88 urinary D/O
Continuing And Vocational Studies 1 with Smith at Blue Ridge Community College (VA)
About this deck
By: brittany abshire
Textbook:
Study Guide to Accompany Textbook of Basic Nursing (Lippincott's Practical Nursing)
Textbook of Basic Nursing
Created: 2011-02-13
Size: 139 flashcards
Views: 89
Textbook:
Study Guide to Accompany Textbook of Basic Nursing (Lippincott's Practical Nursing)Textbook of Basic Nursing
Created: 2011-02-13
Size: 139 flashcards
Views: 89
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Abnormal Ph indicates
gout, calculi, and infections
Abnormal SG indicdates
kidney disease, electrolyte imbalances, liver disorders, burns
Albuminuria indicates
nephritis, kidney stones, renal circulatory difficulties, infection, trauma,
preeclampsia (of pregnancy)
Glycosuria indicates
diabetes mellitus, shock, head injury
Ketonuria indicates
diabetes, starvation, bulimia, faulty fat metabolism, other digestive disturbances
bilirubin indicates
livery dysf(x), biliary obstruction, hepatitis
Hemoglobinuria or hematuria indicates
infection, calculi, cancer, trauma, OD of an anticoagulant, bleeding disorder
Routine or Random UA includes....
- pH
- SG
- Glucose & ketones
- albumin & blood
- bilirubin
What is the normal pH of urine?
4.6-8
Casts (cylindruria)
epithelial, fatty, or waxy tissue abnormally forced out of the renal tubules.
crystalluria
presence of crystals in the urine
pyuria
presence of pus in the urine
urine cx
a urine sample is placed on a cx medium and is allowed to incubate
urine sensitivity
after an organism is detected in a Cx it is than determined what Rx is the most effective in eradicating it.
cyst(o)
pertaining to any bladder
lith(o)
stone
nephr(o)
kidney
pyell(o)
renal pelvis
ureter(o)
ureter
urethr(o
urethra
vesico
bladder
-tripsy
crushing
What is the purpose of a BUN?
to determine how efficiently the glomeruli remove nitrogenous wastes that result from protein metabolism
nitrogenous wastes
urea; results from protein metabolism
Serum ceatinine
- product of protein metabolism
- related to muscle mass
- excreted by the kidenys
What is the chief nitrogenous waste of protein metabolism?
creatinine
Glomeruli filtration must be reduced by what for significant elevation of serum creatinine to occur.
50%
creatinine clearance test
* URINE test
*glomerular filtration rate * renal insufficiency
*often combined with a morning serum creatinine
Main thing creatinine is concerned with?
kidneys
Uric acid studies are useful for....
gouty arthritis or kidney disease
*this study is generally preformed with a 24 hour specimen
Intravenous Pyelogram (IVP)
- x-ray w. radiopaque dye
- outline of KUB (kidneys, ureter, & bladder)
nephrotomogram
*may be preformed along with an IVP
*allows in depth x-ray of the kidneys (the layers and structures within them)
*radiopaque dye & rotating x-ray tube
Diabetic Cautions with Dye
- Decreased renal clearance of the dye
- @ least 2-4 liters for 24 hours after test
- dye can quickly damage the kidneys
Radioactive renogram
(renal scan)
**Tests the kidneys themselves by means of radioactive substance
*Tumors may be detected because they pick up more of the radioactive substance
Cystogram
x-ray study of the bladder and urethra
(used with a flouroscope)
*the x-ray cystogram will show the bladder's outline and the ureters if reflux is present.
vesicoureteral reflux
backflow of urine into the ureters
Voiding Cystourethrogram
(VCUG)
fluoroscopic test done to dx vesicoureteral reflux
How do the VCUG and cystogram work?
They have a contrast medium instilled into the bladder via urethral catheter. When the pt feels the need to void the catheter is removed and x-rays are taken during the actual voiding process.
vesicoureteral reflux
reflux of the urine back into the ureters from the bladder.
What does a retrograde pyelogram show?
The kidneys and the ureter
How is this procedure done? (usually in combo with a cystogram)
The bladder is outlined on x-ray film by instillation of a contrast medium into the bladder via a urethral catheter. Smaller catheters are than introduced to the ureters where they than make their way up into the kidneys.
What are the preparations for a retrograde pyelogram?
- low residue diet
- laxative or enema
- normal dye precautions
retrograde
: occurring or performed in a direction opposite to the normal or forward direction of conduction or flow
pyel
renal pelvis
pyelography
radiographic visualization of the renal pelvis of a kidney after injection of a radiopaque substance through the ureter or into a vein
renal arteriogram
injecting a contrast dye through a catheter into the aorta at the level of the renal blood vessels
cystoscopy
allows the dr to view the inside of the bladder through a tubular instrument (cystoscope) which has a mirror and a fiber optic lens on the end
Cystoscopy Concerns
- need to obtain specimens from both kidneys
- Fluid medium is infused at high pressures so this may cause infected urine to be forced into the kidneys
- U/A and Cx should always be done first because of above
Where is cystoscopy usually done at?
in the operating room so routine operations considerations apply here
How should a needle bx for the kidney be done?
- client in prone position
- with a sandbag under the abdomen (helps to bring the kidney into place)
Urodynamic Testing
series of tests that best determines the actual f(x) (and the ability for them to work in sequence) of the following:
- detrusor muscle of the bladder
- External sphincter
- pelvic muscles
Which is more preferable, urodynamic testing or x-ray procedures that involve dye?
Urodynamic testing (they are safer)
What muscle actually pushes the urine out?
detrusor muscle
What are the two phases of urodynamic testing
1. filling phase
2. emptying phase
What happens during the filling phase of urodynamics?
- sensation of the bladder
- capacity
- muscle activity
- stretch of the bladder wall
- ability of the bladder & the pelvic muscles to hold in urine
accommodation or compliance
the stretch of the bladder wall
What is involved in the emptying phase of urodynamics (voiding or mictrition)?
Tests how well the bladder empties and what strategies the pt uses to empty the bladder completely
Uroflowmetry
- Noninvasive
- usually the 1st test done in urodynamics
- Funneled commode that determines the amount of V and how long it takes the pt to actually void
hypotonic bladder
poor muscle tone
residual urine test
*to see if the client voids all the way
Double voiding technique
used to determine residual urine V; the pt voids and than is required to void again after 5 minutes
What happens during a residual urine test?
A pt is instructed to void;
IMMEDIATELY straight cathed to collect whatever urine remains in the bladder
straight catheter
one that is inserted to obtain a specimen and than removed
bladder scanning
*make be used to measure residual volume
*pt voids
*US is than used to determine the amount of residual V
If residual volume is greater that 150-200 mL, what is usually the problem?
A disorder of the bladder or urethra is probably causing urinary retention
Urodynamic Testing may include:
- Uroflowmetry
- Residual urine V, double voiding technique, and US
- Cystometrogram
- Urethral Pressure Prolfile
- Perineal Electromyogram
Measure of bladder pressure during filling is called....
cystometrogram (CMG)
Bladder pressure remains the same during bladder filling until about _____ mL.
500
Notes about cystometrogram
- pt may have to cough or bear down if incontinence testing
- leak-point pressure is recorded during this if there is leaking of above
What is leak point pressure useful in determining
to determine whether or not a pt is suitable for anti-incontinence surgery
Urethral Pressure Profile (UPP)
used to evaluate the smooth muscle activity along the urethra
What procedure is often done following a CMG?
Urethral Pressure Profile (UPP) & perineal electromyogram
What is done during a UPP (urine pressure profile)
- bladder filled with fluid
- puller mechanism provides slow, even rate of catheter withdrawel
- Urethral wall resistance is than measured
If a low pressure urethra is found, what procedure is appropriate?
a procedure that improves urethral closure is appropriate.
Perineal Electromyogram
test of pelvic muscle function
Transient Incontinence
can be reversed with dx and tx
iatrongenic incontinence
caused by medical interventions or tx
true or total incontinence
urinary leakage that is almost continuous
What is the most common cause of true incontinence in men?
prostatectomy
other causes of true incontinence
- injury to males external urethral muscles
- injury to female's perineal muscles
- congenital or acquired
- extrophy (bladder is exposed on the lower abdomen)
- abnormally placed ureteral orifices on the female s
- cancer
- radiation
- vesicovaginal fistula
Fistula
an abnormal passage that leads from an abscess or hollow organ or part to the body surface or from one hollow organ or part to another and that may be surgically created to permit passage of fluids or secretions
Stress incontinence
urinary leakage following a sudden increase in intra-abdominal pressure
Reflex incontinence
bladder instability
result of upper motor lesions or neuropathies
urge incontinence
due to irritation of the bladder wall
over-flow incontinence
happens when the bladder overfills with urine and is not able to release it.
(usually due to nerve damage as in diabetes or other trauma)
Crede's maneuver
- overflow incontinence
- palpate bladder to get it to express urine
Kegal Exercises
- Stress & Urge incontinence
- increase sphincter tone to prevent leakage on the way to BR
- May need to wear a pad at first
- 3-6 mo w.o improvement than they may be eligible for surgery
- Biofeedback to determine how well the pt is actually doing kegals
Electrical Stimulation (Pelvic muscle Stimulation)
- Urge incontinence
- small electrode attached to a generator is placed in the vagina or rectum
- impulse=contract no impulse=relax
Pessary
- non-surgical option for females with stress urinary incontinence
- device that is inserted into the vagina to support everything
- may be left in there for 4-8 wks
ileal diversion
urinary diversion
surgical ureteral reimplantation
correct abnormally placed ureteral orifices
Purpose of Surgeries Involving the Bladder
- Elevating the neck of the bladder & suturing it in place to restore curve
- Closing an open neck
- artificial sphincter for those with non working urethra
- reread book page 1182
augmentation cystoplasty
increasing the bladder size surgically
Interstim (implantable electrical stimulation)
SEVERE CASES
fine electrode attached to the sacral spinal cord to deliver an electrical current that is believed to both relax the bladder and block the sensation of urgency
Nursing Considerations for urge and reflex incontinence:
- encourage fluids
- Teach to empty the bladder completely
- Biofeedback and kegal exercises
- help with caths
Cystitis
Uirnary bladder infections
(UTI) Urinary Tract Infection
cystitis
Instead of bearing down to empty the bladder, what is a better technique?
Crede's Maneuver
What should a female with a prolapsed bladder do to help to empty it?
the pt can lift the base of the bladder by using a finger in the vagina to tip it into a position that will help in emptying it.
Self ________ may be nec for long term management of incontinence
catherterization
What may be the only presenting sign of UTI in older adults?
Change in mental status. (may be severe)
Remember that they metabolize everything, including Rx, more slowly.
The pt complains of a heavy feeling in the abdomen or perineum. This may be indicative of what?
cystitis
During antibiotic tx fluid intake is ___- ___L per day unless contraindicated.
3-4 liters per day
Why is it recommended that one take 2 G of vitamin C if they have a UTI?
To acidify the urine and kill the bacteria
Chronic Cystitus (Recurrent UTI)
Present with:
- urinary frequency
- incontinence
- nocturia
- dysuria
- long term antibiotics (3-6 months)
dysuria
difficult or painful discharge of urine
Acute Pyelonephritis
inflammation of the renal pelvis and medulla and is the most common form of kidney disease. Usually migrates from somewhere else in the body
Signs and Symptoms of acute pyelonephritis
- rapid onset of fever and chills
- flank pain
- pyuria
- n/v/ha
What is the tx for acute pyelonephritis?
antimicrobial tx for at least 10-14 days
What are the signs of infection?
- dysuria
- frequency
- nocturia
- cloudy urine
- hematuria
- fever, chills, flank pain
Chronic Pyelonephritis
Persistant acute infections or obstruction
*May lead to permenant damage
*tx with aggressive antimicrobial
*can cause death
Interstitial Cystitis
disease of the bladder that may be inflammatory and autoimmune in nature
The lining of the bladder becomes "leaky" and allows irritants from the urine to come in contact with the muscular wall of the bladder
Interstitial Cystitis (IC)
Signs & symptoms of Interstitial Cystitus
- Pelvic pain & painful intercourse
- voiding is not painful but provides relief
- Urine is free of bacteria
- Onset is usually associated with UTI or instrumentation
Dx of Interstitial Cystitus
- hydrodistention of the bladder combined with the below
- Hunner's ulcers
- petechial hemorrhages
- Bladder bx
Tx of Interstitial Cystitus
*symptomatic, no cure
*Elmiron for 3-6 months with instillations of cocktails of drugs into bladder
* May have extreme pain, esp with intercourse
Glomerulonephritis (Bright's Disease)
- Group of diseases in which the kidneys are damaged and partyly destroyed by the inflammation of the glomeruli
- May result in an antigen and antibody response, causing an autoimmune disorder
Acute Glomerulonephritis
appears approx - weeks after an UTI or Scarlet fever
Strep
Most common in children
Signs and symptoms of acute glomerulonephritis
pale, puffy face and edema
get up many times to void
Dx of acute glmerulonephritis
- Dilute urine
- Hematuria
- H/A and irritability
- Casts
Tx of acute glumerulonephritis
- Antibiotics
- bedrest
- diet
Chronic Glomerulonephritis
Can develop at any time w/o any signs
ESRD
destroys nephrons
Signs and symptoms of glomerulonephritis
- course of the disease may last - yrs
- anemia, hypertension, CHF
- blurred vision follwed by blindness
- epistaxis
Hydronephrosis
urinary obstructions block the outflow of the kidneys. may be acute or chronic
Calculi ( stones)
null
lithiasis
the formation of stony concretions in the body (as in the urinary tract or gallbladder)
Uric acid elevations can lead to what type of arthritis?
gouty
Kidney stone pain is ofter called what?
colic
(ESWL) Extracorporeal Shock Wave Lithography
used in cases of kidney stones or upper ureter . If the stone is in the lower ureter (not used in the lower because it is more delicate down there) it can be pushed up into the upper part and can than be treated with ESWL
Percutanous Nephrolithotomy
- Stab wound made in the flank and cath inserted
- Us probe inserted into the cath and the waves are directed to break up the stone
- Cath left in for a few days until edema goes away
Urethroscopic Calculi Removal
Stone basket is inserted and the stone is pulled out
Lithotripsy
Crushing of the stones so that they may pass
A stent is than placed so that is may support and allow drainage
Ureterolithotomy
surgical removal of calculi in the ureter
Monocystic Kidney disease
single cyst that is usually benign and asyptomatic
Polycystic Kidney disease
Multiple cys that are also benign that tend to run in families
Usually dx after birth the masses grow so large that they may often be palpable
Nephroma
cancer of the kidney
hypernephroma
primary cancer of the kidney
Kidney Cancer Info
- Aggressive and almost always malignant
- painless hematuria and palpable mass
- removal of affected kidney
Bladder Tumors
- men ages 50-70 yrs
- Caffeine and artificial sweetner intake may increase risks
About this deck
By: brittany abshire
Textbook: Study Guide to Accompany Textbook of Basic Nursing (Lippincott's Practical Nursing)
Textbook of Basic Nursing
Created: 2011-02-13
Size: 139 flashcards
Views: 89
Textbook:
Study Guide to Accompany Textbook of Basic Nursing (Lippincott's Practical Nursing)Textbook of Basic Nursing
Created: 2011-02-13
Size: 139 flashcards
Views: 89
About StudyBlue
STUDYBLUE makes things that make you better at school.
Things like online flashcards with photos and audio.
Things like personalized quizzes and friendly reminders about when (and what) to study next.
Think of it as a digital backpack™: access to all of your study materials online and on your phone.
STUDYBLUE exists to make studying efficient and effective for every student, for free. Join us.
“I have used this website for three exams, and I see a huge difference in my test results.”
Naj
Naj