Renal and Urological Problems Flashcards
What are some gerontologic considerations and effects of aging on the urinary system and why?
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
What are functions of the kidney?
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
What are some differences in the gerontologic urinary assessment?
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
What is normal findings of a urinary system assessment?
No costovertebral angle tenderness
Non palpable kidney and bladder
No palpable masses
What subjective data would you collect when assessing the urinary system?
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
What is some objective data you would collect when assessing the urinary system?
Do a BMP, collect a urine sample ( look before you send it to the lab) Physical examination Inspection Palpitation Percussion Auscultation
What are some clinical manifestations of disorders of the urinary system?
fatigue headaches blurred vision elevated blood pressure anorexia nausea and vomiting chills itching excessive thirst change in body weight cognitive changes
What are some clinical manifestations of edema when related to the urinary system?
facial (periorbital) ankle ascites anasarca sacral
What are some clinical manifestations of pain when related to the urinary system?
dysuria
flank or costovertebral angle
groin
suprapubic
what are some clinical manifestations of patterns of urination when related to the urinary system?
frequency urgency hesitancy of stream change in stream retention dysuria nocturia overactive bladder incontinence stress incontinence dribbling
what are some clinical manifestations of urine output when related to the urinary system?
anuria
oliguria
polyuria
What are some clinical manifestations of urine composition when related to the urinary system?
concentrated dilute hematuria pyuria color (red, brown, yellowish green)
oliguria
decreased urine output to between 100-400 ml/24 hr
anuria
urine output <100ml/24hrs
dysuria
painful urination
nocturia
waking from sleep due to the need to urinate
polyuria
urine output >2000ml/24hrs
uremia
full blown renal failure
What is a BUN
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
What is Creatinine
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
What diagnostic study/ radiologic procedure is done to assess the urinary system?
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
What is a bladder scanner and what is it used for?
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
What needs to be done before you perform diagnostic studies on the urinary system?
make them NPO
check for allergies (dyes will be used)
Check medications
perform a bowel cleansing
What is an Intravenous Pyelogram (IVP)
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
What are contraindications to Intravenous Pyelogram (IVP)
allergy to iodine
shellfish
decreased renal function with creatinine elevation above 1.5mg/dL - may be contraindicated
What are pre and post procedure duties for a nurse in the case of an Intravenous Pyelogram (IVP)
Pre- NPO 8hrs, bowel cleanse with laxatives, enema evening prior
Post- force fluids to flush out contrast (dye is nephrotoxic)
What is a cystoscopy?
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
After a cystoscopy what does the nurse do?
push fluids
instruct patient dysuria may occur
that they may have pink tinged urine
What is the GFR or Creatinine Clearance?
Most accurate indicator of renal function
Normal range is 70-135ml/minute
How do you get a GFR?
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.
What causes UTIs
urinary stasis having a catheter not urinating after sex not able to empty the bladder bacteria - E-coli is the most common
What are the clinical manifestations of UTI’s
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
How do you diagnose UTI’s
urinalysis
culture and sensitivity
IVP
CT
How do you treat UTI’s
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
What is the therapeutic management for UTI’s
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
What is acute pyelonephritis?
Inflammation of renal parynchyma and collecting system
Typically begins as a lower UTI then ascends
Who is at a greater risk for acute pyelonephritis?
those who have
BPH
Stricture
Stones
What are signs and symptoms of acute pyelonephritis?
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
How do you diagnose and treat acute pyelonephritis?
diagnose with a urine culture
treated with antibiotics for 2-3 weeks
What are the goals of a patient who have pyelonephritis?
will have normal renal function will have normal body temperature will have no complications will have pain relief will have no recurrence
What is urethritis?
inflammation of the urethra
What causes urethritis and how do you treat it?
cause is usually sexually transmitted trichomonas monilia chlamydia gonorrhea You treat the cause
what is interstitial cystitis?
chronic painful inflammatory disease of the bladder
What are the symptoms of interstitial cystitis and how do you diagnose it?
pain, urinary frequency and urgency are primary symptoms
its a diagnosis of exclusion
how do you prevent cystitis?
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
What is glomerulonephritis?
A deposition of immune complexes within the glomeruli leads to inflammation and ineffective renal filtration ability
What is the cause of glomerulonephritis?
may be due to infection or an immune disorder, such as SLE
What are the signs and symptoms of glomerulonephritis?
proteinuria, hematuria, generalized edema and other symptoms of fluid overload, elevated BP, hypertension, oliguria, dysuria, lethargic, low grade fever, headache
how do you diagnose glomerulonephritis?
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
How do you treat glomerulonephritis?
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
What type of urinary tract calculi (kidney stones) are there?
calcium phosphate calcium oxylate uric acid cystine struvite
What are the clinical manifestations of kidney stones?
abdominal or flank pain
hematuria
renal colic
nausea and vomiting
how do you diagnose kidney stones?
U/A Urine culture CT IVP Ultrasound Cystoscopy
What are the risk factors for kidney stones?
infection urinary stasis & retention immobility dehydration increased uric acid increased urinary oxalate
how do you treat kidney stones?
treat pain or infection
evaluate cause of stone
cystoscopy
lithotripsy
What are the goals of a patient with kidney stones?
to obtain adequate pain relief
prevent urinary tract obstruction
educate patient on prevention of future stones
What do you do for renal trauma?
gross or microscopic hematuria may be present
perform a UA< IVP ultrasound, CT or MRI
What is polycystic kidney disease?
the most common life-threatenting genetic disease in the world
Symptoms appear when cysts begin to enlarge
It can effect other organs
What are clinical manifestations of PKD?
hypertension, gross hematuria, proteinuria, heaviness in back, side or abdomen, UTI or renal calculi, palpable enlarged and knobby kidney
How do you diagnose PKD?
based on signs and symptoms, family history, IVP, ultrasound, or CT
How do you treat PKD?
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
What are the risk factors for kidney cancer?
cigarette smoking (most significant risk factor) obesity, hypertension and chemical exposure
how is kidney cancer diagnosed?
by biopsy
What are risk factors for bladder cancer?
smoking and exposure to certain chemicals
women treated with radiation for cervical cancer and people receiving cytoxan
What is urinary incontinence?
uncontrolled leakage of urine
can affect quality of life
How do you treat urinary incontinence?
lifestyle modifications scheduling voiding regimens pelvic floor muscle strengthening (Kegel exercises) anti-incontinence devices containment devices pharmacological intervention surgical intervention
What kind of pharmacological treatment is there for incontinence?
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)
What is urinary retention?
Inability to empty bladder
a medical emergency
What causes urinary retention?
may be due to:
an obstruction (BPH)
deficient bladder muscle contraction strength
neurologic diseases
longstanding DM
over-distention
chronic alcoholism
drugs (anticholinergics)
