Understanding Medical Surgical Nursing Ch 35
Terms
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- urethritis
-
inflammation of the urethra
may be due to
-chemical irritant
-bacterial infection
-sexually transmitted
S/S: urinary frequency/urgency - dysuria - male pt may have discharge - cystitis
-
inflammation & infection of bladder wall
S/S: dysuria - frequency - urgency - cloudy urine - pyleonephritis
-
infection of kidneys
includes formation of abscesses throughout kidney & enlargement of kidney
S/S: urgency - frequency - dysuria - flank pain - fever - chills - cloudy urine - urosepsis
- septicemea (blood infection) resulting from urinary issue
- urethroplasty
- surgical repair of urethra
- nephrolithotomy
-
scope is inserted through skin into kidney to aid in breaking up renal calculi
also irrigates renal pelvis - hydronephrosis
-
results from untreated obstruction in urinary tract
urine backs up & distends ureters then progresses to kidneys
S/S: same as UTI - flank & back pain - symptoms of renal failure - oliguria
- decreased urine output
- anuria
- no urine output
- stents
- tiny tubes placed inside ureters to hold them open
- nephrostomy tube
-
exits through incision in flank area
allows urine to drain into collecting bag
function of kidney can be maintained - nephropathy
-
damage to small blood vessels in kidneys
most common cause of renal failure
long-term complication of diabetes mellitus - nephrectomy
-
surgical kidney removal
includes adrenal gland & surrounding structures (fascia, fat, lymph nodes)
treatment for cancer of kidney - nephrosclerosis
-
renal arteriosclerosis w/thickening & hardening of renal blood vessels
results in decreased ischemia of kidney
caused by hypertension - glomerulonephritis
-
inflammation occurs due to deposit of antigen-antibody complexes in basement membrane of glomerulus
also occurs from antibodies that specifically attack the beasement membrane
inflammation in glomerulus -> glomerulus becomes more porous -> allows proteins/WBCs/RBCs to leak into urine - nephrotoxins
- substances that are harmful to kidneys
- polyuria
- production of large amount of dilute urine
- azotemia
-
increase in serum urea level (BUN)
often raises creatinine levels as well
caused by kidneys being unable to remove waste products of metabolism -
A pt is admitted to the nursing unit w/a diagnosis of UTI. When teaching the pt about prevening UTIs, which of the following information is most important for the nurse to include?
a. Void frequently & after sexual intercourse
b. Drink larg - a. Void frequently & after sexual intercourse
-
A pt has an ileal conduit for treatment of his cancer. While changing the pouch at the stoma site, the nurse notes that the stoma is constantly spilling urine. Which of the following actions should the nurse take?
a. Notify the physician of the cons - b. Continue changing the pouch
-
A pt has a graft inserted into his left arm to provide a blood access for hemodialysis treatments. Which of the following interventions should the nurse do to determine patency of the graft?
a. Observe the tubing for bright red blood
b. Feel fo - b. Feel for a brachial pulse on both arms
-
A pt w/renal failure who is on hemodialysis asks for a snack in the afternoon. His potassium level remains high. Which of the following foods would be contraindicated?
a. Banana
b. Gelatin desert
c. Clear carbonated beverage
d. Cranbe - a. Banana
-
The nurse is caring for a pt w/glomerulonephritis. Which of the following interventions would the nurse recommend be included in the pt's plan of care?
a. Increase fluid intake
b. Decrease sodium intake
c. Increase potassium intake
d. - b. Decrease sodium intake
- urinary tract infection (UTI)
-
invasion of urinary tract by bacteria
risk factors: stasis of urine - contamination (usually by E. coli) - instrumentation - reflux of urine - previous UTIs
S/S: dysuria - urgency - cloudy, foul smelling urine, frequency - urethral stricture
-
narrowing of lumen of urethra caused by scar tissue
common cause is injury due to insertion of catheters or surgical instruments
S/S: diminished urinary stream - prone to develop UTIs - renal calculi
-
kidney stones
hard, generally small stones that form somewhere in renal structures
formed when urinary salts are concentrated enough to settle out
causes include family hx - chronic dehydration - infection - dietary factors - immobility
S/S: flank pain - renal colic - hematuria - dysuria - frequency - urgency - enuresis
*pt can urinate stone 5mm or smaller - cancer of the bladder
-
often starts as benign growth on bladder wall
S/S: painless hematuria - bladder irritability - urinary retention - fistula formation - - cancer of the kidney
-
risk factors include smoking & industrial pollution exposure
S/S: hematuria - dull pain in flank area - mass in area - nephrotic syndrome
-
large amounts of protein are lost in urine from increased glomerular membrane permeability
results in decreased serum albumin & total serum protein
Causes: glomerulonephritis - diabetes - lupus - infections - cancer - drugs -
Signs and symptoms of glomerulonephritis include:
(five listed) -
1 oliguria
2 hypertension
3 electrolyte imbalance
4 edema
5 flank pain - acute renal failure (ARF)
-
sudden loss of kidney function
waste products accumulate in blood
Causes: prerenal failure - intrarenal failure - postrenal failure - prerenal failure
- loss of kidney function associated w/decrease or interruption of blood supply to kidneys
- intrarenal failure
- loss of kidney function associated w/ damage to nephrons inside kidney
- postrenal failure
- loss of kidney function associated w/obstruction blocking flow of urine out of body
- continuous renal replacement therapy (CRRT)
-
used for treating renal failure & preventing further damage
removes fluid continuously along w/hemodialysis
alone to remove fluid/solutes in controlled, continuous manner in unstable pts
blood flows through hemofilter, excess fluids/solutes move into collection bag - hemodialysis
- method for replacing function of kidneys by circulating blood through tubes made of semipermeable membranes
- uremia
- execess in blood of urea, creatinine, & other nitrogenous end products of protein & amino acid metabolism
- chronic renal failure (CRF)
-
gradual decrease in kidney function over time
renal insufficiency stage occurs when pt has lost 75% of nephron function & some signs of mild renal failure are present
end-stage renal disease (ESRD) occurs when 90% of nephrons are lost
S/S: fluid accumulation - elecrolyte imbalance - waste products retained - acid-base imbalances - anemia -
What dietary recommendations are made as a method of medical management for renal failure?
(eight listed) -
1 high calorie
2 low protein (unless dialysis)
3 low sodium
4 low potassium
5 increased calcium
6 low phosphorus
7 restricted fluids
8 vitamins added -
What medications are used in the medical management of renal failure?
(four listed) -
1 diuretics
2 antihypertensives
3 phosphate binders
4 calcium/vit D supplements - Dialysis is started when the patient develops symptoms of severe 1_____ overload, 2_____ potassium levels, 3_____, or symptoms of uremia that are life threatening.
-
1 fluid
2 potassium
3 acidosis - Hemodialysis involves the use of an 1_____ 1_____ to remove 2_____ 2_____ & excess 3_____ from the patient's body.
-
1 artificial kidney
2 waste products
3 water - What are the three methods of vascular access utilized for dialysis patients?
-
1 temporary
2 A-V graft
3 A-V fistula - peritoneal dialysis
- provides continuous dialysis treatment performed by pt or family in the home
- dialysate
- sterile dialyzing solution
- Peritoneal dialysis uses 1_____ flowing through a tube into the 2_____ cavity, where it collects 3_____ 3_____ from the blood. Periodically the used dialysis solution is 4_____ from the abdominal cavity, carrying away 5_____ 5_____ and 6_____ 6_____ from
-
1 dialysate
2 abdominal
3 waste products
4 drained
5 waste products
6 excess water - A donated kidney for a kidney transplant can come from a 1_____ 1_____; a 2_____ 2_____ 2_____; or a 3_____ donor.
-
1 family member
2 living non-related donor
3 cadaver