Adult Urinary, Renal, Bladder disorder Flashcards
(78 cards)
1
Q
List 4 urinary, renal, and bladder disorders in ADULTS?
A
- Polycystic Kidney Disease
- Kidney cancer
- Bladder cancer
- Bladder trauma
2
Q
Disorder:
genetic disorder where multiple cysts form in the kidneys, leading to kidney enlargement and possible kidney failure.
A
Polycystic Kidney Disease (PKD)
3
Q
Disorder:
Injury to the bladder from external forces
A
Bladder Trauma
4
Q
There are 2 forms of Polycystic Kidney Disease (PKD)
A
- Childhood (Recessive) PKD
- Adult (Dominant) PKD (ADPKD):
5
Q
PKD that is Inherited in a recessive manner.
(Recessive: inherrited from both parents)
A
Childhood (Recessive) PKD
6
Q
PKD that is Inherited in a dominant manner.
(inherrited from one parent)
A
Adult (Dominant) Polycystic Kidney Disease (ADPKD)
7
Q
S/S of PKD typically appear when cysts in the kidneys begin to ____.
A
enlarge.
8
Q
PKD EARLY symptoms
List 8
A
- Nausea/vomiting
- Pruritus (itching)
- Fatigue
- Palpable bilateral enlarged kidneys (felt during a physical exam).
- Hematuria (blood in the urine) from cyst rupture.
- Urinary tract infections (UTI).
- Uremia (elevated UREA levels in urine, indicating kidney dysfunction).
- Hypertension: decreased kidney function
9
Q
Q: What are some associated complications of Polycystic Kidney Disease (PKD)?
A
- Liver cysts – Cysts can develop in the liver, affecting its function.
- Heart valve abnormalities – PKD can cause issues with heart valves, such as mitral valve prolapse.
- Diverticulosis – The development of small pouches in the walls of the intestines, which can become inflamed or infected.
- Aneurysms – Weakening of the blood vessel walls, particularly in the brain, which can lead to an increased risk of rupture and hemorrhage.
10
Q
5 PKD Diagnosis include:
A
- DNA Testing: genetic mutation
- Family History: important for dominant form
- Clinical Manifestations
- Ultrasound/CT scan
- IVP (Intravenous pyelogram)- detailed images of kidneys and urinary tract
11
Q
Can patients with PKD progress to End Stage REnal Disease (ESRD)?
A
Yes!
About 50% of patients progress to ESRD by age 60.
12
Q
What is the percent and age that patients with PKD progress to End stage Renal FAILURE
Renal disease and renal failure are diff- keep an eye!
A
70% by age 70
13
Q
Is there a cure for PKD?
A
No. Treatment mainly focuses on managing symptoms and preventing complications
14
Q
Collaborative Care for PKD
2 main ones
A
- Genetic Counseling: understand the risks of inheritance and potential implications for future generations
- Supportive Prevention/Treatment
15
Q
Tx for ESRD and ESRF
List 3
A
- Nephrectomy (removal of kidneys) in some cases.
- Dialysis to filter waste and fluids from the body.
- Kidney Transplant as a potential long-term solution.
16
Q
New Topic: Kidney Cancer
Most common type of malignant kidney tumor
A
adenocarcinoma
(Tubular epithelial cells of kidney)
17
Q
Q: What are the early symptoms of kidney cancer?
A
No “specific” early symptoms
- Makes early detection challenging
18
Q
Risk factors for kidney Cancer
A
- Smoking
- Family Hx
- Obesity
- HTN
- Exposure to asbestos, cadmium, gasoline
- Males > Females
19
Q
Q: What are the classic manifestations of ADVANCED kidney cancer?
A
-
gross hematuria: Blood in the urine
-gross: visible to the eye - flank pain: Pain in the side or back- tumor pressing on surrounding tissues.
- palpable mass
20
Q
Kidney cancer spreads beyond kidneys to nearby structures such as
A
- Renal Vein
- Vena Cava
- lungs
- liver
- long bones
21
Q
DX studies for Kidney Cancer
A
- Intravenous Pyelogram (IVP) with Nephrotomography – Detects most kidney masses.
- Ultrasound – Helps differentiate between a tumor and a cyst.
- Angiography, percutaneous needle aspiration, CT scan, and MRI
- Cystoscopy with a renal biopsy
22
Q
What labs are needed PRIOR to Intravenous Pyelogram (IVP)
A
Obtain baseline BUN/Creatinine
- due to contrast dye used
23
Q
What should you monitor post dx studies
1 specific thing
A
Bleeding- procedures can cause bleeding.
24
Q
What is a RADICAL NEPHRECTOMY surgery
A
- Entire kidney is removed.
- Removal of adrenal gland, surrounding fascia, part of ureter, & draining lymph nodes
25
How is **Radical Nephrectomy** performed?
* via laparoscopy (minimally invasive)
* or through an open approach, where an incision is made, usually around the **12th rib,** to access the kidney.
26
What are the key **post-operative care** considerations for a patient following a **radical nephrectomy**?
* Pain control: PCA pump-patient controlled
* Maintain airway / C&DB / IS
* Monitor for S/S of infection / bleeding
* Position of comfort
* I&O, Indwelling catheter
-*mild (pink) hematuria several days post-op is common*
* **Electrolyte, BUN/Creat**: assess function of remianing kidney
* Activity /driving restrictions 2 weeks minimum
27
**Tx of choice** for Kidney cancer
Partial or radical nephrectomy.
28
*kidney cancer*:
**Radiation** therapy is used ____
Palliatively
29
Q: Is **chemotherapy** an effective treatment for **metastatic** kidney cancer?
No, chemotherapy is not an effective treatment for metastatic kidney cancer
30
Type of 'targeted therapy' used for **metastatic** kidney cancer
**kinase inhibitors** (potent anti-neoplastics)
31
How do **Kinase inhibitors** work?
* work by blocking certain enzymes that help cancer cells grow.
* This helps slow down or stop the cancer from spreading.
* It's a more focused treatment with **fewer side effects compared to traditional chemotherapy.**
32
# Moving on to: Bladder Cancer
**Risk factors** for Bladder Cancer
* **Cigarette smoking**
* **Exposure to dyes used in rubber & other industries**
* **Radiation for cervical cancer**
* **Cyclophosphamide (Cytoxan®) / Pioglitazone (Actos®)**: meds that end up in bladder after being filtered from kidneys
33
Hallmark sign of Bladder cancer- **often 1ST sign**!
**PAINLESS Hematuria**
(blood in urine w/o pain)
34
Besides **PAINLESS hematuria**, what other **urinary** symptoms are associated with **bladder cancer**?
* **Frequency**
* **urgency**
* **dysuria** (painful/discomfort urination)
35
Q: What is the **most reliable DX TEST** for **DETECTING** **BLADDER tumors**?
Cystoscopy
*(Cysto=bladder)*
*(-scopy=visual exam)*
36
Q: What DX test **CONFIRMS** a bladder cancer diagnosis?
Bladder biopsy
37
Is **Chemotherapy** possible with Bladder cancer?
Yes. Sometimes radiation is used with it.
38
2 types of **treatments** for Bladder Cancer
1. Chemotherapy
2. Surgery
39
List 2 ways **Chemotherapy** is **administered** for bladder cancer.
1. Systemic Infusion
2. Intravesical Instillation
40
Chemo administration type:
chemotherapy **drugs are given through an IV (PIV - Peripheral Intravenous Line)**, allowing them to circulate throughout the body.
Systemic Infusion
41
**#1 thing to monitor** for Systemic Infusion
EXTRAVASATION !!!
(Leakage)
42
*Chemo Administration Type:*
* method involves placing chemotherapy **drugs directly into the bladder through a catheter**.
* Medication need to contacts ENTIRE bladder wall and targets cancer cells locally- pt may need to change positions constantly.
**Intra**vesical Instillation
43
Q: What are the 4 SURGICAL **treatment** options for bladder cancer?
1. Transurethral resection of bladder tumor (**TURBT**) with fulguration (electrocautery)
2. Photocoagulation/Open loop resection with fulguration
3. Partial cystectomy
4. Cystectomy (bladder removal)
44
Which bladder surgical tx am I?
**TURBT**: Transurethral resection of bladder tumor with fulguration (electrocautery)
45
No. 1 Assessment POST **TURBT**
Assess for **DVT** post-op due to immobility.
46
Which bladder surgical tx am I?
**Photo**coagulation/ open loop resection with fulguration
47
Which **bladder** surgical tx am I?
**Partial cystectomy**
- Removes a portion of the bladder while preserving function.
48
Which **bladder** surgical tx am I?
**Cystectomy** (bladder removal)
– Requires urinary diversion to reroute urine since the bladder is no longer present.
49
*Post-OP Bladder Cancer Surgery:*
What is the **DESIRED** **urinary output** range to monitor in a **post**-op urology patient?
A: 30-60 mL/hr.
*(Norm: 1500-2000 mL/DAY)*
50
*Post-OP Bladder Cancer Surgery:*
If catheter present post bladder surgery, what should you perform on this catheter?
**irrigate** a catheter gently with 60 mL of NS
-this will prevent obstruction.
51
*Post-OP Bladder Cancer Surgery:*
What **complications** should be monitored for in a patient with a urinary catheter?
* **Hematuria** (*blood in urine*)
* **peritonitis**
* **bladder distention**
* **shock**
* **hemorrhage**: *excessive bleeding due to blood vessel damage*
* **thrombophlebitis**: *inflammation of a vein due to a clot inside this vein*
52
*Post-OP Bladder Cancer Surgery:*
What is used **after** bladder surgery to **collect urine** when normal bladder emptying is not possible?
Urinary drainage pouch
53
What 2 important things should be **monitored** **Post bladder cancer surgery**.
* Monitor the urinary drainage pouch.
* Monitor the pH of the urine – **keep** **acidic**.
54
Q: Why should the pH of urine be monitored and kept acidic?
A: To reduce the risk of infection and stone formation.
55
3 Types of **Urinary Diversion Techniques**
1. Indiana Pouch Reservoir
2. Kock Pouch Reservoir
3. Neobladder to Urethra Diversion
56
*1st type of Urincary Diversion:*
What type of **urinary diversion uses tissue from the LARGE intestine** to create a pouch and the small intestine for the outlet?
A **continent urinary diversion** called **Indiana pouch**
57
What does **CONTINENT** urinary diversion mean?
* the ability to control the release of urine or stool
* urine is **stored** internally in a pouch and can be emptied voluntarily with a catheter, rather than continuously draining into an external bag
58
How is **urine drained** in an **Indiana Pouch**?
By inserting a catheter through the stoma **3 to 6 times daily**
59
*2nd type of Urinary Diversion:*
A type of urinary diversion that uses the **SMALL intestine** to make the pouch, valves, and outlet.
Kock Pouch Reservoir
60
What **part of the small intestine** is used in **Kock** Pouch Reservoir?
Terminal ileum
61
Is the **Kock pouch** considered a **continent urinary diversion**?
Yes!
catheter is also placed in stoma 3 to 6 times daily to drain urine.
62
*3rd type of Urinary DIversion:*
A segment of the intestine is made into a new bladder (reservoir) and **connected to the urethra, allowing urine to be expelled naturally.**
**Neobladder to Urethra Diversion**
*Neobladder = "new bladder"*
63
Is **Neobladder + urthra** considered a 'continent diversion'?
Yes bc urine collects internally and emptied VOLUNTARILY, and not continuous into a urine bag.
64
What must a patient relearn to do with a Neobladder to Urethra diversion?
**Relearn to urinate** since the neobladder cannot contract or squeeze out urine like a bladder.
* Use abdominal muscles to create pressure and push urine out.
* Practice timed voiding (urinating at set intervals Q2-4 hrs.) to prevent overfilling, since they may not feel the usual urge to urinate.
65
Which one am I?
Kock Pouch Resorvoir
66
Which one am I?
Indiana Pouch Reservoir
67
Which one am I?
Neobladder to Urethra Diversion
*(new bladder is made from the small intestine and connected to the urethras)*
68
What are the 3 important **PRE-operative** **assessments** for a patient undergoing urinary diversion surgery?
* **Cardiopulmonary assessment**: heart & lung fuction.
* **Nutritional assessment**: healing and recovery, more fiber.
* **Evaluation of readiness to learn** : assessing anxiety and knowledge deficit.
69
What are the **pre-operative goals** for a patient undergoing urinary diversion surgery?
1. **Relief of anxiety through** education and support.
2. **Adequate nutrition** for optimal healing.
3. Understanding the procedure, including the **stoma's appearance and care** after surgery.
70
Why is it important to educate the patient about stoma appearance and care preoperatively?
To reduce anxiety, promote self-care, and prepare the patient for life after surgery.
71
11 Key **Assessments** for KIDNEY & BLADDER Trauma
* **History of Injury**
* **Anuria** *(no urine)*
* **Hematuria** *(blood in urine)*
* **Flank / Pelvic Pain**
* **Suprapubic Pain**
* **Guarding**
* **Dysuria** *(painful urination)*
* **Difficulty / Inability to Void**
* **Nausea and vomiting**
* **Abdominal Distention**
* **Rebound Tenderness** *(pain upon releasing pressure from abdomen-indicate bladder rupture or internal bleeding)*
72
6 Diagnosis to detect Kidney & Bladder **Trauma**
* Hematuria (UA)
* Ultrasound
* CT (with barium contrast)
* MRI
* IVP with cystography
* Renal arteriography
*CT & MRI done before IVP*
73
*Kidney/Bladder DX:*
Q: Why is **renal** trauma often associated with **bowel** trauma?
*(Bowel: large & small intestine, rectum)*
The kidneys and bowel are in close proximity within the abdomen, so trauma (blunt or penetrating) can affect both organs simultaneously
74
*Kidney/Bladder DX:*
Q: What imaging tests are used to assess BOTH renal and bowel injury?
Abdominal CT and **X-ray with contrast** (barium)
75
How is Barium administered?
**Oraly** *(barium swallow)*
or
**Rectally** *(barium enema)*
76
*Kidney/Bladder DX:*
What does Barium Contrast do?
Barium contrast helps highlight the GI tract BUT **blocks visualization of other organs** like the kidneys.
77
*Kidney/Bladder DX:*
When should barium contrast be administered/scheduled?
Barium contrast should be scheduled **AFTER THE IVP IS COMPLETE** because it obstructs the kidney's visualization during the imaging process.
*IVP done 1st, Barium done 2nd.*- KNOW THIS!!!!
78
What is most commonly used the most:
IVP contrast or Barium?
**IVP contrast** bc its doesnt obstruct views like barium does.
