Renal and Urologic Problems Flashcards
1
Q
UTI General Symptoms?
A
dysuria, frequency, urgency, supra-pubic discomfort/pressure, hematuria/cloudy urine
2
Q
UTI Symptoms in an older adult?
A
non-localized abd pain and cognitive changes
3
Q
Diagnostics for a UTI?
A
- UA to identify presence of nitrites, WBC’s and leukocyte esterase
- CNS study
4
Q
UTI tx?
A
hydrate, antibiotics, teaching (hygiene…)
5
Q
UTI Preventive measures?
A
- regular bowel movements
- bladder emptying
- adequate hydration
- cranberry juice/tabs
- void b4 sex and after sex
- good catheter care
6
Q
Most common cause of UTI?
A
E. Coli
7
Q
Pyelonephritis
A
- Inflammation of the renal parenchyma (Upper UTI) and collecting system, including the renal pelvis
8
Q
Cause of Pyelonephritis?
A
Usually a lower urinary infection that has ascended
9
Q
Pyelonephritis symptoms?
A
- fatigue, fever, chills, vomiting, malaise, flank pain
- lower UTI symptoms,
Costovertebral angle tenderness
10
Q
Acute treatment of Pyelonephritis?
A
Antibiotics and fluids
11
Q
Cystitis
A
Inflammation of the bladder lower UTI
12
Q
Inflammation of the bladder (lower UTI)
A
Cystitis
13
Q
Cystitis risk factors?
A
female and catheter is inserted
14
Q
Cystitis S/S?
A
urgency, frequency, cloudy/foul smelling urine
15
Q
Cystitis Tx?
A
- Urine acidifiers (cranberry juice)
- Urinary tract analgesic
16
Q
Glomerulonephritis Signs/Symptoms
A
hematuria, proteinuria, uremia, pyuria, edema, hypertension
17
Q
What diagnostic test would you do if Glomerulonephritis is suspected?
A
- UA
- blood study (BUN, WBC, creatinine)
- Abd or kidney US/CT
18
Q
Glomerulonephritis Treatment?
A
- Manage symptoms (HTN, edema, and UTI)
- Low protein, low NA diet
- fluid restriction, I&O, weigh daily
19
Q
diet restrictions for glomerulonephritis?
A
Low protein, low NA
20
Q
Pt teaching: glomerulonephritis?
A
- Decrease dietary protein if high BUN
- Daily weight
21
Q
Medical term for stone?
A
Calculus
22
Q
What is the most common type of Urinary Calculi?
A
calcium oxalate
23
Q
Medical term for stone formation
A
Lithiasis
24
Q
Urolithiasis
A
Urinary stone
25
Nephrolithiasis
Kidney stone
26
Urinary Calculi Risk Factors?
- men > women
- age 20-55
- White > AA
- Family history
- UTI
- dehydration
27
Urinary Calculi Signs/symptoms?
- decreased UO
- abd or flank pain
- hematuria
- N/V
- fever/chills
- kidney stone dance (a.k.a. renal colic)
28
Diagnostic for Urinary Calculi?
- CT
- US
- UA
- Kidney Ureter Bladder (KUB) x-ray
29
Urinary Calculi Acute Attack Treatment?
- Treat pain, infection, obstruction
- Hydration
- Medication to relax smooth muscle
- Strain all urine
30
Medication to relax smooth muscle used to treat Urinary Calculi?
Tamsulosin or terazosin
31
Pt Teaching - Urinary Calculi?
- Adequate hydration
- Diet-based on cause
- Pain management
- Lithotripsy, surgical removal
32
Uncontrolled leakage of urine?
Urinary Incontinence
33
Urinary Incontinence is caused by?
"DRIP"
- Delirium/Drugs
- Retention
- Immobility, Inflammation or Impaction of feces
- Polyuria
34
Type of Urinary Incontinence?
"SOUR"
- Stress
- Overflow
- Urge
- Reflux
35
Type of Urinary Incontinence caused by lifting, sneezing, laughing?
Stress
36
Type of Urinary Incontinence caused by BPH or uterine prolapse and the patient complains of "constant dribbling"?
Overflow
37
Involuntary urination without warning
Reflux incontinence
38
Type of Urinary Incontinence caused a spinal cord injury (SCI) or MS?
Reflux incontinence
39
Urinary Incontinence complications?
infection, skin break down and embarrassment
40
Pt teaching- Urinary Incontinence?
- hydration
- scheduled void or cath
- pelvic floor exercises
double voiding
- incontinence pads
- meds
41
Which category of drug is used for urinary incontinence and why?
anticholinergics to relax the bladder muscle
42
Causes of Urinary Retention?
Bladder outlet obstruction and ↓ detrusor muscle contraction
43
S/S of Urinary Retention?
frequent small urination, suprapubic distension or pain, elevated specific gravity
44
Pt teaching-Urinary Retention?
- Double/scheduled - Voiding
- Catheter if indicated
- Diet
- Medications
- Surgery for obstruction
45
Complications of Urinary Retention?
rupture, infection, uremia
46
Indication for a Urinary Diversion?
cancer, neurogenic bladder, trauma, strictures
47
most common Urinary Diversion?
Ileal conduit
48
Ileal conduit
ureters are implanted in part of the ileum, with stoma
49
Types of Urinary Diversions?
- Ileal conduit,
- Cutaneous Ureterostomy
- Nephrostomy
50
Cutaneous Ureterostomy
ureters brought to the abdominal wall, with stoma
51
Nephrostomy
catheter inserted into renal pelvis of the kidney (temp or permanent)
52
Which types of Urinary Diversions have stomas?
Ileal conduit and cutaneous ureterostomy
53
S/S of Benign Prostatic Hyperplasia?
retention, hesitancy, frequency, urgency, dysuria, nocturia, hematuria, difficulty initiating/stopping, dribbling
54
Diagnostics for BPH?
- H&P
- Digital exam
- Urine Culture
- Prostate-Specific Antigen (PSA)
- Transrectal Ultrasound
- Cystoscopy
55
BPH teaching Management?
- med information
- Avoid things that increase symptoms
- alcohol, caffeine, cold medicine
- Limit evening fluids
- Urinate every 2-3 hours (decrease retention)
56
In a patient with BPH, the below increase the risk of?
1) dehydration
2) overhydration
1) infection
| 2) distention
57
5 alpha reductase inhibitors MOA and does what in a patient with BPH?
- inhibits 5-alpha reductase, preventing the production of DHT from testosterone
- causes regression of hyperplasia
58
Alpha adrenergic receptor blockers
| do what in a patient with BPH and take how to be effective?
- Promotes smooth muscle relaxation
| - 2-3 wks
59
What does TURP stand for?
Transurethral Resection of the Prostate
60
TURP (Transurethral Resection of the Prostate) Post-surgical Care?
Antibiotics
Pain management
Assess dressing/drainage
61
TURP Post-op complications ?
- Hemorrhage (assess urine and vitals frequently)
- Bladder spasm
- Urinary incontinence
- Infection
62
During a continuous bladder irrigation, the urine may be bright red for how long?
up to 12 hrs
63
How to determine the flow to be use during a continuous bladder irrigation?
titrate for urine flow to be light pink/clear, no clots
64
Why must the bag never be allowed to run dry during a continuous bladder irrigation?
may increase clotting in the catheter and cause pain
65
UTI risk factors?
prego, menopause, habitual delay of urination, foleys, sex
66
Meds to tx uncomplicated or initial UTIs?
- Trimethoprim-sulfamethoxazole (TMO-SMX)
| - nitrofurantoin (macrodantin)
67
What is pyruria?
increased number WBC's in the urine
68
Acute Poststreptococcal Glomerulonephritis is caused by?
infection of the tonsils, pharynx, or skin by nephrotoxic strains of group A-hemolytic streptococci
69
How long after an infection by group A-hemolytic streptocci will APSGN develop?
5-21 days
70
Manifestations of APSGN?
- generalized body edema
- HTN
- oliguria
- hematuria with a smoky or rusty appearance
- proteinuria
71
ASPGN management?
- rest
- edema and HTN management
- dietary protein restriction if an increase in nitrogenous wastes is present
72
What are the five major categories of stones?
- calcium phosphate
- calcium oxalate
- uric acid
- cysteine
- struvite
73
What is the medical term for the regular reflex of urination?
micturition
74
Complications of an indwelling catheter (> 30 days)
bladder spasm, periurethral abscess, pain, and urosepsis
75
Initial and conservative tx of BPH?
- Meds: 5 alpha reductase inhibitors and a-adrenergic blockers
- watch and wait for asymptomatic or minor symptom presentation
