G/U Chapter 37

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Author:
em1277
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246366
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G/U Chapter 37
Updated:
2013-11-11 23:30:49
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Description:
Disorders of the urinary system
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  1. How to collect a mid-stream urine specimen
    • Clean perineum from front to back
    • Separate labia
    • Start urinating in toilet
    • Move collection container under urine stream 
    • Need at least 10 mL
    • If menstruating, specify on lab form
  2. High specific gravity could mean what?
    • Diabetes
    • Nephrosis
    • CHF
    • Dehydration
  3. What position for renal biopsy
    • Prone, with sandbag under abdomen
    • Hold breath while needle is inserted to keep kidney from moving
  4. Nursing interventions after arteriogram
    • Bedrest up to 12 hours to prevent bleeding at injection site
    • Check distal pulse in leg every 30-60 min
    • Do not bend or raise HOB >45°
  5. Process of forming urine in kidneys
    • 3 regulated processes of nephrons: filtration, reabsorption, and secretion
    • Filtration: blood from heart to nephrons
    • Reabsorption: Essential solutes and water move back into blood from nephron
    • Secretion: Move substances from blood into tubules, where they mix with water and other wastes and converted to urine
  6. Complications of renal biopsy
    • Grossly bloody urine
    • Falling blood pressure
    • ↑ pulse indicates bleeding and must be reported immediately

    • Flank pain
    • Hematuria
    • Light headedness
    • Fainting
  7. Stress incontinence vs.
    Urge incontinence vs.
    functional incontinence
    • Stress:  Involuntary loss of urine <50 mL assoc w/coughing, sneezing, laughing.  Seen after menopause, child-birth for women. Prostatectomy and radiation
    • Urge: Unable to make it to bathroom in time. Most common
    • Functional: Inability to reach toilet because of environment, memory or physical limitations 
  8. How much urine for urinalysis
    10 mL
  9. Why would renal failure patient have low hemoglobin
    • Damaged kidneys don't produce adequate erythropoetin (stimulates RBC production)
    • Blood loss during dialysis
  10. What foods should you avoid with a calcium oxalate kidney stone?
    • Restrict protein and sodium
    • beets
    • rhubarb
    • spinach
    • cocoa
    • instant coffee
    • milk
    • cola
    • beer
  11. Pyelonephritis
    • Infection of the renal pelvis, tubules and interstitial fluid of both kidneys
    • Urinalysis shows casts
  12. What labs to look at in renal failure patient
    • BUN
    • Creatinine
    • BUN/Creatinine ratio
    • Cystatin
    • Uric acid
  13. Why would patient with foley develop UTI
    • Bacteria ascend catheter
    • Usually develop w/in 2 weeks
  14. Nursing actions for renal calculi
    • I&O
    • Observation of urine abnormalities such as hematuria, pyuria or passage of stone
    • Obstruction
    • Temperature
    • BP
  15. How to prevent crystals from forming in the urine
    • Encourage fluid intake to around 3000 mL
    • Encourage walking
    • Avoid offending foods
  16. Teaching for patient with UTI on antibiotics
    • Take all antibiotics
    • Many UTI infections are recurrent, teach what to do to avoid in future
    • Azactam - avoid antacids. avoid if creatnine <30
    • Pyridium - purple skin discoloration, urine orange
  17. Best determinant of fluid volume status
    Daily weight
  18. Symptoms of fluid overload
    • Edema
    • SOB
    • Crackles & weezes
    • Tachypnea
    • JVD
  19. Most common symptom of cancer of the bladder
    Painless hematuria
  20. How much fluids should pt. with UTI have
    • 3000 mL
    • 10 oz cranberry juice
  21. What hourly output should be reported
    <400 mL/day
  22. Things to look for in urine if trauma to kidney
    • Hematuria
    • Inability to void
  23. Med to give for UTI pain
    • Antispasmodic agents
    • Antipyretics
    • Heat to puprapubic area
    • Pyridium
  24. Teaching for Pyridium
    • Urine color changes to red-orange
    • Blue-to purple skin discoloration
    • Changes urine glucose testing
    • Avoid in renal insufficiency
  25. Hydronephrosis
    Abnormal dilation of kidneys caused by obstruction of urine flow
  26. Nephrolithotomy
    • Surgical incision into the kidney to remove a stone
    • Pyelolithotomy is to remove stones in renal pelvis
  27. Teaching to avoid UTI's
    • Void every 3 hours while awake
    • Drink up to 3000 mL water/day
    • One glass cranberry juice/day
    • Avoid baths
    • Wipe front to back
    • Urinate after sex
    • Avoid constricting clothing
  28. Patient has acute renal failure and hypovolemic shock, what might be very significant?
    • 24 hour cratinine clearance test
    • Anxiety
    • Cool, clammy skin
    • Confusion
    • ↓ or no urine output
    • Pale skin
    • Rapid breathing
    • Unconciousness
  29. Most common urinary sale that makes up renal calculus
    • Calcium oxalate
    • Calcium Phosphate
    • Magnesium ammonia
    • Uric Acid
    • Cystine
    • Most contain calcium
  30. Cause of polycystic kidney disease
    Hereditary
  31. Substitutes for sodium to flavor food
    • Garlic
    • Onion
    • Pepper
    • Lemon juice
    • Seasoning blends
    • Vinegar
    • Dry mustard
  32. Primary nursing action before IVP
    • NPO 8 hours before procedure
    • Enemas to empty colon
    • Check allergies, BUN and creatnine
    • Explain warm, flushing sensation and maybe strange tast
  33. Most common complication of renal biopsy and symptoms pt would show
    • Bleeding
    • s/s: bloody urine, flank pain, falling BP
  34. Symptoms of UTI in elderly
    • Change in cognitive functioning
    • Decline in mental status
    • Fever
  35. Teaching for functional incontinence
    • Keep voiding log
    • Determine any acute causes and fix
    • Is clothing inhibiting?
    • Obstacles to bathroom?
    • Initiate schedule
    • Use environmental cues
  36. How to collect 24 hour urine test
    • Urinate and discard specimen
    • Time is noted and this is start
    • All voidings are saved in a container.
    • Incomplete specimens aren't accurate
  37. If you're emptying urine from ileal conduit and it has strands of mucus, what do you do?
    Document.  Normal to have mucus because it comes through the ileum
  38. Nursing care for nephrostomy tube
    • Never clamped - will create pressure that destroys kidney function
    • Make sure it's draining adequately
  39. Interventions after IVP
    • Encourage fluids to remove contrast media
    • Monitor urine output
  40. Patient has catheter, what instructions to prevent UTI
    • Encourage fluid consumption
    • Wash perineum with soap and water once a day
    • Remove catheter as soon as possible
    • Keep catheter securely taped to patient, preventing back and forth movement of catheter
  41. Normal PH of Urine
    4.6 - 8.0 with an average of 6.0
  42. Normal specific gravity
    • 1.002 - 1.035
    • Low specific gravity indicates excessive fluid intake
    • High indicates dehydration
  43. Creatnine clearance
    • Minimum level of 10 mL per min to live w/out dialysis
    • Reference value: 85-135 mL/min
  44. BUN-to-creatinine ratio
    • Evaluates hydration status
    • Elevated occurs in hypovolemia

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