Irsc Gu Nursing, Renal And Dialysis

Front 1

What is the order of operations for assessing the renal excretory system?

Back 1

Inspect, ascultate, palpate, percuss.

Front 2

You are assessing the renal system and you use your stethescope over the left flank area and you hear a dull low constatt woshing sound, what is the appropreate action you should take?

Back 2

This is a bruit and is not a normal assessment finding, this is indicative of abnormal arterial stenosis.

Front 3

Female patient compalins of lower abdominal and suprapubic pain, what is this indicative of?

Back 3

Cystitis (inflimmation of the urinary bladder), abdominal pain is present due to unrinary nervs connected to GI nerves.

Front 4

Patient presents with CVA pain, what is this indicative of?

Back 4

Kidney infection.

Front 5

Male patient presents with ocmplaints of disrupted urinary pattern, what symptoms would you ask him about and would you expect given is older age?

Back 5

Nocturia 1x is normal, 2x if older adult is normal (indicated incomplete void) narrowing of stream on urination, (uretheral stricture).

Front 6

Patient just voided before you began your assessment, you palpate a suprapubic distention and are able to hear a tympanic sound over the intestines and a dull sound over the suprapubic area what does this indicate?

Back 6

Pts bladder is still full, patient may have BPH or flaccid urinary bladder or stones in the urethera or some other ineffectual voiding.

Front 7

Your 75 year old patient has a GFR of 65mL/min what should you do?

Back 7

This is a normal range for the older adult due to age realated changes in the kidney or reduced number of functioning nephrons.

Front 8

The patient's had been diuresing > than 60 mL/hr and the urine color is very pale what is your inital assessment finding from this?

Back 8

The patient has very dilute urine and their creatinine clearance should be checked for urine function, they are experiencing decreased abliity to concentrate their urine.

Front 9

FEmale patient presents with dysuria (painful urination) temp 99.8, WBC's 12, a urine specimine is taken for culture and comes back with 90,000 org/mL what is the appripriate course you would expect the practitioner to take?

Back 9

She would be treated with antibiotics for a UTI although her culture is below 100,000 org/mL she presents with pain and s/s of infection

Front 10

The practitioner orders a 24 hr urine clearance for 1200, what is the appripriate nursing action?

Back 10

Gather all your supplies!!, Have patient void at noon, discard this collection, collect everything else on ice, put a sign on the door of the room and of the bathroom so no one forgets, if you miss one you have to start over.

Front 11

Normal range for GFR

Back 11

85-135 mL/hr (decreased in elderly)

Front 12

YOur patient is going for a IVP (intravenous pyleogram) what do you need to do to prep your patient?

Back 12

they need a bowel prep (enema) and tell them they may feel neasues and or have vomiting (they may have reglan or other antiemetic perscribed PRN)

Front 13

patient's serum creatinine is elevated- 2.2 what soes this indicate in general

Back 13

the GFR is down when creatinine is up, kidneys are not filtering properly.

Front 14

what would this lab value indicate: BUN 36/ 1.2 crit

Back 14

BUN is elevated, creatinine is normal, the pt is dehydrated

Front 15

a body builder who has a very high protien diet has BUN 37/1.5 crit is this of concern?

Back 15

Not necessairly because their diet is so loaded with protien and muscle breakdown, nitrogen is an endproduct of protien breakdown (BUN) and serum creatinine is indicative of muscle breakdown so this is not directly indicative of a kidney problem, you have to check the GFR and other symptoms.

Front 16

Lab value for sodium (Na)

Back 16

135-145

Front 17

Labs: Potassium

Back 17

3.5-5.0

Front 18

Calcium labs

Back 18

9-11 or 4.5-5.5

Front 19

Phosphorous labs

Back 19

3.0-4.5

Front 20

Hydrogen Bicarbonate

Back 20

22-26

Front 21

Uric Acid Labs

Back 21

3.0-7.0

Front 22

what does a KUB do?

Back 22

this is a flat plate x-ray of the abdomen to look at the kidneys ureter and bladder, no prep is needed

Front 23

What should you do to prep your patient for a renal arteriogram?

Back 23

this is injected into the peripheral circulation. The patient must be NPO, assess their allergy to iodine, shell fish, after procedure push fluids as the contrast medium can be nephrotoxic

Front 24

#1 nursing diagnosis for the patient having renal arteriogram

Back 24

Risk for injury from introduction of nephrotoxic agent.

Front 25

Nursing prep for patient having CT scan.

Back 25

They may have contrast dye, again check for allergies (iodine, shell fish, push fluids post procedure), NPO

Front 26

What artery is accessed for the Renal Arteriogram?What nursing management of this patient must you implement?

Back 26

The Femoral Artery, no heparin 2 hrs before, no asparin 7-10 days, no plavix, no coumadin at least 4 days, Pt NPO so blood concentrates, assess for bleeding and clotting times, PT(10-14) and aPTT(24-36)

Front 27

What assessment and intervention must you do for patient coming back from renal arteriogram?

Back 27

Since they had femoral arterial puncture, they need alot of pressure on the site, usually a sandbag on the site, check for pedal pulses, peripheral tissue perfusion, check CRT of the toes and fingers.

Front 28

HOw is a cystogram performed?

Back 28

Done with contrast medium infused into the bladder with foley catheter, this is not nephrotoxic because it is local contrast medium rather than systemic.

Front 29

Cystometrogram

Back 29

fluid is instilled into the bladder via catheter to measure bladder pressure

Front 30

complication of both cystometrogram and cystogram

Back 30

UTI, because you are introducing a catheter

Front 31

Number one nursing diagnosis for renal biopsy

Back 31

Risk for hemmorage

Front 32

When renal biopsy is used what nursing interventions must you be aware of?

Back 32

PT (10-14) aPTT(24-36), patient is placed in the prone position for the procedure, , expect some pink tinged urine, increased ABD pain post procedure indicated a sign of ABD bleeding, patient is on bed rest, watch vitals, S/S of infection

Front 33

Cyctoscopy prep and nursing interventions

Back 33

NPO, bowel prep, anesthesia (general or local), need concent, risk for UTI's, increase fluids to help urination after anesthesia and to help relieve burning, pt needs to urinate every 2-3 hours

Front 34

what is the difference between a relapse UTI and a reinfected UTI

Back 34

relapse is the same organism, reinfection is a different organism

Front 35

Elderly patient presents with a new sudden urinary incontenence. What may this be a sign of?

Back 35

LUTI, cystitis

Front 36

Causes of noninfectious UIT

Back 36

Chemical cystitis
Radiation cystitis
Interstitial cystitis

Front 37

Dryg therapy used to treat interstitial cystitis/painful bladder syndrome

Back 37

TCA-Elavil (Tricyclic Antidepressants) because they have anticolenergic effects

Front 38

The patient asks when do I get my antibiotic for my interstital cycsitis (yea right), what is the appropriate pt teaching to answer their question?

Back 38

They will not ricieve antibiotics because because there is no invading organism (same for other non-infectious cystitis radiation, chemical and interstitial)

Front 39

What other drug therapy besids TCA's (elavil) will you give to the non-infectious UTI patient?

Back 39

Pyridium or OTC versions as this is a urinary analgesic andno antibiotic is needed (this will turn their urine and underware and contact lenses orange), increase their water

Front 40

Drug therapy for infectious UTI? (SMF)

Back 40

Sulfonamides (Bactrim), Macrodantin (anti-infective), Fluoroquinolones (Cipro)

Front 41

Treatment for Renal TB

Back 41

anti TB drugs for up to 12 months

Front 42

Diagnosis for urinary TB

Back 42

screen for pulmonary TB, 3 clean catch urine specimines for acid-fast bacilli

Front 43

Five signs of Renal TB

Back 43

Dysuria, pyuria, flank pain, urinary frequency, hematuria

Front 44

Collaberative management of renal abcess

Back 44

Needs to be excised and drained, and antibiotic therapy instilled.

Front 45

Patient had recent strepococcal infection (strep throat) and now has abrupt onset of hematuria, protienuria, and edema, cola colored urine, fatigeu, n/v. anorexia what is going on with this patient?

Back 45

Acute glomerulonephritis.

Front 46

PAtient presents with UTI symptoms and GI symptoms and acute lower pelvic pain, what could this be indicative of?

Back 46

urinary calculi

Front 47

Patient with presenting symptoms of ureterolithiasis is scheduled for U/A, urine C/A, KUB, and IVP what nursing action must you take?

Back 47

Pt needs to be NPO for IVP also needs bowel prep (enema), patient teaching on possible n/v and increase fluids post procedure to expell nephrotoxic contrast medium, so they urinate q2-3h

Front 48

True or false: you should not ambulate your patient with acute urinary claculi.

Back 48

False- you should ambulate him/her.

Front 49

Patient has uric acid what collaborative care should be implemented.

Back 49

'low purine diet, allopurinol, alkalinize urine with potassium citrate and alkaline diet (veggies, oranges)

Front 50

Female patient has struvite, what collaborative care should you implement.

Back 50

Give asid ash diet, acidify urine, cramberry, prun, plum, all protiens (amino acids) give antimicrobials or lithostat

Front 51

Complications of cytoscopic lithotriposy and cystolitholapaxy.

Back 51

Hemmorage, reatined stone fragements and infection

Front 52

complications of percutaneous nephrolithotomy

Back 52

bleeding, injury to ajacent structures, and infection

Front 53

Nursing care after a nephrectomy.

Back 53

Pain control and incisional care, prevention of respiratory ocmplications (caugh, deep breathe, IS), monitor for adrenal gland insufficienc (risk low blood sugar, steroid drugs, low alderterone, risk of hypotension from lack of Na retention)

Front 54

Most common complication of neurogenic bladder

Back 54

infection due to stasis and cathetherization

Front 55

Drug therapy to stimulate bladder for flaccid bladder disfunction

Back 55

urecholine

Front 56

Drug therapy to relax bladder (and contract internal sphincter) for spastic bladder dysfunction. (P)

Back 56

Probanthine

Front 57

What type of incontenence does the patient have when they have frequent loss of small amounts and the bladder is palpable?

Back 57

Overflow incontenence.

Front 58

What kind of incontenence does the pt have when they have an uncontrolable urge to void and they completely urinate all over themselves.

Back 58

Urge incontenence.

Front 59

What kind of incontenence does the pt have when they sneeze and laugh very hard and they have small ammounts of urine spilled.

Back 59

Stress incontenence.

Front 60

What appropriate pt teaching should you do for the incontent patient?

Back 60

They can do kegal exercises, use the cones, can be ehlped with diet no nicotine, no caffine coffee cola chocolate

Front 61

colenergic (parasympathetic) meds are given to decrease outlet resistance in what type on incontenence?

Back 61

Overflow

Front 62

GFR catagorized as chronic kidney disease

Back 62

<60

Front 63

increased potassium. salt and water retention, kussamals breathing is indicative of what?

Back 63

oliguric phase of ARF

Front 64

indreased output, decreased sodium and potassium, and s/s dehydration are indicative of what?

Back 64

diuretic phase of ARF but nephron's still not working properly

Front 65

BUN and greatinine drop in this phase of ARF

Back 65

recovery phase

Front 66

Nephrotoxic antibiotics

Back 66

vancomycin, beta-lactams (cephlesporins and penems), aminoglysides (neomycin, gentamicin, streptomysin)

Front 67

ESRD classified as

Back 67

GFR <15mL/min or 5% of normal, uremia, requires renal replacement therapy

Front 68

renal insuffieiency classified as

Back 68

azotemia with oliguria and edema, GFR 20-50% below normal