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AH Exam 6 GU/Endocri

AH Exam 6 GU/Endocrine/Dialysis

QuestionAnswer
What are some infectious/inflammatory d/o? UTI, pyelonephritis, urethritis, urethral diverticuli, interstitial cystitis, renal tuberculosis
What are some s/s of a UTI? burning, pressure, frequency, urgency, incomplete emptying, abdominal pain, spasms
What is pyelonephritis? Often caused by a UTI; it is inflammation of the kidney as a result of a bacterial infection. S/S include that of UTI & fever, increased HR, abdominal pain radiating to the back, nausea, tenderness at kidneys
What is urethritis? Inflammation of the urethra most caused by STDs. S/s is painful/difficult urination.
What is urethral diverticuli? Pockets of tissue found via a scope
What is interstitial cystitis? is a bladder pain syndrome. S/S: pain, urgency, frequency, nocturia, sterile urine cultures. VERY disabling
What is renal tuberculosis? TB like seen in lungs, but seen in kidney instead
What is acute pyelonephritis? acute or chronic inflammation of the renal parenchyma and collecting system. AKA kidney infection that starts in the renal medulla and spreads to the cortex.
What is the cause of acute pyelonephritis? an ascending infection from the UT that is bacterial, fungal, protozoan, or viral. It may be caused from reflux or obstruction.
What are some clinical manifestations of acute pyelonephritis? fatigue, fever, chills, flank pain, N&V, s/s of UTI
How do we diagnose acute pyelonephritis? Urinalysis, culture & sensitivity, pyruria (pus in the urine), bacteruria, hematuria (blood), WBC w/ casts, Blood culture, CBC, US/CT
Why do we get a blood culture for pts with acute pyelonephritis? we want to make sure that infection hasn't spread to the blood, and the pt hasn't developed septicemia
What treatment do we use for acute pyelonephritis? What are some collaborative care to go with tx? broad spectrum ATB for 2-3 wks until the culture & sensitivity come back. Fluids, antiemetics, antipyretics, analgesics
what are antipyretics? They help with fever
What is emperic tx? it's treating until the results come back as seen in acute pyelonephritis
How do we treat acute pyelonephritis reinfections? we treat as a new infection, treat w/ long-term therapy, and consider prophylaxis therapy
What are our goals of treatment for acute pyelonephritis? maintain normal renal fxn, relief of acute symptoms, prevent recurrence
What is chronic pyelonephritis? also called interstitial nephritis. It is a frequent infection that causes scarring & atrophy. Accompanied by poor fxn and end stage renal dz
How do we dx chronic pyelonephritis or interstitial nephritis? CT/US to see atrophy & alterations in collecting system like hydropnephrosis
What is urethritis? inflammation of the urethra that is commonly STD related.
What are manifestations of urethritis? S/S of UTI w/ urethral drainage & pain
How do we dx urethritis? UA/Split urine w/ cultures
What is interstitial cystitis? inflammation of the bladder that is chronic and prgoressive. It is provoked by infection & involves a loss of protective bladder
What are the s/s of interstitial cystitis? Painful, s/s of UTIs, perineal pain, pain exacerbation/remission
How do we dx interstitial cystitis? bladder log
What is some collaborative care for interstitial cystitis? symptomatic: diet changes: (low acid foods, coffee, tea, alcohol), urine alkalinization drug, stress relief, TCA's/analgesics, bladder irrigation to desensitize pain receptor and increase protective layer, urinary diversion w/ stoma, avoid tight clothing
What is Pentosan (Elmiron)? It is the only drug approved for use in interstitial cystitis. It enhances the bladder mucosal layer
What are some immunologic d/o of the kidney? glomerulonephritis & nephrotic syndrome
What is nephrotic syndrome? abnormality in collecting system of the kidneys that allows proteins to be dumped. characterized by edema & massive amounts of protein that come out in urine. progressive dz that leads to end-stage-renal dz & kidney clots & high lipids
What is glomerulonephritis? inflammation of the kidney that may lead to ARF or CRF. It is antibody induced injury.
What are some classifications of glomerulopnephritis? acute post-streptococcal, goodpasture syndrome, rapidly progressive, chronic.
What are the s/s of glomerulopnephritis? hematuria, UA w/ RBC/WBC present, proteinuria, elevated BUN/Cr
What is goodpasture syndrome? glomerulonephritis seen in young men who smoke. They will be on dialysis for the rest of their life. It's a rare dz but w/out treatment leads to death within a few weeks
What is APSGN or acute post streptococcal glomerulopnephritis? common in children & young adults. It follows exposure to strep. manifests as hematuria, oliguria/fluid retention, smoky/rusty urine, HTN, abdominal/flank pain
How do we diagnose APSGN? Bun, Cr, ASO (strep), UA, CBC
What is some collaborative care of APSGN? rest, diuretics/low Na+ diet, antihypertensives, ATB
What is RPGN or rapid progression glomerulonephritis? rapid progression to renal failure w/in weeks. treated w/ corticosteroids, cytotoxic agents, dialysis, plasmapheresis, transplant.
What is chronic glomerulonephritis? endstage of glomerular dz. It has has an insidious onset of renal failure. Treatment is supportive & symptomatic
What are renal calculi? calcium stones that are obstructive
What happens when there is a blockage in the ureter? the ureter is going to be enlarged and may lead to infection
Urinary Tract calciuli may be ________ or ___________. calcium phosphate or oxalate, uric acid stones, streuvite stones, or cysteine
What stones are most common in women who have had multiple UTIs? streuvite stones
What are manifestations of kidney stones? flank pain in waves, cramping pain, hematuria, renal colic (abdominal pain from stones)
How do we treat kidney stones? supportive, fluids, pain relief, they will pass if less than 4 mm. We will give them a strainer to urinate into. We will also tell them to come back if they can't urinate.
How do we dx kidney stones? CT, if it's less than 4 mm it will pass on own.
How would the pt know if the stone was moving and obstructed the urinary tract? they wouldn't be able to have urine output
How do we treat larger stones? surgery, a lithotripsy or open
How do we diagnose APSGN? Bun, Cr, ASO (strep), UA, CBC
What is some collaborative care of APSGN? rest, diuretics/low Na+ diet, antihypertensives, ATB
What is RPGN or rapid progression glomerulonephritis? rapid progression to renal failure w/in weeks. treated w/ corticosteroids, cytotoxic agents, dialysis, plasmapheresis, transplant.
What is chronic glomerulonephritis? endstage of glomerular dz. It has has an insidious onset of renal failure. Treatment is supportive & symptomatic
What are renal calculi? calcium stones that are obstructive
What happens when there is a blockage in the ureter? the ureter is going to be enlarged and may lead to infection
Urinary Tract calciuli may be ________ or ___________. calcium phosphate or oxalate, uric acid stones, streuvite stones, or cysteine
What stones are most common in women who have had multiple UTIs? streuvite stones
What are manifestations of kidney stones? flank pain in waves, cramping pain, hematuria, renal colic (abdominal pain from stones)
How do we treat kidney stones? supportive, fluids, pain relief, they will pass if less than 4 mm. We will give them a strainer to urinate into. We will also tell them to come back if they can't urinate.
How do we dx kidney stones? CT, if it's less than 4 mm it will pass on own.
How would the pt know if the stone was moving and obstructed the urinary tract? they wouldn't be able to have urine output
How do we treat larger stones? surgery, a lithotripsy or open
Who is at risk for renal calculi? men ages 20-55, occur in summer due to dehydration
What are some clinical changes you will see w/ obstructive d/o? What happens if it goes undiagnosed? hypertrophy of detrusor muscle fibers because they have to work so hard to overcome obstruction and compensate. Eventually those muscle weaken, separate, and herniate. You will also see reflux of urine back into the bladder which causes infection.
When there is an obstruction in the ureters the damage happens where? above the obstruction.
If the obstruction in in the bladder where do we see damage? in the ureters
What does a partial GU obstruction lead to? How do you treat it? insidious or gradual dz. Tx aimed at relief of obstruction by removal of stone, dilation of stricture, catheterization, or urinary diversion
Renal vascular problems are associated w/ urinary obstructions
Renal artery stenosis is the primary cause of what? how is it dx? primary cause of HTN. Dx by renal arteriogram
Renal Vein Thrombosis may be seen with.. Patients with this are at risk for... how do we treat this? is seen with nephrosclerosis. These pts are at risk for pulmonary emboli. Treated with anticoagulation therapy & surgery.
nephrosclerosis is.. necrosis of renal parenchyma that may progress to glomerular destruction
What is benign nephrosclerosis? result of HTN & atherosclerosis that has an incidence highest in 30-50 yr olds.
what is accelerated or malignant nephrosclerosis? associated with malignant HTN & HTN crisis occurs in pts under 30 or greater than 50
What are some hereditary renal diseases? polycystic kidney dz, medullary cystic dz, alport syndrome
What is alport syndrome? a sex linked dz w/ men that has an alteration in GBM
What is polycystic Kidney dz? when the cortex & medulla are filled w/ cysts of fluid, blood, & pus. They grow and multiply and compress surrounding organs.
What are the s/s of polycystic kidney dz? pain, renal destruction, HTN, hematuria, feeling of heaviness, UTI, renal calculi, palpable kidneys
PKD in kids.. is rare & rapidly progressive. it requires HD & transplant
PKD in adults.. manifests at age 30-40. End stage Renal disease manifests at age 60.
How do we dx PKD? US, IVP, CT, H&P
How do we care for pts with PKD? supportive/symptomatic care o, nephrectomy, dialysis/transplant
What are some causes of incontinence? medications like lasix & cholinergics, polypharmacy, muscle weakness
what are some causes of urinary retention? obstruction/lack of muscle strength, acute which is an emergency, and chronic in which pt can't empty blatter
What can we do for pts w/retention. stick a cath in and tell them to see nephrologist. Measure their post void residual (PVR)
What PVR that's normal? 50-75ML
What are some collaborative care for urinary incontinence? behavioral therapy (counseling for depression), strengthening (kegel), anti-incontinent devices, anticholinergic drugs like detrol, surgical interventions
What are some surgical interventions for urinary incontinence? Urethral stabilization, sling, artifical sphincter, bulking agents, stem cell placement
what is some collaborative care for urinary retention? intermittent cath, alpha adrenergic blockers, surgery like prostatic treatment, stricture relief, repair of pelvic organ prolapse.
What do ureteral catheters do? bypass bladder
What do suprapubic catheters do? go through abdomen to bladder
What do nephrostomy tubes do? alternative to urinary diversion in a stoma. They are caths that come out of both kidneys
What are intermittent catherization? straight cath for retention or for sterile urine specimen
What is a urethral catherization? a normal cath
What is a nephrectomy? it is a surgery to remove the kidney.
What are some pre-op considerations for pt undergoin nephrectomy? pre-op teaching r/t positioning & adequate fluid & electrolyte balance. Positioning is side-lying with arms and legs stretched out as far as possible. So going to have a lot of shoulder & arm soreness.
What are some post-op care for pts undergoing a nephrectomy? monitor urine output, hourly I&O of all catheters/drainage, daily weight, assess respiratory status to avoid atelectasis & pneumonia. Monitor for abdominal distention in case of paralytic ileus
What is a urinary diversion? a continent creation of a valve called a kock pouch or an incontinent diversion of the skin called an ileal conduit.
What is an orthotopic bladder? the downside? new bladder formed from bowel segments. they may have incontinence
What is the advantage to having a continent stoma for urinary diversion? the creating of a valve and kock pouch so urine doesn't leak all the time so they don't have to wear a bag all the time.
What is the downside to a incontinent stoma for urinary diversion? urine constant collected in bag outside body
What are some post-op management considerations for pts with urinary diversions? thromboembolism, SBO/paralytic (keep pt NPO/NGT) , UTI (look for retention), Stoma Care (look for encrustation, excoriation/mucous secretion)
The organisms that cause pyelonephritis commonly reach the kidneys via which of the following? A. The bloodstream B. The lymphatic system C. A descending infection D. An ascending infection D
Types of renal calculi include which of the following? A. Calcium oxylate B. Struvite C. Uric acid D. Potassium chloride E. Cystine F. Calcium Phosphate A,B,C,E, F
Chronic Kidney Disease (CKD) Involves Involves progressive, irreversible loss of kidney function. kidney damage & markers of damage like elevated BUN & creatinine & K+, & GFR< 60 for 3+ mo.
How do we stage CKD? based on the decreased GFR
What is normal GFR? 125 mL/min
What is GFR in the ESRD? less than 15
What GFR is reason to start HD? Less than 15 mL/min
Describe how the kidneys compensate in CKD? remaining nephrons hypertrophy to compensate that results in a systemic dz involving every organ
What are the leading causes of ESRD? Diabetes & HTN
Why do we have the s/s we do with CKD? and what do we ultimately see? Due to retained substances like urea, creatinine, phenols, hormones, electrolytes, and water. So we will see uremia
What is uremia? a syndrome that incorporates all s/s see in various systems through the body as a result of kidney disease
What are some urinary s/s of CKD? polyuria, oliguria, anuria
What is polyuria? results from inability of kidneys to concentrate urine & occurs most often at night
What is anuria? urine output less than 40mL per 24 hrs. It is common in ESRD and w/ pts on dialysis
What are some metabolic s/s of CKD? Waste product accumulation causes increased BUN & Cr. This will cause NV, lethargy, fatigue, HA, impaired thought processes, impaired glucose use & insulin resistance, hyperlipidemia
How does dehydration impact BUN? it increases it.
If BUN is high and Cr is okay what do we deduct? It's not an indicator of kidney function
What are some electrolyte/acid-base imbalance s/s we'll see with CKD? Hyperkalemia w/ dysrhythmias, low Na+, edema w/ HTN & CHF, hypocalcemia & Phosphate & hyperMagnesium (seen in pts taking magnesium supplements for constipation, metabolic acidosis (cuz kidney's not excreting acid & is kidney isn't producing bicarb
What are some hematologic s/s we'll see with CKD? anemia due to decrease in production of erythropoietin, bleeding due to defect in platelet fxn, infection due to altered immune response & diminished inflammatory response
What are some cardiovascular system s/s seen with CKD? HTN, HF, hypertrophy, peripheral edema, dysrhythmias, pericarditis
What are some respiratory system s/s seen with CKD? SOB, edema, pleurtiis, Kussmaul Resp if acidotic, pleural effusion, resp infection predisposition
what are kussmaul resp? fast rapid breaths
What are some GI s/s seen with CKD? EVERYTHING due to excessive urea. Look for open mouth sores, GI bleeding, anorexia, NV
Why do we have neurological problems with CKD? increased nitrogenous waste products, electrolyte imbalance, metabolic acidosis, axonal atrophy, & demyelination of nerve fibers, & acid/base problems
What are some neuro s/s seen with CKD? depression, anxiety, restless leg syndrome, muscle twitching, irritability, decreased ability to concentrate, peripheral neuropathy, altered mental ability, seizures, coma
What are some musculoskeletal system s/s seen with CKD? mineral & bone d/o, osteomalacia, vascular calcifications
What are some integumentary system s/s of CKD? pruritis/itching, uremic frost
What is uremic frost? a powdery appearance on the skin or uremic crystals sitting on the skin
What are some reproductice system s/s seen w/ CKD? infertility, decreased libido, low sperm counts, sexual dysfunction
What are some psychologic changes seen w/ CKD? personality & behavior changes, emotional ability, withdrawal, & depression.
How do we dx CKD? H&P, Dipstick evaluation to detect protein, GFR, BUN, Cr, Renal US, CT, biopsy
What are some collaborative care we can do for pt? correct fluid imbalance, nutrition, erythropoietin IV/SQ, Ca+ supplement & phosphate binder, HTN tx, lower K+, IV insulin & Ca+
What can we do to correct hyperkalemia in CKD? we can give them IV insulin, Ca+ gluconate, Na+ polystyrene sulfonate (Kayexalate),
How do we treat HTN in CKD? wt loss, diet, Na+ & fluid restriction, & Drugs
If the kayexalate enema won't go.. what do you do? do not squeeze the bag because it turns to concrete
What is CKD-MBD? Chronic Kidney Disease Metabolic Bone Disorders.
What do we do about CKD-MBD? we restrict phospahte intake to less than 1000 mg/day, we'll give phsophate binders, calcium carbonate, renagel to lower choelsterol, Vit D supplements like Calcitrol,
Why do CKD pts take tums? it increases Ca+ and binds to phosphate
What is a side effect of taking phosphate binders? constipation
Before administering calcium or vitamin D we must.. make sure phosphate is lowered
How do we treat anemia in CKD? epogen IV or SQ to increase Hgb in 2-3 wks. SE is HTN & Fe+
teach pt w/ CKD about prevention of complications nurse instructs pt: 1. Monitor for proteinuria daily w/ urine dipstick 2. Weigh daily & report a gain of greater than 4 lbs. 3. Take Ca+ based phosphate binders on empty stomach 4. Perform self-cath q4h t 2
Patients on dialysis have what kind of diet? 60-2-2 (60 protein, 2 K+, 2 Na)
When do we start HD? GFR less than 15, fluid overload, HTN, neuro changes
This is the movement of solutes from an area of greater concentration to an area of lesser. diffusion
This is the movement of fluid from an area of lesser to an area of greater concentration of solutes osmosis
This is water and fluid removal that results when an osmotic gradient ocurs across the membrane ultrafiltration
What is peritoneal dialysis? it is obtained by inserting a catheter through the anterior wall done via surgery. After the cath is inserted, skin is cleaned w/ antiseptic solution & sterile dressing applied
How long do you wait after surgery to use a peritoneal dialysis cath? 1-2 wks.
After how long should the peritoneal dialysis exit site be clean, dry, and free of tenderness/redness? 2-4 wks
What are some things we teach our pt about their peritoneal dialysis cath? shower rather than bathe, may leave uncovered
What do we need to teach patients about peritoneal dialysis solutions? to warm it but to be careful about it being hot
How many PD exchnages happen a day? 3-4
What are the 3 phases of PD exchange? inflow, dwell, drain
What changes of protein intake occur with PD? higher intake of protein
What do you do before starting dialysis? feel for a thrill and listen for a bruit
Created by: Kelly Hempeck