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GRCC PN 132 test1

GRCC PN132 Urinary & Urinary calculi

QuestionAnswer
Use sterile technique to obtain a specimen from the drainage tubing if an indwelling catheter is in place Methods to collect for Urinalysis
Midstream clean catch technique to collect specimen in a sterile container Methods to collect for Urinalysis
Steps in collecting urine specimen from an indwelling catheter. Wash your hands - Clamp the proximal drainage tubing directly below the aspiration port with a rubberband or clamp to ensure a sufficient amount of pooled urine for a specimen. 15 min is generally sufficient time to wait to pull urine.
Supplies needed for collecting specimen from an indwelling catheter. Rubber band or screw clamp - sterile syringe- Sterile 20-gauge needle - Alcohol sponge - Sterile specimen collection container - Identification labels and laboratory request slips
24 hour urine collection Methods to collect for Urinalysis
Culture sensitivity Urine is placed on a growth medium to identify drugs that inhibit bacterial growth.
Mid-stream clean-catch technique, straight catheterization, or from indwelling catheter using sterile technique. Methods in collecting specimen for culture and sensitivity test.
Intravenous pyleogram (dye) Uses a contrast medium and x-rays to evaluate the urinary tract.
This test allows evaluation of renal function (by measuring the time required for filteration), and the position, size, shape, and structure of urinary tract organs Intravenous pyleogram (dye test)
This test includes both chemical & microscopic analysis of urine. It is used to identify cells (blood cells or bacteria) casts, (protein structures that develop in the tubules of the kidneys), or crystals. Purpose of urinalysis
KUB (kidney ureter bladder) Abdominal x-ray to evaluate the size, shape, and position or organs in the urinary tract. The bladder should be either filled or emptied.
Cystoscopy Endoscope is used and done with general anesthesia, versed, conscious sedation. NPO before given amnesia.
Assess for hematuria and voiding Cystocopy
This test assess conditions such as urethral strictures, bladder stones, tumors, and congenital abnormalties. Purpose of Cystoscopy
Normal urine clear to pale yellow; aromatic;turbidity (sediment in urine, cloudy urine);
Turbidity urine Sedimant in urine or cloudy urine may mean infection.
Specific gravity measures concentration 1.0 to 1.03
Normal PH 4.5 - 8: no glucose in urine is normal, no ketones is normal
Not normal if bacteria, crystals, RBC's, protein if found in urine If these are present in urine, then this could mean cervical cancer, kidney stones, infection, inflammation, and stress.
Inflammation of urinary bladder Cystitis (AKA uti)
Common esp; in women. Urethras shorter & closer to the vagina & rectum Cystitis (AKA uti)
Most are bacterial, others; virus, fungi, yeast Cystitis (AKA uti)
Urea Formed the metabolism of dietary and body proteins
Creatinine Is produced in relatively constant quantities by muscle cell metabolism
Upper urinary tract infection - inflammation of the renal pelvis Pyelonephritis
Sterility is maintained due to adequate urine volume, unimpeded urine flow, and complete bladder emptying Urinary tract
How does bacteria from the intestines (most common is ecoli) infect the urinary tract? Bacteria ascends from the perineal area inot the lower urinary tract.
Urgency, frequency, Dysuria, hematuria, manifestations of UTI's (cystitis)
Increased temperature, incontinence, bladder spasms, changes color, clarity of urine manifestations of UTI's (cystitis)
Sulfonamide/antibiotic used to treat UTI's Bacterium DS (double strength)
Macrodantin anti-infective used for uti
Cipro anti-biotic - broad spectrum
Pyridium analgesic, anesthetic action on urinary tract; used with antiinfective for UTI
preventing UTI's Wipe front to back; adequate fluid intake; cotton underwear; sterile technique when catheterizing; avoid soap, bubble bath
Urinary calculi stones
Urolithiasis Development of stones within the urinary tract and is the most common cause of obstructed urine flow.
Calculi (stones) most made from calcium and form when a poorly soluble salt crystallizes.
High concentration of salt in urine will trigger crystallization. How calculi are formed
What can you do to avoid stone development? Drink plenty of fluid.
Acute obstruction Causes sever pain in the flank region and possibly radiating to the genitals.
lithiasis stone formation
urolithiasis bladder stone formation
Ureteralithiasis ureter stone formation
Stone formation risk factors Personal or family history of stones, dehydration;excess calcium, oxalate, or protein intake; gout;hyperparathyroidism; urinary stasis.
Calcium and uric acid Predisposition who has excess in system are risk factors for stone formation.
Dehydration Stones more prominent when person is dehydrated.
Increased concentration of urine Stones are likely to form
Immobility Causes calcium formulated renal stones
Excess calcium and protein Calcium formulated renal stones.
Flank pain location - Clinical manifestations of stones Lower back pain
Hematuria Blood in the urine is a manifestation of stones.
Renal colic Spasms and wave of pain like giving birth are manifestations of stones
Nausea and vomiting R/T pain are a manifestation of stones
oliuria Little urine - Clinical manifestations of stones
anuria no urine - Clinical manifestations of stones
Smelly urine Clinical manifestations of stones
Symptoms of stones depends on what? size and location; stones of any size may cause manifestations of UTI, chills, fever, frequency, urgency and dysuria.
What happens if the obstruction (stone) is unrelieved? Kidney may be damaged
What happens urine production continues, but the obstruction blocks the outflow? This leads to increased pressure and distention of the urinary tract behind the obstruction and may result in hydronephrosis and hydroureter.
Hydroureter Distention of the ureter.
Hydronephrosis Abnormal dilation of the renal pelvis and calcyes a nd can result from urinary tract obstructions or from vesicouretal reflux.
Name a test to help detect whether or not pt has a kidney stone? Urinalysis- is done to detect hematuria.
Any stones passed are analyzed to identify their composition. The nurse often is responsible for retrieving stones. All urine is strained and may be saved. Any visible stones or sediment are collected and sent to lab for evaluation.
A KUB xray is done to ID the presence of calculi in the kidneys and ureters and bladder. Diagnostic test to detect if there are kidney stones.
Why would IVP be used to diagnose whether or not there is (calculi) stones This may be used to locate calculi and id hydroureter or heydonephrosis.
Why would doctors chose cystoscopy as a diagnostic test of calculi (stones) This is used to visualize and possibly remove calculi from the urinary bladder and distal ureters.
What type of drug is administered to treat acute renal colic? Narcotic analgesic are used to provide analgesia and relieve ureteral spasms.
Lithotripsy Crushing of renal calculi (stones) using sound or shock waves and is the preferred treatment.
Post-op procedure following lithotripsy Assess for hematuria or any sediment.
Nephrostomy small incision is made in the flank area and a nephroscope is inserted to visualize the renal pelvis. Stones my then be removed of crushed. Stones in renal pelvis or calyces may require this type of surgery.
Percutaneous lithotripsy Stones are fragmented using small ultrasonic transducer or a laser beam. Fragments are removed by irrigation and suction.
Cystoscopy This can be used to crush and remove stones. Also may used to advance a catheter into a ureter to remove a stone.
Nephrolithotomy This surgery removes a staghorn calculus, which invades the calcyes and renal parenchyma.
If kidney damage sever as a result of stones Nephrectomy may be performed- (removal of the kidney)
Nutritional therapy that may reduce the risk of stone development Fluid is increased to 2.5 to 3 liters/daily. Intake should be consumed spaced out throughout the day.
What foods are restricted for calcium stones? Dietary calcium and Vit D enriched foods are restricted.
Why would pt be advised to modify their diet towards foods that would lower their PH (from alkaline to acidic? Because Calcium stones form readily in alkaline urine
Cheese, cranberries, eggs, grapes, meat and poultry, plums and purnes, tomatoes and whole grains. Foods that acidify urine
Green veggies, fruit (except grapes, cranberries, plums, prunes) legumes, milk and milk products and rhubarb. Foods that alkalinize urine
Beans and lentils, chocolate and cocoa, dried fruits, canned or smoked fish except tuna, flour milk and milk products. Foods that high in calcium
Asparagus, beer and colas, beets, cabbage, celery, chocolate and cocoa, fruits, green beans, nuts, tea, tomatoes Food that are high in oxalate (chemical compound that forms needle-shaped crystals)
Goose, organ meats, sardines and herring, venison, moderate in beef, chicken, crab, pork, salmon and veal Foods in high purines (purines form Uric Acid Stones)
What are risk factors for UTI? Catheterization, structural abnormalities, obstructions or strictures, incomplete bladder emptying, chronic disease such as diabetes.
What risk factors do women have for getting a uti? Short, straight uretha; proximity of urinary meatus to the vagina & anus; tissue trauma & possible contamination during sexual intercourse;Use of a diaphgagm for birth control; personal hygiene practices;voluntary urinary retention
What risk factors do men have for getting a UTI? An enlarged prostate gland
What risk factors do elderly have for getting a UTI? Increased bacteria pH, promoting bacterial growth; Higher incidene of diabetes leading to glucose in the urine; Incomplete bladder emptying and urinary retention; changes in vaginal pH; decreased prostatic secretions in men
Created by: Wends1984