructive sleep apnea, constipation.
155
What are some medications that might help with Enuresis in Pediatrics?
Imipramine: tricyclic antidepressant
Desmopressin: ADH effect, $$ save for sleepovers
Oxybutynin: daytime urgency & frequency
156
What drugs are used to treat a UTI?
Macrodantin, Septra DS, Ciprofloxin
157
What are some nursing concerns with Macrodantin?
Take with food to avoid GI upset, do not take with antacid, encourage fluids, monitor I/O, check urine culture
158
What are some SE of Macrodantin?
GI disturbances, n/v, diarrhea, abd pain, dyspnea, chest pain, fever and cough.
159
What are some SE of Pyridium?
GI upset, nausea, neprotoxicity and hepatotoxicity
160
Why are bladder stimulants prescribed?
Bladder function decreased due to neurogenic bladder,
| Due to spinal cord, head or other CNS injury.
161
What drugs are used to stimulate the bladder and how do they work?
Urecholine, which is a direct actying parasympathomimetic; it increases the tone of the urinary muscle, which produces a contraction to urinate.
162
What is an example of a Urinary Antispasmodic and what do they do?
Ditropan
| decrease the urge of urinary incontinence
163
What are the SE of Ditropan and who is it contraindicated for?
Pt should report signs of urinary retention, blurred vision, palpitations, confusion.
contraindicated with cardiac, renal hepatic and prostate problems.
164
What drug is BPH treated with?
Proscar and Flomax
165
How does Proscar (BPH) work?
Lowers the DHT levels with the goal of shrinking the prostate gland.
166
What are the SE of Proscar?
Decreased libido, ED and may take 6 months to work.
167
What are the therapeutic effects of Flomax (BPH)?
Decreased symptoms of prostatic hyperplasia.
168
What are the SE of Flomax?
first dose hypotension and syncope, dizziness, avoid alcohol and activities requiring alertness.
169
What drug is a Androgen Hormone and why is it used?
Testosterone - used for hypogonadism (failure of the testes to produce androgen, sperm or both).
170
What are the SE of Androgen (Testosterone) use?
abd pain, nausea, insomnia, diarrhea & constipation, may increase blood cholesterol levels, Women may develop secondary male characteristics: facial hair, acne and husky voice.
171
What are Anti-androgens used for and how do they work?
They block conversion of testosterone to its active form. Used in the treatment of prostate cancer.
172
What are some SE of Anti-androgens?
Mood and cognitive changes, muscle strength, loss of libido, gynecomastia (breasts in men)
173
When does the Foramen Ovale completely close in an infant?
The Foramen Ovale can take several months to completely close.
174
When does the Ductus Arteriosus completely close in an infant?
Ductus closes within 15-72 hrs of birth and becomes permanently sealed within the 1st month of life.
175
What are the two main categories of defects in pediatric cardiology?
Acyanotic and Cyanotic
176
Where does the blood flow in acyanotic defect?
Left to right (shunt) due to opening present between the right and left sides of the heart.
177
What effect does an acyanotic defect cause?
Increases the volume of blood flowing to the lungs.
178
What are the s/s of acyanotic defect?
Increased cardiac workload, right ventricular strain, right ventricular hypertrophy, CHF, pulmonary hypertension.
179
What are three examples of acyanotic defects?
Patent ductus arterious (PDA)
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
180
What is a clinical manifestation of Patent Ductus Arteriosus (PDA)?
Fatigue, sweating, tachypnea, dyspnea, disinterest or tiring while feeding, FTT, freq pulmonary infections
181
What is a clinical manifestation of Tetralogy of Fallot (TET)?
Difficulty feeding, FTT and Cyanotic or TET spells
182
What is a clinical manifestation of Transposition of the great arteries (TGA)?
Prominent cyanosis, Tachypnea >60 with retractions, dyspnea, tachycardia, cool, clammy skin.
183
What is the long term outlook for infants with PDA?
If left untreated: life span will be decreased due to pulmonary hypertension and development of vascular obstructive disease. Uncomplicated PDA repair will live normal, healthy lives.
184
What is Tetralogy of Fallot?
Most common cyanotic congenital heart defect that refers to 4 heart problems: pulmonary artery stenosis, pulmonary artery is narrowed and stiff, right ventricular hypertrophy, over-riding aorta
185
What is the long term outlook of TET?
Not all children are cured by surgery, but they do have improved quality of life and longevity. Uncomplicated repair will live normal healthy lives.
186
What is the log term outlook of TGA?
Fatal without surgery, many will grow and develop normally. Tachy, brady, or irregular arrhythmias.
187
What is the therapeutic effects of indomethacin?
Stimulates the muscles inside the artery to constrict and causes closure of PDA 75-80% of the time.
188
What is the therapeutic effects of prostaglandin E?
It keeps the smooth muscle in the ductus relaxed in the ventricular septal defect.
189
What causes a TET spell in a child?
Crying, feeding, BM or exertion temporarily increases the pressure in the lungs.
190
What happens to myocardial cell function during periods of hypoxemia?
Triggers the kidneys to produce erythropoietin to stimulate the bone marrow to produce RBC.
191
What are the long term effects of chronic hypoxia?
Impaired cognitive and psychomotor development
192
Explain the surgical procedure involved in TET?
Usually done at 3-12 mos
| VSD patched, pul artery is enlarged, and a palliative shunt.
