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_____ incontinence: increase in abdominal pressure (coughing, laughing, heavy lifting)
______ incontinence: preceded by warning (UTI's, tumors, neurologic dysfunction)
______ incontinence: pressure of urine in bladder overcomes sphincter control (the bladder never fully empties)
______ incontinence: occurs with no warning (loss of sensation, i.e. paraplegia)
______ incontinence: function in isntact, but severe cognitive impariment
When you have oxalate stones, what foods do you need to limit/ avoid?
Foods high in oxalate- chocolate, tea, colas, spinash, grapes, and green breans
What kind of foods need to be avoided if you have calcium stonse?
Restrict protein and sodium
What kind of foods do you need to avoidif you have Uric acid stones?
Avoid foods high in purine (shellfish, organ meats, asparagus, mushrooms)
What is nephrolithotomy?
Surgical removal of the stone
What is extracorporeal shock wave lithotripsy?
Use of sound waves to shatter stone
What is cystography?
Manual removal of stone with invasive device
What are the sign and symptoms usually seen with urolithiasis?
- severe pain
- nausea & vomiting
Signs of rejection or infection?
Oliguria, edema, increasing BP, weight gain, swelling or tenderness
Signs of rejection or infection?
Shaking chills, fever, tachycardia, tachypnea, and leukocytosis or leukopenia
What are the risk factors for bladder cancer?
- *Cigarette smoking*
- Exposure to environmental carcinogens
- High urinary pH
- High cholesterol
- Pelvic radiation therapy
- Cancers or prostate, rectum, and colon
What is the most common symptom of bladder cancer?
Painless hematuria (S & S of UTI)
Which diagnostic tests can you perform for bladder cancer?>
CT, US, Cystoscopy, Biopsy
What is the most common and oldest urinary procedures used?
Ileal conduit (ileal loop)
What urinary diversion method is used for patients at risk (pelvic cancer)?
Cutaneous ureterostomy (ureters directed through abdominal wall and attached to an opening in the skin)
What is the most common continent urinary diversion?
The Indiana pouch- used for patients whose bladder is removed or no longer functions
What is it called when a catheter is inserted directly into kidney (palliative tx)?
Nephrostomy- (High risk for infection- catheter must NEVER be clamped!)
What tips should your patient know when they have a urinary diversion?
- How to take care of appliance (Body image disturbance, skin care)
- Controlling odor (avoid foods that cause strong odors)- diluted white vinegar to decrease odor. Avoid asparagus, cheese, and eggs. Take vitamin C by mouth.
- Pouch management (empty when 1/3 full) Weight will cause pouch separation from skin.
What foods should you avoid to help the odor of an ileostomy bag?
- Avoid asparagus, cheese, and eggs
- Take vitamin C by mouth
History of what precedes glomerulonephritis by 2 to 3 weeks?
What are the clinical manifestations of acute glomerulonephritis?
- Tea colored urine
- Decreased GFR, alterations in the excretion of sodium (leads to HTN and edema)
What organism causes acute glomerulonephritis?
How long does the recovery state of acute renal failure take?
Once the amount of urine excreted starts dropping below 400 cc uremic symptoms occur and _______ may occur.
What is the solution called composed of the ideal
electrolyte balance for hemodialysis?
A condition caused by the retention of waste products
What are the S & S of uremia?
- associated with the retention of substances= n & v, HA,
- dry skin, rapid pulse, scanty urine output, fruity breath
What are the 3 locations you can use as vascular access for hemodialysis?
Subclavians, internal jugular, and femoral catheters
When the foreskin cannot be retracted over the glans of the penis. If a patient is not circumcised then the foreskin must be retracted and cleansed daily or a buildup of secretions accumulate and inflammation occurs.
Urological emergency. Penis is large, hard, and painful. It can cause gangrene and lead to impotence if not treated. Most men wait until is has been a rather long time before seeking treatment.
Caused by inflmmation, trauma, or STD's can cause ______. Treated with dilation of the urethra.
What is the treatment of choice for phimosis?
Female client reports to the nurse that she experiences a loss of urine when she jogs. What type of incontinence is this?
What is a KUB?
Kidneys-ureters-bladder. An xray. (non invasive) Useful in determining presence of tumors, cysts, and stones
What nursing intervention is needed when a paitnet is being prepared for a ultrasonography?
- Requires a full bladder
- Ultrasonography uses sound waves to detect tissue abnormalties
What procedure requires an injection of radioisotope which is monitored as it moves through the blood vessels of the kidney. It is good for evaluation of renal perfusion or function.
______: injection of IV radiopaque contrast. Visualize layers of the kidney.
_______: catheters are advanced into renal pelvis then dye is injected (identifies location of stones)
________: contrast into bladder to determine if backflow occurs
What nursing intervention is important with a patient receiving a nuclear scan?
Drink lots of fluids to promote exceretion of radioisotope by the kidneys
________: femoral artery is pierced and catheter is fed up to renal artery then contrast is introduced. Evaluate renal blood flow, hypertension.
What nursing measure can you anticipate with a femoral catheter insertion?
Lie 30 degrees angle for 6 hours with affected leg straight
________: contrast is instilled into bladder through a urethral catheter. Patient feels urge to void and catheter is removed, and the patient voids and this is visualized on the flouroscope. Examines bladder and urethra.
What allergies do you need to determine for radiology procedures?
What post op intervention is important for urologic procedures?
Prone position and or bed rest for 6-8 hours
What structure allows urine to flow from the kidney to the bladder?
What is an excellent measure of renal function?
- Creatine clearance (creatine is a waste product of skeletal muscle).
- - You need a 24 hour urine collection to assess renal function
What lab value is decreased with CRF?
What is the best description of an AV graft?
synthetic tubing tunneled beneath the skin connecting an artery and a vein
What foods should be selected for a patient with CRF?
- Foods high in iron and calcium.
- (Protein, fluid, and sodium Restriction!)
What is the maximum amount of weight that should be gained between dailysis treatments?
Which type of incontinence is the involuntary loss of urine due to the absence of sensations?
What type of incontinence refers to the loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure?
What is the most common symptom of UTI's in older adults?
changes in cognitive functioning
What finding is hallmark for the diagnosis of nephritic syndrome?
Proteinuria (protein exceeding 3.5 g per day)
What is the correct term for the ability of the kidneys to clear solutes from the plasma?
What is the number one symptom of nephrotic syndrome?
What term would be used to describe a urine output of 400 ml in 24 hours?
______: concentration of urea and other nitrogenous wastes in the blood
excess of urea and other nitrogenous wastes in the blood
A history of infection caused by streptococcus is associated with what disorder?
Retention of which electrolyte is the most life threatening effect of renal failure?
Which medication is given to decrease potassium levels in renal failure?
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
Oliguria (UOP < 400 cc/day)
What kind of diet does a person who has acute glomerulonephritis need to follow?
Increased carbohydrates to provide energy, decreased proteins and sodium
What is the treatment for benign prostate hypertrophy (BPH)?
Transurethral resection of the prostate (TURP)
What complication is very common after TURP?
Obstructed catheter! Examine tubing for blockage
What type of drainage would you expect to find post op TURP?
How often is hemodialysis performed?
3 times per week, 4 hour treatments
The ______ is the kidney, the _______ is the solution used to bathe the kidney.
What type of catheters are inserted for long term use with dialysis?..... What is greatest complication?
- Double lumen catheters.
- Greatest complication is Infection
______: anastomosis of an artery and vein. Takes 4-6 weeks to mature.
What is used when the patient has small veins that wont develop properly into a fistula?
Arteriovenous graft (AV graft): you are able to used sooner than fistula, you can use within 2-3 weeks.
How do you assess for patency of a vascular access site?
- Auscultate for bruit
- Palpate for thrill
What do you need to carry as a dialysis nurse?
Hemostats- b/c if kidney clots or tubes comes loose, you clamp the tubing.
If a patinet seems sleepy or restless after a dialysis treatment, and nausea/vomiting may be a symptom as well, what is occuring?
Dialysis disequilibrium syndrome- cerebral fluid shifts
What diet teaching is needed for a patient on dialysis?
- Protein restriction (1 gm/kg IBW per day)
- Fluid restriction
- Sodium restriction- usually 2 gm per day
_______ is a form of continous renal replacement therapy for patients who are susceptible to rapid fluid shifts
What would be suggested for patients who have diabetes, cardiovascular disease, older patients, and apteints at risk for the side effects of heparin when they need to have dialysis performed?
What is the #1 complication of peritoneal dialysis?
PERITONITIS! Char. by cloudy dialysate, diffuse abdominal pain, and rebound tenderness
What are the long term complications assocaited with peritoneal dialysis?
- Abdominal hernias
- Hiatal hernia
- Hypertriglyceridemia (accelerates atherosclerosis- CV disease frequent killer of peritoneal dialysis patients)
- Some patients complain of constant sweet tase in their mouth
What treats hyperkalemia, fluid overload, acidosis, and other uremic symptoms?
Acute intermittent peritoneal dialysis (hourly exchanges)
How often is dialysis performed for a patient on continuous ambulatory peritoneal dialysis?
- 4 or 5 times a day 7 days a week
- - do not have dietary restrictions
How does continuous cyclic pd (CCPD)?
- Runs 3-5 exchanges during the night while patient sleeps
- In the am, 1 to 2 liters of dialysate left in abdomen until evening
The prostate gland enlarges and obstructs the outflow of urine
Benign prostatic hypertrophy (BPH)
Painless enlargement of the testes is seen in: _________
The nurse has admitted a client with uremia. The nurse plans care for what?
What is a urinary output less than 100 ml in 24 hours known as?
The nurse would assess a patient with Urolithiasis for which symptoms?
- Severe Pain
- Nausea & vomiting
What are the clinical manifestations of acute glomerulonephritis?
- Tea colored urine
- Decreased GFR (HTN & edema)
Hardening or sclerosis of the renal arties due to prolonged hypertension
What category of ARF is; hypoperfusion of kidneys; low BP, decreased GFR (Shock, hypovolemia, MI, anaphylaxis)
What category of ARF is; parenchymal damage to the glomeruli or kidney tubules. (nephrotoxic agents, crush injuries, infections, ACE inhibitors)
What category of ARF is; caused by obstruction somewhere distal to kidney (stones- pressures rise in kidney, GFR decreases)
In acutre renal failure, regardless of urine output, ____ and ______ levels will rise. Azotemia (uremia) will develop.
BUN and creatine
What are the assessment and diagnostic findings in acute renal failure?
- Changes in ruine
- Calcium & phosphorus abnormalties (decreased phos. and increased calcium)
- Metabolic acidosis
- Increased BUN & Creatine (AZOTEMIA)
what is the most dangerous complication with acute renal failure?
- Hyperkalemia (K+>5.5)
- Often require immediate dialysis
- IV glucose and insulin or calcium gluconate may be used
- Kayexalate given PO or pr (exchanges sodium for potassium ions)
- Sodium bicarbonate IV to increase serum pH
In acute renal failure, other than hyperkalemia, what other F & E values might you see?
- Hypocalcemia (8.5-10)
- - Positive Trousseau's and Chvostek's sign
- - Hyperactive reflexes
- -When phosphorus in increased, calcium is decreased
- -Neuromuscular irritability
- -Positive Trousseau's and Chovsteks sign
- -Flat or inverted T waves
Progressive, irreversible deterioration in renal function resulting in azotemia or uremia
Chronic renal failure- End stage Renal disease
What is #1 cause of CRF?
What stage of CRF is less than 10% renal function. BUN and creatine remain elevated. Electrolytes imbalanced, dialysis is indicated.
Stage III (ESRD)
What stage of CRF is 75-90% loss of nephron function. Serum creatine and BUN begin to rise, urine concentrates, anemia. May report polyuria or nocturia.
Every system is affected by CRF
- Neurologic – weakness, fatigue, confusion, behavior changes
- Integumentary – gray, bronze skin, dry, flaky, pruritus, bruising, thinning hair
- Cardiovascular – HTN, edema, tamponade, hyperkalemia, hyperlipidemia, effusions
- Pulmonary – crackles, thick sputum, uremic lung, SOB, uremic lung
- Gastrointestinal – metallic taste, N/V, hiccups, constipation or diarrhea, GI bleeds
- Hematologic – anemia, thrombocytopenia
- Reproductive – amenorrhea, testicular atrophy, infertility, decreased libido
- Musculoskeletal – muscle cramps, bone pain, bone fractures, foot drop
- *Remember- the primary cause of most symptoms is attributed to uremia. The precise mechanism for some of these alterations is not known.
____________ helps replace red blood cells and must be administered three times a week either IV or sub-q in dialysis. It may take 2-6 weeks for the hemotocrit to respond.
The patient in CRF is placed on severe fluid restrictions. How do we calculate these restrictions?
- If the patient is still urinating then the fluid restrictions are 500-600 cc more than the previous days output.
- However if the patient is not urinating then the fluid restriction is 1000-1500 cc per day.
Capillary bed responsible for filtration
1 million structural and functional units of the kidney (urine formation)
What is the 3 step process involved in urine formation?
- Glomerular filtration (normal blood flow- 1200 ml/min)
- Tubular reabsorption (of 180 L produced, 99% reabsorbed into bloodstream)
- Tubular secretion (1000-1500 ml of urine each day)
What hormone regulates sodium and potassium?
What is urea the end product of?
What is the normal range for BUN
If BUN is elevated but creatine is normal, what might you expect?
inflammation of the bladder
what is an infection of the upper urinary tract called?
Pyelonephritis (inflammation of the kidney and renal pelvis)
What food/drink needs to be avoided in patients with UTI's?
Coffes, teas, colas, alcohol (ALL caffiene!)
What does a neurogenic bladder result from?
Injury or CNS disorder such as a stroke
What medication can be given for urge incontinence?
______: catheter is inserted through external meatus into the bladder
______: catheter is threaded through urethra and bladder into ureters by cystoscopy or inserted surgically through abdominal wall (often used to splint ureters)
______: catheter inserted through abdomen into bladder. Most Common diversional method!!
______: inserted directly into renal pelvis when complete obstruction is present.
_______ is used frequently for neurogenic bladder and anuric phase of acute renal failure. Main Goal is to prevent urinary retention
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