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Medsurg > Renal Cancer > Flashcards

Renal Cancer Flashcards

Exam 3

1
Q

RENAL CANCER:
Epidemiology- What is the most common kind?

A

Renal cell carcinoma or adenocarcinoma is most common

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2
Q

RENAL CANCER:
Epidemiology- Who does it occur more often in?

A

Occurs more often in males age 50-70 than females

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3
Q

RENAL CANCER:

Pathophysiology: Where is it usually found?

A

Usually found in the cortex or pelvis of the kidney

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4
Q

RENAL CANCER:

Pathophysiology: What is more common in the kidney?

A

malignant tumors in the kidney are more frequent than benign tumors

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5
Q

RENAL CANCER:

Epidemiology: What ethnicity is it most common?

A

African Americans and American Indians Alaskan native populations have slightly highly rates of renal cancer for unknown reasons

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6
Q

Renal Cancer:
Clinical manifestations: How are patients intially?

A

Initially asymptomatic

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7
Q

Renal Cancer:
Clinical manifestations: How does 10% of the population present?

A

10% present with the classic triad

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8
Q

Renal Cancer:
Clinical manifestations: What is the classic triad?

A

Flank mass

flank pain

hematuria

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9
Q

RENAL CANCER

Management: What is needed to diagnose?

A

Several studies needed to diagnose

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10
Q

RENAL CANCER

Management:

A

Biological immunotherapy- boost immune system or cytokines

Radical nephrectomy

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11
Q

Renal cancer:
When it metastizes, where does it go/

A

Usually to the lungs, liver and long bones of the body

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11
Q

RENAL CANCER

What are risk factors?

A

obesity, hypertension, and exposure to certain substances such as gasoline, abestos, medications like diuretics

smoking

People with any type of cystic disease or ESRD

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12
Q

RENAL CANCER:

Clinical Manifestations: What are other symptoms of Renal Cancer? (not classic triad)

A

other symptoms include weight loss, fatigue, hypertension, fever that is not related to an infection and anemia

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13
Q

If men have renal cancer, what could it cause?

A

Compression of the testicular vein

Enlargement of the scrotum

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14
Q

RENAL CANCER:

What are used to differentiate between solid mass tumors and cysts?

A

There are a number of studies that need to be done to diagnose renal cancers

ultrasounds are used to differentiate between solid masses tumors and cysts

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15
Q

RENAL CANCER:

What other tests are used?

A

other tests include angiography, percutaneous needle aspiration, CT scan an MRI

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16
Q

RENAL CANCER:

What does radionuclide isotopes used for?

A

radionuclide isotopes scanning is used to detect metastasis

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17
Q

RENAL CANCER:

What is urine cystoscopy testing for?

A

urine cystoscopy testing shows the presence of neoplastic or atypical cells

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18
Q

Most renal cancer cells, how do they react to chemotherapy?

A

They don’t react to chemo

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19
Q

RENAL CANCER:

What is renal biopsy for?

A

renal biopsy is sometimes utilized to look at cancerous tissue cells

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20
Q

RENAL CANCER:

How can diagnosed cancer be staged?

A

Once diagnosed cancer can be staged to aid in treatment decisions.

Robson system of staging renal carcinoma is one of the staging system utilized. (don’t need to know different stages just know it exists?)

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21
Q

RENAL TRAUMA

Epidemiology: Who is most likely affected?

A

Most accidents involve males less than 30 years old and represent blunt force trauma

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22
Q

RENAL TRAUMA

Epidemiology: How does it occur?

A

Sharp blow may cause contusions, tearing, or rupture

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23
Q

RENAL TRAUMA

Pathophysiology and clinical manifestations:

How can injuries to renal system range?

A

Injuries to the renal system can range from contusion or hematoma to a shattered kidney

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24
Q

RENAL TRAUMA:

Pathophysiology and clinical manifestations: How is urine?

A

Urinary output can be reduced or absent

Hematuria

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25
Q

Renal Trauma: Why are kidneys vulnerable to injury?

A

The kidneys are vulnerable to injury because of the lack of bone protection

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26
Q

Renal Trauma: What kind of fractures damage renal system? How?

A

pelvic fractures can cause proliferation and tearing of the tissues in the renal system

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27
Q

Renal Trauma: What does hematuria NOT predict?

A

the amount of hematuria does not necessarily predict the degree of damage to the renal system

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28
Q

CHRONIC KIDNEY DISEASE:

Epidemiology: How is it world wide?

A

Worldwide health problem

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29
Q

CHRONIC KIDNEY DISEASE:

Epidemiology: Who are rates higher in? (ethnicity or gender)

A

Rates higher in African Americans and Native Americans

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30
Q

CHRONIC KIDNEY DISEASE:

Pathophysiology: What is it?

A

Progressive, irreversible loss of kidney function

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31
Q

CHRONIC KIDNEY DISEASE:

Pathophysiology: What are the most common causes?

A

Most common causes are diabetes and hypertension

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32
Q

CHRONIC KIDNEY DISEASE:

Pathophysiology: How is it characterized?

A

Characterized in 5 stages delineated by GFR

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33
Q

CHRONIC KIDNEY DISEASE

Clinical Manifestations

A

Devastating effect on every body system

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34
Q

CHRONIC KIDNEY DISEASE

Management: What kind of therapies?

A

Renal replacement therapies

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35
Q

CHRONIC KIDNEY DISEASE

Management: What is management needed for?

A

Hyperkalemia, hypertension, renal osteodystrophy, hypocalcemia, hyperparathyroidism, anemia, and dyslipidemia

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36
Q

CHRONIC KIDNEY DISEASE

Management: What kind of surgery may be necessary?

A

Renal transplantation

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37
Q

CHRONIC KIDNEY DISEASE

Alterations in potassium expression can lead to what?

A

alterations in potassium expression result in lethal arrhythmias

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38
Q

CHRONIC KIDNEY DISEASE

What happens to acid clearance? What does this result in?

A

a decrease in acid clearance and bicarbonate results in metabolic acidosis

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39
Q

CHRONIC KIDNEY DISEASE

What is there a decrease in production of?

A

a decrease in the production of erythropoietin results in chronic anemia

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40
Q

CHRONIC KIDNEY DISEASE

What is the diagnosis of CKD based on?

A

the diagnosis of chronic kidney disease is based on the consistent elevation of serum creatinine levels and a decrease creatinine clearance

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41
Q

CHRONIC KIDNEY DISEASE

What is another clear indicator of CKD?

A

another clear indicator is the presence of protein or albumin in the urine

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42
Q

CHRONIC KIDNEY DISEASE

What can urinalysis indicate for CKD?

A

urine analysis can detect red blood cells white blood cells protein cast and glucose

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43
Q

CHRONIC KIDNEY DISEASE

What can imaging studies indicate for CKD?

A

imaging studies such as renal ultrasound, a CT scan and a renal biopsy can provide additional information as to the status of the structure of the kidney and their function

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44
Q

CKD:

What kind of recipients benefit from kidney transplant the most?

A

recipients who are in good health except for the primary kidney disease are between the ages of five and 50 have the best outcome and prognosis

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45
Q

What are the three types of donors?

A

There are three types of donors

  1. deceased donors,
  2. living relative donors
  3. living unrelated donors
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46
Q

RENAL REPLACEMENT THERAPIES:

What do they do?

A

Artificial processes for removing waste and water from the body when kidneys no longer function

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47
Q

RENAL REPLACEMENT THERAPIES:

Renal replacement therapy techniques
include:

A

Intermittent hemodialysis (HD)

Continuous hemofiltration and HD

Peritoneal dialysis (PD)

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48
Q

RENAL REPLACEMENT THERAPIES:

Renal replacement therapy techniques
include:

Continuous hemofiltration and HD- What are they known as?

A

Known as continuous renal replacement therapies

49
Q

Hemodialysis Vascular Access:

How may IV access be secured?

A

intravenous vascular access may be secured by using a central venous double lumen catheter in the subclavian or internal jugular vein

50
Q

Hemodialysis Vascular Access:

Central venous double lumen catheter- When is it used?

A

this type of access typically is used for a short period of time and is used to treat patients with intermittent hemodialysis or when waiting for secured longer access such as atrial venous fistula or an AV graft

51
Q

Hemodialysis Vascular Access:

How is an AV fistula created?

A

an av fistula is created by surgically joining an artery and a vein typically in the radial artery or the cephalic vein in the non dominant hand

52
Q

Continuous Renal Replacement Therapy:

What is there a risk of occurring? Why?

A

Bleeding- because heparin is used

Muscle cramps, headaches because of the rapid removal of electrolytes

53
Q

Peritoneal Dialysis:

What does this offer the patient? (How can patient take this dialysis)

A

it offers increased patient control and flexibility with options of home treatments

54
Q

Peritoneal Dialysis:

What does it require of the patient?

A

it requires training of the patient that can be performed independently by the patient or even by the family members.

55
Q

Peritoneal Dialysis:

How are dietary restrictions and mobility for patients?

How is clearance of metabolic waste?

A

typically peritoneal dialysis involves fewer dietary restrictions and greater mobility for patients.

56
Q

Peritoneal Dialysis:

What does this type of dialysis avoid?

A

It avoids the rapid fluctuations in extracellular fluid compartments and associated symptoms

57
Q

Peritoneal Dialysis:

How is clearance of metabolic waste?

A

The clearance of metabolic waste is slower but more continuous.

58
Q

Peritoneal Dialysis:

Who is it indicated for?

A

peritoneal dialysis is indicated for patients who desire more control who have vascular access problems and who respond poorly to hemodialysis

59
Q

Peritoneal Dialysis:

Who may PD be easier?

A

older patients with end stage renal disease and diabetes may more easily be maintained with PD

60
Q

Peritoneal Dialysis:

What is used as a dialyzing layer?

A

with PD the peritoneal cavity is used as the dialyzing layer

61
Q

Peritoneal Dialysis:

What does the process consist of?

A

the PD process consists of filling, dwelling and the draining phase

62
Q

Peritoneal Dialysis:

What occurs in the filling phase?

A

in the filling phase room temperature sterile diacetate is instilled into the peritoneal cavity via a permanent indwelling PD catheter

63
Q

What are the most common bacterial infections in the world?

A

UTI’s are one of the most common bacterial infections in the world and it accounts for 10 million healthcare visits

64
Q

What are the most common reason for antibiotic prescription?

A

UTI’s are the most common reason for antibiotic prescription

65
Q

Urinary tract infection:
How does bacteria enter?

A

bacteria usually enters the bladder through the urethra.

66
Q

Population at risk for UTI

A

Women due to the female anatomy

Men of advanced age who have an enlarged prostate

Individuals with diabetes

Individual who require catheterization or incomplete emptying of the bladder

Poor hygiene

Estrogen deficiency

67
Q

Clinical Manifestation of UTI

A

Bladder irritation/ painful urination (dysuria)

Urinary frequency

Urinary urgency

Urinating in small amounts/volume

Gross hematuria/microhematuria

Fever, nausea, vomiting

Flank pain in pyelonephritis

Foul smell urine

68
Q

Medical Management for UTI:

What would a urinalysis show?

A

A urinalysis will show if there are nitrates , leukocytes, myoglobin or bacteria present.

69
Q

Medical Management for UTI:

Why would leukocytes be present in the urine?

A

Leukocytes may be present in the urine if there is some type of inflammation or infectious process going on.

70
Q

Medical Management for UTI:

Why would nitrates be present in the urine?

A

Nitrates can be seen if there are certain bacteria.

71
Q

Medical Management for UTI:

What do nitrites convert to?

A

Nitrates converts into nitrites.

72
Q

Medical Management for UTI:

What is the most common bacteria seen in uncomplicated UTIs?

A

E coli is a very common bacteria that is seen in uncomplicated uti’s.

73
Q

Treatment of UTI:

Uncomplicated UTIs- who is it in?

A

Uncomplicated UTI (a female who is not pregnant, does not have diabetes and is afebrile)

74
Q

Treatment of UTI:

Uncomplicated UTIs- What is the first line therapy? How long? What are examples?

A

First line are antimicrobial therapy

3-day course

Bactrim, Cipro and Macrobid

75
Q

Treatment of UTI:

Complicated UTIs- Who do they occur in?

A

(occurs in patient with diabetes, febrile and male sex)

76
Q

Treatment of UTI:

Complicated UTIs- How long is treatment?

A

Treatment last for 7 to 10 days

77
Q

Treatment of UTI:

What does the choice of antibiotics depend on?

A

Choice of antibiotics depends on the culture

78
Q

Complications Of UTI

A

Drug resistance

Pyelonephritis

Renal abscess

Urosepsis

79
Q

UROLITHIASIS

Epidemiology: Where does it occur? What is the most prevalent?

A

Occur in kidneys, ureter, and bladder, with renal stones being the most prevalent

80
Q

UROLITHIASIS

Pathophysiology
What occurs? Where?

A

Calcifications in the urinary system

81
Q

UROLITHIASIS

Pathophysiology
What is it commonly referred to as?

A

Commonly referred to as kidney stones

82
Q

UROLITHIASIS

Pathophysiology
How do stones form?

A

Microscopic crystals in the urinary tract aggregate together causing a stone to occur

83
Q

UROLITHIASIS:

The calcification in urinary system commonly referred to as

A

Kidney Stones

84
Q

nephrolithiasis

A

nephrolithiasis refers to the calculus in the kidneys

85
Q

ureterolithiasis

A

ureterolithiasis refers to the calculus in the uterus

86
Q

UROLITHIASIS: Who does it occur in the most?

A

kidney stones occur more frequently in male individuals and affects the white population more than the black population

87
Q

UROLITHIASIS: What time of year does it occur the most? Why?

A

it occurs in the United states more commonly in the summer months likely because of humidity sweating and a decrease water consumption leading to dehydration

88
Q

UROLITHIASIS:

The majority of stones are what? What are the others?

A

the majority of stones are calcium and the remaining include uric acid, cystine and Xanthine .

89
Q

UROLITHIASIS:
Clinical manifestations include:

A

Severe pain when stone lodges in the ureter, causing distention and obstruction of urine flow

nausea and vomiting are also signs

pain in the flank area are also signs

gross hematuria can be present in any stone location and occurs in 95% of patients

90
Q

UROLITHIASIS:
Management: What is the test of choice for imaging?

A

A CT scan is a quick noninvasive imaging modality with high sensitivity

Diagnostic modality of choice if noncontrast, stone survey CT scan

91
Q

UROLITHIASIS:
Management: What kind of stones pass spontaneously?

A

50% of stones less than 5 mm pass spontaneously

92
Q

UROLITHIASIS:
Management: When is surgical intervention necessary?

A

Surgical intervention is required when a stone is greater than 10 mm

surgical intervention is required if stones does not pass after four to six weeks

93
Q

Hydronephrosis: What is it and when does it occur?

A

hydronephrosis or swelling of the kidneys occurs when urine flow is blocked allowing urine to accumulate in the kidneys

94
Q

Potential sites of urinary calculi:

A

Kidneys

Ureters

Bladder

95
Q

Extracorporeal Shock-Wave Lithotripsy (E S W L):

What is it used for?

A

To crush kidney stones

96
Q

Extracorporeal Shock-Wave Lithotripsy (E S W L):

What can occur with this procedure (symptom wise)

A

nausea and vomiting can be expected as well as UTI signs such as fever

97
Q

What is a ureteroscopy used for?

A

ureteroscopy is used for mid/ distal stones

98
Q

Ureteroscopy- What is the procedure for this?

A

Under general anesthesia a flexible scope is inserted through the urethra and a bladder to identify and remove the stone

99
Q

INCONTINENCE:

Pathophysiology and clinical manifestations

A

Involuntary or uncontrolled loss of urine in any amount

100
Q

INCONTINENCE:

Pathophysiology and clinical manifestations
What are the types of incontinence

A

Stress incontinence,

urge incontinence,

mixed,

overflow incontinence, or

functional incontinence

101
Q

INCONTINENCE:

Pathophysiology and clinical manifestations
What is stress incontinence?

A

stress incontinent refers to the leaking of urine when an individual laughs, coughs, exercises or lifts something.

102
Q

INCONTINENCE:

Pathophysiology and clinical manifestations
What is urge incontinence?

A

urgent continence is the strong urge to urinate following an uncontrolled leakage

103
Q

INCONTINENCE:

Pathophysiology and clinical manifestations
What is overflow incontinence?

A

overflow incontinence refers to as frequent urination

104
Q

INCONTINENCE:

Pathophysiology and clinical manifestations
What is functional/consonant incontinence?

A

functional incontinence refers to the fact that the individual might be continent or is continent but environmental factors lead to the loss of urine at inappropriate times and areas

105
Q

INCONTINENCE
Management: How is diagnosis made?

A

Diagnosis with history and laboratory tests

106
Q

INCONTINENCE

Management: WHat is the goal of treatment?

A

Goal of treatment is to prevent or stop urinary leakage

107
Q

INCONTINENCE

Management: What kind of exercise is done?

A

Strengthen the pelvic floor such as Kegel exercises

108
Q

INCONTINENCE

What are complications? What is it related to?

A

Complications include skin changes

Related to exposure to a moist environment

109
Q

Incontinence:

What group of medications are there?

A

medications such as anticholinergics calm the overactive bladder by blocking nerve stimulation.

alpha adrenergic blockers

110
Q

Incontinence:

What do anticholinergics do?

A

Calm the overactive bladder by blocking nerve stimulation.

111
Q

Incontinence:

What are types of anticholinergics?

A

Oxybutynin,

112
Q

Incontinence:

What do alpha adrenergic blockers do? What is an example?

A

alpha adrenergic blockers promotes urethral relaxation and relaxation of the bladder neck and muscles these include

Flomax

113
Q

4th most common cancer among men- what is it?

A

BLADDER CANCER

114
Q

BLADDER CANCER: What is the most important risk factor?

A

Smoking is the most important risk factor

115
Q

BLADDER CANCER: What are other risk factors to this?

A

other risk factors include:

occupational hazards from rubber,

chemical, coal

As well as environmental factors such as drinking arsenic containing well water and being exposed to pesticides

116
Q

BLADDER CANCER: How is bladder cancer classified?

A

Classified as non- muscle invasive or muscle invasive cancer

117
Q

BLADDER CANCER:

Pathophysiology and clinical manifestations
What is tumor formation attributed to?

A

Tumor formation is attributed to genetic changes in target cells

118
Q

BLADDER CANCER:

What is the most common symptom?

A

Painless hematuria is the most common

119
Q

BLADDER CANCER

Management include?

A

Thorough history and physical

Early detection and treatment increase survival rates

120
Q

BLADDER CANCER

What do Superficial or low-grade bladder cancers
consist of?

A

Consist of excision or removal through fulguration or laser ablation

121
Q

BLADDER CANCER

Management:
Invasive bladder cancer- what needs to be done?

A

Radical cystectomy

Combined with neoadjuvant or adjuvant chemotherapy

Medsurg (21 decks)

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