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68WM6 Phs2 test 7

68WM6 Phase 2 test 7 Urinary System

Define anasarca Severe, generalized edema
Define anuria urine output less than 100 ml/day
General feeling of tiredness and listlessness asthenia
Azotemia build up of nitrogenous waste products in the blood
dysuria painful or difficult urination
hydronephrosis dialation of the renal pelvis and calyces
nocturia excessive urination at night
pyuria pus in urine
residual urine volume left in bladder after voiding. usually less than 50 ml
which kidney is slightly lower and why? Right kidney is lower due to the Liver
outer covering of kidney; made of strong connective tissue renal capsule
lies beneath the cortex and is darker in color renal medulla
functional unit of the kidney nephron
3 functions of the nephron maintain water balance maintain pH levels in blood removes toxins from the blood stream
Afferent Going INTO the kidney
Efferent Going OUT of kidney
Cup-like structure that collects the glomerular filtrate Bowman's Capsule
The renal tubule contains what? Proximal convoluted tubule, Lood of Henle, distal convoluted tubule, and collecting ducts
what two hormones help kidney maintain fluid and electrolyte balance ADH (anti-diuretic hormone), and aldosterone
stress incontinence bladder tone loss and perineal muscle relaxation - sneeze=pee risk of UTI
Enlargement of prostate that leads to constriction of urethra BPH - Benign Prostate Hypertrophy
what is not normally found in urine protein, glucose, ketones, RBC, WBC, and crystals
True / False - Urine culture and sensitivity requires a clean catch True
urine creatinine clearance levels related to muscle mass, do not exercise during test period. excellent renal function indicator
Abnormal elevation in creatinine levels are caused by what? Glomerulonephritis, polynephritis, acute tubular necrosis, urinary obstruction
Blood tests for renal function Serum clearance, BUN, PSA, Osmolality
Elevated PSA results from: prostate cancer, BPH, Prostatitis Do not manipulate prostate prior to blood draw, can give false positive
Osmolality provides: info on kidney's ability to concentrate urine
Kidney-Ureter-Bladder is a what? X-Ray to evaluate size, structure and position of urinary tract structures
IVP - Intravenous Pyleography is: contrast & radiographs to monitor kidney function - metallic taste / warm flushing sensation
Abnormal finding in a IVP structural deviations, hydronephrosis, calculi within urinary tract, polycystic kidney disease, tumors
retrograde pyleography is: exam of lower urinary tract; contrast injected into ureters to visualize upper tract
visual exam to inspect, treat, evaluate, or diagnose d/o of urniary bladder and proximal structures Cystoscopy
Performed through the skin and provides direct visualization of upper urinary structures nephroscopy
Multiple cross-section pictures obtained at several different sites creates a 3D "map" of kidney structres CT Scan
Evaluates blood supply to kidneys, evaluates masses and detects potential complications after renal transplant Renal Angiogram
male urethra female urethra 18-20cm 2.5-3.0cm
Difference between internal and external sphincter internal provides involuntary control while the external is under voluntary control
Upper urinary tract: kidneys, renal pelvis, ureters
lower urinary tract bladder urethra, pelvis floor muscles
physiology of urination bladder holds 750-1000ml, urge hits at approx 250ml of urine, stretch receptors in bladder wall stimulate urge=involuntary contraction of bladder, internal and external sphincters relax=urination
kidneys for about how much urnie each day? 1-2 Liters
what are some alterations in voiding pattern? Dysuria, frequency, urgency, burning, enuresis, nocturia, polyuria, oliguria, anuria, pneumaturia, hesitancy
Dysuria can be r/t: lower UTI, irritation after sex, use of bath or feminine products, pathological conditions
frequency can be r/t: disease of urinary tract, metabolic disease(DM), HTN, medications
Urgency r/t: acute bacterial infections, chronic prostatitis, and inflammatory lesions in bladder, prostate, and urethra
what is enuresis? no control over flow of urine
Nocturia r/t: heart failure, DM, poor bladder emptying, decreased renal concentrating ability
pneumaturia r/t: rectosigmoid cancer, regional ileitis, sigmoid diverticulitis, gas-forming UTI, fistula between bowel and bladder
Hesitancy r/t: compression of urethra, outlet obstruction, neurogenic bladder, UTI
Upon initial assessment of urinary incontinence, what would the objective data comprise of? Inspect abd for scars, symmetry, and pulsations Examine the back for bulging, bruising, scars Percuss for fullness of bladder-dullness? Palpation of suprapubic area Assess kidney of pain or tenderness
pathophysiology of urinary incontinence? reduced stimuli to bladder sphincters r/t age, unconscious, anesthesia, infection, damaged sphincters, spinal nerve damage, defects
4 clinical manifestations of urinary incontinence: stress, urge, overflow, and functional incontinence
4 pharmacologic agents for urinary incontinence Ditropan, Dibenzaline, Urecholine, Detrol
Nursing interventions for urinary incontinence Develope schedule, encourage adequate fluid intake, bladder training exercises (Kegel exercise)
etiology of urinary retention in males BPH, foreign body in urethra, phimosis, urethritis
a lesion of the nervous system that interfers with normal nerve conduction to the urinary bladder neurogenic bladder
Carbonic Anhydrase inhibitors Dazamide, Diamox, Storzolamide
Loop Diuretics Bumex, Lasix, Demadex
Osmotic Diuretics Osmitrol, Resectisol
Thiazide Diuretics Diuril, HCTZ, Esidrex, Hydrodiuril
K+ Sparing Diuretics Midamor, Aldactone, Dyrenium
Thiazide-like diuretics Hygroton, Lozol, Mykrox
Diuretic Nursing Implications: Weigh Daily, I&O, edema?, lung sounds, turgor, mucous membranes
Diuretics: Assess for: Anorexia, numbness, tingling, confusion, excessive thirst, parethesia, electrolyte imbalance
When would you administer oral diuretics? in the morning
Diuretics & pt/family teaching: orthostatic hypotension is at risk; change position slowly, decrease alcohol, exercise in hot weather. use sunscreen, ask before taking OTC meds. Routine follow-up=impt!
Diuretic evaluation includes what? Decreased BP, Increased Urine, decreased edema, reduced intracranial pressure, prevent hypokalemia, tx hyperaldosteronism
Action of Carbonic anhydrase inhibitor diuretics? Increase Na+ excretion through renal tubule, decrease secretion of aqueous humor in eye= decreased ICP
Noteable side affects of carbonic anhydrase inhibitors metallic taste, kidney stones, hypokalemia VERY painful if given IM
Carbonic anhydrase evaluation includes decreased intraocular pressure, decreased seizures, prevent altitude sickness, prevent uric acid/cystine stones in urinary tract
Where in the nephron do carbonic anhydrase diuretics work? proximal convoluted tubule
Where in nephron do Osmotic diuretics work? Descending Loop of Henle
Where in nephron do Loop Diuretics work? Ascending Loop of Henle
Where in nephron do Thiazide Diuretics work? Distal convoluted tubule
Where in nephron do K+ Sparing Diuretics work? Distal convoluted tubule and collecting duct
What is the action of Loop Diuretics? inhibits the reabsorption of Na and Cl, increases renal excretion of water, Na, Cl, Mg, H, and Ca.
What are Loop diuretics used for? tx HTN, or edema r/t CHF, and renal and hepatic disease
noted pt/family teaching for Loop diuretics in being tx for HTN, continue meds even if feeling better. Reinforce need to continue additional therapies for HTN.
Uses for Osmotic diuretics Acute oliguric renal failure, edema, increased intracranial or intraocular pressure
Action of Osmotic diuretics excrete water, sodium, and chloride
What are 3 uses of K+ Sparing Diuretics? tx edema, manage CHF, tx HTN, counteract K+ loss caused by loop or thiazide diuretics
Action of K+ Sparing diuretics: causes loss of sodium bicarbonate and Ca while saving K+ and H+ ions at Distal Conv. tubule.
What are three K+ Sparing diuretics? Midamor, Aldactone, Dyrenium
What are 4 side effects of K+ sparing diuretics? arrhythymias, consitpation, bluish urine, hyperkalemia, hyponatremia
nursing implications for K+ Sparing diuretics I&O's, daily weight, BP, s/s for hypokalemia (arrhythmias, U wave on ECG, polyuria / polydipsia), periodic ECG's
Pt/family teaching for K+ Sparing diuretics avoid salt substitutes and food high in K+, take even if feeling better, no driving, no OTC meds w/o ok from Dr, bluish colored urine, correct way to take BP
Evaluation / expected outcomes with K+ Sparing Diuretics decreased edema, decreased BP, prevent hypokalemia, tx hyperaldosteronism
What are the uses for Thiazide Diuretics? use alone or with other meds to tx HTN. Tx edema r/t CHF, Renal dysfunctino, cirrhosis, estrogen therapy
What do Thiazide diuretics do? increase kidney's flitration of Na and water. promotes excretion of Cl, K, Mg, and Bicarbonate
Examples of Thiazide diuretics diuril, HCTZ, HydroDIURIL
May increase serum cholesterol, LDL, and triglyceride concentration? Thiazide Diuretics
Desired outcomes for Thiazide Diuretics? Decreased BP, Decreased edema, increased urine output
Thiazide-like diuretic use and action? Mild to moderate HTN and edema r/t CHF increase excretion of Na and water; inhibits Na reabsorption in distal tubule
Examples of Thiazide-like diuretics Hygroton, Lozol, Mykrox, Zaroxolyn
Pt/family teaching for Thiazide-like diuretics encourage pt to comply with HTN control measures - low sodium diet, exercise, stop smoking, low alcohol consumption, stress mngt
Pyridium is what kind of urinary medication? urinary tract analgesic
What is one noteable side effect of Pyridium? Bright orange or reddish-orange urine
What urinary medication would you find as a transdermal patch that you apply to hip, abd, or buttock? Oxybutynin - apply same two days each week to a dry, clean, non-irritated area.
Which urinary medication would you instruct pt to rinse mouth frequently, use good oral hygiene and sugarless gum to decrease dry mouth. This also causes a decrease in perspiration. Oxybutynin
What are the desired effects of Oxybutynin? Relief of bladder spasms and associated symptoms in pts with nuerogenic bladder
Why are urinary tract stimulants (cholinergics) used? Stimulate micturation - relieve urinary retention
name 5 types of urinary catheters Foley, Coude, Malecot & Pezzer, Robinson & Whistle-tip, ureteral, Suprapubic, External (Texas and Condom)
Wear a ______ catheter during the day and a _____ at night. leg bag, larger closed drainage system
Clean pt with ___ and _____ rinse collection bag with ___ and ___ soap and water vinegar and water
What are warning signs of infection around catheter? change in skin color, general weakness, N/V, Abd Pain, flank pain
how much should a pt drink per day with a catheter? 2-3 Liters
What is Kegel exercises? Tighten and hold perineal floor muscles for 10 sec, relax for 10 sec...repeat x 10, 4 x p/day
What are some nursing interventions with pts that have a catheter? develope urination schedule teach Kegel exercises teach proper skin care teach importance of adequate fluid intake
what are causes of infections that are common in elderly pts due to bladder obstructions, insufficient bladder emptying, and increased perineal soiling in females? gram-positive microorganisms and yeast
what conditions contribute to urinary stasis? urinary obstruction, neurogenic bladder, ureteral or urethral reflux, sexual intercourse
what chronic conditions are r/t urinary tract complications? DM, multiple sclerosis, spinal cord injuries, HTN, kidney diseases
why are females more prone to UTI's then males? Females have a shorter urethra and it is closer to rectum.
What is the most common organism that causes a UTI? Gram Negative bacteria
what are the diagnostic tests for urethritis in males and females? men:urethral smear - C&S women: Clean catch UA
What are some S/S of urethritis? urinary frequency, urethral discharge, urethral pruritis, vulvar irritation, (FEVER NOT COMMON)
what is cystitis? inflammation of the bladder
urethritis is often caused by: Gonorrhea
what is pyelonephritis? inflammation of the structures of the kidney, renal pelvis, renal tubules, and interstitial tissue
what are some S/S of pyelonephritis? pain in costovertebral angle, chills, fever, frequency in urination, N/V, stones could form
what are the 4 groups of urinary antiseptics? Quinolones (gram -), Nitrofurantoin(gram - & +), Methenamines(gram - & +), Fluoroquinolones(gram - & +)
Urinary anti-infectives include: Cephalosporins, Pencillins, extended spectrum penicillins, sulfonamides, fluoroquinolones, and other misc...
If pt is on long term anti-infective meds, what should you monitor and how often? AST, ALT, CBC, HCT, Bilirubin - monthly
how long are anti-infectives taken to prevent a superinfection? 10-14 days
what are signs of a superinfection? black, furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools, allergic reaction.
Methenamine is used to tx what? UTI (bladder or kidney)
examples of a Methenamine? Hiprex, Mandelamine, Urex
Directions for missed dose of Methenamine: if twice daily-take missed dose and next dose 5-6 hours apart If three x p/day: take missed dose and next dose 2-4 hrs apart
What is a use of Nitrofurantoin? chronic suppressive therapy for UTI's.
What decreases effectiveness of anti-infectives? milk or antacids
This medication can cause rust-yellow to brown colored urine? Nitrofurantoin
What can cause pain in the lower back, perineum, or rectum? Prostatitis
how long do you expect a pt with prostatitis to be on antibiotic therapy? 4-12 weeks
what are some major things to teach your pt with UTI's or other related infections? Signs and symptoms of infections, take full course of meds, how to prevent infections
what are some causes of Urinary obstructions? Structures/kinks, cysts/tumors, calculi, BPH
Diagnostic tests for Urinary obstructions; KUB, Renal ultrasound, IVP, BUN/Creatinine
what is hydronephrosis? swelling/dialation of renal pelvis & calyces
what is the eitology of hydronephrosis? an obstructrion forms in urinary tract and pressure builds behind it causing potential damage to renal system.
what types of conditions predispose you to renal calculi? Immobility, hyperparathyoid, recurring UTI, dehydration, excessive Vit D intake, osteoporosis
How would you describe pain of a calculi in the urinary system? Pain is often inversely proportionate to size of calculus. Small-big pain! Big-small pain.
what are some nursing interventions r/t urolithiasis? encourage ambulation even with pain, maintain hydration, strain all urine, assess renal function
what is polycystic kidney disease? genetic disorder characterized by the growth of several fluid-filled cysts which can slowly replace much of the kidney
what is the eitiology of a renal tumor? more common in men, primarily carcinomas that develope unilaterally, large when detected due to vague symptoms, cells from proximal convoluted tubule
A palpable mass in the flank, hematuria, and signs of metestsis are signs of what? renal tumor
where is the most common site of urinary cancer? Bladder tumor
fulguration, laser ablation, chemotherapy, and radiation therapy are all tx for what? Bladder tumor
the most common site for this cystic disease is in the collecting ducts? Polycystic kidney disease
Abd pain, headache, GI complaints, voiding disturbances, and a hx of UTI's are all things a pt with what, might tell you? Polycystic kidney disease
List 3 causes of renal function compromise r/t polycystic kidney disease pressure of cyst on kidney, secondary infection, scarring from ruptured cysts
What is: prostate encircles the male urethra at the base of urinary bladder? BPH
What is the most common procedure for relief of BPH? TURP (TranUrethral Resection of the Prostate)
What procedure to relieve BPH uses a laser to ablate the prostate and blood loss is minimal? TULIP (TransUrethral, Ultrasound-guided, Laser-induced Prostatecotomy
What would you teach your pt after a TURP or TULIP? Urine may be bloody for a few days, avoid voiding around catheter-may cause bladder spasms, may have frequent voiding with small amounts, understand meds.
What type of drug is Terazosin hydrochloride and what is it used for? Antihypertensive. decrease contractions in smooth muscles of prostatic capsule/decrease symptoms of prostatic hyperplasia
What kind of medication is Finasteride and what is it used for? Androgen Inhibitor, decrease s/s of BPH
What unique side effects can Finasteride cause? decreased libido, decreased volume of ejaculate, impotence
What lab test can Finasteride effect? PSA - Prostate Specific Antigen
What can the serum PSA be used to screen for? Prostate Cancer
What does alfuzosin do and what kind of medication is it? Urinary tract antispasmodic, relax smooth muscles in bladder neck and prostate & decrease s/s of BPH
what is a unique side effect of alfuzosin? bronchitis, sinusitis, dizziness, headache, and lethargy
What are common sites r/t prostate cancer? pelvic lymph nodes, hips, lower spine
what are three goals of a prostatectomy? remove tumor, preserve urine control, and preserve sexual function
what are nursing goals postoperative for a prostate cancer pt? DO NOT MOVE FOLEY, maintain patency of catheter, avoid clot formation, DO NOT remove tape until told to do so by Dr.
what are 4 techniques for a prostatectomy? TURP, Suprapubic prostatectomy,radical perineal, and retropubic prostatectomy
Of the 4 techniques for a prostatectomy, which is used first because it provides access to pelvic lymph nodes? Retropubic prostatectomy
what is the force which holds fluid in the vascular space? Osmotic pressure
Marked proteinuria, low albumin levels, and edema are all signs of what? Nephrotic syndrome (nephrosis)
What are two diagnostic tests for Nephrosis? Albumin level, Renal biopsy
Low sodium and high protein diet, with loop diuretics are indicators of what? tx for Nephrosis
what kidney d/o is usually preceded by a sore throat or skin infection? Acute glomerulonephritis
distended neck veins, dyspnea with exertion, crackles are all signs of what? glomerulonephritis
what kinds of medications can you expect to be taking while treating glomerulonephritis? Antibiotics, antihypertensives, diuretics, Vitamins - iron, corticosteriods-immunosuppressives
What are the phases of renal failure? Oliguric, Diuretic, Recovery
Urine output exceeds 2 L p/day, hypokalemia, hypocalcemia and hyperphospatemia are signs of what phase of renal failure? Diuretic phase
Increased BUN and creatinine levels, decreased urine, metabolic acidosis, lasts days to 4-6 weeks is what phase of renal failure? Oliguric phase
the terminal stage of renal failure is called Uremia
uremic encephalopathy, respiratory alterations, pulmonary edema, uremic frost, cardiac dysrthythmias, and electrolyte inbalance = chronic renal failure
how often are hemodialysis tx scheduled? 3 x p/wk for 3-6 hours each
peritoneal dialysis works by what? diffusion and osmosis
what are the stages of peritoneal dialysis? Installation stage, equilibration stage, drainage stage
Created by: jrstrader