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129 Cards in this Set
- Front
- Back
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What does TURP stand for??
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Transurethral Resection of the Prostate
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Complications with TURP
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clot formation, bladder spasm, and infection
Less common: *Urinary Incontinence *Hemorrhage *Erectile Dysfunction |
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What kind of a catheter does a pt with TURP have??
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Foley cath
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Nursing Intervention for TURP.....
Closely monitoring Urine |
Intervention:
*monitor Color Amount *monitor every hour for first 24-48 hr Rational: *To prevent any major complications |
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TURP:
Pt teaching for Bloody Urine |
Seeing bloody urine may be upsetting to pt or his family.
It is normal as long as it does not worsen Blood mixed with irritating fluids may look worse than appear in foley bag |
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TURP NI:
*fluids |
Intervention:
*increase fluid intake Contraindications: *If on fluid restriction *non-citrus juices *no caffein *no alcohol Rational: *increase urine flow will help flush out blood from bladder |
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TURP NI
constipation |
Intervention:
*Avoid constipation Rational: *Can lead to activity increased bleeding How to avoid constipation? *increase fluids * stool softener *prune juice |
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TURP NI:
*Aspirin and *NASIDs |
Intervention:
*Avoid Aspirin and NASIDs until risk of bleeding is over Rational: *Aspirin and NASIDs reduce platelet function and increase risk of bleeding. |
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Etiology of Polycystic Kidneys
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It is a hereditary disease.
Characterized by formation of mulitple cysts in the kidneys that can eventually replace normal kidney structures |
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Urethritis
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Inflammation of the urethra
Causes: chemical irritant, bacterial infection, trauma, or exposure to STDs, bubble baths |
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NI for urethritis
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tell pt that medication may make urine turn red-orange while on phenazopryridine
dont take bubble or salt bath finish all antibiotic meds until finished |
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what does CBI stand for?
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Continuous Bladder Irrigation
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TURP:
*Suprapubic pain, purpose for CBI??? |
It is continous bladder irrigation that is given after TURP to help bladder relax and won't expand. NI will be keep the urine flow and don't let the catheter tube kink. Also monitor fluid rate that irrigate the bladder. I&O need to substract the amount of fluid irrigation. "-)
Hope that help. |
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Signs and symptoms of a UTI
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*dysuria
*urgency *frequency *incontinence *nocturia *hematuria *back pain *cloudy urine *foul-smelling urine |
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Signs and symptoms of
Renal Calculi |
*excruciating flank pain
*renal colic( pain going from kidneys down to bladder) *hematuria *dysuria *frequency *enuresis *N/V/D |
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Signs and symptoms of
Renal Calculi |
*excruciating flank pain
*renal colic( pain going from kidneys down to bladder) *hematuria *dysuria *frequency *enuresis *N/V/D |
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Pt education on UTIs
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* Take all medications as prescribed until its gone
*Don't stop taking antibiotics until you stop having the symptoms b/c infection still is there |
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Why is a urine culture done?
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*done to determine the number of bacteria present
*to identify the organism causing infection in the urine |
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How to get a Urine culture?
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*Get a urine culture before antibiotics start
*use midstream clean catch |
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Residual Urine
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Determines the amount of urine left in bladder after void
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what does IVP stand for?
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intravenous pyelogram
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IVP
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*radiological procedure
*X-ray exam that visualizes the renal tissue, calyces, pelvises, ureters, and bladder after the IV inj. of contrast media or dye *provides a rough estimate or renal function |
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Radiological Angiogram
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*Purpose to visualize renal blood vessels
*femoral artery is pierced with a needle and a cath is threated into the arteries into aorta and then renal artery *helps see blood flow to kidneys to determine the cause and tx of kidney disease |
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Cystoscopy
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*is an endoscope of the bladder
* it is done to see infection, calcui, obstruction, tumors, or strictures |
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Stress Incontinence
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*involuntary loss of urine
*less than 50mL of urine *happens when increasing abdomen pressure |
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Examples of Stress incontinence
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*cough
*sneezing *laughing |
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Purpose of Kegel Exercise
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to decrease incidence of incontinence by strengthening the pubococcygeal muscle (supports pelvic muscle)
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How to do Kegel Exercise
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1. find pelvic muscle
2. Pull in perineum as if controlling urination 3. Tighten the muscle that controls urination 4. Hold tight for 10 seconds than relax for 10 seconds 5. do this exercise 30-80 times a day 6. preform at least 10 times during urination |
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Urethritis:
-pt teaching |
*avoid bubble or salt bath
*urethral irritants *tell pt urine will turn orange |
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what is the number one GU infection?
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UTIs
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Pathophysiology of renin
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The cells of walls of afferent arterioles secret renin when the blood pressure is low
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Urethral Strictures
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narrowing of the lumen of the urethra caused by scared tissues
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Pt teaching for urethral strictures
and treatment |
pt has a diminished urinary stream and is prone to UTIs
tx: urinary cath |
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Pathophysiology of Renal Calculi
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it is the formation of crystals or protein when the urine becomes supersaturated
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Lithotripsy
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use of sound, laser, or dry shock-wave energies to break the stone into small fragments
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Extracorporeal shock wave lithotripsy
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pt is immersed in tub of water and ultrasonic shock waves are used to break down the stone, then are drained out
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Nephrotic Syndrome
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*excretion of 3.5g or more of protein a day
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S/S of nephrotic syndrome
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*hypokalemia
~edema ~susceptible to infection ~HTN |
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Acute Glomerulonephritis
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*caused by streptococcal infection
~infection of throat or skin ~upper resp tract infection *protein leaks *proceeds and infection |
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S/S of Acute Glomerulonephritis
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*edema
*oliguria *HTN *leaks protein |
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Chronic Glomerulonephritis
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*no relations with renal disease
*occurs over years *lupus erythematosus and insulin-dependent diabetes may proceed to it |
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S/S of Chronic Glomerulonephrtis
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*proteinuria
*hematuria |
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S/S of glomerulonephritis
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*fluid overload
*oliguria *HTN *electrolyte imbalance *edema |
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NI for acute glomerulonephritis
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*sodium and fluid restriction
*diuretics *Meds to treat HTN *plus antibiotics *dialysis |
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Acute Glomerulonephritis lab tests |
*show protein
*casts *RBCs * and elevated waste (creatine and urea) |
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A urinalysis is collected as.....
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A midstream catch
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If a pt is on phenazopyridine what is a NI??? And for what disease is it used for???
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*their urine will turn orange
* used for urethritis |
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Cytits uses what kind of drugs for an uncomplicated cystits?
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Sulfa drugs
*sulfamethoxazol *trimethoprim (bactrim/ septra) |
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Cystitis uses what drugs for a complicated cystitis???
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Ciproflaxin (cipro)
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NI for cystitis
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*force fluids
*finish all prescribed meds *return for follow-up after meds finished |
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Pyelonephritis
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Infection of the renal pelvis, tubules, intersitial tissue of 1 or 2 kidneys
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What disease has a preexisting condition such as obstruction, strictures, stones, or vessels???
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Pyelonephritis
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Risk factors for pyelonephritis
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-urological surgery
- lymphatic infection -urinary stasis -⬇ immunity |
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This disease is congenital aka hereditary thy results in uremia
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Polycystic kidneys
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Acute pyelonephritis
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Starts in renal medulla and spreads to adjacent cortex.
Formation of small abcesses throughout kidneys and gross enlargement of kidneys |
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S/S of pyelonephritis
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-Fatigue
-urgency -frequency -dysuria -flank pain -fever -chills |
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Dx test in pyelonephritis
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Cast
WBCs RBCs Pus |
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Nursing interventions for UTIs
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Pain
Impaired urinary elimination -r/t frequency Ineffective health maintenance |
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What dsease other than cystitis is a UTI disease (upper)??
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Pyelonephritis
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Complications of pyelonephritis
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-loss of kidney function
-renal failure - septicemia -septic shock |
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Action of phenazopyridine
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Topical. Agent
Relieves pain urgency and frequency |
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Assessment/ Data collection on pt with UTIs
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-Listen to pt concerns
What to ask..... -urination -flank pain -s/s of UTIs -fever and chills -pattern of voiding Predisposing patterns -cath -surgery Urine exams -Color -clarity -odor -concentration *UA *C &S |
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Name urinary irritants that should be avoided
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-cola
-coffee -tea -alcohol |
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Pt teaching for UTIs
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-force fluids (2-3L)
*to flush bacteria -antispasmodic *for irritability and pain -suggest vitamin C (500-1000mg) and cranberry juice -apply heat to suprapubic area *to relive discomfort -empty bladder as soon as urge felt -wear cotton underwear -women avoid sexual intercourse |
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What reduces bacteria growth in urine???
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Acid food/ drinks
*cranberry juice * vitamin C |
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What are renal calculi
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Masses of crystals and protein that form when urine is too saturated
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Etiology of renal calcui
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-family hx
-chronic dehydration -infection -dietary factors (⬆calcium) |
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Dx test of renal calcui
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-KUB
-IVP -ultrasound |
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NI for renal calcui
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-strained urine
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What is lithotripsy
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Uses laser or dry shock-waves energy to break down the stone
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Pt teaching for lithotripsy
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Blood in urine
Pt told to strain urine to identify passage of stone fragments |
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Cystolitholapaxy
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Endoscope placed into urethra to bladder to crush stone
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Nephrolithotomy
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Scopeinserted into skin to kidney to help break down stone and to irritate renal pelvis
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What type of a diet do ppl with renal calculi need??
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Low calcium
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Prevent renal calculi
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Walk around (helps excrete stone)
And reduce bone calcuim reabsorption |
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Hydronephrosis
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Retention of urine and damage to kidneys caused by an obstruction
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Nephrosis
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Aka nephrotic syndrom
Degenerative non-inflammatory disease of tubules |
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What is nephrosis
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Loss of protien
Loss of plasma osmotic pressure |
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NI for nephrosis
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-I&O
-diet (⬆protien & ⬇ Na+) |
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S/S of nephrosis
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-hallmark sign
-anasarca (edema all over body) |
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Etiology of ARF
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Sudden loss or ablility fr kidney to clear waste & regulate F&E balance
Azotemia |
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What is azotemia
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Build up of toxic watse from protein metabolism
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Pt teaching for kidney transplant
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Kidney and ureters transplanted
Tissue and blood must match Special drugs taken to stop immune system from rejecting it for life |
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Where can kidney transplants come from??
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Family members
Living nontelated person Cadaver |
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Best kidney transplant comes from....?
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Family member
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Pt education on urostomy appliance
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Monitor irritants, rash, edema, ulcerations
Teach proper emptying techniques Monitor output, color, clarity Placed for urinary diversions |
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Pt teaching crédes maneuver
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Technique used to aid pt with voiding urine
Holding pressure of bladder to help empty bladder |
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Diet for uremic pt
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Avoids food in POTASSIUM
Ex: bananas, tomatoes, peaches, potatoes, watermelon Avoid JUNK FOOD Ex: processed meat |
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Pt teaching of post TURP
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Urine may be clear with no abnormal bleeding
⬆ fluids up to 2500mL Avoid -constipation -aspirin and NASIDs Lie down if urine bright red Repot bleeding not stopped by BR or fever, swelling, dysuria |
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Pt teaching for AV shunt
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-No bp on arm
-no IV in arm -no carrying/ lifting heavy things on arm -no bracelets or tight clothing on arm -no prolonged bleeding/ sleeping on arm -notify if numbness, cold, infection or bleeding on arm |
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Pt teaching for ileal conduit
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Most common diversion
Proper draining of cath Monitor for peritonitis and skin breakdown Stoma may need to be dialated |
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Pt teach on nephrosis
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2nd to Diabetes lupus, some cancer or hereditary
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Pt teach AGN
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Symptom relief
V. S. BR Control edema with fluids and sodium restrictions Restrict K+ if BUN and creatine are high High calorie diet Check for pruritis, edema, and friability |
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NI for post-op
* decreased urinary output with foley |
Check tubing
Place bag below bladder Increase fluids Check bladder for distention |
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NI for post-op
*pruritis |
Ithing
Mosturize skin Keep hydrated DO NOT use soap or perfumed lotions |
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NI for post op
* postural hypotension |
Sit up slowly
Deep breath while standing |
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S/S of uremic frost
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Crystals on the skin
yellow or gray cast on skin Waste builds up on skin |
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Acute pyelonephritis
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Infection of kidneys
Fatigue Urgency Frequency Dysuria Flank pain Fever Chills |
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S/S of ARF
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Sudden oliguria
Hematuria |
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What type of medication is pyridium
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Urinary analgesic
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Pyridium
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Relieves urgency and frequency
Changes color of urine to red orange Hepatictoxicity and nephrotoxicity |
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Side effects of pyridium
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GI upset
Rash Purple skin discoloration |
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Urethral dilation
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For urinary strictures
Instruments gradually increase in size |
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24 hr urine specimen
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Blood drawn at start and end
Encourage fluids prior and during test Throw out first void Then collect all urine and place in ice or refrigerate |
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pH of blood
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Range: 4.6-8.0
Averge: 6.0 Vegetarian diet: more alkaline High protein diet: more acidic |
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SpeciFic gravity
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Range: 1.01-1.025
Measures dissolved materials The higher= more dissolved Comcentrates urine |
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UA
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For kidney function
NOT a dx Morning specimen Clean catch Midstream catch |
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BUN
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Range 8-20
Urea: waste products of protein metabolism (affected by dehydration) |
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Specific gravity
Less comcentrated Vs. Higher concentrated |
Less= DM
Higher= ⬇ renal perfusion |
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Creatine
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Range: 85-135
10 mL per min needed to live without dialysis Excellent indicator for renal function Measures amt of blood and urine |
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CBC
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Will show elevated WBC
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Uremic frost
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97-99% loss of kidneys function
Pt confused Uremic look * pale, yellow gray paleness=anemia battle is @ loss Dialysis daily or BUN not excreted |
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s/s of hyponatremia
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-N/V
-anorexia |
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Causes of hypervolemia...
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-increase intake (poorly controlled IV)
-decrease in excretion -excessive irrigation -renal failure |
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S/S of hypervolemia
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-acute weight gain 5%
-pitting edema -skin cool and pale -crackled lungs -SOB -HTN -bounding pulse -tachycardia -rapid, shallow, RR, tachypnea -increase in urine output (almost CLEAR) |
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Causes of hypovolemia
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-decrease intake
-hemorrhage -vomiting/ diarrhea -sweating -excesive wound drainage -GI suction -burns and ascites |
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s/s of hypernatremia
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-dry sticky mouth
-thirst -oliguria & anuria |
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S/S of hyperkalemia
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-ARRYTHMIAS
-HR slow and irregular |
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s/s of hypovolemia
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- LOW bp
-Confusion & Restlessness |
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how do you loss sodium
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-diarrhea
-sweating -diuertic |
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s/s of hyperkalemia
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-ARRYTHMIAS
-ekg changes -slow HR -decreased reflexes -weakness and fatigue -abd pain |
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s/s of hypokalemia
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-arrythmias
-decreased reflexes -weak fatiuge and abd pain |
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s/s of hypercalcium
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-ureter stones
-arrythmias -heart failure -resp failure b/c of weakness |
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s/s of hypocalium
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-diarrhea
-diarrhea -cramps -increased HR -tetany *chvosteks's sign ~+ response twichy of lip or all facial muscle *Trousseau's sign ~latent sever tetany ~when you put a bp on a pt and there hand hardens and thumb goes in. Stop and remove bp |
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Magnesium
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Renal failure
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Metabolic Alkalosis
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K+ depletion
Vomiting NG drainage Lasix Overactive adrenal gland Sodium bicarb excess Chloride depletion |
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Metabolic Acidosis
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Accumulations of
-lactic acid in circulatory failure -detoaciodosis in DM -inorganic acids in renal disease -diarrhea -ileostomy, colostomy -aspirin and iron drugs |
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signs of rejection for kidney disease
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INCREASE in....
BUN Creatine K+ -acidosis -oliguria -few days onset or up to 3 wks -edema, wt gain -HTN -fever -apprehension |
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septicemia
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shaking chills and fever
tachycardia leukocytosis leukopenia |
