Obstructive Disorders of the Urinary Tract
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| Pain due to a urinary obstruction is caused by what? | musculature stretch from urine accumulation and muscular contractions attempting to bypass obstruction
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| List 3 subjective symptons of a urinary obstruction. | *Continued urge to void after voiding *Frequently voiding small amounts of urine *Pain- from dull flank through incapacitating pain *Nausea with pain
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| In urinary obstruction, what does catheter choice for a foley depend on? | Location of obstruction
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| In placing an indwelling catheter for urinary obstruction, what drugs are given to decrease smooth muscle motility? | Opiods and anticholinergics
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| What is inserted via cystoscopy to maintain urinary patency? | Ureteral stint
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| What may PTs experience after relief of a urinary obstruction? | significant diuresis (up to 2 Liters per hour)
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| True or False: After a urinary obstruction is relieved, you must institute fluid restriction to prevent residual buildup of fluids. | False. Allow patients to drink, as able, to maintain fluid status
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| What are the hemoglobin levels for males? | 14-18
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| What are the hemoglobin levels for females? | 12-16
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| What are the hematocrit levels for males? | 40-54
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| What are the hematocrit levels for females? | 37-47
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| When do patients with a urinary obstruction seek treatment? | When urinating is difficult or painful
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| What is Hydronephrosis? | Hydronephrosis occurs when urine builds up in the kidneys and cannot drain out to the bladder. The kidneys swell from the excess urine. The condition may affect one kidney or both.
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| When is Hydronephrosis asymptomatic? | if kidney function remains adequate and urine can drain
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| Pain from hydronephrosis is directly proportional to what? | Pain is directly proportionate to degree of stretching of urinary structures
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| What sort of pain will hydronephrosis with a gradual onset cause? | Dull flank pain
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| What sort of pain will hydronephrosis with an acute onset cause? | severe, colicky pain in the flank of the abdomen
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| List 3 S/Sx of Hydronephrosis. | *Hematuria *Bladder distention *Palpable mass in abdomen, tender over kidneys or bladder *Nausea, vomiting *Dyspnea *Edema related to fluid retention
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| When is surgical intervention required for a PT with hydronephrosis? | if the obstruction is severe and affecting renal function
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| What surgical intervention is done if damage from hydronephrosis is severe? | Nephrectomy
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| What drugs are given for pain control in a PT with hydronephrosis? | *Opiods (Morphine, Demerol) *Antispasmodics (Pro-Banthine) *Belladonna preparations for colicky pain
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| What PTs will have a predisposition to renal calculi? | *Immobility *Hyperparathyroid *Recurrent UTI *Gout, uric acid precipitate
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| Why will a PT with Hyperparathyroidism be at risk for renal calculi? | calcium leaves the bones and accumulates in bloodstream (overproduction of calcium)
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| Why will PTs with recurrent UTIs be at risk for renal calculi? | *Infection may make urine alkaline, increasing calcium precipitation *Infection may make the urine acidic, cystine and uric acid may precipitate into stones
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| What are non-predisposing factors that can cause renal calculi? | *Dehydration *Excessive intake of vitamin D, milk or milk products *Osteoporosis *Certain foods, nutrients and medications contribute to the development of stones
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| The majority of PTs who present with renal calculi are who? | men between 20 and 30 years of age
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| Where can urinary calculi form in the urinary tract? | Formation of urinary calculi can develop in any area of the urinary tract
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| What is Urolithiasis? | Formation of urinary calculi
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| What is Nephrolithiasis? | Calculi in the kidney
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| What is Ureterolithiasis? | Calculi in the ureter
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| What is Cystolithiasis? | Calculi in the bladder
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| What guides the medical management and nursing interventions for the treatment of urinary calculi? | Assessment and analysis of calculi
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| How does the severity of pain relate to the size of the calculus? | Pain is inversely proportional. Small stones frequently travel more rapidly down the ureter, causing more forecful ureteral spasm and therefore greater colic.
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| What is an Ureterolithotomy? | Surgical removal of calculi from ureter
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| What is a Pyelolithotomy? | Surgical removal of calculi from the renal pelvis
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| What is a Nephrolithotomy? | Surgical removal of calculi from renal parenchyma
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| It treatment of urinary calculi, what is a Chemolysis? | alkylating or acidifying agents instilled to dissolve stone
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| What is an Extracorporeal shock wave lithotripsy (ESWL)? | Patient submerged in a water tank and ultrasonic shock waves are used to pulverize stone
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| How is the passing of calculi verified? | Urine is strained.
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| What are calculi producing substances that are to be avoided in a long term diet modification? | cheese, whole grains, carbonated beverages, nuts, chocolate, shellfish and organ meat
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| What is taken for treatment of calcium calculi formation? | Sodium cellulose phosphate
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| What is taken to decrease serum urate levels for cystine calculi formation? | Allopurinol
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| True or False: Due to the excrutiating pain associated with urinary calculi, PTs have to be placed on strict bedrest. | False. Encourage patient to remain active- Ambulate with assistance with severe pain and/or narcotic use
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| What must be done with all of the urine from a PT with urinary calculi? | Urine must be strained
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