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NURS 347 EXAM 5 UROLOGY > Obstructive Uropathies > Flashcards

Obstructive Uropathies Flashcards

1
Q

What are the 3 obstructive uropathies we will talk about?

A

Urinary Tract Calculi
Ureteral strictures
Urethral Strictures

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2
Q

What does urinary obstruction mean?

A

Anatomical or functional condition that blocks or impede the flow of urine

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3
Q

Urinary obstruction may be?

A

Congenital or acquired

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4
Q

Where does damage occur from obstruction?

A

Above the obstruction

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5
Q

The severity of the damage may depend on?

A

Location
Duration
Amount of pressure
Dilation
Presence of urinary stasis or infection

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6
Q

It’s also important to note that urinary obstruction can effect not only __but cause your other kidney to ___?

What can come out of this? (2)

A

One Kidney
Compensate ( overwork )

Chronic pyelnophritis & renal atrophy

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7
Q

Where are the sites that an obstruction can occur? (4)

A

Bladder
Ureter ( intrinsic and extrinsic )
Prostate
Pelvic

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8
Q

Most of these sites that cause an obstruction are from? (2)

A

Calculi and tumor

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9
Q

Partial obstruction of ureter or ureteropelvic junction ( UPJ ) can occur if?
So the kidney will what?

UPJ means what?

A

The pressure stays low to moderate

The kidney will continue to dilate without noticeable loss of functions

Renal pelvis narrows into the ureter

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10
Q

If only one kidney is being overworked you have an increase of getting?
Urinary stasis and reflux increases risk of ?

A

Pyelnophritis

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11
Q

If either both kidneys or 1 kidney is involved with obstruction what can happen ? (2)
What will change
What will increase

A

Change in renal function
Bub and creatinine increase

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12
Q

If we have progressive obstruction what can it lead to?

A

Renal failure

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13
Q

What is treatment of this?
Examples

A

Find and relieve blockage
( tube, surgery, urinary diversion )

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14
Q

Urinary Tract Calculi is what?

A

Nephrolithasis
( lithiasis refers to stone formation )
( kidney stone disease )

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15
Q

In the United States urinary tract Calculi effect how many men and women?

A

13% men
7% women

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16
Q

At what age do we normally see urinary tract Calculi?

A

Middle age

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17
Q

Urinary tract Calculi is mainly found in which race? And during which season?

A

White people
Summer time ( hot climate & dehydration )

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18
Q

What are risk factors for kidney stones? (5)
Think basic! Like what things outside

A

Metabolic
Climate
Dietary
Genetic
Lifestyle

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19
Q

Concentration of supersaturated curtails precipate and form stones
That’s why it’s important to reduce this risk by?

A

Keeping urine dilute & free flowing
( hydration ) !!

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20
Q

What are some influencing factors that cause stone formation ? (5)

A

High Urinary ph
High Solute load
Obstruction with urinary stasis
Infection with urea splitting bacteria ( struvite ) ( bacteria causes urine to become alkaline and making struvite )
Infected stones ( staghorn configuration , branching out stone )

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21
Q

When we have infected stones, it can cause? (3)

A

Renal infection
Hydronephrosis
( dilation or enlargement of the renal pelvises & calyces )
Loss of kidney function

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22
Q

What’s the most common stone?

A

Calcium

23
Q

What are the 5 stones?

A

Calcium oxalate
Calcium phosphate
Cystine
Struvite
Uric acid

24
Q

Clinical manifestations of renal Calculi
First symptom ? (10)
Think of numbani!!

A

Sudden severe pain ( renal colic )
Flank area
( Back pain, Lower abdomen )
Ureter stretches, dilates and spasms
Nausea
Vomiting
Kidney stone dance
Dysuria
Fever
Chills
Moist/ cool skin

25
Q

What’s an anagram that I can use to help remember renal Calculi manifestations (10)

A

Pain
Flanks
Under
Nimbani
Very
Kiddy (&)
Dies
From
Chilly
Cold skin

26
Q

Renal colic ( sudden severe pain ) is a result from the ureter ?

A

Stretching
Dilating
Spasms

27
Q

What is the kidney stone dance mean?

A

Laying, sit, walking

28
Q

What are 5 diagnostic studies we must do to find out kidney stones ?

A

Noncontrast helical ct scan
Ultrasound
Urinalysis
24-7 hour urine

Retrieval and analysis
( see what’s inside & underlying cause )

29
Q

What are the 2 concurrent approaches of Interprofessional care for kidney stones?
(5, 2)

A
  1. Manage acute attack
    ( pain, infection, obstruction)
    By giving opioids & nsaids
  2. Evaluate cause of stone formation and prevent further development
    ( family history & personal history )
30
Q

What are Interprofessional care and treatment & patient teaching we can provide to patients with kidney stones? (5)

A

Adequate hydration
Sodium restriction
Dietary changes
Struvite stones - antibiotics / surgery
Strain urine & collect stones for analysis

31
Q

Stones that are less than 4mm or less may pass spontaneously, how long is this process?

A

May take weeks

32
Q

What are two surgeries we can do to remove kidney stones?

A

Endourologic
Lithotripsy

33
Q

What are the considerations for surgery? (5)

A

7mm stones
Bacteriuria / symptomatic infections
Impair renal function
Persistent pain, nausea, paralytic ileus
One kidney

34
Q

What are the 3 endourologic procedures? And explain each one?

A

Cystoscopy
- remove stone in bladder
Cystolitholapaxy
- remove large stone by breaking it with lithotrite ( stone crusher )
Cystoscopic Lithotripsy
- ultrasonic waves break stones

35
Q

What are the complications of the endourologic procedures? (3)

A

Hemorrhage
Retained stone fragments
Infection

36
Q

Endourologic procedures also contain laser or electro hydraulic menthods which are 2 and explain them

A

Flexible utreroscipes
- remove stones from renal pelvis and upper urinary tract

Percutaneous nephroliyhotomy
- nephroscope inserted through skin into pelvis of kidney and remove with irrigation

37
Q

What are the complications of flexible ureteroscopes & Percutaneous nephrolithotomy? (3)

A

Bleeding
Injury to adjacent structures
Infection

38
Q

Lithotripsy helps to remove kidney stones
What do we do?
Post op what do we do and give (2)
This will help the patient how?
(2)
What are complications (3)

A

Put a stent in and helps passage of particles

Hematuria & prophylatic antibiotics

Encourage fluids to dilate urine & reduce pain

Hemorrhage
Infection
Obstruction

39
Q

Type of surgery depends on location of stones
What location is the surgery going into the body ?
Nephrolithotomy
Pyeloithrotomy
Ureterolithitomy
Cystotomy

A

Kidney
Renal pelvis
Ureter
Bladder

40
Q

To manage an obstructing stone the patient should?

A

Drink adequate fluids to avoid dehydration

41
Q

After urolithiasis ( kidney stone ) the patient should have? (4)
Think nutrition!!

A

High intake water 3L a day to produce 2.5 L of urine duly

Limit cola, coffee, tea
Low sodium
Diet depends on type of stone

42
Q

Nursing assessment subjective(7) and objective(5) data we want to know are?

A

Past history
Medications
Surgery
Health perception
Nutritional
Elimination
Cognitive

General
Integumentary
Gastrointestinal
Urinary
Diagnostic findings

43
Q

What is the nursing diagnosis for kidney stones ? (3)

A

Impaired urinary system
Acute pain
Lack of knowledge

44
Q

What is the planning for kidney stone?
(3)

A

Relief of pain
No urinary tract obstruction
Knowledge of ways to prevent

45
Q

Ureteral strictures is what?

A

The narrowing of the lumen of the ureter

46
Q

Ureteral strictures can effect what and alter what? (2)

A

The entire length of ureter and alter kidney function

47
Q

What are the causes of Ureteral strictures? (3)

A

Congenital
Adhesions ( scaring )
Large tumor in peritoneal cavity

48
Q

What are the clinical manifestations Ureteral strictures? (3)

A

Mild to moderate colic
Flank pain
CVAT

49
Q

What’s the treatment of Ureteral strictures? (2)

A

Bypass with stent or nephrostomy tube
Surgery

50
Q

Urethral structures is what?

A

Fibrosis or inflammation of urethral lumen leads to the narrowing and compromised opening and closing with bladder filling and voiding

51
Q

What’s the causes of urethral strictures? (5)

A

Trauma
Urethritis
Surgical
Congenital defect
Idiopathic

52
Q

What’s the manifestations of Urethral structures? (5)

A

Straining to void
Urine stream : dimished; sprayed or split
Post void dripping
Incomplete bladder emptying, (frequency, nocturia)
Severe obstruction

53
Q

What are diagnostic studies for urethral strictures? (4)

A

Retrograde urethrography ( RUG )
Ultrasound urethography
Cystorethrogram
VCUG

54
Q

What’s the treatment of Urethral strictures? (3)

A

Dilation or stenrs
Self Cauterization
Endoscopic or surgical procedure

NURS 347 EXAM 5 UROLOGY (16 decks)

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