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objective 6 Flashcards

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1
Q

what is the purpose of the renal system?

A
  • Maintain fluid and electrolyte homeostasis
  • Excrete urine
  • Buffering system to control pH
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2
Q

what is the renal system critical to the production of?

A
  • Synthesize vitamin D to active form (necessary for
    maintaining blood calcium balance
  • Hormone that stimulates red blood cells (erythropoietin)
  • Hormone that regulate blood pressure (renin)
  • Activate growth hormone
  • Secrete prostaglandins
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3
Q

absence of urine

A

anuria

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4
Q

an increase in the volume of urine

A

diuresis

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5
Q

painful urination

A

dysuria

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6
Q

involuntary nocturnal urination

A

enuresis

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7
Q

when the pt voids more frequently than what is usual for the pt

A

frequency

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8
Q

inflammation of the kidney

A

nephritis

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9
Q

blood in the urine

A

hematuria

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10
Q

difficulty initiating urination

A

hesitancy

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11
Q

the inability of control urination or defecation

A

incontinence

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12
Q

means the presence or formation of stones

A

lithiasis

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13
Q

excessive urination at night

A

nocturia

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14
Q

a decrease in the formation or passing of urine

A

oliguria

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15
Q

the passing of an abnormally large amount of urine

A

polyuria

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16
Q

the presence of an abnormally large amount of protein in the urine

A

proteinuria

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17
Q

the presence of an abnormal amount of white blood cells in the urine

A

pyuria

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18
Q

the inability of the pt to empty their bladder

A

urinary retention

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19
Q

an intense desire to urinate immediately

A

urgency

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20
Q

what are the factors that promote proper renal and urinary function?

A
  • Adequate flow of blood to and from the kidney- good blood pressure,
    sufficient volume (intake of fluids)
  • Functioning filtering system: nephrons, afferent (to) and efferent
    (from) arterioles supply and flow
  • Patent ducts from kidney (ureter) and from bladder
  • Intact bladder (no holes, tears)
  • Proper nerve innovation and info relay (hormones)
  • Functioning pelvic floor muscles ( and spincter function
  • Proper pH
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21
Q
  • A waste product that comes from the normal wear and tear on muscles of the body.
  • Creatinine levels in the blood can vary depending on age, race and body size.
  • Higher than normal levels may be an early sign that the kidneys are not working properly.
  • As kidney disease progresses, the level of creatinine in the blood rises. 53–106 mcmol/L (men)
    44–97 mcmol/L (women).
A

serum creatinine

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22
Q
  • Comes from the breakdown of protein in the foods you eat.
  • A normal BUN level is between 6–25, with 15.5 being the best value.
  • As kidney function decreases, the BUN level rises.
  • Common medications, including large doses of aspirin and some types of antibiotics, can also increase
    your BUN
A

blood urea nitrogen

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23
Q
  • measures of how well the kidneys are removing wastes and excess fluid from the blood.
  • It is calculated from the serum creatinine level using age and gender with adjustment for those of
    African American descent.
  • The normal value for GFR is 90 or above.
  • A GFR below 60 is a sign that the kidneys are not working properly.
  • Once the GFR decreases below 15, one is at high risk for needing treatment for kidney failure, such as
    dialysis or a kidney transplant.
A

estimated glomerular filtration rate

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24
Q

A 24-hour urine test shows how much urine your kidneys produce
can give an more accurate measurement of how well your kidney are working and
how much protein leaks from the kidney into the urine in one day.
compares the creatinine in a 24-hour sample of urine to the creatinine level in
your blood to show how much waste products the kidneys are filtering out each
minute

A

creatinine clearance test

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25
Q

Includes microscopic examination of a urine sample as well as a dipstick test.
 The dipstick is a chemically treated strip, which is dipped into a urine sample.
The strip changes color in the presence of abnormalities such as excess amounts
of protein, blood, pus, bacteria and sugar.
A urinalysis can help to detect a variety of kidney and urinary tract disorders,
including chronic kidney disease, diabetes, bladder infections and kidney stones.

A

urinalysis (R&M)

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26
Q
  • Affect upper and lower urinary tract
  • Inflammation of urinary tract, usually by bacterial infection (E. coli)
  • Classified as: Complicated or uncomplicated; initial or recurrent;
    unresolved or bacterial persistence
A

urinary tract infection

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27
Q

what are the lower UTI emptying symptoms?

A

weak urinary system
hesitancy
intermittency
postvoid dribbling
urinary retention or incomplete emptying dysuria

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28
Q

difficulty starting the urine stream resulting in a
delay between initiation of urination by relaxation of the urethral
sphincter and when urine stream actually begins

A

hesitancy

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29
Q

interruption of the urinary stream

A

intermittency

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30
Q

urine loss after completion of voiding

A

postvoid dribbling

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31
Q

inability to empty
urine from the bladder, which can be caused by atonic bladder or
obstruction of the urethra. Can be acute or chronic

A

urinary retention or incomplete emptying

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32
Q

difficulty voiding; pain on urination

A

dysuria

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33
Q

what are the lower UTI storage symptoms?

A

urinary frequency
urgency
incontinence
nocturia
nocturnal enuresis

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34
Q

what are the gerontologic considerations and UTIs?

A
  • High incidence of chronic illness
  • Frequent use of antimicrobials
  • Presence of infected pressure ulcers
  • Immunocompromised
  • Cognitive impairment
  • Immobility and incomplete emptying of bladder
  • Use of bedpan rather than toilet
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35
Q

Inflammation of the urinary bladder
* Bacteria can invade the bladder from an infection in the
kidneys, lymphatics and urethra
* Causes include urologic invasive procedures, fecal
contamination, prostatitis or BPH, pregnancy & sexual
intercourse (honeymoon cystitis)

A

cystitis

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36
Q

what are the S&S of cystitis?

A
  • Urgency
  • Frequency
  • Low back pain
  • Dysuria
  • Perineal and suprapubic pain
  • Hematuria
  • May experience fever and chills
  • Urinalysis reveals increase in WBC and RBC
  • C&S will identify organism
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37
Q

what is the medical management of cystitis?

A
  • Antimicrobial therapy (e.g., Septra)
  • Cranberry juice and vitamin C recommended to
    keep bacteria from adhering to bladder wall
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38
Q

what is the nursing care for cystits?

A
  • CNI
  • Encourage extra fluids (at least 8 large glasses with at least one glass
    of cranberry juice) excluding coffee, tea, alcohol, & colas- UT irritants
  • Emphasize the importance of finishing prescribed course of
    medication
  • Instruct client on preventive measures
  • Void at regular 2-3h intervals & after sexual intercourse
  • Shower rather than tub bathe
  • Clean perineum with front to back motion
  • Wear cotton underwear
  • Avoid irritating substances (e.g., bubble bath, vaginal sprays)
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39
Q
  • Inflammation of the urethra
  • More commonly seen in men than women
  • If caused by organisms other than gonococci – non-gonococcal
    urethritis
  • Gonorrhea attacks urethral mucous membranes
  • Women: may accompany cystitis or result from a vaginal infection or
    soaps, sanitary napkins or scented toilet tissue
  • Men: Chlamydia, trauma or instrumentation, rectal intercourse or
    intercourse with a woman with vaginal infection
  • Discomfort during urination & frequency
  • Fever not common
  • In male may be due to spread of infection to the prostate or testes
A

urethritis

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40
Q

what is the medical management of urethritis?

A
  • Antibiotic therapy
  • Increased fluid intake (water, cranberry juice)
  • Avoid fluids which are UT irritants
  • Analgesics
  • Warm sitz baths
  • Good diet and plenty of rest
  • If STI, prompt treatment
41
Q

what is the nursing care for urethritis?

A
  • CNI
  • Reinforce the importance of receiving and completing prescribed
    treatment
  • Encourage fluids
  • Warm sitz baths/analgesics for pain
  • Preventive measures
  • Sterile/gentle technique with catheterization
  • Frequent perineal care (especially if incontinent)
  • Client and family teaching re: causes & prevention
  • E.g., hygiene; use of condom/abstinence to prevent spread of
    infection; avoid irritants
42
Q
  • Chronic, painful inflammatory disease of the bladder wall that
    causes disintegration of the lining and loss of bladder elasticity
  • Believed to be associated with an autoimmune or allergic
    response
A

interstitial cystitis

43
Q

what are the clinical manifestations of interstitial cystitis?

A
  • Pain and UTI’s are clinical manifestations
  • Pain is suprapubic, or entire perineal region.
  • Pain relieved by urination
44
Q

what is the collaborative care of interstitial cysitis?

A
  • Dietary and lifestyle changes
  • Medications to control symptoms
  • Reassurance
45
Q
  • Inflammation of the renal pelvis, tubules and collecting system of one
    or both kidneys.
  • Normal fecal flora such as E. coli (85%) and Staph aureus are
    common causes
A

pyelonephritis (upper UTI)

46
Q

results from active bacterial infection causing kidneys to
enlarge and develop abscesses. Prompt dx and Rx required to
prevent septic shock and death from urosepsis
* Urosepsis – systemic infection from a urological soursce

A

acute pyelonephritis

47
Q

results from repeat or continued upper UTI
* Chronic usually associated with anatomic UT anomaly, obstruction, or
vesicoureteral reflux (repeated or continued upper UTI)

A

chronic pylonephritis

48
Q

what are the clinical manifestations of acute pyelonephritis?

A
  • Kidneys inflamed &
    enlarged/abscesses
  • Flank pain/tender
    costovertebral angle (CVA)
  • Colicky abdominal discomfort
  • Chills, fever and malaise-
    systemically ill
  • Frequency, urgency and burning
    on urination if also have cystitis
  • Urine cloudy/foul odor
  • Leukocytosis
  • pyuria
49
Q

what are the clinical manifestations of chronic pyelonephritis?

A
  • Irreversible damage occurs; renal
    dysfunction may not occur for 20
    years or more. Eventual
    development of chronic renal
    insufficiency.
  • Asymptomatic or may have low
    grade fever, vague GI complaints,
    increased BP
  • Polyuria/nocturnal when tubules
    fail to reabsorb water efficiently
50
Q

what is the medical surgical management of acute pylonephritis?

A
  • Ensure adequate fluid intake
  • Avoid caffeine, alcohol, citrus juices,
    chocolate and spiced foods or
    beverages (irritant)
  • Management of the pain and fever
    (apply heat)
  • Antibiotics x 14 days (common for UTI:
    Septra, Cipro – can persist for 6 wks)
  • Stress importance of taking full
    course
  • Antispasmodics and anticholinergics
  • Follow-up urine cultures 2 wk post
    treatment
51
Q

what are the medical surgical management of chronic pyelonephritis?

A
  • Aim is to prevent further kidney
    damage
  • Surgery (nephrectomy) if severe
    hypertension develops & other
    kidney has adequate function
  • End stage renal disease
52
Q

what is the nursing care of acute/chronic pyelonephritis?

A
  • Monitor vital signs and urine
    characteristics ….note pyuria
  • Check blood work- serum
    creatinine & blood urea nitrogen
    (BUN), electrolytes; urine for C&S
  • I&O; Encourage fluid intake 2000-
    3000 mls daily
  • Encourage client to drink cranberry
    juice
  • Take all medications as prescribed
  • Follow up: check BP
  • Avoid alcohol, coffee, tea, cola if
    bladder spasms
  • Monitor for sudden onset of
    confusion, especially in elderly
  • Preventative measures: Void q 2-3
    hr. when awake and before &
    after intercourse; wipe front to
    back; wear cotton underwear;
    avoid irritating bath gels, etc.
53
Q

what is the prevention of pyelonephritis?

A
  • Prevention: avoid indwelling catheters; exercise proper care of
    catheters
  • Exercise correct personal hygiene
  • Take medications as prescribed: antibiotics, analgesics, and
    antispasmodics
  • Apply heat to the perineum to relieve pain and spasms
  • Increase fluid intake
  • Avoid urinary tract irritants such as coffee, tea, citrus, spices, cola,
    and alcohol
  • Frequent voiding
54
Q

what is the cause of transient incontinence?

A

Delirium, Infection of UT, Pharmacologic, Psychological, Excessive urine
production; restricted Activity, Stool Impaction (DIAPPERS)

55
Q
  • Involuntary loss of urine due to sudden increase in intra-
    abdominal pressure i.e. coughing, lifting, straining.
  • Commonly affects women who have had vaginal deliveries
A

stress incontinence

56
Q
  • Involuntary loss of urine associated with strong urge to
    void that cannot be suppressed (preceded by warning in
    advance)
  • Can occur in pt. with neurologic dysfunction that impairs
    inhibition of bladder contraction or in pt. without overt
    neuro dysfunction
A

urge incontinence

57
Q
  • Involuntary loss of urine due to hyperreflexia in absence
    of normal sensations usually associated with voiding
  • Spinal cord injuries
  • No warning or stress precedes periodic involuntary
    urinaiton
A

reflex incontinence

58
Q
  • Involuntary loss of urine due to “outside” factors – ex.
    Medications (Alpha blockers for BP – blocks alpha
    receptors responsible for bladder neck closing pressure–
    side effect is incontinence. Med is stopped and
    symptoms resolve.)
A

iatrogenic incontinence

59
Q
  • Lower urinary tract function is intact but other factors (ex.
    Severe cognitive impairment) make it difficult for pt. to
    identify need to void
A

functional incontinence

60
Q
  • The inability to urinate or effectively empty the bladder
  • Acute or Chronic
  • Acute: usually cannot void at all
  • Chronic: cannot completely empty the bladder (retention with
    overflow)
  • a large volume of residual urine
A

urinary retention

61
Q

s seen with complete urethral obstruction, after general
anesthetic, epidural anesthetic, post gyne/bladder surgery, childbirth,
or the administration of certain drugs

A

acute urinary retention

62
Q

is seen with disorders such as enlarged prostate or
neurologic disorders resulting in neurogenic bladder (does not get
adequate nerve stimulation)

A

chronic urinary retention

63
Q

what are the assessment findings for acute and chronic urinary retention?

A
  • Acute
  • Sudden inability to void, distended bladder, lower abdominal pain
    and discomfort
  • Chronic
  • May go unnoticed (become accustomed as the bladder has stretched
    over time)
  • May void frequently in small amounts or dribbling
  • May be signs of cystitis: fever, chills, pain on urination
  • Increased WBCs in urine
  • Important to determine postvoid residual (PVR)
64
Q

what is medical-surgical management for acute and chronic urinary retention?

A

ACUTE
* Immediate catheterization
* Intermittent (in and out)
* Indwelling
* May need instruments to
dilate urethra
CHRONIC
* Permanent drainage with a
urethral catheter or a
suprapubic cystostomy
* Clean intermittent
catheterization (CIC)
(preferred method)
* Condom catheter for men
* Crede voiding (applying
downward pressure to bladder
during voiding)
* Valsalva voiding (bear down
with defecation;
contraindicated in some
clients)

65
Q

what is the nursing care for acute urinary retention?

A
  • Conscious client will be able to
    verbalize discomfort of urinary
    retention; some others will not (e.g.,
    Alzheimer’s)
  • I&O, monitor voiding pattern ** (8 hrs
    post-op)
  • Palpate gently for a distended bladder
  • Collaborate with physician regarding
    catheterization (indwelling or
    intermittent and type, size)
  • Catheterized q 4-6h depending on
    volume obtained
  • If more than 400 mL should be
    catheterized more often
  • Bladder overdistention leads to loss
    of tone
66
Q

what is the nursing care for chronic urinary retention?

A
  • Assessment (voiding frequency, pain,
    etc.)
  • Intermittent catheterization
  • Indwelling
    catheter-urethral/suprapubic
  • Encourage fluid intake (2000-3000 mL)
    unless contraindicated
  • Especially those that acidify urine
    e.g., cranberry juice
  • Emotional support/teaching
  • Hygiene, perineal care, signs of UTI
  • Self-catheterization
  • Catheter care, taping, drainage
    bag below bladder level, ensure no
    kinking
67
Q

formation of a kidney stone in the urinary tract

A

nephrolithiasis

68
Q

a stone within the ureter

A

ureterolithiasis

69
Q

what are the predisposing factors of kidney and ureteral stones?

A

calciuria, dehydration, alkaline urine,
obstructive disorders causing urinary stasis, osteoporosis,
prolonged immobility, gout (uric acid crystallizes in urine)

70
Q
  • A calculus is a precipitate of mineral salts
  • 70-80% are mainly calcium-calciuria, excessive calcium in the
    urine, is a predisposing factor (immobility, water supply,
    excessive intake of vit D)
A

kidney/ureteral stones

71
Q

what are the 5 categories of stones?

A

Calcium phosphate, Calcium oxalate, uric acid, cysteine and
struvite (mg-ammonium phosphate)

72
Q

what are the clinical manifestations of kidney and ureteral stones?

A
  • Symptoms vary with size, location and cause of calculi
  • Usually sudden, sharp, severe flank pain radiating to the
    suprapubic area and external genitalia- classic symptom
  • Accompanied by renal or ureteral colic-”worst pain known to
    man”
  • Pain severity inversely proportional to stone size
  • The pain causes nausea, vomiting & shock
  • Urinary retention or dysuria (if obstructed)
73
Q

what is the nursing care for kidney and ureteral stones?

A
  • Assess/relieve pain, nausea & vomiting
  • Monitor levels of BUN, creatinine, electrolytes
  • Encourage ambulation & fluid intake (2000-2200 mL/day)
  • I&O; strain urine; check for hematuria, anuria (if bilaterally
    obstructed)
  • Encourage to void q 2-3 hrs/maintain patency of
    catheters/nephrostomy tubes
  • Strict asepsis to prevent microbes entering urinary tract
  • Emotional support & teaching
  • Avoid excessive milk intake, increase acid forming foods
74
Q
  • Most common malignant tumor of the urinary tract is
    transitional cell carcinoma of the bladder
  • Affects more men than women
  • Chronic recurrent stones (often bladder) and chronic lower
    urinary tract infections increase risk.
A

bladder cancer

75
Q

what are the risk factors of bladder cancer?

A
  • Cigarette smoking
  • Exposure to environmental
    carcinogens
  • Recurrent UTI’s
  • Bladder stones
  • High urinary ph
  • High cholesterol intake
  • Pelvic radiation
  • Cancer of prostate, colon and
    rectum in males
76
Q

what are the clinical manifestations of bladder cancer?

A
  • Gross, painless but visible
    hematuria (chronic or
    intermittent); most common
  • Bladder irritability with dysuria,
    frequency and urgency
  • Change in urinary pattern
  • Pelvic or back pain if metastasis
  • Dx: urine specimens for cytology,
    confirmed with cystoscopy and
    biopsy.
77
Q

what is the medical management of bladder cancer?

A
  • Transurethral resection,
    cystoscopy
  • Pharmacologic:
  • Opioid analgesics
  • stool softeners.
  • Chemotherapy (combo- with
    methotrexate, BCG)
  • Radiation (reduce
    microextension of tumor)
78
Q

what is the nursing care of bladder cancer?

A
  • Pre and Post op care: expected
    changes in urine color
  • Quit smoking, avoid alcohol
  • Assess for UTI (Apply CNI for UTI)
  • Stress routine urological follow-ups
  • 15- to 20-minute sitz bath two to
    three times a day to promote
    muscle relaxation and to reduce
    the risk of urinary retention
  • Listen to and provide education for
    fears and concerns
79
Q

(not technically a diversion device):
keeping drainage bag lower than bladder, choose right size
of catheter, lubricant, insert far enough to prevent trauma,
avoid manipulation (traumatize the urethra and bacteria
invade)

A

urinary catheter

80
Q

client ability to void is tested once
obstruction resolved; clamped until can void, then removed

A

suprapubic catheter

81
Q

tube from kidney to outside abdomen

A

nephrostomy tube

82
Q

implanting ureter into 12-cm loop of ileum to
abdominal surface with attached urostomy bag, stents
placed in ureters to prevent occlusion (care like any ostomy)

A

ileoconduit

83
Q

involves inability of nephrons in kidneys to
maintain fluid, electrolyte and acid-base balances, remove
nitrogenous waste products and perform regulatory
functions
Develops as a consequence of various factors such as
decreased blood flow, conditions which damage nephrons
and obstructive disorders

A

renal failure

84
Q

what are the 2 types of renal failure

A

acute
chronic

85
Q
  • Complex disorder with many etiological factors and variant clinical
    manifestations
  • Develops as a consequence of:
  • prerenal (e.g., hypovolemic shock, decreased CO)
  • intrarenal (e.g., nephrotoxicity, lupus)
  • postrenal (e.g., enlarged prostrate, stones) disorders (Chart 45-2 pg.
    1413)
  • Rapid accumulation of toxic wastes occurs (azotemia)
  • serum urea (BUN) and creatinine (CR) levels rise;
  • BUN accumulates when protein is broken down; CR is a waste product of
    the muscles
  • Serum creatinine (CR) good indicator of kidney function
  • Client becomes oliguric and treatment directed towards correcting
    cause and preventing permanent damage
A

acute renal failure

86
Q

what are the 4 stages of acute renal failure?

A

initiation or onset
maintenance
recovery
prevention

87
Q

Once acute kidney injury occurs S&S appear
within hrs/days (initiation)

A

initiation or onset

88
Q

Accompanied by a reduced blood flow to kidney leading to
acute tubular necrosis (death of cells in collecting tubules of nephrons), CR,
UR, K, MG

A

oliguric-anuric

89
Q

gradual increase in U/O glomerular filtration has started to recover -
lots of fluid loss but remain uremic

A

diuresis

90
Q

what is medical management of acute renal failure?

A
  • IV therapy
  • Hemodialysis
  • Peritoneal dialysis
  • Fluid and dietary restrictions
    complex/individualized and
    depend on use of dialysis
    (low/high protein, low Na & K,
    phosphorus, increased Ca,
    decreased fat if
    hyperlipidemia)
  • Correct anemia (iron/vit
    supplements)
91
Q

what are potential nursing diagnoses?

A

excess fluid volume
imbalanced nutrition
risk for impaired skin integrity
activity intolerance
risk for infection
risk for electrolyte imbalances
risk for ineffective coping

92
Q
  • The kidneys are so badly damaged that they do not adequately:
  • remove protein by-products and electrolytes from the blood,
  • maintain acid-base balance
  • perform regulatory functions such as maintaining calcification of bones and
    producing erythropoietin (needed for RBC production).
  • Classified into 5 stages (table 49-6)
  • Renal insufficiency stage occurs when 75% of nephron function is lost
  • End-stage renal disease (ESRD) when 85-90% of nephrons are lost
    (stage 5)
A

chronic renal failure

93
Q
  • Procedure for cleaning and filtering the blood
  • Provides a substitute for kidney function when the kidneys
    are unable to remove waste products, maintain fluid
    electrolyte and acid-base balances
A

dialysis

94
Q

what are the 2 types of dialysis?

A

hemodialysis
peritoneal dialysis

95
Q

requires transporting blood from the client through
a dialyzer, a semipermeable membrane filter within a machine

A

hemodialysis

96
Q

uses the peritoneum, the semipermeable
membrane lining the abdomen, to filter wastes, fluid and
chemicals

A

peritoneal dialysis

97
Q

what are the complications of peritoneal dialysis?

A
  • Exit-site infection
  • Peritonitis
  • Abdominal pain
  • Outflow problems
  • Hernias
  • Lower back problems
  • Bleeding
  • Pulmonary complications
  • Protein loss
  • Carbohydrate and lipid abnormalities
98
Q

what are the complications of hemodialysis?

A

hypotension
dysrhythmias
muscle cramps
loss of blood
hepatitis
sepsis
disequilibrium syndrome

99
Q

what is the nursing care for dialysis?

A
  • Nursing assessment – fluid status (? Weight, BP, peripheral edema,
    heart and lung sounds)
  • Assess condition of vascular access
  • Temperature
  • Skin condition
  • Fluid gained since last treatment
  • Vital signs every 30-60 mins
  • What to do if hypotensive? (elevate feet)
  • Treatment lasts 3-5 hours min 3 times a week

Med-Surg Nursing (13 decks)

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