Exam III

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Exam III
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2010-10-24 03:52:21
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Module M: Rnal-Urinary
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  1. Urine color: Pale, colorless
    Cause: dilute urine from diuretics, alcohol, diabetes, and fluid
  2. Urine color: Yellow-milky/white
    Cause: pyuria, infection, vaginal cream
  3. Urine color: Bright yellow
    Cause: Multivitamin
  4. Urine color: Pink or red
    Cause: Blood in urine, beets, blackberries, dilantin, Rifampin, senna
  5. Urine color: Blue-green
    dyes, methylene blue
  6. Urine color: Orange/amber
    dehydration, fever, bile, billirubin
  7. Urine color: Brown/black
    Old blood, urobilinogen, dehydration, flagyl, quinine, methydopa
  8. Hematuria
    more than 3 RBCs per high power field (red blood cells in urine
  9. frequency: frequent voiding (more than once every 3 hrs)
    cause: infection, prostatitis, obstruction, diuretics
  10. Urgency: strong desire to void
    cause: infection, prostatitis, urethritis, diabetic neuropathy
  11. Dysuria: Painful or difficult voiding
    cause: UTI, inflammation of bladder, prostatitis, stones
  12. Hesitancy: delayed; difficulty in initiating voiding
    cause: decreased renal concentrating ability, heart failure, diabetes, nephrotic syndrome, ascites
  13. Enuresis: involuntary voiding during sleep
    cause: children (CNS probs) obstructive disease of lower urinary tract, failure to concentrate urine, UTI, stress
  14. How many times does a person usually voids?
    • 8x Q24 hrs
    • 1-2 L in 24 hrs
  15. increased urgency and frequency with decreased volume means?
    urine rentention
  16. BUN
    8-23
  17. Creatinine
    0.7-1.5
  18. Uric acid
    2.7-7.7
  19. hemoglobin
    • men: 14-18
    • women: 12-16
  20. Urine pH
    4.5-8
  21. Specific gravity
    1.010-1.015
  22. Osmolality
    • -most accurate measurement of the kidney's ability to dilute and concentrate urine
    • -assesses body's fluid status
    • -urine osmolality is 200-800
    • -serum osmolality is 280-300
  23. Intravenous urography (IVP)
    • -radioplaque adm by IV
    • -shows KUB via x-ray as dye moves from upper to lower
    • -used to estimate renal fn & initial assessment of urologic conditions
  24. Retrograde Pyelography
    catheters advanced through ureters to renal pelvis via cystoscopy. contrast agent injected
  25. Cystography
    • -Catheter inserted to bladder with contrast agent injected to outline bladder wall
    • -used for evaluating vesicureteral reflux (backflow of urine)
  26. *NIC
    • -Assess for bladder injury
    • -expect blood tinged urine, burning, urninary retention
  27. Voiding cystourethography
    • -visualizes lower urinary tract and assess urine storagte in the bladder
    • -used to identify vesicoureteral reflux
  28. Renal clearance
    ability of the kidneys to clear solutes from the plasma
  29. Patho of lower UTI
    • 1. bacteria gains access to bladder
    • 2. attaches and colonize epithelium of urinary tract
    • 3. evade host defense mechanisms
    • 4. initiate inflammation (infection)
  30. Most common cause of UTI
    Fecal organisms (E. Coli)
  31. How bacteria enters urinary tract
    • 1. transurethral (ascending infection) - most common (fecal)
    • 2. bloodstream (hematogenous spread)
    • 3. Fistula from the intestine (direct extension)
  32. S/S of uncomplicated UTI's
    • - burning or urination
    • - frequency
    • - urgency
    • - incontinence
    • - suprapubic/pelvic pain
    • - hematuria and back pain
    • **half of pts have no symptoms
  33. S/S of uncomplicated UTI (elderly)
    • *altered sensorium
    • *lethargy
    • anorexia
    • new incontinence
    • hyperventilation
    • low-grade fever
  34. most common cause of acute bacterial sepsis in patients over 65
    • no estrogen for women
    • no prostatic secretions for men
    • bot get more infections
  35. nrsg dx - UTI
    • Acute pain r/t infection w/in the UT
    • Deficient knowledge about factors predisposing the pt to infection
  36. rnsg interventions - UTI
    • --for pain relief--
    • antispasmodics
    • antibiotics
    • analgesics
    • use of heat on perineum
    • increase fluids
    • no coffee, spices, cola, alcoho - all irritants
    • empty bladder completely
  37. Prevention of UTIs
    • shower - don't bathe
    • clean perineum/urethral meatus front to back
    • increase fluids to flush bacteria
    • avoid coffee, tea, colas, alcohol, spicy foods
    • void q2-3 hrs & completely empty bladder
  38. Pyelonephritis
    • infection of
    • renal pelvis
    • tubules
    • interstitial tissue of 1 or both kidneys

    • Includes
    • chronic pyelonephritis (inflammation of renal pelvis)
    • interstitial nephritis (inflammation of the kidney)
    • renal abscesses
  39. Causes of pyelonephritis
    • upward spread of bacteria from the bladder
    • spread from systemic sources reaching the kidney via bloodstream
  40. S/S of ACUTE pyelonephritis
    *Actively ill with fever, chills, leukocytosis, bacteriuria, and pyuria

    • may also experience--
    • low back pain
    • n/v
    • headache
    • malaise
    • panful urination
    • pain/tenderness
  41. manifestations of acute pyelonephritis
    • enlarged kidneys with interstitial infiltrations of inflammatory cells
    • abscess may be noted
  42. medical mngt of acute pyelonephritis
    • treated as out-pt
    • 2 wk course of abx
  43. complications of acute pyelonephritis
    • chronic or reoccuring symptomeless infection for months/yrs
    • --must follow up to make sure this is not happening
  44. Chronic pyelonephritis
    • repeated bouts of acute may lead to chronic
    • kidneys - scarred, contracted, non-fn
  45. S/S of chronic pyelonephritis
    • fatigue
    • headache
    • poor appetite
    • polyurua
    • excessive thirst
    • weight loss
    • *asymptomatic unless an exacerbation occurs
  46. Complications of chronic pyelonephritis
    • end-stage renal disease (bec. of loss of nephrons)
    • htn
    • kidney stones (from chronic infection)
  47. Medical mngt for chronic pyelonephritis
    long term use of prophylactic abx therapy
  48. implications for chronic pyelonephritis
    • I&O (3-4 L q day)
    • temp q 4 hrs
    • antipyuretic
  49. teaching for chronic pyelonephritis
    • empty bladder fully
    • hygiene
    • prevention by increasing fluids
  50. Urinary incontinence
    involuntary or uncontrolled loss of urine from bladder
  51. risk factors for urinary incontinence
    • age, gender(women), # of vaginal deliveries
    • menopause
    • pelvic muscle weakness
    • incompetent urethra
    • immobility
    • high-impact exercise
    • diabetes
    • stroke
    • obesity
    • cognitive disturbances (dementia, parkinson's)
    • diuretic, sedatives, hypnotics, opioids
  52. types of incontinece
    • stress: result of sneezing, coughing, or changing position
    • urge: strong urge that can't be suppressed
    • funtional: cognitive impairment make it difficult to identify voiding
    • iatrogenic: extrinsic med factors (alpha-adrenergic)
  53. Mngt of urinary incontinence
    • behavior therapy: 1st choice to decrease or eliminate incontinence
    • kegel exrecises: represent behavioral therapy
    • fld mngt: 1500-1600 ml in small amounts am-pm
    • standard voiding: timed, prompted, habit, bladder
    • vaginal cone retention:
    • transvaginal or transrectal electrical stimulation:
    • neuroamodulation
  54. Patho of uro and nephrolithiasis
    • stones form in UT when:
    • increased concentrations of substances (calcium), and uric acid
  55. S/S of stones in renal pelvis
    • intense, deep ache in costovertebral region
    • hematuria
    • pyuria
    • pain radiates downward toward bladder/testes
    • n/v
    • diarrhea
  56. S/S of stones in ureter (ureteral obstruction)
    • acute, wavelike, colicky, pain
    • radiates down to thigh and genitalia
    • desire to void but little comes out with blood
    • urinary retention
  57. Med mngt for stones. Goals:
    • eradicate stones
    • determine stone type
    • prevent nephron destruction
    • control infection
    • relieve any obstruction present
  58. Priority for stones
    • relieve the pain with opioids and NSAIDS first
    • hot baths or moist heat to flank areas
    • increase flds
  59. Nutritional therapy for stones
    increase fld to 8-10 8oz glass (output of 2L q day is good)
  60. nutrition for calcium stones
    • decrease calcium intake
    • increase flds
    • decrease protein and sodium

    meds are ammonium chloride and thiazides
  61. nutrition therapy for uric acid stones
    low-purine diet bec it reduces excretion of uric acid.

    • foods high in purine:
    • shellfish
    • asparagus
    • mushrooms
    • organ meats

    decrease protein

    med is zyloprim bec it reduces uric acid levels and secretion
  62. Nutritional therapy for cystine stones
    • low protein diet
    • increase fluid intake
  63. nutritional therapy for oxalate stones
    • strawberries
    • spinach
    • rhubarb
    • chocolate
    • tea
    • peanuts
    • wheat bran

    *eliminate foods that increase urinary excretion of oxalate
  64. How to prevent kidney stones
    • decrease protein - restrict to 60 grams/day
    • reduce sodium - 3-4 grams/day
    • avoid oxalate containing foods - strawberries, spinach, etc)
    • increase fluid intake - water q 1-2 hrs
    • 2 glasses h2O @bedtime & glass in AM to prevent concentration
    • avoid excessive sweating & dehydration
    • go to doc if UTI suspected

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