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Adult health2 > Renal and Urological Problems > Flashcards

Renal and Urological Problems Flashcards

0
Q

What are some gerontologic considerations and effects of aging on the urinary system and why?

A

Urinary incontinence
Urinary hesitancy
Urinary stream issue

Not able to move around very much
At night safety - leave a light on, make sure there are no rugs
Make sure you create a safe environment

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1
Q

What are functions of the kidney?

A 
Regulate volume and composition of extra cellular fluid
Excrete waste products from the body 
Control B/P
Produce erythropoietin 
Activate vitamin D
Regulate acid base balance
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2
Q

What are some differences in the gerontologic urinary assessment?

A 
Elasticity goes down
Creatinine goes down
Decrease in the amount of renal tissue 
Worry about giving nephrotoxic drugs
  Ibuprofen, NSAIDs, Toridol 
Do a BMP 
  BUN - 10-20mg/dL
  Creatinine -0.5-1.2mg/dL
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3
Q

What is normal findings of a urinary system assessment?

A

No costovertebral angle tenderness
Non palpable kidney and bladder
No palpable masses

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4
Q

What subjective data would you collect when assessing the urinary system?

A

Important health information
Past health history, medications, surgery or other treatments
Functional health patterns
Health perception-health management pattern, nutritional-metabolic pattern, elimination pattern, activity-exercise pattern, sleep-rest pattern, cognitive-perceptual pattern, self-perception-self-concept pattern, role-relationship pattern, sexuality-reproductive pattern
Ask about flank and groin pain, ask about meds, ask if they noticed any changed in urine, pain score

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5
Q

What is some objective data you would collect when assessing the urinary system?

A 
Do a BMP, collect a urine sample ( look before you send it to the lab)
Physical examination
  Inspection
  Palpitation 
  Percussion 
  Auscultation
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6
Q

What are some clinical manifestations of disorders of the urinary system?

A 
fatigue 
headaches
blurred vision
elevated blood pressure
anorexia 
nausea and vomiting 
chills
itching 
excessive thirst 
change in body weight
cognitive changes
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7
Q

What are some clinical manifestations of edema when related to the urinary system?

A 
facial (periorbital)
ankle
ascites 
anasarca 
sacral
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8
Q

What are some clinical manifestations of pain when related to the urinary system?

A

dysuria
flank or costovertebral angle
groin
suprapubic

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9
Q

what are some clinical manifestations of patterns of urination when related to the urinary system?

A 
frequency 
urgency 
hesitancy of stream 
change in stream 
retention
dysuria 
nocturia 
overactive bladder 
incontinence 
stress incontinence 
dribbling
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10
Q

what are some clinical manifestations of urine output when related to the urinary system?

A

anuria
oliguria
polyuria

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11
Q

What are some clinical manifestations of urine composition when related to the urinary system?

A 
concentrated 
dilute 
hematuria 
pyuria 
color (red, brown, yellowish green)
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12
Q

oliguria

A

decreased urine output to between 100-400 ml/24 hr

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13
Q

anuria

A

urine output <100ml/24hrs

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14
Q

dysuria

A

painful urination

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15
Q

nocturia

A

waking from sleep due to the need to urinate

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16
Q

polyuria

A

urine output >2000ml/24hrs

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17
Q

uremia

A

full blown renal failure

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18
Q

What is a BUN

A

Blood Urea Nitrogen
Measures nitrogenous urea in blood; urea is produced by protein metabolism: insufficient secretion causes levels to rise and may indicate renal disorders
May increase in situations of rapid cell destruction such as trauma, high levels of exercise, also with fever,steroid therapy, any bleeding such as GI bleed, dehydration, high protein diet

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19
Q

What is Creatinine

A

A nitrogenous waste resulting from muscle metabolism of creatinine
Creatinine levels reflect GFR
Filtered by the kidneys and excreted in the urine
A good indicator of kidney function; because muscle mass and metabolism is usually constant
Severe renal damage is the only cause of significant elevation

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20
Q

What diagnostic study/ radiologic procedure is done to assess the urinary system?

A

KUB - Kidneys, Ureters, Bladder
A plain film of the abdomen without any specific patient preparation
Shows shape, size and position of the urinary tract
May see obvious stones, strictures, calcifications or obstructions

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21
Q

What is a bladder scanner and what is it used for?

A

Portable ultrasound scanner used at the bedside
Is used to determine the need for intermittent catheterization based on the amount of urine in the bladder rather than the time between urinations or caths
It verifies empty bladder and post void residual

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22
Q

What needs to be done before you perform diagnostic studies on the urinary system?

A

make them NPO
check for allergies (dyes will be used)
Check medications
perform a bowel cleansing

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23
Q

What is an Intravenous Pyelogram (IVP)

A

dye injected intravenously is excreted via kidneys to bladder
Series of X-rays taken
visualize tract- gives clues to structure and function
Cyst tumors lesions and obstructions cause a distortion in normal appearance

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24
Q

What are contraindications to Intravenous Pyelogram (IVP)

A

allergy to iodine
shellfish
decreased renal function with creatinine elevation above 1.5mg/dL - may be contraindicated

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25
Q

What are pre and post procedure duties for a nurse in the case of an Intravenous Pyelogram (IVP)

A

Pre- NPO 8hrs, bowel cleanse with laxatives, enema evening prior

Post- force fluids to flush out contrast (dye is nephrotoxic)

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26
Q

What is a cystoscopy?

A

used to inspect interior of bladder with a tubular lighted scope
can be used to inset ureteral catheters, remove calculi, obtain biopsy of bladder lesions and treat bleeding lesions
is an OR procedure

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27
Q

After a cystoscopy what does the nurse do?

A

push fluids
instruct patient dysuria may occur
that they may have pink tinged urine

28
Q

What is the GFR or Creatinine Clearance?

A

Most accurate indicator of renal function

Normal range is 70-135ml/minute

29
Q

How do you get a GFR?

A

do a 24 hours urine
discard first urination and then every one after that for the next 24 hours is put in a container that is on ice. when the 24 hours is up you hand carry it to the lab.

30
Q

What causes UTIs

A 
urinary stasis
having a catheter 
not urinating after sex 
not able to empty the bladder 
bacteria - E-coli is the most common
31
Q

What are the clinical manifestations of UTI’s

A

dysuria
frequent urination
urgency
suprapubic discomfort or pressure
urine may have visible blood or cloudy appearance
Flank pain, chills or fever are indicative of upper UTI

32
Q

How do you diagnose UTI’s

A

urinalysis
culture and sensitivity
IVP
CT

33
Q

How do you treat UTI’s

A

treat for 3-14 days
antibiotic is given based on the bacteria causing the infection
If symptoms have not subsided by follow-up they will change the antibiotic
Bactrim, Ciprofloxaxin

34
Q

What is the therapeutic management for UTI’s

A 
surgery for structural abnormality, stent
Increase fluids to 3 liters daily 
Administer antimicrobials as ordered 
Administer analgesic and antispasmodic 
Encourage voiding every 2-3hrs 
Monitor I&O and urine characteristics
35
Q

What is acute pyelonephritis?

A

Inflammation of renal parynchyma and collecting system

Typically begins as a lower UTI then ascends

36
Q

Who is at a greater risk for acute pyelonephritis?

A

those who have
BPH
Stricture
Stones

37
Q

What are signs and symptoms of acute pyelonephritis?

A

mild fatigue
CVA tenderness
sudden onset of fever, chills, vomiting, malaise, flank pain, dysuria, urgency and frequency
UA shows WBC’s, bacteria and hematuria (varying degrees

38
Q

How do you diagnose and treat acute pyelonephritis?

A

diagnose with a urine culture

treated with antibiotics for 2-3 weeks

39
Q

What are the goals of a patient who have pyelonephritis?

A 
will have normal renal function
will have normal body temperature
will have no complications 
will have pain relief 
will have no recurrence
40
Q

What is urethritis?

A

inflammation of the urethra

41
Q

What causes urethritis and how do you treat it?

A 
cause is usually sexually transmitted 
  trichomonas 
  monilia 
  chlamydia 
  gonorrhea 
You treat the cause
42
Q

what is interstitial cystitis?

A

chronic painful inflammatory disease of the bladder

43
Q

What are the symptoms of interstitial cystitis and how do you diagnose it?

A

pain, urinary frequency and urgency are primary symptoms

its a diagnosis of exclusion

44
Q

how do you prevent cystitis?

A

drink 8 to 10 glasses of fluid per day
women should wipe from front to back
Avoid vaginal deodorants and bubble baths
urinate after intercourse

45
Q

What is glomerulonephritis?

A

A deposition of immune complexes within the glomeruli leads to inflammation and ineffective renal filtration ability

46
Q

What is the cause of glomerulonephritis?

A

may be due to infection or an immune disorder, such as SLE

47
Q

What are the signs and symptoms of glomerulonephritis?

A

proteinuria, hematuria, generalized edema and other symptoms of fluid overload, elevated BP, hypertension, oliguria, dysuria, lethargic, low grade fever, headache

48
Q

how do you diagnose glomerulonephritis?

A

assess for previous infection - often Group A Beta-hemolytic streptococcus (throat or skin lesions)
urinalysis, 24 hr urine for creatinine clearance
testing for immunological reactions such as ANA, IgG, and C3 complement levels

49
Q

How do you treat glomerulonephritis?

A

antibiotics if it is an infection
management of fluid overload with Na and water restriction, diuretics
Oliguria may lead to increased K+ which needs treatment
Antihypertensives
May need plasmapheresis to remove immune complexes or short term dialysis

50
Q

What type of urinary tract calculi (kidney stones) are there?

A 
calcium phosphate
calcium oxylate 
uric acid 
cystine 
struvite
51
Q

What are the clinical manifestations of kidney stones?

A

abdominal or flank pain
hematuria
renal colic
nausea and vomiting

52
Q

how do you diagnose kidney stones?

A 
U/A 
Urine culture 
CT 
IVP
Ultrasound 
Cystoscopy
53
Q

What are the risk factors for kidney stones?

A 
infection
urinary stasis & retention 
immobility 
dehydration 
increased uric acid 
increased urinary oxalate
54
Q

how do you treat kidney stones?

A

treat pain or infection
evaluate cause of stone
cystoscopy
lithotripsy

55
Q

What are the goals of a patient with kidney stones?

A

to obtain adequate pain relief
prevent urinary tract obstruction
educate patient on prevention of future stones

56
Q

What do you do for renal trauma?

A

gross or microscopic hematuria may be present

perform a UA< IVP ultrasound, CT or MRI

57
Q

What is polycystic kidney disease?

A

the most common life-threatenting genetic disease in the world
Symptoms appear when cysts begin to enlarge
It can effect other organs

58
Q

What are clinical manifestations of PKD?

A

hypertension, gross hematuria, proteinuria, heaviness in back, side or abdomen, UTI or renal calculi, palpable enlarged and knobby kidney

59
Q

How do you diagnose PKD?

A

based on signs and symptoms, family history, IVP, ultrasound, or CT

60
Q

How do you treat PKD?

A

A nephrectomy may be necessary if pain, bleeding or infection becomes a chronic serious problem.
The goal is to prevent UTI & monitor renal function
They need to be drinking 2-2.5L a day to prevent UTI and calculi
They will also be on an antihypertensive

61
Q

What are the risk factors for kidney cancer?

A 
cigarette smoking (most significant risk factor)
obesity, hypertension and chemical exposure
62
Q

how is kidney cancer diagnosed?

A

by biopsy

63
Q

What are risk factors for bladder cancer?

A

smoking and exposure to certain chemicals

women treated with radiation for cervical cancer and people receiving cytoxan

64
Q

What is urinary incontinence?

A

uncontrolled leakage of urine

can affect quality of life

65
Q

How do you treat urinary incontinence?

A 
lifestyle modifications 
scheduling voiding regimens 
pelvic floor muscle strengthening (Kegel exercises)
anti-incontinence devices 
containment devices 
pharmacological intervention 
surgical intervention
66
Q

What kind of pharmacological treatment is there for incontinence?

A 
Muscarinic receptor antagonists 
  oxybutynin (ditropan)
  tolterodine (detrol)
Alpha adrenergic antagonists 
  doxazosin (cardura)
  tamsulosin (flomax)
5 alpha reductase inhibitors 
  finasteride (proscar - may decrease libido)
  dutasteride (avodart)
67
Q

What is urinary retention?

A

Inability to empty bladder

a medical emergency

68
Q

What causes urinary retention?

A 
may be due to:
  an obstruction (BPH)
  deficient bladder muscle contraction strength
     neurologic diseases 
     longstanding DM
     over-distention 
     chronic alcoholism 
     drugs (anticholinergics)

Adult health2 (5 decks)

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