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NURS 412 Final Exam > Renal and Urologic Problems Cont'd > Flashcards

Renal and Urologic Problems Cont'd Flashcards

1
Q

Urinary Tract Calculi
aka: kidney stone, nephrolithiasis, urolithiasis

A

Hard deposits made of minerals and salts that form inside kidneys

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2
Q

Urinary Tract Calculi: Patho - concentrated urine

A

Often stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together
Crystals, when in a supersaturated concentration, can precipitate and form a stone

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3
Q

Urinary Tract Calculi: Patho - Bacterial infection

A

Obstruction with urinary stasis & urinary infection with bacteria
Bacteria cause the urine to become alkaline and facilitates formation of stones
Infected stones, when entrapped in the kidney, may assume a staghorn configuration as they enlarge

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4
Q

Where do urinary tract calculi occur? and how are they prevented?

A

Can occur at any place within the urinary tract.
Keeping urine dilute & free flowing reduces risk for recurrent formation

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5
Q

Urinary Tract Calculi Types: Calculus

A

abnormal stone formation in body tissues by accumulation of mineral salts

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6
Q

Urinary Tract Calculi Types: Lithiasis

A

refers to stone formation

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7
Q

Urinary Tract Calculi Types: Nephrolithiasis

A

Formation of stones in the urinary tract

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8
Q

5 Major categories of stone

A
  1. Calcium phosphate
  2. Calcium oxalate
  3. Uric acid
  4. Cystine
  5. Struvite (magnesium-ammonium phosphate)
    Calcium is the most common type
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9
Q

Clinical Manifestations Urinary Tract Calculi
- interventions

A
  • SEVERE pain - intense and colicky
  • N&V
  • Dilauded, flomax (relaxes the ureters), hot bath, drink lots of fluids
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10
Q

Urinary Tract Calculi: Management of acute attack (2)

A
  • Generally with opioids at frequent intervals
  • Many stones pass spontaneously but stones > 4mm are unlikely to pass through the ureter
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11
Q

Urinary Tract Calculi: Evaluation of cause & prevention

A
  • family hx of stone formation
  • adequate hydration, Na+ restriction, dietary changes, meds to minimize urine formation
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12
Q

Surgery for Urinary Tract Calculi: Indications (6)

A
  • stones too large for spontaneous passage
  • stones associated with infection
  • stones causing impaired renal function
  • persistent pain, nausea, or ileus
  • inability to treat pt medically
  • pt with one kidney
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13
Q

Surgery: types (4)

A
  • cystoscopy: to remove a small stone in the bladder
  • cystolitholaplaxy: a procedure for large stones
  • Lithotrite - ‘stone crusher’: an instrument to break up large stones
  • open surgery
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14
Q

Urinary Tract Calculi: Endo-urological Procedure - Percutaneous Nephrolithotomy

A
  • insertion of nephoscope through a percutaneous sinus track into the kidney pelvis
  • stones are fragmented using ultrasound, electohydraulic, or laser lithotripsy
  • stones are removed using grasping forceps, and pelvis irrigated
  • usually a nephrostomy tube is left in place to maintain patency of ureter
  • Done under x-ray vision, under general anesthetic
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15
Q

Lithotripsy for Urinary Tract Calculi

A
  • use of sound waves to break renal stones into small particles that can pass down ureter
  • done under x-ray or ultrasound
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16
Q

Different Lithotripsy techniques (4)

A
  • Extracorporeal shock-wave lithotripsy (most common)
  • Laser lithotripsy
  • Percutaneous ultrasonic lithotripsy
  • Electrohydraulic lithotripsy
17
Q

Extracorporeal shock-wave lithotripsy

A

‘First generation’ lithotripsy
- non-invasive, under spinal or general anesthesia
- pt placed in a water bath
- repeated shock waves administered to break up stone
- shock waves are generated by a machine, lithotripter, and focused by x-ray onto the kidney stones
- shock wave travel into the body through the skin, reaching the stone

18
Q

Post-Lithotripsy care: hematuria

A
  • common after lithotripsy
  • often, ureteral stent is placed after procedure to promote passage of fragmented stones (removed in 1-2 weeks)
19
Q

Post-Lithotripsy care: Pain and Risk of Infection

A
  • as stone fragments pass down ureter
  • analgesia
  • prophylactic abx may be given as most stones are infected, and shattering can spread infection
20
Q

Post-Lithotripsy care: Elimination and Activity

A
  • Drink 2-3L in 24 hrs (unless in restriction) to flush out stone fragments
  • Resume normal activity
21
Q

Bladder Cancer Etiology

A
  • 6th most common type of cancer in Canadians
  • Most common in men
  • The most frequent malignant tumor of urinary tract - transitional cell carcinoma
  • Most bladder tumours are growth within the bladder
22
Q

Clinical Manifestations of Bladder Cancer

A
  • Gross, painless hematuria (chronic or intermittent)
  • Dysuria
  • Urinary frequency & urgency
23
Q

Treatment for Bladder Cancer

A

When the tumor is invasive or it involves the trigone (where the ureters insert into the bladder)
Free from metastasis beyond pelvic area -> treatment of choice is a partial or radical cystectomy with urinary diversion

24
Q

Partial Cystectomy

A

Resection of the portion of the bladder wall containing the tumor

25
Q

Radical Cystectomy

A
  • removal of the bladder, prostate, seminal vesicles in men
  • removal of bladder, uterus, cervix, urethra, and ovaries in women
26
Q

Urinary Diversion:
2 types

A

Performed to treat cancer of the bladder, neurogenic bladder, congenital anomalies, strictures, trauma to the bladder, and chronic infections with deterioration of renal function
- incontinent urinary diversion
- continent urinary diversion

27
Q

Incontinent Urinary Diversion

A
  • ileal conduit (ileal loop)
28
Q

Continent Urinary Diversion

A

Continent cutaneous reservoir
- intra-abdominal urinary reservoir that is catheterizable or has an outlet controlled by anal sphincter
Neobladder

29
Q

Ileal conduit (ileal loop)

A
  • a 15-20 cm segment of the ileum is converted into a conduit for urinary drainage
  • ureters are anastomosed into one end of the conduit and the other end of the bowel is brought out through the abdominal wall to form a stoma
30
Q

Continent Urinary Diversion

A
  • reservoirs are constructed from ileum, ileocecal segment, or colon
  • the patient needs to self-catheterize q4-6 hrs
  • does not need to wear external attachments
31
Q

Neobladder

A
  • creation of a reservoir made of small intestine and connects it to urethra which allows urination through urethra
  • Reservoir mimics the normal storage function of a urinary bladder
  • Reservoir inside the pelvis
32
Q

Post-op Care of Urinary Diversion (5)

A
  • With removal of part of the bowel - paralytic ileus or SBO
  • Anytime we manipulate the bowel - NPO for a while and NG tube for 3-5 days
  • Mucus in the urine - from intestine
  • Assess stoma and dresing
  • Assess if there is any urine coming out and what does that look like

NURS 412 Final Exam (12 decks)

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