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ADN002 MED SURG > Week 3 Bladder and Kidney Disorders > Flashcards

Week 3 Bladder and Kidney Disorders Flashcards

(91 cards)

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1
Q

4 Layers of Tissue of Bladder

A

Adeventia- Outer Layer
Detrusor Muscle- Smooth Muscle
Submucosal CT- Interface of inner most layer
Transitional Cell Epithelium- Impermeable to water- Innermost layer

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2
Q

Polysaccharides help to maintain biological function to maintain collagen and elastin fibers to retain moisture

A

Glycosaminoglycan

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3
Q

Involuntarily smooth muscle associated with internal sphincter

A

Bladder neck

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4
Q

Lower UTIs include

A

Cystitis
Prostatitis
Urethritis

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5
Q

Upper UTIs include

A

Pyelonephritis- acute and chronic
Interstitial Nephritis
Renal abscess and Perirenal abscess

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6
Q

Uncomplicated UTI

A

Community Acquired

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7
Q

Complicated UTi

A

Hospital Acquired

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8
Q

Renal Abcess

A

Caused by UTI of bladder and spreads to bladder

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9
Q

Perineal Abcess

A

Abscess around one or both kidneys secondary to UTI complications

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10
Q

Cystitis

A

Inflammation of urinary bladder

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11
Q

Factors Contributing UTI

A

GAG function
Ureterovesical Reflux
Ureterovesical Reflux
Uropathogenic bacteria
Shorter Urethra in woman
RF- sex, moisture, genetics, hygiene, procedures, pregnancy, decreased prostatic fluid

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12
Q

E. Coli, Klebsialla Pneumoniae

A

Uropathogenic bacteria that are gram -

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13
Q

Efflux/ Anteograde

A

Downward movement of urine

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14
Q

Reflux or Retrograde

A

Upward movement of urine

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15
Q

Most common cause of sepsis

A

UTI

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16
Q

Indicator of UTI for older adults is

A

Acute Confusion

Early symptoms include burning, urgency, and fever

Some may develop incontinence and delirium

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17
Q

Myogenic

A

Over distention of bladder

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18
Q

Neurogenic

A

Decreased bladder tone

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19
Q

Most common cause of UTIs for men?

A

Chronic Bacterial Prostatitis

Also males have decrease prostatic fluids

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20
Q

HOUDINI

A

Hematuria
Obstruction
Urology surgery
Decubitus Ulcer
I Input and output
N DNR
I immobility

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21
Q

UTI Assessment

A

Pain, burning, urination
Half Asymptomatic
Association with sexual practices
Assess urine and cultures and other tests

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22
Q

Nursing Diagnosis UTI

A

Acute Pain
Deficient Knowledge
Impaired Urinary Elimination
Urinary Retention
Risk for impaired skin integrity
Ineffective renal perfusion

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23
Q

Nursing Planning UTI

A

Relief of pain
Increase knowledge
Urine culture
Pt meet CAUTI criteria

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24
Q

Nursing Process UTI Implementing

A

Treat with antibiotics
Anti fungal
Pyridium- analgesic- orange urine
Routine toileting
I and Os
Catheter Care

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25
Interventions UTI
Wipe front to back Medications Application of heat Avoidance of UTI irritants Frequent voiding Pt Education
26
Complications of UTI
Nocturia Urinary Frequency Sepsis Renal Failure Nosocomial Infection Rx to medication Tx
27
Sepsis screening completed when?
Blood work is resulted
28
What qualifies Sepsis?
Positive SIRS Have one or more signs of infection If positive SIRS and infections Pt is septic
29
Severe Sepsis
One or more signs of organ dysfunction
30
Organ Dysfunction Vitals
BP lower than 90 HR increase RR above 22 T above 38 C SPo2 less than 90
31
When is Septic Shock determined?
Pt experiences refractory hypotension after fluid resuscitations interventions SBP drops below 90 after 30ml fluid Bolus Watch for overload of fluids
32
SIRS
temp HR WBC RR
33
qSOFA
RR Systolic GCS
34
Urinary Incontinence
Not a normal consequence of aging Underdiagnosed or underreported problem that can have significant impact on life and decrease independence and may lead to compromise of upper urinary system
35
Stress Incontinence
Physical activity that increases intraabdominal pressure, stresses bladder
36
Reflex Incontinence
Urine leaks upon bladder contraction without warning
37
Urge Incontinence
Loss of voluntary control. Sudden urges to urinate
38
Overflow Incont.
Involuntarily release of urine from a distended overfull bladder
39
Functional Incont.
Aware of need to urinate but physically unable or mentally unable to get to the bathroom Disabling medical condition prevents ability to get to the bathroom (arthritis)
40
Iatrogenic Incontinence
Drug induced Usually due to muscle relaxants and drugs that affect the nervous system ex: Sedatives, hypnotics, ACE inhibitors, Loops, NSAIDs, Ca channel blockers
41
Nursing Dx for Incontinence Issues
Urinary Incontinence by Functional Overflow Reflex Stress Urge Toileting Situational Low Self Esteem
42
Pt Education of Urinary Incontinence
Not inevitable and is treatable Management takes time Develop and use voiding log or diary Behavioral Interventions Medication education Strategies for promoting continence
43
Common Drug for Urinary Incontinence is
Oxybutynin
44
What do anticholinergics do?
Decreases activity in muscles, decrease bodily fluid production, and stabilizes mood. Acts as anti spasmodic. Focus on detrusor muscle.
45
Muscarinic Antagonist
Blocks activity of the muscarinic acetylcholine receptors Ex Derifenacin Flavoxate Solifenacin Tolterodine Trospium
46
Anticholinergic Toxicity
Overdose produces exaggerated effects. Increases sympathetic effects Symptoms Hyperthermia Mydriasis Delirium Seizures, coma, and respiratory arrrest
47
Anticholinergic Overdose Tx
Activated Charcoal Use physostigmine salicylate (parasympathetic alkaloid) Via IV slowly Diazepam used to tx and prevent seizures Ice bags, cooling blankets, tepid sponges Reduces fever
48
What is the most common cause of urinary retention?
Lack of nerve innervation Also called neurogenic bladder Other causes diabetes, enlarged prostate, pregnancy, neurological disorders such multiple sclerosis or Parkinson's Pt may describe a sensation of bladder fullness or incomplete bladder emptying and may experience leakage
49
What medications causes urinary retention?
Amitriptyline, Nortriptyline, or trimipramine
50
Amrytripline inhibits reuptake of
Noreepinephrine and serotonin
51
Nortriptyline inhibits reuptake of
Noreepinephrine
52
Trimipramine inhibits reuptake of
norepinephrine and serotonin with anticholinergic properties
53
Acute Care for Urinary Retention
Straight Cath or In N Out Cath Drains bladder completely Give bladder massage while draining Done with sterile technique Foley Catheterization Send home with leg Educated proper use, draining, and positioning Follow up with urology
54
Tx of Urinary Retention
Cholinergic Agonist Bethanechol Sympathomimetic agent that acts cholinergic receptors in the urinary and GI tracts to increase muscle tone . Increased tone in detrusor muscle in bladder and allows emptying
55
Muscarinic Agonist
Cholinergic Absorbs GI tract Does not cross BBB Crosses placenta and breast milk
56
Bethanecol
Gradual increase the medication 10-50 mg PO 3-4 times per day Take 1 hour before meals or 2 hours after meals Pt should avoid 1hr after administration Asses BP, EKG, sweating and flushing, ABD pain, nausea or vomiting Antidote is atropine . Blocks the action of acetylcholine thus blocks parasympathetic actions
57
Chlonergic Agonist does what?
Increases Acetylcholine Pt over doses shows extreme parasympathetic actions
58
Emergency Tx of Bethanechol
Atropine is antidote to organophosphate poisoning and this includes insecticides
59
What causes the inactivation of of actylcholinerase?
Sarin gas and insecticides Causes overload and causes excessive stimulation of muscarinic and nicotine receptors Excessive secretions
60
What works on nicotinic synapses?
Pralidoxime
61
Medications to treat Urinary Retention include?
Alpha 1 blockers . Promote relaxation of smooth muscle Most end in -osin
62
-OSINS
Assists with dilating urethra and ureters to assist with urination.
63
Phosphodiesterase -5 Enzyme
Contraindicated with nitroglycerin and if given may drop the BP with too much vasodilation Initially treated for HTN
64
What is pyelonephritis?
Inflammation of the renal pelvis Classic symptoms include Chills and fever Leukocytosis- Elevated WBC in serum Bacteruria Pyuria Flank Tenderness
65
Diagnostic Studies for Pyelonephritis
CBC and Chem Panel Urinalysis- Protein, RBCs Urine Culture Urine Dipstick Nitrates and Leukocytes Ultrasound- Fluid(Hydronephrosis), Kidney stone CT- Fluid, kidney stone, abscess, tumor
66
Swelling of kidney due to a build up of urine. Happens when urine can't drain out from the kidney to the bladder from blockage or obstruction
Hydronephrosis
67
Stages of Hydronephrosis
Grade 1- Grade V Higher the grade, more urine reflux.
68
Tx of Pyelonephritis
Same as UTIs Take NSAIDs Toradol, Ibuprofen for kidney related pain Encourage Fluid intake Assess Pt for improvement and watch for urosepsis Recurrent Pyelonephritis may be due to CKD
69
Stone formation in kidney
Nephrolithiasis
70
Stone formation in bladder or urinary tract
Urolithiasis
71
Kidney Stones
Hard deposits of minerals and acid salts that accumulate in concentrated urine Formation depends on: substances in urine, fluid amount, presence of infection, mobility Instruct Pt to void into strainer
72
Tx of Renal Calculi
Encourage fluid intake Pain under control Tamsulosin- Alpha 1 Blocker, also used for BPH Change Diet Strain Urine May need to give antiemetic
73
Renal Calculi Types
Calcium Uric Acid Struvite Cystine
74
Oxalates
Potato chips, peanuts, beets, and spinach
75
Purines
Animal Proteins
76
Struvite
More common in women with UTI Lead to obstruction and can be large
77
Cystine
Rare, due to genetics and leads to cytinuria
78
Risk Factors for Renal Calculi include :
Obesity, dehydration, gastric bypass, diest high in protein, glucose, and salt, IBS, and taking direutics
79
3 common sites for Renal Stones
Ureteropelvic Junction Ureteral Segment Ureterovesical Junction
80
Physical Removal of stones in ureter near the bladder
Ureteroscopy
81
Extrocorpeal Shockwave Therapy
Lithotripsy Use of electromagnetic waves to break up stone
82
Percutaneous Nephrolithotomy
Device used to penetrate multiple layers of tissue to reach kidney and remove stone
83
Ureteroscope
Used to obtain kidney stone all depends on the Pt and size of the stone
84
Pt Education
S/S to report Follow Up care Urine Ph formation Measures to prevent Importance of fluid intake Medication education as needed
85
Dietary Education
Restrict foods that breakdown into salts that formed the salts
86
Calcium Oxlate
Proteins, spinach, beets, and chocolate
87
Calcium Phosphate Stones
Dairy, broccoli, sardines, and salmon
88
Struvite Stones
Bacteria, Ammonia, alkaline environment
89
Uric Acid
Seafood, bacon, turkey, veal, and liver
90
Cystine Stones
Genetics Pork, poultry, dairy, garlic, onions, Brussel sprouts
91

ADN002 MED SURG (18 decks)

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