Med Surg Ch 10.txt
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Med Surg Ch 10.txt
What is a nephrectomy?
A surgical removal of the kidney
How often is a pt repositioned after a nephrectomy?
Every 2 hours
What is a nephrostomy?
An incision to drain the pelvis of the kidney
What can happen if a nephrostomy catheter is clamped?
What happens to the non-functioning kidney during a transplant?
It remain in place until the donor kidney is positioned
What are the signs and symptoms of transplant rejection or infection?
Increased blood pressure, oliguria, edema
What is an effective drug used to prevent tissue rejection, yet maintain system immunity?
What is a cystectomy?
Surgical removal of the bladder
What is the most common urinary diversion?
Ileal conduit (Bricker's procedure)
Where are the ureters implanted in an ileal conduit?
Into a loop of the ileum that is isolated and brought to the surface of the abdominal wall
How often is urine flow measured after an ileal conduit?
Hourly - if less than 30 ml/hour it's reported to the doctor
What should a nurse watch for in a patient with an ileal conduit?
What does the presence of ketones in the urine indicate?
What does the presence of albumin in the urine indicate?
Increased blood pressure or toxicity of the kidneys
What type of diet is appropriate for a pt with acute renal failure?
Protein-sparing, high carbs, low potassium & sodium
What is necessary to identify the level of renal function?
Accurate documentation of urine output
What is chronic renal failure?
End-stage; kidneys unable to regain normal function
What are the signs and symptoms of chronic renal failure?
Headache, lethargy, asthenia
How is a diagnosis of ESRD confirmed?
Bun of 50+ and creatinine of 5+
What type of diet is important for a pt with ESRD?
High in calories from carbs
What medical management is instituted for a pt with ESRD?
Conserve renal function as long as possible
What is dialysis?
The filtration of blood
What is hemodialysis?
The process of filtering a pt's blood through a mechanical kidney, then returned to the patient's circulatory system
Why must blood levels of drugs be closely monitored in a pt on hemodialysis?
To prevent toxic accumulation
How often is hemodialysis scheduled?
3 times a week for 3-6 hours
What type of pt would utilize peritoneal dialysis?
One who is ambulatory
How often is peritoneal dialysis performed?
4 times per day for 7 days
What is peritoneal dialysis?
Dialysis through a semipermeable membrane
Who is peritoneal dialysis contraindicated for?
A pt with previous abdominal surgery or chronic back pain
What is prostatism?
Any condition of the prostate gland that causes retention of urine in the bladder
What is prostatectomy?
Removal of the prostate gland
How is benign prostatic hypertrophy treated?
With an antihypertensive
What type of surgery is less invasive and less stressful for a pt with BPH?
How is tissue removed during TURP?
Through the urethra
What type of catheter is used on a pt with TURP?
Closed bladder irrigation
What type of solution is used in a closed bladder irrigation?
An isotonic solution
What should the pt expect after prostatic surgery?
Why should catheter drainage tubes be checked frequently?
For kinks that would occlude urine and cause bladder spasms
What is nephritic syndrome?
A group of signs characterized by marked proteinuria, hypoalbuminuria, and edema
What is oliguria?
Decreased urine output
What diet is important for a pt with nephrotic syndrome?
Protein replacement, low salt
What meds are used to treat nehprotic syndrome?
Corticosteroids, loop diurectics
What is acute renal failure?
Renal failure from sudden onset such as from trauma, infection, inflammation or toxicity
What happens during the oliguric phase of acute renal ailure?
BUN and creatinine increase and urine decreases
What are the signs and symptoms of ARF?
Anorexia, nausea, vomiting, edema
What is the primary function of the kidney?
Excretion of waste products
What is the urinary system composed of?
2 kidneys, 2 ureters, 1 urethra, 1 bladder
What is the responsibility of a nephron?
It filters blood and processes urine
How do the kidneys control fluids and electrolytes?
By excretion, secretion, and reabsorption
How do the kidneys maintain acid-base balance?
By directly excreting H+ ions and forming bicarbonate for buffering
How do the kidneys regulate blood pressure?
By controlling circulating volume and rennin secretion
Where do the kidneys excrete waste from?
The glomerlar filtrate
How do the kidneys stimulate the production of RBC's?
Erythropoietin secreted by the kidneys stimulates bone marrow to produce RBC's
What happens to the kidneys when the body has suffered increased fluid loss?
The amount of filtrate produced by the kidneys is decreased
What happens when the posterior pituitary gland releases ADH?
The ADH causes distal tubules to increase the rate of water reabsorption
What happens when the distal tubules increase water reabsorption?
It returns water to the bloodstream and increases blood pressure to a more normal level
What is the pH of urine?
What is the most common urinary diagnostic study?
What does a specific gravity w/a measure?
The pt�s hydration status and the ability of the kidneys to concentrate urine
What is the normal serum range for a BUN?
What does a BUN determine?
The kidneys ability to rid the blood of nonprotein nitrogen waste and urea
What is the normal range for serum creatinine?
What is creatinine?
A product used in skeletal muscle contraction excreted entirely by the kidney
How are creatinine levels measured?
for a 24-hour period
What do elevated prostate specific antigen levels indicate?
Prostate cancer, benign prostatic hypertrophy, prostatitis
What does the assessment of osmolality measure?
The weight of he solute � determines the kidneys concentration ability
What does a KUB radiograph assess?
The size, structure, and position of the urinary tract structures
What is the normal color of urine?
Pale yellow to amber
What can an abnormal creatinine clearance indicate?
What I an IVP/IVU?
A test to evaluate the structure of the urinary tract, filling of the renal pelvis with urine, and transport of urine to the bladder
What should the nurse assess prior to an IVP?
Any iodine allergies
How is a pt prepared for an IVP?
NPO for 8 hours
What can be examined in a retrograde pyelography?
The upper and lower urinary tract
What can be examined in a retrograde cystography?
The urinary blader
What can be examined in a retrograde urethrography?
The status of the urethral structure
What takes place during a voiding cystourethrography?
x-rays are taken while a pt voids to detect abnormalities of the urinary bladder and urethra
What is an endoscopic procedure?
A visual exam of a hollow organ using an instrument
What is cystoscopy?
A visual exam to inspect, treat or diagnose disorders of the urinary bladder
What does a renal angiography evaluate?
Blood supply to the kidneys, masses, and detects possible complications after a kidney transplant
How is a pt placed after a renal angiography?
Flat in bed for several hours
What info does a renal venogram provide?
The kidneys venous drainage
When is dye not used in a CT scan?
If inadequate renal function is noted
What type of nurse cannot care for a pt who has had a renal scan?
The pregnant nurse
What can be seen in a transrectal US?
The prostate gland
What are the nursing measures for a pt who has undergone a renal biopsy?
Bed rest w/bathroom privileges for 24 hours
When is a urodynamic study indicated?
When neurological disease is suspected of being and underlying cause of incontinence
What is the function of a thiazide diuretic?
It impairs sodium and chloride reabsorption which leads to the excretion of electrolytes and water
What is the function of a lop or high-ceiling diuretic?
It inhibits the reabsorption of sodium and chloride
What is the most potent of all diuretics?
Loop or high-ceiling
What is the function of potassium-sparing diuretics?
They inhibit sodium reabsorption and potassium secretion
When are osmotic diuretics used?
To manage edema
What is the main use of a thiazide diuretic?
Management of systemic edema and control of mild/moderate hypertension
What is a carbonic anhydrase inhibitor used for?
To lower intraocular pressure; also has a diuretic effect on the urinary system
What drug is used to reduce bladder spasms?
Oxybutynin chloride (ditropan)
What drug is used to relieve nocturia, incontinence and dysuria?
What drug is used to stimulate the bladder?
Bethanechol chloride (urecholine)
What is used as an anesthetic on the mucosa of the urinary tract?
Phenazophyridine (Pyridium, Urogesic)
What drug is used to prevent BPH?
What drug causes relaxation of smooth muscle and improves urine flow in a pt with BPH?
Tevazosin hydrochloride (Hytrin)
When is Quinolone used?
To treat UTI�s caused by gram-neg microbes
What is used to treat both gram-positive and gram-negative microbes in the urinary tract?
What pt�s use methenamine?
Those with chronic recurrent urinary tract infections as a preventive measure
What does fluroquinolone/Norfloxacin treat?
UTI�s gonorrhea, gonococcal urethritis
When is a coude` catheter used?
For suspected enlargement of the prostate gland
Which catheter is the most common with a balloon to hold it in the bladder?
What catheters are used to drain urine from the renal pelvis of the kidney?
Malecot, pezzer, or mushroom
Which catheter has multiple openings to facilitate intermittent drainage?
What catheter is used if there is blood in the urine?
What catheter is introduced through the abdominal wall above the symphysis pubis?
Cystostomy, vesicostomy, suprapubic
How many times a day is catheter care performed?
What should the nurse do FIRST if urine flow falls to less than 50 ml/hr in a catheter pt?
Check drainage system for proper placement
When is self catheterization used?
For pt�s with spinal cord injuries
How often are kegel exercises performed when bladder training?
Groups of 10-20 four times a day
What is urinary retention?
The inability to void even with the urge to void
What are the signs and symptoms of urinary retention?
Distend and can be palpated
What is the primary goal of nursing intervention for incontinence?
Reinstitution of normal voiding patterns
What muscles are developed to improve voluntary control over voiding?
The perineal muscles
What can influence voiding patterns?
Fluid intake and meds
When continence is established, how much residual urine should be retained?
Less than 50 ml
What is incontinence?
The involuntary loss of urine from the bladder
What is the loss of voluntary voiding control, resulting in urinary retention or incontinence?
What causes a neurogenic bladder?
A lesion of the nervous system that interferes with the normal nerve conduction to the urinary bladder
What is a UTI?
The presence of microorganisms in any urinary system
What is bacteruria?
Presence of bacteria in the urine
Why are females more prone to UTI�s?
Because the urethra is short
What are the common signs and symptoms of a UTI?
Urgency, frequency, burning on urination
What is nocturia?
Excessive urination at night
What is asthenia?
A general feeling of tiredness & listlessness
What is hematuria?
Blood in the urine
What is pyuria?
Pus in the urine
What is cystitis?
Inflammation of the wall of the urinary bladder
What are the signs and symptoms of cystitis?
Dysuria, urinary frequency and pyuria
Cystitis is confirmed by a u/a that reveals a bacterial count greater than what?
What is interstitial cystitis?
A chronic pain disorder in the urinary bladder and surrounding region
What is pyelonephritis?
Inflammation of the structures of the kidney
What is azotemia?
Excessive nitrogenous compounds in the blood
What is almost always the cause of pyelonephritis?
How is pyelonephritis diagnosed?
Bacteria & pus in the urine and leukocytosis
How long is a patient on antibiotics to treat pyelonephritis?
What is urolithiasis?
Formation of urinary calculi
How do urolithiasis develop?
From minerals that have precipitated out of solution & adhere, forming stones
What type of pt�s are predisposed to urolithiasis?
People who are immobile or have recurrent UTI�s
Where is the pain associated with urolithiasis?
Flank, radiating to the groin, genitalia, and the inner thigh
What diagnostic tests are used to determine urolithiasis?
KUB, IVP, ultrasound, u/a, cystoscopy
How are stones in the lower tract removed?
surgical incision or cystoscopy
How can a nurse help a pt pass stones?
Increase activity level and fluid intake
What must a nurse do to all urine from a patient with stones?
What are the risk factors of renal tumors?
Smoking, familial incidence and preexisting renal disorders
What are the signs and symptoms of advanced renal tumors?
Weight loss, dull flank pain and a palpable mass
What is polycystic kidney disease?
A genetic disorder characterized by the growth of numerous cysts which can slowly replace much of the kidney
Where is the most common site of cysts?
The collecting ducts
What happens to BUN and creatinine levels in a patient with renal cysts?
They are raised
What medical management is aimed at a patient with renal cysts?
Relief of pain and symptoms
What is benign prostatic hypertrophy?
Enlargement of the prostate gland
What happens to the bladder during BPH?
As the prostate enlarges, it puts pressure on the bladder & prevents complete emptying
What patient assessment is priority in a pt following a renal angiography?
Which group of muscles are used during kegel exercises?
What activity is harmful for the incontinent patient
Restricting fluid intake
What is the most important factor to foster patient compliance with a treatment plan?
Provide the pt with an active role in the planning
When is the best time to give a patient lasix?
What foods are highest in potassium for the ESRD pt?
Grapefruit, tomatoes, oranges and bananas
What symptom will show that Pyridium is effective?
Decreased burning sensation
How does the nurse calculate the actual urine output during continuous bladder irrigation?
Measure the total output and deduct the amount of irrigation solution used
What statement indicates the need for further instruction before a renal angiography?
�I�m glad I don�t have to stay in bed after the test.�
What is the goal for peritoneal dialysis?
To remove toxins and metabolic waste
What would the nurse do in postoperative care of the patient with an arteriovenous shunt?
Use strict surgical asepsis for dressing changes
What is the teaching priority for the pt with acute renal failure?
Prevention of infection
What is the ESRD pt receiving hemodialysis at risk for?
What is the primary short term goal for disorders of the urinary system?
Normal patterns of urinary elimination
What is the nurses first action when discovering there is nor urine drainage from a post op pt�s foley catheter?
What is the most common cause of renal failure?