Renal

Question 1

Symptoms uti vs bph

Answer 1

Urgency, dribbling, frequency

Burning with urinationonly uti

Question 2

What is an ileal conduit?

What color of stoma is considered medical emerg

Ways to prevent low perfusion and irritation

Answer 2

• part of ileum is used to divert urine. Ureters are connected to the ileum which serves as stoma
• Should be pink and moist if bluish or gray —> low perfusion, med emergency, call MD
• To prevent low perfusion and irritation apply app 0.1 in pouch larger than stoma

Question 3

Peritoneal dialysis for clients with what condition

Process

What needs to be monitored during instillation and dwell times

Answer 3

• for pts with chronic kidney failure
• Dialysate infused into abdom8nal cavity, tubing clamo while dialysate dwells for a specific period. Tubing then unclamped fluid drains out.
• During instillation and dwell t8me, monitor for signs of respiratory distress (crackles, dyspnea, rapid respirations) which can result from too fast instillation, abdomen overfilled, fluid goes into thoracic cavity thru diaphragmatic channels. Crackles heard when more dialysate infused thAn removed

Question 4

Overflow incontinence two causes

It leads to what

Encourage pt to…

Answer 4

• occurs due to two things
• 1. Compressionof urethra (bph, uterine prolapse)
• 2. Impaired bladder muscle (spinal cord injury, diabetic neuropathy, anticholinergicnmeds)
• Causes incomplotebbladder emptying — distension of bladder — overfilling of bladder — dribbling ogf urine
• Encourage pt to
• Fixed voiding sched
• Valsava maneuver (bearing down) and crede maneuver (gentle pressure to lower abdomen)
• Perinea, check for skin breakdown
• Measure postvoid residualvolime
• Wait 20-30 seconds after voiding and then void again

Question 5

What is a cystoscopy

Expected outcomes within 48 hours

Complications and when to call MD

Answer 5

• scope inserted through urethra into urinary bladder with client in lithotomy position
• Within 48 hours, expected outcomes: pink tinged urine, frequency, dysuria - ots should increase fluids. Drink 4-6 glasses of water daily to dillute urine. Avoid bladder irritantx like alcohol and caffeine.
• Also expected within 48 hours - abdominal discomfort and bladder spasm - take analgesic, warm bath, sitz bath.
• Complication — urinary retention, hemorrhagd, infecton. Call when there is bright red blood when urinating, blood clots, cant urinate, fever and chills, abdominal pain unrelieved by analgeisc. Pt may need antibiotics of bladder irrigation

Question 6

Treatment for acute urinary retention

Complication

Answer 6

• complete bladder decompression rather than intermittent urine drainage which only drains 500-1000 mls. Radpid decompression causes sudden release of bladder contents — parasympathetic response activated — decrease in BP and HR — assess for hypotension and bradycardia

Question 7

Pessary

Answer 7

• vaginal device used to support bladder. For ppl with pelvic organ prolaps. Md fits it. Pt cna remove and clean. Can have sex intercourse. Sx not needed.

Question 8

Hyperkalemia signs

ECG

Tmt

Answer 8

• Fatigue and generalized weakness, (severe case) muscle paralysis amd dysrhythmias. Could also be asymptomatic

• calcium gluconate - for those with ecg changes (peaked T waves). Not meant to decrease potassium. Only Stsblizes myocardium by raising threshold for dysrrythmia occurrence. I.e. to prevent life threatening dysrhrythmia
• Decrease potassium thru iv regular insulin with dextrose (shifts potassium to cells), sodium polystyrene sulfomate (exchanges potassium with sodium in bowel. Then k is excreted in stool. , hemodialysis

Question 9

Pt with ckd at risk for what?

Prevent progression of ckd through..

Answer 9

Pts with ckd at risk for
• hyperkalemia and fluid overload
management to prevent progression of ckd
• fluid restrict, low sodium, low potassium (raw carrots, tomatoes, orange juice not good), low phosphorous (chicken, turkey, dairy), low protein but if on hemodialysis — protein is ok to prevent malnutrition

Question 10

Normal Bun

Normal serum albumin

Answer 10

Normal BUN
• 2.1 - 7.1 mmol/L

Normal serum albumin
• 3.5 - 5

Question 11

Priority action for someone with splinter in eye

Answer 11

• path both eyes to prevent further eye movement even if only one eye injured

Question 12

Chronic kidney disease

Answer 12

progressive disease, gradual onset irreversble

• Fatal unless there is dialysis or kidney transplant

Question 13

Lab value become abdnormal in pt with ckd

Answer 13

Lab value become abdnormal in pt with ckd
• Decreased serum calcium (1. decrease in ohosphorous excretion ➡️ phosphate binds with calcium. ➡️ serum calcium decrease 2. decrease activation of vitamin D — impaired calcium absorption from gut — decreased serum calcium 3. Decrease in serum ca — increase pth — bone deminiralization to release calcium — increased serum calcium
• Decreased Hemoglobin - coz fewer rbc are formed dt kidney less able to make eryhtopoietin needed to make rbc
• Increased bun, creatinine - inability to remove nitorgenous waste
• Increase potassium

Question 14

Link between htn and ckd

Answer 14

Hypertension and ckd link
• htn can be a cause or an effect of ckd
• Htn damages kidneys.
• Ckd causes activation of ras which causes htn dt vasoconstriction

Question 15

Calcium acetate

Answer 15

Calcium acetate

• phosphate binder to decrease amount of serum phosphorous e.g. in ppl with ckd

Question 16

Captopril

Answer 16

Captopril

• ace inhibitor, antihypertensive

Question 17

Peritoneal dialysis advantages and disadvantages

Answer 17

Peritoneal dialysis
Advantages
• Portable, less complicated
• Less vascular access problems
• Fewer diet restrictions
• Diabetics ok to use

Peritoneal dialysis disadvantages
• peritonitis by bacteria or chemical
• Infections
• Hyperglycemia, protein loss into dialysate

Question 18

Hemodialysis advantages and disadvantages

Answer 18

dialysate

Hemodialysis
Advantages
• rapid removal of wastes and potassium

Hemodialysis
• diadvantages
• Vascular acces problems
• Diet restrictions
• Hypotension problems
• Heparinization required. Can lead to hemorrhage. No procedure 4-6 hours after
• Blood loss lead to further anema

Question 19

Av graft

Answer 19

Av graft

• synthetic tubing tunneled beneath the skin connecting artery and vein in arm lr inner thigh.

Question 20

Immunosuppressants

Answer 20

Immunosuppresants
• sac
• Solu medrol
• Azathioprine
• Cyclosporine

Question 21

Types of kidney organ rejection

Answer 21

Kidney organ rejection types

1. Hyperacute - within first 48 hours. Needs immediate removal
2. Acute - up to 2 years after. Usually first 2 weeks. Increase immunosuppresants
3. Chronic rejection - months or years. Needs balance of fluid and protein intake but eventually will need dialysis

Question 22

What is bph

Symptoms

Treatment

Answer 22

BPH (Benign Prostatic Hyperplasia)
- Enlargement of prostate
- Causes constriction of urethra since prostate surrounds urethra and bladder neck– this causes problems with urination
- Symptoms:
o Hesistancy
o Intermittent voiding
o Nocturia
o Post void leakage
o Diffifulty voiding
o Incomplete bladder emptying – stagnant urine increases risk for UTI
o Overdistention of bladder due to accumulation of urine – can backflow to kidney and cause kidney damage
- Treatment:
o finasteride and doxazosin to reduce size
o avoid caffeine, alcohol, antihistamines coz they worsen symptoms
o TURP
▪ Transurethral resection of prostate – removal of prostate tissue

Question 23

Ruling out prostate cancer

Answer 23

Ruling Out Prostate Cancer
Prostate Cancer Prevention
- Blood test PSA – prostate specific antigen yearly for all men above 50 (earlier if high risk like have a first degree relative with prostate cancer)
o Psa secreted only by prostate tissue and suggests prostate disease, high levels means advanced cancer, low levels means hyperplasia or early stage cancer
o Psa generally higher in older men than younger men even If cancer not present
o Can be falsely positive if done right after digital rectal exam
- Digital rectal exam for all men above 50 yearly, earlier if high risk
o Palpation of hard, irregular nodes means cancer
Prostate Cancer metastasis
- Bone metastasis will have elevated alkaline phosphatase

Question 24

What is turp surgery

Answer 24

Removal of some of prostate tissue to reduce size in BPH or remove cancerous tissue in prostate cancer. Done through urethra so no need to make incision in abdomen

Question 25

tests before turp

Answer 25

To know bleeding tendencies - RBC, Hgb, Hct, PT, APTT (Activated partial thromboplastin time) to make sure pt has enough RBCs and does not have bleeding tendencies since prostate gland is highly vascular, theres a high risk of haemorrhage postop o To know if theres kidney damage - BUN (blood urea nitrogen), serum creatinine – urea is end product of protein metabolism and creatinine is a result of skeletal muscle use. Both secreted by kidney. Both will be elevated if kidney function impaired

Question 26

Turp preoperAtive teaching

Answer 26

Moving in bed and changing positions, get out of bed and walk after surgery
o Special sleeves – intermittent pneumatic compression sleeves and graduated compression stockings to help circulation in legs after sx to avoid DVT
▪ Trauma and swelling from sx can impede venous return from lower extremeties causing venous stasis and increased risk for DVT postop
o Urinary catheter will be placed postop + CBI (fluid will be bloody)
o Side effects of Sx if unaware
▪ Sex unaffected since unlikely that nerves will be damaged since no incision will be made, will have an erection but ejaculate less semen

Question 27

Turp post op assessments

Answer 27

Complication of Sx
▪ Haemorrhage which can lead to shock, sign of shock from hemorrhage
• Decreased bp due to low fluid volume
• Increased hr to compensate so that tissues will be perfused
• Pallor in early stages of haemorrhage since sympathetic NS causes compensatory peripheral vasoconstriction
• Restlessness due to cerebral hypoxia
▪ **normal to see pink to red Serum sodium
▪ To assess for turp syndrome – occurs when irrigation fluid is absorbed systemically, occurs during sx or 24 hours after
• Severe hyponatremia and hyperv olemia occurs urine or bloody urine with clots immediately postop due to trauma from sx,

Question 28

Post op interventions for turp

1. Cramping
2. Urination

Answer 28

Cramping or tightness in abdomen – bladder spasms due to sx trauma normal 24-48 hours after sx
▪ Use relaxation techniques along with meds (oxybutynin, belladonna and opium to reduce spasms)
▪ Check for kinks and clots on urinary drainage tube, this can worsen spasms
▪ Ensure CBI is continuous and promote fluids to promote urine flow
o If pt feels like urinating, tell them itès normal for someone with cath to feel that way but avoid trying to urinate around cath as it could increase pain and spasms
o Monitor input output to monitor urine output and check absorption of irrigation fluid
o If urinary cath removed, assess for urinary retention by inspecting (there is swelling) and palpating suprapubic area
o Give urinal so that urine can be measured