Renal and Urologic System (Kelsey's Handout)

Question 1

Etiology and RF of UTI’s

Answer 1

• most adult women
• sexual activity
• pregnancy
• previous UTI
• incontinence
• indwelling catheters

Question 2

Why are women more at risk for UTI’s?

Answer 2

• shorter urethra

- close proximity to fecal flora

Question 3

Structural abnormalities that can increase risk of an UTI?

Answer 3

• kidney stones
• cystocele-bladder bulge into vagina
• enlarged prostate

Question 4

Functional abnormalities that can increase risk of an UTI?

Answer 4

• reflux of urine from bladder to kidney
• MS
• SCI
• low bladder tone and urine retention contributing to UTI (PD, MS, LMNL, disc disease, surgery)

Question 5

S/S of UTI

Answer 5

• buring, pain, discomfort with urination
• urgency
• freq.
• nocturia
• enuresis
• fever, chills, malaise (general discomfort)
• diaphragm, shoulder, lumbar pain

Question 6

S/S of UTI in older adult:

Answer 6

• malaise
• anorexia
• mental status change
• confusion
• flank pain, chills, fever often indicate upper UTI

Question 7

What can mimic UTI S/S?

Answer 7

overactive pelvic floor muscles and interstitial cystitis

Question 8

PT implications for UTI

Answer 8

• may not be able to fully participate in exercise
• early intervention (fever >102, vomiting, nausea, confusion refers to MD)
• prevent spread of infection
• watch for insidious onset of back or shoulder pain, confusion, history of UTI refers to MD

Question 9

Classical Triad for Renal Cell Carcinoma?

Answer 9

1. Flank pain
2. hematuria
3. palpable abdominal mass

Question 10

Implications for PT with Renal Cell Carcinoma:

Answer 10

watch for sternal pain (tumor)

• may benefit form STM
• manage side affects

Question 11

where does kidney stone obstruction usually occur?

Answer 11

where ureter crosses iliac vessels or at the ureterversical junction

Question 12

Four basic stones are:

Answer 12

1. calcium**
2. struvit
3. uric acid
4. cystine

Question 13

Classic presentation of a kidney stone

Answer 13

is acute “colicky” flank pain radiating to the groin or perineal areas.
-pain is severe and unable to find comfortable position

Question 14

Kidney stone S/S are consistent with a UTI and in 90% of the time what is present?

Answer 14

Hematuria

Question 15

Medications for kidney stones if fluid intake is not enough:

Answer 15

1. Thiazide diuretics (increases Ca excretion)
2. alkali (increases urine citrate excretion)
3. allopurinol (prevents uric acid crystals)

Question 16

If you are a PT working with someone with Kidney stones what would indicate that you should refer them to an MD?

Answer 16

fever, chills, and sweats

Question 17

Clinical manifestations of Bladder cancer:

Answer 17

• painless hematuria is the most common sign

- 85 % gross hematuria, onset is sudden, intermittent frequency

Question 18

is hematuria related to tumor size or stage of bladder cancer?

Answer 18

no

Question 19

during bladder cancer what can cause bladder enlargements and painful spasms?

Answer 19

clots blocking urethra

Question 20

is bladder cancer more common in men or women?

Answer 20

men

Question 21

Clinical manifestations of Neurogenic Bladder disorders?

Answer 21

• partial or complete urinary retention
• incontinence,
• urgency,
• suprapubic pain
• frequent urination

Question 22

Clean intermittent catheterization protocol:

Answer 22

performed in 4-hour interval, reduced vesicoureteral reflux and kidney damage

Question 23

♣ Implication for short-term indwelling urinary catheter:

Answer 23

• Accurate monitoring of urine output
• Relief of urinary obstruction
• Prevention of obstruction from large clots when hematuria is present
• For surgical procedures involving general or spinal anesthesia
Incontinence when ulcers are present

Question 24

alteration of kidney function or structure for a duration of 3 months or longer

Answer 24

Chronic Kidney Disease

Question 25

most common causes of chronic kidney disease

Answer 25

1. diabetes 2. hypertension 3. glomerulonephritis

Question 26

Stage 1 of CKD:

Answer 26

- GFR normal or increased - no impaired renal fx or sx present - unaffected nephrons hypertrophy to compensate for damaged ones - BUN returns normal - creatine returns normal - can be REVERSED

Question 27

Stage 2:

Answer 27

- damaged capillaries allow small amounts of albumin to be excreted in urine - stage can be years w/proper management of hypertension and blood glucose

Question 28

Stage 3:

Answer 28

- more noticeable albumin levels in urine and decreased in blood - noticeable edema - creatinine and BUN levels increase - waste accumulation in blood

Question 29

Stage 4:

Answer 29

kidney unable to fx and complications appear - proteinuria is hallmark - kidneys can no longer excrete toxins - progress to stage 5 quickly

Question 30

Stage 5:

Answer 30

- end stage renal disease | - dialysis

Question 31

contraindications for transplant of kidney:

Answer 31

- active or non-compliant metastatic cancer - active ischemic cardiac and cerebrovascular disease - dementia - debility

Question 32

Renal transplant complications:

Answer 32

- hypertension - lipid disorders - hepatitis - cancer - tendinopathies - osteopenia - corticosteroids impari bone formation

Question 33

Dialysis complications

Answer 33

- increased thirst - wt. gain - abdominal distension - depression - infertility - amenorrhea - uterine bleeding - increased susceptibility to infection

Question 34

Where can pain occur in the early days of dialysis?

Answer 34

chest and back | -watch for thromosis

Question 35

Exercise and CKD:

Answer 35

- lifting and carrying can be difficult - strength training, balance and mobility are key components for HEP - performed during, before, or after dialysis - provides better mvmt of fluids during dialysis

Question 36

What are the two most commonly monitored values during renal failure?

Answer 36

-serum creatinine and BUN

Question 37

Dyspnea at rest or with exertion, increased fatigue or chest pain with exercise may indicate?

Answer 37

low hematocrit levels