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H & Illness 4: A & C illness > week 11 > Flashcards

week 11 Flashcards

1
Q

problems in the urinary system
infection what undergoes this and obstruction

A

infection
- urethra ( urethritis )
- bladder ( cystitis )
- kidney ( pyelonephritis )

obstruction
- calculi ( stones )
- benign prostatic hyperplasia ( BPH )
- cancer (urinary system )

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2
Q

what undergoes kidney failing

A

trauma /injury to kidney
acute/chronic kidney injury

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3
Q

what is the elimination

A

filters out blood and gets rid of things our body doesn’t need

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4
Q

what is this describing : from a human physiological perspective, the term is defined as the excretion of waste production

A

elimination

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5
Q

wha is this considered as a elimination

A

water is waste product ( kidney in large getting rid of extra )

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6
Q

the urinary system :
what are the 3 things that are pressure

A

capsular pressure
osmotic pressure
blood pressure
these are the three pressure

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7
Q

what is enlarge prostate?

A

prostate can interfere with urine
consider interventions that could be done drainage from the bladder

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8
Q

urinary system : what do we think about two things

A

what is the normal ( regular job )
filtering maintaining electrolyte balance ( acid base balance, regulating blood pressure

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9
Q

blood tells us ( report how kidney is doing )

abnormality , in electrolytes ( kidney is not working out , regulating our blood and filtering )

is this true or false.

A

this is true

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10
Q

urinary system : how we do we know if the urinary system is working ?
normal kidney functions

A

filter waste products
maintain fluid and electrolyte balance
acid base balancet

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11
Q

true or false . regulate blood pressure and eyrhtopoeitin, would indicate normal kidney functions

A

true

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12
Q

what should nurses monitor for ?

A

fluid balance
- intake ( IV , PO, NG feeding )
output ( u.o , diarrhea, ng suction, etc, suction,etc )
weight ( daily, trends )

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13
Q

should nurses monitor for edema nad ausculate lungs, for urinary system ?

A

yes this is practicedwha

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14
Q

t are the labs we are monitpring for when it comes to the urianry system

A

urea, creatine, K, hgb , abg, vital signs

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15
Q

wht do we do regular basis that kdiney is working ? fluid balance

A

this is true

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16
Q

what are the common meds for urinary system ?

A

nsaids
antibiotics
tmp-smx ( spetra, bactrim )
ciprofloxacin

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17
Q

what are the common medications
recall that diuretics is one ( what udnergoes this )
they do not help with kidney funtining but what do they help wtih ?

A

lasix ( loop, diuretic )
they dont help with kidney functioning but they help with the symptoms ( getting rid of the fludi )

force kidney to diuresis , used when kidneys declined

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18
Q

what type of relation do the nsaids have /

A

have negative effects in the kidneys ( especially low perfusion tot eh kidneys ) nsaids do in relation in kidney interfere with prostaglandin production , prostaglandin helps kidney vasodilator in low perfusion

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19
Q

if the pt is in renal failure , what do u question

A

question nsaid order, renal pt may be in nsaids, dont take it as they will never, but see how their kidneys are funcitoning.

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20
Q

what is the number one type of infections and what is the second one ?

A

urianry tract infections is the seocnd one
resp infections is the first one

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21
Q

with bladder symptoms : what type of common medications are we utilizing

A

pyridium ( urianry analgesic 0
oxybutin ( decrease of muscle spams of bladder and urinary tract )

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22
Q

what does pyridium help with ?

A

helps pain in the baldder : big nursing consieration is turns your urine into colour ( bright orange )
u might look into if they are on this med

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23
Q

what common meds are we using for bph

A

proscar ( decrease size of prostate )
flomax ( relaxes smooth muscle of prostate )

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24
Q

true or false. drugs that could be sued to decreased enlarged prostate , common for med and give these to older audlts gentlemen

A

true

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25
Q

what can go wrong with the kidney ?

A

big ideas
infection
obstruction
injury

from aki to ckd

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26
Q

true or false. AKI is something we can intervene and reverse situation quickly

A

this is true

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27
Q

true or false. we can prevent long term damage to our kidenys if we ca intervene if not treating infections appropriately or effectively we can build up scar tissue because of inflammation.

A

true

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28
Q

chronic infections can lead to chrinc kidney disease( kidney stones, scar tissue can form - if not fixed=

A

this is true

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29
Q

problem #1
infection
exemplars:

A

lower an upper uti

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30
Q

what is urinary tract infection
recognize cues ( review)
who is at risk?
what is uncomplicatede cystitis vs complicated cystitis

A

pts with diabetes, abnormality in urinary tract kidney stones, older adults ( older and pregnant female : high risk with pregnancy )
for children genetically abnormalities how the bladder drains ( prone to retaining urine and can have repeating urinary tract )

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31
Q

what is urinary complciated ? how long does it usually last

A

7-14 days usually starts in the bladder - ascending because of ecoli

we do not want infection getting close to the kidneys ( can affect kidney functioning scar tissue )

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32
Q

dysuria, urgency , frequency, palapted ( infected blader- sore )
what is the difference between puhyscial imple urine tract or to the kidenys

they have cvh tenderness , fever, and nausa and vomitting - blsadder infeciton

A

yes these are all true

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33
Q

what are hte diagnostics tests we are utulziing for uti

A

1 urianlysis

leukocytes nitrates wbc rbc and casts

all of thesea re going to beelevated

#2 urine culture

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34
Q

what does casts tells us

A

if there is a intra renal problem

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35
Q

what does rbc tells us in the diagnostic tests for uti

A

rbc - some areas that could be bleeding a little bit
casts - tells u tehe tubules of a nephron

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36
Q

is a screening of all compoennts found in the blood
this gives us specific ( blood which abx needs to be ordered )
is this true or false.

A

this is true

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37
Q

what is the important thing we look for someone who has infection : this is for analyzing cues for urinary tract infectiomn

A

important thing we look forif a pt has an infection
- gluco cytes and nitrates that indicates a bacterial infection and took both samples - now we can send th rine culutre 0 because we have evidence of urinary infection

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38
Q

urinary tract infection
plan/prioritize

what can go wrong ?

A

cystitis – pyelonephritis
urospesis
AKI
CKD ( chronic utis )

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39
Q

what is the wrost case scenario for someone who has uti

A

they will become ureaseptic : fever, chills, nausea, vomitting ( irritating symptoms )

starts seeing changes to the vital signs

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40
Q

what is our interventions for uti ?
interventions : take action

management of utis
what are the 4 as for drug theraphy

A

analgesic, antipyretic, anitbiotic, antispasmodic ( ditopran )

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41
Q

what is the other management for utis : interventions : take action for uti

A

fluid intake
sitz bath
suregry ( remove cause of recurrent utis )

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42
Q

is it okay to give both analgesic and antipyretic as management for uti

A

yes it is okay to do that

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43
Q

why is fluid bath given for uti

A

warm water calms the inflame area, u want to pish fluid and not want to retain

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44
Q

true or false. offer pt a sitz bath

A

true this is true

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45
Q

what is our intervention if al the other intefventions are not working ?

A

need surgery

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46
Q

uti evaluate and educate
who needs a urianry catheter

A

urinary retention
hourly u/o in critically ill
during surgert
sci
clots in the bladderr

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47
Q

recall that rthese poeple needs a urinary cathether who else:
* Urinary retention
* Hourly u/o in critically ill
* During surgery
* SCI
clots in the bladder

A

open wounds in perineum
immobolized patients ( ex: cva )

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48
Q

what is our role in preventing infection ?

A

sterile technique
push fluids ( encourage our patient drink )
flush out
mobility ( even helps with decrease try to advocate for ur patient )

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49
Q

got sedated and does not feel like peeing
- might need a foly
-critically ill ( how well kidenys are functioning.) ins oand pouts eveyr hour
surgery - put foley anyone going through general anaesthetic going after time
need straight cath - and regularly - lower incident of infection

true or false.

A

true

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50
Q

to protect skin
the wound not healing - cath may be required

A
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51
Q

A patient with a urinary tract infection (UTI) is prescribed antibiotics. What is the most important nursing intervention?
A. Encourage increased fluid intake.
B. Monitor blood glucose levels.
C. Apply a warm compress to the abdomen. D. Provide a high-protein diet.

A

A. encourage increased fluid intake

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52
Q

A patient is admitted with acute pyelonephritis. What is the priority nursing intervention?
A. Encourage ambulation.
B. Administer prescribed analgesics.
C. Monitor Urea and Creatinine.
D. Provide sitz bath.

A

C

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53
Q

con
think about seriousness, is it contained or spread
think abt interfere with renal functioning

A

concept connection : elimination

think about seriousness, is it contained or spread think about interfere with renal functioning

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54
Q

problem #2 obstruction exemplars :

A

nephrolithiasis/urolithiasis
bph
renal/bladder ca

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55
Q

the importance of forward flow into the kidneys

when we have obstruction ( overtime what will happen )

A

overtime it will increase pushing back into the blood pressure

if it cannot overcome the hydrostatic pressure we are going to lose ( and lose of filtration ) think abt that

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56
Q

worst case scenario for obstruction
major problem : hydronephoris/hydroureter

A

back flow if pressure really interrupt our gfr
reasons why we get obstruction in urinary tract or trauma

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57
Q

enlargement of kidney or ureter resulting from an outflow obstruction

A

hydronephrosis/hydroroureter

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58
Q

what is the potential causes of hydronephrosis/hydrorouter

A

kidney stones/tumors/trauma, etc

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59
Q

what can lead to kidney damage and necrosis if treatment doesn’t occur in a timely manner : what is this ?

A

hydronephorisis/hydroroureter

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60
Q

what is it physical pain for hydronephrosis

A

flank or abdominal pain

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61
Q

interventions for hydronephrosis/hydroureter

A

treat cause of obstruction

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62
Q

this is too much water in the roureter what is this describing :

A

hydroureter
and or kidney

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63
Q

develop sudden aki
and flow into the kidney is infected ( perfusion into the kidney is affected )Or necrosis in the kidney can occur

A

true

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64
Q

increase capsular pressure - alot of discomfort

A

YES THIS SI TRUE

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65
Q

IMPORTANT: to think abt is the kideny pain and what causes it

A

consider the emergency reverse this obstruction

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66
Q

assesment : recognize cues ( review ) nephrolithiasis/urolithiasis

A

risk factors: relative who had kidney stones , the genetic component ( differences in metabolism of some components more likely to absorbs calcium =, struviate , olciate, collecting the urine , crystallizing in high contraction

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67
Q

what is the most common cause of nephrolithiasis/urolithiasis

A

pain, pain pattern - where the stone is located, the pain is confined to the abdomen or the flank ( the usually in the kidney )

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68
Q

common symptoms

of nephrolithiasis/urolithiasis

A

where it starts to radiating on the over as it reaches ( rough edges , causes trauma , irritative symptoms bleeding and increase the risk of infection

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69
Q

this is painful ( travelling down , most painful experiences )

for men closed to experiencing labour

A

nephrolithiasis/urolithiasis

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70
Q

who is at risk for nephrolithiasis/ urolithiasis

A

diabetes people who are overnight people with gout

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71
Q

dehydration and present kidney stones in the summer months - become dehydrated: what is this describing

A

this is describing urolithiasis

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72
Q

what is complication for nephrolithiasis/urolithiasis

A

urine flow and too bad

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73
Q

nephrolithiasis/urolithaisis
analyze cues

more solute compare to the amount of water ( shows dehydration )

what are you doing ?

A

sending a urine analysis of a possible kidney stones

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74
Q

what undergoes urinalysis for nephrolithiasis/urolithiasis

A

specific gravity
osmolarity
pH
RBCs
WBCs
crystals
urine appearance

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75
Q

specific gravity
osmolarity
pH
RBCs
WBCs
crystals
urine appearance

info this gives

A

specific gravity
osmolarity
= hydration

pH- high acidity : uric acid and crystine stones
low acidity: calcium and struviate stones

RBC - bleeding

WBC - infection ( trauma and obstruction of urine flow )

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76
Q

crystals
urine appearance

A

present with stones ( if they are talking stones : crystals )
may be cloudy or hematuria

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77
Q

nephrolithiasis/urolithiasis
take action : non surgical interventions

medication:

A

opoids/nsaids/oxybutynin

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78
Q

how to decide between opoid and oxybutin

A

nauseated and vomiting if someone is vomitting - never pick the oral route easier to give them iv route

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79
Q

nephrolithiasis/urolithiasis

take action: non surgical interventions

medications

A
  • Opioids, NSAIDs*, Oxybutynin
  • Antibiotics
  • Thiazide diuretic
  • Allopurinol
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80
Q

antiobitocs is for infection
thiazude diuretic
allopurinol

A

allopurinol - is for uric acid
thiaziade diuretic - wash out for calcium

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81
Q

thiazide diuretic is for what ?

A

pass stones and can prevent future stones

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82
Q

hydration ( avoid under and over hydrating ) : don’t over hydrate , is this true abt nephrolithiasis/urolithiasis

A

yes this is true

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83
Q

strain urine ( catch stone ) can identify which type of stones it is , is this true or false.

A

true

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84
Q

what does walking help with nephrolithiasis/urolithiasis

A

help gravity helps us

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85
Q

is extracoporeal shock wave lithotripsy considered a non surgical: give more description about this

A

a bit more invasive
this person in the getting this ( shock wave going through the skin and at the kidney and breaking stones and consistency of sands )

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86
Q

nephrolithiasis/urolithiasis: ECSW lithotripsy : nursing care post procedure

what are things u look for immediately after someone who had a procedure done ?

A

make sure oxygen is hooked up to the wall
urianry tract ( make sure foley bad is down ) it is draining
always following foley abg up ( is it kinked? )
make sure urine is travelling down the bag

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87
Q

true or false. it is important to establish a baseline with nephrolithiasis/urolithiasis

A

this is true

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88
Q

what to expect for nephroliathiasis/urolithiasis
ecsw lithotripsy : nursing care post procedure

A

patient sedation
pain
hematuria ( should lessen over time )
flank bruising ( may ocucur )
utreteral stent ( may be placed 0

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89
Q

what is a ureteral stent ?

A

inside keeping urether open, cannot be seen on the outside
small in size and took a pen and little tube urether stent after a procedure like this -opne in urether reduce iritation as the come up and no obstruction

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90
Q

true or false someone who had a extracoroporeal shock wave lithoripsy we need to check sedation : in terms of this expand on it

A

check how sedation is doing
do we give water ? needs to decide ( loc ) make sure intanct

  • ask for pain
    -ask if they want pain med
91
Q

true or false. u could ask a question like would u like a sip of water when smeone had ecsw lithotripsy

A

yes this si true
if loc is good, checked gag reflex ( when someone had freezing down the throat ) scope, henral anesthesia

92
Q

general sedation u do not have to check for the gag reflex?

A

yes dont have to check

93
Q

define if this statement is true. dont phone the doctor , is it normal ? if stones passed through ( thissi norm, note the colour, expect hematuria and pain )
what i wont expect : if bp is lower THAN baseline WHE HE COMES BAck BUT SHOULD BE COMING UP WHEN HE WAKES UP
IF BP is not improved, not recvering as i expect them too

A

true

94
Q

what is teh complications of nephrolithiasis/urolithiasis
ecsw lithotripsy: nrsing care post procedure

A

hemorrhage
sepsis

  • if come back half full of dark urine
    can obstruct urinary tract and need irrigation

check vitals and blood pressure and temperature

95
Q

nephrolithiasis/urolithiasis
interventions: take action ( surgical management )

what are the 3 that could be utilized

A

ureteroscopy
percutaneous ureterolithotomy, and percutaneous nephrolithotomy

and open surgical procedure

96
Q

what undergoes ureteroscopy

where is the scope placed through

A

the scope is placed through urethra and bladder into ureter

97
Q

what happens once stone is seen in ureteroscopy

A

once stone is seen, removed with grasping baskets, forceps, or loops

98
Q

true or false. stenting of ureters can be performed, in ureteroscopy

A

this is true

99
Q

true or false. stenting of ureters can be perfromed in ureteroscopy

A

true, and tithotripsy can also be performed

100
Q

what is percutaneous ureterolithotomy , and percutaneous nephrolithomy

A

removal of a stone in the ureter or kidney through the skin ( 1 cm cut )

101
Q

what type of anesthesia do we use for percutaneous ureterolithotomy , and percutaneous nephrolithomy

A

local or general anesthesia

102
Q

what is this describing : through the skin or urether or straight to the kidney

A

percutaneous ureterolithotomy, and percutaneous nephrolithotomy

103
Q

often a uretheral stent onnephoromy tube is placed permanently to drain urine , is this true.

A

false, its temporry
the tube sits in the renal pelvis

104
Q

what is open surgical procedure nephrolithiasis/urolithiasis

A

remove large, impacted stone ( other methods have failed )

general anesthesia

may need ureteral stent, nephrostomy tube, wound drain

105
Q

for percutaneoous ureterolithomy, and pecutaneous nephrolithotomy

where are they going to the stone?

A

fluroscopy or xray, they are going to the stone - to get the location

106
Q

true or false. for open surgical procedure , impacted now we have to open up the pt

open procedure to remove a stone

A

true

107
Q

where would the location be for open srugical procedure?

A

it would be on the back
kidney is located in the peritoneal space, they have dressing across the back

108
Q

urether stet - not a lot of monitroing )
( if urine is coming out this is working , a lack of urine output if nothing ic oming out )
opstretomy tube - this is a big deal , made a little incision ove ht etop of kidney, cathete sits indie the renal pelvis ( kdieny )

A

this is true

109
Q

if ureteris blocking stone s- what is it called ?
if alrger incision and nephrostomy tube and little bag hanging ther e- last option liekly had open surgical procedure andcut open and loke inside the kidney

A

hydronephrosis
yes that is true

110
Q

what is this explaining : going through the skin urether to remove the stone very invasive, and more of recovery

drain coming out of his incision as well

A

open ureterolithotomy or pyelolithotomy

111
Q

what is nephrostomy tubes

A

catheter coming into the renal pelvis and draining it out
bag is way up there and coming out of ur back look closer

112
Q

interventions : take action ( surgical management ) nephrolithiasis/urolithiasis

A

place strain all urine - on the back of the sheet, who empties the urine , healthcare aid did have instructions to do that

113
Q

what i expected during teh post op ?

A

hematuria ( is expected )

114
Q

what should we have durin post op care for nephrolithiasis and urlothiasis ( getting thier stones removed )

A

vital signs
water jug ( kdieny basi n ). encourage fluidspass through
ins and out sheets
strainer

115
Q

what undergoes the post op care for getting stones remove surgical

A

Post Op Care
* recover from sedation/anesthesia
——Vital signs, ABCs, LOC
* monitor for bleeding
——incisions & urine

  • maintain adequate fluid intake/output
    ——– IV fluid until drinking, Ins=outs
  • strain urine
116
Q

iv fluid ( patient is waig up and all of thse procedures need sedation , we do not immediately come ain force fluid )
they have fluid running, heo flush out urianry system and as they start dirning dslow down iv rat e
and take all

need pain meds ( have ordered prn )

A

true

117
Q

what is the patient education for nephrolihaisis and urlothiasis

A

remian hydrated ) 3 L day
drugs ( thiazide diurteics, allopurinol )
walk
nutrtional therpahy ( na protein)
manage anxiety

118
Q

BPH Benign Prostatic Hyperplasia
Recognize Cues

symptoms

A

see luts ( lower urinary tract symptoms ) – increase risk of infecion

retention, hesitanyc. leaking dribbling

incontinence (voerflow )

oncomplete bladder emptying

119
Q

grows impeded urine outflow
someone can have enlarged prostate - but notinterfering with urethra
where the prostate is pressing ( what matters ) in the urianry tract
what is this describng

A

bph

120
Q

BPH benign prostatic hyperplasia
analyze cues
diagnose testing :

A

DRE
TRUS
urinalysis/ucul

121
Q

recall that :
DRE
TRUS
urinalysis/ucul
is how to diagnose testing
for bph

what else

A

cbc
urea/crea
psa ( prostate specific antigen )

122
Q

bph ( benign prostatic hyperplasia )
analyze cues : what is this mean

A

screening

123
Q

what does dre : finger in the rectum ( and palpate the prostate )

A

digital rectal exam

124
Q

what does trus mean

A

trans rectal ultrasound

125
Q

urinalysis/ucul
define the description for it

A

changes in urinary retention
retaining urine - increase the risk of infection
overtime if this i

126
Q

overtime if this is overtime obstruction and kidneys are experiencing blood flow : urea and creatine

A

true

127
Q

bph : benign prostatic hyperplasia
intervention : take action ( non surgical )

behaviour modification

A

avoid ++ fluid, drugs that cause retention ( incontinence is worse, and increase worse for retention )

128
Q

what is the drug theraphy : for bph

A

alpha adnergic antagonists ( tamsulosin-flomax )

—- helps with shrinking the size of prostate and relaxing smooth muscle

129
Q

recall that: alpha adnergic antagonists ( tamsulosin-flomax ) is for bph

—- helps with shrinking the size of prostate and relaxing smooth muscle

what else

A

5 alpha reductase inhibitors ( finasteride - proscar )

130
Q

Minimally invasive approaches
◦ Prostate artery embolism
◦ Transurethral needle ablation (TUNA)
what else ?

A

◦ Transurethral microwave therapy (TUMT)

131
Q

minimally invasive approaches
for prostate artery embolism :

A

decrease blood flow the prostate- interfere starts to shrink

132
Q

transurethral needle ablation ( TUNA )
minimally invasive appraoches : BPH

A

using low frequency of energy trying to shrink the prostate

133
Q

prostate- bph
intervetion : take action ( surgical )
transurethral resectin of the prostate ( TURP )

A

enlarged portion removed through endoscope

134
Q

Prostate- BPH
Intervention: Take Action (Surgical)
Transuretheral resection of the prostate (TURP)
* Enlarged portion removed through endoscope

post op :

A

catheter placed, may need continous bladder irrigation

135
Q

where is the surgery done for bph

A

surgery is done through urethra kinda scrape away the part of the prostate more room for urinary output

136
Q

what is this describing : quite risk of bleeding inside the kideny or bladder - which can cause trauma

A

TURP
3 way bladder irrigation

137
Q

what is this describing used to reduce the risk of clot formation and maintain indwelling urinary catheter (IUC) patency by continuously irrigating the bladder via a three‑way catheter

A

this is continous bladder irrigation

138
Q

initially instil 2 full syringe before attempting to remove clots : this prevents sucking on the bladder wall : what is this ?

A

irrigating an obstructed 3 way catheter

139
Q

cancer of the urinary system :
assesment : recognize cues ( review )

what are the three cancer types

A

1) bladder cancer
2) renal cancer
3) prostate cancer

140
Q

what are the risk factors for bladder cancer

A

tobacco use, exposure to gasoline and diesel fuel, chemicals

141
Q

what are the symptoms for bladder cancer

A

painless blood in urine, dysuria, frequency, urgency

142
Q

what are the diagnostics for bladder cancer

A

ct/mri/us/cystosopy ( bx )

143
Q

true or false. more room in the bladder ( would have to be large tumour to compress )
for symotoms in bladder cancer

A

true

144
Q

what is the risk factors for renal cancer

A

tobacco use, exposure to heavy metals, asbestos

145
Q

what are the symptoms for renal cancer

A

flank pain- dull or acing

late sign : blood in urine

146
Q

what is the risk factors for prostate cancer

A

advancing age

146
Q

what is the symptoms for prostate cancer

A

early : bladder outlet obstruction

late sign : gross, hematuria, abdominal pain

147
Q

what is the diagnostics for prostate cancer

A

DRE ( digital rectal exam )
ct/mri/us/cystoscopy ( bx )

148
Q

what is urothelial ( bladder ) cancer
intervention : take action

non surgical management :

A

intravesical chemo ( inside the baldder )
- use separate toilet
-wash clothing ( 10 % bleach solutin )

149
Q

what is transurethral resection of the bladder tumor ( TURBT )

what is it ?

A

cutting part of the baldder out ( still left there, but removing part of it )

cut through abdomen do not remove bladder

150
Q

what is complete cystectomy ( bladder removal )

A

should not be peeing as other people ( strong chemical of that urine )

men should sit down to void ( wash the toilet they are using

void in commode ( something we can control not affecting other people )

151
Q

urothelial ( bladder cancer )
intervention : take action
think about how they are continent or incontinent : ask about those things : think abt if it cannot be taken out.

doesn’t have to cut through skin, going through urethra can take bladder out completely

just read it

A

okay

152
Q

urothelial ( baldder cancer )
intervention : take action
types of urinary diversion methods

A

ureterostomies
conduits
sigmoidostomies

153
Q

what is ureeterostomie : this is a type of urianry diversion

A

1 or 2 comibed together or have a stong
have a bag to collect it
incontienent ( no spincher anymore to control the body.)

154
Q

what is a conduits : a type of urianry diversion method

A

conduits - portion of the instestines make cnnections to colelct ( still have osteomy ) saw up one end and other ennd comes through abdomimal wall
gives more room for urine to collect it

155
Q

true or false. stoma : can be anywhere: bladder ( other things can have stoma )
if there is an opening into the body ( stoma )`

A

yes this is true

156
Q

what is a sigmoidostomies

A

usually because of bladder cancer

combined with feced, this pt is continent ( but barely , extra fluid )

157
Q

kind of make fake bladder
and comes in through soy
vecuase urine is her to collect, consider continent

illeal reservoir ( kock’s pouch )

A

true

158
Q

sigmoidostomies
- have attach uretereties of clon
true or false.

A

true

159
Q

cystectomy : post op

A

general post op monitoring ( pain bleeding, db + c , infection )
volume status

160
Q

recall that we are doing this during the post op for cystectomy , but what else ?

  • general post op monitoring (pain, bleeding, DB+C, infection)
  • volume status
A

collaboration with enteral stoma ( ET ) nurse for ostomy care

  • anxiety, body image, sexuality
161
Q

infection, bleeding, drinking enough, teaching and help intrastoma nurse for post op cystectomy is something to look at

A

true

162
Q

renal cancer
interventions : take action
non surgical management
- chemo is typically not as effective

A

yes this is true, it is not as effective

163
Q

what is the surgical management for renal cancer

A

nephrectomy ( removal of part or all of the kidney )

164
Q

what is the post op for nephrectomy

A

kidney function of remaining kidney
pain, bleeding, infection

165
Q

recall that adrenal gland insufficiency. is something that could be seen in post op nephrorectomy

A

addisons disease ( not stress hormone, not enough cortisol )
hard time maintaining blood pressure, temp, heart rate blood sugar

166
Q

what is important to see in a renal cancer ?

A

glucocortocoid and mineralcorticoid is important

urine output and urea/cretitine is important

167
Q

urine output over 30mLs pre hour
blood work ( urea and creatine )
might see other component that are not normalize because of kidney

A

yes

168
Q

what is the thing with open nephrectomy ?

A

atelectasis
all of their breathing muscles ( hurts to take deep breaths )

169
Q

A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip

A

yes

170
Q

Prostate Cancer
Interventions: Take Action

Treatment Options;

A

Radiation therapy (external or internal)
Chemotherapy
Prostatectomy (surgical removal of prostate)
* laparoscopic or open

171
Q

post op care for prostate cancer

A

Post-op care:
- kidney function of remaining kidney
- pain, bleeding, infection
- Kegal exercises if incontinence

172
Q

blood clotting 0 3 ways catheter important in reducing that risk

A

yes

173
Q

A patient with bladder cancer is scheduled for a cystectomy with ileal conduit creation ( part of bowl) What preoperative teaching should the nurse include?
A. Explain the need to report hematuria immediately. B. Discuss the importance of fluid restriction.
C. Instruct how to care for the stoma and appliance. D. Teach how to perform Kegel exercises.

A

c

174
Q

Which order should the nurse question for her patient with urolithiasis?
A. Encourage ambulation. B. Administer oxybutynin
C. Restrict fluid intake.
D. Prepare for lithotripsy.

A

c

175
Q

problem #3
injury
exemplars

A

trauma
aki/ckd

176
Q

kidney trauma
recognize cues

urologic procedures

what is the cause ?
what is the assessment ?

A

penetrating or blunt wound, urologic procedures

assessment : observe for bleeding

177
Q

what is the diagnosis for kidney trauma

A

dx: us or ct scan , urinalysis, cbc, urea, crea

178
Q

true or false. severity of trauma depends on the extent of the injury

A

true

179
Q

what is a big thing in kidney trauma ?

A

bleeding is a big thing ( million blood vessels on kidneys )

180
Q

what is monitoring and treatment for kidney trauma

A

VS ( watch for shock ) , iv fluids if needed

ins and outs, fluid balance, hematuria

myoglobinuria

review meds- any nephrotoxic antibiotics

surgery if needed

181
Q

nephrotic syndrome : review
diuretic to move fluid out of the body
causes fluid floss form intravascular spaces ( this diminishes edema could come back in circulation get rid of it )
restrict sodium - get heparin to prevent clots for forming
lipid lowering drugs

true or false.

A

true

182
Q

nephrotic syndrome : review
assessment and intervention

what is it ?

A

immunologic kidney disorder when glomerular permeability increases so larger molecules pass through the filtration membrane into urine.

183
Q

what is the pt population for nephrotic syndrome review

A

strange immune reaction
if u can i understand losing massive amount of proteins
nephrotic syndrome

184
Q

issues with nephrotic syndrome : review

A

low serum albumin - edema ( diuretis, NA rest )
— i and o balance, weight, measure girth ( ascites )
— skin care

reduced kidney function
hypercoagulability- clots ( heparin )

185
Q

nephrotic syndrome : review
recall that :
low serum albumin - edema ( diuretics, NA rest )
— i and o balance, weight, measure girth ( ascites )
— skin care

what else?

A

hypercoagbuality ( clots ) we use heparin
elevated serum cholesterol ( lipid lowering meds )
nutrition status – normal or high protein diet ( depending gfr )

altered immune response ( increased risk infection )

186
Q

lose a lot of protein - blood pressure seep out , a lot of edema , and reduction in kidney functioning

is this true or false, amongst nephrotic syndrome.

A

true

187
Q

nephrotic syndrome : depends on ______ : may need protein or not

A

GFR
increase protein if adequate no if not

188
Q

what are some meds used to treat immunosuppresants

A

acei
lipid lowering
drugs
heparin
mild diuretics

189
Q

one of the things we lose - clotting factors - result in this state
- critical thinking: elevated cholesterol : has to do with the liver respond
is this true amongst nephrotic syndrome

A

true

190
Q

Practice Question
A patient with nephrotic syndrome is experiencing significant edema. What dietary intervention should the nurse implement?
A. Increase sodium intake.
B. Encourage high-protein foods.
C. Restrict fluid intake.
D. Provide a high-fiber diet.

A

B

191
Q

Acute Kidney Injury (AKI)
Assessment: Recognize Cues

Cause:
S&S nurses must recognize Δ’s

A

pre, intra, and post renal
S and S must recognize
: * Fluid volume status (In&Out, weight)
* Urine characteristics/amount
* Lab results (Urea, Crea, Na,K, Ca, Phos)

192
Q

any volume in patients : pressure coming in and has to overcome the resistanc in the capsule

we get worried about sudden drop of bp
what can this lead to ?

what is intra?

what is post renal ?

A

sudden aki

damage to self kidney

obstruction

193
Q

Acute kidney injury : interventions : take action
depend on which is the cause : we give them a lot of fluids

what should we avoid ?

A

yes this is true
treatment is decided based on the cause of the aki

avoid hypotension/avoid nephrotoxic agents and drugs

194
Q

what should we monitor for in acute kidney injury

A

monitor or signs of fluid overload ( may need fluid restriction or diuretic ) — look for edema/listen to their lungs

195
Q

what is lab work for acute kidney injury : what should we watch out for ?

A

watch for imbalances and correct as needed

nutrition : dietician to balance protein, na, k ( restrict certain things )

196
Q

dialysis as last resort if unable to manage symptoms

A

example : don’t stress the kidney further ( question if hard on the kidney )

197
Q

chronic kidney disease : recognize and analyze cues

affect all system
neuro
cvs
resp

A

decrease loc
htn, edema, pericarditis
kussmaul’s, pulm edema

198
Q

Chronic Kidney Disease
GI
GU
MUSK/SKEL
INTEG

A

gi : decrease apetite, metallic taste, nausea and vomitting

gu : urine/output

musk/skel: osteodystrophy

integ : pruritis, ecchymosis

199
Q

what is uremia ?

A

end stage of chronic kidney disease

200
Q

which reason which would be pre renal - the surgery jake is an 80 year pt who had surgery for colon caner 2 days ago, and developed fever overnight. he was started abx and this morn, he went for a ct scan of is abdomen, his urine output is decrease this am and his creatine is elevated

A

hang bolus of 500 ml to be give over an hour
strict ins and outs
because the next hour is going to be very important

  • pre renal - should be able to tell if its pre renal ( if it gets better then ) urine output putting up
    respond to that fluid ( likely pre renal cause )

ct dyes
abx
surgery ( is at risk usually cause people to bleed, and volume loss ) ‘multiple reason why this might’ve experience kidney injury

201
Q

ckd: intervention : take action

what is our intevrentions ?

A

managing fluid volume
diet
blood pressure control
and preventing injury

202
Q

what undergoes manging fluid volumes

A

weights, fluid restriction , input and output

monitor signs/symptoms of overload

203
Q

what undergoes diet what undergoes ckd

A

invovle a dietician na k and phosphate restriction

204
Q

what undergoes blood pressure control : for ckd

A

ace inhibtor, ccb , bb, diuretics

205
Q

what is preventing injury for ckd

A

fractures, infection, bleeding
avoid antacids with Mg
use caution wit opoids

206
Q

control their blood pressure
all connected to the blood vessels
look for any that is not working
( fractures, if they fall etc. ) minimize risk of infection is this true amongst the diet in ckd

A

this sit true

207
Q

chrinic kidney , not able to get rid of mg s this true or false?

A

this is true

opioids can make someone ambulate - takes longer

208
Q

what is dialysis : general ideasolutes and water move across the semipermeable membrane from the blood to the dialysate or from dialysate to the blood, in accordance with concentration gradients

what is this describing

A

dialysis

209
Q

fluid very different from their blood , is this true amongst dialysis.

what is their blood like ?

A

this is true

thier blood is high elements like potassium, creatine, urea, and leave in the blood

we give them dialysis low contraction of those things

210
Q

ckd : interventions: take action

this is the end stage of chronic kidney disease and need dialysis and push them into the category

indications for hemodialysis:

A

acidosis

electrolytes ( send dialysis usually potassium, if we cannot control - too dangerous )

intoxication/ingestions – drugs there own is building to toxic levels

overload
uremia – signs of uremia

211
Q

ckd
interventions : take action
caring for a dialysis patient

A
  • Know the pt’s dry weight
  • May need to hold drugs prior to dialysis
  • Measure VS on return to unit
212
Q

recall that ckd interventions take action for caring for a dialysis patient :

recall that : * Know the pt’s dry weight
* May need to hold drugs prior to dialysis
* Measure VS on return to unit

A
  • Assess vascular access site (bleeding)
  • Assess LOC, headache, n&v after treatment * Monitor blood work after dialysis treatment
213
Q

ckd : caring for a dialysis pt
know the pts weight why ?

A

optimal weight have gone

through dialysis - the trend with dialysis their weight is down.

between days goes up and down
we try to get them back up in dry weight ( if they got the fluid off, sometimes they get all them off and sometime they cant )

214
Q

may need to hold drugs prior to dialysis for caring for a dialysis patient :

A

which drug is dialysis

215
Q

measure VS on return to unit
they have

A

they may go hypotensive, usually this is taken care off in the dialysis unit

216
Q

recall that assessing vascular access site ( bleeding ) for ckd

A

they have put needle in the fistula ( risk of bleeding )

217
Q

ckd : assessing LOC, headache, nausea and vomiting after treatment

A

indicate fluid shift is too quickly

218
Q

is this true or fale. monitor blood work after dialysis treatment for ckd.

A

always send post dialysis bloodwork

219
Q

give a description through an av fistula

A

only way we can give patients dialysis

vein and artery sewn together to fistula = high pressure of artery
(vein expands , and what becomes thick) allows us to repeatedly puncture it and remove and return fluid quickly ( try to cool off , maybe fistulas to access )

220
Q

dialysis through an av fistula

A

we want to feel it ( feel thrill, blood rushing through auscultate and hear bruit turbulate blood low )1

221
Q

dialysis through an av fistula
what do u do ?

A

palpate thrill
auscultate bruit

222
Q

dialysis through a central line
what is it called
give description

A

vas cath
very thick and hard
and got two huge clamps on it

as a bedside nurse do not ever touch and access a vas cath

this is only for dialysis

223
Q

peritoneal dialysis

A

the blood ( permeable is the peritoneum so competent of out blood will leak to the dialysis and leave for a period of time and empty it )

it will go into abdominal cavity and empty it out and same thing as urine
gotten rid of waste product
component in the dialysis in the and will go to the pts blood

H & Illness 4: A & C illness (21 decks)

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