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NURS 412 Final Exam > Renal and Urologic Problems > Flashcards

Renal and Urologic Problems Flashcards

1
Q

Urinary Tract Infection: Bacterial Count

A
  • Bacterial count of >10^5 CFU/mL
  • 10^2 to 10^3 CFU/mL can also be indicative of UTI if present with signs and symptoms
  • CFU - colony forming units
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2
Q

Most common pathogen of UTI

A

Escherichia cole (E. coli)
- also by fungal and parasites - uncommon

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3
Q

Upper UTI

A

renal parenchyma, renal pelvis, ureters

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4
Q

Lower UTI

A

bladder, urethra

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5
Q

Clinical Manifestations UTI (6)

A
  • dysuria
  • Fever (upper UTI)
  • cloudy urine, hematuria
  • hesitancy/urgency/frequency
  • burning on urination
  • upper UTI: flank pain, fever, chills
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6
Q

Diagnosis of UTI

A
  • WBC and nitrites and leukocytesterase (enzyme produced by WBC) in the urinalysis
  • Do a CNS after a urinalysis
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7
Q

Management of UTI

A

Health promotion (preventative)
Full course of antibiotics
Short term: 1-3 days
Longer term: 7-14 days (for UTI caused by obstructions or catheter. more complex)

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8
Q

Acute Pyelonephritis Pathophysiology

A
  • inflammation of renal parenchyma & collecting system
  • bacterial infection (most common cause)
  • begins with infection of lower urinary tract
  • often presence of pre-existing: vesico-ureteral reflux, dysfunction of lower urinary tract infection e.g BPH
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9
Q

Acute Pyelonephritis: clinical manifestations (5)

A
  • flank pain, chills, costovertebral tenderness (where ribs and back meet)
  • vomiting, nausea
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10
Q

Acute Pyelonephritis Treatment
mild vs severe

A
  • mild - abx 14-21 days
  • severe - hospitalized IV abx so it gets there quicker. Something for pain and fever. Analgesics and a follow-up culture
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11
Q

Chronic Pyelonephritis

A
  • Shrunken kidney whose function is lost d/t scarring or fibrosis
  • Outcome of recurring infection in upper urinary tract
  • aka: interstitial nephritis, chornic atrophic pyelonephritis, or reflux nephropathy
  • loss of functioning nephrons
  • level of renal function varies depending on if 1 or both kidneys are involved
  • Often progresses to end-stage renal disease
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12
Q

Urethritis

A
  • inflammation of urethra from bacterial or viral infection
  • usually from sexual transmission
  • difficult to diagnose as urethral discharge may not be present in women
  • treatment based on identifying & treating the cause and obtaining symptomatic relief
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13
Q

Purulent discharge in urethritis means:

A

gonococcal urethritis

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14
Q

Clear discharge in urethritis

A

non-gonococcal urethritis

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15
Q

Interstitial cystitis

A

a chronic, painful inflammatory disease of the bladder
Believed to be associated with autoimmune or allergic response

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16
Q

2 primary clinical manifestations of Interstitial Cystitis

A

pain
lower urinary tract symptoms

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17
Q

Diagnosis of Interstitial Cystitis

A
  • cystitis suspected when pt experiences symptoms of a UTI despite absence of bacteriuria, pyuria, or a positive urine culture
  • careful history and physical examination required
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18
Q

Interstitial Cystitis: dietary and lifestyle alterations

A
  • to relieve pain and decrease voiding frequency and noctura
  • eat low acidic foods, avoid coffee, tea, carbonated & alcoholic drinks
  • OTC supplement, calcium glycerophosphate, can provide relief from irritating effects of certain foods
19
Q

Interstitial Cystitis Nursing Management

A
  • assessment focuses on characterization of the pain associated with IC
  • Data collection - voiding diary kept over a period of at least 3 days to determine voiding frequency & patterns of nocturia
20
Q

Glomerulonephritis
What is it?
Characterized by: (4)

A

An immune-related inflammation of the glomeruli characterized by proteinuria, hematuria, decreased urine production, and edema
Condition affects both kidneys equally
Tubular, interstitial, and vascular changes also occur

21
Q

Glomerulonephritis is divided into a number of classifications which may describe:

A
  • extent of damage (diffuse or focal)
  • initial cause of disorder (systemic lupus, systemic sclerosis, streptococcal infection)
  • extent of changes (minimal or widespread)
22
Q

Clinical manifestations of Glomerulonephritis (5)

A
  • varying degrees of hematuria (microscopic to gross)
  • urinary excretion of RBCs, WBCs, and casts
  • Proteinuria, increased BUN, increased creatinine
  • Usually, recovery from the acute illness is complete
  • If progressive -> destruction of renal tissue and marked renal insufficiency
23
Q

Acute Poststreptococcal Glomerulonephritis

A
  • most common in children & young adults but all age groups can be affected
  • occurs 5-21 days after an infection of pharynx or the skin (strep sore throat, impetigo) by nephrotoxic strains of group B-hemolytic streptococci
    Causes inflammation in glomeruli
    95% recovery completely
24
Q

Clinical Manifestations of Acute Poststreptococcal Glomerulonephritis (5)

A
  • Generalized body edema (result of decreased glomerular filtration)
  • hypertension (from increased extracellular vol)
  • Oliguria
  • Smoky urine - indicative of bleeding in upper urinary tract
  • Proteinuria
25
Q

Management of Acute Poststreptococcal Glomerulonephritis

A
  • focus is on symptomatic relief
  • rest until signs of glomerular inflammation (proteinuria, hematuria) and hypertension subside -
  • restrict Na+ and fluid intake & admin diuretics
  • May need to restrict dietary protein if evidence of increased BUN
  • Traetment with Abx only if strep infection is still present
26
Q

Goodpasture’s Syndrome

A

Uncommon autoimmune disease that affects both the kidney’s and the lungs
Characterized by pulmonary alveolar hemorrhage and glomerulonephritis
Characterized by presence of antibodies circulating against glomerular and alveolar basement membrane (antiGBM(glomerular basement membrane) antibody disease)

27
Q

Clinical Manifestations of Goodpasture’s Syndrome

A

Hemoptysis, cough, dyspnea, pallor, crackles and wheezes, hepatomegaly, edema
Pulmonary hemorrhage

28
Q

Chronic glomerulonephritis

A

Reflects the end stage of glomerular inflammatory disease
Characterized by proteinuria, hematuria and slow development of uremic syndrome
Does not usually follow an acute course; progresses insidiously toward renal failure over a few to 30 years

29
Q

Nephrotic Syndrome

A

The combination of nephrotic range proteinuria with a low serum albumin level and edema
Is a clinical course that can be associated with a number of diseases

30
Q

Nephrotic-range proteinuria

A

loss of >3 gms protein/day in urine

31
Q

Approx 1/3 pts with nephrotic syndrome will have systemic diseases such as… (2)

A
  • diabetes or systemic lupus
32
Q

Clinical Manifestations of Nephrotic Syndrome (6)

A
  • peripheral edema
  • massive proteinuria (increased glomerular membrane permeability)
  • Dyslipidemia (decreased serum protein stimulating hepatic lipoprotein synthesis)
  • increased cholesterol and low-density lipoproteins
  • Altered immune response - as a result infection is a cause of morbidity and mortality
  • With nephrotic proteinuria - loss of anticoagulants can result in hypercoagulation state.
33
Q

Most serious complication of nephrotic syndrome

A
  • hypercoagulability with thrombo-embolism
  • because of loss of anticoagulation proteins in proteinuria and increased liver synthesis of clotting factors
34
Q

Nephrotic Syndrome: Management (7)

A
  • focus is symptomatic relief
  • relieve edema
  • cure or control primary disease
  • low Na+, low to moderate protein
  • restriction of salt
  • lipid lowering agents
  • steroids in severe cases of nephrotic syndrome
35
Q

Kidney Cancer: most common type

A

adenocarcinoma (renal cell carcinoma)

36
Q

The most significant risk factor for kidney cancer

A

cigarette smoking

37
Q

Manifestations of Kidney Cancer (6)
- earliest (3)
- classic (3)

A

Earliest manifestations:
- weight loss
- weakness
- anemia
Classic manifestations
- gross hematuria
- flank pain
- palpable mass

38
Q

Treatment of Choice for Kidney Cancer

A
  • radical nephrectomy (RN)
  • Radical RN is the surgical removal of the kidney. Adrenal gland, surrounding fascia, part of ureter, and lymph nodes
39
Q

2 types of Nephrectomy

A

Radical nephrectomy
Partial nephrectomy
- kidney-sparing surgery
- only removed diseased tissue from a kidney

40
Q

Types of procedure: Nephrectomy

A
  • laparoscopic surgery
  • robot-assisted laparoscopic surgery
  • open surgery
41
Q

Radical Nephrectomy: Indication

A
  • Presence of multifocal renal masses in one kidney, and normal contralateral kidney
42
Q

Laparoscopic Nephrectomy

A
  • Candidates:
    People with a small & non-malignant kidney
    Not for people who are overweight
    Performed under GA
    Kidney is dissected laparoscopically in the peritoneal cavity and placed in an impermeable bag
    The kidney is morcellated within the bag, which is removed via a mini incision
43
Q

Post-Op Care Nephrectomy

A
  • ABC
  • VS
  • Kidneys are highly vascular - high risk for hemorrhage, observe wound dressing, drainage tube
  • pain control, epidural, opioid infusion, PCA
  • Accurate I&O
  • Risk of resp problems, mobilize DB&C
44
Q

Complications of Nephrectomy (6)

A
  • hemorrhage
  • pneumothorax
  • chest infection
  • wound infection
  • UTI - foley
  • DVT

NURS 412 Final Exam (12 decks)

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