GU – Flashcard
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Pyelonephritis
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inflammation of the renal parenchyma and collecting system
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Pyelonephritis: Clinical Manafestations
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-mild fatigue -sudden onset of chills -fever -vomiting -malaise -flank pain -dysuria -urgency -frequency -costovertebral tenderness
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Pyelonephritis: Diagnostic
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-H&P -UA -Urine for culture and sensitivity -U/S (initially) -CT scan -IVP -CT/IVP -VCUG radionuclide imaging -CBC count with WBC differential -Blood culture -Percussion for flank pain
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Pyelonephritis: Mild symptoms collaborative therapy
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-Outpatient management or short hospitalization -Broad spectrum antibiotics -Switch to sensitivity-guided therapy -adequate fluid intake -NSAIDs or antipyretic drugs -F/U urine culture and imaging studies
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Pyelonephritis: Severe symptoms Collaborative therapy
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-Hospitalization -Parenteral antibiotics -Oral antibiotics when patient tolerates oral intake -adequate fluid intake -NSAIDs or antipyretic drugs -Urinary analgesics -F/U urine culture and imaging studies
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Pyelonephritis: Nursing implementation
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-continuing medications as prescribed -having a follow-up urine culture -recognizing manifestations of recurrence or relapse -Encourage the patient to drink at least 8 glasses of fluids every day -Rest
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Risk factors for Urinary Tract Calculi
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-abnormalities that result in increased urine levels of calcium, oxalic acid, uric acid, or citric acid -warm climates that cause increased fluid loss, low urine volume, and increased solute concentration in urine -Large intake of dietary proteins that increase uric acid secretion -Excessive amounts of tea or fruit juices that elevate urinary oxalate level -Large intake of calcium and oxalate -Low fluid intake that increases urinary concentration -Family history of stone formation, cystinuria, gout, or renal acidosis -Lifestyle -Sedentary occupation, immobility
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Types of urinary calculi
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-Calcium phosphate -Calcium oxalate -uric acid -cystine -struvite
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Urinary calculi: Clinical manifestations
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-severe pain that begins suddenly -sharp pain in the flank area, back, or lower abdomen -nausea -vomiting -Renal colic= sharp, severe pain which results from the stretching, dilation, and spasm of the ureter in response to the obstructing stone -hard time laying still -dysuria -fever -chills
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Urinary calculi: Diagnostic studies
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-Noncontrast spiral CT (CT/KUB) is the diagnostic study commonly used in patients with renal colic -ultrasound -IVP -UA= confirm diagnosis of a urinary stone by assessing for hematuria, crystalluria, and urinary pH -serum calcium, phosphorus, sodium, potassium, bicarbonate, uric acid, BUN, and creatinine levels -H&P -24 hour urine collection
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Urinary calculi: Collaborative care
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-Management of acute attack by treating the pain, infection, and/or obstruction -Administer opioids to relieve renal colic pain -Tamsulosin, terazosin relax the smooth muscle in the ureter and can facilitate stone passage -Evaluation of the cause of stone formation and prevention of further stone development -Adequate hydration, dietary sodium restrictions, dietary changes, and drugs are employed to minimize urinary stone formation -The drugs prevent stone formation in various ways including: altering urine pH, preventing excessive urinary excretion of a substance, or correcting a primary disease
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Indications for urinary stone surgical removal
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-stones too large for spontaneous passage (usually greater than 7mm) -stones associate with bacteriuria or symptomatic infection -stones causing impaired renal function -stones causing persistent pain, nausea, or paralytic ileus -inability of patient to be treated medically -patient with only one kidney
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Lithotripsy
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-procedure used to eliminate calculi from the urinary tract -extracorporeal shock-wave -laser -percutaneous ultrasonic -electrohydraulic
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Purine
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-High: sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads -Moderate: chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
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Calcium
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-High: milk, cheese, ice cream, yogurt, sauces containing milk, all beans (except green beans), lentils, fish with fine bones, dried fruit, nuts, Ovaltine, chocolate, cocoa
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Oxalate
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-High: dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, Ovaltine, tea, Worcestershire sause
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Urinary tract calculi: Nursing interventions
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-Adequate fluid intake to produce approximately 2L/ day -Turning patient every 2 hours -helping patient sit or stand -Teach patient dosages, scheduling, and potential side effects of drugs -Pain management and patient comfort new primary nursing interventions -Tell patient not to walk unattended while experiencing acute renal colic
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Kidney Cancer: Risk factors
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-Men > women -50-70 years of age -Cigarrete smoking -Family history -Obesity -HTN -exposure to asbestos, calcium, and gasoline
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Kidney Cancer: Clinical manifestations
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-Hematuria -Flank pain -palpable mass in the flank or abdomen -weight loss -fever -HTN -anemia
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Kidney Cancer: Diagnostic Tests
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-CT scan= used to diagnosed and can detect small kidney tumors -Ultrasound= differentiate between solid mass or a cyst -Angiography -Biopsy -MRI -Radionucleotide isotope scanning
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Kidney cancer: Nursing interventions
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-Teach about prevention -Teach about early symptoms
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Kidney Cancer: Collaborative Care
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-Treatment of choice: partial nephrectomy or radical nephrectomy
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Bladder Cancer: Risk factors
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-Cigarette smoking -exposure to dyes used in rubber and other industries -chronic abuse of phenacetin-containing analgesics -women who were treated with radiation for cervical cancer -chronic recurrent renal calculi -chronic lower UTIs -patients who have indwelling catheters for a long period of time
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Bladder cancer: Clinical manifestations
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-Microscopic or gross, painless hematuria -dysuria -frequency -urgency
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Bladder cancer- Diagnostic studies
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-CT -Ultrasound -MRI -Cystoscopy with biopsy to confirm diagnosis
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Bladder cancer: Nursing intervention
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-Periodic surveillance -Pre-op instructions: drinking a large volume of fluid for the first week after procedure Teach the patient to self monitor the color and consistency of the urine (urine is pink but should not be bright red or contain clots) -Administer opioid analgesics along with stool softeners -Help patient and family cope with fears about cancer, surgery, and sexuality. -Emphasize importance of follow-up care -Follow-up cystoscopies are required on a regular basis after surgery for bladder cancer
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Ileal Conduit
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-Ureters are implanted into part of ileum or colon that has been resected from intestinal tract -Abdominal stoma is created
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Ileal conduit: Advantages/ Disadvantages
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-Advantage: relatively good urine flow with few physiologic alterations -Disadvantage: External appliance necessary to continually collect urine
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Ileal Conduit: Special considerations
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-Surgical procedure is complex -Postoperative complications may be increased -Reabsorption of urea by ileum occurs -Meticulous attention is necessary to care for stoma and collecting device
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Cutaneous ureterostomy
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-Ureters are excised from bladder and brought through abdominal wall, and stoma is created. -Ureteral stomas may be created from both ureters, or ureters may be brought together and one stoma created.
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Cutaneous ureterostomy: Advantages and Disadvantages
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-Advantages: No need for major surgery as required for IC. -Disadvantage: External appliance necessary because of continuous urine drainage.Possibility of stricture or stenosis of small stoma
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Cutaneous ureterostomy: Special considerations
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-Periodic catheterization may be required to dilate stoma to maintain patency
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Nephrostomy
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-Catheter is inserted into the pelvis of the kidney -Procedure may be done to one or both kidneys and many be temporary or permanent -It is most frequently done in advance disease as palliative procedure
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Nephrostomy: Advantages/ Disadvantages
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-Advantages: No need for major surgery -Disadvantages: High risk of renal infection. Predisposition to calculus formation from catheter
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Nephrostomy: Special considerations
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-Tube may have to be changed every month -Never clamp the catheter
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Urinary diversion: Pre-op teaching
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-Discuss psychosocial aspects of living with a stoma -Teach the patient with a continent diversion to catheterize at least every 6 hours and irrigate the push dailyy
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Urinary diversion: Post-op management
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-NPO status -NG tube -Prevent injury to the stoma and maintain urine output -Advise the patient that mucous in the urine is a normal occurrence -Urine kept acidic to prevent alkaline encrustations -Patients with neobladder: To avoid bladder overdistension, patients should void at least every 2-4 hours; sit during voiding, and practice pelvic floor muscle relaxation to aid voiding. FU x-ray studies include a pouchogram 3-4 weeks after surgery to assess for healing
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Benign Prostatic Hyperplasia (BPH)
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-benign enlargement of the prostate gland
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BPH: Risk factors
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-aging -obesity -lack of physical exercise -alcohol consumption -ED -smoking -diabetes -family history
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BPH: Clinical manifestations
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-Irritative symptoms: -nocturia -urinary frequency -urgency -dysuria -bladder pain -incontinence -Obstructive symptoms: -decrease in caliber and force of urine -difficulty in initiating voiding -intermittency -dribbling at the end of urinations
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BPH: Diagnostic studies
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-H&P -DRE -UA with culture -PSA -serum creatinine -Postvoid residual -Transrectal ultrasound -uroflowmetry -cystoscopy
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Transurethral resection of Prostate (TURP)
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-Use of excision and cauterization to remove prostate tissue cystoscopically. -Remains the standard treatment for BPH
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TURP advantages/ disadvantages
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-Advantage: ED unlikely -Disadvantages: Bleeding, retrograde ejaculation
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Transurethral incision of prostate (TUIP)
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-Involves transurethral incision into prostatic tissue to relieve obstruction -Effective for men with small to moderate prostates
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TUIP: Advantages/Disadvantages
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-Advantages: -Outpatient procedure -Minimal complications -Low occurrence of ED or retrograde ejaculation -Disadvantages -Urinary catheter needed after procedure
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Open Prostatectomy
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-Surgery of choice for men with large prostates, bladder damage, or other complicated factors -Involves external excision with two possible approaches
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Open Prostatectomy: Advantages/Disadvantages
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-Advantages: -Complete visualization of prostate and surrounding tissue -Disadvantages -ED -Bleeding -Post op pain -Risk of infection
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BPH: Health Promotion
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-Teach risk factors -Advise patients with obstructive symptoms to urinate every 2-3 hours and when they feel the urge -Fluid intake should be maintained at a normal level to avoid dehydration or fluid overloa
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BPH: Post-op care
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-Bladder irrigation is typically done to remove blood clots from the bladder and ensure drainage of urine
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Prostate Cancer
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-androgen dependent adenocarcinoma that is usually slow growing
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Prostate cancer: Risk factors
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-Age -Ethnicity -Family history -obesity -a diet high in red and processed meat and high fat diary products along with a low intake of vegetable and fruit
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Prostate Cancer: Clinical Manifestations
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-dysuria -hesitancy -dribbling -frequency -urgency -hematuria -nocturia -retention -interruption of urinary stream -inability to urinate -Pain in the lumbosacral area that radiates down to the hips or the legs, combined with urinary symptoms, may indicate metastasis
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Prostate cancer: Diagnostic tests
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-Prostate may feel hard, nodular, and asymmetric on DRE -Elevate PSA
