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323 Cards in this Set
- Front
- Back
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Noninvasive X-Rays or imaging studies (5)
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Computerized Tomography (CT)
KUB MRI Intravenous Pyelogram Renal angiogram |
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KUB
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X-ray of the kidneys ureters and bladder
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KUB reveals (4)
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Calculus (stones),
Hydronephrosis Cysts Tumors |
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CT
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Non invasive technique that provides excellent cross-section views of the kidney and the urinary tract.
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CT reveals (6)
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GU masses
Nephrolithiasis obstructions chronic renal infections Urinary tract trauma Soft tissue abnormalities to include lymph node enlargement. |
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CT scan use of Contras Medium
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1st time not used, 2nd time given IV
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Patient posistioning during CT
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Lies on adjustable table with body in fixed posistion.
Scanning system rotates around body. Patient must lie still usually wit arms above head. Talking or moving will distort images |
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CT Nursing Teaching
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Teach patient to lie still and quitely through procedure.
May feel flushing, nausea or vomiting with flushing of Contrast Medium thru IV Radiation exposure is minimal Procedure 30-45 min long with contrast mediums |
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Nursing Intervetions prior to CT (4)
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assess patient for allergies to iodine or shell fish
Establish IV line for contrast Obtain consent May require bowel prep |
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Nursing INterventions post CT
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Ensure pt receives normal diet upon return
Encourage fluid to minimize dehydration from bowel prep, and to prevent nephrotoxicity from contrast. Observed for possible delayed allergic reaction |
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MRI
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Uses powerful magnetic field to obtain images from body.
Alters hydrogen ions aligns protons protons imit signal which converts to image |
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MRI Nursing Intervention - Education
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Pt will be able to communicate outside via microphone
Educate it is painless but will hear a loud thumping noise when coils are pulsed Tube is narrow, assess for claustrophobia (if it is - sedation may be needed) |
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MRI Nursing Interventions Pre
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all metalic objects removed
Extensive assessment to see if patient is a candiate for Mri |
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IN MRI things considered metal in patients...
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aneurism clips, orthopedic hardware
artificial heart valves Pace maker intrauterine devices somet tattoos |
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Intravenous Pyelogram
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View urinary system.
Injection of radiopague contrast medium that is filtered through kidney and excreted via urinary tract idenfities absence, presence, location, size,configuration of kidney ureter and bladder |
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Prior to IVP 6
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check allergies
NPO or has clear liquids only after liquid dinner Enema or cathartics night before Teach that warm flush may occur when contrast injected IV line established Obtain consent |
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Pyelonephrosis
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Clubbing of kidney
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Post IVP Interventions 4
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Ensure patient receives normal diet
Encourage fluids to minimize dehydration from bowel prep and nephrotoxicity from contrast Monitor I/O, promptly report alterations to physician Observe for possible delayed reactions |
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Renal Angiography
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Invasive radiographical procedure that evaluates the renal arterial system.
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Renal Angiography Procedure
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Die injected through femoral cath dir into renal artery.
Shows vascular abnorms b/c it is not secreted into collecting sstem. |
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Renal Angiography is capable of evaluating...
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Masses (Neoplasms or cysts)
to determine changes in blood flow. |
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Pre and Post Interventions for Renal angiography 4
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Ensure patient is on bed rest for 8 to 12 hours.
Extremity is kept in straight alignment and pulses (femoral) are checked observe for bleeding or increased tenderness, and hematoma at site. Maintain pressure dressing over site for 24 hours. |
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Cystoscopic Exam
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Lighted scope through ureter into bladder. alows for viewing, biopsy and removal of calculi
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Cystoscopic Exam allows viewing of 4
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urethra
bladder ureteral orifaces prostatic urethra |
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Cystoscopic Procedure - Position and Teaching
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Lithotomy posistion
Normal saline inserted into bladder and patient told to hold void |
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Pre-Cystoscopic Nursing Interventions
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May be under local anestetic at urethral office.
May be IV Sedation Spinal or general anest. If local - pt may feel spasms pressure Teach relaxation techniques NPO for 8 hours prior Obtain consent |
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Post Cystoscopic Nursing Interventions
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Force fluids to ensure adequate outflow to washout anybacteria from instruments.
Monitor intake and output assess for urinary retention from edema following instrumentation warm sitz bat and relax meds help releive tension cath may be ness if no relief |
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Complications of Cystocopic 5
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Hemorrhage
Bladder perforation Urinary Retetion Infection Pink tinged urine is normal but bright red is bad and clots are abnormal |
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Retrograde Pyelogram
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Small cath through cytoscope into ureters and renal pelvis
Contras injected and xray taken Helpful if IVP did not show much |
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Retrograde Pyelogram used for...
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Obstruction removal or bypass by uretal caths
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Retrograde Pyelogram Complications
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Ureteral trauma
bleeding infection |
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Nursing interventions
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similiar to cystoscopic / IVP
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Normal BUN level
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5-25
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BUN serves as index for what function?
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Renal function
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Bun is increased or decreased in Renal impairment?
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Increased
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BUN level starts to rise when GFR falls between what percent?
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40 and 60%
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BUN Elevation from Nonrenal Factors 7
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Hypovolemia
Excessive Protein Intake Starvation Surgery Trauma Fever Corticosteroids |
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BUN decreased due to
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Increase in extracellular volume (dilutes)
Low protein diet End stage renal failure any condition that results in expanded fluid volume (pregnacy) |
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Normal Creatine values
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0.7-1.5
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Creatine indicator of?
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Kidney damage and progression of renal failure (most accurate).
Passed through glomer filtration. |
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Increased Creatine greater than 1.2 indicates?
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Nephron loss
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Twice normal levels of creatinine indicate how much nephron loss?
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50%
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Ten times greater indicates?
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ESRD 90% loss
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Normal BUN creatinin ratio
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10:1 or 15:1
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Inreased BUN:creatinine suggest?
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Dehydration
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Lower Ratio of BUN:Creatinine
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Overhydration, low intake of protein, severe liver disease
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Normal Creatinine Clearance level
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Greater than 70ml per minute
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Creatnine CLearnace is a measurment of?
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GFR - shows how much creatinine is passed from blood every minute.
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Poor creatinine clearance is an early sign of ?
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Renal Disease
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Creatinine Clearnace collected in 24 hour specimen.
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a
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Renal Biopsy used to diagnose
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Existance, extent and origin of renal disease
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Closed Renal Biopsy
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Done via needle while location is confirmed via ultrasound or fluroscopy
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Open Renal Bipsy is done through a... incision
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Nephrostomy
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Pre Renal Biopsy Interventions 7
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OBtain consent
Fasting for 8 hours Baseline Vitals Intravenous line established Insure coagulation studies HGB/HCT done Obtain urine to compare to post |
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Renal Biopsy Posisiton of client
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Prone with pillow under
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Client posistion after Renal Biop
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On back for 6 to 8 hours.
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Post Renal Biopsy Interventions
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VS
Look for signs of bleeding Report increased pulse of fall in BP, vomiting or dull aching in abdomen which indicate hemorhage Check dressin q 10 minutes for hour then hourly Check urine for hematuria - may occur quickly after biopsy Keep serial urines to check for increasing/decreasing hematuria |
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Post Renal Biop what would indicate hemorhage bleed into peritoneal space?
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Backache, shoulderpain or dysuria. Notify physicia
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Post REnal BIop what labs are drawn, when, and why?
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HGB/HCT 8 hours after, assess for changes.
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How much fluid is patient to drink after Renal Biopsy and why?
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3,000 unless severe kidney failure to prevent blood clot and retention
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Post Renal Biop teach client to withstand heavy weight for how long?
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2 weeks.
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Complications of Renal Bip
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Hemorrhage, Hematoma, Infection
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What happens to GFR in aging?
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Slows down
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Kidney Tubular function, reabsorption are what with older age
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Decreased
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What happens with agin in renal system in males
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Increased collagen in bladder wall or secondary to prostatic enlargement
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Renal changes in women with aging
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vaginal or urethral tissues atrophy and become thinner due to decreased estrogen levels
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Renal changes with aging include decreased filtration and tubular function which results in
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the disability to concentrate urine
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In aging renal changes, cardiac outflow is decreased increasing peripheral resistance which does what to urinary output
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Decreases
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4 effects of aging on renal system
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bladder capacity decreases
tendency to retain urine develops Nocturia increases Urinary sphincter weakens |
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Urinary Rention
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Inability to empty the bladder completely during attempts to void.
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3 causes of Urinary Retention
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obstruction
Decreased sensory output Musle Tension |
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Urinary Retention obstruction due to
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BHP
Strictures CLots Clots Stones Bladder outlet obstruction |
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Decreased sensory input
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CVA
Diseases with neurological impact deficient detrusor muscle contraction strength |
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Muscle tention urinary retention due to
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anxiety
surgery anorectal problems |
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Symptoms of Urinary Retention
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Nocturia
Distended bladder and bladder pain Overflow incontinence |
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Overflow Incontinence
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Bladder fills to point where sphincter cannot hold.
Void 25-50 ccs every void. |
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Bladder Ultrasonography
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Noninvasive measure of urine in bladder.
Portable for use at bedside automatically calculates a nd displays bladder vol |
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Complications of Urinary Retention
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INcreased risk of urinary tract infection
Increased risk of calculi Upper resp trac problems including: Pyelonephritis Hydronephrosis Renal insuff ARF Bladder rupture |
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Pyelonephritis
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Inflammation of renal pelvis and calyces
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Hydronephrosis
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Collection of urine in renal pelvis secondary to obstructed overflow
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Immediate treatment for Urinary Retention
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In/Out cath requires order
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Decompression complications of bladder
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Sweating
Hypotention Pallar Hematuria |
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Medicine that increases bladder emptying
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Urecholine
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Stress Incontinence
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Urine leaking when sneezing or coughing
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Urge incontence
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Sudden uncontrollable need to void with fullness
May lose significant amt before reaching bathroom |
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Overflow incontenence
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Poor urinary stream
Dribbling Symptoms of Stress/Urge Detrusor hyperactivity with impaired contractility May mimic stress or overflow Common in elderly |
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Functional Incontinence
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Inappropriate voiding
Immobility Impaired Cognition |
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Reflex Incontinence
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Involuntary bladder contractions- no warning
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Mixed incontinence
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two or more types
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Etiology of bladder incontinence is usually related to
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pelvic floor relaxation
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Pelvic floor relaxation seen in bladder incontinence can be caused by
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Abdominal stretching during giving birth
abdominal surgery obesity heavy lifting chronic cough long term constipation |
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Treatment for incontinence
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Treat cause such as UTI
caffine Diuretic Kegel Exercises |
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Meds given for Incontinence
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Anticholinergics
Alpha adrenergic blockers Estrogen |
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Estrogen for incontinence
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improve pelvic structural integrity
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Alpha adrenergic blockers for incontinence
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Increase urethral resistance - Acutrim improves smooth muscle contraction at bladder outlet
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Anticholinergics in incontinence
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INhibit involuntary bladder contractions
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A device for treatment of incontinence
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Pessary - can cause urethral compression or obstruction.
Difficult to remove or insert |
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A surgery for the treatment of incontinence
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Bladder neck suspension
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Bladder neck suspension
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Used to treat incontinence, brings angle between bladder and urethra closer than normal.Effective in 90 percent of clientsw ith a uretrhocele
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Cystocele
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A protrusion of the bladder into the vagina
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Cystocele usually results from
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Straining during child birth
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Symptoms of cystocele
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Pelvic pressure
Incontinence Urency Frequency |
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Managment of cystocele
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Kegel
Pessary Sx |
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Cystitis
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Inflammation of the bladder usually secondary to infection.
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Most common infection involved in cystitis
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Transending Ecoli from transurethral entry Most common in women
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What makes acention of bacteria more common in women?
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Shorter urethra
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Symptoms of Cystitis 5
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Pyuria
Dysuria Freq and Urg Hematuria Supraputic Tenderness |
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Pyuria
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WBC, puss in urine
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Dysuria
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Painful urination
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Treatment for Cystitis
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May resolve without treatment
Cranberry Juice |
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How does cranberry juice help cystitis
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decrease ability of bacteria to attach to wall
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Antibiotics used in Cystitis
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Bactrum
Septra Macrodantin |
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Patient Education regarding Cystitis
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Avoid tub baths and take showers
Avoid spermacides Avoid oil-base lubricants Void after intercourse Hygienic care cleanse from front to back |
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What is the leading cause of Urinary Obstruction/
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Calculi (stones)
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Urolithiasis
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Presence of stones in urinary tract..may be formed in the bladder.
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Ureterolithiasis
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Presence of stones in the ureter
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Nephrolithiasis
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Stones in the kidney
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Men or women most effected with stones in Kidney tract?
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Men
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How many of stones pass spontaneously?
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90 %
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Formation of Calculi
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Crystalization involving nucleation in which crystallites are formed from supersaturated urine.
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Stones form when urinary concentrations of these increase...
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Calcium oxylate
Calcium phosphate Uric Acid |
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Supersaturation
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Process of stone formation from increased concentrations of calcium oxylate, calcium phosphage, and uric acid.
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supersaturation is dependent on
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amount of substance
Ionic strength ph of urine |
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Normal Urine Ph
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4-8
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The more alkaline the pH these are less soluble
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calcium and phosphate
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The more acidic te pH of the urine these are less soluble
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Cystine, and Uric Acid
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Predisposing Factors for Stones
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Mucoproteins, a fibrous matrix which crystals are desposited and stuck too accounts for fam history of stones.
Urinary stasis Dehydration Meds Immobility |
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Meds that predispose for Calculi
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High doses of ascorbic acid,antacids,antibiotics, sulfonamides
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Hypercalcuria
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Calcium Phosphate stones
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What percent of stones contain calcium and why?
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75% caused from conditions of increased calcium in blood (hypercalcemia) and urine causing precipitation of calcium ad formation of stones
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Causes of hypercalcemia
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Hyperparathyroidism
Renal Tubular acidosis Cancers Granulomatous diseases (sarcoidosis, tuberculosis) Excessive intake of Vitamin D Excessive intake of milk Myeloprofliferative disesase: leukemia, polycythemia vera, multiple myeloma. |
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Diet mods for Calcium Phosphate Stones
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ACID ASH DIET (Low calcium) decreases ph making urine more acidic.
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Acid ash diet foods
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Included:Cheese, meat, eggs, fish oysters, poultry, bread, cereal, whole grains, pastries, cranberries, prunes, plums, tomatoes, corn and legumes.
Foods to Avoid: carbonated beverages, baking soda or powder, all vegetables except corn and legumes. Olives, corn, nuts (other than peanuts) |
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Prevention of Calcium Stones
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Liberal fluid intake
Limit protein intake to 60g a day to minimize urinary calcium excretion Sodium restriction to 3-4 g a day b/c excessive salt increases calcium excetion in all ppl with hypercalcuria. |
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Calcium Oxylate Stones
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Caused by supersaturation of calcium and oxalate
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Calcium Oxalate Stones Prevention
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Strive to have a dilute Urine
Acid ash diet Avoid foods high in oxalate |
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Oxalate Containing Foods
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Spinach
Strawberries Tea Almonds Cashews Chocolate Beans Rhubarb |
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Tripple phosphate Stones
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Struvite Stones also known as infection stone.
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Struvite stones account for how many stones
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15%
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Struvite stones are made of
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Phosphate, Ammonium Phosphate, Magnesium Phosphate
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Why Struvite is called and Infection Stone
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A bacterial stone (usually Proteus)raises urine pH and causes phosphate to precipitate. Usually results in staghorn Calculi
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Staghorn Calculi
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a large stone that may be shaped by and virtually fill and entire renal pelvis.
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Preventions of Struvite Stones
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Maintain dilute urine 8x8oz/day
Maintain medication to rid bacteria May be maintained on meds to remain acidic lithostat or ammonium chloride |
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In Struvite Ammonium Chloride and Lithostat are taken to
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Keep urine acidic
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Uric Acid Stone
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Caused by increased urate excretion (Hyperuricuria) from Gout. May also be caused from high diet of purine rich foods.
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Uric Acid Calculi - urine tends to be more
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Acidic
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In uric acid calcuil patient should avoid purine rich foods which include:
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Sardine, anchovies, asparagus, mushrooms, organ meat and wine. AVOID ORAGN MEATS
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Diet for uric acid calculi:
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Acid ash diet
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Medication for Uric acid calculi
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Allopurinol (zyloprim) lower serum uric acid levels and urinary uric acid excretion.
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Primary symptom of Calculi
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Renal Colic
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Renal colic
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passage of calculi from kidneys to ureter
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Renal Pelvis Calculi Pain is caused by and described as
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Hydronephrosis
Dull and constant at costovertebral angle |
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Ureter Calculi Pain description
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Excrutiating and intermittent, caused by spasm of ureter and anoxia of wall of ureter from stone. Not actual stone itself!
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Symptoms of Calculi Pain
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Pain follows ureter to suprapubic area and radiates to external genitalia and is accompanied by nausea and vomiting. Usually 2-3 attacks before passing stone.
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Complications of Calculi
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Hematuria, Obstruction, Infection
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Nursing Interventions for Calculi 7
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Eliminate Pain and Infection
Resolve causative Factors Prevent future calculi growth Force Fluids (2-4 L / day) Strain Urine Teach Diet Medications for pain |
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Meds for pain caused by Calculi include
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Analgesics
NSAIDS Thiazide diuretics (decrease urinary calcium) |
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Differential Diagnosis of Calculi 6
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Appendicitis
Choleystitis Peptic Ulcer Pancreatitis Ectopic Pregnancy Dissecting aneurism |
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Mechanical Treatment of Calculi using shock wave
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Extracorporeal Shock Wave Lithotrispy - waves from outside of body.
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Mechanical Treatment for larger Calculi using an percutaneous tract and nephroscope
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Percutaneous Nephrolithotomy
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Removal of Stones after pulveration of them by Percutaneous Nephrolithotomy
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Fragments may be irrigated and suctioned out or retrieved with basket or foreceps.
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Percutaneous Nephrolithotomy may causing bruising where?
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On Back
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Open surgeries for Calculi according to their location in Urinary Tract
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Pyelolithotomy - Calculi in Pelvis
Nephrolithotomy - Calculi in Kidney Ureterolithotomy - Calculi in Ureter Cytoscopy/Ureteroscopy - basket for stones in bladder or close in ureter |
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Surgical Removal Of Kidney
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Nephrectomy
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For which of the following does the nurse need to obtain a written consent?
MRI IVP CT Scan KUB |
all except KUB
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What is the first test ordered when a patient is suspected to have a kidney stone?
1. MRI 2. IVP 3. Cystoscope 4. KUB |
KUB
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During which of the folowing would a physician obtain a biopsy?
a. MRI b IVP c. Cystoscope d. Retrograde pyelogram |
Cystoscope
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What instruction should the nurse give to a patient having an IVP?
1. You will have a clear liquid breakfast the morning of sx. 2. Youll feel aw arm flush when the dye is injected 3. e will give you laxatives the morning of IVP 4 You will be in lithotomy posistion |
Feel warm flush
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Which of the following is the most important question before IVP?
1. are you allergic to seafood? 2 do you have metal in body 3. have you been npo all night 4. Have you emptied your bladder? |
allergic to seafood
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What is the name of the procedure in which a tube is passed from the ureter into kidney pelvis and dye is injected?
1. Retrograde pyelogram 2. Intravenous pyeogram 3. Cystoscopic exam 4. Computerized Tomography |
Retrograd pyelogram
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A patient is scheduled for an MRI of the kidney. Which information in a patient's healt history would be of most concern to the nurse?
1. I've had diarrher all night I've had a history of hypertension 3. I'm allergic to iodine 4. I have a pacemaker |
I have a pacemaker
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Which of the following lab tests indicate ddehydration instead of renal failure?
. bun 50 creat 4.0 . bun 40 creat 1.2 bun 25 creat 1.5 bun 15 creat 3.0 |
bun 40 creat 1.2
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What is the first test ordered when a patient is suspected to have a kidney stone?
1. MRI 2. IVP 3. Cystoscope 4. KUB |
KUB
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Which of the following is the most accurate measure of renal function?
Renal biop Blood Urea nitrogen Urine Urea Nitrogen Creatinin Clearance |
Creatinine Clearance
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During which of the folowing would a physician obtain a biopsy?
a. MRI b IVP c. Cystoscope d. Retrograde pyelogram |
Cystoscope
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Which of the folowing would be of most concern to the nurse in a patient about to have a renal biopsy?
BUN 50 mg PT of 20 seconds Creatinine of 1.5 mg Blood in Urine |
All concern....but PT of 20 seconds is answere
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What instruction should the nurse give to a patient having an IVP?
1. You will have a clear liquid breakfast the morning of sx. 2. Youll feel aw arm flush when the dye is injected 3. e will give you laxatives the morning of IVP 4 You will be in lithotomy posistion |
Feel warm flush
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Which of following comments by the patient who jut had a renal bipsy would be of most concern to the nurse?
I feel the need...the need for pea (the need to urinate) I'm feeling nauseated My back is hurting me Im very sleepy |
My back is hurting me
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Which of the following is the most important question before IVP?
1. are you allergic to seafood? 2 do you have metal in body 3. have you been npo all night 4. Have you emptied your bladder? |
allergic to seafood
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What is the name of the procedure in which a tube is passed from the ureter into kidney pelvis and dye is injected?
1. Retrograde pyelogram 2. Intravenous pyeogram 3. Cystoscopic exam 4. Computerized Tomography |
Retrograd pyelogram
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What is the first test ordered when a patient is suspected to have a kidney stone?
1. MRI 2. IVP 3. Cystoscope 4. KUB |
KUB
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A patient is scheduled for an MRI of the kidney. Which information in a patient's healt history would be of most concern to the nurse?
1. I've had diarrher all night I've had a history of hypertension 3. I'm allergic to iodine 4. I have a pacemaker |
I have a pacemaker
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During which of the folowing would a physician obtain a biopsy?
a. MRI b IVP c. Cystoscope d. Retrograde pyelogram |
Cystoscope
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What instruction should the nurse give to a patient having an IVP?
1. You will have a clear liquid breakfast the morning of sx. 2. Youll feel aw arm flush when the dye is injected 3. e will give you laxatives the morning of IVP 4 You will be in lithotomy posistion |
Feel warm flush
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Which of the following lab tests indicate ddehydration instead of renal failure?
. bun 50 creat 4.0 . bun 40 creat 1.2 bun 25 creat 1.5 bun 15 creat 3.0 |
bun 40 creat 1.2
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Which of the following is the most important question before IVP?
1. are you allergic to seafood? 2 do you have metal in body 3. have you been npo all night 4. Have you emptied your bladder? |
allergic to seafood
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Which of the following is the most accurate measure of renal function?
Renal biop Blood Urea nitrogen Urine Urea Nitrogen Creatinin Clearance |
Creatinine Clearance
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What is the name of the procedure in which a tube is passed from the ureter into kidney pelvis and dye is injected?
1. Retrograde pyelogram 2. Intravenous pyeogram 3. Cystoscopic exam 4. Computerized Tomography |
Retrograd pyelogram
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Which of the folowing would be of most concern to the nurse in a patient about to have a renal biopsy?
BUN 50 mg PT of 20 seconds Creatinine of 1.5 mg Blood in Urine |
All concern....but PT of 20 seconds is answere
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A patient is scheduled for an MRI of the kidney. Which information in a patient's healt history would be of most concern to the nurse?
1. I've had diarrher all night I've had a history of hypertension 3. I'm allergic to iodine 4. I have a pacemaker |
I have a pacemaker
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What is the first test ordered when a patient is suspected to have a kidney stone?
1. MRI 2. IVP 3. Cystoscope 4. KUB |
KUB
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Which of following comments by the patient who jut had a renal bipsy would be of most concern to the nurse?
I feel the need...the need for pea (the need to urinate) I'm feeling nauseated My back is hurting me Im very sleepy |
My back is hurting me
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Which of the following lab tests indicate ddehydration instead of renal failure?
. bun 50 creat 4.0 . bun 40 creat 1.2 bun 25 creat 1.5 bun 15 creat 3.0 |
bun 40 creat 1.2
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During which of the folowing would a physician obtain a biopsy?
a. MRI b IVP c. Cystoscope d. Retrograde pyelogram |
Cystoscope
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Which of the following is the most accurate measure of renal function?
Renal biop Blood Urea nitrogen Urine Urea Nitrogen Creatinin Clearance |
Creatinine Clearance
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Which of the folowing would be of most concern to the nurse in a patient about to have a renal biopsy?
BUN 50 mg PT of 20 seconds Creatinine of 1.5 mg Blood in Urine |
All concern....but PT of 20 seconds is answere
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What instruction should the nurse give to a patient having an IVP?
1. You will have a clear liquid breakfast the morning of sx. 2. Youll feel aw arm flush when the dye is injected 3. e will give you laxatives the morning of IVP 4 You will be in lithotomy posistion |
Feel warm flush
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Which of following comments by the patient who jut had a renal bipsy would be of most concern to the nurse?
I feel the need...the need for pea (the need to urinate) I'm feeling nauseated My back is hurting me Im very sleepy |
My back is hurting me
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Which of the following is the most important question before IVP?
1. are you allergic to seafood? 2 do you have metal in body 3. have you been npo all night 4. Have you emptied your bladder? |
allergic to seafood
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What is the name of the procedure in which a tube is passed from the ureter into kidney pelvis and dye is injected?
1. Retrograde pyelogram 2. Intravenous pyeogram 3. Cystoscopic exam 4. Computerized Tomography |
Retrograd pyelogram
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A patient is scheduled for an MRI of the kidney. Which information in a patient's healt history would be of most concern to the nurse?
1. I've had diarrher all night I've had a history of hypertension 3. I'm allergic to iodine 4. I have a pacemaker |
I have a pacemaker
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Which of the following lab tests indicate ddehydration instead of renal failure?
. bun 50 creat 4.0 . bun 40 creat 1.2 bun 25 creat 1.5 bun 15 creat 3.0 |
bun 40 creat 1.2
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Which of the following is the most accurate measure of renal function?
Renal biop Blood Urea nitrogen Urine Urea Nitrogen Creatinin Clearance |
Creatinine Clearance
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Which of the folowing would be of most concern to the nurse in a patient about to have a renal biopsy?
BUN 50 mg PT of 20 seconds Creatinine of 1.5 mg Blood in Urine |
All concern....but PT of 20 seconds is answere
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Which of following comments by the patient who jut had a renal bipsy would be of most concern to the nurse?
I feel the need...the need for pea (the need to urinate) I'm feeling nauseated My back is hurting me Im very sleepy |
My back is hurting me
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A patient with 24 hour urine collection reports urinating with a bowel movement in a bed pan. The nurse should:
Start the 24 hour urine over again at that time Pour the urine into the collection jug Measure and record the amount of urine and discard it Extend the time of collection for one voiding and discard all urine |
Start the 24 hour urine over again at that time
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A patient complains of "wetting her pants" when she sneezes. This is known as:
Urge Incontinence Stress Inc Functional Inc Reflex Inc |
Stress Incontinence
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Which factor is the most likely etiology of stress incontinence
A history of having 4 children A hx of diabetes and polyureia A hx of frequent UTIs Taking baths instead of showers |
Hx of having 4 children
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Due to the effects of aging, elderly patients are more likely to
have pain with oiding have hematuria develop bladder tumors Develop UTIs |
Develop UTIs
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What should the nurse teach a patient with cystitis to prvent future recurrences?
Cleanse from front to back after bowel Practice Kegel exercises Drink lots of orange juice Take tub baths instead of showers |
Cleans from front to back after bowel
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Which factor may contribute to urinary retention?
A history of diabetes mellitus Syndrome of Inappropriate ADH (SIADH) A hx of cerbrovascular accident Tumor in kidney pelvis |
all except dm
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A patient is crying with bladder pressure and the PCT gives her a bedpan. Which of hte folowing would be of most concern to the nurse?
The urine was amber and aromatic The amount voided was 50 ml The patient had a hard time starting the stream The patient is receiving IV fluids |
The amount voided was 50ml
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Pre Op Interventions for a client undergoing Nephrectomy 4
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Consent, NPO, Skin prep, Teaching
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Teaching to a client preop Nephrectomy includes
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IS, TCDB, OOB gradually, frequent VS mnitor first 24 hours
Teach patient how to splint surgical site Reassure patient remaining kidney will assume renal function Teach patient that they may have foley, stents, drains, and will have a large dresssing. |
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Nursing INterventions for client post op Nephrectomy
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Monitor VS q15 min x4 then q30min x 2 hours, then begin to reduce frequency as patient is deemed stable.
Check dressing for bleding with every vital sign check Observe for hemorrhage and signs and symptoms of shock High incision - watch for respiratory functioning. |
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End Stage Renal Disease - Potential Causes 3 classifications
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Pre-renal
Intra-renal Post-renal |
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Causes of Pre-renal ESRD
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Poor perfusion of kidney from volume depleted states
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Pre-Renal ESRD is caused by poor perfusion of kidney from volume depleted states...these include (9)
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Hemorrhage
Impaired Cardiac Performance CHF Cardiogenic Shock GI losses Vomiting Diarrhea NG suctioning |
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Intrarenal ESRD causes
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Structural Damage to kidney
Infection: Acute Glomerulonephritis (GN) |
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Structural Damage to kidneys leading to Intra-renal ESRD can be:
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Burns, crushing injury, infection, nephrotoxic agents such as aminogycoside antibiotics, Heavy metals and chemicals: lead mercury, ethylene lgycol, carbon tetrachloride, arsenic.
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Aminoglycoside antibiotics
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Gentamicin
Tobramicin |
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Post-Renal ESRD causes
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Urinary tract obstruction
(calculi, tumors, BPH, strictures, clots) |
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Treatment of REnal Failure (3)
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Fluid Restriction
Diet Restriction Dialysis - to revere damage in ARF |
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Diet Restrictions for Renal Failure:
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2 Gm Sodium
2 Gm Potassium 40-60 Gm Protein (to decrease nitrogen) |
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Chronic Kidney Renal Disease has 5 stages that are based on
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Level of kidney function
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ESRD is the final stage of
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Chronic Kidney Disease
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In ESRD the GFR is
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less than 15 ml/min
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ESRD requires renal replacement via
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dialysis or transplantation
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Complications of Renal Failure (4)
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Fluid volume overload
Electrolyte Imbalance Anemia Access problems - nurse is responsible for assessing thrill and bruit of fistulas. |
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Anemia complication from Renal Failure is b/c
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Kidney makes erythropoietin, a hormone that stimulates bone marrow to produce RBC's or erythrocytes
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BHP stands for
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Benign Prostatic Hypertrophy
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BHP Causes (3)
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Age-related, nonmalignant enlargement of the prostate gland that develops when the number of prostate cells increase.
As the prostate enlarges it causes narrowing of the urethra Cause is unkonw however hormonal changes related to aging have been implicated |
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Symptoms of BHP (13)
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Weakened and diminished urinary stream; difficulty instarting stream; straining
Dribbling, frequency Urgeny with inability to empty bladder causing urinary stasis, infection, cystitis May elevate pressure within bladder causing the wall to thicken and diverticula to form Urine may back-up (reflux) causing distention in the renal pelvis which leads to back pain. Prolonged obstruction may lead to renal insufficiency and failure with an alteration in renal function tests. Inability to void Hematuria |
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Diagnosis of BHP
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Made through digital rectal examination
Felt as symmetrical enlargement of gland with a rubber to firm consistency |
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Treatment of BHP
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Watchful waiting; with early diagnosis able to watch to see if progresses
Alpha blocker drug treatment |
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BHP - Alpha blocker drug treatment Examples:
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Minipress, Hytrin
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Alpha blocker drug treatment MOA
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Relaxes muscles in prostate
May caues impotence |
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Medication that can shrink prostate
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Proscar
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Proscar side effects
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May cause flushing, breast enlargement and erectile dysfunction
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Treatment dependent on severity of BHP
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Balloon Dilation
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Surery for BHP is indicated when?
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When a patient cannot urinate, has frequent infections, has hematuria, urine backup and/or stones
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Surgical Procedure for BHP is called?
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Transurethral Prostatic Resection
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Procedure for TURP Transurethral Prostatic Resection
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Endoscope inserted through urethra
Cutter inserted and cuts away pieces 3-way foley with 30cc balloon is inserted for continuous bladder irrigation Traction is placed on foley to decrease bleeding. |
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Surgery in which prostate gland is removed from urethra by way of the baldder.
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Suprapubic Resection
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Suprapubic Resection used if
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Large amount of prostate needs to be removed
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BHP - Alpha blocker drug treatment Examples:
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Minipress, Hytrin
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Alpha blocker drug treatment MOA
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Relaxes muscles in prostate
May caues impotence |
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Medication that can shrink prostate
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Proscar
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Proscar side effects
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May cause flushing, breast enlargement and erectile dysfunction
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Treatment dependent on severity of BHP
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Balloon Dilation
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Surery for BHP is indicated when?
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When a patient cannot urinate, has frequent infections, has hematuria, urine backup and/or stones
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Surgical Procedure for BHP is called?
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Transurethral Prostatic Resection
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Procedure for TURP Transurethral Prostatic Resection
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Endoscope inserted through urethra
Cutter inserted and cuts away pieces 3-way foley with 30cc balloon is inserted for continuous bladder irrigation Traction is placed on foley to decrease bleeding. |
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Surgery in which prostate gland is removed from urethra by way of the baldder.
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Suprapubic Resection
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Suprapubic Resection used if
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Large amount of prostate needs to be removed
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How is urine drained after Suprapubic Resection
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drained via foley, cystostomy tube or both after surgery
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Post op care for TURP and Suprapubic Resection
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Urine turns from red to pink in about a day, amber after 3 days
Avoid vigorous exercise, heavy lifting Sexual intercourse restricted for 6-8 weeks Avoid straining with boel movemtns Wlltake a stool sfotener such as Colace |
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What surgeries should you avoid enemas, rectal temps or rectal tubes?
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TURP and Suprapubic prostatic resectomy
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How much fluid should be consumed prior to BHP surgery?
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2500 cc/day
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SHould a client sit after surgery with BHP
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No periods of sitting for 2-4 weeks after sx
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WHen will dribbling stop after a BHP sx?
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when Edema decreases
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The only thing that should be stuck up butt after BHP for a while is what? and what for?
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Belladonna and Opiate for spasms
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Belladonna and Opiate are for?
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Spasms prior to BHP sx
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Complications from BHP Surgery
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Bleeding
Bladder spasms Retrograde Ejaculation Urethral stricture Incontinence Sexual functioning Sex may be altered due to patient belief that he will be impotent Urinary incontinence: do perineal exercises |
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How is urine drained after Suprapubic Resection
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drained via foley, cystostomy tube or both after surgery
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Which of the following is a cause of pre-renal failure?
Hypertension BPH Glomerulonephritis Urinary Calculi |
Hypertension
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How is urine drained after Suprapubic Resection
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drained via foley, cystostomy tube or both after surgery
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Post op care for TURP and Suprapubic Resection
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Urine turns from red to pink in about a day, amber after 3 days
Avoid vigorous exercise, heavy lifting Sexual intercourse restricted for 6-8 weeks Avoid straining with boel movemtns Wlltake a stool sfotener such as Colace |
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Post op care for TURP and Suprapubic Resection
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Urine turns from red to pink in about a day, amber after 3 days
Avoid vigorous exercise, heavy lifting Sexual intercourse restricted for 6-8 weeks Avoid straining with boel movemtns Wlltake a stool sfotener such as Colace |
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What surgeries should you avoid enemas, rectal temps or rectal tubes?
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TURP and Suprapubic prostatic resectomy
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How much fluid should be consumed prior to BHP surgery?
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2500 cc/day
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What surgeries should you avoid enemas, rectal temps or rectal tubes?
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TURP and Suprapubic prostatic resectomy
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SHould a client sit after surgery with BHP
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No periods of sitting for 2-4 weeks after sx
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How much fluid should be consumed prior to BHP surgery?
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2500 cc/day
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WHen will dribbling stop after a BHP sx?
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when Edema decreases
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SHould a client sit after surgery with BHP
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No periods of sitting for 2-4 weeks after sx
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WHen will dribbling stop after a BHP sx?
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when Edema decreases
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The only thing that should be stuck up butt after BHP for a while is what? and what for?
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Belladonna and Opiate for spasms
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The only thing that should be stuck up butt after BHP for a while is what? and what for?
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Belladonna and Opiate for spasms
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Belladonna and Opiate are for?
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Spasms prior to BHP sx
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Belladonna and Opiate are for?
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Spasms prior to BHP sx
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Complications from BHP Surgery
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Bleeding
Bladder spasms Retrograde Ejaculation Urethral stricture Incontinence Sexual functioning Sex may be altered due to patient belief that he will be impotent Urinary incontinence: do perineal exercises |
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Complications from BHP Surgery
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Bleeding
Bladder spasms Retrograde Ejaculation Urethral stricture Incontinence Sexual functioning Sex may be altered due to patient belief that he will be impotent Urinary incontinence: do perineal exercises |
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Which of the following is a cause of pre-renal failure?
Hypertension BPH Glomerulonephritis Urinary Calculi |
Hypertension
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Which of the following is a cause of pre-renal failure?
Hypertension BPH Glomerulonephritis Urinary Calculi |
Hypertension
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Which of the following is a cause of post-renal failure?
CHF Pyelonephritis Ureteral stricture Aminoglycoside therapy |
Ureteral stricture
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The nurse should regulate a CBI following aTURP at what rate?
Fast enugh for the urine to be clear yellow Fast enough for the urine to be pink Fast enough for the urine to be red At approx 125 ml/hr |
Look up
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Cancer of the prostate - who has lowest incidence?
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Japanese
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Cancer of prostate peaks between what ages
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60-70
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Lab Values Checked for Prostate Cnacer
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Serum prostatic acid phosphatatse (PAP) elvated
LDH, BUN and creatinine elvated Alkaline phosphatase increases with bone metastatsis Prostate specific antigen (PSA) elevation suggestive of prostate cancer |
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Elevated Levels of Prostatic acid phosphatase are
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0.11-.60 (look up)
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PSA Prostate specific antigen - what number is abnormal?
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> 4.0
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How is Pancreatic Cancer diagnosed?
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Digital Rectal Exam
Transrectal ultrasound PSA and other blood work |
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Stage 1 of prostate cancer
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Tumor not clinically palpable but detectable in microscopic secretions by biopsy
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Stage 2 of Prostate Cancer
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Palpalbe tumore confined to prostate with no distant metastasis
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Stage 3 of Prostate Cancer
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Tumor extending beyond prostatic capsule, with or without invasion of contiguous capsule, with or without invasion of contiguous organs but without distant metastasis
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Stage 4 of Prostatic Cancer -
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metastasis confined to pelvis or distant.
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Medical Treatment for Prostatic Cancer
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Watchful Watiing
Tumor may be slow growing , oldermen may not seek treatment under asumption that other ailments are morel ikely to kil them first Hormonal manipulation Estrogen Orchiectomy Radiation Brachytherapy Drug Treatment |
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Radiation used in Med Treatment for Prostate Cancer does what?
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Kills caner cells and/or prevents division and spreading
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Brachytherapy used in MedTreatment of Prostatic Ca is
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internal radiation with seeds
Radiation only goes to soft tissue in prostate lasts for a year |
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Drug therapy for Prostate Cancer Consists of 5 drugs
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Diethylstibestrol (DES)
Flutamide (Eulexin) Cyproterone (Androcur) Finasteride (Proscar) Zoladex Testosterone ablating agents |
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PC - Finasteride (Proscar)
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Androgen hormone Inhibitor, kills prostatic cancer cells
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Testosterone ablating agents - PC
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decrease release of pituitary gonadotrophins and dcreases serum testosterone levels
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Zoladex
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Hormone antagonist implanted under skin every 12 weeks that blocks substances needed for tumor growth
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Flutamide (eulexin) - CA
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FLutamide (Eulexin) antiandrogen agent causes adreanl androgen suppresion
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Cyproterone (Androcur) - PC
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Synthetic progesterone derivative, it inhibits androgens at the target cells. Lowers incidence of cardiovascular and sexual function side effects.
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Radical Prostatectomy
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Sx Treatment for Prostate Cancer
Removal of prostate and seminal vesicles |
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In a radical prostatectomy how will sexual function be reatained?
|
If nerve sparing techniques are used
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Rad Prostatectomy is usually limited to men who
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are in good health under 70
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Surgical Treatments for Stage 1 PC
|
Rdical perineal or retropubic prostatectomy
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Stage 2 Sx Tx for PC
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Radical pelvic lymph adenectomy and radiation therapy
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Stage 3 Sx Tx for PC
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Radical prostatectomy, pelvic node dissection, radiation, hormonal tx.
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Stage 4 Sx Tx for PC
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Hormonal Tx, radiation and chemotherapy
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Transurethral Prstatectomy
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PC surgery cystoscope inserted through urethra an dprostate removed
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Retropubic resection
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PC surgery - low abdominal incision but bladder not opened; foley inserted post-op
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Perineal Prostatectomy
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PC Sx. Incision made between scrotum and rectum
May remove adenomatous prostate tisue and adjacent tissue Lithotomy position during sx ill be impotent after sx |
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The two most common approaches for a radical prostatectomy are...
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Perineal prostatectomy and Retropubic
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Potential complications for PC Surgery
|
URinary Incontinence
Erectile dysfunction |
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Erectile dysfunction is caused by what? in PC Sx
|
Nerve bundles associated with erection are located just outisde top portion of gland
Hormone manipulation may result in loss of erectile funciton |
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Urinary Incontinence is caued from what? in PC Sx
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Damage to bladder neck and urethral sphinter metstasis
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After radical prostatectomy patient will have loss of ejactulation and emission secondary to
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removal of seminal vesicles and transection of vas deferens
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IF this is performed in PC sx, nerves at greater risk, anatomic differences may determine retention of erectile potency
|
Pelvic Node dissetion
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Nursing Interventions for PC Sx
|
Teaching about foley care, majority will be discharged with cath and may hve incontinence after foley removed
Bladder spasms may continue - uSe B and O supos Sexual dysfunction wil prob be one of their biggest concerns but the hardest to talk about. |
