Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
62 Cards in this Set
- Front
- Back
|
Nephrotic Syndrome – results from
|
protein wasting caused by glomerular damage
--just the nephron is involved |
|
|
Nephrotic Syndrome CM
-what is seen in the urine (2) |
•Proteinuria
• Hematuria |
|
|
Nephrotic Syndrome CM
-what is seen in the blood (2) |
•Hypoalbuminemia
•Hyperlipidemia b/c the lipoprotein (lipids) can’t be excreted which causes the CM of high cholesterol levels, urine will appear foamy |
|
|
Nephrotic Syndrome CM
Edema - where is this most notable? |
• periorbital is most notable in the morning, and dependent such as in the ankles when sitting)
|
|
|
Nephrotic Syndrome CM
-tell me about clotting? |
Hypocoagulability –ability of the blood to clot is impaired
|
|
|
Nephrotic Syndrome CM
-immune response? |
Decreased immune response
•Humoral and cellular immune responses are altered leading to infection |
|
|
Nephrotic Syndrome - Treatment
•Treat symptoms/treat cause -what should you do with the extremities? -what should you auscultate? |
-elevate feet
-lungs sounds (fluid volume excess) |
|
|
Nephrotic Syndrome - Care
|
•Daily weights
•I/O •Measuring abdominal girth or extremity •Skin care •Avoid trauma •Small frequent meals •Monitor for nutritional deficits •Avoid getting infections |
|
|
Nephrectomy/Transplant Care
-Nephrectomy is done when someone donates a kidney (The person donating the kidney has more pain than the person receiving the kidney) -what do you do with the bad kidney? |
it is more traumatic to remove it rather than leave it in there. the surgery would be longer. they just attach the new kidney and leave the old one in there. they would only remove the bad kidney if it was doing bad to the kidney.
-they have 3 kidneys |
|
|
Nephrectomy/Transplant Care
Pre-procedure: what do you do about the pt who is donating the kidney? |
-make sure the pt donating the kidney has gone through all their testing
-donor needs to make sure that is what they want to do because if something goes wrong with their kidney, all they have is 1. |
|
|
Nephrectomy/Transplant Care
Post-procedure -what are you monitoring for? |
•Monitor for paralytic ileus b/c you are manipulating the GI tract
|
|
|
Nephrectomy/Transplant Care
-monitor hemorrhage where? -what should you expect the urine to look like? |
•Monitor for hemorrhage in the urine & surgical site (expect clear yellow urine and SOME blood tinged urine, if the urine is bloody/tomato juice looking something is wrong) –kidney should work right way
|
|
|
Nephrectomy/Transplant Care
-urine output, make sure it is what? |
•Make sure their UO is 50 – 100 ml/hr
– may have as much as 1 L out/hr and then ↓ |
|
|
Nephrectomy/Transplant Care
urine output, note that the color is what initially? |
-note that urine is pink and bloody initially
|
|
|
Nephrectomy/Transplant Care
-monitor for a decrease urine output. when should you contact the doctor? |
•Monitor for ↓ UO (less than 50 mL/hr, hematuria, or clots in the urine )
|
|
|
Nephrectomy/Transplant Care
-for the pt getting the transplanted kidney, what do they do for life to prevent rejection of the kidney? |
immunosuppressive therapy for life
|
|
|
Nephrectomy/Transplant Care
-post procedure. we are monitoring the pulses, why? |
-monitor pulses looking for a problem with cardiac output
|
|
|
Nephrectomy/Transplant Care Discharge
-do we restrict fluids? |
no, we push fluids for life to make sure no bacteria gets in the kidney
|
|
|
Nephrectomy/Transplant Care Discharge
Monitor for rejection -what are they looking for? |
(fever, pain or tenderness over the grafted kidney, 2-3lb wt gain in 24 hrs, edema, hypertension, elevated BUN and creatinine, decreased creatinine clearance, elevated WBC)
|
|
|
Nephrectomy/Transplant Care Discharge
Malignancies – what do you teach them about this? |
someone with a transplanted kidney has a 6% chance of developing cancer in the kidney (100 times greater than general population)
|
|
|
Bladder Cancer – CM
-3? |
•Painless hematuria
•Urinary frequency & urgency •Urethral obstruction (the cancer is growing and it can cause problems and not being able to urinate causes distension) |
|
|
Bladder Cancer – CM
-why is their CM painless? |
because there is not an organism
|
|
|
Bladder Cancer - Diagnosis (what are the 2 most common ways used?)
|
-CT - most common
-Cystoscopy and biopsy confirm –most common |
|
|
Cystoscopy and biopsy confirm bladder cancer
-tell me about this procedure? |
-cysto scrapes away the cancer
-done in physicians office -they will use lidocane to numb the urethra |
|
|
Cystoscopy and biopsy confirm bladder cancer
-what may the pt complain of after this procedure (2) -what do you tell them to do to manage this? |
-may complain of burning and urgency afterwards
-push fluids |
|
|
Cystoscopy and biopsy confirm bladder cancer
-what do you tell them about the appearance of their urine? |
-urine may be bloody initially for the first few times they void
|
|
|
Bladder Cancer - Treatment
•TURBT (transurethral resection of bladder tumor) |
-go in through urethra and scrape away the cancer and irrigate the bladder for a few
days |
|
|
Bladder Cancer - Treatment
Chemo -why is this not a good choice? |
– high incidence of cancer returning
-follow ups are required |
|
|
Bladder Cancer – Surgery if it can’t be cured with a less invasive approach
•Partial cystectomy – •Total cystectomy – |
•Partial cystectomy – removal of up to half the bladder
•Total cystectomy –removal of all the bladder |
|
|
Partial Cystectomy – Post-Op Care
-what do you teach them about the size of their bladder? |
-there bladder will be smaller (can hold 50-100mL) BUT it will eventually expand
|
|
|
Partial Cystectomy – Post-Op Care
-what do you teach them about fluids? -what do you tell them to avoid? |
•Push fluids first week
(avoid ETOH) |
|
|
Partial Cystectomy – Post-Op Care
-what do you teach them about the catheter |
• Urinary retention is a complication so you want a catheter in place and you don’t want distension to disrupt the surgical site
--Catheter after surgery and may go home with it in |
|
|
Partial Cystectomy – Post-Op Care
Urine output? |
UO is reduced greatly to about 60 mL but as the bladder tissue expands, the capacity increases to 200-400mL
|
|
|
Partial Cystectomy – Teaching
•Push fluids Urine will be what color initially? |
Urine will be pink initially
|
|
|
Partial Cystectomy – Teaching
•Push fluids -the urine appears pink at first, but as time goes on, what happens to the color of the urine? |
7 – 10 days after procedure dark red or rust colored flecks in urine
|
|
|
Total Cystectomy - Urinary Diversion
-surgical procedures performed to create alternate pathways for urine collection and excretion •Incontinent urinary diversions - ileal conduit (most common) what is this?? |
-where they take part of the small intestine, clean it out, and create a new bladder and there is a stoma from the ileal conduit to the outside of the body and the person wears an appliance
|
|
|
Total Cystectomy - Urinary Diversion /Incontinent urinary diversions - ileal conduit (most common)
-what medication does the pt take? |
-the pt is on an antibiotic regimen prior to surgery, they will be on clear liquids, maybe go lightly, and also on erythromycin (6 tablets) and neomyacin sulfate
|
|
|
Total Cystectomy - Urinary Diversion /Incontinent urinary diversions - ileal conduit (most common)
- erythromycin and neomyacin sulfate, why are they prescribed? |
-both of those antibiotics are absorbed only in the intestinal system and they are not absorbed from the GI tract. so if u have pneumonia or a UTI, it won’t touch that. it is not absorbed systemically but u want to sterile the gut so u have a clear area that is organism free because u r creating a new bladder. urine goes form kidney, to ureters, to this ileal conduit.
|
|
|
Total Cystectomy - Urinary Diversion / Continent urinary diversions (Kock, Mainz, Indiana, Flordia)
-tell me about this type of diversion? |
-internal pouch made with a 1 way valve in which the catheter is inserted into the bladder to drain the urine
-there is no external appliance |
|
|
Total Cystectomy - Urinary Diversion –
which one has an outlet control by anal sphincter or is catheterized |
Continent urinary diversions (Kock, Mainz, Indiana, Flordia)
|
|
|
Total Cystectomy - Urinary Diversion –
Which one: self catheterize & drain the reservoir 4 – 6 hours, no external appliance |
Continent urinary diversions (Kock, Mainz, Indiana, Flordia)
|
|
|
Total cystectomy – Urinary diversion
-Urine starts flowing right away so what do you teach them? |
Teach how to switch to leg bag
-urine is flowing right away, teach them how to manage it because of the constant flow |
|
|
Management of urinary diversion
-When do you teach them to empty their appliance? |
-when appliance is 1/3 full because if it gets too full, it will pull on the appliance which can be pulled off
|
|
|
Management of urinary diversion
-what do we teach them about fluids? |
–Hydration don’t’ want them to become dehydrated, because that increases their risk for infectin
|
|
|
Management of urinary diversion
-wha do we teach them about their stoma? |
–Should be pink and moist (pale and dry is bad – ischemia) similar to a rose bud
–in time the stoma will shrink |
|
|
Management of urinary diversion
Tecah them to monitor for Peristomal hyperplasia, what is that? |
(encrustations) looks like sand, don’t wipe off,
-comes from alkalotic urine so we want to keep the urine acidic |
|
|
Management of urinary diversion
-do we want to teach them to keep the urine alkalotic or acidotic? |
–Acid urine
(drink cranberry) |
|
|
Management of urinary diversion
-when you are about to change their diversion, what do you do? |
-put on something that will absorb the urine because it is constantly flowing
-have everything ready to go, know what you need -remove old appliance, wash the skin, and have the new one ready to go. have the wash clothes wet with soap on, have the new appliance ready to go = urine is flowing |
|
|
Management of urinary diversion
–if it is a brand new urostomy and you see something yellow coming out of the stoma, what do you do? |
do not try to remove it. it is the stent and/or skin. gently wipe
|
|
|
Management of urinary diversion
-what do you teach them to carry with them at all times? -what do you teach them to do at night? |
-bring extra clothes with you in case of accident
-teach them how to switch the bag over to a larger one at night |
|
|
Management of urinary diversion
-how much skin should be exposed around the stoma? |
-no more than 1/16 or 1/8 inch of the skin exposed at the base of the stoma (you want the stomas appliance to be tight)
|
|
|
Wilms Tumor
-what is this? |
most common intra-abdominal and kidney tumor of childhood
|
|
|
Wilms Tumor
Diagnosis: |
This tumor grows quickly, the parent may notice that their childrens diaper doesn't fit anymore or their pants don't fit.
|
|
|
Wilms Tumor
CM – grows quickly -tell me about S/S in their abdomen? (2) |
–Abdominal mass- firm, nontenderm confined to one side and deep within the flank
–Abdominal pain |
|
|
Wilms Tumor
CM – grows quickly -what happens to their urine? |
Hematuria
|
|
|
Wilms Tumor
CM – grows quickly BP? |
-Hypertension caused by excess amounts of renin by the tumor
|
|
|
Wilms Tumor
CM – grows quickly H/H? |
–Anemia caused by hemorrhage within the tumor
which leads to fatigue and anorexia |
|
|
Wilms Tumor
CM – grows quickly -do they have a fever? |
–fever
|
|
|
Wilms Tumor
CM – grows quickly -Respiratory system? (2) |
–Dyspnea & SOB
|
|
|
Nursing Care: Wilms Tumor
What is the one thing we must know? |
NO PALPATATION to keep the encapsulated tumor intact. Rupture of the tumor can cause the cancer cells to spread throughout the abdomen, lymph system, and blood stream
|
|
|
Nursing Care: Wilms Tumor
What else can you do to make sure nobody touches the tumor? |
-put up a sign DO NOT PALPATE because it is very fragile
|
|
|
Wilms Tumor
-Management |
Nephrectomy
|
