Miss martin chapter 34 add for final

5. While caring for a patient who has received ESWL (lithotripsy) for renal calculi, the nurse would anticipate what possible actions that may be taken to help the patient increase the rate of stone passage? (Select all that apply.) 1. Performance of PDI therapy 2. Administration of corticosteroids and calcium channel blockers and alpha antagonists, as prescribed 3. Administration of Vicodin for pain 4. Cystoscopy to retrieve the stones

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4. A 45-year-old man has a history of calcium oxalate stones which can result in further renal calculi. What should you include about diet in this patient's education? 1. He should increase his protein intake, but restrict dietary calcium and sodium. 2. He should increase intake of spinach and nuts. 3. He should increase fluids and dietary calcium. 4. He should increase sodium, but decrease protein intake.

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7. A patient with CRF has a BUN of 120 mg/dL. What is the primary significance of this laboratory value? 1. It is an expected laboratory result for a patient with CRF. 2. The value signifies renal insufficiency. 3. The result in conjunction with uremic signs indicates need for dialysis. 4. The patient should be referred as a good candidate for peritoneal dialysis.

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6. A nurse is assisting in administering BCG intravesically to a patient with bladder cancer. Place the steps in the correct order to accomplish this procedure. 1. Clamp the urethral catheter for 2 hours. 2. Change position every 15 to 30 minutes. 3. Aseptically insert a urinary catheter. 4. Drain urinary bladder. 5. Instill the BCG fluid.

3,4, 5, 1, 2

10. A patient with CRF is on dialysis and waiting for a kidney transplant. The patient says, "I am never going to be at the top of the list for a kidney. I wish I could just die and get it over with." What is the most therapeutic response? 1. "I am sure you are going to get a kidney. A lot of people donate these days." 2. "Are you thinking about hurting or killing yourself?" 3. "I would be discouraged too, but I have never been very good at waiting." 4. "You seem really down today. What's going on?"

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5. identify the conditions that predispose a perspon to develope renal calculi.

(1) supersaturation of the urine with crystalloids that do not readily dissolve (e.g., calcium, uric acid, and cystine); (2) urinary infections, which can produce bacteria and other debris that form a core for stone formation; (3) inadequate fluid intake, which results in concentrated urine and inadequate flushing of the urinary tract; (4) sluggish flow of urine, as may occur with bed rest or immobility; and (5) certain substances in the urine (e.g., urate, a salt of uric acid), which encourage the formation of crystals of calcium oxalate or calcium phosphate. In the past, patients with calcium oxalate stones were encouraged to decrease dietary calcium; however, evidence-based practice now indicates that these patients should actually be encouraged to increase fluids and dietary calcium, but decrease protein and sodium intake and foods that are high in oxalate, such as spinach and nuts

1. Which patient statement indicates that she needs additional teaching regarding the discharge instructions for urinary tract infection? 1. "I will always wipe from back to front after a bowel movement." 2. "I should avoid wearing tight slacks." 3. "I won't wash my underclothing with strong detergents." 4. "I will take a shower instead of a tub bath."

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2. A patient with a history of throat infection becomes suddenly ill with fever, chills, flank pain, widespread edema, puffiness around the eyes, visual disturbances, and marked hypertension. The nurse would anticipate which diagnostic test? 1. Urinalysis 2. Intravenous pyelogram 3. Serum amylase 4. Prothrombin time

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8. What is included in the nursing care of a patient undergoing peritoneal dialysis? (Select all that apply.) 1. Maintain aseptic technique when accessing a peritoneal catheter. 2. Instruct the patient to remain supine until the dialysate is drained. 3. Weigh the patient before and after dialysis. 4. Monitor vital signs. 5. Check color and volume of effluent.

1,3,4

9. A nurse is sending a patient to the dialysis clinic. What predialysis nursing intervention should be included? (Select all that apply.) 1. Withholding anticoagulants 2. Administering antihypertensive 3. Assessing dialysis access site 4. Checking vital signs 5. Monitoring laboratory values

1,3,4

Nursing care of the patient undergoing peritoneal dialysis includes: (Select all that apply.) 1. maintain aseptic technique when accessing peritoneal catheter. 2. instill warmed dialysates slowly. 3. weigh patient before and after dialysis. 4. monitor vital signs. 5. check color and volume of effluent.

1,3,4,5

The nurse is sending the patient to the dialysis clinic. Predialysis nursing intervention includes: (Select all that apply.) 1. withholding anticoagulants. 2. administering antihypertensive medication. 3. assessing dialysis access site. 4. checking vital signs. 5. monitoring laboratory values.

1,3,4,5

Mr. Mell, a 43-year-old interstate truck driver, complains of severe right lower back pain with nausea, vomiting, and pink-tinged urine. He relates a history of stones and reports, "It always feels like this until the kidney stone passes." The provider orders IV normal saline, morphine, routine laboratory tests to include BUN and creatinine, and an IVP. 1. What are three or four risk factors for kidney stones that might apply to Mr. Mell? 2. His BUN result is 17 mg/dL. What does this result indicate? What is your responsibility in reporting this data? 3. What is the care for Mr. Mell after a lithotripsy?

1: UTI, male, history of kidney stones, immobility from sitting in chair long periods of time 2: high but within normal limits 3: if PT experiencing cramping pain give pain meds. inform PT to have fluid intake of 3000-4000ml to help wash out broken stone fragments

Mrs. Diaz, 35 years old, has had a nephrostomy for treatment of hydronephrosis caused by a renal stone in the pelvis of the kidney. She returns from the surgical unit with a nephrostomy tube, a urethral catheter, and a rubber Penrose drain in place. 1. Explain the purpose of the nephrostomy tube. 2. What is the specific care for these drains and tubes?

1: drain purulent material from infected kidney 2: check the location of surgical wound, and focus on promoting unimpeded urine flow by properly caring for caths and tubs

3. A patient with nephrotic syndrome is admitted with severe generalized edema, ascites, and cloudy urine. The patient is irritable and tired. What is the priority nursing problem? 1. Potential for infection 2. Fluid volume excess 3. Pain 4. Fatigue

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2. explain the etiology and pathophysiology of acute pyelonephritis.

Etiology and pathophysiology Beta-hemolytic streptococcal infection Immune: antigen-antibody reaction

What are three diagnostic tests that are used to confirm bladder cancer?

Cytoscopy, IVP, Biopsy

Often the only sign of cancer of the bladder is ------

Hematuria

9. When is continuous renal replacement therapy (CRRT) used?

PT in the ICU who have ARF and multisystem organ involvment. or thse who are hemodynamically unstable.

7. Name the diagnostic test and radiologic studies performed on a patient with trauma to the kidney.

Radio: KUB, IVP, CT scan serial urinalysis, hemoglobin, hemacrit, electrolytes

3. what are the characteristics of nephrotic syndrome?

characterized by extensive proteinuria, hyperlipidemia (elevated blood lipids), hypoalbuminemia (low blood albumin), and severe edema. Facial edema, especially periorbital edema, may be present in the morning, whereas lower extremity edema is more evident at the end of the day. Ascites (accumulation of serous fluid in the abdominal cavity) may also occur because of fluid retention. The patient may be irritable, tired, or lethargic. Diagnostic tests include urinalysis and serum tests for protein and lipids. A renal biopsy may be used to verify the diagnosis or to evaluate the extent of kidney damage

6. What procedures are necessary if kidney stone cannot be passed spontaneously?

When the stone is not passed spontaneously, cystoscopy or surgical intervention is necessary. Nephrolithotomy (incision into the kidney to remove a stone) or pyelonephrolithotomy (surgical removal of a stone from the renal pelvis) can be performed for large stones that will not pass.

10. What are the three types of immunosupressive drugs used to prevent organ rejection?

antibodies, cytokine inhibitoR, antiproliferative agents

Mr. Jakes, 25 years old, complains of sudden onset of fever and chills, flank pain, and "feeling full all over and peeing dark smoke-colored urine." He tells you he had strep throat 2 weeks ago, but is otherwise healthy. 1. Based on Mr. Jakes's history and complaints, what physical assessments should you perform? 2. Why is the history of strep throat 2 weeks ago significant? 3. The provider informs Mr. Jakes that he has glomerulonephritis and prescribes complete bed rest. How long must bed rest continue?

check for puffness around the eyes 2. body responds to a bacterial, viral, or parasitic infection from else where in the body 3. absolute bed rest till clinical signs of hematuria, proteinuria, and hypertension are gone

How does photodynamic therapy for bladder cancer work?

inject light sensitive molecules into IV. They attach to the cancer then the they cut using a red light to destroy it.

4. What is a nephrostomy, and under what conditions is it performed?

it is a surgical incision into a kidney to drain the kidney artificaly. Used to correct obstructions from large stones or strictures of the ureters.

The primary treatment for cancer of the kidneys is ------- before metastasis has occured.

naphrectomy

8. Explain the phases of acute tubular necrosis

oliguric/nonoliguric- either voids alot or a little. Diuretic- lack of dialysis leads to leads to fluid buildup kidney cannot concentrate urine output is 1000-2000. recovery phase kidneys start to normalize again

1. Describe the common signs and symptoms of cystitis, and explain how it is treated.

painful urination, freq and urgent urination, and low back pain Tendency to recur—less acute symptoms like fatigue, anorexia, and constant feeling of bladder pressure between flare-ups Elderly and confusion—cloudy urine, hematuria, and signs of infection Treatment and nursing management Antibiotics Topical estrogen and postmenopausal womenEncourage fluids (8-12 large glasses unless contraindicated)Cranberry and altered pHSitz bath and hot water bottles, vit C

What are four risk factors for cancer of the bladder?

urinary stasis, smokers, urban areas, exposure to chems