renal system 1
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| show | 0.5-1.2 mg/dL
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| BUN- normal | show 🗑
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| BUN/Creatinine ratio | show 🗑
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| show | Voided
Cean catch
Catheterized
Suprapubic aspiration
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| Urine collections | show 🗑
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| Osmolality | show 🗑
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| Blood osmololity– N | show 🗑
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| Urine osmololity N | show 🗑
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| Radiographic/special procedures | show 🗑
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| show | nformed consent- is an operative procedure
Can be closed or open procedure
Use U/S or fluoroscope
Bleeding – major risk
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| Cystoscope & Cystourethroscope | show 🗑
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| Treatment | show 🗑
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| before treatment | show 🗑
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| Retrograde Procedures | show 🗑
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| Ureters & pelves | show 🗑
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| Bladder | show 🗑
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| Urethra | show 🗑
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| retrograde Procedure | show 🗑
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| show | identify obstruction or structural abnormality (ex. fistulas, diverticula, tumors)
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| Urodynamic Studies | show 🗑
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| Cystometrogram (CMG) | show 🗑
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| CMG | show 🗑
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| show | information about nature of urinary incontinence or urinary retention
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| UPP procedure | show 🗑
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| show | evaluate strength of muscles used in voiding
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| EMG procedure | show 🗑
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| Urine Stream Test | show 🗑
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| urine stream test procedure | show 🗑
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| Inguinal hernia | show 🗑
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| Hydrocele | show 🗑
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| Phimosis | show 🗑
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| show | urethral opening on dorsal (upper) surface of penis
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| show | urethral opening on ventral (underside) surface of penis
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| show | ventral curvature of penis; usually seen with hypospadias
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| show | undescended testicles
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| show | congenital absence of a portion of the abdominal & bladder wall; bladder appears to be turned “inside out”
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| show | may result in gender reassignment
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| Surgery in the pediatric client: | show 🗑
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| show | Passage of urine, without control, past the age when a child should be expected to attain bladder control (2-3 years of age for daytime, 4 years of age for nighttime). Children over 5 years of age need evaluation for organic cause.
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| show | may have a small bladder capacity. (Normal bladder capacity, in ounces, is the child’s age plus 2).
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| show | desmopressin (DDAVP)- is a synthetic ADH given transnasally
OTC devices
If enuresis is stress related, the child may develop another habit, such as thumb sucking or stuttering, if you remove this habit.
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| Hemolytic-uremic syndrome (HUS) | show 🗑
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| show | Etiology- thought to be associated with bacterial toxins, chemicals, and viruses; RBC’s hemolyze, causing renal failure
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| S/S of HUS | show 🗑
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| Rx of HUS | show 🗑
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| Wilms tumor (Nephroblastoma) | show 🗑
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| show | a firm, nontender, one sided, encapsulated mass (usually found by a parent), fatigue, fever, weight loss, hypertension
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| show | U/S, CT, liver biopsy
Need a rapid diagnose & surgery within 24-48 hours of admission
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| show | surgery to remove tumor, affected kidney & adrenal gland, followed by radiation & chemotherapy
NOTE: Do NOT palpate the mass- could potentially cause a spread of cancer cells
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| show | Broad term used to describe any infection in the kidneys, ureters, bladder or urethra
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| show | Those with indwelling catheters or immunocompromised Urinary obstruction- partial or total
Vesicoureteral reflex
Characteristics of urine- diabetic, concentrated or alkaline urine
Females, older adults
Sexual activity
Recent use of antibiotics
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| show | S/S- dysuria, urethral discharge
Etiology- usually STD ex. gonorrhea, chlamydia, trichomonas
Dx- U/A, urethral C & S
Rx- antibiotics
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| Females | show 🗑
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| Cystitis (bladder) | show 🗑
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| show | Etiology unknown, chronic, rare
12:1 ratio women to men
S/S- those of cystitis, have a small bladder, Hunner’s ulcers (bladder lesions)
Dx- U/A normal, cystoscopy, potassium sensitivity test
Rx- “Rescue cocktail”
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| Asymptomatic bacteriuria | show 🗑
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| show | Most common cause of cystitis
S/S- polyuria, dysuria, urinary retention, suprapubic tenderness, hesitancy
Rx- antibiotics
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| Upper Urinary Tract Infection: Pyelonephritis (kidney & renal pelvis) | show 🗑
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| Pyelonephritis Rx | show 🗑
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| Etiology of UTIs | show 🗑
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| Predisposing factors of UTIs | show 🗑
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| Dx of UTIs | show 🗑
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| Rx: | show 🗑
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| Prevention of UTIs | show 🗑
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| Home remedies | show 🗑
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| Urethral strictures | show 🗑
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| show | congenital, complication of STD, trauma (ex. catherization, urologic instrumentation,
or childbirth)
More common in men
Causes other problems - recurrent UTIs, urinary incontinence/retention
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| show | unable to urinate, overflow incontinence
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| show | 1. Dilation of urethra (urethroplasty)
2. Removal or graft of affected area
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| Urinary Incontinence | show 🗑
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| show | Surgery- urologic, prostate, gynecologic
Trauma- back injuries (S2-S4)
Procedures- radiation
Cystocele or rectocele
Inappropriate bladder contraction- disorders of brain, CNS, bladder
Autonomic neuropathy ex. DM (diabetes mellitus), syphilis
Elderly
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| Diagnose UTI | show 🗑
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| show | involuntary loss of small amounts of urine with activities that increase abdominal and detrusor pressure (sneeze, cough, exercise)
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| show | unable to tighten the urethra enough to overcome the increased detrusor pressure
1. Weakness of bladder neck supports
2. Damage to urethral sphincter from urethral surgery, trauma, radiation, childbirth
3. Low estrogen levels
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| show | Kegels,Diet- weight loss, stop smoking,avoid alcohol & caffeine, artificial sweeteners, citrus Urethral inserts
Vag ring, vag cones
Drug therapy- not FDA
1. estrogen
2. anticholinergics/ antispasm.
3. antidepressants-
Tofranil
C
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| Surgery- recommended if frequent UTIs or kidney stones | show 🗑
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| Urge incontinence | show 🗑
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| Interventions- surgery not recommended | show 🗑
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| show | detrusor muscle does not contract and the bladder becomes overdistended; urine leaks outs
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| S/S | show 🗑
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| Cause | show 🗑
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| Interventions: | show 🗑
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| Bladder compression | show 🗑
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| Crede method | show 🗑
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| show | breathing exercises increase intrathoracic and abdominal pressure to cause bladder emptying
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| show | empties bladder and then within a few minutes, attempts a second bladder emptying
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| Splinting- if cystocele | show 🗑
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| show | Caregivers and pt. taught procedure using clean (not sterile) technique
Regular schedule established to prevent bladder overdistention (usually 300 ml or less)
On prophylactic antibiotics, 2-3 weeks when started
U/A q 2-4 weeks
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| show | urine leakage caused by factors other than disease of the lower UT
Can be transient or permanent
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| functional incontinence | show 🗑
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| show | kidney stone;asymptomatic until passes into the lower urinary tract Calculi can form in kidney (nephrolithiasis) or ureter reterolithliasis)When calculi occludes ureter and blocks urine, ureter and kidney dilates; hydroureter & hydronephrosis develop
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| Etiology | show 🗑
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| Ca+ Cause of Stone Formation: | show 🗑
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| show | Low salt diet Thiazide diuretics ex. Hctz (Hydrochlorathiazide- promotes Ca+ reabsorption from renal tubules back into the body)If stone calcium oxalate- dietary rest. of foods high in oxalate (tea, cocoa, beer, green leafy veg., fruits, nuts, wht germ)
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| Struvite | show 🗑
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| show | 8%- may occur with gout
High urine acidity- urine pH 6-6.5
Rx: Dietary- decrease intake of purine sources (organ meats, poultry, fish, gravies, red wines) Meds- allopurinal (Zyloprim)
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| show | 3%
Derived from urinary proteins; inherited defect in renal absorption of cystine
Rx: Dietary- same as uric acid Meds- Captopril (Capoten
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| show | Renal colic- severe pain (usually flank) with radiation to groin; pain when stone is moving or
if obstructed
Pallor, N & V, diaphoresis
Hematuria, oliguria, anuria
V/S- BP, pulse and RR
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| Dx Studies: | show 🗑
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| Interventions: | show 🗑
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| show | STRAIN ALL URINE- (urine strainer)
Fluid intake; 2-3 liters per day
Stent placement- small tube placed in ureter during ureteroscopy Purpose: dilate ureter to allow passage of stone or stone fragments
Indwell cath may be placed to allow passage > ureth
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| show | Extracorporeal Shock Wave Lithotripsy (ESWL) – commonly called lithotripsy May have IVP done prior to ESWL
May have stent placement by endoscopy before procedure
Adverse effect: flank bruising
Lithotripsy can also be performed through a ureteroscope
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| Procedures – if unable to pass | show 🗑
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| Open procedures- only when other attempts have failed | show 🗑
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| Postop care - prevent urosepsis | show 🗑
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| show | Must fix the cause or can cause permanent renal damage.
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| cause: | show 🗑
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| show | treat the cause of obstruction
Stent placement
May require urinary diversion system: temporary (nephrostomy tube, suprapubic catheter) or permanent
Dialysis for renal deterioration
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| show | malignant tumors of the urothelium (lining of cells in the UT organs)
Primarily of the bladder
Once spread beyond these cells, usually highly invasive and metastatic (liver, lung, bone)
Risk factors: tobacco use, exposure to environmental toxins, o
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| S/S | show 🗑
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| Diagnose: | show 🗑
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| show | Without treatment, tumor will invade surrounding tissues, metastasis (liver, lung, bone)
& lead to death
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| Nonsurgical: | show 🗑
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| Surgical treatment: | show 🗑
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| Ureterostomy | show 🗑
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| show | transplanting ureters into a pocketed segment of the ileum & connected to a stoma; must wear a pouch
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| Ileal reservoir | show 🗑
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| show | ureters diverted into the large intestine; urine excreted with bowel movements.
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| show | Wound, skin & drainage site care
Address self-esteem, body image, sexual function
Education: External pouch system or catherizations, skin care
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