OTH: Renal/Urological Flashcards
Lower UTI
2 areas of inflammation/infection
Cystitis: inflammation/infection of bladder
Urethritis: inflammation/infection of urethra
Lower UTI usually secondary to ____ ____, may also involve ___ and ___
Ascending UTI
Kidneys, ureters
Lower UTI: associated with symptoms of urinary ___ and ___, sensation of ___ with urination. What is appearance/characteristic of urine? Where is pain noted?
Frequency, urgency
Burning
Cloudy, foul smelling
Pain in suprapubic, lower abdominal, or groin
Upper UTI is called ? Associated with?
pyelonephritis: inflammation/infection of 1 or both kidneys
Upper UTI: symptoms?
Systemic:
Fever, chills, malaise, headache, tenderness and pain over kidneys, tenderness over costovertebral angle, frequent and burning urination, N+V may occur
What is Murphy’s sign? Associated with what condition?
Pain/tenderness over costovertebral angle
Upper UTI
Upper UTI: where else may pain be located?
Over kidneys on palpation/percussion
Which is more serious: Upper or Lower UTI
Upper UTI
Increased risk of UTI in persons with ? (5)
What population has increased risk?
- Autoimmunity
- Urinary obstruction and reflux
- Neurogenic bladder and catheterization
- DM
- Kidney transplant
— older adults and women
What is renal cystic disease? What can it lead to?
Renal cysts are fluid-filled cavities that form along the nephron
—> can lead to renal degeneration or obstruction
What are the types of renal cystic disease? (5)
- Polycystic
- Medullary
- Sponge
- Acquired
- Simple
Symptoms of renal cysts include? (3, possibly 4)
Which type are typically asymptomatic?
- Pain
- Hematuria (from ruptured cysts)
- HTN
(4. Fever associated with infection)
—Simple typically asymptomatic
Obstructive disorders include: (6)
- Developmental defects
- Renal calculi
- Prostatic hyperplasia or cancer
- Scar tissue from inflammation
- Tumors
- Infection
What are renal calculi?
Kidney stones: formed from normal components of urine (calcium, magnesium, etc.)
Symptoms of kidney stones? Where does pain radiate?
Renal colic pain (pain from stone lodged in ureter worse by stretching the collecting system), radiating to lower abdominal quadrant, bladder area, perineal area.
N+V are common, skin may be cool and clammy
Tx for kidney stones?
Extracorporeal shock wave lithotripsy (ESWL)
Tx for kidney stones?
- Increase fluid intake
- Thiazides diuretics
- Restriction of foods high in oxalate
- acidification or alkalination of urine depending on type of stone.
Acute Kidney Failure: Sudden loss of kidney function with resulting elevation in serum __ and __
Urea
Creatinine
Chronic renal failure is progressive loss of kidney fxn leading to ?
End-stage kidney failure
What does chronic renal failure result from?
- Prolonged acute urinary tract obstruction and infection
- DM
- SLE
- Uncontrolled HTN
What is uremia?
Symptoms are?
End-stage toxic condition resulting from renal insufficiency and retention of nitrogenous wastes in blood
Sx: anorexia, nausea, mental confusion
Chronic renal failure: RED FLAGS
- Dizziness, headaches, ____ (psych), memory loss, inability to ____, ____ (muscle action), ____ (LOC)
- ___ (BP), DOE, HF
- Chronic pain: where?
- Edema: where?
- Muscle weakness: peripheral ___, cramping, restless __
- Skeletal: osteo___, osteo___, bone pain, fx
- Skin: ___ (color), ecchymosis, pruritis, ___ (clammy or dry?)
- ___, tendency to bleed easily
- Decreased endurance
- ANS dysfunction: (3) what?
- Anxiety, Concentrate, Convulsions ,Coma
- HTN
- Ischemic leg pain, painful cramps
- Pulmonary and peripheral
- Neuropathy, legs
- Osteomalacia, osteoporosis
- Pallor, dry
- Anemia
- —
- Decreased HR/BP, orthostatic hypotension
Process of diffusing blood across semipermeable membrane for purposes of removal of toxic substances; maintains fluid, electrolyte, and acid-base balance in presence of renal failure; peritoneal or renal (?)
Dialysis
hemodialysis
Symptoms of nausea, vomiting, drowsiness, headache, seizures- result of rapid changes after beginning procedure
Dialysis disequilibrium
Signs of cerebral dysfunction (speech difficulties, mental confusion, myoclonus, seizures, death) — what does this result from and what is condition?
From prolonged years of dialysis
Dialysis dementia
Contraindication of dialysis
taking BP at the shunt
Locate peritoneal catheters if used— what do you have to be aware of?
Avoid trauma to area
What should you examine with dialysis?
For multisystem dysfunction: vital signs, strength, sensation, ROM, function, endurance
What is stress incontinence?
Sudden release of urine due to increase in intra-abdominal pressure
With stress incontinence, weakness/laxity of ___ and __. Examples? (3 listed)
Pelvic floor musculature, sphincter weakness
- Postpartum incontinence
- Menopause
- Damage to pudendal nerve
Urge incontinence?
Bladder begins contracting and urine is leaked after sensation of bladder fullness is perceived; inability to delay voiding to reach toilet
What is urge incontinence a result of?
Detrusor muscle instability or hyperreflexia, sensory instability (hypersensitive bladder)
What is overflow incontinence?
Bladder continuously leaks secondary to urinary retention (overdistended bladder or incomplete emptying of bladder)
Cause of overflow incontinence? (3) and what are examples of each cause?
Anatomical obstruction (prostate enlargement) Acontractile bladder (SCI, DM) Neurogenic bladder (MS, suprasacral spinal lesions)
Functional incontinence?
Leakage associated with inability or unwillingness to toilet
What is functional incontinence caused by?
- Impaired cognition (dementia); depression
- Impaired physical functioning (stroke)
- Environmental barriers
What is mixed incontinence?
Usually combination of stress and urge
Catheter may be indicated for what type of incontinence? What are complications?
Overflow
Possible skin integrity concerns, UTIs common
Surgery for incontinence?
Bladder neck suspension, removal of prostate obstruction, suprapubic cystostomy
Bladder training is? May involve what methods?
Prompted voiding to restore a pattern of voiding
- Toileting schedule (regular intervals)
- Intermittent catheterization
Examination for incontinence includes?
- Identify symptoms: onset, duration, urgency, frequency, timing
- Strength of pelvic floor muscles using perineometer
- Fxn mobility, environmental factors
PT interventions for what type of incontinence?
Stress, urge
Pelvic floor muscle exercises target what muscle? (For stress incontinence)
Pubococcygeus muscle
How do you teach Kegels?
Type 1 vs 2
Type 1: holding contractions, progressing to 10-second holds, rest 10 seconds between
Type 2: quick contractions to shut off flow of urine, 10-80 reps/day
Incontinence tx: FES used for muscle re-ed if pt is unable to ___ ___ ___
Initiate active contractions
Incontinence tx: Biofeedback: uses __ __ to reinforce active contractions, ___ bladder
Pressure recordings
Relax
Progressive strengthening: use of weighted ___ ___ (lol) for HEP or pelvic floor exercises
Vag cones
Provide behavioral training— record keeping/voiding diary, education about anatomy, reasons for weakness/incontinence… avoid ___, and ___ exercises. Functional mobility training, ensure independence, environmental modifications, maintain adequate __ __ and teach __ __ /hygiene strategies.
Valsalva, heavy resistance
Skin care, skin care
