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Foundations 2 > Unit 3- Renal > Flashcards

Unit 3- Renal Flashcards

1
Q

urinary tract infection (UTI)

A
  • involves any portion of the lower urinary tract (ureters, bladder, urethra, prostate)
  • due to high virulence bacteria overcoming normal host bacteria
  • may also be due to immunocompromised host
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2
Q

types of UTIs

A
  • cystitis (most common)
  • urethritis
  • prostatitis
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3
Q

upper UTI

A

•inflammation of kidney pelvis

Ex: pyelonephritis

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4
Q

cystitis

A
  • inflammation of the bladder
  • most often caused by E. coli
  • bacteria growing in perineal area and moving into the bladder following irritation, trauma, catheterization
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5
Q

urosepsis

A
  • systemic infection that can lead to overwhelming organ failure, shock, and death
  • most common cause of sepsis in hospitalized pts
  • more common in OAs
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6
Q

risk factors for UTI

A
  • female
  • catheter
  • stool incontinence
  • bladder distention
  • disease states
  • OA
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7
Q

subjective data UTI

A
  • lower back/abd pain
  • nausea
  • urinary frequency/urgency
  • dysuria (discomfort)
  • perineal itching
  • hematuria
  • pyuria
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8
Q

urinary frequency vs. urgency

A
  • frequency is the urge to urinate often in small amnts

* urgency is feeling urination will occur now

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9
Q

pyuria

A
  • cloudy urine

* > 4 WBC in urine sample

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10
Q

objective data UTI

A
  • fever
  • vomit
  • voiding in small amnts
  • nocturia
  • discharge
  • foul smell
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11
Q

s/s UTI in OA

A
  • confusion
  • incontinence
  • loss of appetite
  • nocturia/dysuria
  • hypotension, tachycardia, tachypnea (sepsis)
  • fever
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12
Q

urinalysis

A
  • evaluates waste products from kidney and detects urologic disorders
  • analyzed for color, clarity, concentration, acidity/alkalinity, specific gravity, drugs, glucose, ketones, and protein
  • early AM sample best
  • need at least 10 mL
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13
Q

urinalysis of UTI

A
  • confirmed bacteria, sediment, and WBCs

* takes 48 hrs to confirm type of pathogen and # colonies (for abx tx)

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14
Q

presence of glucose, ketones, proteins, nitrates, and leukocyte esterase in urinalysis indicates…

A
  • diabetes
  • fat metabolism (DKA)
  • infection
  • cancer
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15
Q

urinalysis WBC count > 10,000 indicates

A
  • increased # of immature neutrophils in response to infection
  • increases r/o STI
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16
Q

cystoscopy

A
  • detects urethral/bladder injury
  • contrast dye instilled thru catheter to provide image of bladder/ureters
  • performed for complicated/recurrent UTI
  • monitor pt for 72 hrs for infection
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17
Q

nursing intervention UTI

A
  • 3 L fld/day
  • cranberry juice to decrease risk of UTI
  • admin abx (sulfonamides- bactrim); fluoroquinolones- cipro/levaquin)
  • encourage frequent urination
  • warm sitz bath (shower better)
  • proper wiping
  • avoid catheterization
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18
Q

cranberry juice and UTIs

A

•compound in cranberries bay stop certain bacteria from adhering to mucosa of urinary tract

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19
Q

cranberry juice contraindicated

A

•if pt has chronic cystitis it will worsen

*irritant, rather than preventative

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20
Q

complications of UTI

A
  • urethral obstruction
  • pyelonephritis
  • severe kidney damage
  • urosepsis
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21
Q

pyelonephritis

A
  • infection/inflammation of kidney pelvis, calyces, and medulla
  • begins in lower urinary tract w/ organism ascent into pelvis
  • most often caused by e/ coli
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22
Q

pyelonephritis consequences

A

•filtration, reabsorption, and secretion impaired

*decreased renal fxn

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23
Q

actue pyelonephritis

A

•active bacterial infection that can cause…

  • inflammation
  • tubular necrosis
  • abscess formation
  • temporarily altered kidney fxn
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24
Q

chronic pyelonephritis

A
  • repeated infections that cause progressive inflammation and scarring of kidney pelvis
  • changes blood flow to kidney, glomerulus, and tubular structure
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25
Q

risk factors for pyelonephritis

A
  • OA (esp. w/ BPH)
  • stones
  • spinal cord injury (reflux)
  • pregnancy
  • malformations
  • bladder tumor
  • illness
  • incomplete bladder emptying
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26
Q

s/s pyelonephritis

A
  • fever/chills
  • abd pain
  • nausea
  • malaise
  • dysuria
  • CVA tenderness
  • bacteremia
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27
Q

pyelonephritis labs

A 
•urine analysis
•WBC > 10,000
•blood cultures positive for bacteria
•increased BUN and Cr levels
•C-reactive protein elevated (inflammation)
*same as UTI labs
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28
Q

blood urea nitrogen (BUN)

A
  • breakdown of protein in liver creates by-product that is excreted by kidneys
  • affected by dehydration, infection, chemo, steroids, and liver damage
  • not indicative of UTI, but helpful if chronic
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29
Q

normal BUN levels

A

•7-22 mg/dl

*elevated suggests kidney dz

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30
Q

serum creatinine (Cr)

A
  • produced due to muscle breakdown
  • kidney dz is ONLY cause of elevated levels
  • specific to KIDNEY
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31
Q

normal Cr levels

A

•0.5-1.2

*elevated suggest kidney dz

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32
Q

diagnostic procedures pyelonephritis

A
  • KUB x-ray
  • gallium scan
  • IVP
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33
Q

KUB x-ray

A
  • kidneys, ureters, bladder
  • used to detect calculi (stone), structural abnormalities, stricture, Ca2+ deposits, obstruction
  • pt in supine position
34
Q

gallium scan

A

•nuclear med test that uses dye to see organs having infection/inflammation

35
Q

IVP

A
  • intravenous pyelogram

* used to detect calculi or structural abnormalities

36
Q

complications of pyelonephritis

A
  • septic shock
  • chronic kidney dz (r/t fibrosis of kidney)
  • HTN (dec. filtration causes fld retention)
37
Q

pyelonephritis tx

A
  • goal to promote comfort and urinary elimination
  • analgesics for pain
  • antispasmodics for bladder spasms
  • abx for bacterial UTIs
38
Q

urologic calculi

A
  • urologic stones caused by many disorders
  • exact mechanism uknwn
  • most contain Ca2+, phosphate, oxalate
  • most expelled w/o invasive procedures
39
Q

urolithiasis

A
  • presence of calculi in urinary tract

* usually asymptomatic until passing thru tract

40
Q

nephrolithiasis

A

•formation of calculi in kidney

41
Q

ureterolithiasis

A

•formation of calculi in ureters

42
Q

formation of stones

A
  • supersaturation of urine w/ Ca2+ that becomes crystallized and becomes a stone
  • slows urine flow
  • damages urinary tract lining
43
Q

predisposing factors for renal calculi

A
  • decreased amnts of inhibitor substances that would normally prevent supersaturation and crystal aggregation
  • high urine acidity/alkalinity
  • drugs that contribute to stone formation
44
Q

risk factors for renal calculi

A
  • male
  • damaged urinary tract
  • decreased urinary flow
  • urinary stasis, retention
  • dehydration
45
Q

s/s renal calculi

A
  • renal colic
  • urinary frequency/dysuria
  • fever
  • diaphoresis
  • pallor
  • N/V
  • tachycardia/pnea
  • BP fluctuations w/ pain
  • oliguria/anuria/hematuria
46
Q

renal colic

A

•sudden, intense pain that is located in the flank and is unrelieved by position changes as stone moves out of kidney pelvis and thru ureter

47
Q

oliguria/anuria w/ calculi

A
  • due to stones obstructing urine flow

* medical emergency tx to preserve kidney fxn

48
Q

flank pain suggests…

A

•stone in kidney or ureter

49
Q

radiating flank pain suggests…

A
  • pain radiating to abd, scrotum, testes, vulva

* stones in ureter or bladder

50
Q

urinalysis calculi

A
  • if infection malodorous w/ turbidity (cloudy)
  • elevated RBC, WBC, bacteria
  • crystals on microscope
  • abnormal Ca, Ph, uric acid
51
Q

diagnostic tests calculi

A
  • KUB
  • IVP (unless suspect obstruction)
  • CT or MRI (if x-ray insuff.)
  • ultrasound
  • cystoscopy
52
Q

nursing interventions calculi

A
  • meds
  • stone passage (save for lab)
  • 3L+ fld intake
  • IV flds
  • ambulation
53
Q

medications for calculi

A
  • opioids- pain
  • NSAIDs- inflammation
  • smasmolytic drugs
  • abx b/c at risk for UTI
54
Q

smasmolytic drugs

A
  • Ditropan
  • tx for renal calculi
  • anti-spasmotic drugs
  • AE of inc. intraocular press use (not good for glaucoma)
  • monitor for dizzy, tachy, retention
55
Q

extracorporeal shock wave lithotripsy (ESWL)

A
  • uses shock wave energies to break stones into fragments
  • moderate sedation
  • ECG monitoring
  • analgesics
  • may elicit hematuria
  • strain urine following procedure to monitor stone fragments
56
Q

stenting for renal calculi

A

•small tube placed in ureter to dilate and allow stone passage

57
Q

retrograde ureteroscopy for renal calculi

A

•use basket forceps to grasp/remove stone

58
Q

percutaneous ureterolithotomy for renal calculi

A

•use laser to grasp/extract stone

59
Q

open surgery for renal calculi

A
  • surgical incision to remove large, impacted stones

* may access ureter, kidney pelvis, or kidney

60
Q

complications of renal calculi

A

•obstruction
•hydronephrosis
*controlling infections crucial to prevent sepsis

61
Q

hydronephrosis

A
  • stone blocks portion of urinary tracts, causing urine reflux into kidney
  • results in kidney distention
62
Q

renal calculi preventative nutrition

A
  • avoid excess intake of protein, Na+, Ca, oxalates, caffeine, etoh
  • encourage foods high in purines
  • adequate hydration
63
Q

oxalate food sources

A 
•rhubarb
•spinach
•beets
•nuts
•chocolate
•tea
•wheat bran
•strawberries
•vit C
*AVOID to prevent renal calculi
64
Q

foods high in purines

A
  • lean meats
  • organ meats
  • whole grains
  • legumes
65
Q

indwelling catheter procedure

A
  • don’t delegate to AP
  • assess client for allergies, bladder distention, LOC, ability to cooperate, mobility
  • perineal care
  • STERILE technique
66
Q

shift to left

A
  • increased # immature WBCs (neutrophils)

* > 10,000

67
Q

what intervention for urolithiasis

A

•strain all urine

68
Q

pt has hydronephrosis secondary to calculi. stone removed and post obstructive diuresis is occurring. What intervention should be taken?

A
  • assess for urine output every shift

* monitor electrolytes

69
Q

stone sent to lab to be analyzed for what…

A

•composition of calculi

70
Q

DC teaching for pt w/ uric acid calculi the RN should instruct to avoid which type of diet?

A

•high-purine

71
Q

pt w/ urolithiasis has chronic UTIs, so likely has which type of urinary stone

A

•calcium oxalate

72
Q

flank pain indicates…

A

•inflammation of the kidney

73
Q

cystitis pain involves…

A
  • suprapubic area, not kidneys

* NOT flank pain

74
Q

increased BUN indicates…

A

•dehydration

75
Q

increased Cr indicates

A

•kidney impairment

76
Q

priority after urography

A

•hydration b/c dye can cause dehydration

77
Q

Which nursing activity illustrates proper aseptic technique during catheter care

A
  • placing collection bag below level of bladder

* prevents reflux

78
Q

interventions to decrease the risk for cystitis

A

•drink 2.5 liters of fld daily

79
Q

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients

A

•Re-evaluating periodically the need for indwelling catheters

80
Q

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begin

A
  • I take over-the-counter naproxen (Aleve) twice a day for joint pain
  • Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure

Foundations 2 (10 decks)

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