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89 Cards in this Set

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What is it called when a UTI spreads into the blood?
Urosepsis. It's life-threatening.
What type of UTI causes fever?
Pyelonephritis.
What is a complicated UTI?
A pt that also has obstructio, stones, cathetar, DM, neuro disease, pregnancy, or recurrent infection.

Places pt at high risk for urosepsis.
What is the difference b/w unresolved bacteriuria and bacterial persistence?
Unresolved bactururia is when the antibiotic agent does not achieve adequate concentration in the blood or is DCed too soon.

Bacterial persistence is when the bacteria develop a resistance or when foreign body in urinary system serves as a harbor.
What causes women to be at higher risk for UTI?
Menopause b/c lower estrogen levels cause an increase in vaginal pH, allowing bacteria to grow.
What pH maintains the antibacterial characteristics of urine?
<6.0
What is the most common hospital acquired infection?
Catheter-acquired UTI's b/c of development of bacterial biofilms on the inner surface of the catheter.
How do women do a clean catch urine specimen?
Spread labia, wipe front to back with moistened clean gauze sponge.

NO ANTISEPTIC. CAUSES FALSE POSITIVES.
How do older adults show symptoms of UTI?
Abdominal discomfort, cognitive impairment, slight decline in temp
What do we use to initially treat UTIs?
Trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrim)

nitrofurantoin (Macrodantin)

Long-term use of nitrofurantoin can result in pulmonary fibrosis and neuropathies. Pt should notify PCP if fever, chills, cough, chest pain, dyspnea, rash, or numbness or tingling of fingers or toes develops. Avoid sunlight.
What nonpharmacologic techniques can we use for UTI's?
Heating pad to suprapubic area or lower back, warm showers
What foods/drinks should a person with UTI avoid?
Caffiene, alcohol, citrus juices, chocolate, highly spiced foods (bladder irritants)

Pt should drink 8ml of unsweetened cranberry juice or 300-400mg of extract tablets/day
What is the biggest facter for acute pyelonephritis?
Pregnancy
How long is a person with acute pyelonephritis treated with antibiotics?
2-3 weeks

S/S resolve in 2-3days
What is the complication of interstitial nephritis?
ESRD

Interstitial nephritis is when the kidneys have become small, atrophic, and shrunken due to scarring and fibrosis.
What teaching should we do with the urethritis pt?
Warm sitz baths. Avoid sexual intercourse.
What causes urethral diverticula?
Trauma from childbearing, urethral instrumentation, dilation, infection with gonnorrhea.
What are the symptoms of urethral diverticula?
Anterior vaginal wall mass that is tender and expresses purulent discharge through the urethra.

Lower UTI symptoms.
What is interstitial cystitis?
Autoimmune attack of bladder mucosa. Dx of exclusion.

Avoid bladder irritants, take calcium phosphorus (Prelief) to alkalinize the urine to provide relief from irritating effect of certain foods.
What exacerbates interstitial cystitis?
Stress, bladder irritants.
What med is the only med approved for interstitial cystitis?
Pentosan. Enhances glycosaminoglycan layer of the bladder. Takes 2-3 weeks to work.
SIDE EFFECT IS BLEEDING!! IT IS RELATED TO HEPARIN!!

Give opiods for immediate relief. Amitriptyline (Elavil) and nortriptyline (Aventyl) to reduce burning pain and urinary frequency.

Instil DMSO in to bladder.
What herbal supplements are bladder irritants?
High potency vitamins.
What is the first sign of renal TB?
Symptoms of UTI.
What is glomerulonephritis?
Inflammation of the glomeruli from autoimmune (SLE, scleroderma, strep)
What are the clinical manifestations of acute poststreptococcal glomerulonephritis?
Generalized body edema, HTN, oliguria, rusty/smoky/bloody looking urine, proteinuria.

Most pts with this recover completely.
What dx tests are suggestive of poststreptococcal glomerulonephritis?
antistreptolysin-O titer, erthrocyte casts
How do you treat poststreptococcal glomerulonephritis?
Rest, Na and H2O restriction, diuretics, antihypertensives, adjustment of dietary protein levels
What is Goodpasture syndrome?
Rare autoimmune disease that causes damage to kidneys and lungs. Probably due to the flu, hydrocarbons, penicillamine, or genetic factors.
What is the biggest risk factor for Goodpasture syndrome?
Being a young, male, smoker.
How is Goodpasture syndrome treated?
Chemo drugs, plasmapheresis, dialysis, kidney transplant
What is the normal serum level for albumin?
3.5-5.0
What is nephrotic syndrome?
When the glomerulus is excessively permeable to proteins causing low plasma albumin and tissue edema.

Can be due to inheritance, SLE, DM, amyloidosis, infection, cancer, allergens, drugs like penicillamine/NSAIDS/captopril/heroin
What are the S/S of nephrotic syndrome?
HTN, hyperlipidemia, decreased serum albumin/protein, proteinurea, anasarca
Why do people with nephrotic syndrome have hyperlipidemia?
Dimished plasma oncotic pressure from decreased serum proteins stimulates hepatic lipprotein synthesis.
What are the complications of nephrotic syndrome?
Thrombus, infection (due to malnourishment)
What is the most important nursing intervention for nephrotic syndrome?
Edema related.

Daily weights, I&O, measure abdominal girth, careful skin care, monitor effect of diuretic therapy.
What is trabeculation?
When the bladder neck get obstructed, the bladder hypertrophies to squeeze the pee out, then it can't compensate anymore and the muscle bundles separate.

Area between the muscle bundles is called cellules.

Then b/c they have no muscle support they form diverticula where pee gets trapped and infected.
What is nephrolithiasis?
Kidney stones
Who gets nephrolithiasis most?
Whites with a family hx
What contributes to the formation of struvite stones?
Bladder infection with Proteus, Klebsiella, Pseudomonas, and some staphylococci cause the urine to become alkaline and form struvite (magnesium ammonium phosphate) stones

Women usually get these.
What risk factors lead to kidney stones?
Warm climates (b/c it causes dehydration and urine concentration)

Diet (tea/fruit juice, lg intake of protein/Ca, or low fluid intake)

Genetic

Lifestyle (Sedentary occupation, immobility)
What causes calcium oxalate stones? How do you treat them?
Usually men with too much calcium or oxalate (tea/fruit juice) in the diet.

Hydrate.
Reduce dietary oxalate.
Give thiazide diuretics and cellulose phosphate to chelate the Ca.
Give K citrate to maintain alkaline urine.
Give cholestyramine to bind oxalate.
Give Ca lactate to precipitate oxalate in GI tract.
Reduce daily Na intake.
How do you treat struvite kidney stones?
Antibiotics for the UTI, Acidify urine. Sx.
Who gets uric acid stones and how do you treat them?
People with gout, acid urine. Usually Jewish people.

Alkalinize urine with K citrate. Administer allopurinol.
Reduce dietary purines.
What foods acidify the urine?
Cheese, corn, cranberries, eggs, fish, grains, lentils, meats, nuts, pasta, plums, poultry, prunes, rice
What foods alkalinize the urine?
All fruits except cranberries, prunes, and plums.

All veggies except corn.

Milk.
What foods contain purines?
Beer, other alcoholic beverages.

Anchovies, sardines in oil, fish roes, herring.

Yeast.

Organ meat (liver, kidneys, sweetbreads)

Legumes (dried beans, peas)

Meat extracts, consomme, gravies.

Mushrooms, spinach, asparagus, cauliflower.
What are the symptoms of kidney stones?
Dull costovertebral pain, renal colic, cool, most skin, groin pain
What do you want to avoid in pts with renal failure?
IVP, contrast
What inhibits the chemical action of Proteus, Klebsiella, Pseudomonas, and staph?
Acetohydroxamic acid. Good for retarding the formation of struvite stones.
How do you prevent stones in an immobile pt?
Turn q2hr, hydrate
Nursing intervention for kidney stone pt: What do you have them do with their pee?
Strain it, have them ambulate
What is a urethral stricture?
result of fibrosis or inflammation of the urethral lumen from trauma, gonorrhea, repeated catherizations.
What are the clinical manifestations of a urethral stricture?
Diminished force of urinary stream, straining to void, sprayed stream, postvoid dribbling, split urine stream.
How do you treat urethral strictures?
Progressively enlarging stents (filiforms and followers)

Teach pt to dilate the urethra by self-catheterization using a soft, red rubber tip catheter every few days.
What effect does HTN have on the kidneys?
Nephrosclerosis
What do we suspect if a pt with no hx of HTN suddenly gets HTN, especially when they are younger than 30 or older than 50?
Renal artery stenosis
What is Polycystic kidney disease? What are the nursing interventions?
Autosomal dominant in adults (recessive in kids)

kidney filled with cysts that enlarge and compress surrounding tissue

prevent uti, prepare for nephrectomy, diet modification, fluid restriction, antihypertensives
What is Alport syndrome?
Chronic hereditary nephritis.

hematuria, sensorineural deafness, deformities of anterior surface of the lens

defect in the gene for collagen, resulting in altered synthesis of GBM

supportive tx/kidney transplant
What is the most significant risk factor for the development of renal carcinoma?
Cigarette smoking
What are the risk factors for bladder cancer?
Cigarettes, dyes in ruber and cable industries, abuse of phenacetin (an old analgesic)

Cytoxan

cervical cancer tx
What are the symptoms of bladder cancer?
Painless hematuria
What color should urine be after bladder surgery?
Light pink. 7-10 days later it should be dark red or rust colored b/c the scabs are coming off.
What nursing interventions do you do after bladder sx?
Give opioid analgesics and stool softeners
Encourage 15-20 min sitz baths 2-3x/day
What is intravesical therapy?
Have pt empty bladder, chemo (Thiotepa or BCG) is instilled in the bladder. Have pt change position q 15 min so chemo gets all over the bladder.

May get flu-like symptoms, but you don't get the typical chemo symptoms.
What preop management does the nurse do for renal surgery?
Have pt drink enough fluids, check electrolyte balance, place pt in hyperextended, side-lying position.
What postop intervention does the nurse do after renal sx?
Measure urine output and record q 1-2hours

Don't clamp or irrigate the catheter without an order.

Assess urine drainage on the dressing and estimate the amount

Daily weights

Keep pt NPO until bowel sounds/flatus

Mucous in urine is normal

Keep urine acidic to prevent alkaline encrustations
How does the pt take care of a Kock, Mainz, Indiana, or Florida pouch?
These are continent urinary diversions, so they will catheterize q 4-6 hours and wear a small bandage over the stoma. Irrigate daily.
Major risks of bladder sx
Thrombophlebitis, paralytic ileus
Care of an ileal conduit
Change appliance when fluid intake has been restricted for several hours
What is azotemia?
Accumulation of nitrogenous waste products (BUN/creatinine)
What is a prerenal kidney injury?
Something causing a reduction in renal blood flow. There is no damage to the kidney tissue.
What is intrarenal kidney damage?
Direct damage to the kidney tissue.

Ex. nephrotoxins, hemolyzed RBC's, myoglobin released from necrotic muscle cells.
What is the most common cause of intrarenal acute kidney injury?
Acute tubular necrosis.

Risks for ATN include: major surgery, shock, sepsis, blood transfusion reaction, muscle injury, prolonged hypotension, nephrotoxic agents.
What is a postrenal kidney injury?
Some sort of mechanical obstruction in the outflow of the urine.

Bilateral ureteral obstruction leads to hydronephrosis (kidney dilation).
What are the 3 stages of acute kidney failure?
Oliguric, diuretic, recovery
What is the RIFLE classification for staging acute kidney injury?
Risk - serum creatinine x1.5; GFR decreased by 25%, urine output <0.5ml/kg/hr for 6 hr

Injury - Creatinine increased x2; gfr decreased by 50%; urine output <0.5 ml/kg/hr for 12 hour

Failure - Creatinine increased x3; gfr decreased by 75%; urine output <0.3ml/kg/hr for 24 hr of anuria for 12 hr

Loss - persistent acute kidney failure; complete loss of kidney function >4wk

End-stage kidney disease - complete loss of kidney function >3mo
What are the characteristics of urine in the oliguric phase of acute renal failure?
Specific gravity fixed at around 1.010 and osmolality at 300 mOsm/kg, casts, WBCs, RBCs

Same specific gravity and osmolality as for plasma, reflecting tubular damage with a loss of concentrating ability by the kidney.
What is the characteristic of the blood in the oliguric (1st) stage of acute kidney failure?
Metabolic acidosis b/c the kidneys cannot synthesize ammonia which is needed for hydrogen ion excretion.

Damaged tubules can't conserve Na, so hyponatremia.

Can't excrete K, so hyperkalemia.
What happens to respirations in metabolic acidosis?
Kussmaul respirations
What are the characteristics of an EKG in hyperkalemia?
Peaked T waves, widened QRS complex and ST segment depression.
What is the best indicator of kidney damage?
CREATININE!!

BUN may increase from dehydration, corticosteroids, catabolism resulting from infections/fever/severe in jury/GI bleeds
What neurological sign do you see in the oliguric phase of acute renal injury? (1st phase)
Asterixis from nitrogenous waste accumulation.

(Flapping tremor of hands)
What is the 2nd phase of acute renal failure?
Diuretic phase where hypovolemia and hypotension can occur from massive fluid losses. High urine volume of 3-5L/day is caused by inability of tubules to concentrate the urine. Kidneys have recovered ability to excrete wastes, but not concentrate the urine.
What do you watch for in the diuretic (2nd phase) phase of acute kidney injury? How long does it last?
Hyponatremia, hypokalemia, dehydration. 1-3weeks.
What diagnositic test do you NEVER allow with kidney failure pts?
MRI or MRA. Gadolinium (the contrast agent) causes nephrogenic systemic fibrosis (cutaneous hyperpigmentation, induration and joint contracutres, fibrosis in other organs)
How do you calculate fluid intake in the oliguric phase of acute renal failure?
Losses for past 24hrs + 600ml for insensible losses = fluid allocation for the next day
How do we treat hyperkalemia?
Regular Insulin with glucose (to move K in to the cells)

Sodium Bicarbonate (to correct acidosis and cause a K shift in to cells)

Ca Gluconate (Ca raises threshold for excitation resulting in dysrhythmias)

Dialysis (Most effective)

Kayexalate (1mEq K exchanged/gram of drug. Causes osmotic diarrhea)

Dietary restriction (limit to 40mEq/day)
What are important nursing interventions for acute renal failure?
Daily weights, mouth care (to prevent stomatitis from excess ammonia in the saliva)