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Nurs 342 - Week#1-3
Nursing in Health & Illness II: Renal, Urinary & Organ Transplantation
| Question | Answer |
|---|---|
| What are the causes of UTI? | Usually colonic flora: e-coli, proteus, pseudomonas |
| What are the risk factors for UTIs? | 1. Urinary retention 2. Female elderly 3. Sexual intercourse 4. Pregnancy 5. Poor hygiene 6. Immobility 7. Catheters |
| What are the common causes of nosocomial UTI? | 1. Catheters--open track to the bladder 2. Catheters--poor aseptic technique used for insertion |
| What are the S/S of UTI? | 1. Frequency, urgency, dysuria 2. Hematuria, pyuria, 3. Pain--perineal, suprapubic, flank 4. CVA tenderness |
| What are the remarkable lab values for UTI? | 1. UA--presence of WBC's or bacteria; UA (cathed) "clean catch" culture & sensitivity 2. CBC shows elevated WBC's; fever, chills, malaise |
| What does a typical treatment protocol for UTIs involve? | 1. Antibiotics—broad spectrum (Sulfamethoxazole/trimethoprim, Cephalosporin, Quinolone's), fluids—2-3 L q.d, acidify urine—cranberry, prunes...no caffeine/ETHOH, void q.2-3.h, hygiene |
| What is the tx for dysuria r/t UTI? | Phenazopyridine (Pyridium); Urinary analgesic--turns urine orange—warn patients (Interferes with UA for glucose, etc) |
| What is the tx for a more severe UTI? | Aminoglycosides—Gentamicin, Treat fever—acetaminophen, Fluids—PO or IV, Analgesics for pain |
| What is the tx for Chronic UTI or Pyelo? | Monitor cultures, BUN, Creatinine, evaluate urinary tract for cause. Can lead to renal failure |
| Describe Pyelonephritis. | More severe UTI, upper tract. |
| What are the S/S of Pyelonephritis? | Same as UTI: 1. CVA tenderness, fever, chills, N/V. 2. Pain—ureter up to epigastrum, Constant or colicky. 3. UA—bacteria, WBC’s, WBC casts, RBC’s |
| What sort of teaching can help prevent UTIs? | 1. Hydration 2. Hygeine—peri care 3. Void after intercourse 4. Cotton underwear 5. Acidify urine |
| Treating which sort(s) of obstruction(s) can help prevent UTIs? | Stones, prostate |
| How can one treat neurogenic urinary retention to prevent UTIs? | Self-catheterization (aseptic technique), cholinergics such as Bethanechol (Urecholine; avoid w/glaucoma/bowel obstructions) |
| What are disadvantages to indwelling vs. intermittent catheterization with respect to UTI prevention? | Indwelling catheterization can cause biofilm colonization which can serve as a growth medium for bacteria/yeast. |
| Describe the implications for the use of Macrodantin (Nitrofurantoin). | Macrodantin (Nitrofurantoin) chronically→urinary antiseptic Turns urine brown, Take with food or milk (gi upset). Treat acute UTI, prevent recurrent UTI in high risk |
| What are the risk factors for urinary retention? | 1. Neurologic disease, injury 2. Obstruction—strictures, prostatic hypertrophy 3. Bed rest 4. Medication—anticholinergic side effects 5. Dehydration |
| What are some ways to encourage voiding? | Normal position, privacy, time, running H2O, drink H2O, place hand in warm H2O, pour over perineum |
| What do we know about Cather Associated UTIs? | 1. The longer a catheter remains in place, the greater the risk of UTI. 2. As of 2008 Medicare & Medicaid stopped reimbursing for care of CAUTI |
| How can we reduce the risks of CAUTIs (Cather Associated UTIs)? | 1. Sterile technique 2. Proper specimen collection for accurate dx 3. Foley care--clean/secure 4. Drainage bag below catheter (not on floor) 5. Prompt removal of foley. |
| Describe the pathophysiology of glomerulonephritis. | Inflammatory reaction after Strep. |
| What are the S/S of glomerulonephritis? | Fever, chills, weak, N/V, HTN, generalized/periorbital edema (fluid overload), abd pain, flank pain, oliguria |
| What results would one expect from a client with glomerulonephritis? | 1. gross proteinuria, hematuriacola colored urine, 2. Low serum protein, 3. High BUN, creatinine, 4. Azotemia may develop rapidly |
| What is a common treatment regimen for glomerulonephritis? | 1 Penicillin—may continue several months 2. Bed rest in acute phase 3. Diet—low Na+, low protein, high CHO, restrict K+ as needed 4. Diuretics for edema, HTN 5. Antihypertensives 6. Plasmapheresis—reduce antibodies or 7. Immunosupressants |
| Describe nursing care for a client with glomerulonephritis. | Monitor I & O, BP, edema, Electrolytes, BUN, Creat, Skin care for edema |
| Describe the pathophysiology of Nephrotic Syndrome. | Strep infection->Glomerulonephritis: Severe proteinuria→ hypoalbuminemia→ low osmotic pressure→ edema→ hypovolemia→ stim. Na+ & H2O retention→edema |
| Describe the treatment for Nephrotic Syndrome. | Goal: reduce inflammation. How? Corticosteroids, immunosuppresants (cytoxan), reduce fluid/salt, low/mod protein intake, high calorie, albumin or plasma IV to increase osmotic pressure, diuretics (aldosterone blocker: aldactone; K+ sparing) |
| What should a nurse taking care of a client w/ Nephrotic Syndrome be monitoring for? | 1. Monitor fluid status— I & O, daily weight, Abd. Girth, BP, 2. Careful skin care, 3. Isolation (if WBC low), 4. Anticoagulants (hypercoagulability)—monitor, teach safety, 5. Bed rest in acute/early phase |
| Describe the long term management of Nephrotic Syndrome. | 1. Repeated exacerbations/remissions. 2. Proteinuria decreases as azotemia worsens. 3. Usually ends in renal failure |
| Who has a higher risk of a urinary-tract lithiasis? | Male, 30’s (20-55), Family history, prior history |
| What are some S/S of renal calculi? | 1. Pain!! Renal colic—crampy pain, severe flank pain, CVA, radiates to low Abd, bladder, groin, testes, 2. Hematuria—gross or microscopic, 3. Nausea, vomiting, diarrhea, 4. Pallor, diaphoresis, anxiety, 5. May see S/S UTI |
| Describe the dx process for stones w/in the UT/kidneys. | UA—hematuria, pH, crystals , Urine culture & sensitivity, ***Strain all urine*** KUB—flat Abd X-ray—may see stone, also CT scan, Cystoscopy—visualize stone, remove it, History—gout, uricosurics, meds which change urine pH, excess Ca++ intake |
| Describe the non-surgical method of removing a kidney/gall stone. | Litholapaxy cysto, basket and crush stone Lithotripsy; Shock waves aimed at stone--breaks up stone, May take 6 weeks to pass, Teach—hydration, strain urine. Analgesics for renal colic, monitor for hematuria |
| Why would a physician impliment the use of a ureteral stent? | Placed to bypass stone, prevent obstruction, |
| How does one record I/Os when a client has both a foley cath, AND a ureteral stent. | Record output separate from foley cath. |
| What is an IVP? | IVP—Intravenous Pyelogram; a diagnostics test for viewing calculi—lithiasis—stones |
| What are some nursing implications for an IVP? | Inject contrast→outline kidney, ureters, bladder ****Allergies—iodine, fish ****Glucophage (Metformin)—must withhold for 2-3 days risks renal failure (pre-treat with Acetylcysteine). Non-emergency preparation—laxative the night before |
| What is the treatment for a kidney/gall stone? | Almost 90% pass spontaneously. Acute care—symptomatic. Pain Control—Narcotics Fluids—PO or IV—at least 3 L/day ***Strain all Urine*** Antiemetics. Antispasmodics—anticholinergics. Warm bath, moist heat—relax pt. Bed rest abc if needed |
| What is appropriate client education for someone waiting to pass a kidney/gall stone? | Take home meds, fluid intake, strain urine—bring in any passed stone or gravel |
| What are the nursing implications r/t post-op care for clients undergoing surgical removal of kidney stones? | Similar to any Abd surgery; Observe for bleeding, drains—amt, color, some blood OK Color of urine—TCDB, leg exercises, TEDs, SCD’s VS-often dehydrated Oxygenation—TCDB Elimination: Foley cath—hygiene, I & O Pain Control—must TCDB, PCA, epidural |
| What are some signs of renal shutdown r/t stones? | Oliguria, anuria, acidosis, confusion, hypertension, rising BUN, creatinine |
| What is the purpose for urinary diversion? | Why? Removal of the bladder (cystectomy) due to cancer or trauma. |
| What are the different types of urinary diversions available to a client with bladder cancer (or trauma)? | 1. Ileal Conduit or loop, 2. Ureterostomy, 3. Nephrostomy (all require appliance for urine) |
| Why would someone need to undergo nephrectomy surgery? | Trauma, cancer, polycystic disease or donation of the kidney. |
| What are pre-op considerations for the nurse monitoring a client about to undergo nephrectomy surgery. | Testing to assure remaining kidney is functioning. |
| List nursing considerations for a post-op nephrectomy client. | • Flank incision—may be laparoscopic • Fluid & electrolyte balance is key • Monitor urinary output carefully! • TCDB and incentive spirometry • Adequate analgesia for deep breathing • Monitor Abd distention—paralytic ileus common |
| What are the nursing implications for a post-op client with a urinary diversion? | 1. Assess abd wound 2. Monitor stoma—bleeding, drainage, 3. Monitor urinary output 4. Monitor bowel function (segment of bowel used to create diversion) 5. Risk of infection—wound, urinary |
| What kind of education would a post-op urinary diversion client need? | 1. Care of ostomy—appliance, skin care, 2. Adjustment to body image change—Ostomate clubs, 3. Prevention & monitoring for S/S UTI: High fluid intake, Mucus in urine is normal. Collaborate with Enterostomal Therapy Nurse |
| What kind of teaching would a client with a continent diversion need? | Self-catheterization: Irrigate pouch daily, no appliance, may wear small bandage on stoma for mucous or drainage |
| What is Acute Renal Failure? | Acute Renal Failure: A clinical syndrome characterized by a rapid loss of renal function with progressive Azotemia |
| What is Renal Insufficiency? | Renal Insufficiency: Reduced renal function—reduced GFR, elevated BUN/Creatinine (Chronic Kidney Disease) |
| What is Chronic Renal Failure? | Chronic Renal Failure:Progressive, irreversible nephron destruction in both kidneys |
| What is End Stage Renal Disease? | End Stage Renal Disease (ESRD)→GFR is < 15ml per minute |
| What is Azotemia? | Azotemia: Accumulation of nitrogenous wastes (BUN) & serum creatinine |
| What is Uremia? | Uremia: Renal decline leads to symptoms in multiple body systems |
| What is Oliguria? | Oliguria: Decreased Urinary Output (UO) to <400ml/day |
| What is Anuria? | Anuria: Complete suppression of urine formation by the kidney--<100 ml/24 hrs |
| What are normal values for BUN, Creatinine, and the BUN to Creatinine ratio? | BUN: 8-25; Creatinine: .6 to 1.5; BUN to Creatinine ratio s/b about = 10:1 |
| What is a normal creatinine clearance? | 85-135 |
| What are normal ABG values? | pH 7.35-7.45, pO2 80-100 mmHg, pCO2 35-45 mmHg, HCO3- 22-26 mEq/L, O2 Sat 90-100%, Base XS -2 - +3 mEq/L |
| What are normal values for: Serum Osmolality, Urine Osmolality, and Urine Specific Gravity? | Serum Osmolality: 280-297 mOsm/kg, Urine Osmolality: 50-1200 mOsm/kg, Urine Specific gravity: 1.010 – 1.022 |
| Describe what is happening when a client experiences prerenal acute kidney failure | Diminished renal perfusion: Circulatory volume depletion, Hemorrhage, GI losses, Burns, Sepsis, Diuretics, CO decrease (MI, CHF), Afferent arterial pressure, Renal vascular obstruction |
| Describe what is happening when a client experiences intrarenal-cortical acute kidney failure | Renal capillary swelling: Vascular: malignant hypertension Infectious: streptococcal Immunologic processes – Goodpasture’s syndrome, Systemic Lupus |
| Describe the radiological tests used for renal failure diagnostics. | • Abdominal X-ray (KUB) • Intravenous Pyelogram (IVP) • Renal Scan • Renal Arteriography • Diagnostic Ultrasonography • Percutaneous Renal Biopsy for Renal Cancer |
| What causes intrarenal-medullary acute renal failure? | Prolonged ischemia, MAP < 60mm Hg for over 40 min. secondary to massive hemorrhage, shock. Nephrotoxic Injury. Antibiotics, NSAID’s, other drugs, Contrast dyes |
| What causes postrenal acute renal failure? | Obstruction to outflow, Ureteral obstruction, Prostatic hypertrophy, Renal calculi, Bladder infection Extraurethral – abdominal tumor |
| What is the most common type of acute renal failure? | Intrarenal—due to ischemia or nephrotoxins |
Created by:
scottheadrick
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