Care of the Patient with Urinary Disorders

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What are the Nursing Interventions for Pyelonephritis?
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1. Patient Teaching 2. Recognizing signs of Infection (elevated body temp, fever, flank pain, chills, fatigue, malaise) 3. Encourage 8 oz fluids per day.
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What are the clinical manifestations of Pyelonephritis?
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Fever Chills Nausea Malaise CVA Tenderness Azotemia Prostration Flank Pain
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Name the Medications for Pyelonephritis
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vancomycin Bactrim Septra tobramycin ciproflaxin (Cipro) ofloxin (Floxin) ampicillin gentamycin
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What is Pyelonephritis?
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Pyelonephritis is inflammation of the kidney structures, (renal tubules, renal pelvis, interstitial tissue). The kidney becomes edematous and inflammed, urine may be cloudy, pyuria and bloody. Can cause hyperparathyroidism.
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What is Hydronephrosis?
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Hydronephrosis is the dilation of the renal pelvis and calyces. The obstruction generates pressure from accumulated urine that cannot flow past the obstruction.
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What can happen if Hydronephrosis is left untreated/prolonged?
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The pressure from Hydronephrosis can cause fibrosis and loss of function of the nephrons. If left untreated, the kidney may be destroyed.
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What are the clinical manifestations of Hydronephrosis?
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It can occur without any symptoms as long as kidney function is adequate and urine can drain. May cause slow only a dull, flank pain severe stabbing Nausea Vomitting
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Name the medical management for Hydronephrosis
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Surgery to relieve obstruction & preserve renal function. Nephrectomy if kidney is severely damaged.
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What are the medications used for Hydronephrosis?
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Antiinfective Medications: penicillin sulfonamides (Gantrisin) sulfamethoxazole (Septra) (Bactrim) Opiods (Morphine, meperidine) propantheline (Pro-Banthine) belladonna preparations
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Nursing Interventions for the patient with Hydronephrosis?
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Nurse should focus on : administering medications as ordered Monitoring Intake & Output Observe for signs/symptoms of infection Monitor Vital Signs Encourage Fluids Assess for Pain Catheter Care if Present Observe Dressing if surgery was performed
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What should be included in the Patient Teaching for Hydronephrosis?
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An explanation of the abnormality, along with signs and symptoms of infection or obstruction. Measures to prevent infection should be explained, such as adequate fluid intake, perineal hygiene daily with mild soap & water (dry thoroughly). Regular bladder emptying.
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What is Urolithiasis?
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It is the formation of renal calculi or stones in any area of the urinary tract.
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Nursing Interventions for Urolithiasis
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Strain all Urine smallest peck must be saved for assessment. Encourage fluids to at least 2000 ml a day unless contraindicated. Administer analgesics as ordered Emphasize the need for follow up treatment. Nurse may be responsible for clarifying diet restrictions. Pts. who form calcium stones need to lessen their intake of dietary calcium.
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Name the foods to avoid for pts. with Urolithiasis
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cheese greens whole grains carbonated beverages nuts chocolate shellfish organ meats
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What is a Renal Tumor?
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They are adenocarcinomas that develop and are quite large when detected.
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What are the Signs and Symptoms of Renal Tumor?
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Intermittent painless hematura weight loss dull flank pain gross hematuria respiratory distress bone pain
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What are the nursing interventions for a Renal Tumor?
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the nurse should emphasize follow up care, including following discharge instructions and keeping return appointments.
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What is a Renal Cyst?
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Polycystic Kidney Disease. a genetic disorder characterized by the growth of nmerous fluid-filled cysts, which slowly replace the kidney. Patient may then progress to ESRD.
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What are the Signs & Symptoms of Renal Cysts?
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Abdominal Pain Flank Pain headache gastrointestinal problems Voiding Disturbances History of Recurrent UTI’s
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What are the Nursing Interventions for Renal Cysts?
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The nurse should closely monitor blood pressure which is usually elevated Monitor hematuria Document the degree of pt. complaints & response to interventions.
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What is a Bladder Tumor?
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Benign papillomas and invasive carcinomas. Most common site of cancer in the urinary tract.
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What are the Clinical Manifestations of Renal Tumors
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Pt. may delay seeking medical attention because the primary sign of bladder cancer is painless intermittent hematuria.
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What is the Medical Management for Renal Tumors?
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Removal of the tissue by burning Chemotherapy agents Radiation therapy Urinary Diversion may be necessary.
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What are the Nursing Interventions for Renal Tumors?
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The nurse should closley monitor with cytological studies as the recurrence rate is 60%. Emphasize the importance of follow-up care. Care is influences by pts. disease process, medical treatment. illness. and pt. response to treatment. Observe voiding patterns and urine character to monitor response to these therapies.
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What is Benign Prostatic Hypertrophy?
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it is the benign enlargement of the prostate. The prostate enlarges, and exerts pressure on the urethra and vesicle neck of of the urinary bladder. , which prevents complete emptying. It is common in men over 50 years of age. Unknown cause, may be influenced by hormonal changes.
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What are the clinical manifestations of BPH?
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Symptoms like urinary obstruction. UTI Hematuria Oliguria Signs of renal insufficiency
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What are pt. Complaints of BPH?
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Pt. Will complain of: Difficult to start urine stream Slow painful urination Complaints of frequency Nocturia Prostatism
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What are the medications for BPH?
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Avodart (dusteride) Terazosin (hytrin)
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Nursing Interventions for Benign Prostatic Hypertrophy
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Initial management is aimed at relieving the obstruction by inserting a Foley catheter. Avoid rapid decompression of the bladder to prevent rupture of mucosal blood vessels. Remove no more than 1000 ml urine from a distended bladder initially.
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Medicall Management of Benign Prostatic Hypertrophy
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Four Prostatectomy Techniques: 1. Transurethral Prostectomy 2. Suprapubic Prostectomy 3. Radical Perineal Prostectomy 4. Retropubic Prostectomy
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What is Transurethral Prostectomy?
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TURP os the most used technique because its less stressful and evasive. done by approaching pthe gland through the penis and bladder using a restethoscope.
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Nursing Interventions for Pt. With TURP?
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Patient with TURP may have continuous or intermittent bladder irrigation to prevent occlusion of catheter w/ blood clots. Continuous bladder irrigation can cause urine to be light red to pink and intermiitent irrigation will be a clear, cherry red. Family needs to know that hematuria is expected after surgery. Vital signs and urine color monitored every 2 hrs. for first 24 hrs. to detect early signs of complications. check catheter drainage tubes for kinks that would occlue urine flow and cause bladder spasms. Pt. is advised there will initially experience frequency, voiding small amounts with some dribbling. Nurse to record time, amount and color of each voiding if physician requests that samples of recent voiding be saved for assessment.
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What is Nephritis?
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A number of kidney disorders characterized by inflammation of the kidney-involving the glomeruli, tubules, or interstitial tissue and abnormal function. (acute and chronic glomerulonephritis).
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What is the clinical manifestation of a pt. with acute glomerulonephritis?
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Pt. may have swelling of the face, around the eyes. some pts. may have a lot of symptoms, while others are vague. Can cause hyperparathyroidism anorexia nocturia malaise exertional dyspnea
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What does the nurse assess in diagnosing Acute Glomerulonephritis?
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Skin integrity and general condition of the skin presence, degree, nature of edema unusual heart sounds, crackles, distention of neck veins hematuria changes in urine color from coca-cola to frank sanguineous changes in voiding decrease in urine output amount dysuria
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Medical Management of Acute Glomerulonephritis
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Treatment of Primary symptoms while preventing complications serum electrolyte levels (Sodium and potassium) may need to adjust dietary intake of sodium and potassium. Monitor level of consciousness when BUN is elevated. Bed rest & fluid intake adjustments are guided by urinary output untill diaphoresis is adequate.
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Medications for Acute Glomerulonephritis
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Penicillin (To protect againt recurrent infection) Diuretics (To control fluid retention) Antihypertensives (To control blood pressure)
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What are the Nursing Interventions for Acute Glomerulonephritis?
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Intervention based on individual pt. needs Focus on controlling symptoms and prevention of complications. Dietary intake to include protein restrictions (to decrease blood urea levels) Carbohydrates to provide a source of energy. Monitor Intake and Output Monitor vital signs. Level of activity determined by degree of edema, hypertension, proteinuria, hematuria, (because excessive activity may increase these signs)
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The importance of Patient Teaching in Acute Glomerulonephritis
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Patient teaching is important because of the long-term nature of glomerulonephritis. Pt. May feel well, so they must be convinced to continue prescribed treatment and to return for follow up care.
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What is Acute Renal Failure?
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the inability of the kidneys to remove wastes, concentrate urine, or concerve or eliminate electrolytes. Diabetes mellitus is the most common cause of renal failure. Burns, heart failure, volume depletion, and renal disease are also contributing factors.
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Phases of Acute Renal Failure
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Oliguric Phase: BUN & serum creatinine levels rise while urine output decreases. Oliguric phase lasts 4 to 6 weeks. diuretic phase: Blood Chemistry levels begin to return to normal and urine output increases. Recovery Phase: Return to normal or near-normal function.
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What are the Clinical Manifestations of Acute Renal Failure?
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Pt. may experience: anorexia nausea vomitting edema associated signs/symptoms of diminished renal function.
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What does nurse assess for in Acute Renal Failure?
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Pt. complaint of: lethargy loss of appetite nausea headache dry mucous membranes poor skin tugor urine output less than 400 ml/24 hrs. vomitting diarrhea anasarca drowsiness muscle twitching seizures
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What is the Diagnostic Test for Acute Renal Failure?
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BUN and creatinine test will confirm diagnosis.
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What is the Medical Management for Acute Renal Failure?
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Renal Dialysis may be necessary. diet should be protein-sparing. high in carbohydrates low in potassuim and sodium.
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Name the medications prescribed for Acute Renal Failure
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Diuretics to increase urine output) furosemide (Lasix) hydrochlorothiazide (Hydrodiuril) Potassium lowering agents sodium polysterene sulfonate (Kayexalate)
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Nursing Interventions for Acute Renal Failure
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Documentation of urinary output is necessary to identify the level of renal function Pt. with Azotemia must be observed for changes in level of consciousness. Monitor fluid status Monitor vital signs Closely monitor response to therapies. Teach dietary restrictions & medication regimen Report signs/symptoms of infection and returning of renal failure to physician. Provide nutritional support.
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What is Chronic Renal Failure?
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Chronic Renal Failure or ESRD is when the kidneys are unable to regain normal function. As much as 80% of nephrons may be severely impaired before renal function is detected. Dialysis or kidney transplant will be needed to maintain life. Can cause hyperparathyroidism
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What are the common causes of Chronic Renal Failure?
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Pyelonephritis chronic glomerulonephritis, glomerulonephrosis, chronic urinary obstruction, severe hypertension diabetes mellitus gout PKD
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What are the signs and symptoms of Chronic Renal Failure?
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Headache Lethargy azotemia asthenia anorexia pruritis elimination changes anuria muscle cramps twitching impotence dusky yellow-tan or gray skin color disorientation & mental lapses (CNS involvement)
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Name the patient complaints in Chronic Renal Failure
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Pt. complains of: Joint Pain edema severe headaches nausea anorexia intermittent chest pain weakness fatigue hiccups (intractable singultus) decreased libido menstrual irregularities impaired concentration
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How does Uremic encephalapathy affect the CNS in Chronic Renal Failure (ESRD)?
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It affects the CNS by altering alertness, and awareness. Respirations will become Kussmaul. (abnormal, very deep very rapid sighing respirations) Coma develops. The accumulation of urates in the blood results in halitosis with a ureine order and “uremic frost” on the skin inf the form of a white powder.
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What is Uremic Frost?
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Urea compounds and other waste products of metabolism that cannot be excreted by the kidneys into the urine are excreted through the small superficial capillaries into the skin, where they collect on the surface
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Identify the medical management of Chronic Renal Failure
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Renal dialysis kidney transplantation
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Name the drugs used to treat Chronic Renal Failure
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anticonvulsants to control seizure activity phenytoin (Dilantin) diazepam (Valium) Antianemics Vitamin Supplements Antiemetics: prochlorperazine (Compazine) Antipyrutics: cyproheptadine (Periactin) Biological Response Modifiers to stimulate RBC Production: epoetin alfa (Epogen) [to treat anemia caused by decreased erythroprotein]. Iron Deficiency anemia treated with: ferrous sulfate iron dextran (Dexferrum per Z-track IM method, give before adminstering Epogen t o be effective).
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What are the diagnostics tests for Chronic Renal Failure?
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Confirmed by elevated BUN level of at least 50 mg/dl and sreum creatinine levels greater than 5 mg/dl.
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Identify the Nursing Interventions for Chronic Renal Failure
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Interventions fous on restoring homeostasis. Fliiod balance is the prime importance. Measure to control fluid imbalance depend on specific needs of pt. Nutrition focuses on preserving protein stores nad preventing production of protein wastes that the kidney would have to clear. Diet is High in calories 2500 to 3000 a day. Diet is high in carbohydrates Diet is high in fats (from polyunsaturated sources (to maintain weight and spare protein) Foods high in potassium are restricted. (because potassium is retained). Sodium is controlled at sufficient levels without causing retention. Show emotional support.
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What is dialysis?
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It is a medical procedure to remove certain wastes from the blood through a semi-permeable membrane. to help resote balance when normal kidney function has failed.

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