PrepU Patho Ch 25
A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis?
Acute pyelonephritis Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations.
A nurse is giving discharge instructions for a client who was diagnosed with acute pyelonephritis 3 days previously. Which instruction is important for the nurse to discuss when teaching the client?
It is important that the client take the prescribed antibiotic for the duration of the prescription. Acute pyelonephritis is treated with appropriate antimicrobial drugs and may also require intravenous hydration. Unless obstruction or other complications in the client occur, the symptoms usually disappear within several days. Treatment with an appropriate antimicrobial agent usually is continued for 10-14 days.
What is the most common cancer of the kidney?
Renal cell carcinoma Renal cell carcinoma accounts for 80% to 90% of all kidney tumors
The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include:
protein in the urine. In a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema, and hyperlipidemia.
Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?
Extracorporeal shock wave lithotripsy (ESWL) ESWL is a nonsurgical treatment that uses sound waves, laser, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature.
A client had been diagnosed with a simple cyst of the kidney and is presenting with symptoms. Which manifestations does the nurse anticipate the client will display? Select all that apply.
Hematuria Hypertension Infection Most simple cysts do not produce signs or symptoms, or compromise renal function. When symptomatic, they may cause flank pain, hematuria, infection, and hypertension related to ischemia-produced stimulation of the renin-angiotensin system. They are most common in persons older than age 50 years.
Select the manifestations of renal cell carcinoma. Select all that apply.
Often silent in the early stages Hematuria Palpable flank mass Kidney cancer is largely a silent disorder during its early stages, and symptoms usually denote advanced disease. Presenting features include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. It is, however, intermittent and may be microscopic; as a result, the tumor may reach considerable size before it is detected. One of the features of renal cell carcinoma is its ability to metastasize.
Which substance would not be found in glomerular filtrate?
Protein The glomerular filtrate has a chemical composition similar to plasma (which contains sodium, potassium and water), but it contains no proteins because large molecules do not readily cross the glomerular wall.
A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?
There is possible obstruction in the urinary tract. Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs. The other answers can cause lower UTIs, but an obstruction would be considered because of the frequency of the infections.
A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed:
acute postinfectious glomerulonephritis. The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR decreases, is one of the first symptoms.
