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Urinary System

Chapter 45&46-Urinary System/Renal & Urologic Problems

3 Functions of Kidneys Controls electrolytes, release erythropoitein, acid/base balance-produce bi-carb
Kidneys extract what % of cardiac output kidneys extract 20-25% of cardiac output
What should NOT be found in urine? should not get through semi-permeable membrane of glomerulus sugar, protein (ketones), WBC, RBC
What is GFR Glomerular function rate: decreased GFR=decrease kidney function. If dehydrated, GFR decreased--alone does NOT indicate kidney failure
What is hydronephrosis? Fluid builds up around the renal pelvis; is a symptom of something, does not indicate kidney failure
What is the normal concentration of urine? specific gravity=1.003-1.03
What is fixed specific gravity? 1.010=same as plasma, indicates kidneys are not filtrating
What are serum renal labs? BUN/Creatine electrolytes: Na, K, Ca, Phos Bicarb: venous CO2
What is a KUB: Kidneys, Ureter, Bladder? x-ray; can show stones
What is an Intravenous Pyelogram (IVP)? IV injection of dye, then take x-ray *must be NPO for 8 hrs prior *no allergies to iodine or shellfish *with dye,will feel warm sensation expected, feel like peeing themselves *push fluids after; hard on kidneys, need to flush
What is a Retrograde Pyelogram? Done when can't give IV dye. Scope thru urethra into bladder, then inject dye into ureter *NPO 8 hours prior *push fluids after
What does an ultrasound of the kidneys show? Shows possible mass(es) or size of kidney
Does a CT scan or MRI reveal more info about the kidney CT gives more detail of kidney tissue than MRI
What is a renal biopsy? Give info about the kidney tissue; large needle CT or ultrasound guided *Type & cross for blood ahead of time Contraindications: uncontrolled HTN (risk for bleed), only have one kidney, d/c coumadin; INR <1.5
What are some pt teachings for after a renal biopsy procedure? After procedure keep on affected side (to apply pressure) for 30-60 min, bedrest for 24 hours, no heavy lifting 5-7 days
What is a cystoscopy? Pt in lythotomy position; scope thru urethra to bladder. Visualization of bladder to see cancer, see stones, do biopsies *NPO before procedure
What should a pt expect after a cystoscopy? *burning, frequency, pink-tinged urine *soreness *bright red urine NOT expected or normal *warm sitz bathes help *apply heat and/or take mild analgesics
What is the normal pH of urine? normal urine pH=4-8, average of 6
What is pyelonephritis? UTI, has worked its way up and now affects the kidney
What is cystitis? UTI, affecting bladder
What is urethritis? UTI, affecting urethra; puss coming out of urethra
What is urosepsis? UTI, now into blood; common in elderly pts
What is Complicated UTI? Other things/issues are involved with UTI--diabetes, Foley stones
What is recurrent UTI? antibiotics not working on UTI, keeps coming back; if long term--only treat if symptomatic; it's a chronic issue
Who's at risk for UTIs? *ppl w/urinary retention issues *women w/multiple partners *post-menapausal women, decrease in normal flora *ppl with instrumentation (Foley) *chg in urine pH
How will an elderly person present with UTI? abdominal pain, confusion
How do you dx UTI? UA w/ C&S
What is the tx for UTI? antibiotics, increase fluids, prevention
What is the most common microorganism to cause UTI? E. coli
What is acute pyelonephritis? inflammation of the renal parenchyma (tissue)
What are causes of pyelonephritis? UTI moved upped ureter, kidney reflux, urine back up ureter, BPH, obstruction, stone
What are S&S of pyelonephritis? Lower Urinary Tract Symptoms (LUTS)-urgency, frequency; fatigue, chills, fever, flank pain, costal vertebral tenderness
What is Tx & care of pyelonephritis? Aggressive antibiotics 2-3 wks; S&S should resolve in 48-72 hours. If relapse, will treat for at least 6 weeks w/diff antibiotic
How to Dx pyelonephritis? Symptoms, labs (inc. WBC), urinalysis=positive nitrates, WBC, and casts (tissue cells in urine), C&S
What is chronic pyelonephritis? Recurrent, not getting better--kidneys begin to shrink & lose function, if affects both kidneys can result in chronic kidney failure, ESRD
What is Urethritis? Inflammation of urethra, caused by bacteria or virus; typically an STD In men, gonorrhea (tx w/doxycyclin); purulent drainage Clear discharge: trychomonus, tx w/Flagyl In women, can be a yeast inf. (Nystatin & Diflucan) *Need to treat partners if STD
What is Urethral Diverticula? Typically occurs in women. Result of obs. of skenes glands; affects bottom 1/3 of uretha
What are S&S of urethral diverticula? LUTS, post-void dribbling, urinary incontinence
How is urethral diverticula dx? sediment or hematuria in urine or anterior wall mass, will be tender, can express puss with manual exam; if mass large, may send to CT-Treatment is surgery for removal
What is interstitial cystitis? AKA-Painful bladder syndrome. Chronic, painful inflamm. disease of bladder S&S: urgency, frequency; most freq in women
How is painful bladder syndrome dx? R/O everything else; no single treatment. Avoid bladder irritants; avoid stress; will affect sex life, chg positions
What are tx options for painful bladder syndrome? Elevil & Aventil--used to decrease pain and frequency; may need opiate analgesics--Norco, Vicodin
What is glomerulonephritis? bilateral; third leading cause of renal failure; anti-glomerial basement membrane (anti-GBM)antibodies attack basement membrane; have immune complexes deposited in glomerulus (clogs membrane; causes compl activation, leads to inflamm in membrane, damages
What are S&S of glomerulonephritis? Hematuria, WBC, RBC, casts & protein in urine, increase BUN & Creatinine Goal: to eval for infections & autoimmune diseases; treat for infection, then check ESR, RA
What is post-streptococcal glomerulonephritis? Immune complexes too big to get through glomerular basement; clogs
Who does post-streptococcal glomerulonephritis affect? Affects children & young adults; 5-21 days after strep infection (group-A beta hemolytic strep)
What are S&S of post-streptococcal glomerulonephritis? Generalized edema, HTN, oliguria (less than 400mL in 24 h), smoky, rusty urine, periorbital edema (eyes)
How to Dx post-streptococcal glomerulonephritis? Protein in urine; not enough pull in vascular space, low serum protein=edema Lab: Anti-streptolysin-O (aka, ASO titer): blood test, may do renal biopsy
How to Tx post-streptococcal glomerulonephritis? Rest, steriods to decrease inflamm (solumederol), diuretics to decrease edema, low Na, fluid restrict diet, treat w/antibiotic for recurrent strep infection; if HTN, treat w/meds
What is Good Pasture Syndrome? What are S&S? A cytotoxic, autoimmune disease in (Immune complexes too big to get through glomerular basement); inflammatory reaction S&S: flu-like symp w/cough; hemoctysis (coughing blood), crackles in lungs, hematuria, anemia
How is Good Pasture Syndrome Dx: Based on symptoms & anti GBM antibodies
What is Tx for Good Pasture Syndrome? Corticosteriods, Immune suppression=drugs: cytoxin or Imuran; Plasma Foresis=plasma exchange to remove auto immune complexes; similar to dialysis
Who's at risk for Good Pasture Syndrome? young males, smokers death results from respiratory failure
What is Nephrotic Syndrome? Glomerulas is excessively passive to proteins; massive overflow of protein in urine *infection leading cause of death; chronic, no cure
What are S&S of Nephrotic Syndrome? serum albumin very low; results in massive edema; elevated cholesterol & triglycerides b/c lack of protein; fatty casts in urine
What is Tx of Nephrotic Syndrome? Based on symptom management: low Na diet, 2-3g/day; mod to low protein diet; daily wts; measure circum. of extremeties; small freq meals; infection prevention **skin care is crucial for these pts b/c of pitting edema; must keep clean, dry
What's a big risk for Nephrotic Syndrome? In a hyper-coaguable state; need to watch for renal vein thrombosis; if occurs, will have 6mos anti coagulation
Why do kidney stones occur? elevated Ca levels; concentration of urine; incr. pH, Ca & Phos precipitate out; decreased pH, uric acid (found in ppl w/gout) & cysteine precipitate out
What are kidney stones made of? what they are made of helps decipher how to treat Calcium Oxylate, Calcium Phosphate, Uric Acid, Cysteine & Struvite struvite assoc w/ UTI; large & staghorn, occupy renal pelvis
What are S&S of kidney stones? abd or flank pain, renal colic (as stone passes), cool, moist skin, pain in testicles or groin area
What are diagnostics to find kidney stones? ultrasound, CT, IVP, UA for pH & to decide how to treat, Urine culture-UTI
How do you tx kidney stones? pain control, as stone passes; strain urine-->4mm will not pass; urethral stents (dilates ureter); change diet
What is a cystolitholapaxy? Crushes stones thru cystoscope
What is cystoscopic lithotripsy? ultrasound to pulverize stone; to make passing easier
What is a uteroscope? used to go up thru ureter and try to get stone out
What is percutaneous nephrolithotomy? nephrostomy tube, bringing ureter to surface & leave it there. Risks: bleeding & infection
What is lithotripsy? Breaking up of the stone; diff ways to do it--typically ultrasound; uretal stent may be put in place for 1-2 weeks; may be a string hanging out of urethra to help pull out S&S: hematuria, pink, NOT bright red
What's the most common surgical complication of surgery for stones? May have flank or lateral incision; hemorrhage most common complication
What is nutrition concerns for ppl with stones? push fluids, about 3L/day after removal; limit caffeine; limit purines for uric acid
What is a ureteral stricture? narrowing of ureter; most common w/surgical, scar tissue S&S: mild/mod colic Tx: stent, dilate where stricture is located; nephostomy tube (last resort)
What is urethral stricture? narrowing of urethra; result of fibrosis, scar tissue, previous trama; can create voiding obstruction
What are S&S of urethral stricture? decreased force of urine, dribble, may have to strain to void, may have sprayed stream, may have urinary retention
What is Tx for urethral stricture? dilation to open up; stents; or surgically repair
What is Nephrosclerosis? narrowing of small arteries of kidney; leads to decreased blood flow & necrosis of kidney S&S: HTN, then decreased renal funtion...kidney failure
What is Renal Artery Stenosis? Hx of athlerosclerois; CAD--makes more prone for renal artery stenosis; not adequate blood flow
What are possible tx for artery stenosis? angioplasty to try to stent renal artery (ballon); if kidney not getting enough blood flow-keeps sending out RENIN which causes vasocontriction, inc BP; if adeq blood supply cannot be supplied, may lose kidney
What is renal vein thrombosis? vein not leaving kidney Due to trauma, cancer or pregnancy. S&S: Flank pain, hematuria, r/t nephrotic syndrome Tx:anti-coagulation, may go in to surg. remove clot & save kidney Tx:
What is Polycystic Kidney Disease? autosomal dominant condition; bilateral; ppl 30-40y/o, Kidneys become overrun with cysts; blood, serous fluid or puss-filled
What are S&S of polycystic kidney disease? HTN, hematuria, feeling of heaviness in back, side or abdomen; can palpate kidney, it can affect heart, liver, intestines; gradual loss of kidney function
What is the care & tx for polycystic kidney disease? Take the kidneys out if pain, bleeding or infection; leave in as long as possible; Tx: antihypertensives, genetic counseling--eventually will need transplant or dialysis
Who does kidney cancer affect: Men more than women; 50-70y/o; smokers-#1 risk factor
What are S&S of kidney cancer? Hematuria, flank pain, palpable mass, weight loss, HTN, & anemia; no early symptoms, by the time it's diagnosed usually in advanced stages--mets in lungs, liver & long bones
What are diagnostic studies for kidney cancer? ultrasound, CT, IVP
What are treatments for kidney cancer? Stage 1 or 2=radical nephrectomy; also includes adrenal glands, ureter and lymph nodes Stage 3 or greater=radiation for pallative care; chemo doesn't work-no good chemo agent
What is survival rate with nephroctomy? 60% have five year survival rate
What is survival rate of stage 3 or greater? 3-10% five year survival rate
Who does bladder cancer affect and what are risks and S&S? Affects men more than women, 60-70y/o Risks: smoking, recurrent calculi, chronic UTIs S&S: painless hematuria, frequency & urgency
What are diagnostics for bladder cancer? UA & check for neoplastic cells, CT, ultrasound. Confirming dx=cystoscopy with biopsy
How is bladder cancer classified? Superficial Invasive Metastatic
What are treatments for bladder cancer? *intravesicular chemo-inside bladder *resect the bladder & take portion out *Systemic chemo drugs: Cysplatin, adriamycin & methotrexate
What is Transurethral resection with fulguration? go in w/scope & resect tumor out w/cauderizing & blade For more superficial lesions
What is laser photocoagulation? destruction of bladder tumor w/laser; burning it off
Nursing care for after bladder cancer procedures... push fluids, no alcohol, pink urine expected, bright red=NO, no clots 7-10 days post may have dark red, rust in urine=scabs, healing give stool softeners analgesics; 3-6 mos f/u cystoscopy
What is a partial cystectomy? removal of part of the bladder; some left in tact
What is a radical cystectomy with urinary diversion? Male: removal of bladder, prostate and seminal vesicles Female: removal of bladder, urethra, cervix, ovaries & uterus
What is urinary incontinence? unintentional leaking of urine; not normal, not expected with aging Stress incontinence, overflow or urge incontinence
What is urinary retention? Bladder does not empty completely; 50-75mL normal post-void residual; not normal, not expected with aging
What is a retropubic colpa suspension? muscles that attach to bladder are loose; surgery not 100% Complications: voiding dysfunction, vaginal prolapse
What is pubal vaginal sling? muscles that attach to bladder are loose; surgery not 100% Complications: voiding dysfunction, vaginal prolapse
Nursing Care for urinary incontinence & retention... Kegel exercises, avoid bladder irritants, alcohol, caffeine, stop smoking, void q 2-3 h
What is a ileal conduit? After radical cystectomy, portion of ilium brought to surface; ureters attached to ilium
What is a continent urinary diversion? No bag. Create a bladder made of bowel, attach to surface; small stoma that does not continuously leak; straight cath q 4-6 h
What is orthotopic bladder reconstruction? bowel used to construct bladder, attach ureters, urethra still connected; may straight cath--no innervation between "fake" bladder & brain; may have to straight cath in meatus
What must a pt have for continent urinary diversion or orthotopic bladder reconstruction? normal renal function, no IBS, >2yr life expectancy; obesity is an issue
What are some pt teachings pre-surgery for UTI surgery? adequate fluid volume; flank incision or lower abdominal incision; 12th rib may have to be removed depending on incision
What are some pt teachings and things to look for post-surgery for UTI surgery? watch urine output q 1-2 h, daily weights; respiratory-DB & C, IS; splinting lower abdominal incision; NPO until bowel sound return, stool softener after BS return
What are ways to help someone with urinary retention? run water, peeing in shower, sitz bath
Created by: divelmama
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