Urinary System Flashcards
Tests you should know about
Urinalysis/urine culture
BUN (10-20 mg/dl)
Creatinine (0.6-1.5)
Normal BUN/creatinine ratio is 10:1
KUB: Kidney-ureter-bladder x-ray, no contrast, may need bowel prep., painless
CT scans: masses, metastasis, lymphadenopathy
MRI-more sensitive in differentiating cysts vs. neoplasms
More Tests: IVPs
Intravenous pyelogram (IVP)-uses contrast medium, evaluates the entire urinary tract
Pre-procedure: assess for iodine allergies (steroids can prevent this, antihistamines), assess creatinine, bowel preparation is mandatory by 6 pm the night before the test, NPO after midnight, salty or metallic taste with dye injection
Post-procedure: hydrate to flush dye, monitor for allergic reaction if patient is sensitive
Mucomyst for iodine clearance, po liquid
More Tests:
Renal angiograms: uses contrast to evaluate renal and pelvic arteries primarily used to diagnose: RENAL ARTERY STENOSIS
Ultrasound: masses
Scopes: direct visualization, cystoscopy, nephroscopy
Cystograms-check for voiding patterns
Bladder Cancer
Risk factors: smoking, exposure to dyes, asbestos, aromatic amines, artificial sweeteners, chronic cystitis, PID
Highly treatable if tumor is superficial
Most common sign: PAINLESS HEMATURIA
Treatment for Bladder Cancer
Chemo (directly into the bladder) and radiation (not as effective but used with advanced cancer)
Urethral transection
Partial cystectomy
Radical cystectomy with urinary diversion
2 Ways to Divert Urine Through Surgical Intervention
Ileal Conduit
Part of the intestine is used to connect the ureters to a stoma, MUCOUS SHREDS ARE NORMAL, artificial pouch or bag is outside the body, urine may look cloudy
monitor stoma appearance, how should it look?
Nursing diagnosis: Disturbed Body Image
Review Ileal Conduit Image
Review ileal Conduit Images
Another Urinary Diversion
Indiana pouch, Florida Pouch, Kock pouch
Reservoir created by using ascending colon and terminal ileum, ureters are diverted to the pouch, connection to the abdomen
PATIENTS MUST SELF-CATHETERIZE THIS EVERY 3-4 HOURS
Nursing diagnosis: Disturbed Body Image
Review Image of Indiana, Kock Pouch
Review Image
Urinary/Renal Caliculi
Caused by renal stasis, stone formation (usually calcium, sometimes oxalate, uric acid, struvite)
Men more than women
More common among European, Asian descent
Common in the southeast (stone belt), northern Ohio is somewhat of a stone belt
Stone Formers
Urinary stasis Long history of calculi High mineral content in drinking water Diet high in purines, oxaltes, calcium supplements, animal proteins UTIs, foleys, neurogenic bladder Female genital mutilation
Foods High in Purines-Lead to Uric Acid Stones
Beef Pork, bacon Lamb Seafood Foods made with high amounts of yeast Beer, breads, wines
Foods High in Oxalates
Plant foods, very little in animal foods Beans, beets Beer, alcohol Teas with long brew time (5 min) Berries, grapes, kiwi, citrus, tomatoes,most fruits Chocolate Soy products Whole wheat flour
Assessment of Calculi
Subjective:
- Pain which is sharp, sudden and severe, low back, radiates
- Renal Colic vs. ureteral colic
- N/V
- Sweating
- Anxiety
- UTI’s with urinary retention
Assessment of Calculi
Objective:
- Hypertension and tachycardia
- Elevated temperature
- Elevated WBC
- Pink urine/hematuria
- KUB standard diagnostic test
Treatment of Calculi
Increase fluids: 3-4 L/day with half of that being water
Reduce pain: narcotics, antispasmodics (Ditropan)
Dietary changes: Calcium? Yes, have it. But with oxalate, decrease: tea, tomatoes, colas, rhubarb, chocolate, citrus fruits. With uric acid: low purines, no aged cheese, wine, bony fish, organ meats
Medications
Calcium: thiazide diuretics
Calcium oxalate stones: Vit. B, magnesium oxide, cholestyramine, allopurinol (Zyloprim)
Uric acid stones: allopurinal
Lithotripsy: stones are fragmented with electrical charges
Things you should know before you graduate:
Before calling the doctor for a low urine output, assess for distension, irrigate the foley and maybe even change the foley, do bladder scan
The difficulty of putting foleys in men-difficulty with the long urethral canal! When can you inflate the balloon?
What about BPH?
Stabilize the foley with tape or commercial products
What antibiotic for TB causes urine to be orange?
Urine output should be how much per hour?
Diabetes and the Kidneys
Diabetic nephropathy-leads to renal failure
Type 1 and type 2
Nephrons are destroyed, glomerulus scars leading to renal insufficiency
The best indicator for assessing for nephropathy is: microalbuminuria
When the patient starts spilling protein, even in small amounts, the patient is more likely to go into renal failure in 5-10 years
Rhabdomyolysis
Caused by traumatic skeletal muscle trauma
Also caused by: strenuous exercise, seizures, heat stroke, prolonged coma, statin use
Myoglobin released- toxic to the renal tubules (need to draw serum myoglobins to assess) causes urine to have a brown color
Can lead to acute renal failure or chronic
Treat with fluids initially to flush out myoglobin
If kidneys fail: dialysis, monitor electrolytes and fluid balance
Check up………..
Describe teaching interventions for women to prevent UTI…………
Pre and post-procedure care for IVPs include………
Interventions for UTI treatment include……
The leading risk factor for bladder cancer is………
T/F Mucous shreds indicate infection in a patient with an illeal conduit
A urostomy stoma should appear…………
Patient with uric acid stones should reduce the amount of _________ in their diet (what foods then?)
Interventions to manage renal stones include………..
The best laboratory test to monitor kidney function in the diabetic patient is…………
Rhabdomyolosis is caused by the release of _________ into the bloodstream