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Med Surg > Urinary disorders > Flashcards

Urinary disorders Flashcards

1
Q

Urinalysis

A

evaluate renal system and renal disease

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2
Q

Urine culture and sensitivity

A

determines the presence of microorganisms (culture) and appropriate antibiotic treatment (sensitivity)

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3
Q

Specific gravity

A

ability of the kidneys to concentrate urine (decrease may indicate renal disease)
1.005-1.030

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4
Q

Creatinine

A

increase occurs when at least 50% of renal function is lost; Reflects glomerular filtration rate
1

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5
Q

Glomerular filtration rate (GFR)

A

estimates how much blood passes through the tiny filters in the kidneys (glomeruli) each minute.
125 ml/min

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6
Q

BUN blood urea nitrogen

A

levels indicate the extent of renal clearance of urea nitrogenous waste products

Increase may occur from dehydration, high protein diet, infection, stress, corticosteroid use, GI bleed, factors that cause muscle breakdown
7-20

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7
Q

Creatinine clearance

A

determines how well kidneys excrete creatinine; 24 hour urine collection and serum creatinine collection (estimates GFR)

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8
Q

Cystitis Dx and CM

A

Dx: Urinalysis- leukocyte esterase (infection) and nitrate (bacteria)
Urine culture: expensive, 48 hours, indicated when uti is complicated.
Serum WBC- may be elevated with a left shift - increased bands
CM:fever, burning with pain, foul odor to urine, lower stomach pain, chills, increased wbc, cloudy urine, back pain

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9
Q

Cystitis Tx

A

Nonsurgical Management
Medications – antibiotics, antiseptics, (promote comfort) analgesics, antispasmodics (decrease bladder spasm and promote bladder emptying)
Nutrition – H2O, cranberry juice (alkalotic urine promotes bacteria growth)
Warm sitz baths

Surgical Management
Removal of obstruction or repair of vesicoureteral reflux
Cystoscopy – remove calculi or obstructions

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10
Q

Urethral Strictures

A

Narrowed areas of the urethra
Causes - complications of a STD, trauma during childbirth, catheterization, or urologic procedures
May lead to overflow incontinence, also urinary retention in the bladder which leads to recurrent UTIs
Urethroplasty – surgical removal of the affected area

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11
Q

Urinary incontinence

A

Most common in older adults and women.

Lab assessment to rule out UTI

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12
Q

Stress incontinence

A

Most common type
loss of small amounts of urine while coughing, sneezing, lifting, exercising
common after childbirth
avoid caffeine, alc, nicotine, sugar

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13
Q

Urge incontinence

A

“Overactive bladder”
inability to relax the detrusor muscle leading to a strong urge to void and often leakage of large amounts of urine
Causes – stroke, other neurologic problems, urinary tract problems, irritation from concentrated urine or artificial sweeteners, caffeine, alcohol, citric intake, diuretics, and nicotine
scheduled bathroom times

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14
Q

Mixed incontinence

A

often stress and urge incontinence

More common in older women (during or after menopause)

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15
Q

Overflow incontinence

A

“reflex incontinence”
detrusor muscle fails to contract and the bladder becomes overdistended
Bladder reaches maximum capacity and some urine must leak out to prevent bladder rupture
Causes – urethra may be obstructed (enlarged prostate, stone, stricture, tumor, genital prolapse) leading to incomplete bladder emptying or urinary retention
Treatment – surgery to relieve obstruction or repair of genital prolapse
Behavioral interventions - most effective is intermittent catheterization; bladder compression

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16
Q

Functional incontinence

A

Due to loss of cognitive function (or physical or social impairment such as stroke or cognitive disability)
Treatment – habit training
Women – intravaginal pessary – device supports the uterus and vagina and helps maintain the correct position of the bladder

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17
Q

Urolithiasis

A

Presence of calculi (stones) in the urinary tract
Nephrolithiasis – formation of stones in the kidney
Ureterolithiasis – formation of stones in the ureter

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18
Q

Hydroureter

A

(ureter dilation) may occur if the stone occludes the ureter and blocks the flow of urine

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19
Q

Hydronephrosis

A

enlargement of the kidney with urine due to a blockage in the lower tract
–>Oliguria (100-400 ml/d) or anuria (

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20
Q

Urolithiasis

CM, Complications, Tx

A

Manifestations: sharp/excruciating pain, may cause pt to be nauseas, may be hematuria, difficulty voiding, frequency
Complications: Hydroureter, Hydronephrosis –> Oliguria (100-400 ml/d) or anuria (3L/day to prevent obstruction and promote urine flow

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21
Q

Urothelial Cancer

A

Malignant tumors of the lining of transitional cells in the kidney, renal pelvis, ureter, bladder (most common), and urethra

22
Q

Urothelial cancer risk factors, CM and Tx

A

Risk factors – tobacco use and exposure to harmful environmental agents
Tumors confined to the bladder -treated with a simple excision; Invading bladder muscle layer treated with excision and intravesical (inside the bladder) chemotherapy; Invading deep muscle layer treated with radical cystectomy with urinary diversion, chemotherapy, and radiation
Manifestations – subtle- painless intermittent gross or microscopic hematuria
Surgical Management after cystectomy

23
Q

Anuric after bladder trauma

A

urine prob going into abdominal cavity so it’s an emergency

24
Q

Polycystic kidney disease (PKD)

A

inherited disorder in which fluid-filled cysts develop in the nephrons
As the cysts fill with fluid and enlarge, the nephron and kidney function become less effective
Cysts are at risk for infection, rupture and bleeding
Leads to HTN

25
Q

Polycystic kidney disease (PKD) CM and Tx

A

U/A - proteinuria (glomerular damage) and hematuria
Manifestations – dull, aching pain (occurs early) due to increased kidney size (distended abdomen; kidneys palpable); sharp pain, bright red or cola-colored urine (from ruptured cyst), nocturia (decreased urine concentrating ability)
Later S/S – increasing HTN, edema, and uremic problems (anorexia,
N/V, fatigue, pruritus)
Pain – drug therapy and complementary approaches
Caution w/NSAIDs b/c reduces renal blood flow
Severe pain – cyst aspiration and drainage of cysts
Antibiotics if cysts infected
HTN/Renal Failure – 2L fluid/day to prevent dehydration (reduces renal function); restrict Na intake; antihypertensives and diuretics; if renal failure progresses – limit protein intake

26
Q

Pyelonephritis

A

bacterial infection in the kidney and renal pelvis (most common organism – E.Coli)
U/A - + leukocyte esterase and nitrites, WBCs, and bacteria

27
Q

Causes of pyelonepthritis

A

Acute – active bacterial infection; usually due to obstruction, pregnancy, reflux
Chronic (may be asymptomatic) – repeated or continued infection; causes –urinary tract defect, obstruction (tumor, stone, and enlarged prostate in >65yo), or infected urine reflux (most common cause) from bladder to ureters - vesicoureteral junction
Other causes of both – urinary catheter, DM (reduced bladder tone), NSAIDs (papillary necrosis and reflux)

28
Q

Glomerulonephritis (GN) and Tx

A

glomerular injury resulting in proteinuria, hematuria, decreased GFR, edema, and HTN and headache

maintain bed rest to protect kidney, restrict fluids, reduce protein and sodium but increase calories, monitor daily weight
Penicillin, steroids, anti hypertensives

29
Q

Acute Glomerulonephritis (GN)

A

infection usually precedes; usually recover quickly and completely
U/A – proteinuria, hematuria (usually microscopic – smoky, reddish brown, rusty, or cola colored urine); serum albumin decreased b/c of proteinuria and fluid retention causing dilution
Elevated BUN, creatinine, and decreased GFR
Diagnosed by renal biopsy

30
Q

Chronic glomerulonepphritis

A

develops over 20-30 years; unable to determine cause b/c kidneys are atrophied and cannot be biopsied
Always leads to ESKD - 3rd leading cause of ESKD
Exact cause unknown, however, changes in kidney tissue result from HTN, DM, infections and inflammation, or poor blood flow to the kidneys (nephrotoxic drugs)
Manifestations – mild proteinuria, hematuria, HTN, fatigue, decreased UOP, and fluid overload
Nursing Considerations
Management – slow the progression and prevent complications
Dietary (restrict fluid and Na, but fluid intake sufficient to prevent reduced renal blood flow), medications for uremic symptoms (protein restriction)
Assess for fluid overload- crackles, edema, increased BP, weight gain
Fluid restriction = 24 urinary output + 500 ml

31
Q

Nephrotic syndrome

A

group of symptoms, not a disease

increased glomerular permeability leading to massive loss of protein in urine, edema and decreased plasma albumin levels

32
Q

Interstitial nephritis

A

Kidney disorder in which the spaces between the kidney tubules become swollen (inflamed) affecting the kidneys’ function
If drug induced – often a rash and elevated eosinophil count
Progression to ESKD unless cause is identified and removed (ex. – avoid medication)

33
Q

Nephrosclerosis

A

thickening in the nephron blood vessels, resulting in narrowing in the vessel lumen
Decreased renal blood flow, chronically hypoxic kidney tissue, ischemia and fibrosis develop over time
Occurs with all types of HTN, DM, and atherosclerosis
Nursing Considerations – control HTN and reduce albuminuria to preserve renal function (ACE inhibitors)

34
Q

Renovascular disease

A

Renal artery stenosis (RAS) from atherosclerosis or blood vessel hyperplasia is the main cause of renovascular disease.
Renovascular disease causes ischemia and atrophy of kidney tissue.
CM: may have sudden onset of HTN
Tx: control HTN

35
Q

Diabetic nephropathy

A

The leading cause of ESKD
1st manifestation – persistent albuminuria – often cause for a renal biopsy
The leading cause of ESKD

36
Q

Renal cell carcinoma

A

Cancer of the lining of the renal tubules
Most common renal cancer in adults (men aged 50-70 yo)
Complications – metastasis and urinary tract obstruction
CM: Flank pain, hematuria
Tx: kidney needs to be removed bc chemo and radiation isnt effective

37
Q

Renal trauma

Pedicle injuries

A

lacerations in the renal artery or vein; Rapid Hemorrhage and death may occur
Kidneys are very vascular

38
Q

Acute renal failure

A

Rapid decrease in kidney function
Can be caused by trauma, allergic reactions, kidney stones or shock (drink 2-3L/day)
Pre, intra or post renal failures
Monitor Decreased urine specific gravity – loss of urine concentrating ability (earliest sign of renal tubular damage)
Elevated BUN/Creatinine, electrolyte imbalances, usually NOT anemia
Tx: phosphate biders to lower phosphorus while replacing calcium

39
Q

Prerenal failure

A

reduced blood flow to the kidneys (severe hypotension from hypovolemic shock, dehydration, or heart failure)
CM:hypotension, tachycardia; decreased UOP, cardiac output, and CVP; and lethargy

40
Q

Intrarental failure

A

damage to the glomeruli, interstitial tissue, or tubules (infections, nephrotoxic drugs, glomerulonephritis, vasculitis, obstructed renal blood flow)
CM: oliguria, anuria, edema, HTN, tachycardia, SOB, distended neck veins, elevated CVP, wt gain, crackles, anorexia, N/V, lethargy, LOC change, hypocalcemia and hyperkalemia

41
Q

Postrenal failure

A

obstruction of urine flow from kidney (cancer, stones, strictures, BPH)
oliguria, intermittent anuria, symptoms of uremia, and lethargy

42
Q

azotemia

A

build-up of nitrogenous wastes

43
Q

Chronic kidney disease

A

Progressive and irreversible
5 stages of CKD – glomerular filtration rate decreases with each stage – 5th stage is End Stage Kidney Disease (ESKD)

2 most common causes are DM and HTN

44
Q

CKD affects on the body

A

Metabolic changes – urea and creatinine excretion is disrupted
Early = hyponatremia
Later = hypernatremia; hyperkalemia (fatal dysrhythmias); metabolic acidosis; hypocalcemia/hyperphosphatemia
Cardiac changes – HTN; hyperlipidemia; HF; pericarditis
Hematologic changes - anemia (later stages)
GI changes – uremia leads to halitosis, stomatitis, anorexia, N/V, hiccups, and peptic ulcer disease

45
Q

Hemodialysis

A

Removes excess fluids and wastes products and restores chemical and electrolyte imbalances
Patient’s blood passes through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney
When to start – not based on GFR, based on patient’s symptoms
Requires good vascular access (large amount of blood flow – 250-300ml/min during the 3-4 hour treatment)
Weight pt before and after, assess for thrill and bruit, withhold bp meds

46
Q

Post hemodialysis complications

A

hypotension (hold vasoactive drugs before HD), headache, N/V, malaise, dizziness, and muscle cramps
Must be done gradually or risk for DDS (dialysis disequilibrium syndrome)- Clinical signs of cerebral edema, such as focal neurological deficits, papilledema[4] and decreased level of consciousness, if temporally associated with recent hemodialysis, suggest the diagnosis.

47
Q

Hemodialysis vascular access

A

AV fistula – formed by connecting (anastomosis) an artery to a vein

AV graft – the graft is make of synthetic material

Want to hear a bruit and feel thrill over fistula or graft site- indicative of patent fistula or graft
No IV sticks or lab draws or bp in arm with fistula or graft

48
Q

Continuous Renal Replacement Therapy (CRRT)

A

Standard treatment for ARF (& CRF) in ICU setting
Kinder gentler better tolerated type of dialysis
Similar to HD, but temporary – avoids rapid shifts in fluid and electrolytes

Indications - fluid volume overload, diuretic resistance, unstable blood pressure and cardiac output

49
Q

Peritoneal Dialysis

A

A rubber catheter is surgically placed in the abdominal cavity for infusion of dialysate. Perineum is used as a filter for the kidney.

1-2L of dialysate infused by gravity or by PD machine, the fluid stays in the cavity for a specified time, the fluid then drains by gravity or PD machine into a drain bag which equals 1 exchange- fluid should be clear and pale yellow

The peritoneal outflow contains dialysate and excess water, electrolytes, and nitrogen-based waste products

Complications – peritonitis (connection site contamination) –cloudy outflow, fever, abdominal pain, malaise, N/V

50
Q

Renal transplant

A

Not a cure – requires lifetime medications; risk for rejection, infection, and cancer due to immunosuppression
Typical age range – 2-70 yrs.
Exclusion criteria – advanced cardiac disease, cancer in the last 2-5 years, all metastatic cancer, chronic infection, alcohol or other substance abuse

51
Q

Renal transplant complications

A

ATN – acute tubular necrosis – results from hypoxic damage when there is a delay in organ recovery to transplantation
Thrombosis – occurs in major renal blood vessel usually 2-3 days after transplant – diagnosed by renal scan and requires immediate surgical repair
Infection – major cause of death and must be prevented with drug therapy, aseptic technique, and hand washing

Acute rejection: 1week-2 years after transplate
Chronic rejection: months-years
Symptoms of rejection: flu symptoms, fluid retention, oliguria, fever

Med Surg (12 decks)

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