Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR205 > Week 11 > Flashcards

Week 11 Flashcards

1
Q

Renal function helps…

A

Renal function helps maintain the body’s state of homeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The function of renal and urinary systems is

A 
Regulating fluid and electrolytes (excretion/re-absorption):
Fluid balance 
Acid-base balance 
Electrolyte balance 
Removing wastes
Providing hormones: 
Red blood cell production
Erythropoietin
Bone metabolism
Assists in conversion of Vitamin D to maintain calcium balance
Blood pressure regulation
Renin/Prostaglandins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Subjective data - patient assessment

A

Past medical history and pre-existing conditions: (Diabetes/hypertension/calculi/childbirth/STDs)

Medications (allergies):
potentially nephrotoxic (gentamycin/captopril/NSAIDs/aspirin)
others change urine colour (nitrofurantoin/dantrolene)
increase urine output (diuretics)
alter sphincter function/bladder contraction (Ca. channel blockers/antidepressants/antihistamines)
haematuria (anticoagulants)

Past surgical history/treatments – related to this system
Functional health pattern questions:
Changes in voiding habits/haematuria/pain (dysuria)
Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Objective data - patient assessment

A

Physical examination:
Especially abdominal and kidney palpation
Presence of oedema
Bladder percussion
Digital (rectal) prostatic palpation (DRE)
Inspection of genitalia/urinary meatus
Abnormal anatomy (female circumcision/”whistle-cock”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnostic tests for renal and urinary system

A

Urinalysis - baseline information – 1st am spec.
24 hr urine collection - creatinine/protein/specific components
Empty bladder at designated time
MSU/catheter spec.
Residual urine – left in bladder after urination (< 50-150mls)
Blood tests – specifically creatinine & urea
Radiological – x-rays/IVP/ultrasound/CT Scan/MRI/’scopes
Radionuclide Imaging/biopsy/cystoscopy
Renal function tests

Patient preparation
? Full bladder/? Encourage fluids/? fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The prostate gland

A

encircles the urethra just below the neck of the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Benign prostatic hyperplasia (BPH)

A

Proliferation of cells leading to increase in gland size
Occurs in 50% of men over 50 yrs/90% of men over 80 yrs/etc
Depending on lobe affected can gradually compress (and obstruct) urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prostate cancer

A

Malignant tumour affecting 1 in 11 Australian men/kills 20-25% of those diagnosed
Earlier detection leads to better/more successful treatment
Can lead to urinary retention/obstruction
Frequently diagnosed by pain/fracture after it metastasises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical manifestations of benign prostatic hyperplasia

A 
Mild to severe
Mild weakening of urinary stream
Frequency
Hesitancy
Dribbling
Incomplete bladder emptying
Retention
Nocturia
Urgency
Dysuria
Incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of benign prostatic hyperplasia

A

Depends on severity of symptoms/age & condition of pt.
Conservative
“watchful waiting”/dietary changes/bladder training
Medication
anti-androgenics (finasteride)/alpha adrenergic agonists (prazosin)

Surgical :
Microwave thermotherapy/needle ablation
Laser prostatectomy/electrovaporisation
Transurethral resection prostate (TURP) – most common 
(open) radical prostatectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Urinary retention is

A

Inability of the bladder to empty completely

types: chronic or acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Residual urine is the

A

Amount of urine left in the bladder after voiding

Generally 100/150 mLs on 1/2/3 occasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Assessment of urinary retention

A

Subjective – feel “empty” or “full”/dysuria/previous problem

Objective – pt. dribbling/monitor output (“fluid balance”)distension /palpation/percussion/pt. restless or agitated/bladder scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nursing measures to promote voiding

A 
Set environment (privacy)/running water /baths/warm compresses
Catheterisation may be necessary to prevent bladder overdistension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Benign prostatic hyperplasia common surgery is

A

Trans Urethral Resection of Prostate (TURP)
Under general or spinal anaesthetic
From 15 mins to 2-3 hours depending on size of prostate
Complications minimal (haemorrhage/hyponatraemia/infection)
Post-op - large bore 3 way catheter/bladder washout (BWO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nursing management for Trans urethral resection of prostate

A

Preop - ? retention - IDC/UTI – antibiotics/education
Postop
Bladder Washout
Accurate monitoring and measurement of input/output essential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urinary tract infections are classified according to

A

Lower tract – urethritis/cystitis/prostatitis (dysuria/generally unwell)
Upper – pyelonephritis/interstitial nephritis/renal abscess
Complicated (IDC/obstruction/stone/pregnancy/recurrent)
Uncomplicated – in otherwise normal tract
Initial or recurrent
Unresolved or persistent
Bacteria type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Urinary tract sterility is maintained by

A 
Complete emptying of bladder
Antibacterial capabilities of mucosa
Peristaltic actions of urethra
Vesico-ureteric competence (valve/trigone angle/musculature)
Urine acidity (<6.0) and flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Predisposing factors for UTI

A

Obstruction (stone/stricture/BPH)
Urinary retention/incomplete bladder emptying (high ‘residuals’)
Foreign objects (catheterisation/stents)
Sex/age/immunological/pregnancy/hormonal/hygiene/anatomical
Immunosuppression
Co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

UTI diagnosis

A

Via urine dipstick test(indication not diagnostic)
MSU
Clinical manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

UTI - lower urinary tract clinical manifestations

A 
Dysuria
Frequency
Urgency
Nocturia
Weak stream
Dribbling
Hesitancy
Intermittency
Incomplete emptying of bladder
Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

UTI - upper urinary tract clinical manifestations

A 
Dysuria
Frequency
Urgency
Nocturia
Weak stream
Dribbling
Hesitancy
Intermittency
Incomplete emptying of bladder
Haematuria
Abdominal/flank/supra-pubic pain
Vomiting/diarrhoea
Fever/chills
Confusion
General malaise
23
Q

UTI - upper and lower urinary tract in older patients clinical manifestations

A

Confusion/lethargy
Frequency/urgency/dysuria
Anorexia
Low grade febrile episodes

24
Q

Prevention of UTI

A

Avoid indwelling catheters, aseptic insertion & hygienic care of catheters
Personal hygiene
Void after sex/wipe front to back
Medications as prescribed:
Antibiotics, analgesics, and antispasmodics
Increased fluid intake
Avoid urinary tract irritants such as coffee/tea/citrus/spices/ cola/alcohol
Frequent voiding/reduce urine retention
? Prophylactic cranberry juice
Patient education

25
Q

Treatment of UTI

A

Antibiotics

Recurrent  UTIs:
Prophylactic antibiotics
Investigate abnormalities/treat cause
Cranberry juice(?)
Patient education
26
Q

Renal failure is

A

partial or complete kidney dysfunction
Leads to accumulation of metabolic wastes
Leads to alteration in fluid/electrolyte and acid-base balance

27
Q

Acute renal failure

A

Rapid loss of renal function (hours or days)
Decreased GFR & ? oliguria
Reversible (potentially) but high mortality rate
More common in elderly

28
Q

Chronic renal failure

A

Slow insidious and irreversible

Can have acute on chronic episodes

29
Q

End-stage renal disease

A

Final, irreversible stage of chronic renal failure

30
Q

Azotaemia is the

A

accumulation of nitrogenous wastes

31
Q

Uraemia is

A

symptomatic changes in multiple body systems due to progressive azotaemia

32
Q

Glomerular filtration rate

A

~ 100 - 120 ml/minute

33
Q

Catabolism is the

A

breakdown of body proteins

34
Q

Acute renal failure - pre renal

A

Factors that decrease renal blood flow:
Hypovolaemia (haemorrhage)
Dehydration/nausea & vomiting
Decreased cardiac output (heart failure/MI)
Decreased peripheral vascular resistance (septic shock)
Decreased renal blood flow (renal vein emboli)

35
Q

Acute renal failure - intrarenal

A 
Factors that cause direct damage to the renal parenchyma:
Nephrotoxic injury 
(drugs – gentamycin/heavy metals)
Infection (pyelonephritis/glomerulonephritis)
Thrombosis
Toxaemia (pregnancy)
Malignant hypertension
SLE (systemic lupus erythematosus)
36
Q

Acute renal failure - post renal

A 
Mechanical obstruction
BPH
Bladder cancer
Renal calculi
Neuromuscular disorders
Prostate cancer
Spinal cord diseases
Strictures
Trauma
37
Q

Phases of acute renal failure

A
  1. Initiation phase
    From time of injury to clinical manifestations evident
  2. Oliguric (Maintenance) phase
    Notable fall in GFR and tubular damage
    Uraemic symptoms and oedema increase/hypertension
    Confusion/fatigue/acid-base imbalance/anaemia/ECG changes (hyperkalaemia)
  3. Diuretic (maintenance) phase
    Glomeruli and tubules still dysfunctional
    High urine volume/still severely uraemic with all it’s affects
    Dehydration potential
  4. Recovery Phase (3 – 12 months)
    Glomerular and tubular repair and regeneration
    Gradual recovery and improvement in all areas
38
Q

Clinical manifestations of acute renal failure

A

Potentially evident in every body system
Persistent nausea & vomiting & diarrhoea
Lethargy/general malaise/fatigue
Signs of dehydration (dry mucous membranes/skin)
Uraemic fetor
CNS symptoms
Twitching/drowsiness/headache/seizures
Urine output variable according to the stage of ARF (~20mLs/hr)
ECG changes
Haematuria

39
Q

Diagnosis of acute renal failure

A

Urinary changes/blood tests/renal function tests/scans

40
Q

Treatment of acute renal failure

A

Detect & resolve the underlying cause
Treat the clinical manifestations & prevent complications
Nutritional support

Continuous renal replacement therapy (haemodialysis)
Used more frequently for early intervention to prevent complication and recovery

Medications:
IV fluids/volume expanders to improve renal perfusion
Diuretics to increase urine output (decrease fluid overload/washout wastes)
Antihypertensives to decrease blood pressure
NSAIDs/nephrotoxic drugs ceased
Proton-pump inhibitors/other to prevent GI haemorrhage
Calcium resonium to decrease hyperkalaemia (!)
All drug doses need to be titrated carefully as most are excreted through the kidneys

41
Q

Nursing care for acute renal failure

A

Monitoring:
Vital signs/skin assessment (for dehydration)
Subjective & objective assessment (cardiac/pulmonary function)
Fluid balance monitoring (intake and output) - strict
Previous 24 hrs output + 600mls (insensible loss) - ???
Daily weight/regular oral hygiene
Administer drugs (& monitor for side effects)
Monitor lab. results (frequent)
General nursing care (skin)/bed rest (reduce metabolic rate)
Asepsis
Patient & family support/education

Nutritional (dietician monitored)
Balance bodily requirements with preventing fluid & electrolyte disorders
Daily kilojoules – 125-150kj/kg
Increased carbohydrates to provide energy (& spare protein)
Protein (high in essential amino acids) – 0.6-2.0g/kg (restricted)
Potassium in diet dependant on serum levels (restricted)
Sodium (restricted to decrease oedema)
Phosphate (restricted)

Enteral feeding (TPN – Total Parenteral Nutrition) if unable to eat/drink but will likely require haemodialysis to remove extra fluid
Fluid balance monitoring (intake &amp; output) – strict/daily weight

All fluid and food is measured/weighed/specially prepared

42
Q

Chronic renal failure is the

A

Result of chronic disease processes with gradual destruction of glomerular filtration and tubular function
Can be as a result of ARF where full recovery not achieved

43
Q

Chronic renal failure management

A

Preserve existing renal function
Preventing and managing complications
Providing psychological support

Pharmacological:
Complex as many drugs are excreted via the kidneys
Treat underlying cause of CRF and associated conditions
Manage clinical manifestations
Diuretics/antihypertensives/resonium/phosphate binders etc

Nutrition and fluid management:
Nutritional and fluid management in line with ARF

44
Q

Nursing care of chronic renal failure

A

(Basically as per ARF)
Fluid management
Nutritional management
Full nursing care

Patient self management:
Educate and encourage
Community resources and support groups

Depends on setting – home/regional/tertiary hospital

45
Q

End-stage renal failure

A

Requires renal replacement therapy
Haemodialysis
Peritoneal dialysis
Kidney transplantation

Either in-hospital or at home

46
Q

Urinary catheterisation diagnosis

A

Monitoring urine output
Instillation of radio-opaque dye/medications
Obtaining specimens

47
Q

Urinary catheterisation treatment

A 
Obstruction/retention
Post procedure (surgery/childbirth)
48
Q

Urinary catheterisation types

A

Intermittent/indwelling
Insertion into bladder/ureter/kidney

Ileal diversion (bags)

49
Q

Urinary catheterisation complications

A 
Only if necessary
Bladder scanners instead of residual catheters
UTIs (during insertion/while inserted)
Track for infection
Mucosal irritation
Invasive and embarrassing  
Bladder spasms
Urethral false passage/rupture
Urethral strictures
Pressure necrosis
Allergy (most now latex free)
50
Q

Supra-pubic catheterisation

A

Temporary
Post surgical/Post trauma
Permanent
Urethral destruction
Patient choice (? easier care if paralysed)
Residual urine pre removal (clamp for 4 – 6 hrs/pt attempts to void then unclamp & drain.
2 x successful residual urines under 100/150 - removed)

51
Q

Advantages to supra-pubic catheterisation

A

Comfort & mobility/less UTI/spont. voiding post removal easier

52
Q

Complications of supra-pubic catheterisation

A

Encrustaceans/bladder stones/UTIs/presence of wound

Requires more specialised care

53
Q

Nursing management of indwelling (urethral) catheter

A

Depends on type/indication
Monitor drainage:e
Amount/colour/odour
Fluid balance chart

Secure catheter (an issue of importance):
With traction (if ordered) for tamponade (post TURP bleeding)
Prevent urethral erosion/comfort/accidental removal/leakage
For men – abdomen or upper thigh (varying practice)
For women – upper thigh
Surgical tape or proprietary device (varies)

Monitor for infection

NUR205 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions