Nursing Lecture Test 3

Front 1

What can urologic emergencies result from?

Back 1

Trauma or disease.

Front 2

What are two urologic emergencies?

Back 2

Urethral Obstruction (Blocked cat)

Acute Renal Failure (ARF)

Front 3

Define Urethral Obstruction

Back 3

The inability to urinate b/c of a blockage of the urethra.

Common in neutered male cats

Front 4

What are common causes of Urethral Obstruction?

Back 4

Uroliths (Urinary Stones)

Urethral Plugs

Front 5

Define Uroliths (Urinary Stones)

Back 5

Composed of very organized crystals of phosphate, urate, cystine, oxalate, etc

Front 6

What are two kinds of Uroliths?

Back 6

Struvite - magnesium ammonium phosphate

Calcium Oxalate

Front 7

Define Urethral Plugs

Back 7

Consist of a soft, compressible material that contains variable quantities of minerals, cells and cellular debris, and mucus-like protein (soft tissue)

Front 8

What are the factors that interact to produce uroliths and urethral plugs?

Back 8

Viruses, bacteria, diet, decreased water consumption, physical inactivity, urine retention, stress and urine pH may all contribute

Front 9

What are CS of Urethral Obstruction?

Back 9

1. May present alert or depressed, depending on the duration and degree of obstruction.
2. Stranguria - straining to urinate
3. Pollakiuria - incr freq in litter box
4. Hanging out in litter box - squatting
5. Hematuria - little tiny blood spots (not life threatening)
6. Owners may report "constipation"
7. Anuria and pain w/complete obstruction - no urine

Front 10

What can look similar to a blocked cat?

Back 10

UTI

Front 11

What are CS of Prolonged Urethral Obstruction?

Back 11

1. Depression
2. Pain - contracting stomach, "yowling"
3. Dehydration
4. Vomiting
5. Low body temp
6. Electrolyte imbalances

Front 12

What is the minimum database for the blocked cat?

Back 12

1. PCV/TS
2. Glucose and BUN
3. Electrolytes (Particularly K+)
4. Lead II ECG
5. Obtain urine

Front 13

What can happen b/c of the inability of the kidneys to excrete H+ and K+?

Back 13

Blocked cats can become hyperkalemic and acidotic

Front 14

If there are ECG abnormalities, we will want to treat them with...

Back 14

1. Sodium bicarbonate 0.5 - 1.0 mEq/kg over 15 mins.
2. 10% calcium gluconate 1-3 ml/cat IV SLOWLY
3. IV glucose 20% solution
4. With or w/o insulin (1 u per 3 g glucose administered)

Front 15

Why Sodium bicarbonate 0.5 - 1.0 mEq/kg over 15 mins?

Back 15

Corrects acidosis

Front 16

Why 10% calcium gluconate 1-3 ml/cat IV SLOWLY?

Back 16

Protects heart

Front 17

Why IV glucose 20% solution?

Back 17

Body will secrete insulin

Front 18

Why With or w/o insulin (1 u per 3 g glucose administered)?

Back 18

Will push K+ back into cells.

Front 19

What is the "unblocking" procedure?

Back 19

1. Carefully palpate the bladder and attempt to express urine.
2. An IV catheter is placed.
3. Fluid therapy is initiated.
4. Sedation is given.
5. Cat is positioned on its side or back depending on preference.
6. A tomcat catheter is passed carefully into the urethra.
7. If there is a significant blockage present, often flushing with pulsating motions will help to dislodge it.
8. Have patience, repeat process.
9. When the plug is dislodged, urine will flow freely into the catheter and the bladder can be emptied. Always send out sample to see what stone was present.
10. Often the urine that has been sitting in the bladder will be bloody and contain "grit".
11. When the bladder has been drained, it should be flushed until the solution runs close to clear.
12. When the bladder has been flushed, the Tom-Cat catheter is removed and a red rubber catheter is placed.
13. The red rubber catheter should be either a 3.5 or 5 French.
14. This catheter is sutured in place and attached to a urine collection system.

Front 20

After unblocking cats, what should be closely monitored?

Back 20

1. Temperature
2. Fluid rate
3. Physical Parameters
4. Urine Output
5. IV and urinary catheter maintenance.

Front 21

Should hospitalized cats wear an e-collar?

Back 21

Yes, once they recover from anesthesia, to prevent them from chewing at their urinary catheter.

Put it on while he is asleep.

Front 22

How long is the urinary catheter generally left in place?

Back 22

24-48 hours

The cat is maintained on IV fluids and urine output is monitored.

Front 23

How often is urine output monitored?

Back 23

Every two hours - need to make sure it's not obstructed.

Front 24

When are cats usually sent home?

Back 24

Not until they are urinating a steady stream on their own.

Front 25

What is the medical management/home care for a cat w/blocked tendencies?

Back 25

1. Low magnesium diet.
2. Feed diets that promote the formation of urine that is acidic for cats that produce struvite crystals.
3. Cats should always have clean, fresh water available - water fountains attracts cats to water.
4. Canned food provides more water than dry food.
5. Cats who have a hx of blocking should be monitored for UTI.
6. Provide an adequate number of litter boxes (usually one more than the number of cats in the household), and keep them clean.

Front 26

What is acute renal failure (ARF)?

Back 26

A sudden decrease in renal function.

Of sudden onset and is potentially reversible, depending on the degree of damage to the kidneys.

Occurs when approximately 3/4 of the nephrons of both kidneys cease to exist.

Front 27

Chronic renal failure

Back 27

Has been present for months to years and is irreversible.

Cannot be cured, but the CS may be managed to help maintain a reasonable quality of life.

Front 28

What are the causes of Acute Renal Failure (ARF)?

Back 28

Prerenal

Intrinsic renal

Postrenal

Front 29

Prerenal (ARF)

Back 29

A functional consequence of reduced blood flow to the kidneys.

1. Prerenal azotemia is reversible w/restoration of adequate renal perfusion, if not, can progress to ARF.
2. Possible causes: dehydration, heart failure, anesthesia, hemorrhage.
3. These animals can concentrate their urine.

Front 30

Intrinsic Renal (ARF)

Back 30

Results from damage to the cellular structure of the kidney by ischemic or toxic events.

1. Ischemic - shock, decreased cardiac output, renal thrombosis
2. Nephrotoxins - ethylene glycol, antibiotics such as cephalosporins and aminoglycosides, snake venom
3. Causes - Leptospirosis and bacterial infections including pylonephritis.
4. These animals are often isosthenuric (SG=1.007-1.017) and oliguic.

Front 31

Postrenal (ARF)

Back 31

Obstruction of the outflow of urine from the animal

1. Possible causes - urethral obstruction, bladder tumor, ureteral obstruction, ruptured urinary tract.
2. These animals are often anuric.

Front 32

ARF CS

Back 32

1. Anorexia
2. Vomiting
3. Listlessness (Lethargy)
4. Diarrhea
5. Oliguria (Low prod of urine), anuria or polyuria (depending on cause)
6. Azotemia & dilute urine
7. During PE, one would expect to find a normal body condition and hair coat.

Front 33

ARF Diagnosis

Back 33

1. CBC
2. Chem Screen
3. Urinalysis
4. Urine culture should be run if cause is not obvious.
5. Ethylene glycol test if there is a possibility of exposure.
6. Lepto titers
7. Renal biopsy will confirm a dx of ARF and may establish a cause.

Front 34

Clinical Course of Disease (ARF)

Back 34

1. Initiation Phase
2. Oliguric Phase
3. Polyuric Phase
4. Phase of Functional Recovery

Front 35

Clinical Course of Disease (ARF) - Initiation Phase

Back 35

The time from renal insult until the recognition of decreased GFR, decreased urine output and azotemia.

This phase lasts 1-2 days.

Front 36

Clinical Course of Disease (ARF) - Oliguric Phase

Back 36

Happens to about 90% ARF patients

Many patients die or are euthanized b/c of poor prognosis during this phase.

Hyperkalemia is a concern during this phase

For patients that do ultimately recover, the oliguric phase lasts 1-2 weeks

Front 37

Clinical Course of Disease (ARF) - Polyuric Phase

Back 37

Characterizzed by a progressive increase in urine production in patients who were initially oliguric.

This phase may indicate the beginning of renal repair and the return of function.

Dehydration is a major concern during this phase and fluid therapy must be diligently managed.

The length of this phase is variable (days to weeks)

Front 38

Clinical Course of Disease (ARF) - Phase of Functional Recovery

Back 38

Has neither a clearly defined beginning or end.

BUN, creatinine and urine volume gradually return to normal.

Concentrating ability is the slowest to return.

Permanent residual damage may become evident at this point.

Some ARF patients progress to CRF.

Front 39

ARF Treatment

Back 39

Vary in each case depending on the initial cause

If the underlying cause is identified, it is treated directly.

1. Fluid Therapy
2. Drug Therapy
3. Nutritional Support
4. Hemodialysis & Peritoneal Dialysis

Front 40

ARF Treatment - Fluid Therapy

Back 40

Should be replaced in 8-12 hours; balanced, isotonic crystalloids are generally OK

1. Initial therapy - LRS, Normosol-R, Plasmalyte, 0.9% NaCl
2. Maintenance - Maintenance therapy and continuing losses replaced over 24 hours. "Ins and Outs" should be carefully monitored.
3. Correct electrolyte imbalances
4. Treat hyperkalemia if severe.
5. Treat sustained acidemia if SEVERE (pH<7.15)

Front 41

ARF Treatment - Drug Therapy

Back 41

1. Treat with anti-emetics (vomiting) - Reglan
2. Treat with H2-blockers (decrease GI acid production - famotidine, ranitidine
3. Diuretics - Lasix
*****ALL REQUIRE DOSING ADJUSTMENT WITH RENAL FAILURE****

Front 42

ARF Treatment - NUTRITIONAL SUPPORT

Back 42

1. ANIMALS THAT CAN BE FED ORALLY SHOULD RECEIVE A RENAL DIET.
2. ANORECTIC AND VOMITING PATIENTS CAN BE GIVEN TPN (TOTAL PARENTAL NUTRITION) IF VERY SICK OR PPN (PARTIAL PARENTAL NUTRITION)

Front 43

ARF Treatment - Hemodialysis & Peritoneal Dialysis

Back 43

Available at some university hospitals.

Peritoneal Dialysis - while trying to correct actual issue.

Front 44

Stats on ARF Prognosis

Back 44

ARF patients have a 50% chance of survival

1. Lily toxicity cats - 20% survival
2. Ethylene Glycol - 1% survival
3. NSAID toxicity - 50-60% survival
4. Lepto - 75-85% survival

50% of patients that do survive will have clinically significant chronic renal dysfunction.

CURE is renal transplant

Front 45

What is the name for renal failure associated with recalled pet foods?

Back 45

MARF - Melamine Associated Renal Failure