urologic disorder 2

Question 1

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

Answer 1

Renal Calculi

Question 2

Factors for development of calculi

Answer 2

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

Question 3

Signs and symptoms

Answer 3

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

Question 4

Medical diagnosis

Answer 4

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

Question 5

Medical treatment for renal calculi

Answer 5

Most calculi are passed spontaneously 
Ambulation and adequate hydration facilitate passage  
Opioid analgesic/antispasmodics relieve pain 
Endourologic procedures 
Surgical procedures 
Nephrolithotomy 
Pyelolithotomy 
Ureterolithotomy

Question 6

Prevention Renal Calculi

Answer 6

High fluid intake to keep urine dilute, dietary restrictions for specific elements (i.e., calcium and purines), regular exercise, medications to alter urine pH

Question 7

Assessment Renal Calculi

Answer 7

Pt’s usual fluid intake and diet, including vitamin & mineral supplements
Location, severity, and nature of the pain
Changes in urine amount or characteristics

Question 8

Interventions for Renal Calculi

Answer 8

Acute Pain 
Impaired Urinary Elimination 
Risk for Deficient Fluid Volume 
Risk for Infection 2 to urinary statis
Ineffective (renal) Tissue Profusion

Question 9

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

Answer 9

Renal Cancer

Question 10

early stages Renal Cancer

Answer 10

Early stages of cancer rarely has symptoms

Question 11

later stages Renal Cancer

Answer 11

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

Question 12

Medical diagnosis Renal Cancer

Answer 12

Excretory urography, IVP, retrograde pyelography, ultrasound, arteriography, computed tomography, magnetic resonance imaging, and renal biopsy

Question 13

Medical treatment Renal Cancer

Answer 13

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

Question 14

Preoperative Care Renal Cancer

Answer 14

Ineffective Coping related to potentially fatal disease

Knowledge Deficient re: tests, procedures, and effects of nephrectomy

Question 15

Postoperative Care Nursing Interventions Renal Cancer

Answer 15

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

Question 16

Most common malignancy of urinary tract

Ureteral orifices and bladder neck are the most common sites

Answer 16

Bladder Cancer

Question 17

cause Bladder Cancer

Answer 17

Tars in smoking tobacco, aniline dyes in industrial compounds, and tryptophan have been implicated in development of bladder cancer

Question 18

Signs and symptoms Bladder Cancer

Answer 18

Painless, intermittent hematuria
Other signs and symptoms: bladder irritability; infection, with dysuria, frequency, and urgency; and decreased stream of urine

Question 19

Medical diagnosis Bladder Cancer

Answer 19

Urinalysis, IVP, CT scan, and cystoscopy

Question 20

Medical treatment Bladder Cancer

Answer 20

Surgery is the treatment of choice
Cystoscopic resection and fulguration or laser photocoagulation
Segmental bladder resection and radical cystectomy
Urinary diversion

Question 21

Assessment Bladder Cancer

Answer 21

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

Question 22

cause Acute Renal Failure

Answer 22

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

Question 23

Onset stage Acute Renal Failure

Answer 23

Short (1-3 days); increasing BUN and serum creatinine with normal to decreased urine output

Question 24

Oliguric stage Acute Renal Failure

Answer 24

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

Question 25

Diuretic stage Acute Renal Failure

Answer 25

Urine output exceeds 400 mL/day; may rise above 4 L/day Kidneys excrete BUN, creatinine, potassium, and phosphorus and retain calcium and bicarbonate

Question 26

Recovery stage Acute Renal Failure

Answer 26

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

Question 27

Medical treatment Acute Renal Failure

Answer 27

``` Fluid and dietary restrictions, restoration of electrolyte balance, and dialysis Drug therapy Diet Fluids Hemodialysis and peritoneal dialysis Continuous renal replacement therapy ```

Question 28

Assessment Acute Renal Failure

Answer 28

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

Question 29

Interventions Acute Renal Failure

Answer 29

``` Excess Fluid Volume Decreased Cardiac Output Anxiety Disuse Syndrome Deficient Knowledge ```

Question 30

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:

Answer 30

Chronic Kidney Disease

Question 31

Causes Chronic Kidney Disease

Answer 31

Causes: See table 58-3 in text for complete list of causes. Most common: hypertension, diabetes mellitus, and atherosclerosis

Question 32

Chronic Kidney Disease: Signs & Symptoms

Answer 32

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

Question 33

Chronic Kidney Disease: Medical Treatment

Answer 33

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

Question 34

Chronic Kidney Disease: Dialysis

Answer 34

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

Question 35

Hemodialysis | Chronic Kidney Disease

Answer 35

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

Question 36

Peritoneal dialysis | Chronic Kidney Disease

Answer 36

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

Question 37

Peritoneal dialysis Advantages over hemodialysis: Chronic Kidney Disease

Answer 37

``` less anemia, reduced cost, fewer dietary and fluid restrictions, independence, closer to normal kidney function ```

Question 38

Peritoneal dialysis disAdvantages over hemodialysis: Chronic Kidney Disease

Answer 38

``` risk of peritonitis (the major complication) catheter site infection, hyperglycemia, elevated serum lipids, body image disturbance ```

Question 39

AssessmentChronic Kidney Disease

Answer 39

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

Question 40

Nursing Interventions for:Chronic Kidney Disease

Answer 40

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