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Med Surg II

Chapt 49 - Urinary Disorders

What is the primary function of the kidney? Excretion of water
Where are the kidney's located? Behind the peritoneum (retroperitoneal)
What are the three major functions of the nephron? Controlling body fluid levels by selectively removing or retaining water, assisting with the regulation of the pH of the blood, and removing toxic waste from the blood
What is the blood flow through the nephron? Afferent arteriole, Filtration in glomerulus, Reabsorption in proximal convoluted tubule, Reabsorption in loop of Henle, Secretion in distal convoluted tubule, Efferent arteriole (AFRRSE)
What are the three phases of urine formation? Filtration of water & blood products, reabsorption, secretion
What happens to the BP when the body experiences increased fluid loss through hemorrhage, diaphoresis, vomiting, diarrhea, or other means? Drops
What hormone does the posterior pituitary gland release which causes the distal convoluted tubules to increase their rate of water reabsorption? ADH
What raises the BP to a more normal level and causes urine to become concentrated? Action of ADH which returns water to bloodstream
What is the albumin level in urine? None
What is the normal glucose level in urine? None
What is the normal erythrocyte level in urine? None to trace
What is the normal ketone level in urine? None
What is the normal leukocyte level in urine? None or trace
What is the normal pH level in urine? 4.6-8.0
What is the normal color of the urine? Yellow/Clear
What is the normal clarity/turbidity of the urine? Clear
What are the possible causes of albumin in the urine? Renal disease, increased blood pressure, or toxicity of the kidney cells from heavy metals
What does glucose in the urine indicate? High blood glucose levels
What does erythrocytes in the urine indicate? Infection, tumors, or renal disease
What occurs when there are ketones in the urine? Too many fatty acids are oxidized
What does it mean when leukocytes are found in the urine? Infection in the urinary tract
What are abnormal colors of urine? Amber or orange
What is abnormal clarity of urine? Cloudy
What does increased specific gravity indicate? Dehydration (fever, diaphoresis, vomiting, diarrhea)
What does BUN (Blood Urea Nitrogen) test determine? Kidney's ability to rid the blood of non-protein nitrogenous waste and urea, which results from protein breakdown
What is the normal BUN level? 10 - 20 mg/dL
What do you do if BUN level is elevated? Institute preventive measures to protect patient from possible disorientation or seizures
How is creatinine, nitrogenous wastes-urea, and ammonia produced in blood? Protein breaks down
How is creatinine excreted? By kidneys; directly proportional to renal excretory function
What is creatinine used to diagnose? Impaired kidney function
What is affected little by creatinine level, unlike BUN? Dehydration, malnutrition, or hepatic function
What is the normal serum range of creatinine? Female: 0.5-1.1 mg/dL Male: 0.6 - 1.2 mg/dL
What does IV urography/IV pyelography evaluate? Structures of urinary tract, filling of renal pelvis w/urine, and transport of urine vial ureters to bladder
What do you assess patient for prior to IV urography/pyelography? Assess for allergy to iodine or iodine containing foods such as iodized salt, shellfish, seaweed products
What is the prep for urography/pyelography? Light evening meal, non-gas-forming laxative evening before, NPO 8 hrs before the test
When are x-rays taken during urography/pyelography? At various intervals to monitor movement of dye
What are the affects of aging on the urinary system? Loss of 50% of kidney filtering by age 70 due to decrease in blood supply to kidneys and loss of nephrons, bladder loses tone, perineal muscles of relax, and incomplete emptying of the bladder
What are the nutritional considerations for a patient with urinary dysfunction? Acid-ash, alkaline-ash, and fluid intake
How are kegel exercises done? Tighten muscles of perineal floor, used for stress incontinence
What is total incontinence? Complete loss of bladder control
What is stress incontinence? Results from the pressure or stressors on the bladder sphincter by events such as sneezing or heavy lifting
What is urge incontinence? Feelings of urgency to void followed by incontinence (associated with Parkinson's and Alzheimer's)
What is overflow incontinence? Repeated inability to fully empty the bladder results in an overly full bladder, which leaks out unexpectedly
What is mixed incontinence? Mixture of both stress and urge incontinence
What is functional incontinence? Influence of mental and physical impairments resulting in an inability to make it to the toilet in time to void
Why is urinary incontinence common in older adults? Weakened musculature in bladder & urethra, diminished neurologic sensation combined with decreased bladder capacity, effects of medication such as diuretics, and urinary stasis
What are the NI for UI? Frequent toileting, meticulous skin care, avoid alcohol, caffeine, and spicy foods, and bladder training
What is the most common causative agent in UTI? Bacteria - E Coli
Why are females more susceptible to UTI? Shorter urethra that is proximal to the vagina and rectum
What are the s/s to UTI? Urgency, frequency, pain/burning on urination, nocturia, abdominal discomfort, perineal pain, or back pain, and urine may be cloudy or blood tinged
What is cystitis caused by? Urethrovesical reflux, introduction of a catheter or similar instrument, or contamination from feces
What is interstitial cystitis (IC)? Chronic pelvic pain disorder with recurring discomfort or pain in the urinary bladder and surrounding region
What foods do you avoid for IC? Food and beverages that cause bladder irritation such as aged cheese, alcohol, artificial sweeteners, chocolate, citrus juices, onions, soy, caffeine, and tomatoes
What are the nursing interventions for prostatitis? Warm sitz bath and analgesics for pain, stool softeners
What is the difference in acute and chronic prostatitis? Acute - avoid sexual arousal & intercourse to rest prostate Chronic - intercourse may be beneficial
What is urolithiasis? Formulation of calculi in the urinary tract; develops from minerals that have precipitated out of solution and adhere, forming stones that vary in size & shape
What is the result if urolithiasis is left untreated? Hydronephrosis
What is the NI for urolithiasis? Encourage at least 2 L fluid/day, strain all urine (send found stones to lab)
What dietary changes should a patient with urolithiasis have? Reduced calcium, reduced phosphorus, and reduced purine foods (cheese, greens, whole grains, carbonated beverages, nuts, chocolate, shellfish, and organ meats
What are the risk factors with renal tumors? History of dialysis, family history, hypertension, horseshoe kidney, polycystic kidney disease, and smoking
What are the s/s of polycystic kidney disease (PKD)? Abdominal & flank pain, headache, GI complaints, voiding disturbances, and history of recurrent UTI's
What are the s/s of benign prostatic hypertrophy (BPH)? Decreased force of stream of urine (early symptom), difficulty starting stream of urine, painful urination, frequency of urination, nocturia
What are the complication of urinary obstruction? UTI, hematuria, and oliguria
What medications are used to treat BPH? Alpha blockers, which improve ability to urinate by relaxing both the bladder neck and the fibers of the prostate
What are examples of alpha blockers? terazosin (Hytrin), doxazosin (Cadura), and terazosin (Flomax)
What medications do you avoid with alpha blockers? Anticholinergic's, antihistamines, decongestants, and antidepressants
What is the standard of surgical intervention for BPH? TURP - Transurethral resection of the prostate
How do you prevent occlusion with TURP? Continuous or intermittent bladder irrigation
How often do you monitor v/s and urine color with TURP? Every 2 hours for 24 hours
What may a patient experience after removing catheter? Frequency, voiding small amounts with some dribbling
What is nephrotic syndrome? Disorder characterized by marked proteinuria, hyperlipidemia, hypoalbuminemia, and edema
What is anasarca? Severe generalized edema
What are the NI for nephrotic syndrome? Maintain bed rest, assess for electrolyte imbalances, skin care
What is the diet for nephrotic syndrome? Protein replacement, sodium restriction
What commonly precedes acute glomerulonephritis? Sore throat or skin infection (usually streptococci) or SLE
What are the s/s of acute glomerulonephritis? Anorexia, nocturia, edema, crackles in lung sounds, hematuria
What is the diet for acute glomerulonephritis? Protein restriction (to decrease blood urea levels), high carbs, may need sodium & fluid restriction
What is the u/o for the oliguric phase of ARF? Decreases to less than 400 mL/24 hours
What is the u/o for the diuretic phase of ARF? Increases to 1 to 2 L/24 hours
What are the s/s of chronic renal failure? H/A, asthenia (decreased strength or energy), pruritus, elimination changes, anuria, muscle cramps, anemia, and CNS involvement such as disorientation & mental lapses
What do you maintain during dialysis? Asepsis and universal precautions
What do you monitor before and after dialysis? Weigh before and after treatment to determine fluid loss, obtain v/s every 30-60 minutes
Who can help patient and family adapt to living with dialysis and transplantation? American Association of Kidney Patients
Describe the most common urinary diversion Ileal conduit - Ureters are implanted into a loop of ileum that is isolated and brought to surface of abdominal wall; drainage bag is fitted over stoma to contain constant drainage of urine
What should the stoma look like postop? Moist, pink and may bleed slightly and initially may be edematous; mucus will be present in urine from intestinal secretions
What does it indicate if BUN & Creatinine levels are increased and RBC are decreased? Impaired renal function
What are the s/e of Lasix? Excessive urination/hypokalemia, hypochloremia, hyponatremia, hypocalcemia, and/or hypomagnesemia
What are the s/s of fluid overload (hypervolemia)? Changes in pulse rate, respirations, cardiac sounds, and lung fields
What are the s/e of thiazide diuretics? Hypokalemia, hyponatremia, and/or hypercalcemia
What are foods that contain potassium? Baked potatoes, raw bananas, apricots, or navel oranges
Created by: tandkhopkins