Urinary

Question 1

What is a UTI?

Answer 1

Infection in the urinary tract that is caused by a pathogenic microorganisms.

Can be classified as complicated or uncomplicated

Question 2

What are manifestations of a UTI?

Answer 2

-Burning on urination (Dysuria)
-Increased frequency (more than every 3 hours)
-Nocturia (awaking at night to pee)
-suprapubic or pelvic pain
-Urgency

Question 3

How can UTIs be prevented?

Answer 3

-shower over bath
-good hygiene
-drink lots of H2O
-avoid urinary track irritants (coffee, tea, soda, alcohol)
-voiding habit (void at least every 2-3 hours)
-medications (take all as prescribed)

Question 4

What are some complications that can occur due to UTI

Answer 4

Rental/ kidney failure
Urosepsis

Question 5

What should be included in a nursing assessment for a pt with a UTI

Answer 5

1) assess changes in urinary pattern (frequency, urgency, hesitancy)

2) asses or knowledges about meds and preventative measures

3) assess characteristics of pts urine (color, concentration, odor, volume, and cloudiness)

Question 6

What are nursing interventions for UTI?

Answer 6

1) relieve pain
2) give fluids
3) promote voiding (every 2-3 hours)
4) irritants (avoid them; coffee, tea, soda, alcohol)

Question 7

What is Pyelonephritis?

Answer 7

Infection in the kidneys that is caused by a bacterial infection in lower urinary tract

Question 8

What is the most common organism to caused pyeloneohritis?

Answer 8

Eacherichia Coli

Question 9

What are S/S of pyelonephritis?

Answer 9

Flank pain
Dysuria
Polyuria
Urgency
Frequency
Malaise
Fever / N/V (due to infection)

Question 10

What are complications that could come from pyelonephritis?

Answer 10

Kidney failure
Renal scarring
Sepsis

Question 11

What are nursing interventions to treat pyelonephritis?

Answer 11

1) manage s/s: pain, fever, ectc
2) administer meds
3) increase fluids
4) void frequently
5) educate: avoiding irritants (coffee, tea, soda, alcohol), non pharm management, disease process

Question 12

What is Urolithiasis? (Rental Calculi)

Answer 12

Stones (Calculi) in urinary tract

Caused by concentration of substances like calcium oxalate, calcium phosphate, and uric acid

Question 13

What is Nephrolithiasis?

Answer 13

When stones form in the kidneys

Question 14

What is ureterolithiasis?

Answer 14

When stones form in the ureters

Question 15

What are calculi (stones) composed of?

Answer 15

-Calcium oxalate and calcium phosphate (85%)
-Uric acid, struvite, and cystine

Question 16

What are manifestations of stones that form in the renal pelvis?

Answer 16

-Intense, deep ache in costovertebral region (back) -radiates anteriorly down bladder
-Hematuria
-pyuria
-N/V
-tenderness
-Diarrhea

Question 17

What are manifestations of stones lodged in ureter? (Uretal colic)

Answer 17

-Acute, excruciating, colicky, wavelike pain that radiates down thigh to genitalia
-Frequent desire to void, but with little urine passed
-Urine contains blood due to abrasive action of stones

Question 18

What are manifestations of stones lodged in bladder?

Answer 18

-irritation associated with UTI and hematuria
-urinary retention (if it obstructs bladder neck)
-possible urosepsis if infection is present

Question 19

How do you diagnose stones?

Answer 19

X-ray
ultrasound
CT
IVP
UA/Culture
BUN/Cr.
CBC
PTH
24 hour urine

Question 20

How are stones managed?

Answer 20

Manage
-pain
-Nausea

Meds
-Alpha adrenergic blockers

Increase
-fluid
-increase calcium (for calcium stones)
-low purine died (for uric acid stones)
-stone removal

Medical intervention
-Ureteroscopy (lazer, electrohydraulic lithotripsy, or ultrasound) then remove
-ESWL (extracorporeal shock wave lithotripsy)
-Chemolysis (stone dissolution)
-Surgical removal

Question 21

What is ESWL (extracorporeal shock wave lithotripsy)?

Answer 21

Using shock wavers to break up the kidney stones into smaller fragments so they can be extreted.

Question 22

What should nurses be assessing after ESWL ?

Answer 22

-Pain
-N/V/D
-Hematuria
-strain urine for stones

Question 23

What are complications for ESWL?

Answer 23

-Infection/pyelonephritis (kidney infection)
-Urinary tract obstruction (stone train following lithotripsy)
-acute renal failure
-hydronephrosis (swollen and stretched kidneys)

Question 24

How should nurses intervene after ESWL?

Answer 24

-administer opiod analgesics
-comfortable position
-assess in ambulating / promote and encourage ambulating
-monitor pain closely
-encourage increase fluids
-administer iv fluid if pt cannot drink
-monitor i/o (focusing on total output)
-strain urine

Question 25

What is Glomerulonephritis?

Answer 25

An autoimmune disorder that triggers inflammation and proliferation of glomerular tissues (the filtering parts of the kidneys)

Kidney inflammation

This results in damage to the basement membrane or capillary endothelium, a sudden onset of hematuria, proteinuria, and RBC casts in the urine.

Caused by A Beta-hemolytic streptococcal infection

Question 26

What are manifestations of glomerulonephritis?

Answer 26

-Hematuria
-Periorbital edema
-fever (103-104 at onset, drop to 100)
-hypertension (60-70% of pts for first 4-5 days)
-oliguria (low urine output*) high specific gravity with albumin, R&W blood cells, and casts)
-fluid overload
-cerebral symptoms (headache, drowsiness, convulsions, vomiting)

Question 27

What is medical management for glomerulonephritis?

Answer 27

Diet
-Na+ restriction
-Fluid restriction

Activity
-bedrest

Medication
-Antibiotics
-loop diuretics
-vasodilators
-CCB

Question 28

What are nursing interventions for glomerulonephritis?

Answer 28

-Manage activity (bedrest)
-prevent infection
-monitor I/O
-monitor BP
-Monitor urine characteristics

Question 29

What is chronic renal failure?

Answer 29

-End result of gradual, progressive, or loss of kidney function

Results when kidneys cannot remove the body’s metabolic waste and perform their normal function. This leads to the renal function declining, and end products (waste) accumulating in the body

Question 30

What in risk factors for developing renal falure?

Answer 30

-Diabetes
-age (60+)
-kidney disease present at birth
-family history
-autoimmune disorder (lupus or erythmatosus)
-bladder outlet obstruction
-race (sickle cell disease)

Question 31

What are manifestations of renal failure?

Answer 31

-Peripheral neuropathy
-severe pain
-restless leg syndrome (burning feet)

Question 32

What are complications from renal failure?

Answer 32

-hyperkalemia (body cannot get rid of excess)
-pericarditis (retention of uremic waster)
-hypertension (due to Na and H2O retention)
-Anemia (decreased RBC production, and bleeding in GI track from toxin accumulation)
-Bone disease

Question 33

What is medical management for renal disease?

Answer 33

Medication
-Calcium and phosphorus binders
-antihypertensive and cardiovascular agents
-Anti-seizure agents
-Erythropoietin

Nutritional therapy
-regulate protein intake
-fluid balance
-sodium and potassium restriction

Dialysis

Question 34

What are important assessments that nurses need to make for renal failure patients?

Answer 34

-fluid status
-dietary patterns
-nutritional status
-understand underlying causes
-assess pt and family responses
-assess for s/s of hyperkalemia

Question 35

What are nursing interventions for renal failure?

Answer 35

-Fluid status
-nutritional intake
-independence
-protein
-medication
-rest

Question 36

What is Dialysis?

Answer 36

-Gets rid of excess fluid and electrolytes (waste) in the body
-It helps the body achieve acid-base balance
-Eliminates waste products
-Restores internal homeostasis by osmosis, diffusion and ultrafiltration

Question 37

What is Hemodialysis?

Answer 37

A machine that filters wastes, salts, and fluid from the blood

Question 38

What is an AV fistula?

Answer 38

a port for hemodialysis access:
one in vein: blood from the dialysis machine goes into the vein to be taken back to heart
one in artery: blood from artery (that has already been released from heart) is taken to dialysis machine to be filtered

Question 39

What is a central venous catheter?

Answer 39

Another access point for hemodialysis that goes right into the central vein at the neck.

Question 40

What are nursing care instructions during dialysis?

Answer 40

-monitor for complications
-monitor VS and coagulation
-Have protamine sulfate ready to reverse heparin
-provide emotional support and offer activities

Question 41

What are complications for dialysis?

Answer 41

-Clotting/infection of access site
-Disequilibrium syndrome (rapid decrease of BUN and circulating fluid volume)
-hypotension
-anemia
-infectious disease

Question 42

What are some fistula/graft precautions

Answer 42

only to be used for dialysis **no blood draws or routine IV acess
*no BP in the arm of an active fistual/graft

Question 43

When is peritoneal dialysis chosen over hemodialysis?

Answer 43

-Choice of older adults
-pts who are unable to tolerate anticoagulation
-pts with difficulty vascular access
-pts with chronic infection who are unstable
-pts with chronic disease (DM)
-pts with heart failure or severe hypertension

Question 44

What is peritoneal dialysis?

Answer 44

The access point is in the stomach:
-dialysis solution (cleansing fluid) flows through tube into abdomen
-peritoneum acts as a filter and removed waste from blood
-After a set amount of time, fluid with filtered waste flows out of abdomen

Question 45

What are complications for peritoneal dialysis?

Answer 45

-infection
-abdominal pain