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Genitourinary #1

QuestionAnswer
What are the functions of the kidney? Form urine, balance solute and water transport, excrete metabolic waste products, conserve nutrients, regulate acid-base balance, secrete hormones that regulate BP/erythrocyte production/calcium metabolism
List the processes of urine formation (there's 3). Glomerular filtration, tubular reabsorption, tubular secretion
What is glomerular filtration rate (GFR)? Amount of fluid filtered from the blood per minute. Normal range is 120-125 mL/min (adults).
Describe tubular reabsorption. Tubules regulate rate and degree of water and ion reabsorption according to hormonal signals
Describe tubular secretion. Basically the reverse of reabsorption. Substances move from the blood into the tubules to be filtrated.
What happens when tubular secretion is not as effective? Substances (like ammonia) are not filtrated out of the blood resulting in toxicity.
How is solute balance and water transport regulated? ADH (Anti-diuretic hormone) secretion causes pores of collecting tubules to enlarge -> water in interstitial spaces then reabsorbed and urine is concentrated.
What waste products increase when kidneys are not functioning? Urea, uric acid, creatinine, ammonia, potassium, phosphate
What waste products decrease when kidneys are not functioning? Sodium (due to diluted urine) and calcium (inverse of phosphate)
What are the functions of renal hormones? Activate vit D (allows absorption of calcium and phosphate) and secrete erythropoietin (stimulates bone marrow to produce RBCs)
List the types of nephrotoxic medications (there's 6). NSAIDs, antibiotics (aminoglycosides, sulfonamides), chemotherapy/immunosuppressants, heavy metals, antihyperlipidemics ("statins"), street drugs
What can cause incontinence? Low fluid intake, fecal impaction, UTI, CNS depressants, calcium channel blockers, tumors
Describe stress incontinence and treatments. Loss of urine with increased abdominal pressure (ex. coughing). Tx = kegels, wt loss, estrogen, anticholinergics/antispasmodics, surgery, estrogen, electrical stimulation
Describe urge incontinence and treatments. Strong desire to void with large loss of urine. Tx = anticholinergics, tricyclic antidepressants, bladder training
Describe overflow incontinence and treatments. No urge to void-usually caused by spinal cord lesions. Tx = surgery, urecholine, bladder compression, intermittent self-catherization (most common).
Describe functional incontinence and treatments. Leakage in socially unacceptable circumstances. Tx = applied devices (caths, diapers), environmental alterations (raise toilet seat), surgery, bladder training, kegels
What is benign prostatic hypertrophy (BPH)? Enlargement of the prostate gland that causes bladder outlet obstruction.
List s/s of BPH. Difficulty in starting (hesitancy) and continuing urination, reduced force, incomplete bladder evacuation, dribbling, nocturia
List diagnostic tests for BPH. Prostate gland exam and blood studies (increased BUN, creatinine, and WBC [if infection], may have increased PSA)
What medications treat BPH? 5-alpha reductase inhibitor (5-ARI), alpha-blocking agents, and herbs or foods (saw palmetto or tomato for lycopene)
What surgery corrects BPH? Transurethral resection of the prostate (TURP). Criteria = chronic UTIs, hematuria, hydronephrosis, and acute urinary retention.
Describe post-op care for BPH sx. Monitor for s/s infection, hemorrhage, and pain. If obstruction, turn off irrigation and irrigate catheter with 30-50 mL of NS with lg piston syringe. Increase fluid intake to 2-2.5 L/d
What causes urolithiasis? Caused by calcium phosphate, calcium oxalate, struvite, and cystine/uric acid. Either by diet or tumors, gout, or hyperparathyroidim.
What are the s/s of kidney stones? PAIN! N/V, diaphoresis, pallor, oliguria or anuria.
List meds to relieve pain from kidney stones. Morphine (preferred) or other opiod analgesic, NSAIDs, antispasmodics, antiemetics
What is percutaneous nephrolithotripsy? Key hole surgery that uses energy to break up calculi. NPO 4 hrs before and no anticoagulant meds at least 1 wk before.
What should be included in discharge teaching after percutaneous nephrolithotripsy? Strain urine so composition of stone can be identified and prevented, no driving for 1-2 wks, no tub baths, follow-up appt in 1-4 wks, return to work in 4d-6 wks. If stent placed-critical to have it removed.
What are important interventions to remember for a percutaneous nephrostomy tube? Do not clamp-look for kinks, secure tubing to skin, keep drainage bag below kidney, keep site and surrounding skin clean and dry, irrigate regularly.
What are important interventions to remember for a lithotripsy? Uses multiple shock waves without damaging surrounding tissue, synchronize shock waves with EKG,admin antibiotics for 2 wks, and insert stent with nephrostomy tube
What are contraindications for a lithotripsy? Exaggerated spinal curves, calcium deposits in the ureters, stone that cannot be seen by contrast,or a very large stone over 1 1/4"
What are normal post-op findings after a lithotripsy? Bruising, colicky pain (stone not removed), and bright red or tea-colored urine
List other treatments for stones. Increase fluid to 3 L/d, drink water at bedtime, avoid excessive sweating/dehydration, treat UTIs promptly, and diet restrictions (depends on composition)
Name which medications treat each type of stone. Thiazide diuretics for hypercalciuria. Allopurinal for hyperoxaluria and gout. AMPG and Captopril for cystinuria.
What is polycystic kidney disease? Inherited disorder in which grape-like cysts form within the nephrons. S/s can appear at 30 y/o
What are the s/s of polycystic kidney disease? Steady dull or colicky abd/flank pain, proteinuria, hematuria, HTN, and increased abd girth.
What are the potential complications of polycystic kidney disease? HTN, ineffective breathing pattern, or renal failure
Describe management of polycystic kidney disease. Limit protein intake (only high biologic value protein) to lower uremia, restrict sodium according to OP, restrict fluid, limit phosphorus, and admin antihypertensives/diuretics/analgesics.
What should you teach a pt with polycystic kidney disease? Avoid tight clothing around waist, no contact sports, how to take BP, and advise to have genetic counseling as each child has a 50% chance of having gene
What are the s/s of acute post-streptococcal glomerulonephritis? Onset of 5-21 d after strep infection (throat, tonsils, or skin), generalized edema, HTN, oliguria, hematuria. RARELY leads to renal failure!
What are the s/s of chronic glomerulonephritis? Onset of 20-30 yrs with unknown cause, mild proteinuria/hematuria, HTN, occasional edema, and fatigue. ALWAYS leads to renal failure!
Which labs increase or decrease in chronic glomerulonephritis? Increase: BUN, creatinine, potassium, phosphorus. Decrease: GFR, Na (may also be normal), calcium, pH (acidosis)
What is nephrotic syndrome? Condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine to be excreted.
What are the s/s of nephrotic syndrome? Severe proteinuria, edema, HTN, low albumin, high serum lipid levels.
Describe tx of nephrotic syndrome. Steroids and/or immunosuppressive meds if immunological cause. ACE inhibitors for proteinuria, cholesterol-lowering meds for hyperlipidemia, diuretics/Na restriction for edema and HTN. Protein restriction based on GFR
Created by: 541787602