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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?

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
What’s an anagram that I can use to help remember renal Calculi manifestations (10)
Pain Flanks Under Nimbani Very Kiddy (&) Dies From Chilly Cold skin
26
Renal colic ( sudden severe pain ) is a result from the ureter ?
Stretching Dilating Spasms
27
What is the kidney stone dance mean?
Laying, sit, walking
28
What are 5 diagnostic studies we must do to find out kidney stones ?
Noncontrast helical ct scan Ultrasound Urinalysis 24-7 hour urine Retrieval and analysis ( see what’s inside & underlying cause )
29
What are the 2 concurrent approaches of Interprofessional care for kidney stones? (5, 2)
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
What are Interprofessional care and treatment & patient teaching we can provide to patients with kidney stones? (5)
Adequate hydration Sodium restriction Dietary changes Struvite stones - antibiotics / surgery Strain urine & collect stones for analysis
31
Stones that are less than 4mm or less may pass spontaneously, how long is this process?
May take weeks
32
What are two surgeries we can do to remove kidney stones?
Endourologic Lithotripsy
33
What are the considerations for surgery? (5)
7mm stones Bacteriuria / symptomatic infections Impair renal function Persistent pain, nausea, paralytic ileus One kidney
34
What are the 3 endourologic procedures? And explain each one?
Cystoscopy - remove stone in bladder Cystolitholapaxy - remove large stone by breaking it with lithotrite ( stone crusher ) Cystoscopic Lithotripsy - ultrasonic waves break stones
35
What are the complications of the endourologic procedures? (3)
Hemorrhage Retained stone fragments Infection
36
Endourologic procedures also contain laser or electro hydraulic menthods which are 2 and explain them
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
What are the complications of flexible ureteroscopes & Percutaneous nephrolithotomy? (3)
Bleeding Injury to adjacent structures Infection
38
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)
Put a stent in and helps passage of particles Hematuria & prophylatic antibiotics Encourage fluids to dilate urine & reduce pain Hemorrhage Infection Obstruction
39
Type of surgery depends on location of stones What location is the surgery going into the body ? Nephrolithotomy Pyeloithrotomy Ureterolithitomy Cystotomy
Kidney Renal pelvis Ureter Bladder
40
To manage an obstructing stone the patient should?
Drink adequate fluids to avoid dehydration
41
After urolithiasis ( kidney stone ) the patient should have? (4) Think nutrition!!
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
Nursing assessment subjective(7) and objective(5) data we want to know are?
Past history Medications Surgery Health perception Nutritional Elimination Cognitive General Integumentary Gastrointestinal Urinary Diagnostic findings
43
What is the nursing diagnosis for kidney stones ? (3)
Impaired urinary system Acute pain Lack of knowledge
44
What is the planning for kidney stone? (3)
Relief of pain No urinary tract obstruction Knowledge of ways to prevent
45
Ureteral strictures is what?
The narrowing of the lumen of the ureter
46
Ureteral strictures can effect what and alter what? (2)
The entire length of ureter and alter kidney function
47
What are the causes of Ureteral strictures? (3)
Congenital Adhesions ( scaring ) Large tumor in peritoneal cavity
48
What are the clinical manifestations Ureteral strictures? (3)
Mild to moderate colic Flank pain CVAT
49
What’s the treatment of Ureteral strictures? (2)
Bypass with stent or nephrostomy tube Surgery
50
Urethral structures is what?
Fibrosis or inflammation of urethral lumen leads to the narrowing and compromised opening and closing with bladder filling and voiding
51
What’s the causes of urethral strictures? (5)
Trauma Urethritis Surgical Congenital defect Idiopathic
52
What’s the manifestations of Urethral structures? (5)
Straining to void Urine stream : dimished; sprayed or split Post void dripping Incomplete bladder emptying, (frequency, nocturia) Severe obstruction
53
What are diagnostic studies for urethral strictures? (4)
Retrograde urethrography ( RUG ) Ultrasound urethography Cystorethrogram VCUG
54
What’s the treatment of Urethral strictures? (3)
Dilation or stenrs Self Cauterization Endoscopic or surgical procedure

NURS 347 EXAM 5 UROLOGY (16 decks)

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