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255 Cards in this Set
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What to ask when learning about patient's G/U problems?
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Onset of problem? Effect of problem? Pain? UTI history? Hesitancy/straining? dysuria? hematuria? nocturia? incontinence? History of renal calculi? anuria? Smoker? (increases risk of renal/bladder cancer) Alcohol drinker? Fever/chills?
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What are the elements of physical assessment for G/U?
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inspection
auscultation palpation (percussion?) |
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Where is the area of focus when assessing for G/U problems?
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abdomen
suprapubic region genetalia lower back |
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When perfoming a G/U exam, where should you inspect & what are you looking for?
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abdomen & flank regions
asymmetry, swelling, discoloration (bruising/redness) especially in costovertebral region |
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What are we listening for in G/U examination?
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sign of bruit over each renal artery (may indicate stenosis)
(mid-clavicular line) renal vessels best heard midway between xyphoid process & umbilicus--2cm from the midline |
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Can you palpate the kidneys?
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Not normally, but possible if diseased--painful for patient.
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What else can be detected in G/U exam?
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distended bladder (may need Foley catheter to take care of that problem)
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Why would you percuss the bladder?
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to assess for residual urine--
sounds dull if distended |
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If a pt has renal calculi, percuss the ___________ flank first.
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non-tender
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What does costovertebral tenderness suggest?
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kidney infection (pyelonephritis)
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creatinine is
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a protein produced by muscle and released into the blood
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serum creatinine measures
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muscle and protein metabolism
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Why is serum creatinine an excellent measure of kidney function?
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muscle mass and creatinine are usually constant--only renal disease raises creatinine levels
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What can elevate BUN?
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rapid cell destruction from infection, strenuous exercise (e.g. marathon), high fevers--things that cause you metabolize protein
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Is BUN a reliable measurement of kidney function? Why?
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No, other things besides diseased kidneys may raise BUN levels
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What is Blood Urea Nitrogen (BUN)?
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a byproduct of protein metabolism in the liver
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Why is the BUN/creatinine ratio helpful?
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Helps determine if it is a renal function problem or something else causing the elevation of BUN. With hypovolemia, BUN rises more rapidly than creatinine.
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Normal creatinine levels
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0.7-1.2 mg/dL
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Nephrologists view anyone with a constant creatinine level of 1.2 as .....
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"prerenal"
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Normal BUN range
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7-18 mg/dL
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Normal BUN:Creatinine ratio
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10:1 or 20:1
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What is estimated GFR?
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another good indicator of kidney function
on serum lab tests different values for blacks & whites |
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What are we looking for when inspecting a urine sample?
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color
odor clarity slight ammonia smell |
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specific gravity measures...
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the concentration of urine compared to water (1.0)
Urine specific gravity |
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How does the diet affect urinary pH?
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vegetables/certain fruits--alkaline
high proteins--acidic (important for recurring UTIs and renal calculi) |
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If blood glucose reaches a certain threshold, it may spill over into the urine. What is the threshold?
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> 220 mg/dL
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What is the single most important indication of renal disease?
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protein in the urine
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ketones are...
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products of incomplete metabolism of fatty acids; don't usually see them in the urine
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Why do we not normally see protein in the urine?
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proteins are larger in size, so the glomerulus does not let them seep out
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What types of sediment can be found in urine?
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cells, casts, crystals, bacteria
(could indicate infection) |
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microalbuminuria is detected by what test?
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immuno assay test
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Normal urine albumin levels
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2-20 mg/dL for men
2.8-8 mg/dL for women (dipstick begins to measure at 30 mg/dL, well above the normal range) |
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Why do a C&S (culture & sensitivity) on a urine sample?
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to see what organism is growing in the urine and what antibiotic will best treat it
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What does the 24 hour urine creatinine clearance test do for us?
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creatinine clearance test calculates the GFR
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What does GFR measure?
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the volume of blood cleared of endogenous creatinine in 1 minute
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What is the best indicator of overall kidney function?
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24 hour urine creatinine clearance
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24 hour urine creatinine clearance compares which creatinines?
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blood creatinine vs. urine creatinine
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Normal creatinine clearance range:
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0.6 to 1.8 g per 24h
90-139 mL/min--males 80-125 mL/min--females |
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Creatinine clearance of <10 mL/min is...
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criteria for dialysis
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When should a 24 hour urine test start? What urine is collected first?
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First thing in the AM when pt gets out of bed.
(FIRST voiding is not collected) |
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Where should urine be kept during 24 hr urine test?
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on ice
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Urine osmoloality measures...
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total # of particles in the urine (concentration)
Normal is 300-900 milliosmoles/kg in 24 hr period |
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What radiographic exams are done on the urinary system?
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KUB
IVP CT cystography |
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What does a KUB (kidneys, ureters, bladder x-ray) show?
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gross anatomic features
any obvious stones or strictures calcifications (stones, TB) obstructions shows physician shape & size of organs |
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What is IVP and what does it show?
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intravenous pylography
A series of x-rays follows the flow of an injected dye through the urinary system. Gives a better idea of urinary system outline and function--shows size, shape, adequacy uptake, strictures in K,U,B |
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Why be careful with contrast?
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contrast-induced renal failure is a risk, esp. in elderly, dehydrated, and people with renal insufficiency
(must know BUN & creatinine levels before doing an IVP) |
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What does CT show?
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a 3-D presentation of K, U, B, & surroundings
Can show renal calculi, tumors, obstructions, lacerations, & other abnormalities (pictures done in "slices," can be done without contrast medium if necessary, but not normal) |
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What is a cystourethography?
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An x-ray that takes pictures of the bladder while pt is voiding. Must have urinary catheter b/c dye is injected into bladder via catheter.
Done for recurrent UTIs (abnormality), injury, strictures of urethra, enlarged prostate |
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renal arteriography
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looks for damage to the blood vessels in the kidneys
(aneurysms, ruptured vessels) |
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What is important when caring for a post-op renal arteriography pt?
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Monitor for bleeding--puncture side, swelling/edema, peripheral pulses, warmth of extremeties
Encourage fluid intake. Keep pt prone with legs straight. |
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Why is a renal biopsy performed?
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to determine pathologic reasons for renal function
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Danger in performing renal biopsy?
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Bleeding--kidneys are very vascular.
Monitor coagulation pre-op. Monitor BP, urine (hematuria), HR Left kidney usually biopsied (closer to skin, not next to liver) |
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Renal ultrasounds use sound waves to detect abnormalities in the tissues & organs. Is this the normal method of checking for kidney stones?
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No, usually KUB, IVP are used--but it could be a first step in diagnosis
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Upper or lower urinary tract? What is infected?
Cystitis Prostatitis Pyelonephritis Urethritis |
lower--urinary bladder
lower upper lower--urethra |
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What predisposes one to UTIs?
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obstruction, calculi, age, gender, sexual activity, diabetes mellitus, DM, vesicouretral reflux, charicteristics of urine
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How does obstruction contribute to UTIs?
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causes incomplete bladder emptying, creating a medium for bacterial growth
(renal calculi, BPH-men, cystocoele/prolapse-females) |
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Pyelonephritis causes ____________ and can lead to ___________.
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scarring; renal failure
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Irritation of perineum and urethra promotes _____________ and spermicides can ___________
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migration of bacteria
alter urine pH |
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Bladder displacement during pregnancy redisposes to ...
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cystitis
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Why does diabetes mellitus predispose one to UTIs?
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excess glucose provides a rich medium for bacteria
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How does urine pH affect UTIs?
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alkaline urine promotes bacterial growth
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Cystitis can be caused by...
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bacteria, virusus, fungi, parasites (infectious)
chemicals, radiation (non-infectious) |
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Typically, an infection moves _____ the urinary tract.
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up
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Cystitis is not life-threatening, but infectious cystitis can lead to ________ and __________ , which are considered life-threatening.
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pyelonephritis
sepsis |
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Spread of infection from the urinary tract to the systemic circulation is termed....
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urosepsis
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What can urosepsis lead to?
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overwhelming organ failure, shock, death
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Is urosepsis common?
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Most common cause of sepsis in hospitalized pt is UTI
(incidence of UTI is 2nd only to upper respiratory infections in primary care) |
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Manifestations of cystitis
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frequency
urgency dysuria hesitancy low back pain incontinence nocturia burning pain Urine may be cloudy, have foul odor, or blood tinged Distension after voiding (incomplete emptying--predisposes to infection) |
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Diagnosis of UTI
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urinalysis--count bacteria, WBCs andRBCs
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What urinalysis findings constitute infection?
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presence of 100,000 colonies per mL
presence of WBCs |
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If obstruction or constriction is suspected, what screening tools may be used?
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urography
abdominal sonography computerized tomography cystoscopy |
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Drug therapy for cystitis:
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antibiotics (based on C&S and pt's reactions)--fluoroquinilones, cephalosporins, penicillin, sulfonamides
analgesics (for burning and pain associated with voiding)--pyridium (turns urine orange) antispasmodics antifungals |
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Interventions for cystitis
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Maintaining urinary elimination --voiding on urges, develop toileting routines
Dietary--drinking 8 oz with meals & between meals, no less than 2L, cranberry juice Warm sitz bath--ease of starting urinary flow Surgery, if necessary |
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Nursing responsibilities to treat/prevent bladder infection:
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Proper hydration--3L daily is optimal
Acid/ash diet--produce acidic urine--cranberry juice, meats, eggs, prunes, cranberries, plums, whole grains, vitamin C Administer meds, analgesics on time as ordered Wipe front to back, shower--don't bathe, cotton underwear, void before & after sex, no tight jeans, avoid feminine hygiene sprays and perfumed products Use strict, aseptic technique when inserting catheter |
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What is the cause of urethritis?
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males--usually STD
females--usually in post-menopausal women (low estrogen levels?) |
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Symptoms of urethritis
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similar to UTI. Also:
high frequency, low output pain--burning nocturia dark/cloudy urine strong "fishy" smell strong urge to urinate dull pain in back or abdomen general feeling of being unwell fever? |
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Definition of prostratitis
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inflammation of the prostate usually asssociated with urethritis and/or infection of the lower urinary tract
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Common bacterial causes of prostratitis
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e-coli
enterobacter |
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symptoms of prostratitis
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low back pain
urgency fever/chills dysuria urinary frequency |
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Tx of prostratitis
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antibiotics
oral anti-inflammatory agents prostatic massage Sitz baths |
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noninfectious urinary disorders
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urinary strictures
urinary incontinence urolithiasis bladder trauma urothelial cancer |
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What are urethral strictures?
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Narrowed areas of the urethra
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Causes of urethral strictures
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childbirth complications
catheterization trauma compliacations of STDs (more common in men) |
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Most common symptoms of urethral strictures
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obstruction of urine flow
painless, but urinary stasis can lead to UTIs |
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urethroplasty
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infected area removed or grafted to allow urinary passage
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urinary incontinence
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involuntary loss of urine severe enough to cause social problems
(not a normal consequence of aging/childbirth) |
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Is urinary incontinence commonly reported?
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very underreported due to stigma
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Why does urinary incontinence occur?
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pressure in urethra greater than pressure in bladder
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Forms of urinary incontinence
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stress incontinence--can't tighten urethra enough; must strengthen weakened pelvic girdle muscles
urge incontinence--inability to suppress the urge from the detrussor muscle overflow incontinence--failure of detrussor to respond by contracting (urine leaks out to prevent bladder rupture) mixed incontinence-- occurs more often in females functional incontinence--occurs with loss of cognitive function (e.g. dementia), unaware |
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Interventions for stress incontinence
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exercises--Kegel therapy (for females)
dietary--weight loss, avoid alcohol & caffeine drugs--estrogen (stress incont.), anticholinergics, antispasmodics, TCAs vaginal cone--a weight used to exercise pelvic floor muscles Also: psychotherapy, behavior modification, surgery |
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Interventions for urge incontinence
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drug--anticholinergics
diet--avoid diuretic foods (caffeine, alcohol) Space fluids throughout day, limit in evening Toileting routines (regular intervals throughout day) Bladder training; habit training Exercises--Kegel Electrical stimulation--stimulates muscles |
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Interventions for reflex incontinence
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drug therapies
Behaviour interventions: bladder compression (manually assist bladder in emptying) Valsalva maneuver--increases pressure Double voiding--go, stand, go again |
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Interventions for reflex incontinence
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Adult "diapers",
Urinary catheterization (pt doesn't realize that there is a socially acceptable place to empty bladder) |
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What is urolithiasis?
nephrotlithiasis? ureterolithiasis? |
presence of calculi in urinary tract
formation of calculi in kidneys formation of calculi in ureter |
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What % of people form renal calculi?
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10%
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If bilateral obstruction occurs from calculi...
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can cause acute renal failure
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hydronephrosis
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enlargement of kidney
irreversible, can cause permanent damage |
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Incidence of renal calculi is higher in ____, with the exception of _______ calculi
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men, struvite
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Most common type of calculus?
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Calcium
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Pain from renal calculi is the result of
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ureteral spasm--excrutiating
Damages urothelial lining--hematuria |
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If obstruction is not removed
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urinary stasis can lead to UTI, renal function impairment
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Factors that predispose to formation of calculi:
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urinary stasis
urinary retention immobilization dehydration Keep pt hydrated, & bladder emptied |
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Struvite calculi need a(n) __________ environment to form.
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alkaline
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Manifestations of urolithiasis
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renal colic (sudden, unbearable, pain)
N/V, pallor, diaphoresis frequency, dysuria--when stone reaches bladder flank pain--stone in kidney or upper ureter flank pain + abdominal/scrotal/vulvar radiation--stone in lower ureter or bladder Pain sharpest when stone is moving or urinary flow blocked; resolves when stone passes into bladder |
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Other symptoms of kidney stones (besides pain)
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hematuria
rust-colored appearance odor oliguria anuria (bilateral obstruction--leads to acute renal failure) |
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Obstruction of urine is a(n) __________; could lead to ________
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emergency; loss of kidney function
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Diagnostic assessment of renal calculi (besides obvious presentation)
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urinalisys--RBCs from damage to endothelial lining, WBCs from inflammation/infection
KUB--stone will show on x-ray; hydronephrosis Urogram--shows if urinary obstruction is present |
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Contrast dye can lead to ___________ so ____________is necessary
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acute renal failure
forcing fluids (to flush out the dye) |
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Most important intervention to patient with kidney stones
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pain relief--NSAID (ketorolac/toredol) or opioid given intravenously
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Nonsurgical interventions for urolithiasis
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pain relief meds
alternative therapy (visualization/relaxation) avoid overhydration (stone may just float in the kidney) extracorporeal shock wave lithotripsy (breaks up stones with sound waves) |
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Surgical interventions for urolithiasis
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Minimally invasive: basket to retrieve stone from ureter
or Open the kidney to remove large stone (struvite, e.g.) |
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Nursing responsibilities for kidney stone pt
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Take a good history
Monitor lab results (UA, WBCs--infection?) pain relief! Keep pt well-hydrated Save stones for lab if you catch any (strainer) Dietary changes? (decrease calcium: spinach, chocolate, juices, soft drinks, berries--oxylate) Citrates can decrease stone formation (lemonade) |
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Uric acid stones
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caused by a LOW acidic pH
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Taking a history on a renal calculi pt? Ask about:
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dietary habits,
risk factors (medications), past UTIs, gout, mobility status signs of infection/obstruction--fever, chills, N/V, pain/urgency/frequency/hesitation/incontinence with urination |
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Uterothelial cancers
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malignant tumors of the urothelium
usually occur in the bladders can be highly invasisve (metastatic) |
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Greatest risk factor for bladder cancer
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Smoking (4-7 times more likely)
Also other chemicals (chlorine byproducts) |
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Occupations at higher risk for bladder cancer:
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dry cleaning, paper manufacturing, apparel manufacturing, rope/twine making
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Tx for bladder cancer is dependent on...
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staging
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Signs of bladder cancer
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painless hematuria (pt may ignore this) is predominant sign
Cystoscopy is primary means for evaluating for cancer Also dysuria, frequency, urgency |
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Tx for bladder cancer
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biopsy for staging
chemotherapy/radiation therapy radical surgical removal Systemic chemotherapy with metastases |
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Causes of bladder trauma
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penetrations--stabbing, gunshot, fractures
blunt injury--compression of abdominal wall & bladder (e.g. seatbelt in car wreck) |
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Does bladder trauma require surgery?
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Yes, if other than simple contusion
Cystography will show defects in bladder filling Cystourethrogram will show bladder emptying (extravasation of urine) |
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How does chronic renal failure affect every body system?
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Fluid volume excess
Electrolyte and acid-base Accumulated nitrogenous wastes Hormonal inadequacies |
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Definition of acute renal failure
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a rapid decrease in renal function, leading to the accumulation of metabolic waste in the body
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Causes of acute renal failure
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Inadequate kidney perfusion
Damage to the glomeruli Obstruction |
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Categories of acute renal failure
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Prerenal azotemia
-Impaired or diminished renal blood flow Intrarenal ARF -Damage to filtering structures Postrenal azotemia -Obstruction in the flow of urine distal to the kidney |
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What is prerenal azotemia
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Pt has Impaired or diminished renal blood flow
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What is intrarenal Acute Renal Failure
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Damage to filtering structures
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What is postrenal azotemia?
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Obstruction in the flow of urine distal to the kidney
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Causes of prerenal azotemia:
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Hemorrhage, Shock, Sepsis, Anaphylaxis, Volume depletion, Pulmonary embolism, Pericardial tamponade, Congestive heart failure
(anything that dramatically reduces blood flow to kidneys) |
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Manifestations of prerenal azotemia:
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Hypotension
Tachycardia Lethargy Decreased urine output Decreased cardiac output Decreased central venous pressure |
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Characteristics of postrenal azotemia:
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Bilateral obstruction must occur
Obstruction results in elevated Bowman capsule pressure Urine production is impaired Azotemia develops |
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Characteristics of intrarenal failure:
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Acute tubular necrosis (ATN)
Accounts for 20-30% of ARF cases Nephron injury occurs Renal tubule - most common site of injury Recovery - minimum of 2 weeks Normal renal function may take 3-12 months |
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Manifestations of intrarenal failure:
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Oliguria or anuria
Edema/rales/crackles Hypertension Tachycardia Shortness of breath Jugular distention Elevated CVP |
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Phases of ARF
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Initiation Period
Oliguria Period Diuresis Period Recovery Period |
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Characteristics of Oliguric phase (in ARF):
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Increasing BUN & Creatinine
Hyperkalemia Metabolic acidosis Hyperphosphatemia Hypocalcemia Hypermagnesemia |
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Diagnostic Assessment in ARF
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↑BUN
↑Creatinine Abnormalities in serum electrolytes Urine specific gravity >1.020 (prerenal) & 1.010 in intrarenal failure X-ray to determine kidney size Renal ultrasound, CT, Renal biopsy |
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Interventions in ARF
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Drug therapy
+Diuretics +Fluid challenges +Calcium Channel Blockers +sodium polystyrene (Kayexalate) Diet therapy Dialysis Therapy Continuous renal replacement therapy |
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Nutritional Therapy for ARF
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High carbohydrate meals
Restrict potassium and phosphorus Prevent dehydration and overhydration |
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Indications for dialysis in ARF
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Uremia
Uremic pericarditis Persistent hyperkalemia Uremic encephalopathy Uncompensated metabolic acidosis Fluid volume excess unresponsive to diuretics |
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NAME THAT CONDITION:
Progressive, irreversible kidney injury Terminates in ESRD Mortality is 100% without dialysis or renal transplant Treatments are based on underlying cause |
Chronic Renal Failure
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In Chronic Renal Failure, Healthy nephrons compensate by _____________________.
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enlarging and increasing clearance capacity
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CRF Stages 1 & 2: _______________ Renal Reserve
Renal function decrease ________ No accumulation of ____________ Healthy kidney compensates ↓ ability to ____________ urine |
Diminished
50% metabolic wastes concentrate |
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CRF Stage 3: Renal ____________
Renal function ↓_______ Metabolic wastes begin ______________ Affected nephrons no longer compensate ↑Creatinine & ↑BUN are evidence of ↓GFR & ↓Creatinine clearance Urinary output indicates impairment of filtrate _________________ ability |
Insufficiency
75% accumulating concentration |
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CRF Stages 4 & 5: _______________
Renal function ↓ _______ Excessive amounts of _______________ Hypocalcemia worsens Erythropoietin levels are extremely ___________ ↑K+ levels & metabolic ____________ may be life threatening |
End-stage renal disease
90% nitrogenous wastes depressed acidosis |
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Manifestations of ESRD
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Fluid volume overload
Jugular vein distention Bounding pulses Rales in the lungs Peripheral edema Hypertension/Chest pain Osteodystrophy Anemia |
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WHAT METABOLIC IMBALANCE AM I?
Anorexia Tachycardia Nausea & Vomiting |
Hyperphosphatemia
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WHAT METABOLIC IMBALANCE AM I?
Seizures Numbness Carpopedal spasms |
Hypocalcemia
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WHAT METABOLIC IMBALANCE AM I?
Irritability Bradycardia Dysrhythmias Elevated T wave on EKG |
Hyperkalemia
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Drug therapy for ESRD includes:
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Diuretics
Erythropoietin Antihypertensives Phosphate binders Calcimimetic Agents Vitamin D supplement Vitamin B complex vitamins |
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Name 3 renal replacement therapies.
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Hemodialysis
Peritoneal Dialysis Renal Transplant |
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What 3 physical principles are used in dialysis?
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Osmosis
Ultrafiltration Diffusion |
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Water moves by concentration gradient in....
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osmosis
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Solution moves by pressure gradient in....
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ultrafiltration
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Solvent moves by concentration gradient in....
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diffusion
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____________ is the most common form of dialysis. It also provides the most ________ correction of abnormalities.
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hemodialysis
rapid |
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Hemodialysis uses a _____________ membrane is between the blood and ___________
Dialysate is pumped past the membrane in the _______________ blood flow Requires direct access to the patient’s ____________ via special intravenous catheters or vascular access |
semipermeable
dialysate opposite direction of bloodstream |
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Primary complications of hemodialysis
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Hypotension
Dysrhythmias Muscle cramps Hypovolemic shock Orthostatic hypotension |
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Nutrition for hemodialysis patient
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Increased protein
Fluid restriction Sodium restriction Potassium restriction Phosphorus restriction |
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Alternative to hemodialysis
Takes place within the peritoneal cavity Slower process for waste removal Semipermeable membrane in this process is the peritoneal membrane |
peritoneal dialysis
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Types of peritoneal dialysis:
CAPD CCPD IPD |
Continuous ambulatory peritoneal dialysis
Continuous cyclic peritoneal dialysis Intermittent peritoneal dialysis |
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Advantages of peritoneal dialysis:
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Self-management
Less restrictive diet Freedom from a machine Control over daily activities Avoidance of venipuncture Less restriction of fluid intake Less risk of blood pressure problems |
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Diet for peritoneal dialysis
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High-protein, well balanced diet
Increase daily fiber intake Limit carbohydrates in weight gain Potassium, sodium, and fluid restrictions not usually needed |
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Renal Transplant:
Alternative to _____________ in ESRD Primary limiting condition is ____________ of organs Refinements in ________ therapy and surgical _____________ have made transplantation a viable option Success is ____________ any other organ transplantation |
dialysis
availability immunosuppressive; techniques superior to |
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In kidney transplants, what outcome improves prognosis?
What does organ survival depend upon? What kind of medication will be necessary? |
Immediate functioning of organ
blocking recipient's immune response to transplanted organ anti-rejection medication |
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Immunosuppressive therapy for transplant recipients includes ________________.
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Prednisone (a Corticosteroid)
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manifestations of organ rejection
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Oliguria
Edema Fever Weight gain Increasing blood pressure Swelling or tenderness |
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Manifestations of infection following a kidney transplant:
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Shaking
Fever/chills Tachypnea Tachycardia Increase/decrease in WBCs indicating leukocytosis or leukopenia |
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Polycystic kidney disease:
___________ is the most common form (30s-40s onset) In ____________ the symptoms begin in the earliest months of life Acquired cystic kidney disease develops as a result of ____________ |
Autosomal dominant PKD
Autosomal recessive PKD long term kidney problems (kidney failure/dialysis) |
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PKD, one of the most common kidney disorders, is more common in what race?
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Caucasians
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What happens in PKD?
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Fluid filled cysts form in the nephron, causing kidneys to become grossly enlarged and displace other organs. The cysts are prone to infection and rupture.
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Is PKD painful?
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Yes, as the kidneys enlarge, it becomes quite painful.
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PKD manifestations
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pain in the back/side
renal calculi headaches UTIs hematuria cysts in kidneys and other organs heart valve abnormalities |
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Vascular cysts from PKD are called ______ cysts and may rupture in the ___________
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berry; brain
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Can you palpate the kidneys in PKD?
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You can due to their enormous size, but you should take care not to rupture a cyst
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How do we diagnose PKD?
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urinalysis (protein, blood, bacteria, WBCs)
renal sonograms CT scans MRIs |
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Tx for PKD
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control BP & other comorbidities
medicine & surgery for pain treat/avoid infection (antibiotics) will lead to ESRD, necessitating dialysis or transplant No cure! |
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Name 3 obstructive disorders:
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Hydronephrosis
Hydroureter Urethral Strictures |
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Describe hydronephrosis.
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an abnormal collection of urine in the renal pelvis; usually indicates an obstruction high in the ureter
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Describe hydroureter.
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obstruction of the lower part of the ureter (calculus, scar tissue, kink in the ureter, tumor)
permanent damage can occur of o |
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Describe urethral strictures.
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scars in or around the urethra (from surgery, disease, or injury
external pressure (rare) |
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Increased Risk for Urethral strictures
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Men with repeated STDs, urethritis, BPH
injury or trauma to pelvic region (even catheter induction) |
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Pyelonephritis
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a kidney infection (usu. bacterial) that has spread from the bladder (from a catheter, cystoscope, surgery, conditions such as kidney stones that prevent outflow from the bladder)
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What is the hallmark sign of pyelonephritis?
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costovertebral angle tenderness
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Why will the acutely ill patient with pyelonephritis need IV antibiotics?
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Due to risk of bacturemia
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Using your fist to rap the back at the costovertebral angle will result in ...
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severe pain for the pt with pyelonephritis
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Chronic pyelonephritis is characterized by:
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renal inflammation & fibrosis (from recurrent infections, vesicoureteral reflux)
most common in pts with anatomical anomaly long term complications: hypertension, renal failure, proteinuria, glomerulosclerosis |
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Manifestations of chronic pyelonephritis
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fatigue, fever, flank pain, dysuria, N/V,
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Interventions for chronic pyelonephritis
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ID & treat infections promptly
Monitor & control BP If renal impairment is present, increase fluid intake to prevent dehydration Dietary consult (protein restrictions?) Surgery (if predisposed to pyelonephritis) |
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Name 3 immunologic renal disorders.
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Acute Glomerulonepritis
Chronic Glomerulonepritis Nephrotic Syndrome |
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What is glomerulonephritis?
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a renal disease usually affecting both kidneys
inflammation of the glomeruli treatment depends on the pattern of infection |
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Acute glomerulonephritis is an immunologic triggered inflammation of glomerular tissue. Can damage kidneys.
What is the prototype? |
post-streptococcal glomerulonephritis
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What happens in glomerulonephritis?
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Infection causes glomeruli to swell & narrow. Protein & RBCs are allowed to exit the bloodstream & enter the urine.
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What is azotemia?
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Retention of excessive amounts of nitrogenous wastes in the blood.
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Manifestations of glomerulonephritis:
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hematuria, proteinuria (albumin), azotemia, hypertension (retention of renal sodium & water), edema in face & eyelids, assess for crackles, dyspnea/orthopnea, weight (fluid retention), fatigue, N/V if uremia is present
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Lab values for glomerulonephritis
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hematuria, proteinuria
decreased serum protein b/c protein is lost in urine fluid retention GFR is decreased percutaneous renal biopsy is done |
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Treatment for glomerulonephritis
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abx, diuretics, sodium/water restrictions, antihypertensive therapy, protein/potassium restrictions (prevent hyperkalemia), short term hemodialysis
diuresis usually occurs in days to weeks & GFR normalizes |
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Chronic glomerulonephritis
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irreversible & progressive glomerular & tubular interstitial fibrosis, resulting in a decreased GFR & accumulation of metabolic wastes
Can lead to CKD, ESRD & CVD, End result is HTN, small kidneys, and renal failure |
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What symptoms are often the only ones identified in chronic glomerulonephritis?
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Mild proteinuria, hematuria, HTN, and occasional edema
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Name some manifestations of chronic glomerulonephritis.
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nocturia, HTN, edema, signs of uremia (weakness, fatigue, loss of appetite, pruritis, tremors, seizures)
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The following assessment findings indicate _______________:
+hyperkalemia**, metabolic acidosis, hypocalcemia**, hyperphospatemia**, anemia**, hypoalbuminemia, mental status changes, impaired nerve conduction +Albumin lost in urine, reduced GFR +Elevated BUN (norm is 7-18 mg/dL), anemia, increased serum creatinine (norm is 0.6-1.2 mg/dL) |
glomerulonephritis
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What is nephrotic syndrome?
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a condition of increased glomerular permeability causing massive proteinuria, edema, and hypoalbuminemia
The bridge between CKD and ESRD Hypoalbuminemia leads to increased liver activity--lipid production, hypercoaguability, leads to proteinuria & further decline in kidney function Proteinuria causes |
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Primary features of nephrotic syndrome:
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proteinuria: > 3.5 g of protein in 24 h
hypoabuminemia: < 3g/dL of serum albumin edema lipiduria HTN Increased coagulation |
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Complications seen in nephrotic syndrome
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infection, thromboembolism, pulmonary emboli (from increased coagulation, acute, renal failure, and accelerated atherosclerosis)
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Medical mgmt of nephrotic syndrome
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diuretics, ACE inhibitors (to reduce proteinuria)
cyclosporin, corticosteroids, antineoplastic agents, immunosuppressants (to control immune response) |
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Nursing Responsibilities for pt with nephrotic syndrome
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Teaching diet therapy
Moderating protein (1 g protein/kg/day) Restricting sodium, potassium Vitamin replacement (calcium, Vit D) Encourage flu shot Teach to prevent infection Monitor I & O, weight, edema, electrolytes, signs of Pulmonary edema Ensure quality diet, adequate intake |
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nephrosclerosis is...
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a progressive disease resulting in hardening of small blood vessels in kidneys
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Nephrosclerosis is usually the result of
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HTN or diabetes
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2nd most common cause of ESRD in Caucasians (1st common cause in blacks)
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nephrosclerosis
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Treatment of nephrosclerosis aims at...
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reduction of BP (to preserve renal function)
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What is renovascular disease?
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a pathologic process affecting renal arteries, resulting in severe lumen narrowing & drastic reduction of bloodflow to kidneys
causing ischemia |
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Most common causes of renovascular disease?
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renal artery stenosis from atherosclerosis or fibromuscular hyperplasia
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Leading cause of ESRD?
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diabetic nephropathy
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In diabetic nephropathy, we must control
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protein intake, BP
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Can dipstick in urine detect protein in urine in diabetic nephropathy?
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Not until after progressive damage has already occurred
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What constitutes major renal trauma?
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Damage (lacerations) to the cortex, medulla, or renal vessels
Involves bleeding; Requires surgery |
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How do we detect extravasation of urine following kidney, ureter, or bladder injury?
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X-ray with contrast dye, CAT scan
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What does prostrate specific antigen show?
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Detects local progression and early recurrence of CA
PSA >10ng/mL indicates high probability of prostate cancer (norm is 4 ng/mL) |
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What is acid phosphatase level used for?
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helps diagnose and stage prostatic cancer
Normal 0.11-0.60U/L |
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What is the most important screening tool for prostate cancer?
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digital rectal exam
size, shape & constistency of prostate are examined |
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What organism causes prostatitis?
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Most commonly, E. coli.
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Prostitis is often associated with lower urinary tract symptoms and ______ discomfort or dysfunction
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sexual
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Most common urologic diagnosis in men younger than 50
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prostitis
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Manifestations of prostitis
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Urgency
Burning Nocturia Frequency Perineal discomfort Pain with/without ejaculation |
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Managing prostitis
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Antibiotics for 10-14 days
Analgesics for pain Bedrest helps alleviate symptoms Sitz baths for pain and spasm relief Stool softeners to prevent straining Avoid sitting for long periods of time |
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Definition of Benign Prostatic Hyperplasia
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enlargement or hypertrophy of the prostate gland
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One of the most common pathologic conditions in the aging male
Second most common cause of surgical intervention in males over age 60 |
BPH
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WHAT IS THIS CONDITION?
Nocturia Urinary frequency Dribbling at the end of urination Hesitancy starting urine flow Abdominal straining with urination Low excretion volume Recurrent urinary tract infection Increased frequency at night |
Benign Prostatic Hyperplasia
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Medications for BPH
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Medications
5-alpha reductase inhibitor finesteride (Proscar) Alpha-adrenergic receptor blockers Cardura Hytrin |
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Most common cancer in men
Second leading cause of cancer death |
Prostate cancer
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Most prostate cancers are what specific type of cancer?
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adenocarcinomas
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What is removed during a radical prostatectomy?
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prostate and seminal vesicles
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What are the negative consequences of radical prostatectomy?
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Impotence
Various degrees of urinary incontinence |
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Defn of erectile dysfunction (ED)
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inability to achieve or maintain an erection for sexual intercourse
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Tx of ED
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Lifestyle changes
Psychotherapy Prostheses Medication therapy Phosphodiesterase inhibitors Viagra Levitra Cialis Testerone |
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What is testicular torsion?
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Rotation of the testis which twist the blood vessels in the spermatic cord
It is a Medical emergency |
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Symptoms of testicular torsion:
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sudden testicular pain, nausea, lightheadedness, swelling of the scrotum
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Most common cancer in males ages 15-35
Second most common malignancy in males aged 35-39 |
testicular cancer
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Testicular cancer is usually ____________ and ___________ early, spreading to the __________ and the __________
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malignant; metastasizes; lymph nodes; lungs
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Testicular cancer is one of the most __________ solid tumors and is __________ bilateral
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curable; rarely
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MANIFESTATIONS OF testicular cancer:
Lump or swelling, Discomfort, pain, or feeling of heaviness in a ___________ Pain or dull ache in the____________ or lower ________ Enlargement of a _________, or change in the way it feels Sudden collection of fluid in the __________ Enlargement or tenderness of the ___________ |
testicle
back; abdomen testicle scrotum breasts |
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Tx of testicular cancer:
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Surgery (Orchiectomy)
Chemotherapy Radiation therapy |
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What is a Spermatocele?
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a sperm-containing cystic mass that develops on the epididymis alongside the testicle
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What is a Varicocele?
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a cluster of dilated veins posterior to and above the testes
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What is a Hydrocele?
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a cystic mass, usually filled with straw-colored fluid, forming around the testis
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What is Cryptorchidism?
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failure of the testes to descend into the scrotum
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What is Hypospadias?
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a congenital anomalie in which the urethral opening is a groove on the underside of the penis
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What is Epispadias?
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a congenital anomaly in which the urethral opening is on the dorsum of the penis
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Why is a breast self exam best performed after menstrual cycle begins?
(During days 5 to 7 counting the first day of the cycle as 1) |
Less fluid is retained at this time--easier to palpate a mass
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dialyzer
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dialysis machine ("artificial kidney")--contains a semipermeable membrane through which only particles of a certain size can pass
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urinary casts
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proteins secreted by damaged kidney tubules
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exchange (peritoneal dialysis)
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complete cycle of peritoneal dialysis; includes fill, dwell, and drain phases
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Protection of ___________ is a high priority for chronic hemodialysis patients
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the permanent dialysis access (fistula or graft)
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What is the most common and serious complication of peritoneal dialysis?
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peritonitis
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What is a suprapubic catheter?
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a urinary catheter that is inserted through a suprapubic incision into the bladder
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