Renal and Urologic Problems

A patient has undergone a lithotripsy procedure and is at risk of obstruction of the ureter by edema. Which catheter should be used for preventing obstruction of the ureter?

A ureteral catheter is used after surgery to splint the ureters and to prevent them from being obstructed. Urethral catheters are the most commonly used catheters. The urethral catheter is inserted through the external meatus, to the urethra, past the internal sphincter, and into the bladder. A suprapubic catheter is placed while the patient is under general anesthesia. A nephrostomy catheter is inserted on a temporary basis to preserve renal function when the ureter is completely obstructed.

A patient with bladder cancer is scheduled for surgery to create an ileal conduit. How should the nurse explain the ileal conduit?

An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected with one end of the segment closed. The ureters are surgically attached to the segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form a stoma. The patient must wear a pouch to collect the urine that continuously flows through the conduit. An ileal conduit is a permanent urinary diversion procedure. An ileal conduit does not divert urine into the sigmoid colon or create an opening in the bladder allowing urine to drain into an external pouch.

An older male patient visits his primary health care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)?

Benign prostatic hyperplasia (BPH) causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.

The nurse provides a patient who is prone to urinary tract infections with a list of recommended food and beverage choices to increase the patient's urine acidity. What type of juice should the nurse include on the list?

Cranberry juice has high acidity and is recommended most often. Foods that promote urine acidity are also referred to as "acid-ash." Apple juice, carrot juice, and prune juice are not considered part of an acid-ash diet.

The nurse is preparing a lecture on Healthcare Associated Urinary Tract Infections (UTIs) for nursing students. Education should include identification of the following organism as the primary cause:

E. coli is the most reported organism, and pseudomonas is second. Catheter-associated UTIs are the most frequent hospital-acquired UTI. MRSA and streptococci are not reported organisms in hospital-acquired UTIs.

The patient is wondering why anesthesia is needed when the lithotripsy being done is noninvasive. The nurse explains that the anesthesia is required to ensure the patient's position is maintained during the procedure. The nurse knows that this type of lithotripsy is called:

ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive. Laser lithotripsy uses an ureteroscope and small fiber to reach the stone. Electrohydraulic lithotripsy positions a probe directly on the stone then continuous saline irrigation flushes are used to rinse the stone out. Percutaneous ultrasonic lithotripsy places an ultrasonic probe in the renal pelvis via a percutaneous nephroscope inserted through an incision in the flank.

The nurse is attending to a patient with obstructing urinary calculi. The patient is treated with Tamsulosin (Flomax) to help ease passage of the stones. In addition, opioids are administered to relieve colic pain. What actions should the nurse perform to ensure treatment effectiveness and patient safety? Select all that apply.

Encouraging the patient to move helps promote the movement of the stone from the upper to the lower urinary tract, resulting in the passage of stones. The nurse should also strain all urine voided by the patient using gauze or a urine strainer to ensure that any spontaneously passed stones are retrieved. To ensure safety, the patient is not left to walk unattended while experiencing acute renal colic, particularly when opioid analgesics are being given. Restricting fluid intake does not help; instead increasing fluid helps to dilute the urine and eases the spontaneous passage of stones. Bed rest is advised only if ordered, during which the patient should be moved every 2 hours.

A patient from a long-term care facility is admitted to the medical unit with pyelonephritis. What is a common cause of pyelonephritis for patients residing in long-term care facilities?

For residents of long-term care facilities, urinary tract catheterization is a common cause of pyelonephritis. Fever is a symptom of pyelonephritis, but does not cause it. Gram-negative bacilli causes urinary tract infections, not pyelonephritis. Urethral trauma from childbearing can cause urethral diverticula, not pyelonephritis.

A patient is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which question is most important for the nurse to ask the patient?

Glomerulonephritis is an inflammatory process, usually resulting from antibodies reacting with group A hemolytic streptococcal antigens, the organism responsible for strep throat. Allergies, fluid intake, and measles exposure are not germane to the diagnosis of acute glomerulonephritis.

The nurse understands that a beta-hemolytic streptococcal infection should be treated aggressively to prevent which complication?

Glomerulonephritis may occur after a beta-hemolytic streptococcal infection. The disease process involves an unusual antigen-antibody reaction in the glomeruli of the kidneys, which causes the condition. Pneumonia, lung fibrosis, and pheochromocytoma are not caused by a beta-hemolytic streptococcal infection.

A nurse assesses a patient with renal calculi and expects to find what clinical manifestations?

In addition to severe flank pain and possible abdominal pain, nausea and vomiting are associated with renal calculi because the nerves that innervate the kidneys also serve the stomach. Constipation, polyuria, and diarrhea are not associated with renal calculi. Sometimes these patients may experience abdominal pain and fever. Patients with renal calculi may also have hematuria.

A nurse is teaching a patient about measures to prevent the recurrence of urinary tract infections (UTIs). What instructions should the nurse include? Select all that apply

It is necessary to maintain an adequate fluid intake and to urinate regularly. Delaying urination when there is urge to urinate increases the chances of bacterial infection. Cleansing the perineal area with warm soapy water after a bowel movement reduces the risk of infection. It is important to wipe from front to back to avoid the risk of getting fecal matter near the urethra. Acidic foods and drinks like lemon juice, orange juice, and tomatoes irritate the bladder and should be avoided.

The nurse anticipates that which procedure will be prescribed as a therapeutic medical intervention for renal calculi?

Lithotripsy (also known as extracorporeal shock wave) is a noninvasive therapeutic treatment in which high-energy shock waves are used to crush or pulverize renal calculi in the renal pelvis, ureter, and bladder. Once crushed into smaller particles, the calculi can be more easily eliminated from the genitourinary tract with the aid of increased fluids and pain medication. The myelogram is a neurological diagnostic procedure most commonly used for spinal issues. The renal sonogram and intravenous pyelography are diagnostic tools for renal problems but are not medical interventions.

The nurse is assessing the risk factors for urinary tract calculi in a group of patients. What are the factors that the nurse knows contribute to the development of urinary tract calculi? Select all that apply.

Low fluid intake increases urinary concentration and the chances of urinary tract calculi. A sedentary occupation can cause delayed urination and increased urinary stasis, which can lead to calculi. Excessive intake of tea can elevate urinary oxalate levels, which can cause oxalate renal stones. A diet low in calcium does not increase the risk of urinary calculi; instead, a high-calcium intake with lower fluid intake can predispose a woman to stone formation. Adequate intake of dietary proteins is recommended, but a large intake of dietary proteins can increase uric acid excretion and increases the risk of forming renal calculi.

The patient who is two days postoperative ileal conduit loop informs the nurse that there is mucus in the urine. Which is the correct response by the nurse?

Mucus is a normal production of the intestinal liner. This will not cause any disruption in flow of the urine. Mucus in the urine is not caused by a decrease in fluid intake. It is not necessary for the health care provider to assess the stoma, as this is a normal finding. Catheterizing the stoma will not remove the mucus.

The nurse is evaluating the care plan for the patient with a diagnosis of urinary tract calculi. Which statement by the patient indicates a need for a change in the nursing plan of care?

Pain control is the priority with this patient, but the patient needs to be mobile to assist in passing the stone. The statement regarding the patient needing to be on bed rest requires further education. The patient reporting no pain upon voiding indicates that the stone may have passed. The patient does not need to strain urine once the stone has passed. The patient being free of pain is an ideal goal.

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. What are priority nursing assessments in the care of this patient?

Peripheral edema is characteristic of nephrotic syndrome , and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels commonly are not associated with the diagnosis of nephrotic syndrome.

A 22-year-old female patient had a physical for a new job. Her blood pressure was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure?

Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually has hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.

The patient complains of incontinence of urine while coughing or sneezing during the physical assessment. The nurse explains to the patient that this is defined as:

Stress incontinence occurs when the patient coughs or sneezes. In stress incontinence, the leakage is in small amounts and may not be daily. Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. This usually occurs frequently throughout the day and night. Reflex incontinence is a condition that occurs when no warning or stress precedes periodic involuntary urination. Urination is frequent, is moderate in volume, and occurs equally during the day and night. Trauma incontinence occurs when a fistula develops as result of trauma or surgery.

A nurse is performing a physical examination on a patient suspected of having urinary tract calculi. What primary manifestation should the nurse be observant for during the assessment?

The first symptom of a kidney stone is usually severe pain in the flank area, back, or lower abdomen. Abdominal distension and fever may occur later in the course of the disease. Bacteria on urine analysis is not a predictor of urinary calculi but is observed when a patient has a urinary tract infection.

Nurses have a major role in prevention of urinary tract infections (UTIs). Which guidelines can help prevent hospital-acquired UTIs? Select all that apply.

The patient should not be catheterized unless absolutely necessary. Hand hygiene is the number one prevention method in spreading infection in the hospital setting. Routine perineal care daily with soap and water is evidenced-based practice to prevent UTI. Betadine should not be applied to the catheter insertion site daily. Intermittent catheterization places the patient at high risk for hospital-acquired UTIs

The nurse prepares to discharge a patient who has a renal calculus. What is the most important instruction for the nurse to include in the patient's teaching?

The renal calculus could pass after the patient is discharged and be expelled in the urine. Laboratory analysis of the stone reveals the exact contents and will guide further treatment. Bed rest is not recommended or necessary. A clear-liquid diet may not be necessary if the patient can tolerate the usual diet. Having the patient perform relaxation exercises to ease pain is secondary in importance to straining the urine.

The patient with type 2 diabetes has a second urinary tract infection (UTI) within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection?

This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole should be used for uncomplicated UTIs.

Which renal disease is caused by Trichomonas in women?

Urethritis is an inflammation of the urethra. It is a bacterial or viral infection, which may be caused by Trichomonas and monilial infection in women and chlamydial infection and gonorrhea in men. Interstitial cystitis is a chronic, painful inflammatory disease of the bladder. It is also called painful bladder syndrome. The symptoms of interstitial cystitis are urinary urgency, frequency, and pain in the bladder. Urethral diverticula are localized outpouchings of the urethra. They are usually caused by enlargement of obstructed periurethral glands. Chronic pyelonephritis is associated with small, atrophic, and shrunken kidneys. It is usually caused by recurring infection of the upper urinary tract.

Which nursing diagnosis is a priority in the care of a patient with renal calculi?

Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.