Impaired Renal from Nursing 1215
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| The common pathogen that causes UTIs | E. Coli
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| This type of UTI usually has systemic symptoms such as fever, chills, and flank pain | Upper UTI
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| This is inflammation of the bladder | Cystitis
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| This is inflammation of the urethra | Urethritis
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| This classification of UTI is one that is defined as an uncomplicated UTI in a person who has never been infected | Initial UTI
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| This classification of UTI is one that is defined as reinfection caused by a second pathogen in a person that has experienced a previous infection that was unsuccessfully eradicated. | Recurrent UTI
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| Define unresolved bacteriuria | Recurrent UTIs that are:
A. Initially resistant to antibiotics
B. The antibiotic agent does not reach adequate concentrations to kill the bacteria.
C. The drug is discontinued before the bacteriuria is eradicated
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| What is bacterial persistence? | Bacteria:
A. Develop a resistance to the antibiotic being used for treatment
B. A foreign body in the urinary system allows for bacteria to survive even with antibiotic therapy.
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| What are symptoms of UTIs | Frequency, urgency, burning, nocturia, lower back and suprapubic pain, hematuria, urinary retention
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| Fever is an indicator of what type of UTI? | Pyelonephritis
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| Older adults don't have typical symptoms for UTIs. What symptoms do we see? | Mostly neurological symptoms
Abdominal discomfort, cognitive impairment, clinical deterioration
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| What type of testing can we use to test for UTIs? | Urine analysis and sensitivity testing
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| People with this medical condition see frequently recurring UTIs? | Diabetics
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| This is an intervention designed to flush out bacteria. | Drinking 2- 3mL/day
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| What is an important teaching point to make when teaching about the drug therapy for UTIs? | Continue the dose even after symptoms disappear
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| This is an Upper UTI that is characterized by bacteria infection of the renal pelvis, tubules, and interstitial tissue of one or both of the kidneys | Pyelonephritis
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| What are some of the causes of Pyelonephritis? | Urine reflux back into the ureters
Urinary obstruction such as BPH and kidney stones
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| What type of Pyelonephritis has enlarged kidneys with interstitial infiltrations of the inflammatory cells? | Acute Pyelonephritis
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| This type of Pyelonephritis results in atrophy and destruction of tubules/glomeruli. This can cause eventually renal failure. | Chronic Pyelonephritis
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| What are some s/s of Pyelonephritis? | Flank pain (from kidney involvement)
Pyuria (pus in the urine)
fatigue, chills, fever, vomitting, malaise
CVA (costovertebral angle) tenderness
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| Why is it important to monitor BP of someone with Pyelonephritis? | It helps prevent renal deterioration
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| List some of the causes of renal calculi | Increased or decreased pH
Slow urine flow; maybe from obstruction
Immobility
Damage to the UT
Repeat UTI
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| What are some symptoms of renal calculi? | Oliguria from obstruction
Pain at the CVA (costovertebral angle) traveling to the groin
UIT symptoms
Hematuria
intermittent pain (spasms as the stone is being pushed down the UT)
Fever
Pain
Chills
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| An important part of diagnostic study for renal calculi is to do what with the stone? | Retrieve it and analyze it
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| What are ways to diagnose renal calculi? | cystoscope
IV pyelogram: highlights UT
KUB: Kidney, ureter, bladder (hydronecrosis)
Serum labs: increased calcium, oxalate, uric acid
Renal stone analysis
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| What is some nutritional teaching we can do for those with renal calculi? | 1. Intake adequate amounts of fluid and calories
2. Decrease protein and sodium to prevent further trauma to the renal system
3. Limit calcium only if there is a significant amount of calcium in the stone
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| Name some procedures to rid the body of renal calculi? | a. Ureteroscopy: laser = sand like particles
b. ESWL = non-invasive
c. Electrohydraulic lithotripsy: small pieces that have to be removed by forceps or suction.
d. Percutaneous Nephrolithotomy
e. Surgical removal
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| High protein diets are associated with what for renal calculi? | Increased urinary excretion of calcium which can lead to calcium kidney stones
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| Dark ruffage (spinach and cabbage), tomato, beets, and tea are associated with what type of renal calculi? | Oxalate stones
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| A patient is placed on low purine diet. We would expect to see this intervention with the formation of what type of renal calculi | Uric stone
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| What is one important intervention that can help the passage of renal calculi? | Ambulation and give fluids
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| Monitoring the patient's I/O can help identify what? | Obstruction
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| What are some types of urinary diversions? | Incontinent and continent
orthotopic bladder
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| This is a urinary diversion to the skin? | Incontinent Diversion
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| What are some important things to know about incontinent urinary diversions? | They have a stoma that is not continent and will need to use a external collecting device
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| How often do you catheterize continent urinary diversions? | every 4 -6 hours
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| This type of procedure creates a new bladder and urine can drain through the urethra | Orthotopic neobladder
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| What is an important teaching point for orthotopic neobladder? | There is no connection between the brain and this bladder to tell you when to go. You must have a voiding schedule
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| This condition occurs in 50% of men by age 50. | BPH
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| What are some symptoms of BPH? | difficulty urinating and intermittency
Dribbling
Frequency, urgency, dysuria, bladder pain, nocturia, incontinence
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| What is a complication with BPH? How is it treated? | Acute urinary retention treated with catheter to drain the bladder
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| What is serious complication with BPH that is potentially fatal? | Renal failure from hydronephrosis
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| What are some medications to avoid with BPH? | decongestants, anticholinergics, and antihistamines
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| This drug can take up to 6 months to be effective for the treatment of BPH symptoms | Finasteride (Proscar)
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| Name some procedures used to treat BPH | Transurthral Needle Ablation: heats the prostate
Transuretral incision of the prostate (TUIP)
Transurthetral Resection (TURP): removal of prostatic tissue
Laser prostactomy: cut, coagulate, vaporize prostatic tissue
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| What are two substance individuals with BPH should avoid? | Alcohol and caffeine which cause smooth muscle contraction
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| What are some postoperative complications of BPH procedures? | Hemorrhage, bladder spasm, urinary incontinence, and infection
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| Explain CBI associated with BPH | Continuous bladder irrigation
Rate of infusion is based on color of the drainage
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