Beth - Week 10 - Exam 4 Flashcards
(55 cards)
1
Q
what is urolithiasis?
A
formation of calculi in the kidney, bladder, urinary tract
2
Q
what is nephrolithiasis?
A
calculi in the kidneys
3
Q
what is hydronephrosis?
A
unilateral swelling of one kidney or stones
4
Q
what are the risk factors for urinary obstruction problems?
A
- infectious (frequent UTI)
- cancers (obstructive tumors)
- metabolic (↑ in calcium, phosphate, oxalate, uric acid, cysteine, struvite (Mg ammonium phosphate)
- environment (hot/warm climate)
- dietary (↑ protein, ↑ caffeine, ↓ fluid intake)
- genetics (family hx of stone)
- lifestyle (lack of exercise_
- immobility (bloods not circulating)
5
Q
T/F the most common causes of urinary obstruction problems differs by age
A
TRUE
6
Q
what is the common causes of urinary obstruction problems in children?
A
- Anatomic abnormalities (including
posterior urethral valves or stricture and
stenosis at the ureterovesical or ureteropelvic
junction)
7
Q
what are the common causes of urinary obstruction problems in young adults?
A
calculi (not hydrated)
8
Q
what are the common causes of urinary obstruction problems in older adults?
A
BPH or prostate cancer, retroperitoneal or pelvic tumors, metastatic cancer and calculi
9
Q
what are the three steps in the pathology of obstructive nephropathy?
A
- Urinary stasis (causes: calculus formation)
- Frequent UTI (causes: local ischemia)
a. obstruction results in renal
insufficiency
b. dilation of the collecting ducts & distal
tubules
c. chronic tubular atrophy - Increased intratubular pressure
*Dilation takes 3 days from the onset of
obstructive uropathy to develop.
10
Q
what are the nursing assessment/sxs of stones in the bladder?
A
UTI
hematuria
urinary retention
less painful to no pain
11
Q
what are the nursing assessment/sxs of stones in the ureters?
A
pain is described as agonizing
frequent desire to urinate but little urine output
12
Q
what are the nursing assessment/sxs of stones in the renal pelvis?
A
pain localized inc voiding inc RBC inc WBC in urine distention of renal pelvis colic pain is described as costavertebral raidating downward
13
Q
what are the different types of urinary tract calculi and how often do they occur?
A
- Calcium Oxalate (occurs 40% in population)
- Calcium Phosphate (occurs10% in population)
- Struvite Staghorn type (Mg Ammonium Phosphate)
(occurs15% in population) - UTI usually Proteus - Uric Acid (occurs 8% in population)
- Cystine (occurs 2% in population)
14
Q
what are the diagnostics for obstructive nephropathy?
A
- CT (usually IV contract)
- Ultrasound
- UA (if positive culture and sensitivity)
- Gout (Hyperuricemia (high uric acid level))
15
Q
Uric acid test isn’t considered a definitive test for gout. only testing a person’s ______ for _____ is absolute
A
joint fluid; monosodium urate
16
Q
what are the clinical manifestations for urinary obstruction?
A
- severe pain (sudden/sharp in lower abd, flank or back or groin)
- caused by the stones stretching dilating and cutting d/t spasms of the ureters
- symptoms of mild shock (cool, clammy, tachycardia, fever, chills)
- men have pain in testicle
- women have pain in labia
17
Q
what is hydronephrosis?
A
enlarged kidney; complication of renal obstruction
- stones or enlarged prostate that cause backup of the urine in one or both kidneys
- kidneys retain urine
18
Q
what can untreated hydronephrosis lead to?
A
kidney damage
19
Q
what are the diagnostics for hydronephrosis lead to?
A
UA
ultrasound
CT
voiding cystourethrogram
20
Q
what is nephrolithiasis?
A
stone formation in kidney; stones or enlarged prostate that cause backup of the urine in one or both kidneys
21
Q
what is bladder cancer?
A
- rare type of cancer
- more frequent than kidney cancer
- grows within the bladder
- more common in men > 60 years
22
Q
what are the sxs of bladder cancer?
A
- often asymptomatic
- chronic or intermittent hematuria, gross hematuria, dysuria, frequency, urgency
23
Q
what are the diagnostics used for bladder cancer?
A
- ultrasound
- CT
- MRI
- Cystoscopy with biopsy
24
Q
what is the tx for bladder cancer?
A
immunotherapy, molecularly targeted therapies, or localized radiation therapy
- TURP, laser photocoagulation, cystectomy
25
what is kidney cancer?
rare type of cancer
- starts in the lining of small tubules of kidneys
- more common in men age greater than 60 years
26
what are the sxs of kidney cancer?
often asymptomatic
| - flank pain, hematuria, palpable abdomen mass
27
what is the tx for kidney cancer?
- Immunotherapy, molecularly targeted therapies, or localized radiation therapy
- Nephrectomy
- Partial or radical with removal of adrenal gland
28
what are the risk factors for bladder and kidney cancer?
- Smoking
- Environmental factors
- Exposure to Asbestos, cadmium, gasoline, dyes (used in rubber & paint)
- Obesity
- HTN
- Cystic kidney disease
- Renal Calculi
- Drugs: Cyclophosphamide & Actos
29
what is the pt education for those with urolithiasis?
- prevention of risk factors is best
- dietary changes for types of stones
- infectious sxs
- hydration
- mobility
- voiding education (don't hold urine; women - empty bladder)
- lifestyle (exercise → circulation)
30
what dietary changes are used for calcium stones?
- low protein diet to decrease excretion of calcium in the urine
31
what dietary changes are used for oxalate stones?
- low oxalic acid diet: limit dark greens, chocolate, strawberies and peanuts
32
what are the dietary changes used for uric acid stones?
low purine diet: limit shell fish, mussels, asparagus, mushrooms, organ meat - keep urine basic and reduce uric acid
33
what is the invasive/surgical interventions for urolithiasis?
- Lithotripsy
- Ureteral Catheters or Stents (Interventional radiology)
- Nephrostomy Drains (Interventional radiology)
- Nephrectomy (Surgery)
- Urinary Diversions-continent & Incontinent
systems (Surgery)
- lithotripsy - ESWL (extracorporeal shock wave lithotripsy)
34
what are the characteristics of lithotripsy ESWL?
- sound/shock waves
- impulse to area of stone
- lasts 45-1 hr
- anesthesia (local, regional, or general)
- success is higher than 90% for stone clearance
- if unsuccessful invasive interventions are required.
35
what are the nursing responsibilities for lithotripsy ESWL?
- explain tx (ESWL)
- pt education (conscious sedation - can be local or general)
- assessment pre-procedure (no anticoags (ASA/NSAID)
- post procedure (pain, bruising at site, expected hematuria, monitor urine output and strain for stones)
36
T/F: all diversions divert urine away from the bladder or kidney. Nephrostomy drain or tube directly in the kidney connected to a bag of some type
TRUE
37
what are ureteral stents?
tube (soft silicone) device place within the ureter d/t obstruction to restore renal function (temporary or permanent)
38
what are the different types of ureteral stents?
- internal or external (right or left)
- insertion by cystoscopy or open procedure
- self-retaining (coils in kidney and extends to bladder)
39
***TEST*** what are the nursing assessement and care for a urinary drain/stent?
- assess position/placement
- assess ureteral flow/I+O (q 1-2 hr)
* **notify MD if ↓ U/O
- assess characteristic of urine and drain site
- assess for bleeding at the site
- assure non-obstruction drainage
* **if dislodged, cal MD immediately
* **never clamp
* **rarely irrigated - must have orders if do it it sterile
* * report sxs of infection
40
what are suprapubic catheters?
- usually temporary catheter
41
what are suprapubic catheters used for?
patients who have
- prostate surgery
- urethral surgery
- bladder surgery
42
what is the nursing care for suprapubic catheter?
- nursing care is same as all drains and stents except
- temporary
- caution w/ the catheters placement (sutured in place)
- complications - poor drainage
43
what are the indications for a nephrostomy?
- renal tumor
- polycystic kidney
- trauma
44
what are the 2 ways to perform a nephrostomy?
- laparoscopic (preferred) or open
45
what are the characteristics of laparoscopic nephrostomy?
- five puncture sites
- pt recovery quicker
- reduced complications
46
what are the characteristics of open nephrostomy?
- large incision 6 - 10 in
- pt recover is longer
- increased complications
47
what are the complications with nephrectomies?
```
• ABCs
- nephrectomy is close to diaphragm
- nerve can be injuried
- pain prevents deep breaths
- implement IS
- pneumonia
• abdominal distention
- common paralytic ileus d/t manipulation
```
48
how are continent/incontinent urinary diversions chosen for patients?
- pt age
- condition of bladder
- obesity
- degree of ureteral dilatation
- kidney function
- pt's ability to learn and willingness to participate
49
what are the two types of simple conduits for incontinent urinary diversions?
- ileal conduit (implanting ureter into a loop of ikleum and pulled through the abd wall
- colon is the conduit
50
what are the 6 characteristics of the colon conduit?
- 6 - 8 inches
- isolated from the intestinal tracck
- NO valve
- NO voluntary control
- urine flows constantly
- requires an external xollection device (bag)
51
what are the 6 types of continent urinary diversions?
- Kock’s Pouch
- Mainz Pouch
- Indiana Pouch
- Florida Pouch
- Neobladder (ureters implanted into new bladder)
- intraabdominal reservoir
52
T/F names of the continent urinary diversion depend on the segment of bowel used
TRU
53
what are the characteristics of an intraabdominal reservoir?
- Requires catheterization or outlet (anal sphincter)
- Similar to Ileal conduit
- Continence mechanism is used THIS TIME A
VALVE IS PRESENT
- Intussusception of the bowel
- Self-catheterization (4-6 hrs)
- No external collection devise
- Patients can wear bandage to cover stoma
54
what are the nursing assessment/interventions for someone with a urinary diversion?
- assess I+O (measure U/O if <30cc call MD)
- assess skin (keep urine pH < 6.5 because of alkaline encrustation ↑ skin irritation; ensure pt appliance is connected properly, check tube is in stoma, connect to bag)
- assess odor (foul? alkaline? concentrated? educate pt on foods that cause strong odors: asparagus, cheese, eggs; reduce odors with ↑ fluid, PO ascorbic acid, deodorizers, white vinegar)
- educate the pt that mucous maybe normal; they need to increase fluids
55
what are the assessment/teaching for a person with an incontent urinary diversion?
- bag usually lasts 3-5 days
- empty when 1/3 to 1/2 full
- watch for leakage
- better to change the appliance in AM
- use something absorbent while cleaning stoma
- can use a collection bag at NOC
- maintain clear dry skin
