321 - Exam 3 (Renal Calculi)* P 12-20

Front 1

Renal Calculi
-how do kidney stones form?

Back 1

-kidney stones form by the supersaturation of urine with an element (such as calcium)

Front 2

Renal Calculi
-tell me about the pain the pt experiences from a kidney stone?

Back 2

-people will develop pain in the flank/back area because that is where the kidney stone is forming (kidney or ureter)
-the pain comes from the stone moving. when the stone stops moving, the pain goes away

Front 3

Renal Calculi
-the pain is so severe that what CM develop? (3)
-what happens once the stone is passed through the ureters?

Back 3

-the pain is so severe which causes nausea, vomiting, diaphoresis. once the stone gets dropped into the bladder, the pain goes away. then it goes through the urethra which will cause pain. some people don’t pass the stone from the bladder, it says there for life.

Front 4

Renal Calculi can cause 2 other complications, which are:

Back 4

hydroureter or hydronephrosis (the stone blocks the ureters and the urine backs up in the kidney and the kidney becomes enlarged and boggy)

Front 5

Renal Calculi
-tell me about fluid restriction?

Back 5

there is none, they should drink A LOT

Front 6

-Urolithiasis: refers to the formation of

Back 6

urinary calculi which form in the ureters

Front 7

-Nephrolithiasis: refers to the formation of

Back 7

kidney calculi

Front 8

Types of stones
•Calcium oxalate
-occur as a result of (2)
-occur in acidic or alkaline urine?

Back 8

MOST COMMON
-–Hypercalciuria, hyperoxaluria
–Alkaline urine

Front 9

Types of stones
-Struvite (MgNH4PO4 magnesium-ammonium phosphate)
-important one, esp in spinal cord pts, why?

Back 9

because it puts them at risk for UTI because of stasis of urine

Front 10

Types of stones
-Struvite (MgNH4PO4 magnesium-ammonium phosphate)
-occurs in acidic or alkaline urine?

Back 10

–Alkaline urine

Front 11

Types of stones

Calcium phosphate
-mixed with?
-form in acidic or alkaline urine?

Back 11

–Mixed with struvite or oxalate stones
–form in Alkaline urine (hyperparathyroidism)

Front 12

Types of stones

Uric acid
-caused by what 2 things?
-does this form in acidic or alkaline urine?

Back 12

-inherited, caused by excess dietary purine or from gout
-acidic urine (so they need an alkaline diet)

Front 13

Types of stones
-why is it important to know what enviornment stones form in?

Back 13

whichever stones form in, you tell them to follow a diet opposite of that. for example, calcium oxalate stones form in alkaline urine, so prescribe a diet that is acid-ash

Front 14

Kidney stones Diet
-increase intake of what?

Back 14

increase intake proteins which will increase uric acid excretion

Front 15

Kidney stones Diet
-what elevates the urinary oxalate level?

Back 15

Excessive amounts of tea or fruit juices elevate urinary oxalate level

Front 16

Kidney stones Diet
-what does low fluid intake do?

Back 16

increases urinary concentration

Front 17

Urinary Calculi - Dx

what are the 2 best ways?

Back 17

CT scan is the best way and then a UA

Front 18

Urinary Calculi - Dx

-what does the UA results show?

Back 18

-increased RBCs, WBCs, and bacteria, blood

Front 19

What is a cystoscopy?

Back 19

–they go through the urethra into the bladder, done if they think the stone is in the bladder or the end of the ureters

Front 20

Urinary Calculi - CM

Back 20

-Pain
-N/V
-Diaphoretic
-Fever (low grade)
-hematuria
- tachycardia, tachypnea

Front 21

Urinary Calculi - Care
-what meds are given?
-tell me about fluids?
-what do you do with the urine?

Back 21

•Analgesics at regularly scheduled intervals
•Fluids – po or IV (3000mL to facilitate the passage of the stone and prevent infection)
•Strain urine for the presence of stone and send the stones to the lab for analysis

Front 22

Urinary Calculi - Care

-tell me about ambulation

Back 22

encourage ambulation or turn and reposition the immobilized pt to promote passage of the stone

Front 23

Urinary Calculi – Drugs to Prevent Stone Formation

Calcium stones: 3

Back 23

1) thiazides-(bind calcium so it doesn’t accumulate)
2) phosphates,
3)ascorbic acid

Front 24

Urinary Calculi – Drugs to Prevent Stone Formation

what is ascorbic acid?

Back 24

(AKA: vitamin C.. if the kidney stones form in an alkalotic envt, this makes the envt more acidic. some people drink cranberry juice which is acidic)

Front 25

Urinary Calculi – Drugs to Prevent Stone Formation

Struvite: 2 drugs

Back 25

prophylactic antibiotic therapy or acetohydroxamic acid / ascorbic acid(retards chemical action from bacteria)

Front 26

Urinary Calculi – Drugs to Prevent Stone Formation

Uric acid: what drug do you give to prevent this?

Back 26

allopurinol

Front 27

Urinary Calculi – Prevention of Stone Formation

Hydration- what should you tell them to drink

Back 27

Water over tea and colas

Front 28

Urinary Calculi Prevention - Diet

Uric acid stones are caused by (2)

Back 28

excess dietary purine or from gout

Front 29

Urinary Calculi Prevention - Diet / Uric acid stones:

Uric acid stones form in acidic or alkaline urine?

Back 29

-tend to form in acidic urine

Front 30

Urinary Calculi Prevention - Diet / Uric acid stones:

-what kind of diet should they include?

Back 30

-include alkaline ash diet

Front 31

Urinary Calculi Prevention - Diet / Uric acid stones:

-what should they decrease their intake of?

Back 31

decrease intake of high purine foods such as organ meats, gravies, red wines, sardines

Front 32

Urinary Calculi Prevention - Diet
•Calcium phosophate stones are caused by

Back 32

the supersaturation of urine with calcium and phosphate

Front 33

Urinary Calculi Prevention - Diet
•Calcium phosophate stones
-what should their diet include?

Back 33

-diet includes acid ash diet because calcium stones are alkaline

Front 34

Urinary Calculi Prevention - Diet
•Calcium phosophate stones
decrease intake of foods high in _________ & ________ to reduce urianry content of these elements

Back 34

decrease intake of foods high in calcium and phosphate

Front 35

Urinary Calculi Prevention - Diet
•Calcium oxalate stones: caused by

Back 35

supersaturation of urine with calcium and oxalate

Front 36

Urinary Calculi Prevention - Diet
Calcium oxalate stones:
-diet includes what?

Back 36

acid ash foods because calcium stones are alkaline

Front 37

Urinary Calculi Prevention - Diet
-Calcium oxalate stones:

decrease intake of foods high in ______________ & ______________

Back 37

-decreasing intake of foods high in calcium and sodium

Front 38

Urinary Calculi Prevention - Diet
-Calcium oxalate stones:

-avoid oxalate food sources such as:

Back 38

tea, peanuts, chocolate, cocoa, beans, spinach, and rhubarb

Front 39

Urinary Calculi Prevention - Diet
-Struvite stones: composed of what 2 elements?

Back 39

magnesium and ammonium phosphate

Front 40

Urinary Calculi Prevention - Diet
-Struvite stones:
the stones are caused by what?
-do they form in acidic or alkaline urine?

Back 40

-stones are caused by urea-splitting bacteria

-tend to form in alkaline urine

Front 41

Urinary Calculi Prevention - Diet
-Struvite stones: the diet includes what (acidc ash or alkaline ash?)

Back 41

-diet includes acid ash foods such as dairy products, red and organ meats, and whole grains to reduce urinary phosphate content

Front 42

Acid Ash Diet
-Outcome:
-Diet makes the urine more ______
-decrease what type of food?

Back 42

Acid Ash Diet
-Outcome: decrease the pH of the urine
-Diet makes the urine more acidic
-decrease dairy products

Front 43

Extracorporeal shock-wave lithotripsy:
-what is this?

Back 43

-Ultrasound locates the stone and crushes the stone, and the stones can pass more easily
-uses sound, laser, or shock wave energies to break the stone into fragments

Front 44

Extracorporeal shock-wave lithotripsy:
-is this an invasive procedure?

Back 44

- Noninvasive procedure for breaking up stones located in the kidney or upper ureters

Front 45

Extracorporeal shock-wave lithotripsy:

-what sedation is this used under?

-where is this done?

Back 45

-requires conscious sedation

-usually done in x-ray

Front 46

Extracorporeal shock-wave lithotripsy:
--Stenting: may be placed to do what?

Back 46

to facilitate passing stone fragments (dilates ureters, enlarging the passageway for the stone to be passed)

Front 47

Extracorporeal shock-wave lithotripsy:
--Stenting:
Tell me how a pt would get this out?
-how do you know when to take the stent out?

Back 47

The stents have a J hook with a string on the bottom of them. The string is to pull out the stent. Stents are uncomfortable. It is flexible.
-stents come out when antibiotics are finished, usually 14 days

Front 48

Extracorporeal shock-wave lithotripsy:
--Stenting:
what is common in their urine after this procedure?

Back 48

Hematuria common after surgery (should see pink urine)

Front 49

Nephrostomy tube
–looks like a small catheter that is placed in the kidney, balloon is inflated to hold it in place and you irrigate it.
-When is it placed? (3)

Back 49

if you have an obstruction or so much edema in the ureters that you don’t think urine can pass.
-Or if they had to crush the stone in the kidney and you want to irrigate out the kidney.

Front 50

Nephrostomy tube
-how much do they use to irrigate this?
-what kind of syringe is used?

Back 50

-They are irrigated with very small amounts (10mL) of normal saline.
--Irrigate slowly with a small syringe (5 or 10 mL syringe) because a large syringe would cause a lot of pressure

Front 51

Nephrostomy tube
-where do you put the drainage bag?

Back 51

-The nephrostomy tube is connected to a bag, make sure it is below the level of the kidney

Front 52

Urinary Tract Infection

Cystitis:
-what is it?

Back 52

-inflammation of the bladder
-most common UTI
-lower UTI infection

Front 53

Urinary Tract Infection

Pyelonephritis:
-what is it?
-it is a common cause of?

Back 53

-infection in the kidney
-common cause of septicemia

Front 54

Urinary Tract Infection

Urosepsis:
-what is it?
-what are clinical manifestations?

Back 54

UTI that has spread to systemic circulation

--tachycardia, tachypnea, hypotension, fever

Front 55

LUTI – CM (Cystitis)

Urgency & Frequency
-why?

Back 55

the bacteria has accumulated in the bladder and is sticking to the wall causing irritation and inflammation. when the urine hits these areas, it causes spasms in the bladder

Front 56

LUTI – CM (Cystitis)

-what are other clinical manifestations?

Back 56

-Voiding small amounts
-Incontinence
– Nocturia
-Weak stream
-Post void dribbling
-Incomplete emptying

Front 57

LUTI – CM (Cystitis)

if a patient has a foley, what are some S/S they would have?

Back 57

-Foley: leakage, color, consistency
-bladder spasms causes the urine to leak around the catheter
-start them on an antibiotic, and change the catheter
-the urine will be cloudy yellow, and appear clumpy (which is the WBCs clumping)

Front 58

LUTI – CM of Children

-what is unique about their CM?

Back 58

their CM will appear sooner because they have small bladders

Front 59

LUTI – 3 CM of Children

Back 59

•Enuresis-bed wetting, because of the spasms
•Abdominal pain
•fever

-a child who has frequent UTIs needs to be evaluated as to why they are occurring and if there is any sexual abuse going on

Front 60

LUTI – CM

in the elderly, the presentation is different.

Back 60

The first CM that you see is a fever and back pain. it goes to the kidneys almost right away

Front 61

LUTI - Diagnosis
•UA looking for:

Color appears as what?

Back 61

-color may be yellow and cloudy, or pink tinged

Front 62

LUTI - Diagnosis
•UA looking for:
-what is the most common type of bacteria causing a UTI?

Back 62

-e-coli is the most common bacteria that causes UTI

Front 63

LUTI - Diagnosis
•UA
--what do we start them on while we are waiting for a culture?

Back 63

-cultures take 3 days to get back so we start them on septra or bactrum right away.

Front 64

LUTI - Diagnosis
•UA looking for 4 other presentations:

Back 64

–Nitrites (indicating bacteriuria= presence of bacteria in urine )
–WBC –elevated with a shift to the left
–Leukocyte esterace (enzyme present in WBCs)
–Hematuria

Front 65

LUTI - Diagnosis
•UA
-specific gravity?
-pH?

Back 65

elevated specific gravity

pH (alkalotic)

Front 66

UTI treatment
-2 things we do?

-what drug do we start them on?

Back 66

-fluids
--acidify urine
broad spectrum antibiotic (Trimethoprim/sulfamethoxazole (TMP/SMX))

Front 67

LUTI - Treatment

LUTI - Treatment
•Fluids (2-3 L/day)
•Broad spectrum - Trimethoprim/sulfamethoxazole (TMP/SMX)
•Fluoroquinolones•Nitrofurantoin (Macrobid)
-----long term use causes:

Back 67

pulm fibrosis and neuropathies

Front 68

LUTI - Treatment

Fungal source: what 2 drugs can one use

Back 68

amphotericin or fluconazole

Front 69

LUTI - Treatment

Urinary analgesics help do what?

Back 69

numb the bladder so you don’t have those spasms, can get them OTC

Front 70

LUTI - Treatment
•Urinary analgesics (Pyridium) what does this drug do?

Back 70

-drug reduces bladder pain and burning on urination by exerting a analgesic effect on the mucosa of the urinary tract

Front 71

LUTI - Treatment
•Urinary analgesics (Pyridium)
-what SE does this drug have?

Back 71

will cause the urine to change color. reddish/orange

Front 72

Pylonephritis – CM
-where is this infection located?
-what is the most common cause?

Back 72

-bacterial infection in the kidney and renal pelvis – UPPER urinary tract

-organisms (ecoli is the most common cause) move up from the lower urinary tract into the kidney tissue

Front 73

Pylonephritis – CM
Organs are involved:
what are other S/S (5)

Back 73

•Fatigue/malaise
•Fever/chills
•Vomiting
•Flank pain on the affected side
•Costovertebral angle tenderness pain

Front 74

Pylonephritis
Diagnosis: UA: (3)

Back 74

pyuria, bacteriuria, hematuria

-cloudy, bloody, or foul smelling urine with the presence of increased WBCs

Front 75

UTI - Prevention

-what are some things you can teach?

Back 75

•Wipe from front to back
•Void at first urge
•Push fluids

Front 76

UTI - Prevention

-what kind of clothes should you tell them to wear?

Back 76

•Wear cotton panties and avoid tight clothes

Front 77

UTI - Prevention

-what can you teach?

Back 77

•Microwave the underwear and that will kill organisms
•Void and drink a glass of water after intercourse, flush away organisms
•avoid tub baths, vaginal deodorants and sprays, sitting in wet swimming suit

Front 78

Pylonephritis - Treatment

Treat symptoms
--what other meds do you give ?

Back 78

•Fluids – 3000mL a day
•NSAIDS
•Urinary analgesic
•Trimethoprim/sulfamethoxazole (TMP/SMX)
•Fluoroquinolones
•Fungal - amphotericin or fluconazole

Front 79

Pylonephritis
-diet?
high in _____
low in ______

Back 79

--high calorie, low protein diet

Front 80

Pylonephritis -
what non pharm technique can you do to relieve the flank pain?

Back 80

provide warm moist compresses to the flank area to relieve pain

Front 81

Pylonephritis -
-b/c it affects an organ which is so vascular,what should we be concerned about?

Back 81

the organisms can travel throughout the body so be concerned about septicemia

Front 82

Glomerulonephritis
-a term that includes a variety of disorders, most of which are caused by

Back 82

an immunological reaction

Front 83

what disease?

-usually autoimmune

Back 83

- Glomerulonephritis
•Idiopathic

Front 84

-what disease? results in proliferative and inflammatory changes within the glomerular structure

Back 84

Glomerulonephritis

Front 85

Glomerulonephritis Causes:

Back 85

Acute renal failure (when the GFR is low, or BUN and creatinine are still high after a year, they could be going into chronic renal failure and glomerulonephritis is taking place)

Front 86

strep that is not treated, the organism enters the kidney...what disease can this result in?

Back 86

glomerulonephritis so it is important that step is treated

Front 87

history of pharyngitis or tonsillitis 2-3 weeks before symptoms
--what disease can this cause?

Back 87

Glomerulonephritis

Front 88

Glomerulonephritis - CM
--edema, why?

Back 88

-Edema b/c the nephrons are not working and fluid can’t be excreted

Front 89

Glomerulonephritis - CM

--tell me about proteins blood levels

Back 89

-Hypoalbuminemia –low levels of proteins in the blood because the basement membrane is no longer intact so the erythrocytes and albumin leak out

Front 90

Glomerulonephritis - CM

--tell me about the color of their urine

Back 90

-Hematuria (gross amount) –RBC is leaking out bc the basement membrane is not intact

Front 91

Glomerulonephritis - CM

--Tell me about protein from a UA

Back 91

-Proteinuria that produces a persistent and excessive foam in the urine (proteins leaking out because the basement membrane is no longer intact)

Front 92

Glomerulonephritis - CM
-BUN?
-Creatinine?
-GFR?

Back 92

-elevated BUN, creatinine,


GFR decreases

Front 93

Glomerulonephritis - CM

Tell me about their pH?

Back 93

-low pH

Front 94

Glomerulonephritis & Acute Renal failure. What is the connection?

Back 94

-ARF can occur as a result but it can also be a cause

Front 95

Glomerulonephritis - CM
-BP?
-vision?
-UO?
-will they have a fever?

Back 95

-hypertension
-reduce visual acuity
-oliguria or anuria
-yes, they will have a fever

Front 96

Glomerulonephritis - CM
-tell me about activity?

Back 96

-provide bed rest and limit activity