OTH: Renal/Urological

Question 1

Lower UTI

2 areas of inflammation/infection

Answer 1

Cystitis: inflammation/infection of bladder
Urethritis: inflammation/infection of urethra

Question 2

Lower UTI usually secondary to ____ ____, may also involve ___ and ___

Answer 2

Ascending UTI

Kidneys, ureters

Question 3

Lower UTI: associated with symptoms of urinary ___ and ___, sensation of ___ with urination. What is appearance/characteristic of urine? Where is pain noted?

Answer 3

Frequency, urgency
Burning
Cloudy, foul smelling
Pain in suprapubic, lower abdominal, or groin

Question 4

Upper UTI is called ? Associated with?

Answer 4

pyelonephritis: inflammation/infection of 1 or both kidneys

Question 5

Upper UTI: symptoms?

Answer 5

Systemic:
Fever, chills, malaise, headache, tenderness and pain over kidneys, tenderness over costovertebral angle, frequent and burning urination, N+V may occur

Question 6

What is Murphy’s sign? Associated with what condition?

Answer 6

Pain/tenderness over costovertebral angle

Upper UTI

Question 7

Upper UTI: where else may pain be located?

Answer 7

Over kidneys on palpation/percussion

Question 8

Which is more serious: Upper or Lower UTI

Answer 8

Upper UTI

Question 9

Increased risk of UTI in persons with ? (5)

What population has increased risk?

Answer 9

1. Autoimmunity
2. Urinary obstruction and reflux
3. Neurogenic bladder and catheterization
4. DM
5. Kidney transplant
   — older adults and women

Question 10

What is renal cystic disease? What can it lead to?

Answer 10

Renal cysts are fluid-filled cavities that form along the nephron
—> can lead to renal degeneration or obstruction

Question 11

What are the types of renal cystic disease? (5)

Answer 11

1. Polycystic
2. Medullary
3. Sponge
4. Acquired
5. Simple

Question 12

Symptoms of renal cysts include? (3, possibly 4)

Which type are typically asymptomatic?

Answer 12

1. Pain
2. Hematuria (from ruptured cysts)
3. HTN
   (4. Fever associated with infection)

—Simple typically asymptomatic

Question 13

Obstructive disorders include: (6)

Answer 13

1. Developmental defects
2. Renal calculi
3. Prostatic hyperplasia or cancer
4. Scar tissue from inflammation
5. Tumors
6. Infection

Question 14

What are renal calculi?

Answer 14

Kidney stones: formed from normal components of urine (calcium, magnesium, etc.)

Question 15

Symptoms of kidney stones? Where does pain radiate?

Answer 15

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

Question 16

Tx for kidney stones?

Answer 16

Extracorporeal shock wave lithotripsy (ESWL)

Question 17

Tx for kidney stones?

Answer 17

1. Increase fluid intake
2. Thiazides diuretics
3. Restriction of foods high in oxalate
4. acidification or alkalination of urine depending on type of stone.

Question 18

Acute Kidney Failure: Sudden loss of kidney function with resulting elevation in serum __ and __

Answer 18

Urea

Creatinine

Question 19

Chronic renal failure is progressive loss of kidney fxn leading to ?

Answer 19

End-stage kidney failure

Question 20

What does chronic renal failure result from?

Answer 20

1. Prolonged acute urinary tract obstruction and infection
2. DM
3. SLE
4. Uncontrolled HTN

Question 21

What is uremia?

Symptoms are?

Answer 21

End-stage toxic condition resulting from renal insufficiency and retention of nitrogenous wastes in blood
Sx: anorexia, nausea, mental confusion

Question 22

Chronic renal failure: RED FLAGS

1. Dizziness, headaches, ____ (psych), memory loss, inability to ____, ____ (muscle action), ____ (LOC)
2. ___ (BP), DOE, HF
3. Chronic pain: where?
4. Edema: where?
5. Muscle weakness: peripheral ___, cramping, restless __
6. Skeletal: osteo___, osteo___, bone pain, fx
7. Skin: ___ (color), ecchymosis, pruritis, ___ (clammy or dry?)
8. ___, tendency to bleed easily
9. Decreased endurance
10. ANS dysfunction: (3) what?

Answer 22

1. Anxiety, Concentrate, Convulsions ,Coma
2. HTN
3. Ischemic leg pain, painful cramps
4. Pulmonary and peripheral
5. Neuropathy, legs
6. Osteomalacia, osteoporosis
7. Pallor, dry
8. Anemia
9. —
10. Decreased HR/BP, orthostatic hypotension

Question 23

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 (?)

Answer 23

Dialysis

hemodialysis

Question 24

Symptoms of nausea, vomiting, drowsiness, headache, seizures- result of rapid changes after beginning procedure

Answer 24

Dialysis disequilibrium

Question 25

Signs of cerebral dysfunction (speech difficulties, mental confusion, myoclonus, seizures, death) — what does this result from and what is condition?

Answer 25

From prolonged years of dialysis | Dialysis dementia

Question 26

Contraindication of dialysis

Answer 26

taking BP at the shunt

Question 27

Locate peritoneal catheters if used— what do you have to be aware of?

Answer 27

Avoid trauma to area

Question 28

What should you examine with dialysis?

Answer 28

For multisystem dysfunction: vital signs, strength, sensation, ROM, function, endurance

Question 29

What is stress incontinence?

Answer 29

Sudden release of urine due to increase in intra-abdominal pressure

Question 30

With stress incontinence, weakness/laxity of ___ and __. Examples? (3 listed)

Answer 30

Pelvic floor musculature, sphincter weakness 1. Postpartum incontinence 2. Menopause 3. Damage to pudendal nerve

Question 31

Urge incontinence?

Answer 31

Bladder begins contracting and urine is leaked after sensation of bladder fullness is perceived; inability to delay voiding to reach toilet

Question 32

What is urge incontinence a result of?

Answer 32

Detrusor muscle instability or hyperreflexia, sensory instability (hypersensitive bladder)

Question 33

What is overflow incontinence?

Answer 33

Bladder continuously leaks secondary to urinary retention (overdistended bladder or incomplete emptying of bladder)

Question 34

Cause of overflow incontinence? (3) and what are examples of each cause?

Answer 34

``` Anatomical obstruction (prostate enlargement) Acontractile bladder (SCI, DM) Neurogenic bladder (MS, suprasacral spinal lesions) ```

Question 35

Functional incontinence?

Answer 35

Leakage associated with inability or unwillingness to toilet

Question 36

What is functional incontinence caused by?

Answer 36

1. Impaired cognition (dementia); depression 2. Impaired physical functioning (stroke) 3. Environmental barriers

Question 37

What is mixed incontinence?

Answer 37

Usually combination of stress and urge

Question 38

Catheter may be indicated for what type of incontinence? What are complications?

Answer 38

Overflow | Possible skin integrity concerns, UTIs common

Question 39

Surgery for incontinence?

Answer 39

Bladder neck suspension, removal of prostate obstruction, suprapubic cystostomy

Question 40

Bladder training is? May involve what methods?

Answer 40

Prompted voiding to restore a pattern of voiding 1. Toileting schedule (regular intervals) 2. Intermittent catheterization

Question 41

Examination for incontinence includes?

Answer 41

1. Identify symptoms: onset, duration, urgency, frequency, timing 2. Strength of pelvic floor muscles using perineometer 3. Fxn mobility, environmental factors

Question 42

PT interventions for what type of incontinence?

Answer 42

Stress, urge

Question 43

Pelvic floor muscle exercises target what muscle? (For stress incontinence)

Answer 43

Pubococcygeus muscle

Question 44

How do you teach Kegels? | Type 1 vs 2

Answer 44

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

Question 45

Incontinence tx: FES used for muscle re-ed if pt is unable to ___ ___ ___

Answer 45

Initiate active contractions

Question 46

Incontinence tx: Biofeedback: uses __ __ to reinforce active contractions, ___ bladder

Answer 46

Pressure recordings | Relax

Question 47

Progressive strengthening: use of weighted ___ ___ (lol) for HEP or pelvic floor exercises

Answer 47

Vag cones

Question 48

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.

Answer 48

Valsalva, heavy resistance | Skin care, skin care