Unit 5 - GU & Reproductive
Polycystic kidney disease diagnostic testing
Ultrasound CT MRI DO NOT BIOPSY
A 22 year-old female client presents to the clinic with complaints of burning, pain, and urgency when urinating. The patient has a fever of 100°F. The urine is strong in odor and cloudy with sediments. What questions should the nurse ask during the assessment to gain more information about the possible causes of the urinary tract infection?
-How much fluid do you drink each day and how often do you urinate? What type of fluids do you drink? -Are you sexually active? What contraceptives do you use? Do you urinate after sexual intercourse? -Tell me about your normal bathing practices. -Do you wear tight garments or leather or panty hose? -Have you had urinary tract infections in the past? -Have you ever had kidney stones or any obstructions in your urinary tract in the past?
A nurse is caring for a client 4 hr postoperative following a kidney biopsy. Which of the following interventions should the nurse take? (Select all that apply). A. Monitor for hematuria. B. Check for flank pain. C. Monitor for extravasation of tissue surrounding the biopsy site. D. Encourage ambulation. E. Administer aspirin PRN for pain.
-Monitor for hematuria. -Check for flank pain.
73 y/o female presents to the office with concerns that every time she coughs or sneezes she has urine leakage. The client is 5 foot tall and 150lbs. The client has had 3 children. What diagnostic testing would you anticipate?
-Urinalysis -Bladder scan
Cystography
-dx imaging with dye into bladder to visualize on x-ray -Risk for infection -Monitor for dye allergies
Creatinine
0.6 - 1.2 Kidney disease elevated blood creatinine (Indicated less than 50% function)
Glomerulonephritis nursing management
Conserve client energy Consult provider about fluid restriction Administer abx as prescribed Teach relaxation exercises to reduce stress Monitor resp status & BP Monitor Fluid and electrolytes Daily weights Strict I&Os Low sodium diet
Complications of nephrotic syndrome
Monitor for s/sx of infection, anemia, blood clots r/t lipid issues
Ultrasound
Purpose - assesses the size of the kidneys; images the ureters, bladder, masses, cysts, calculi, and obstructions of LOWER urinary tract Full bladder for the Kidney ultrasound
73 y/o female presents to the office with concerns that every time she coughs or sneezes she has urine leakage. The client is 5 foot tall and 150lbs. The client has had 3 children. What education could you give to your client to prevent urine leakage?
-Bladder training -Void q2 hours -Kegals
Discuss the role of the kidneys in regulating acid-base balance
-Excreting hydrogen ions (acidic) -Retaining bicarbonate ions (basic) -Slow process to start but effects last longer
Risks of kidney disorders
-Fluid and electrolyte imbalances -Monitor daily weights (1kg gain is equal to 1L retained fluid) -Hyperthermia -Delayed wound healing
Urinary Catheter Specimen
-If it is very first put in you can collect it from the bag -Clean the Leur lock, clamp it, once there is enough urine collect it
Cystoscopy Nursing Considerations
-Lidocaine gels for comfort during procedure -Monitor for bleeding & sx of infection (72 hours) -Monitor VS & output -Document color of urine (can be pink-tinged) -Encourage oral fluids to increase output -Monitor I&Os
Complications of Kidney Disease: Imbalances nutrition
-Nutritional status; weight changes, laboratory data -Nutritional patterns, history, preferences -Provide food preferences within restrictions -Encourage high-quality nutritional foods while maintaining nutritional restrictions -Stomatitis or anorexia: modify intake related to factors that contribute to alterations -Adjust medication times related to meals
How does the adrenal cortex function in conjunction with the kidney to increase blood pressure?
-Renal cortex secretes aldosterone due to response of poor perfusion -This also leads to increased BP
Cystoscopy
-Requires informed consent -Visual examination of urinary bladder with cystoscope -Monitor afterwards for infection, sx of obstruction -Normal to have burning or blood after examination or urgency -Monitor I&Os -Upper Scope: NPO
Gerontologic Considerations: Kidneys
-Sclerosis of the glomerulus and renal vasculature -Decreased blood flow to kidneys -Decreased GFR -Altered tubal function and acid-base balance -Incomplete emptying of bladder -Urinary stasis -Decreased nerve innervations -Decreased drug clearance = increased drug-drug interactions -Higher risk for adverse drug effects -Increased risk for hypernatremia or FVD -Increased risk for UTI
Renal Cancer
-Smoking is a significant risk factor (further risks in chart) -Typically no symptoms -May have a palpable mass -Only 10% have s/s: #1 sign-painless hematuria, dull back pain, mass in the flank -Treatment: combination of surgery and medication -If unable to have surgery radiation may have be a palliative measure
What is the role of the vasa recta in blood pressure regulation?
-Special vessels in the kidney -Constantly monitor BP as blood passes through the kidney -Essential to maintain renin-angiotensin system -Failure of feedback of this is major cause of htn
Renin-Angiotensin-Aldosterone system
-decreased blood pressure causes the cells of kidneys to secrete renin which converts angiotensinogen (inactive) to angiotensin I (active) which is then converted into angiotensin II by angiotensin-converting enzyme (ACE) -Angiotensin II stimulates the adrenal cortex to secrete aldosterone - leads to absorption of Na and increased blood pressure (vasoconstriction), prostaglandin release, ADH release -once blood pressure is restored, there is a decreased drive to stimulate renin release
The nurse is caring for a client diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Hypokalemia b) Anemia c) Metabolic alkalosis d) Increased glomerular filtration rate (GFR)
Anemia
Chronic glomerulonephritis symptoms
Anemia Cardiomegaly Distended neck veins Fluid in lungs Confusion Headache Increased BP facial/periorbital edema Lethargic Low grade fever edema
Glomerulonephritis sx
Anorexia Nausea Dysuria Oliguria Fatigue Hypertension Difficulty breathing Crackles S3 heart sound Weight gain Reddish-brown urine Periorbital edema
Nephrotic syndrome basic description and risks
Any condition that seriously damages the glomerular membrane resulting in increased permeability to plasma proteins - excrete too much protein in urine (damage to glomerulous) Risks: chronic glomerulonephritis, DM, SLE, multiple myeloma, renal vein thrombosis, HIV, Hep B&C
Signs and symptoms of AKI
Appearing critically ill Lethargy Dry skin and mucous membranes CNS: drowsiness, headache, muscle twitching, seizures
The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. a) Percuss for pain in the right side of the abdomen b) Assess for the presence of peripheral edema. c) Auscultate the client's peripheral pulses d) Assess the client's blood pressure. e) Assess the client's urine consistency
Assess for the presence of peripheral edema. Assess the client's blood pressure.
June Brite, 35 years of age, is admitted to the medical-surgical unit after a vaginal hysterectomy with bilateral salpingo-oophorectomy for the treatment of uterine cancer. What will occur as a result of this type of surgery and what are the treatment options?
Bilateral salpingo-oophorectomy: ovaries and fallopian tubes removed Menopausal sx can develop Treatments include HRT @ low dose and taper off at menopause age (if not at high risk of breast cancer), treat sx, administer calcium and vitamin D to reduce risk of osteoporosis
Polycystic kidney disease medical treatment
Control the symptoms Nephrectomy Drain the cyst May end up on dialysis Antibiotics Antihypertensives Low sodium diet Stool softeners Pain medications (Avoid NSAIDS)
A client who has been diagnosed with bladder cancer is schedule for an ilea conduit. Preoperatively, the nurse reinforces the client's understanding of the surgical procedure by explaining that an ileal conduit: A. Is a temporary procedure that can be reversed later. B. Diverts urine into the sigmoid colon, where it is expelled through the rectum. C. Conveys urine from the ureters to a stoma opening on the abdomen. D. Creates and opening in the bladder that allows urine to drain into an external pouch.
Conveys urine from the ureters to a stoma opening on the abdomen.
A nurse is discussing laboratory values associated with the renal system with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the values? A. Potassium levels are increased in clients who have polyuria. B. Specific gravity is decreased in clients who have hypovolemia. C. BUN is decreased in clients who have dehydration. D. Creatinine levels are increased in clients who have acute kidney injury.
Creatinine levels are increased in clients who have acute kidney injury.
June Brite, 35 years of age, is admitted to the medical-surgical unit after a vaginal hysterectomy with bilateral salpingo-oophorectomy for the treatment of uterine cancer. What discharge instructions should the nurse provide the patient?
Diet high in vitamin C for wound healing, high iron d/t possible blood loss Restrict activity (heavy lifting 5-10lbs, strenuous activity, sexual activity) for six weeks Avoid the use of tampons or anything vaginally S/SX of infection or UTI List of menopause symptoms Don't drive on narcotics Stool softeners to avoid vagaling Exercises: walking, kegels
June Brite, 35 years of age, is admitted to the medical-surgical unit after a vaginal hysterectomy with bilateral salpingo-oophorectomy for the treatment of uterine cancer. What nursing care should be provided for the patient as she arrives on the medical-surgical unit?
Foley cathether for first 24 hours Monitor for signs of infection Monitor for hemorrhage DVT precautions Monitor bowel sounds Splint abdomen for turn/cough/deep breathe Promote coping mechanisms/emotional support EARLY ambulation - but no standing or sitting for prolonged periods
Causes of Acute Kidney Failure
Hypovolemia Hypotension Reduced cardiac output and heart failure Obstruction of the kidney or lower urinary tract Obstruction of renal arteries or veins
The nurse is teaching a client about formation of kidney stones. The nurse educates the client that which of the following is a risk factor toward the development of kidney stones? a) immobilization b) diabetes insipidus c) a diet high in potassium d) hypoparathyroidism
Immobilization
Glomerulonephritis basic description and risks
Immunologic kidney disorder; inflammation of the glomerulous Risks: ESKD, prior infection (skin or upper respiratory tract), recent travel, SLE, STREP OR IMPETIGO
The nurse is educating a client with chronic pyelonephritis. The nurse should be sure to address which of the following items to prevent recurrence of this condition? a) Limit fluid intake to 1.5 L/day to minimize bladder fullness. b) Decrease sodium intake to prevent fluid retention. c) Increase fluids to 3 to 4 L per 24 hours to dilute the urine. d) Decrease intake of calcium rich foods to prevent kidney stone
Increase fluids to 3 to 4 L per 24 hours to dilute the urine.
Renal Biopsy Contraindications
Increased clotting times Septic patients Current UTI Morbid obesity (difficulty getting to the kidney)
Stages of renal failure
Initiation - initial injury Oliguria - increased urea/uric acid, uremic sx appear, experience oliguria Diuresis - increase of urine output, increasing GFR, lab values stabilize; monitor pts for dehydration!!! Recovery - 3-12 months, labs return to baseline
Medical management of acute nephritic syndrome
Medical management includes supportive care and dietary modifications (low salt, low protein); treat cause if appropriate—antibiotics, corticosteroids, and immunosuppressants
What acid-base imbalance is likely to occur when a patient is in renal failure?
Metabolic acidosis r/t inability to secrete hydrogen ions and conserve bicarbonate
Nursing management of polycystic kidney disease
Monitor for infection Treat the pain Low sodium diet Monitor urine output Monitor BUN and Creat
A nurse is assessing a client who has a urine output of 250 mL in a 24-hr period. Which of the following Descriptive terms should the nurse place in the client's electronic record? A. Enuresis B. Anuria C. Nocturia D. Oliguria
Oliguria
A nurse is assessing a client who is 2 weeks postoperative following a kidney transplant. Which of the following manifestations should the nurse identify as possible organ rejection? A. Temperature of 36.1C (97.0 F) B. Insomnia C. Oliguria D. Weight loss
Oliguria
A nurse assessing a client notes that the client has a constant leakage of small amounts of urine and a bladder that is distended and palpable. The nurse should associate these findings with which of the following types of urinary incontinence? A. Stress incontinence B. Urge incontinence C. Reflex incontinence D. Overflow incontinence
Overflow incontinence
Glomerulonephritis medical treatment
Possible potassium or protein restriction Manage htn Treat the infection Abx (r/t strep) Antihypertensives Diuretics Corticosteroids
Types of renal failure
Prerenal failure - prior to the kidney Intrarenal failure - prolonged renal ischemia (things happening within kidney) Postrenal failure - past the kidney (urinary tract obstruction)
A nurse has identified that the patient has overflow incontinence. What is a major factor that contributes to this clinical manifestation? A. Coughing B. Mobility deficits C. Prostate enlargement D. Urinary tract infection
Prostated enlargement
The nurse is assessing a client with suspected nephrotic syndrome. Which of the following signs is the hallmark of the diagnosis for nephrotic syndrome? a) Hyponatremia b) Proteinuria c) Hyperalbuminemia d) Hypokalemia
Proteinuria
IVP - intravenous pyelogram
Purpose - identify the vascular content of the urinary system Prep - NPO/light eating the day prior -Watch kidney function -Medication list r/t contrast (NSAIDS/Vancomycin)
Cystoscopy Purpose, Prep, Education
Purpose - look for abnormalities of bladder wall through the urethra Prep - NPO after midnight Bowel prep to relieve pressure on the bladder Education During procedure client is in lithotomy May have pink urine afterwards (scant bleeding)
KUB
Purpose - xray of Kidneys, Ureters, and bladder to detect renal calculi, strictures, calcium deposits, or obstructions
Renal Biopsy - Purpose, prep, education
Purpose- collection of tissue for testing; frequently done with renal cancers and glomerulonephritis Prep- NPO 4 to 6 hours -Monitor coag studies -Do not take anticoagulants -Monitor BP- high BP = increased bleeding Education -Lay prone with sandbag under belly -Will have to hold their breath
The nurse is caring for a client with suspected pyelonephritis. Which laboratory value supports a diagnosis of pyelonephritis? a) Myoglobinuria b) Ketonuria c) Pyuria d) Low white blood cell (WBC) count
Pyuria
A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this patient? a) The disease is self-limiting and cysts usually resolve spontaneously. b) The disease is incurable and the nurse's interventions will be supportive. c) The client will eventually require surgical removal of his or her renal cysts. d) The client is likely to respond favorably to lithotripsy treatment of the cysts.
The disease is incurable and the nurse's interventions will be supportive
A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A. The leukocyte count B. The platelet count C. The hematocrit (Hct) D. The erythrocyte sedimentation rate (ESR)
The hematocrit (Hct)
Nephrolithiasis diagnostic testing
Ultrasound CT KUB IVP (AVOID CONTRAST D/T OBSTRUCTION)
Pyelonephritis basic description and risks
Untreated UTI Poor hygiene (EColi) BPH Prostatitis Spinal cord injuries Pregnancy CAUTI Diabetes
The nurse advises a client with renal stones to avoid eating shellfish, asparagus, and organ meats. The nurse emphasizes these foods because she knows that his renal stones are composed of which of the following substances? a) Calcium b) Uric acid c) Struvite d) Cystine
Uric Acid
Glomerulonephritis Labs
Urinalysis RBC and protein Decreased GFR Increased Bun & CR Hyperkalemia, hyperphosphatemia, hypocalcemia
Questions to ask a patient related to genitourinary problems
Urinary incontinence? Difficulty urinating/hesitancy? Pain with urinating? Any odor? Color/cloudiness? Urgency or frequency? Blood in the urine? Sexual history Nocturia? (BPH? Prostate issues?) History of UTI/kidney stones Any edema/SOA (kidney failure) Any discharge? Fever? Chills? AMS? (infection)
Assessment and Diagnostic of Kidney Injury
Urine output, blood in urine? Decreased specific gravity Ultrasounds, CT, MRI Decreased GFR
The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent: A. Urine reflux into the stoma B. Appliance separation C. Urine leakage D. The need to restrict fluids
Urine reflux into the stoma
A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? A. Omeprazole B. Vancomycin C. Ondansetron D. Diphenhydramine
Vancomycin
Urine osmolality
accurate measurement of kidneys ability to dilute/concentrate urine, may detect decreased kidney function
Gerontologic considerations in Kidney disease
kidneys less able to respond to fluid/electrolyte shifts, may have atypical/nonspecific signs of renal failure, atypical UTI signs. Elderly may experience falls, confusion, constipation, medication toxicity problems r/t decreased renal function
Polycystic kidney disease symptoms
Abdominal/flank pain Enlarged abdominal girth Progressive kidney failure High risk for UTIs Elevated BP Nocturia Hematuria
Nephrolithiasis medical treatment
Ablation Lythotrypsine Have to let it pass Stent Placement Flomax Pain meds Toradol Oxybutin
BUN
7-18 Breakdown of protein in the liver Elvated = Kidney disease
A nurse is teaching a client who is scheduled for a cystoscopy. Which of the following information should the nurse include in the teaching? A. "You should limit fluids for 12 hr following the procedure." B. "You may have pink-tinged urine after this procedure." C. "You can eat a full liquid meal up to 1 hour before the procedure." D. "You will be placed on your right side during the procedure."
"You may have pink-tinged urine after this procedure."
73 y/o female presents to the office with concerns that every time she coughs or sneezes she has urine leakage. The client is 5 foot tall and 150lbs. The client has had 3 children. What further assessment would you like to get from this client?
-How long has this been going on -Any fever/chills -Pain/difficulty urinating
24 hour urine
-looks at creatinine clearance to evaluate kidney disease -Should void and throw away first void, and then start at that time -Keep on ice/in fridge (not room temperature)
A nurse is planning on teaching a client who is scheduled for an intravenous pyelogram (IVP). Which of the following statements should the nurse include in the teaching? -"The procedure will be cancelled if the urinalysis indicates the presence of red blood cells." -"High frequency sound waves will be used to identify renal system structures." -"You will be able to resume your regular diet as soon as the test is complete." -"After the procedure you will be encouraged to drink plenty of fluids."
"After the procedure you will be encouraged to drink plenty of fluids."
Nephrolithiasis/kidney stones description and risks
Increase fluids to 3 to 4 L per 24 hours to dilute the urine.
Bladder Scan
Purpose - see residual (post void or lack of urination)
RFT (renal function tests)
Specific gravity, urine osmolarity
A nurse is caring for a client who has chronic glomerulonephritis. The nurse should expect to find a decrease in which of the following serum laboratory values? A. Potassium B. Phosphate C. Creatinine D. RBC
RBC
Specific gravity
degree of concentration of the urine, depends on hydration status Decreased fluid intake = high specific gravity Increased fluid intake = low specific gravity
A nurse is providing teaching to a client who has nephrotic syndrome. The nurse should recognize that which of the following client statements indicates a need for further teaching? A. "I can expect swelling in my face." B. "I will lose protein in my urine." C. "I should expect my provider to perform a kidney biopsy." D. "I should increase my sodium intake."
"I should increase my sodium intake."
A nurse instructs a female client about collecting a midstream urine sample. Which of the following client statements indicates an understanding of the procedure? A. "I'll urinate a little then stop." B. "I'll clean the inside of the container with a wipe." C. "I'll use the cleansing wipe from front to back." D. "I'll use each cleansing wipe twice."
"I'll use the cleansing wipe from front to back."
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a) "Squamous cell carcinomas do not present with detectable symptoms." b) "You should have sought treatment earlier." c) "Very few symptoms are associated with renal cancer." d) "Painless gross hematuria is the first symptom in renal cancer."
"Very few symptoms are associated with renal cancer."
Complications of Kidney Disease: Excess fluid volume
-Assess for s/s of fluid volume excess, keep accurate I&O, and daily weights -Limit fluid to prescribed amounts -Identify sources of fluid (jello & soups as well) -Explain to patient and family the rationale for fluid restrictions -Assist patient to cope with the fluid restrictions -Provide or encourage frequent oral hygiene
A 22 year-old female client presents to the clinic with complaints of burning, pain, and urgency when urinating. The patient has a fever of 100°F. The urine is strong in odor and cloudy with sediments. What patient education should be provided?
-Avoid bubble baths, Avoid applying powder to the perineum, Avoid wearing tight clothing, pantyhose, or leather pants, Always clean the perineum from front to back, Always empty the bladder after sexual intercourse. -seek medical attention whenever the patient has burning or pain on urination and urgency or flank pain. -drink 8 to10 glasses of noncaffeinated fluids each day to dilute the urine and help flush out the bacteria -Empty the bladder every 2 to 3 hours -Complete the course of antibiotics, as ordered. -Instructions to use another contraceptive method in addition to the oral contraceptives because antibiotics can make the oral contraceptive less effective. -Instruct that application of a warm compress to the perineum may help to decrease pain and bladder spasms. -Instruct to notify the physician if the fever and symptoms continue or get worse after being on the antibiotic for 2 days.
Midstream Urine Catch
-Clean peri area first -Start voiding -Put in mid stream -Take back out -Don't touch the skin
Nursing Considerations and Contraindications of IVP
-Contrast requires 18g IV -Elevated creatinine = no go -Nephrotoxic meds (Vanc and NSAIDS) -No pregnancy -Monitor for allergies to contrast
Retrograde pyelography
-Dye is injected and different films are taken with catheters into ureters -Check for allergies r/t dye -Monitor for complications: infection, hematuria, perforation of ureter
IV urography
-Dye is injected and then KUB x-ray taken -Check for allergies r/t dye
A nurse is planning care for a client who is scheduled to have a kidney biopsy. Which of the following information should the nurse include in the plan? (Select all that apply). A. Obtain a urine specimen prior to the procedure B. Obtain written, informed consent C. Administer diphenhydramine prior to the procedure D. Maintain NPO status prior to the procedure E. Obtain coagulation studies
-Obtain a urine specimen prior to the procedure -Obtain written, informed consent -Maintain NPO status prior to the procedure -Obtain coagulation studies
Kidney Surgery Postoperative Interventions
-Pain relief measures, analgesic medications -Promote airway clearance and effective breathing pattern, turn, cough, deep breathe, incentive spirometry, positioning -Monitor UO and maintain potency of urinary drainage systems -Use strict asepsis with catheter -Monitor for signs and symptoms of bleeding -Encourage leg exercises, early ambulation, and monitor for signs of DVT
Renal Biopsy Nursing Consideration
-Post op - monitor V/S, H&H -Sx of infection -I&Os to ensure kidney is still functioning -Will see blood in urine afterwards -No biopsy if they have polycystic kidney disease or only one kidney
Kidney Surgery Postoperative Management
-Potential hemorrhage and shock -Potential abdominal distention and paralytic ileus -Potential infection -Potential thromboembolism
CT/MRI Purpose, Prep, Education
-Purpose - 3D imaging of renal/urinary system to assess for kidney size and obstruction, cysts, or masses (or to stage cancer) -Prep - assess for allergies r/t contrast -Education - must lay still during test NO MRI WITH METAL Loud and long, if claustrophobic may need sedation
Function of kidney and urinary systems
-Removing wastes -Providing hormones involved in red blood cell production (erythropoietin) -Bone metabolism -Control of blood pressure -Rid of urea, uric acid via urine -Helps body activate Vit D -Maintain balance of potassium, sodium, calcium -Releases erythropoietin -Acid/base balance
What is the physiologic reaction in the kidney to a decrease in blood pressure?
-Vasa recta detect decrease BP -Then other cells in kidney secrete renin Renin then converts angiotensin into angiotensin 1 -Angiotensin 1 then changes to angiotensin II (POWERFUL VASOCONSTRITOR) -When vasa recta sense increased BP it stops stimulating secretion of renin
How does angiotensin II affect blood pressure?
-Very powerful vasoconstrictor -Vasoconstriction increases BP
Pyelonephritis medical treatment
ABX Pyridium Azo Antipyretics
Nursing management of renal cancer
Accurate I&Os May need dialysis Control pain post op (and bleeding) Infection d/t immunosuppressants COMFORT MEASURES Reduce anxiety Treat BP
The nurse is instructing a group of clients regarding risk for kidney disorders. A history of infection specifically caused by group A beta-hemolytic streptococcus is associated with which of the following disorders? a) Acute renal failure b) Acute glomerulonephritis c) Chronic renal failure d) Nephrotic syndrome
Acute glomerulonephritis
A nurse is preparing a client for a kidney biopsy. Which of the following client conditions should the nurse identify as a contraindication for this diagnostic test? A. Elevated creatinine level B. Flank pain C. Urinary retention D. Bleeding tendencies
Bleeding tendencies
A 24-hour urine collection is scheduled to start at 0100. When should the nurse start the procedure? A. At 0100, with or without a specimen B. At the first specimen that was voided at 0400 C. 2 hours after the urine was discarded D. After discarding the 0100 specimen
After discarding the 0100 specimen
Nephrolithiasis nursing management
Ambulate Change positions Increase fluids (3L/day) Educate on how to avoid (foods) Monitor for sx of infection
The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which of the following as a measure to prevent additional kidney stones? a) Increase protein intake b) Adhere to a low-potassium diet c) Avoid drinking water before bedtime d) Avoid drinking black tea
Avoid drinking black tea
What information should the health education nurse include about Pap smears?
Begin at age of 21 or sexually active If normal or no history - every 3 years If abnormal every year Cervical cancer screening or HPV
A nurse is caring for a client with chronic kidney disease. When the nurse gives education about dietary supplements the nurse should teach the client to increase which of the following nutrients? A. Potassium B. Sodium C. Phosphorus D. Calcium
Calcium
What clinical manifestations should the health education nurse include about cervical cancer?
Can be pain free Sx include abnormal bleeding, watery discharge, pain/bleeding after intercourse, irregular vaginal bleeding
Renal Angiography Pre-Procedure Nursing Interventions
Catheter inserted into renal artery Dye injected may need laxative to empty colon for better view, shave injection sites (femoral or axillary), mark pulse sites, check allergies r/t dye
Renal Angiography Post-Procedure Nursing Interventions
Catheter inserted into renal artery Dye injected vitals, BP on opposite side of axillary site if used, monitor for hematoma, monitor pulses, color/temp of affected extremity
The health education nurse nurse discusses other diagnostic tests used to diagnose/stage cervical cancer. What information should she include in this portion of the educational program?
Cervical biopsy Vaginal ultrasounds CT scan PET scan Labs
Kidney Surgery Postoperative Management Complications
Complications: bleeding , pneumonia, infection, and DVT
IVP Education
Contrast makes them feel like they peed themselves
Polycystic Kidney Disease description and risks
Cysts on the kidney replacing good kidney tissue
Comorbidities that can cause dysfunction of genitourinary system
Diabetes Htn Smoking Obesity Pregnancy M/S (immobilization) Parkinsons (immobilization) Spinal Cord injuries UTI Strep (GLOMERULONEPHRITIS) BPH
Causes of Chronic Kidney Failure
Diabetes mellitus Hypertension Chronic glomerulonephritis Pyelonephritis or other infections Obstruction of urinary tract Hereditary lesions Vascular disorders Medications or toxic agents
A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse include in the discharge teaching? Select all that apply. A. Drink at least 3,000mL of fluid each day B. Minimize daily activities C. Keep urine alkaline to prevent urinary tract infections D. Avoid odor-producing foods, such as onions, fish, eggs, and cheese E. Wear snug clothing over the stoma to encourage urine flow into the drainage bag.
Drink at least 3,000mL of fluid each day Avoid odor-producing foods, such as onions, fish, eggs, and cheese
Renal cancer diagnostic testing
Early detection - monitor if they have risk factors Ultrasounds, CT scans
The nurse is caring for a client with a new ureteral catheter. Which action is a priority while caring for the new catheter? A. Irrigate every 8 hours with normal saline B. Ensure the catheter is draining freely C. Clamp the catheter every 2 hours D. Ensure the catheter drains at least 30 mL per hour
Ensure the catheter is draining freely
A client is admitted with nephrotic syndrome. When writing this patient's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? a) Constipation related to immobility b) Risk for injury related to altered thought processes c) Hyperthermia related to the inflammatory process d) Excess fluid volume related to generalized edema
Excess fluid volume related to generalized edema
Pyelonephritis symptoms
Fever Chills Back pain (colicky) Pyuria SX of UTI
Steps of formation of urine
Filtration in glomerulous Absorption Secretion into renal tubules or urine
A nurse is caring for a client who has polycystic kidney disease (PKD). Which of the following findings should the nurse expect? A. Hypotension B. Flank pain C. Confusion D. Urinary retention
Flank pain
Polycystic Kidney Disease
Fluid-filled cysts grow and enlarge kidneys Cysts destroy nephrons and replace normal structures NOT CURABLE- WILL LEAD TO ESKD
Glomerular filtration rate (GFR)
Greater than 90 The lower the number, the higher the kidney failure
Specific Assessment findings r/t genitourinary problems
Hematuria Edema Htn Glomerulonephritis - edema in the eyes/face Confusion Fatigue Bladder distension Different colored urine Elevated BUN and CR Decreased output Flank pain (kidney infection or stones) Chronic renal failure problems: edema, htn, hyperkalemia, metabolic acidosis, anemia Residual urine
Sx of polycystic kidney disease
Hematuria Polyuria HTN Renal calculi UTI Proteinuria Flank pain May feel enlarged kidneys while palpating abdomen
Failure of RAAS causes...
Hypertension
The nurse is caring for a client diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess related to this condition? a) Hypertension b) Flank pain c) Fever d) Periorbital edema
Hypertension
Acute glomerulonephritis ("HAD STREP")
Hypertension ASO antistreptolysin titer positive (test used to diagnose strep infections) Decreased GFR: inflammation due to complexes in the glomerulus (low urine output)...oliguria (watch potassium level) Swelling in face/eyes (edema)...mild Tea-colored urine (cola colored)...from hematuria Recent strep infection Elevated BUN and creatinine Proteinuria (mild)
Acute nephritic syndrome complications
Hypertensive encephalopathy, heart failure, pulmonary edema. Without treatment end stage renal disease will occur in weeks to months
Nephrotic syndrome symptoms
Hypoalbuminemia Hyperlipidemia Peripheral edema Proteinuria - URINALYSIS Decreased albumin and blood protein Foamy urine Weight gain d/t excess fluid Fatigue Oliguria Loss of appetite Hypertension Malaise
Medical Treatment for nephrotic syndrome
Kidney biopsy Treat underlying cause Antihypertensives (ACE inhibitors) Diuretics Cholesterol reducing medications (Statins for lipoprotein problems) Blood thinners Corcticosteroids Abx
Glomerulonephritis diagnostic testing
Kidney biopsy, skin or throat cultures, 24 hr urine, urinalysis
A nurse is teaching a client about chronic kidney disease. Which of the following instructions should the nurse include? A. Limit fluid intake B. Limit caloric intake C. Eat a diet high in phosphorus D. Eat a diet high in protein
Limit fluid intake
Nursing Management: Acute Nephritic Syndrome
Maintain fluid balance Fluid and dietary restrictions Patient education Follow-up care
Nephrolithiasis symptoms
Pain ("worse than childbirth") Colicky Radiates around to abdomen Unable to urinate N/V Blood in urine
The nurse should conduct a focused assessment for the client with suspected bladder cancer for which common sign of this disease? A. Suprapubic pain B. Dysuria C. Painless hematuria D. Urine retention
Painless hematuria
Renal cancer symptoms
Painless hematuria Weight Loss MAY BE ASYMPTOMATIC EARLY IN THE PROCESS Flank pain Signs of kidney failure
Lab changes in Kidney Disorders
Phosphorus deficit High potassium (monitor for EKG changes)
Nursing management of nephrotic syndrome
Reduce amount of fat/cholesterol in diet Low sodium diet Monitor I&Os Monitor BP Monitor BG r/t steroid use Assess swelling Monitor for fluid overload High protein diet Daily weights
Renal cancer medical treatment
Remove it or slow the growth with chemo and radiation (may be palliative) Nephrectomy Chemo
Renal cancer risk factors
Smoking Male Obestity PKD Chemical exposure
The nurse is conducting a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? a) Avoiding alcohol use b) Control of sodium intake c) Smoking cessation d) Adherence to immunizations
Smoking cessation
73 y/o female presents to the office with concerns that every time she coughs or sneezes she has urine leakage. The client is 5 foot tall and 150lbs. The client has had 3 children. What kind of incontinence is the client experiencing?
Stress incontinence
Pyelonephritis medical management
Teach them the proper way to wipe Teach to urinate after intercourse Educate on the sins of baths Non cotton underwear Push fluids Treat their fever Treat their symptoms Monitor for sepsis- tachycardia, warm/flushed, fever
A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.) A. Green beans B. Tomatoes C. Bananas D. Asparagus E. Potatoes
Tomatoes Bananas Potatoes
Pyelonephritis dx
UA w/ C&S (clean catch, midstream)
A nurse is caring for a client and observes that the client's urine is dark amber, cloudy, and has an unpleasant odor. The nurse should recognize that these findings are associated with which of the following? A. Urinary tract infection B. Urinary incontinence C. Urinary retention D. Urinary frequency
Urinary tract infection
A nurse is caring for a client who has impaired renal function. For which of the following findings should the nurse notify the provider? A. Urine output of 175mL in the past 8 hours B. Urine output of 2,200mL in the past 24 hours C. First voided urine in the morning has a strong odor D. Urine is cloudy after sitting in the urinal for 6 hours
Urine output of 175mL in the past 8 hours
A nurse is caring for a client who has an indwelling urinary catheter and a prescription for a urine specimen for culture and sensitivity. Which of the following actions should the nurse take? A. Insert the needle into the needless port at a 60° angle. B. Withdraw 3 to 5 mL of urine from the port. C. Wipe the area of needleless port with sterile water. D. Don sterile gloves.
Withdraw 3 to 5 mL of urine from the port.
Acute Nephritic Syndrome Manifestations
hematuria, edema, azotemia, proteinuria, and hypertension
Renal Biopsy Complications
hemorrhage Infection Cloudy, foul smelling urine Urgency Urine positive for sediment & RBCs
Signs and Symptoms Chronic Kidney Disease (CKD)
increased creatinine, anemia, metabolic acidosis, abnormalities in calcium and phosphorous, fluid retention, electrolyte imbalances and HTN
Urinalysis
looking for protein, glucose, nitrates, urine color, clarity, pH, specific gravity color, clarity, concentration/dilution, specific gravity, acidity/alkalinity, presence of metabolites
Nursing Interventions of AKI
monitor fluid/electrolytes, reduce metabolic rate, promote pulmonary function, prevent infection, provide skin care, psychosocial support
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of thefollowing sets of values should the nurse expect? A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg D. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg
pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
Urine culture purpose
send off to see if pts have any bacteria in urine, pick correct abx
Chronic Glomerulonephritis lab results
urine with fixed specific gravity, casts, proteinuria, electrolyte imbalances and hypoalbuminemia GFR below 50
