265 test 4 part 2

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265 test 4 part 2
2012-12-08 00:50:46
265 test part

265 test 4 part 2
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  1. For an Intravenous Urography, dye is injected via IV.  The dye is excreted in the urine.  X-rays are taken at various times.  

    What are the three things we need to remember about Intravenous Urography?
    They generally do a bowel prep using laxatives.  

    Contrast dye is used.  Check to see if patient has allergy to shellfish.  

    Patient is NPO prior to the procedure.  
  2. Percutaneous Lithotripsy:  What are 3 problems that can result?
    possible infections


  3. A patient has calcium phosphate stones.  Which types of foods should be limited.
    Intake of protein rich foods should be limited.  There is also some benefit to decreasing dietary calcium rich foods such as milk/dairy.  

    Also restrict sodium.
  4. A patient has uric acid stones.  Which types of foods should be avoided?
    The patient should have a low purine diet.  Foods with high purine content should be avoided.  

    • Avoid the following:
    • Shellfish
    • Fish (salmon, sardines, anchovies, herring, crab
    • Poultry, goose gravies
    • Beef
    • Pork
    • Veal
    • Venison
    • Organ Meats
    • Red wines
    • Asparagus
    • Mushrooms
    • Other proteins
  5. A patient has oxalate stones.  Which foods should be limited?
    Limit foods high in oxylates such as:

    • Green leafy veg: cabbage, asparagus,
    • green beans, spinach, rhubarb, swiss chard, celery

    cocoa, beets,  chocolate,

    Teas, colas, coffee, beer

    Blackberries, strawberries

    wheat germ, wheat bran

    nuts (like peanuts)

    tomatoes, beets, okra,

    lime peel.
  6. Describe the following procedure.  
    Ileal conduit (ileal loop or bricker procedure)
    Oldest of the diversion procedures – has low incidence of complications and surgeons are all familiar with the procedure à “GOLD standard”

    Urine is diverted from the bladder by transplanting the ureters from their point of attachment to the bladder to attach to a segment of the ileum. The segment of ileum has been cut away to lead out through the abdominal wall as a passageway and stoma is created at the surface. The remaining intestinal segments are reanastomosed to keep an intact bowel and GI function goes back to normal.

    • After surgery a skin barrier and drainage bag are applied around drainage site –
    • custom size bag is worn until edema subsides; clear drainage bags are better for visualization of the stoma  Stoma will shrink once edema subsides

    Stents are placed in the ureters to prevent occlusion secondary to edema, stay in place 15 days post op; JP drains will be in place where bladder was removed. 
  7. Discuss care for patient who has had ileal conduit (ileal loop, bricker procedure).
    • Monitor urine output – if less than 30mL/hr, may indicate dehydration or an obstruction in ileal conduit with possible backflow or leakage from ureteroileal site
    • Stoma may be irrigated with  normal saline q6-8 hrs if prescribed

    Monitor stoma:  should be normal pinkish red color; dark purple suggests hypoxia, stoma should not be painful, but it is sensitive and can be easily irritated by alkaline urine

    Watch for urine leakage and odor

    Encourage fluids to flush conduit

    Pt may secrete lg amounts of mucus with the urine bc of mucous membranes in the bowel segment – normal occurrence. 
  8. Describe appliance application and maintenance for a patient who has had an ileal conduit (ileal loop or bricker procedure).
    • Application &Changing Device –
    • when removing device, push skin from appliance rather than pulling appliance from skin to avoid damage to skin; clean skin around stoma with mild soap and water, gently pat dry, place 2 gauze squares over opening to absorb drainage
    • while you are emptying device; cut new device opening 1/8 inch larger than stoma size;

    • If disposable, discard immediately
    • If reusable, wsh in lukewarm soap and water, allow to airdry after new appliance is in place

    Empty appliance frequently to keep free of odors

    • Odor
    • control – avoid foods that give urine a strong odor (asparagus, cheese, eggs,. Garlic, seafood, onions)
  9. Stress Incontinence:


    How is it treated?

    Who might have it?
    most common type esp in women

    Loss of sm amounts of urine during coughing, sneezing, jogging, lifting

    Cannot tighten urethra enough to overcome increased detrusor pressure 

    • Common after childbirth when pelvic muscles are stretched, weakened; common after menopause due to low estrogen levels – vaginal, urethral muscles become thin
    • and weak

    It is sometimes treated with estrogen therapy.  Also Kegels may be used to treat it (strengthen pelvic floor muscles; tighten muscle for 4 sec 10 times, 30-80 times per day for at least 6 weeks).  Also, vaginal cones may be used to treat it.  

    A woman who has had 4 or 5 kids may end up with stress incontinence.
  10. Urge Incontinence:


    How is it treated?

    Who might have it?
    perception of an urgent need to go as a result of bladder contractions regardless of volume of urine

    Pts cannot suppress the signal – have strong, sudden urge to void and often leak lg amounts of urine à also knonw as “over active bladder”

    • May be due to abnormal detrusor contractions or stroke, other neurologic problems
    • Drugs such as diuretics, nicotine, artificial sweeeteners, caffeine, alcohol, citrus irritate this problem as well.

    Often anticholinergics are given for urge incontinence.
  11. Overflow Incontinence:


    Who might have it?
    • Due to over distention of bladder
    • (Bladder distends and overflows, no contraction of detrusor, may not even feel the urge to go at all.)

    Frequent of constant dribbling, may have urge or stress incontinence symptoms as well

    Can result from spinal cord injury, stroke, diabetic neuropathy, or after certain types of pelvic surgery
  12. Functional Incontinence:


    Who might have it?
    Due to other factors beside abnormal function of the bladder or urethra

    May be due to loss of cognitive function in pts affected by dementia

    (head injury, loc changes, or mobility problems - you can't make it to the bathroom)  It is caused by something other than a problem with the urinary system.  

    A disoriented person may have functional incontinence.