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Med Surg > urologic disorder 2 > Flashcards

urologic disorder 2 Flashcards

1
Q

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

A

Renal Calculi

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2
Q

Factors for development of calculi

A 
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
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3
Q

Signs and symptoms

A

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

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4
Q

Medical diagnosis

A

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

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5
Q

Medical treatment for renal calculi

A 
Most calculi are passed spontaneously 
Ambulation and adequate hydration facilitate passage  
Opioid analgesic/antispasmodics relieve pain 
Endourologic procedures 
Surgical procedures 
Nephrolithotomy 
Pyelolithotomy 
Ureterolithotomy
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6
Q

Prevention Renal Calculi

A

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

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7
Q

Assessment Renal Calculi

A

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

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8
Q

Interventions for Renal Calculi

A 
Acute Pain 
Impaired Urinary Elimination 
Risk for Deficient Fluid Volume 
Risk for Infection 2 to urinary statis
Ineffective (renal) Tissue Profusion
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9
Q

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

A

Renal Cancer

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10
Q

early stages Renal Cancer

A

Early stages of cancer rarely has symptoms

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11
Q

later stages Renal Cancer

A

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

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12
Q

Medical diagnosis Renal Cancer

A

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

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13
Q

Medical treatment Renal Cancer

A

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

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14
Q

Preoperative Care Renal Cancer

A

Ineffective Coping related to potentially fatal disease

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

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15
Q

Postoperative Care Nursing Interventions Renal Cancer

A 
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
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16
Q

Most common malignancy of urinary tract

Ureteral orifices and bladder neck are the most common sites

A

Bladder Cancer

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17
Q

cause Bladder Cancer

A

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

18
Q

Signs and symptoms Bladder Cancer

A

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

19
Q

Medical diagnosis Bladder Cancer

A

Urinalysis, IVP, CT scan, and cystoscopy

20
Q

Medical treatment Bladder Cancer

A

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

21
Q

Assessment Bladder Cancer

A

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

22
Q

cause Acute Renal Failure

A

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

23
Q

Onset stage Acute Renal Failure

A

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

24
Q

Oliguric stage Acute Renal Failure

A

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

25
Q

Diuretic stage Acute Renal Failure

A

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

26
Q

Recovery stage Acute Renal Failure

A

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

27
Q

Medical treatment Acute Renal Failure

A 
Fluid and dietary restrictions, restoration of electrolyte balance, and dialysis
Drug therapy
Diet 
Fluids 
Hemodialysis and peritoneal dialysis 
Continuous renal replacement therapy
28
Q

Assessment Acute Renal Failure

A

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

29
Q

Interventions Acute Renal Failure

A 
Excess Fluid Volume 
Decreased Cardiac Output 
Anxiety 
Disuse Syndrome 
Deficient Knowledge
30
Q

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:

A

Chronic Kidney Disease

31
Q

Causes Chronic Kidney Disease

A

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

32
Q

Chronic Kidney Disease: Signs & Symptoms

A

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

33
Q

Chronic Kidney Disease: Medical Treatment

A

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

34
Q

Chronic Kidney Disease: Dialysis

A

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

35
Q

Hemodialysis

Chronic Kidney Disease

A

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

36
Q

Peritoneal dialysis

Chronic Kidney Disease

A

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

37
Q

Peritoneal dialysis
Advantages over hemodialysis:
Chronic Kidney Disease

A 
less anemia, 
 reduced cost, 
 fewer dietary and fluid restrictions, 
 independence, 
 closer to normal kidney function
38
Q

Peritoneal dialysis
disAdvantages over hemodialysis:
Chronic Kidney Disease

A 
risk of peritonitis (the major complication) 
 catheter site infection, 
 hyperglycemia, 
 elevated serum lipids, 
 body image disturbance
39
Q

AssessmentChronic Kidney Disease

A

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

40
Q

Nursing Interventions for:Chronic Kidney Disease

A

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

Med Surg (35 decks)

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