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Renal and Urological Problems Flashcards

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0
Q

What are some gerontologic considerations and effects of aging on the urinary system and why?

A

Urinary incontinence
Urinary hesitancy
Urinary stream issue

Not able to move around very much
At night safety - leave a light on, make sure there are no rugs
Make sure you create a safe environment

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1
Q

What are functions of the kidney?

A 
Regulate volume and composition of extra cellular fluid
Excrete waste products from the body 
Control B/P
Produce erythropoietin 
Activate vitamin D
Regulate acid base balance
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2
Q

What are some differences in the gerontologic urinary assessment?

A 
Elasticity goes down
Creatinine goes down
Decrease in the amount of renal tissue 
Worry about giving nephrotoxic drugs
  Ibuprofen, NSAIDs, Toridol 
Do a BMP 
  BUN - 10-20mg/dL
  Creatinine -0.5-1.2mg/dL
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3
Q

What is normal findings of a urinary system assessment?

A

No costovertebral angle tenderness
Non palpable kidney and bladder
No palpable masses

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4
Q

What subjective data would you collect when assessing the urinary system?

A

Important health information
Past health history, medications, surgery or other treatments
Functional health patterns
Health perception-health management pattern, nutritional-metabolic pattern, elimination pattern, activity-exercise pattern, sleep-rest pattern, cognitive-perceptual pattern, self-perception-self-concept pattern, role-relationship pattern, sexuality-reproductive pattern
Ask about flank and groin pain, ask about meds, ask if they noticed any changed in urine, pain score

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5
Q

What is some objective data you would collect when assessing the urinary system?

A 
Do a BMP, collect a urine sample ( look before you send it to the lab)
Physical examination
  Inspection
  Palpitation 
  Percussion 
  Auscultation
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6
Q

What are some clinical manifestations of disorders of the urinary system?

A 
fatigue 
headaches
blurred vision
elevated blood pressure
anorexia 
nausea and vomiting 
chills
itching 
excessive thirst 
change in body weight
cognitive changes
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7
Q

What are some clinical manifestations of edema when related to the urinary system?

A 
facial (periorbital)
ankle
ascites 
anasarca 
sacral
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8
Q

What are some clinical manifestations of pain when related to the urinary system?

A

dysuria
flank or costovertebral angle
groin
suprapubic

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9
Q

what are some clinical manifestations of patterns of urination when related to the urinary system?

A 
frequency 
urgency 
hesitancy of stream 
change in stream 
retention
dysuria 
nocturia 
overactive bladder 
incontinence 
stress incontinence 
dribbling
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10
Q

what are some clinical manifestations of urine output when related to the urinary system?

A

anuria
oliguria
polyuria

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11
Q

What are some clinical manifestations of urine composition when related to the urinary system?

A 
concentrated 
dilute 
hematuria 
pyuria 
color (red, brown, yellowish green)
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12
Q

oliguria

A

decreased urine output to between 100-400 ml/24 hr

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13
Q

anuria

A

urine output <100ml/24hrs

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14
Q

dysuria

A

painful urination

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15
Q

nocturia

A

waking from sleep due to the need to urinate

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16
Q

polyuria

A

urine output >2000ml/24hrs

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17
Q

uremia

A

full blown renal failure

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18
Q

What is a BUN

A

Blood Urea Nitrogen
Measures nitrogenous urea in blood; urea is produced by protein metabolism: insufficient secretion causes levels to rise and may indicate renal disorders
May increase in situations of rapid cell destruction such as trauma, high levels of exercise, also with fever,steroid therapy, any bleeding such as GI bleed, dehydration, high protein diet

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19
Q

What is Creatinine

A

A nitrogenous waste resulting from muscle metabolism of creatinine
Creatinine levels reflect GFR
Filtered by the kidneys and excreted in the urine
A good indicator of kidney function; because muscle mass and metabolism is usually constant
Severe renal damage is the only cause of significant elevation

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20
Q

What diagnostic study/ radiologic procedure is done to assess the urinary system?

A

KUB - Kidneys, Ureters, Bladder
A plain film of the abdomen without any specific patient preparation
Shows shape, size and position of the urinary tract
May see obvious stones, strictures, calcifications or obstructions

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21
Q

What is a bladder scanner and what is it used for?

A

Portable ultrasound scanner used at the bedside
Is used to determine the need for intermittent catheterization based on the amount of urine in the bladder rather than the time between urinations or caths
It verifies empty bladder and post void residual

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22
Q

What needs to be done before you perform diagnostic studies on the urinary system?

A

make them NPO
check for allergies (dyes will be used)
Check medications
perform a bowel cleansing

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23
Q

What is an Intravenous Pyelogram (IVP)

A

dye injected intravenously is excreted via kidneys to bladder
Series of X-rays taken
visualize tract- gives clues to structure and function
Cyst tumors lesions and obstructions cause a distortion in normal appearance

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24
What are contraindications to Intravenous Pyelogram (IVP)
allergy to iodine shellfish decreased renal function with creatinine elevation above 1.5mg/dL - may be contraindicated
25
What are pre and post procedure duties for a nurse in the case of an Intravenous Pyelogram (IVP)
Pre- NPO 8hrs, bowel cleanse with laxatives, enema evening prior Post- force fluids to flush out contrast (dye is nephrotoxic)
26
What is a cystoscopy?
used to inspect interior of bladder with a tubular lighted scope can be used to inset ureteral catheters, remove calculi, obtain biopsy of bladder lesions and treat bleeding lesions is an OR procedure
27
After a cystoscopy what does the nurse do?
push fluids instruct patient dysuria may occur that they may have pink tinged urine
28
What is the GFR or Creatinine Clearance?
Most accurate indicator of renal function | Normal range is 70-135ml/minute
29
How do you get a GFR?
do a 24 hours urine discard first urination and then every one after that for the next 24 hours is put in a container that is on ice. when the 24 hours is up you hand carry it to the lab.
30
What causes UTIs
``` urinary stasis having a catheter not urinating after sex not able to empty the bladder bacteria - E-coli is the most common ```
31
What are the clinical manifestations of UTI's
dysuria frequent urination urgency suprapubic discomfort or pressure urine may have visible blood or cloudy appearance Flank pain, chills or fever are indicative of upper UTI
32
How do you diagnose UTI's
urinalysis culture and sensitivity IVP CT
33
How do you treat UTI's
treat for 3-14 days antibiotic is given based on the bacteria causing the infection If symptoms have not subsided by follow-up they will change the antibiotic Bactrim, Ciprofloxaxin
34
What is the therapeutic management for UTI's
``` surgery for structural abnormality, stent Increase fluids to 3 liters daily Administer antimicrobials as ordered Administer analgesic and antispasmodic Encourage voiding every 2-3hrs Monitor I&O and urine characteristics ```
35
What is acute pyelonephritis?
Inflammation of renal parynchyma and collecting system | Typically begins as a lower UTI then ascends
36
Who is at a greater risk for acute pyelonephritis?
those who have BPH Stricture Stones
37
What are signs and symptoms of acute pyelonephritis?
mild fatigue CVA tenderness sudden onset of fever, chills, vomiting, malaise, flank pain, dysuria, urgency and frequency UA shows WBC's, bacteria and hematuria (varying degrees
38
How do you diagnose and treat acute pyelonephritis?
diagnose with a urine culture | treated with antibiotics for 2-3 weeks
39
What are the goals of a patient who have pyelonephritis?
``` will have normal renal function will have normal body temperature will have no complications will have pain relief will have no recurrence ```
40
What is urethritis?
inflammation of the urethra
41
What causes urethritis and how do you treat it?
``` cause is usually sexually transmitted trichomonas monilia chlamydia gonorrhea You treat the cause ```
42
what is interstitial cystitis?
chronic painful inflammatory disease of the bladder
43
What are the symptoms of interstitial cystitis and how do you diagnose it?
pain, urinary frequency and urgency are primary symptoms | its a diagnosis of exclusion
44
how do you prevent cystitis?
drink 8 to 10 glasses of fluid per day women should wipe from front to back Avoid vaginal deodorants and bubble baths urinate after intercourse
45
What is glomerulonephritis?
A deposition of immune complexes within the glomeruli leads to inflammation and ineffective renal filtration ability
46
What is the cause of glomerulonephritis?
may be due to infection or an immune disorder, such as SLE
47
What are the signs and symptoms of glomerulonephritis?
proteinuria, hematuria, generalized edema and other symptoms of fluid overload, elevated BP, hypertension, oliguria, dysuria, lethargic, low grade fever, headache
48
how do you diagnose glomerulonephritis?
assess for previous infection - often Group A Beta-hemolytic streptococcus (throat or skin lesions) urinalysis, 24 hr urine for creatinine clearance testing for immunological reactions such as ANA, IgG, and C3 complement levels
49
How do you treat glomerulonephritis?
antibiotics if it is an infection management of fluid overload with Na and water restriction, diuretics Oliguria may lead to increased K+ which needs treatment Antihypertensives May need plasmapheresis to remove immune complexes or short term dialysis
50
What type of urinary tract calculi (kidney stones) are there?
``` calcium phosphate calcium oxylate uric acid cystine struvite ```
51
What are the clinical manifestations of kidney stones?
abdominal or flank pain hematuria renal colic nausea and vomiting
52
how do you diagnose kidney stones?
``` U/A Urine culture CT IVP Ultrasound Cystoscopy ```
53
What are the risk factors for kidney stones?
``` infection urinary stasis & retention immobility dehydration increased uric acid increased urinary oxalate ```
54
how do you treat kidney stones?
treat pain or infection evaluate cause of stone cystoscopy lithotripsy
55
What are the goals of a patient with kidney stones?
to obtain adequate pain relief prevent urinary tract obstruction educate patient on prevention of future stones
56
What do you do for renal trauma?
gross or microscopic hematuria may be present | perform a UA< IVP ultrasound, CT or MRI
57
What is polycystic kidney disease?
the most common life-threatenting genetic disease in the world Symptoms appear when cysts begin to enlarge It can effect other organs
58
What are clinical manifestations of PKD?
hypertension, gross hematuria, proteinuria, heaviness in back, side or abdomen, UTI or renal calculi, palpable enlarged and knobby kidney
59
How do you diagnose PKD?
based on signs and symptoms, family history, IVP, ultrasound, or CT
60
How do you treat PKD?
A nephrectomy may be necessary if pain, bleeding or infection becomes a chronic serious problem. The goal is to prevent UTI & monitor renal function They need to be drinking 2-2.5L a day to prevent UTI and calculi They will also be on an antihypertensive
61
What are the risk factors for kidney cancer?
``` cigarette smoking (most significant risk factor) obesity, hypertension and chemical exposure ```
62
how is kidney cancer diagnosed?
by biopsy
63
What are risk factors for bladder cancer?
smoking and exposure to certain chemicals | women treated with radiation for cervical cancer and people receiving cytoxan
64
What is urinary incontinence?
uncontrolled leakage of urine | can affect quality of life
65
How do you treat urinary incontinence?
``` lifestyle modifications scheduling voiding regimens pelvic floor muscle strengthening (Kegel exercises) anti-incontinence devices containment devices pharmacological intervention surgical intervention ```
66
What kind of pharmacological treatment is there for incontinence?
``` Muscarinic receptor antagonists oxybutynin (ditropan) tolterodine (detrol) Alpha adrenergic antagonists doxazosin (cardura) tamsulosin (flomax) 5 alpha reductase inhibitors finasteride (proscar - may decrease libido) dutasteride (avodart) ```
67
What is urinary retention?
Inability to empty bladder | a medical emergency
68
What causes urinary retention?
``` may be due to: an obstruction (BPH) deficient bladder muscle contraction strength neurologic diseases longstanding DM over-distention chronic alcoholism drugs (anticholinergics) ```

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