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55 Cards in this Set
- Front
- Back
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What is cystitis?
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Inflammation of the urinary bladder caused from kidney stones, urinary stasis, lack of good hygiene
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What are the s/s of cystitis?
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Urinary frequency, urgency, bladder spasms, painful urination, nocturia, hematuria can develop; elderly - confusion and lethargy if sepsis
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What is nocturia?
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Urinating more than one time at night
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What is pyelonephritis?
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Inflammatory condition affecting the renal pelvis that can lead to renal failure; infection of the kidney from bacterial invasion usually from the ureters, but can be blood born; also caused from stones and reflux of urine; common organism that causes is E. Coli
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What are the s/s of pyelonephritis?
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Acute s/s: high fever, chills, malaise, NV, dysuria, severe pain or a dull ache in the flank area
Chronic s/s: more insidious and causes gradual scarring of kidney tissue (scarring can cause atrophy of the kidneys then ischemia in the kidneys); low grade fever, weakness, bacteria and pus in the urine |
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What is the nsg care for pyelonephritis?
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Increase fluids, monitor I&Os, monitor urine character and color, vital signs, IV fluids, promote comfort
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What is the medical tx for pyelonephritis?
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Prompt tx with antibiotics, remove obstruction, bed rest, analgesics, antipyretics to decrease fever, salt and protein restriction if chronic
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What is acute glomerulonephritis?
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Inflammatory condition that affects the glomerulus; can occur 2-3 weeks after a group A beta-hemolytic strep infection (strep throat, impetigo); systemic disease, antigen anti-body reaction, systemic disease process (Lupis); glomerular membrane becomes more permeable allow blood and protein to enter the filtrate
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What are the s/s for acute glomerulonephritis?
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Elevated BUN and serum creatinine, proteinuria, smoky or tea colored urine (blood in urine), periorbital edema, facial puffiness, generalized edema in the extremities, GFR decreased, increased BP, generalized of wide spread edema (usually face first), anemia-low RBCs, fever, chills, flank pain
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When a pt has acute glomerulonephritis, what lab levels will be elevated?
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BUN and serum creatinine
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What is the medical tx for acute glomerulonephritis?
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Diuretics, antihypertensives, antibiotics, bed rest in acute phase, low protein, high carb diet, limit fluids if oliguria or anuria, Na and K might be restricted or limited, fluids restricted
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What is the nsg care for acute glomerulonephritis?
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Bed rest until feel better, good skin care, vital signs checked frequently (BP, P, T), daily wts - accurate indicator of fluid volume, pt teaching about importance of diet restriction, monitor accurate intake and output, monitor IV fluids, check breathing patterns due to fluid overload **Wts and I&Os are priority!** Monitor cardiac status for failure or pulmonary edema - SOB, cyanosis, restlessness
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When does acute glomerulonephritis most often occur?
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Usually following an infection with group A beta-hemolytic strep (such as strep throat, impetigo)
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What is BUN (blood urea nitrogen)?
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Evaluates kidney function; a general indicator of a kidney's ability to excrete urea; main protein of amino acid metabolite excreted
Increased in renal failure, high protein diet, dehydration, diuretics, etc. |
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What is the nml range for BUN?
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5-20 mg/dl, slightly higher in older adults
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What is serum creatinine? (blood test)
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A waste product of skeletal muscle breakdown; increases in renal disorders
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What is the nml levels of serum creatinine?
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Nml is 0.4-1.2 mg/dl
Females - 0.5-1.1; Males - 0.6-1.2; slightly lower in older adults |
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What is the nml urine pH?
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4.5-8.0
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What is the nml specific gravity of urine?
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1.005 - 1.030
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What is the diagnostic test IVP?
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Intravenous pyelogram; uses an iodine dye for contrast; several xrays are taken as the contrast passes through the kidneys, ureters, bladder
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What are the nursing implications for the test?
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Ask pt whether they have any allergies to shellfish or iodine; they have to be NPO and they have to have permit signed since invasive; clear liquids only 8 hrs prior
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What is a cystoscopy? Purpose?
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Invasive procedure used to dx or for tx; use direct visualization with scope into the urethra, bladder, and ureters; dx lesions, any type of abnormal bleeding; go in with scope and can take biopsy
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What is BPH?
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Enlargement of the prostate gland; benign prostatic hyperplasia
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What are s/s of BPH?
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None unless the urethra is pressed; then difficulty urinating, decreased force of urinary stream, hesitancy, dribbling after voiding, nocturia
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What 2 tests are very important to detect cancer of the prostate?
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Digital rectal exam/Transrectal ultrasonography of the prostate - to look for nodules, tenderness
Prostatic Specific Antigen (PSA) - glycoprotein produced by prostate, tested in blood, elevated only in prostate disease and prostate cancer. If above 10, suspicious of prostate cancer, if BPH then levels rarely rise over 10 |
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What medications are used to tx BPH?
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Alpha-adrenergic antagonists such as minipress - to prevent vasoconstriction
Flomax/Cardura - relax smooth muscle to improve urinary flow Anti-androgen agents - (Proscar) to slow or stop the growth of prostate tissue, suppresses testosterone production Estrogen - to suppress testosterone |
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What is TURP?
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Transurethral Prostatic Resection - part of the gland is removed by way of urethra, using an endoscope; no incision is made, used to tx BPH
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What is pre op and post op care for prostate surgery?
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Pre op - enema as ordered, maintain urinary flow, indwelling cath may be necessary; accurate I&Os, pre and post op routine - explanation of care post-op such as catheter, drains, irrigation system, VS, care of incision; pt teaching - deep breathing and leg exercises
Post op care - Irrigation system - CBI, deep breathing, prevent blood clots, VS, TCDB, monitor drsg, observe for complications (bleeding, hemorrhage (occurs most frequently 24 hrs post op), bloody urine, blood in catheter is viscous, clots, decreasing urinary output, complaint of bladder spasms, H&H may decrease) |
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What is CBI?
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Continuous bladder irrigation system - has 3 way catheter (one to foley, one to irrigation solution, and one from bulb inflation); can adjust the flow rate to keep urine red pink to pink tinged in color
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What does the nurse need to monitor for when caring for a pt with a CBI?
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Monitor for complications of hemorrhage possible usually in the first 24 hrs post op, report persistent bleeding or bright red bleeding with many clots to physician, report changes in BP, rising pulse, increased respirations; if c/o pain and bladder spasms and no urine draining from catheter, means clots obstructing cath, irrigate and increase solution flow rate; monitor voiding after cath is removed, monitor for bladder distention, monitor pain and admin analgesics, admin drugs for bladder spasms (Ditropan, B&O suppository)
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What are common symptoms of bladder cancer?
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Painless bleeding/hematuria - most common initial manifestation, urgency, dysuria, frequency
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What is a cystectomy?
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Surgical removal of the bladder with urinary diversion
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What is an ileal conduit (urinary ileostomy, ileal loop, Bricker's procedure)?
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A portion of the ileum is formed into a pouch, ureters are inserted into the pouch and open end is brought to surface to form stoma, requires a urine bag
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What is the pre op and post op care for a pt with a urinary diversion?
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Pre Op - paperwork signed, notify pt of post op what to expect
Post Op - monitor for hemorrhage, infection; careful I&Os, characteristics of urine - pinkish color first day and clear by the third post op day; should not be any foul smelling urine; protect skin; emptying bag when it is 1/3-1/2 full; use larger collection device at night; care of stoma bag and skin care; wash and soak bag in white vinegar diluted solution; use 1/2 vinegar and 1/2 warm water to remove crystals around stoma, if no stones clean with warm soapy water; prevent odor (inc fluid, good hygiene); provide pt teaching on self catheterization |
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What are the causes of renal stones?
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A very high concentration of salts in the urine and this can cause crystals
Causes of renal stones - urinary infections, inadequate fluid intake, bed rest, high levels of urate in the urine, super saturation of urine with crystalloids and salts |
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What are the s/s of renal stones?
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Severe pain in the flank area over the affected kidney and ureters, may have NV, blood in urine, renal colic (waves of severe agonizing pain), feeling of frequency but not really having to go due to the pressure of the stone
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What is nsg care for pt with renal stones?
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Assess pt's at risk (family hx, males are at increased risk, immobilized pt, pts with recurrent UTIs), admin analgesics, antibiotics, antispasmodics, increase fluids (3000-4000 cc/day), strain all urine so that we can collect stone so that they can send them to lab and see what kind of stone it is, what caused it, and the type of tx and diet restrictions they may need; assess characteristics of urine, VS, I&Os, maintain adequate drainage of urinary catheter, want them to be ambulatory, pt teaching on diet and preventing UTIs
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What are the medical tx for renal stones?
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Analgesics, antispasmodics (for bladder spasms), increase fluid intake to flush stones, antibiotic therapy to prevent infection or if there is an infection, cystoscopy (scope inserted in urethra to take out stone), lithotripsy (used to break up stone into smaller pieces to be excreted), and surgery (last resort, if the other procedures don't work or if there are so many stones in the renal pelvis they couldn't get to
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What are 3 types of renal failure and causes?
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1. Pre-renal: before the kidneys; some causes are shock, MI, severe hemorrhage; impaired blood supply to the kidneys
2. Intra-renal: problems within the kidneys, some type of damage occurs within the kidney tissue. Some causes are bacterial disease, vascular disease, diabetes. 3. Post-renal: after the kidneys, obstruction of urine outflow. Some causes are obstruction, back flow of urine, and kidney stones. |
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What is the medical tx for renal failure?
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Treat cause and prevent complications, maintain F&E balance, correct acid/base imbalances (tx with bicarb), manage anemia and HTN, cleanse the blood of uremic waste with hemodialysis and peritoneal dialysis, observe for s/s of infection, uremic frost (cannot excrete uremia), nutritional management (limit sodium, fluid restriction, K restriction, limit proteins (give complete proteins: lean meats, fish, etc), increase carbs, give Ca supplement), vitamins, diuretics to help with HTN, vasodilators; if untx can lead to neurological problems - confusion and disorientation
Tx for electrolyte imbalances: hyperkalemia, hyperphosphatemia, hypernatremia, hypermagnesemia, hypocalcemia, chronic renal failure |
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Explain the 3 stages of renal failure.
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Stage 1: Decrease reserve but no accumulation of waste, urine concentration decreases, the healthier kidney works harder, s/s: polyuria and nocturia
Stage 2: increased metabolic waste, BUN and creatinine increase, GFR falls, oliguria and edema occur, fatigue, HA, nausea Stage 3: increased metabolic waste, electrolyte and fluid imbalance serious, dialysis/kidney transplant needed, homeostasis can't be maintained --> ESRD |
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What is the nsg care for a pt with renal failure?
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Focus on anemia, bleeding tendencies, infection, NV, anorexia, CHF, HTN; daily wts, I&Os, monitor pattern of urination, restrict fluids as ordered, monitor labs BUN, electrolytes, creatinine, assess mental status (confusion, disorientation)
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What kind of diet is needed for a pt with renal failure?
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; Diet - low protein, Na, K; inc carbs (good complete protein in small amts), fluid restriction, Ca supplements (low K can cause seizures, high K can cause arrhythmias, dysrhythmias)
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What is the nsg care for an AV fistula or graft?
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Observe for infection/clotting; check for circulation in fingers, feel for palpable thrill, auscultate for bruit (audible murmur); protect from injury, avoid taking BP or venipuncture in arm or leg with graft or fistula, sleep with extremity free not tucked under (no pressure), elevate above heart level post op for 24-72 hrs; observe for: fluid overload, electrolyte imbalance, anemia, bleeding, infection at site or in blood, check BG for hypoglycemia, hypotension; no antihypertensives because it will lower BP, NTG patches, digitalis or anticoagulants in the morning before dialysis; daily wts and VS, pt teaching of dialysis: care of cannula/access site, diet/fluid restriction, medications, give lots of support/encouragement
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What is the nsg care for a pt that has a UTI?
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Sitz bath, pt education to wipe front to back, void before and after intercourse, clean under the foreskin, no bubble baths or sprays, increase fluids 2500-3500 cc/day, vitamin C or cranberry juice to acidify urine, have pt void frequently (q2-4 hrs while awake), avoid caffeine (causes spasm of the bladder)
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What is the teaching to give a pt to prevent UTIs?
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Wipe front to back, void before and after intercourse, clean under foreskin, no bubble baths or sprays, increase fluid intake (2500-3500 cc/day), void frequently (q2-4 hrs)
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What are meds used to tx UTIs?
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Urinary antiinfectives, antiseptics, urinary analgesics (Pyridium - turns urine orange color), antibiotics (sulfonamides - drink plenty of water to prevent crystallization, Septra - crystals can form in the urine)
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What are safety measures to have for a pt that has nocturia, especially if they are confused?
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Floor mats, night lights, decrease fluid intake before bed, SR up X2, call light in reach, bed alarm, non-slip slippers
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What substances should not be found in urine?
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No glucose, protein, ketones, bilirubin, bacteria, or blood should be in the urine
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Why is serum creatinine a better indicator of kidney function than the BUN?
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The serum creatinine is a better indicator of kidney function because it is more specific by increasing only in renal disorders. They both evaluate kidney function, but the BUN is broader and more of a general indicator of kidney ability.
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What is the creatinine clearance? What is its norm?
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It is a specific test for overall kidney function; urine test collected over 24 hrs. It evaluates the GFR (the amt of fluid filtered from the blood into the Bowman's capsule per min). The nml creatinine clearance is 15-25 mg/kg
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What are nml consistencies found in urine?
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Urine is mostly water (95%), Na, K, Cl (5% salts), urea, creatinine, and uric acid; all eliminated through the process of renal filtration
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What complications need to be monitored for after prostate surgery?
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Monitor for bleeding, hemorrhage - a complication that occurs most frequently in 24 hrs post op, (bloody urine, blood in catheter is viscous, clots, decreasing urinary output, complaint of bladder spams, H&H may decrease)
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Why is it important to monitor K+ and Ca+ electrolytes in a pt with renal failure?
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With low K+ and low Ca+ levels pt can have seizures; with high K+ and Ca+ levels pt can have arrhythmias, dysrhythmias, cardiac arrest
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What are complications of peritoneal dialysis?
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Peritonitis – inflammation/infection of peritoneum (make sure there is a clear return , not cloudy = infection)
Obstruction or other catheter problems Fluid overload Leakage Respiratory problems |
