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ADN002 MED SURG > Week 3 Bladder and Kidney Disorders > Flashcards

Week 3 Bladder and Kidney Disorders Flashcards

1
Q

4 Layers of Tissue of Bladder

A

Adeventia- Outer Layer
Detrusor Muscle- Smooth Muscle
Submucosal CT- Interface of inner most layer
Transitional Cell Epithelium- Impermeable to water- Innermost layer

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2
Q

Polysaccharides help to maintain biological function to maintain collagen and elastin fibers to retain moisture

A

Glycosaminoglycan

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3
Q

Involuntarily smooth muscle associated with internal sphincter

A

Bladder neck

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4
Q

Lower UTIs include

A

Cystitis
Prostatitis
Urethritis

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5
Q

Upper UTIs include

A

Pyelonephritis- acute and chronic
Interstitial Nephritis
Renal abscess and Perirenal abscess

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6
Q

Uncomplicated UTI

A

Community Acquired

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7
Q

Complicated UTi

A

Hospital Acquired

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8
Q

Renal Abcess

A

Caused by UTI of bladder and spreads to bladder

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9
Q

Perineal Abcess

A

Abscess around one or both kidneys secondary to UTI complications

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10
Q

Cystitis

A

Inflammation of urinary bladder

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11
Q

Factors Contributing UTI

A

GAG function
Ureterovesical Reflux
Ureterovesical Reflux
Uropathogenic bacteria
Shorter Urethra in woman
RF- sex, moisture, genetics, hygiene, procedures, pregnancy, decreased prostatic fluid

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12
Q

E. Coli, Klebsialla Pneumoniae

A

Uropathogenic bacteria that are gram -

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13
Q

Efflux/ Anteograde

A

Downward movement of urine

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14
Q

Reflux or Retrograde

A

Upward movement of urine

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15
Q

Most common cause of sepsis

A

UTI

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16
Q

Indicator of UTI for older adults is

A

Acute Confusion

Early symptoms include burning, urgency, and fever

Some may develop incontinence and delirium

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17
Q

Myogenic

A

Over distention of bladder

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18
Q

Neurogenic

A

Decreased bladder tone

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19
Q

Most common cause of UTIs for men?

A

Chronic Bacterial Prostatitis

Also males have decrease prostatic fluids

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20
Q

HOUDINI

A

Hematuria
Obstruction
Urology surgery
Decubitus Ulcer
I Input and output
N DNR
I immobility

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21
Q

UTI Assessment

A

Pain, burning, urination
Half Asymptomatic
Association with sexual practices
Assess urine and cultures and other tests

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22
Q

Nursing Diagnosis UTI

A

Acute Pain
Deficient Knowledge
Impaired Urinary Elimination
Urinary Retention
Risk for impaired skin integrity
Ineffective renal perfusion

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23
Q

Nursing Planning UTI

A

Relief of pain
Increase knowledge
Urine culture
Pt meet CAUTI criteria

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24
Q

Nursing Process UTI Implementing

A

Treat with antibiotics
Anti fungal
Pyridium- analgesic- orange urine
Routine toileting
I and Os
Catheter Care

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25
Q

Interventions UTI

A

Wipe front to back
Medications
Application of heat
Avoidance of UTI irritants
Frequent voiding
Pt Education

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26
Q

Complications of UTI

A

Nocturia
Urinary Frequency
Sepsis
Renal Failure
Nosocomial Infection
Rx to medication Tx

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27
Q

Sepsis screening completed when?

A

Blood work is resulted

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28
Q

What qualifies Sepsis?

A

Positive SIRS Have one or more signs of infection

If positive SIRS and infections Pt is septic

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29
Q

Severe Sepsis

A

One or more signs of organ dysfunction

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30
Q

Organ Dysfunction Vitals

A

BP lower than 90
HR increase
RR above 22
T above 38 C
SPo2 less than 90

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31
Q

When is Septic Shock determined?

A

Pt experiences refractory hypotension after fluid resuscitations interventions

SBP drops below 90 after 30ml fluid Bolus

Watch for overload of fluids

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32
Q

SIRS

A

temp
HR
WBC
RR

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33
Q

qSOFA

A

RR
Systolic
GCS

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34
Q

Urinary Incontinence

A

Not a normal consequence of aging

Underdiagnosed or underreported problem that can have significant impact on life and decrease independence and may lead to compromise of upper urinary system

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35
Q

Stress Incontinence

A

Physical activity that increases intraabdominal pressure, stresses bladder

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36
Q

Reflex Incontinence

A

Urine leaks upon bladder contraction without warning

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37
Q

Urge Incontinence

A

Loss of voluntary control. Sudden urges to urinate

38
Q

Overflow Incont.

A

Involuntarily release of urine from a distended overfull bladder

39
Q

Functional Incont.

A

Aware of need to urinate but physically unable or mentally unable to get to the bathroom

Disabling medical condition prevents ability to get to the bathroom (arthritis)

40
Q

Iatrogenic Incontinence

A

Drug induced

Usually due to muscle relaxants and drugs that affect the nervous system

ex: Sedatives, hypnotics, ACE inhibitors, Loops, NSAIDs, Ca channel blockers

41
Q

Nursing Dx for Incontinence Issues

A

Urinary Incontinence by
Functional
Overflow
Reflex
Stress
Urge
Toileting
Situational Low Self Esteem

42
Q

Pt Education of Urinary Incontinence

A

Not inevitable and is treatable
Management takes time
Develop and use voiding log or diary
Behavioral Interventions
Medication education
Strategies for promoting continence

43
Q

Common Drug for Urinary Incontinence is

A

Oxybutynin

44
Q

What do anticholinergics do?

A

Decreases activity in muscles, decrease bodily fluid production, and stabilizes mood.

Acts as anti spasmodic. Focus on detrusor muscle.

45
Q

Muscarinic Antagonist

A

Blocks activity of the muscarinic acetylcholine receptors

Ex
Derifenacin
Flavoxate
Solifenacin
Tolterodine
Trospium

46
Q

Anticholinergic Toxicity

A

Overdose produces exaggerated effects.

Increases sympathetic effects

Symptoms
Hyperthermia
Mydriasis
Delirium
Seizures, coma, and respiratory arrrest

47
Q

Anticholinergic Overdose Tx

A

Activated Charcoal
Use physostigmine salicylate (parasympathetic alkaloid)
Via IV slowly

Diazepam used to tx and prevent seizures
Ice bags, cooling blankets, tepid sponges
Reduces fever

48
Q

What is the most common cause of urinary retention?

A

Lack of nerve innervation

Also called neurogenic bladder

Other causes diabetes, enlarged prostate, pregnancy, neurological disorders such multiple sclerosis or Parkinson’s

Pt may describe a sensation of bladder fullness or incomplete bladder emptying and may experience leakage

49
Q

What medications causes urinary retention?

A

Amitriptyline, Nortriptyline, or trimipramine

50
Q

Amrytripline inhibits reuptake of

A

Noreepinephrine and serotonin

51
Q

Nortriptyline inhibits reuptake of

A

Noreepinephrine

52
Q

Trimipramine inhibits reuptake of

A

norepinephrine and serotonin with anticholinergic properties

53
Q

Acute Care for Urinary Retention

A

Straight Cath or In N Out Cath

Drains bladder completely
Give bladder massage while draining
Done with sterile technique

Foley Catheterization
Send home with leg
Educated proper use, draining, and positioning
Follow up with urology

54
Q

Tx of Urinary Retention

A

Cholinergic Agonist
Bethanechol

Sympathomimetic agent that acts cholinergic receptors in the urinary and GI tracts to increase muscle tone . Increased tone in detrusor muscle in bladder and allows emptying

55
Q

Muscarinic Agonist

A

Cholinergic
Absorbs GI tract
Does not cross BBB
Crosses placenta and breast milk

56
Q

Bethanecol

A

Gradual increase the medication
10-50 mg PO 3-4 times per day
Take 1 hour before meals or 2 hours after meals
Pt should avoid 1hr after administration
Asses BP, EKG, sweating and flushing, ABD pain, nausea or vomiting

Antidote is atropine . Blocks the action of acetylcholine thus blocks parasympathetic actions

57
Q

Chlonergic Agonist does what?

A

Increases Acetylcholine

Pt over doses shows extreme parasympathetic actions

58
Q

Emergency Tx of Bethanechol

A

Atropine is antidote to organophosphate poisoning and this includes insecticides

59
Q

What causes the inactivation of of actylcholinerase?

A

Sarin gas and insecticides

Causes overload and causes excessive stimulation of muscarinic and nicotine receptors
Excessive secretions

60
Q

What works on nicotinic synapses?

A

Pralidoxime

61
Q

Medications to treat Urinary Retention include?

A

Alpha 1 blockers . Promote relaxation of smooth muscle
Most end in -osin

62
Q

-OSINS

A

Assists with dilating urethra and ureters to assist with urination.

63
Q

Phosphodiesterase -5 Enzyme

A

Contraindicated with nitroglycerin and if given may drop the BP with too much vasodilation

Initially treated for HTN

64
Q

What is pyelonephritis?

A

Inflammation of the renal pelvis
Classic symptoms include
Chills and fever
Leukocytosis- Elevated WBC in serum
Bacteruria
Pyuria
Flank Tenderness

65
Q

Diagnostic Studies for Pyelonephritis

A

CBC and Chem Panel
Urinalysis- Protein, RBCs
Urine Culture
Urine Dipstick
Nitrates and Leukocytes
Ultrasound- Fluid(Hydronephrosis), Kidney stone
CT- Fluid, kidney stone, abscess, tumor

66
Q

Swelling of kidney due to a build up of urine. Happens when urine can’t drain out from the kidney to the bladder from blockage or obstruction

A

Hydronephrosis

67
Q

Stages of Hydronephrosis

A

Grade 1- Grade V

Higher the grade, more urine reflux.

68
Q

Tx of Pyelonephritis

A

Same as UTIs

Take NSAIDs
Toradol, Ibuprofen for kidney related pain

Encourage Fluid intake
Assess Pt for improvement and watch for urosepsis

Recurrent Pyelonephritis may be due to CKD

69
Q

Stone formation in kidney

A

Nephrolithiasis

70
Q

Stone formation in bladder or urinary tract

A

Urolithiasis

71
Q

Kidney Stones

A

Hard deposits of minerals and acid salts that accumulate in concentrated urine

Formation depends on: substances in urine, fluid amount, presence of infection, mobility

Instruct Pt to void into strainer

72
Q

Tx of Renal Calculi

A

Encourage fluid intake
Pain under control
Tamsulosin- Alpha 1 Blocker, also used for BPH
Change Diet
Strain Urine
May need to give antiemetic

73
Q

Renal Calculi Types

A

Calcium
Uric Acid
Struvite
Cystine

74
Q

Oxalates

A

Potato chips, peanuts, beets, and spinach

75
Q

Purines

A

Animal Proteins

76
Q

Struvite

A

More common in women with UTI
Lead to obstruction and can be large

77
Q

Cystine

A

Rare, due to genetics and leads to cytinuria

78
Q

Risk Factors for Renal Calculi include :

A

Obesity, dehydration, gastric bypass, diest high in protein, glucose, and salt, IBS, and taking direutics

79
Q

3 common sites for Renal Stones

A

Ureteropelvic Junction
Ureteral Segment
Ureterovesical Junction

80
Q

Physical Removal of stones in ureter near the bladder

A

Ureteroscopy

81
Q

Extrocorpeal Shockwave Therapy

A

Lithotripsy
Use of electromagnetic waves to break up stone

82
Q

Percutaneous Nephrolithotomy

A

Device used to penetrate multiple layers of tissue to reach kidney and remove stone

83
Q

Ureteroscope

A

Used to obtain kidney stone all depends on the Pt and size of the stone

84
Q

Pt Education

A

S/S to report
Follow Up care
Urine Ph formation
Measures to prevent
Importance of fluid intake
Medication education as needed

85
Q

Dietary Education

A

Restrict foods that breakdown into salts that formed the salts

86
Q

Calcium Oxlate

A

Proteins, spinach, beets, and chocolate

87
Q

Calcium Phosphate Stones

A

Dairy, broccoli, sardines, and salmon

88
Q

Struvite Stones

A

Bacteria, Ammonia, alkaline environment

89
Q

Uric Acid

A

Seafood, bacon, turkey, veal, and liver

90
Q

Cystine Stones

A

Genetics
Pork, poultry, dairy, garlic, onions, Brussel sprouts

91
Q
A

ADN002 MED SURG (18 decks)

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