urologic disorder 2 Flashcards
The precipitation of calcium salts (calcium phosphate or calcium oxalate), uric acid, magnesium ammonium phosphate, or cystine (All are normally found in the urine)
Urinary tract obstruction
Renal Calculi
Factors for development of calculi
Concentrated urine Excessive intake of calcium, vitamin D, protein, oxalates, calcium-based antacids Familial tendency Hyperparathyroidism Immobility or sedentary lifestyle Urinary stasis Altered urine pH Lack of kidney substance that inhibits calculi formation
Signs and symptoms
Pain:
Dull flank pain: a calculus in the renal pelvis or stretching of the renal capsule from urine retention (hydronephrosis: see next slide)
If calculus lodges in a ureter: excruciating pain in the abdomen that radiates to the groin or the perineum
Nausea and vomiting may accompany pain
Hematuria
Medical diagnosis
KUB (kidney, ureter and bladder xray)
IVP (intravenous pyelogram xray with IV contrast medium)
Retrograde pyelogram (insetion of a cystoscope into the urethra, then thread a catheter into the ureters, inject a dye, take xrays)
Ultrasound
Medical treatment for renal calculi
Most calculi are passed spontaneously Ambulation and adequate hydration facilitate passage Opioid analgesic/antispasmodics relieve pain Endourologic procedures Surgical procedures Nephrolithotomy Pyelolithotomy Ureterolithotomy
Prevention Renal Calculi
High fluid intake to keep urine dilute, dietary restrictions for specific elements (i.e., calcium and purines), regular exercise, medications to alter urine pH
Assessment Renal Calculi
Pt’s usual fluid intake and diet, including vitamin & mineral supplements
Location, severity, and nature of the pain
Changes in urine amount or characteristics
Interventions for Renal Calculi
Acute Pain Impaired Urinary Elimination Risk for Deficient Fluid Volume Risk for Infection 2 to urinary statis Ineffective (renal) Tissue Profusion
80% of malignancies: adenocarcinomas; primarily affect men 55-60 years of age
Less common squamous cell carcinomas of the renal pelvis affect men and women equally
Tumor may be large before it is detected. Renal malignancies metastasize to the liver, lungs, long bones, and the other kidney
Renal Cancer
early stages Renal Cancer
Early stages of cancer rarely has symptoms
later stages Renal Cancer
Later stages: anemia, weakness, and weight loss; painless, gross hematuria classic sign, but usually occurs in the advanced stage. A dull ache in the flank area also is a late symptom
Medical diagnosis Renal Cancer
Excretory urography, IVP, retrograde pyelography, ultrasound, arteriography, computed tomography, magnetic resonance imaging, and renal biopsy
Medical treatment Renal Cancer
Radical nephrectomy
Removal of kidney, adrenal gland, surrounding periephric fat, fascia and sometimes ureter
In general, renal tumors are not responsive to radiation or chemotherapy
High risk paitents that are inoperable:
Embolization: occlusion of the renal artery to kill tumor
cells
Cryoablation: special needles used to freeze and then
thaw caner cells which eventually die
Palliative measure only for extensive metastases
Preoperative Care Renal Cancer
Ineffective Coping related to potentially fatal disease
Knowledge Deficient re: tests, procedures, and effects of nephrectomy
Postoperative Care Nursing Interventions Renal Cancer
Monitor vital signs; Routinely check drains and tubes Monitor dressings for drainage Auscultate breath sounds and bowel sounds Acute Post-op Pain At risk for deficient fluid volume: record intake and output Risk for Infection Ineffective Coping Post op teaching
Most common malignancy of urinary tract
Ureteral orifices and bladder neck are the most common sites
Bladder Cancer
cause Bladder Cancer
Tars in smoking tobacco, aniline dyes in industrial compounds, and tryptophan have been implicated in development of bladder cancer
Signs and symptoms Bladder Cancer
Painless, intermittent hematuria
Other signs and symptoms: bladder irritability; infection, with dysuria, frequency, and urgency; and decreased stream of urine
Medical diagnosis Bladder Cancer
Urinalysis, IVP, CT scan, and cystoscopy
Medical treatment Bladder Cancer
Surgery is the treatment of choice
Cystoscopic resection and fulguration or laser photocoagulation
Segmental bladder resection and radical cystectomy
Urinary diversion
Assessment Bladder Cancer
Description of urinary signs and symptoms
Fatigue and weight loss
Health history may reveal use of tobacco or exposure to carcinogenic chemicals
Patient’s emotional state, coping strategies, and sources of support
cause Acute Renal Failure
Pre-renal failure: decreased blood flow to glomeruli
Intra-renal failure: nephrotoxic agents, kidney infections, occlusion of intrarenal arteries, hypertension, diabetes mellitus, or direct trauma to the kidney
Post-renal failure: obstructions beyond the kidneys that cause urine to back up
Onset stage Acute Renal Failure
Short (1-3 days); increasing BUN and serum creatinine with normal to decreased urine output
Oliguric stage Acute Renal Failure
The urine output decreases to 400 mL/day or less
Serum values for BUN, creatinine, potassium, and phosphorus increase
Serum calcium and bicarbonate decrease
Follows onset stage and continues for up to 14 days
Diuretic stage Acute Renal Failure
Urine output exceeds 400 mL/day; may rise above
4 L/day
Kidneys excrete BUN, creatinine, potassium, and phosphorus and retain calcium and bicarbonate
Recovery stage Acute Renal Failure
As renal tissue recovers, serum electrolytes, BUN, and creatinine return to normal
May take 3 to 12 months or longer
Not all patients recover full kidney function
Medical treatment Acute Renal Failure
Fluid and dietary restrictions, restoration of electrolyte balance, and dialysis Drug therapy Diet Fluids Hemodialysis and peritoneal dialysis Continuous renal replacement therapy
Assessment Acute Renal Failure
Monitoring fluid status is critical
Signs and symptoms of electrolyte imbalances
Signs and symptoms related to immobility: pressure sores, impaired circulation, constipation, and atelectasis
Fears, anxiety, coping strategies, sources of support
Interventions Acute Renal Failure
Excess Fluid Volume Decreased Cardiac Output Anxiety Disuse Syndrome Deficient Knowledge
Progressive nephron destruction of both kidneys
Creatinine clearance: important measure of renal
function
Uremia: when kidneys unable to maintain fluid and
electrolyte or acid-base balance
Renal insufficiency: 75% to 95% loss of nephron
function
End-stage renal disease:
Chronic Kidney Disease
Causes Chronic Kidney Disease
Causes: See table 58-3 in text for complete list of
causes. Most common: hypertension, diabetes
mellitus, and atherosclerosis
Chronic Kidney Disease: Signs & Symptoms
Azotemia (increased nitrogenous waste products in blood)
Hyperkalemia
Hypocalcemia
Metabolic acidosis
Fluid balance (hypernatremia and hypervolemia)
Insulin resistance
Anemia
Suppressed immunologic function
Cardiovascular system (CHF and dysrhythmias)
Neurologic system (mental status changes)
Integumentary system (accumulation of waste products)
GI system (irritation, nausea, vomiting, a metallic taste in the mouth, and bleeding)
Musculoskeletal system (renal osteodystrophy)
Reproductive system (sex hormones decline and libido is diminished)
Endocrine function (hyperparathyroidism)
Emotional and psychological effects
Chronic Kidney Disease: Medical Treatment
IV glucose and insulin, calcium carbonate, calcium acetate, or sodium polystyrene sulfonate to treat hyperkalemia
Calcium, active vitamin D, and phosphate binders to treat hypocalcemia
Fluid restriction and diuretics to treat hypervolemia
Diuretics, beta blockers, calcium channel blockers, and ACE inhibitors for hypertension
Iron supplements, folic acid, and synthetic erythropoietin to treat anemia
Hypertonic glucose to treat disequilibrium syndrome
High-carbohydrate, low-protein diet to prevent excess urea
Chronic Kidney Disease: Dialysis
Passage of molecules through semipermeable membrane into special solution called dialysate solution
Dialysis operates like the kidney
Small molecules (urea, creatinine, and electrolytes) pass out of the blood, across a membrane, and into a solution
The goals of dialysis
Remove end products of protein metabolism from the blood
Maintain safe concentrations of serum electrolytes
Correct acidosis and replenish the body’s bicarbonate buffer system
Remove excess fluid from the blood
Hemodialysis
Chronic Kidney Disease
Blood is removed and circulated through an “artificial kidney” to remove excess fluid, electrolytes, wastes
Dialyzed blood then returned to the patient
Requires vascular access
By catheter, cannula, graft, or fistula
Subclavian or femoral catheters for temporary access for dialysis during acute renal failure while a graft or fistula matures (dilates and toughens) or for patients on peritoneal dialysis who need immediate access for hemodialysis
Peritoneal dialysis
Chronic Kidney Disease
Uses the patient’s own peritoneum as a semipermeable dialyzing membrane
Fluid instilled into peritoneal cavity
Waste products drawn into the fluid, which is then drained from the peritoneal cavity
May be temporary or permanent
Temporary: catheter inserted into the peritoneal cavity through the abdominal wall
Long-term: catheter is implanted into the peritoneal cavity
Peritoneal dialysis
Advantages over hemodialysis:
Chronic Kidney Disease
less anemia, reduced cost, fewer dietary and fluid restrictions, independence, closer to normal kidney function
Peritoneal dialysis
disAdvantages over hemodialysis:
Chronic Kidney Disease
risk of peritonitis (the major complication) catheter site infection, hyperglycemia, elevated serum lipids, body image disturbance
AssessmentChronic Kidney Disease
Frequent monitoring for changes important
Fluid balance evaluated closely
Accurate intake and output records
Signs and symptoms of fluid volume excess that can lead to cardiac failure: increasing edema, dyspnea, tachycardia, bounding pulse, rising blood pressure
Signs and symptoms of electrolyte imbalances
Appetite, usual daily intake, weight gain or loss pattern, and prescribed diet
Nursing Interventions for:Chronic Kidney Disease
Excess Fluid Volume
Imbalanced Nutrition: Less Than Body
Requirements
Disturbed Sensory Perception
Ineffective Coping
Situational Low Self-Esteem
Risk for Infection
Risk for Injury
Constipation
Diarrhea
Sexual Dysfunction
Self-Care Deficit
