Patho Ch 27-33
A patient injured severely in a motor vehicle accident is hospitalized with acute kidney injury as well as multiple broken bones and lacerations. When family members ask what is meant by the term 'prerenal,' the nurse responds
"Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney"
A major modifiable risk factor for nephrolithiasis
(aka renal calculi ) modifiable risk is dehydration
The microorganism that causes vast majority of UTI
E. Coli
The condition in which the urethra opens on the dorsal aspect of the penis is known as
Epispadias - hypospadias would be urinary meatus ventral undersurface of the penis
A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate because *hint what declines?*
GFR declines
In patients with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease?
Greater than 90% nephron loss
Erection requires the release of nitrous oxide into the corpus cavernosum during sexual stimulation. T?F?
True
The best innervation for acute kidney injury (AKI) is prevention. T? F?
True
The most common cause of urinary obstruction in male newborns and infants is urethral valves. T?F?
True
The prognosis of penile carcinoma depends on the stage. T?F?
True
The most common ordered diagnostic test for evaluation of the urinary system
Ultrasonography - safer
What problem is a patient likely to experience in end-stage renal disease (ESRD)?
Uremia - kidney can't excrete urea - also hyperkalemia
Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing
acute tubular necrosis
A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. this happens because
albumin is excreted in urine - hence massive proteinuria
Abscess of menstruation is called
amenorrhea - dysmenorrhea = painful menses causing hospitalization. menorrhagia = more or longer periods metrorrhagia = bleeds between periods
The pathophysiology basis of acute glomerulonephritis is
an immune complex reaction - type 3 hypersensitivity (IgG)
Scrotal pain in males and labial pain in females may accompany renal pain as a result of
associated dermatomes - derma in T10-L1
cryptorchidism is
associated with increased incidence of testicular cancer
One cause of extrinsic renal system obstruction is: A. Pelvic tumor. B. Papillary necrosis. C. Clot. D. Neurogenic bladder.
pelvic tumor
Treatment of uterine prolapse may involve insertion of a _____ to hold the uterus in place A. IUD B. pessary C. endopelvic mesh implant D. catheter
pessary - if no hysterectomy
If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues, the patient will then experience
polyuria and sodium wasting - high BUN creates diuresis with high sodium levels
Sexual impotence is rarely because of
primary causes
A progressive decrease in the force of urinary stream, dribbling of urine, and difficulty initiating the urinary stream are characteristic of
prostatic enlargement - prostatic is so enlarged its pushing on bladder = decrease urine
Nephrotic syndrome involves loss of large amounts of ________ in the urine.
protein
Signs consistent with a diagnosis of glomerulonephritis include
proteinuria
The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is
proteinuria
The effect on the renal tubules during the postoliguric phase of acute tubular necrosis involves
regeneration of the renal tubular epithelium
The main clinical manifestation of a kidney stone obstructing the ureter is
renal colic - flank pain due to stones
The greatest risk for bladder cancer is
smoking
Sudden, severe testicular pain is indicative of
testicular torsion. A twisting of the spermatic cord with subsequent testicular ischemia and infarction EMERGENCY .
When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of protein," the nurse's response is based on the knowledge that
the glomerular membrane has increased permeability - happens in nephrotic syndrome, hence massive proteinuria because of albumin leakage
Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because
they are deficient in vitamin D
The most common cause of intrinsic kidney injury is _____ injury. A. tubular B. vascular C. glomerular D. interstitial
tubular - usually problem with renal tubules (ATN)
Pelvic floor muscle training is appropriate for
urge incontinence - teach how to hold pee/ strengthen muscles with kegels
A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be
uric acid crystals - gout causes elevated serum uric acid levels
n addition to E. Coli, a risk factor for development of pyelonephritis is
urinary retention and reflux
The urinalysis most indicative of cystitis includes presence of
nitrites - cystitis = LUT = bladder inflammation
The risk for contrast media-induced acute tubular necrosis (ATN) is highest in A. 70 year old with heart failure B. 12-year old with recurrent bladder infx C. 50-year-old post gallbladder sx D. 30- year old with appendicitis
70-year old with heart failure - others have no risk factors for this
renal insufficiency occurs when _____ % of the nephrons are not functional
75-90% - 90% + = ESRD
Which intervention has been found to retard the advancement of chronic kidney disease?
ACE inhibitors
Infection by ________ accounts for nearly half of all reported cases of vulvovaginitis.
Candida albicans - yeast infx - chlamydia & gonnerhea = PID ( pelvic imflammatory dz)
most common types of uterine tumors are known as
Leiomyomas - aka benign fibroid tumors
The defining characteristic of sever acute kidney injury is
Oliguria - or anuria, kidney so inflamed cant/hardly excrete pee
Cervical cancer can be detected in the early, curable stage by the ______ test
Papanicolaou - pap smear - main causes of cerv cancer = HPV
The most common cause of ischemic acute tubular necrosis (ATN) in the United States is
Sepsis - remember Mr. Fallbrook
The pathology report for a patient with penile cancer has this statement: The tumor involves the shaft of the penis. The cancer is at what stage?
Stage II - I = GLANS & FORSKIN. III = inguinal nodes but operable IV = disseminated dz (neoplastic)
The urea-splitting bacteria contribute to the formation of ________ kidney stones. A. urea acid B. struvite C. calcium oxalate D. cystine
Struvite
dysfunctional uterine bleeding (DUB) is caused by
absent or diminished levels of progesterone - low/no progesterone to prevent bleeds
The condition characterized by oliguria and hematuria is
acute glomerulonephritis
Postrenal acute kidney injury may be caused by
bilateral kidney stones - obstructs urine flow from kidneys
Detrusor muscle overactivity can be improved administration of
botulinum toxin
A common component of renal calculi is
calcium - renal calculi aka nephrolithiasis
A breast lump that is painless, hard, and unmoving is most likely
carcinoma - fibrocystic breast dz = firm, mobile and tender
Uterine prolapse is caused by a relaxation of the
cardinal ligaments
A patient has ureteral colic. the manifestation requires immediate notification of physician
chills and fever - not normal - normal s&s pink urine, vomit, flank pain
The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN) in hospitalized patients is
contrast media
The type of glomerulonephritis which is most likely to result in a swift decline in renal function that then progresses to acute kidney injury is
crescentic glomerulonephritis
What reproductive tract disorder is most likely to be associated with urinary stress incontinence?
cystocele - protrusion of bladder potion into anterior vagina that's weakened - rectocele involves tectum = constipation
A person is unaware that his bladder is full of urine, but complains that he is leaking urine almost constantly. The most accurate term for this type of incontinence is
overflow
The most common sign/symptom of renal calculi is
pain - stones HURT!
The disorder characterized by a neurologic lesion that affects bladder control is
neurogenic bladder
Anemia in people who have end-stage chronic renal disease is caused by
decreased secretion of erythropoietin
A 32-year-old female complaining of severe pain with menstruation and inability to participate in her routine household activities is likely experiencing
dysmenorrhea
A potential risk factor for breast cancer includes
early menarche and late first pregnancy It has been observed in many research studies that giving birth at a young age (less than 18 years) is associated with a decreased risk of breast cancer, and that giving birth for the first time aged 35 years or older increases the risk. Parity (the number of children a woman has given birth to) has been associated with risk, with low parity increasing risk and high parity having a protective effect. fat in the diet is a risk factor for breast cancer.
Endometriosis is a condition in which
ectopic endometrial tissue is present
The patient most at risk for postrenal acute kidney injury is A. middle-aged woman with bladder infection B. patient who has both hypertension and diabetes C. young child with reflux at the ureterovesical junction D. elderly patient with hypertrophy of the prostate
elderly patient with hypertrophy of the prostate - postrenal = obstruction after below kidney level
A patient diagnosed with micropenis may be evaluated for
endocrine disorders - check testosterone levels then if tx fails = female sex assignment
Appropriate management of end-stage renal disease includes
erythropoietin administration
It is true that polycystic kidney disease is
genetically transmitted
In addition to renal colic pain, signs or symptoms of ureteral stones may frequently include
hematuria
The most frequent initial symptom of bladder cancer
hematuria - bladder bleeds
Hyperlipidemia occurs in nephrotic syndrome because
hepatocytes synthesize excessive lipids - along with lipiduria - liver trying to make of for albumin loss
The consequence of upper urinary tract obstruction in a single ureter is
hydronephrosis - ureter blocked/obstruction = kidney swell
calcium oxalate stone formation is facilitated by
hypercalciuria
excessive vomiting in pregnant women is known as
hyperemesis gravidarum - "too much vomit"
The condition associated with end-stage renal disease that is the most immediately life-threatening
hyperkalemia
one of the most frequent causes of chronic kidney disease is
hypertension - HTN and DM
Osteoporosis commonly occurs in patients with end-stage renal disease because of
hyperthyroidism
Phimosis is a disorder of the penis characterized by a. sustained, painful erection. b. inability to retract the foreskin. c. inability to achieve erection. d. malpositioning of the urinary meatus.
inability to retract the foreskin - paraphimosis = inability to pull foreskin past glans (p head) - A= Priapism. C = impotence. D = hypospadias.
A change occurring in a pregnant women that is indicative of potential disorder is
increased urinary protein
The patient reports persistent pelvic pain and urinary frequency and urgency. She says the pain improves when she empties her bladder. She does not have a fever and her repeated urinalyses over the past months have been normal, although she has a history of frequent bladder infections. She also has a history of fibromyalgia and hypothyroidism. Based on her history and complaints, her symptoms are characteristic of A. ureteral stone B. interstitial cystitis C. neuroses D. neurogenic bladder
interstitial cystitis - causes: damaged bladder wall from inflammation like bladder infections
The difference between stress incontinence and urge incontinence is that stress incontinence
is caused by a pelvic floor muscle problem, whereas urge incontinence is caused by a problem with the detrusor muscle
One of the most common causes of acute tubular necrosis (ATN) is
ischemic conditions - necrosis = tissue death/ischemia
