Med Surg Ch 10.txt

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Med Surg Ch 10.txt
2010-01-26 20:47:13
Urinary Disorders

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  1. What is a nephrectomy?
    A surgical removal of the kidney
  2. How often is a pt repositioned after a nephrectomy?
    Every 2 hours
  3. What is a nephrostomy?
    An incision to drain the pelvis of the kidney
  4. What can happen if a nephrostomy catheter is clamped?
    Acute pyelonephritis
  5. What happens to the non-functioning kidney during a transplant?
    It remain in place until the donor kidney is positioned
  6. What are the signs and symptoms of transplant rejection or infection?
    Increased blood pressure, oliguria, edema
  7. What is an effective drug used to prevent tissue rejection, yet maintain system immunity?
  8. What is a cystectomy?
    Surgical removal of the bladder
  9. What is the most common urinary diversion?
    Ileal conduit (Bricker's procedure)
  10. 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
  11. How often is urine flow measured after an ileal conduit?
    Hourly - if less than 30 ml/hour it's reported to the doctor
  12. What should a nurse watch for in a patient with an ileal conduit?
  13. What does the presence of ketones in the urine indicate?
    Diabetes, starvation
  14. What does the presence of albumin in the urine indicate?
    Increased blood pressure or toxicity of the kidneys
  15. What type of diet is appropriate for a pt with acute renal failure?
    Protein-sparing, high carbs, low potassium & sodium
  16. What is necessary to identify the level of renal function?
    Accurate documentation of urine output
  17. What is chronic renal failure?
    End-stage; kidneys unable to regain normal function
  18. What are the signs and symptoms of chronic renal failure?
    Headache, lethargy, asthenia
  19. How is a diagnosis of ESRD confirmed?
    Bun of 50+ and creatinine of 5+
  20. What type of diet is important for a pt with ESRD?
    High in calories from carbs
  21. What medical management is instituted for a pt with ESRD?
    Conserve renal function as long as possible
  22. What is dialysis?
    The filtration of blood
  23. What is hemodialysis?
    The process of filtering a pt's blood through a mechanical kidney, then returned to the patient's circulatory system
  24. Why must blood levels of drugs be closely monitored in a pt on hemodialysis?
    To prevent toxic accumulation
  25. How often is hemodialysis scheduled?
    3 times a week for 3-6 hours
  26. What type of pt would utilize peritoneal dialysis?
    One who is ambulatory
  27. How often is peritoneal dialysis performed?
    4 times per day for 7 days
  28. What is peritoneal dialysis?
    Dialysis through a semipermeable membrane
  29. Who is peritoneal dialysis contraindicated for?
    A pt with previous abdominal surgery or chronic back pain
  30. What is prostatism?
    Any condition of the prostate gland that causes retention of urine in the bladder
  31. What is prostatectomy?
    Removal of the prostate gland
  32. How is benign prostatic hypertrophy treated?
    With an antihypertensive
  33. What type of surgery is less invasive and less stressful for a pt with BPH?
  34. How is tissue removed during TURP?
    Through the urethra
  35. What type of catheter is used on a pt with TURP?
    Closed bladder irrigation
  36. What type of solution is used in a closed bladder irrigation?
    An isotonic solution
  37. What should the pt expect after prostatic surgery?
  38. Why should catheter drainage tubes be checked frequently?
    For kinks that would occlude urine and cause bladder spasms
  39. What is nephritic syndrome?
    A group of signs characterized by marked proteinuria, hypoalbuminuria, and edema
  40. What is oliguria?
    Decreased urine output
  41. What diet is important for a pt with nephrotic syndrome?
    Protein replacement, low salt
  42. What meds are used to treat nehprotic syndrome?
    Corticosteroids, loop diurectics
  43. What is acute renal failure?
    Renal failure from sudden onset such as from trauma, infection, inflammation or toxicity
  44. What happens during the oliguric phase of acute renal ailure?
    BUN and creatinine increase and urine decreases
  45. What are the signs and symptoms of ARF?
    Anorexia, nausea, vomiting, edema
  46. What is the primary function of the kidney?
    Excretion of waste products
  47. What is the urinary system composed of?
    2 kidneys, 2 ureters, 1 urethra, 1 bladder
  48. What is the responsibility of a nephron?
    It filters blood and processes urine
  49. How do the kidneys control fluids and electrolytes?
    By excretion, secretion, and reabsorption
  50. How do the kidneys maintain acid-base balance?
    By directly excreting H+ ions and forming bicarbonate for buffering
  51. How do the kidneys regulate blood pressure?
    By controlling circulating volume and rennin secretion
  52. Where do the kidneys excrete waste from?
    The glomerlar filtrate
  53. How do the kidneys stimulate the production of RBC's?
    Erythropoietin secreted by the kidneys stimulates bone marrow to produce RBC's
  54. What happens to the kidneys when the body has suffered increased fluid loss?
    The amount of filtrate produced by the kidneys is decreased
  55. What happens when the posterior pituitary gland releases ADH?
    The ADH causes distal tubules to increase the rate of water reabsorption
  56. What happens when the distal tubules increase water reabsorption?
    It returns water to the bloodstream and increases blood pressure to a more normal level
  57. What is the pH of urine?
  58. What is the most common urinary diagnostic study?
  59. What does a specific gravity w/a measure?
    The pt�s hydration status and the ability of the kidneys to concentrate urine
  60. What is the normal serum range for a BUN?
    10-20 mg
  61. What does a BUN determine?
    The kidneys ability to rid the blood of nonprotein nitrogen waste and urea
  62. What is the normal range for serum creatinine?
  63. What is creatinine?
    A product used in skeletal muscle contraction excreted entirely by the kidney
  64. How are creatinine levels measured?
    for a 24-hour period
  65. What do elevated prostate specific antigen levels indicate?
    Prostate cancer, benign prostatic hypertrophy, prostatitis
  66. What does the assessment of osmolality measure?
    The weight of he solute � determines the kidneys concentration ability
  67. What does a KUB radiograph assess?
    The size, structure, and position of the urinary tract structures
  68. What is the normal color of urine?
    Pale yellow to amber
  69. What can an abnormal creatinine clearance indicate?
    Renal disease
  70. 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
  71. What should the nurse assess prior to an IVP?
    Any iodine allergies
  72. How is a pt prepared for an IVP?
    NPO for 8 hours
  73. What can be examined in a retrograde pyelography?
    The upper and lower urinary tract
  74. What can be examined in a retrograde cystography?
    The urinary blader
  75. What can be examined in a retrograde urethrography?
    The status of the urethral structure
  76. What takes place during a voiding cystourethrography?
    x-rays are taken while a pt voids to detect abnormalities of the urinary bladder and urethra
  77. What is an endoscopic procedure?
    A visual exam of a hollow organ using an instrument
  78. What is cystoscopy?
    A visual exam to inspect, treat or diagnose disorders of the urinary bladder
  79. What does a renal angiography evaluate?
    Blood supply to the kidneys, masses, and detects possible complications after a kidney transplant
  80. How is a pt placed after a renal angiography?
    Flat in bed for several hours
  81. What info does a renal venogram provide?
    The kidneys venous drainage
  82. When is dye not used in a CT scan?
    If inadequate renal function is noted
  83. What type of nurse cannot care for a pt who has had a renal scan?
    The pregnant nurse
  84. What can be seen in a transrectal US?
    The prostate gland
  85. What are the nursing measures for a pt who has undergone a renal biopsy?
    Bed rest w/bathroom privileges for 24 hours
  86. When is a urodynamic study indicated?
    When neurological disease is suspected of being and underlying cause of incontinence
  87. What is the function of a thiazide diuretic?
    It impairs sodium and chloride reabsorption which leads to the excretion of electrolytes and water
  88. What is the function of a lop or high-ceiling diuretic?
    It inhibits the reabsorption of sodium and chloride
  89. What is the most potent of all diuretics?
    Loop or high-ceiling
  90. What is the function of potassium-sparing diuretics?
    They inhibit sodium reabsorption and potassium secretion
  91. When are osmotic diuretics used?
    To manage edema
  92. What is the main use of a thiazide diuretic?
    Management of systemic edema and control of mild/moderate hypertension
  93. What is a carbonic anhydrase inhibitor used for?
    To lower intraocular pressure; also has a diuretic effect on the urinary system
  94. What drug is used to reduce bladder spasms?
    Oxybutynin chloride (ditropan)
  95. What drug is used to relieve nocturia, incontinence and dysuria?
    Flavoxate (Urispas)
  96. What drug is used to stimulate the bladder?
    Bethanechol chloride (urecholine)
  97. What is used as an anesthetic on the mucosa of the urinary tract?
    Phenazophyridine (Pyridium, Urogesic)
  98. What drug is used to prevent BPH?
    Finasteride (Proscar)
  99. What drug causes relaxation of smooth muscle and improves urine flow in a pt with BPH?
    Tevazosin hydrochloride (Hytrin)
  100. When is Quinolone used?
    To treat UTI�s caused by gram-neg microbes
  101. What is used to treat both gram-positive and gram-negative microbes in the urinary tract?
    Nitrofurantoin (Macrodantin)
  102. What pt�s use methenamine?
    Those with chronic recurrent urinary tract infections as a preventive measure
  103. What does fluroquinolone/Norfloxacin treat?
    UTI�s gonorrhea, gonococcal urethritis
  104. When is a coude` catheter used?
    For suspected enlargement of the prostate gland
  105. Which catheter is the most common with a balloon to hold it in the bladder?
  106. What catheters are used to drain urine from the renal pelvis of the kidney?
    Malecot, pezzer, or mushroom
  107. Which catheter has multiple openings to facilitate intermittent drainage?
  108. What catheter is used if there is blood in the urine?
    Whistle tip
  109. What catheter is introduced through the abdominal wall above the symphysis pubis?
    Cystostomy, vesicostomy, suprapubic
  110. How many times a day is catheter care performed?
    2 times
  111. 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
  112. When is self catheterization used?
    For pt�s with spinal cord injuries
  113. How often are kegel exercises performed when bladder training?
    Groups of 10-20 four times a day
  114. What is urinary retention?
    The inability to void even with the urge to void
  115. What are the signs and symptoms of urinary retention?
    Distend and can be palpated
  116. What is the primary goal of nursing intervention for incontinence?
    Reinstitution of normal voiding patterns
  117. What muscles are developed to improve voluntary control over voiding?
    The perineal muscles
  118. What can influence voiding patterns?
    Fluid intake and meds
  119. When continence is established, how much residual urine should be retained?
    Less than 50 ml
  120. What is incontinence?
    The involuntary loss of urine from the bladder
  121. What is the loss of voluntary voiding control, resulting in urinary retention or incontinence?
    Neurogenic bladder
  122. What causes a neurogenic bladder?
    A lesion of the nervous system that interferes with the normal nerve conduction to the urinary bladder
  123. What is a UTI?
    The presence of microorganisms in any urinary system
  124. What is bacteruria?
    Presence of bacteria in the urine
  125. Why are females more prone to UTI�s?
    Because the urethra is short
  126. What are the common signs and symptoms of a UTI?
    Urgency, frequency, burning on urination
  127. What is nocturia?
    Excessive urination at night
  128. What is asthenia?
    A general feeling of tiredness & listlessness
  129. What is hematuria?
    Blood in the urine
  130. What is pyuria?
    Pus in the urine
  131. What is cystitis?
    Inflammation of the wall of the urinary bladder
  132. What are the signs and symptoms of cystitis?
    Dysuria, urinary frequency and pyuria
  133. Cystitis is confirmed by a u/a that reveals a bacterial count greater than what?
  134. What is interstitial cystitis?
    A chronic pain disorder in the urinary bladder and surrounding region
  135. What is pyelonephritis?
    Inflammation of the structures of the kidney
  136. What is azotemia?
    Excessive nitrogenous compounds in the blood
  137. What is almost always the cause of pyelonephritis?
  138. How is pyelonephritis diagnosed?
    Bacteria & pus in the urine and leukocytosis
  139. How long is a patient on antibiotics to treat pyelonephritis?
    14-21 days
  140. What is urolithiasis?
    Formation of urinary calculi
  141. How do urolithiasis develop?
    From minerals that have precipitated out of solution & adhere, forming stones
  142. What type of pt�s are predisposed to urolithiasis?
    People who are immobile or have recurrent UTI�s
  143. Where is the pain associated with urolithiasis?
    Flank, radiating to the groin, genitalia, and the inner thigh
  144. What diagnostic tests are used to determine urolithiasis?
    KUB, IVP, ultrasound, u/a, cystoscopy
  145. How are stones in the lower tract removed?
    surgical incision or cystoscopy
  146. How can a nurse help a pt pass stones?
    Increase activity level and fluid intake
  147. What must a nurse do to all urine from a patient with stones?
  148. What are the risk factors of renal tumors?
    Smoking, familial incidence and preexisting renal disorders
  149. What are the signs and symptoms of advanced renal tumors?
    Weight loss, dull flank pain and a palpable mass
  150. What is polycystic kidney disease?
    A genetic disorder characterized by the growth of numerous cysts which can slowly replace much of the kidney
  151. Where is the most common site of cysts?
    The collecting ducts
  152. What happens to BUN and creatinine levels in a patient with renal cysts?
    They are raised
  153. What medical management is aimed at a patient with renal cysts?
    Relief of pain and symptoms
  154. What is benign prostatic hypertrophy?
    Enlargement of the prostate gland
  155. What happens to the bladder during BPH?
    As the prostate enlarges, it puts pressure on the bladder & prevents complete emptying
  156. What patient assessment is priority in a pt following a renal angiography?
    Puncture site
  157. Which group of muscles are used during kegel exercises?
    Perineal floor
  158. What activity is harmful for the incontinent patient
    Restricting fluid intake
  159. What is the most important factor to foster patient compliance with a treatment plan?
    Provide the pt with an active role in the planning
  160. When is the best time to give a patient lasix?
    9 am
  161. What foods are highest in potassium for the ESRD pt?
    Grapefruit, tomatoes, oranges and bananas
  162. What symptom will show that Pyridium is effective?
    Decreased burning sensation
  163. 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
  164. 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.�
  165. What is the goal for peritoneal dialysis?
    To remove toxins and metabolic waste
  166. What would the nurse do in postoperative care of the patient with an arteriovenous shunt?
    Use strict surgical asepsis for dressing changes
  167. What is the teaching priority for the pt with acute renal failure?
    Prevention of infection
  168. What is the ESRD pt receiving hemodialysis at risk for?
  169. What is the primary short term goal for disorders of the urinary system?
    Normal patterns of urinary elimination
  170. What is the nurses first action when discovering there is nor urine drainage from a post op pt�s foley catheter?
    Ensure patency
  171. What is the most common cause of renal failure?