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36 Cards in this Set

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Urolithiasis
Presence fo calculi (stones) in the urinary tract
Renal Calculi Risk Factors
decreased fluid intake
dietary factors
certain meds (dyazide, crixivan, antiacids, steroids)
Runs in families
more common in caucasians
Too much vitamin A or D or C or high in purine
Vitamin B deficiency
Hystory of hyperuricemia, gout, hyperparathyroidism, renal tubular acidosis
Chronic obstruction with urinary stasis
S/s of Renal calculi
PAIN - most common symptom
Blood in the urine, urgency, dysuria, urine ordor, fever, inability to urinate
DX of Renal Calculi
Urine analysis
KUB
US
CT scan
IVP
NI for pts with uroliathiasis
Pain control is priority
Demerol, morphine, toredol and NSAIDS
Pain control options, observe respiratory compromise, BP, and safety concerns
Treatment of Urolithiasis
Wait for passing the stone of 5mm or less
insertion of percutaneous nephrostomy tube
Stent placed in retrograde fashion
Lithotripsy
OR for stones > 2 cm
Nephrectomy in extreme cases (removal of kidney)
Complications of urolithiasis
Hydronephrosis and renal damage
How to prevent the development of renal calculi
drink 2-3 L per day
acidify urine with cranberry juice
Avoid high protein diet (60 mg/day)
Low sodium diet
Thiazide diuretics
reduce calcium excretion
Allopurinol
Reduces uric acid concentration
Prevention of recurrent uric acid stones
Urine pH testing
sodamint to alkalinize urine ot enhance urate solubility
low purine diet
Preventio of recurrent sturvite stones
teach s/s of UTI, dipsticks to test for nitrites and leukocytes
avoid prolonged periods of recumbency which slows renal drainage and alters calcuim metabolism. At risk for super infections due to long antibiotics.
Preventio of Recurrent cystine stones
Hereditary disorder of amino acid transport
Teach to alkalinize urine be taking sada mint to increase cystine solubility
teach to test urine pH
Depen lowers cystine concentration
Diet low in protein
Urinary Stricture (narrowing of urethria)
Rarely causes pain, may be related to STD's, trauma secondary to urinary catheterization (never force a catheter), trauma secondary to instrumentation during childbirth
Urinary Stricture can cause
obstruct the flow of urine
back up of urine in renal system can lead to development of UTI
Overflow incontinence
Treatment of Urinary Stricture
Dilation of urethra
Urethroplasty
Benigh Prostatic Hypertrophy BPH
Enlargement of prostate - 50% of men over age 50, cause unknown
S/S of BPH
Problems urinating, palpate bladder, PSA, DRE< CBC, creatinine/BUN, Diagnostic Test IVVP, KUB
Proscar
To shrink prostate takes 6 - 12 months before noticeable improvement from symptoms
SE of Proscar
Erectile dysfunction and loss of libido
Flomax, Cardura
Alpha blockers relax bladder neck and prostatic urethra. Also used for HTN.
SE of Flomax or Cardura (alpha blockers)
Hypotension
Treatment of BPH
Prostatic massage, frequent sexual intercourse, voiding when urged, avoiding ETOH, diuretics, caffeine, avoid meds that increase urinary retention (antispasmotics, antihistamines, decongestants)
Complications of BPH
Hydronephrosis is from obstruction of urine flow and can lead to destruction of rental function
Client with difficulty voiding can lead to hydronephrosis
Surgery might be done
TURP
No incision, scope into urethra, NI includes catheter care, continuous bladder irrigation, urine output q2, bleeding, H&H preop, administer meds (antispasmodics and analgesics
Prostatic Surgery
Monitor flow, color consistency o furine when using three-way closed irrigation and drainage system
Manual Irrigation
with 50 ml of irrigating fluid using aseptic technique if ordered
Prostatic surgery post op
Administer anticholinergics to reduce bladder spasms, avoid over distention of bladder, administer pain meds and stool softeners, administer antibiotics, s/s of infection, report testicular pain, edema, and tenderness
Polycystic Kidney Disease (PCKD)
Most common inherited rental disease - 50% of both sexes offspring will have PCKD
S/s of PCKD
Pain in the flank and abdomen
Edema in teh abdomen - incrased abdominal girth
Constipation secondary to abdomina edema
Increasing pressure upon intestines
S/s of PCKD
HTN, HA, nocturia, uremic signs in later stages, psychosocial
DX of PCKD
enlarged kidenys, cysts will show up on US, CT, MRI, Proteinuria, serum creatinine/BUN increased
NI for PCKD
Diet: Decrease sodium increase fiber, 2-3 liters fluid, avoid NSAIDS, aminoglycosides, and contrast dye and other meds that are nephrotoxic
NI for PCKD
Inform all HCP of disease, avoid TC drugs, notify HCP of s/s of UTIS or urinary retention
Problems of PCKD
Weight gain of more than 2 lbs per day (call dr), treat HTN right away, counseling