Renal Powerpoint+Kyle Lecture Notes

How is urine retention diagnosed?

bladderscann

Tx of upper/lower UTI?

Bactrim - sulfa antibiotic If non-responsive to PO then IV ABs

The college physician determines she has cystitis. Upon explaining this to the client, she begins to cry. "I am about to get married in 2 days and I don't want to have to abstain on my honeymoon." What is the best advice from the nurse? A "I'm sorry but you should abstain for the next week or so for the duration of your antibiotic treatment." B. "If you use a condom, you can have intercourse anytime C "Limit intercourse to once a day so you can avoid any discomfort." D. "You can have sex whenever you want."

D. "You can have sex whenever you want."

A client undergoes transurethral resection of the prostate for benign prostatic hyperplasia. The client has a 3-way Foley catheter with continuous bladder irrigation. Which assessment is the best indication that the bladder irrigation flow rate is productive? BP 120/80, HR 80 Client has no bladder spasms Irrigation input 3000mL, foley output 3000mL Output urine is light pink color

Output urine is light pink color Transurethral resection of the prostate (TURP) involves the insertion of a scope to remove obstructing prostate tissue. Continuous bladder irrigation (CBI) with a 3-way Foley catheter is initiated after the procedure. The catheter balloon applies direct pressure to the bleeding tissue while the tubing allows the urine to drain. During the first 24 hours, the urine color changes from reddish-pink to pink. Small clots are also expected for up to 36 hours after surgery. However, the nurse should adjust the irrigation rate with these normal findings so that the urine remains light pink without clots (Option 4). (Option 1) Vital signs within normal limits indicate hemodynamic stability but will not reflect the patency of the draining catheter. (Option 2) Painful bladder spasms are expected after TURP and catheter placement. Spasms are typically treated with antispasmodics (eg, belladonna-opium suppositories, oxybutynin [Ditropan]). (Option 3) The total Foley output should be more than the CBI input, as the Foley output includes CBI fluid (not processed through the kidneys) plus the normal renal output of urine. An obstruction is indicated if the CBI input is equal to or greater than the Foley output. Educational objective:A 3-way Foley catheter with continuous bladder irrigation allows urine to drain after a transurethral resection of the prostate. During the first 24 hours, the urine color changes from reddish-pink to pink. Small clots may occur for up to 36 hours. However, the nurse adjusts the irrigation flow to keep the urine light pink without clots. Additional Information Reduction of Risk Potential NCSBN Client Need

S/S of lower UTI? 5 Dx? 1

Symptoms: Burning with urination, oliguria, frequency, concentrated, smelly DX: U/A - looking at specific gravity would be higher(1.010-1.030), RBC, WBC, Nitrates.

S/S of upper UTI? 3+1 Dx? 1

Symptoms: Flank pain, Fever, N/V, symptoms of lower DX: U/A - looking at specific gravity would be higher(1.010-1.030), RBC, WBC, Nitrates.

Nursing care post procedure for cystoscopy? 3

○ Adequate fluid to flush bladder ○ Strain all urine ○ Monitor of increased bleeding and S/S of infection

Nursing care pre procedure for cystoscopy

○ If general anesthesia, NPO, but if local then no prep and encourage fluids

Dx for calculi? 4

○ UA, C&S ○ IVP (Intravenous pyelogram)views degree and site of obstruction-contrast dye is being used to increase visualization ○ Ultrasound ○ BUN / Creatinine

Presentation S/S of calculi? First priority is?

● Abdominal or flank pain (usually severe), hematuria, N/ ● If non-obstructing pain may be absent ● As it moves down pain moves down to testicles, labia, and groin ● May have mild shock cool, moist skin ● Can cause UTI, fever, chills ● Pain is our first priority

Pt education for lithotripsy? 3

● Because we like evidence that the stone has passed teach client to Strain all urine ○ Increase fluids ○ Monitor for increased bleeding and signs of infection

Best collection method for urine culture

● Best to collect via straight cath for specimen integrity ● Otherwise, clean catch midstream with proper cleaning technique

Lifestyle changes for prevention and/or BPH? 3

● Lifestyle changes for prevention and/or BPH: restrict fluids at night, voiding schedule & Dietary changes

Causes of BPH? 3

● Often a family history(1 degree relatives) ● Environment (Men in western culture are most likely to develop obstructive problems) ● Diets high in zinc, butter, margarine increase risk and diet high in fruits have lower risk

Treatment Goal for BPH

● Treatment Goal is to restore bladder drainage, relieve symptoms & to prevent and treat complications

Common causes of calculi

● Warm climates cause increased fluid loss, low urine volume, and increased ● concentration of urine ● Diet-increased protein, tea, fruit juices (increased urine oxalate), calcium and/or ● decreased fluids ● Genetics family HX of stones, gout ● Lifestyle-sedentary occupation, immobility