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Renal and Upper GU
Renal and Upper GU By Lucy
| Question | Answer |
|---|---|
| Diagnostic Tests | Ultra sound, UA, bladder scanners, CT scan, KUB x-rays, and Intravenous urography (IVP: bowel prep, allergy information, and fluids). |
| Other Diagnostic Tests | ultrasonography, cytoscopy and cystourethroscopy, renal angiography,and renal biopsy. |
| Lithiasis | Is stone formation. |
| Five Major Catagories of stones | Calcium phosphate, calcium oxalate, uric acid, cystine, and struvite (magnesium ammonium phosphate). |
| Interventions for calculus | Drug therapy, opioid analgesics, NSAIDS, pain medications at regular intervals, constant delivery system, and spasmolytic drugs. |
| How to treat Calcium Oxalate Stones | Calculus gets trapped in the ureter. TX: Thiazides, cellulose phosphate, Cholestyramine, and calcium. |
| How to Treat Struvite Stones | Stone is always associated w/UTI. Usually staghorn type. TX: Antibiotics and Acetohydroxamic acid. |
| How to Treat Calcium Phosphate Stones | Stone is usually a mix of Struvite and Oxalate. TX: treat the underlying cause. |
| How to Treat Uric Acid Stones | Found mostly in men. TX: Allopurinol |
| How to Treat Cystine Stones | Genetic defect in absorption of cystine. TX: PCN, Potassium citrate and tipronin to prevent cystine crystallization. |
| Lithotripsy | Uses sound, laser, or dry shock wave energy to break the stone into small fragments. Client goes under conscious sedation. Topical anesthetic cream is applied to skin site of stone. Continuous monitoring. |
| Polycystic Kidney Disease | Most common life threatening genetic disease in the world. Autosomal dominant. Manifests between 30-40 years of age. The cysts are fluid filled (pus or blood) and kill tissue by compression. Appear golf ball like on autopsy. |
| Key Manifestations for Polycystic Kidney Disease | Early-no symptoms, abdominal or flank pain, hypertension, nocturia, increased abdominal girth, constipation, bloody or cloudy urine, and kidney stones. |
| DX of Polycystic Kidney Disease | Clinical manifestations, family HX, IVP, ultrasound, and CT. May affect all organ systems. Progresses to ESRD. ESRD by age 60 in 50% of the patients. Patients usually die of complications. In mild disease, the disease is not the cause of death. |
| Interventions for Polycystic Kidney Disease | Prevent infection. Pain management- meds vs surgery. Medication-anti-hypertensives. Energy management. Monitor fluid and electrolytes- I/O. Genetic counseling. |
| Nursing Interventions for Polycystic Kidney Disease | To promote self-management and understanding of: Fluid therapy, drug therapy, measure and record blood pressure, and diet therapy. |
| Cysts and Benign Tumors | Thorough evaluation for cancer. Cysts can cause tissue damage as it enlarges. Many cysts cause no symptoms. cysts are a structural birth defect that occur in fetal life. Simple cysts are drained by percutaneous aspiration. |
| Renal Cell Carcinoma | Adenocarcinoma most common.50-70 years of age.Risk factors include smoking, obesity,HTN, asbestos, gasoline, and cadmium exposures. Manifestations include anemia, erythrocytosis, hypercalcemia,liver dysfunction,hormonal effects,increased sed rate,and HTN. |
| DX of Renal Cell Carcinoma | IVP, ultrasound, CT, MRI, and Angiography. TX: Surgical vs Non-surgical. |
| Non-Surgical management of Renal Cell Carcinoma | Radiofrequency ablation, although effect is non known. Chemotherapy: limited effect. Biological response modifiers and tumor necrosis factor: lengthen survival time. |
| Surgical Management of Nephrectomy | Preoperative care. Operative procedure-positioning, removal of the kidney. Postoperative care: Monitoring, pain management. Prevent complications. |
| Hydronephrosis, Hydroureter, and Urethral Stricture | Provide privacy for elimination. Conduct Crede maneuver as necessary,apply double-voiding technique. Apply urinary catheter as appropriate. Monitor degree of bladder distention. Follow infection protection measures. |
| Acute Pain Interventions for Nephrectomy. | Pain management interventions. Lithotripsy. Percutaneous ultrasonic pyelolithotomy. Diet therapy. Drug therapy- antibiotics and urinary antiseptics. |
| Surgical Management for Nephrectomy | Preoperative care:Antibiotics and client education. Operative procedure:Pyelolithotomy, nephrectomy, ureteral diversion. ureter reimplantation. Postoperative care for urologic surgery. |
| Nephrostomy | Client preparation. Procedure. Follow-up care including:assess for amount of drainage. Type of urinary damage expected. Manifestations of infection. |
| Pyelonephritis | Bacterial infection in the kidney(upper urinary tract).Key features:fever, chills, tachcardia, & tachypnea.Flank and back pain.Abdominal discomfort.Turning,nausea,& vomiting,urgency,frequency,nocturia.General malaise or fatigue. |
| Key Features of Chronic Pyelonephritis | Hypertension, inability to conserve sodium, decreased concentrating ability, tendency to develop hyperkalemia, and metabolic acidosis. |
| Potential for Renal Failure | Interventions include:Use of specific antibiotics. Compliance with therapies and regular follow-up. Blood pressure control. Fluid therapy. Diet therapy. |
| Acute Glomerulonephritis | Assessment. Management of infection. Prevention of complications:diuretics, sodium, water, potassium, and protein restrictions, dialysis, plasmapheresis, and client education. |
| Chronic Glomerulonephritis. | Develops over a period of 20-30 years or longer. Assessment. Interventions include:Slowing the progression of the disease and preventing complications and diet changes. |
| TX for Chronic Glomerulonephritis | Fluid intake, drug therapy, dialysis, and transplantation. |
| Nephrotic Syndrome | Condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and be removed from the blood. Severe loss of protein into the urine. |
| TX for Nephrotic Syndrome | TX involves: Immunosuppressive agents. Angiotensin-converting enzyme inhibitors. Heparin. Diet Changes. Mild diuretics. |
| Renovascular Disease | Profoundly reduces blood flow to the kidney tissue. Causes ischemia and atrophy. Diagnosis. Interventions: Drugs to control high blood pressure and procedures to restore the renal blood supply. |
| Nephrosclerosis | Thickening in the nephron blood vessels, resulting in narrowing of the vessel lumen. Occurs with all types of hypertension, atherosclerosis, and diabetes mellitus. Collaborative management:Control high blood pressure and preserve renal function. |
| Diabetic Nephropathy | A microvascular complication of type 1 or type 2 diabetes. Diabetes is the #1 cause of ESRD. Manifests as persistent albuminuria. Avoid nephrotoxic agents and dehydration. Assess need for insulin. |
| Renal Trauma | Minor injuries such as contusions. Major injuries-lacerations to the cortex, medulla, or branches of the renal artery.Collaborative management. Nonsurgical management: drug therapy and fluid therapy. Surgical management:Nephrectomy or partial nephrectomy. |
Created by:
tiniekittie12
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