Nurs 342 Exam 4

blood supply

25% of cardiac output (1200 ml/min)

The doctor orders CBI for a client who had a TURP this am. To effectively implement this order, it is most important for the nurse to infuse the irrigation solution: A. To maintain UO clear to light pink in color B. When the urine is red with visible clots C. So that the intake equals the output D. At a rate of 50ml/hr

A. To maintain UO clear to light pink in color

As charge nurse, which of the following patient's nursing care would you assign to the LPN/LVN, working under the supervision of an RN? A. a 48-year-old patient with cystitis who is taking oral antibiotics B. a 64- year-old patient with kidney stones & a new order for lithotripsy C. a 72-year-old patient with urinary incontinence needing bladder training D. a 52-year-old patient with pyelonephritis and severe acute flank pain

A. a 48-year-old patient with cystitis who is taking oral antibiotics

The client is admitted to the ER after a gunshot wound to the abdomen. Which nursing intervention would the nurse implement first to prevent AKI? A. administer NS IV B. take vital signs C. place client on telemetry D. Assess abdominal dressing

A. administer NS IV

A client is admitted with a suspicion of bladder cancer. A nurse assesses the client for which of the following earliest manifestations of the disease? A. hematuria with no pain B. painful urination & hematuria C. pyruia & palpable abdominal mass D. proteinuria & dysuria

A. hematuria with no pain

YOU ARE ADMITTING A 66 YEAR OLD PATIENT SUSPECTED OF HAVING A UTI. WHICH PIECE OF THE PATIENT'S MEDICAL HISTORY SUPPORTS THIS DIAGNOSIS? A. The patient's wife had a UTI 1 month ago B. The patient has been followed for prostate disease for 2 years C. The patient had intermittent catheterization 6 months ago D. The patient had a kidney stone removed one year ago

B. The patient has been followed for prostate disease for 2 years

The client is diagnosed with rule out AKI. Which condition would predispose the client to developing pre-renal AKI? A.diabetes mellitus B. hypotension C. aminoglycosides. D. BPH

B. hypotension

The client with ESRD related to type 1 DM has completed hemodialysis 1 hour ago. Which nursing intervention is of priority in assisting the alert adult client to transfer from the bed to the chair post-dialysis? A. check the blood glucose level B. monitor for dizziness on standing C. wrap the AV fistula with gauze D. do not move the arm with the AV fistula

B. monitor for dizziness on standing

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the patient is day 1 postoperative TURP. Which intervention should the nurse implement? a) Remove the indwelling catheter b) Titrate the NS irrigation to run faster c) Administer protamine sulfate IV push d) Administer vitamin K slowly

B: Titrate the NS irrigation to run faster Rationale: increasing the irrigation fluid will flush out the clots and blood

DX AKI

BUN and Cr determines severity electrolytes UA CT/ultrasound/biopsy

The client is two days post-op TURP and is complaining of an increasing urge to void. The client has a 3-way urinary catheter with CBI. After assessing that the catheter is patent and is draining freely, the priority nursing intervention is to: A. Reassure the client that the catheter is draining appropriately B. Document the client's complaints and assessment findings C. Give the client a B&O suppository for bladder spasms. D. Notify the physician

C. Give the client a B&O suppository for bladder spasms.

WHICH LAB RESULT IS MOST INDICATIVE OF CYSTITIS? A. Serum WBC 9000/mm3 B. Urinalysis with 1-2 WBCs present C. Urine bacteria 100,000 colonies/ml D. Serum hematocrit 36%

C. Urine bacteria 100,000 colonies/ml

The client diagnosed with AKI is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the K+ level? A. erythropoietin B. calcium gluconate C. regular insulin D. osmotic diuretic

C. regular insulin

THE NURSE IDENTIFIES THE CLIENT WITH THE GREATEST RISK FOR A URINARY TRACT INFECTION AS A: A. 37-year-old man with renal colic associated with kidneys stones B. 26-year-old pregnant woman who has a history of urinary tract infections C. 69-year-old man who has urinary retention caused by benign prostatic hypertrophy D. 72-year-old woman hospitalized with a CVA who has a Foley catheter because of urinary incontinence

D. 72-year-old woman hospitalized with a CVA who has a Foley catheter because of urinary incontinence

A CLIENT WITH PROSTATITIS SECONDARY TO KIDNEY INFECTION HAS RECEIVED INSTRUCTIONS ON MANAGEMENT OF THE CONDITION AT HOME AND PREVENTION OF RECURRENCE. A NURSE EVALUATES THAT THE CLIENT UNDERSTOOD THE INSTRUCTIONS IF THE CLIENT VERBALIZED THE INTENTION TO: A. Keep fluid intake to a minimum to decrease the need to void B. Exercise as much as possible to stimulate circulation C. Stop antibiotic when pain subsides D. Use warm sitz baths and analgesics to increase comfort

D. Use warm sitz baths and analgesics to increase comfort

The client diagnosed with AKI has a serum K+ of 6.8 mEq/L. Which collaborative treatment would the nurse anticipate for the client? A. administer a phosphate binder B. decrease of pain by 3 levels on a 1-10 scale. C. assess the client for leg cramps D. prepare the client for dialysis.

D. prepare the client for dialysis.

What are some major problems caused in the oliguric phase of AKI?

Fluid overload Metabolic acidosis Na+ and K+ imbalance Unable to excrete metabolic waste products

Nursing Assessment

Health hx: -previous medical and surgical hx -medications -urinary changes -pain -patient's perception of problem physical exam: -presence of pain -edema -general appearance, hydration -cva tenderness -palpable bladder -kidney palpation

Which classification of renal failure (pre, intra, or post) is most concerning in regards to damage to the kidneys? Why?

INTRArenal : kidney damage occurs -Pre and Post are relatively treatable. Intrarenal reflects direct damage to the kidneys

urinary tract calculi

"stones" - more common men -- common summer monthes -UTIs - struvite -high pH: calcium phosphate, calcium oxalate (bladder), uric acid, cystine, STRUVITE CM: pain - back, hematuria, N/V, chills, S/S of UTI, "kidney stone dance" DX: NON-CONTRAST CT, UA (check pH), BUN and Cr TX: -pain (opioids) -hydration: 3L -less sodium & limit oxalate rich foods (spinach, rhubarb) -most pass spontaneously if less 4mm -retreaval/removal: break up and irrigate OR insertion and suck up NI: monitor I/Os, encourage fluids, strain urine, encourage activity, educate diet & hydration

Testicular cancer

-35x higher in males with undescended testes; exposure to estrogen, HIV, fam hx Types: Seminomas -most common, slow growing, 25-45 Nonseminomas -rare, agressive, late 30s CM -lump on scrotum, painless enlargement -heaviness of scrutum -backache, weight loss, general weakness DX: palpation of mass, ultrasound of testes, chest xray/ct for mets TX: removal surgery radiation - seminomas chemo - nonseminomas NI: emotional support, pain meds, prepare chemo/radiation, education (often do sperm bank if surgical)

Goodpasture syndrom

-autoimmune disease, antibodies against glomerular and alveoli CM: -flu like symptoms -pulmonary: SOB, cough, crackles/rhonchi -renal: hematuria, weakness, pallor, anemia TX: -corticosteroids, immunosuppressants, dialysis

TX AKI

-correct cause -manage S/S -prevent complications oliguric: give diuretics and fluid restrict (yesterdays UO +600 ml) diuretic: correct hypovolemia start dialysis early monitor fluids (weight/I/O) decrease K+ and Na+ diet

chronic glomerulonephritis

-end stage of glomerular inflam -slow, insidious progression to renal failure -characterized by: proteinuria, hematuria, uremic syndrome -detected by UA or elevated BP TX: supportive and symptomatic, tx HTN

Benign Prostatic Hyperplasia (BPH)

-enlargement of prostate; compresses urethra (cause partial or complete obstruction) CM: gradual onset, NOCTURIA, frequency, urgency, pain, hesitancy, intermittency, dribbling AUA symptom index complications: -urinary retention - uncomfortable, increase uti/stones, need cath to drain -UTI - secondary to sepsis -hydronephrosis - distention, can cause renal failure -pyelonephritis DX: Digital rectal exam, PSA rule out cancer, transrectal ultrasound (TRUS) TX: -restore bladder drainage, symptom relief -dietary changes, rstriction fluids, timed voiding -surgery - laser, stents, TURP (can cause incontinence and is invasive) -drugs:5-alpha reductase inhibitors (do not handle if pregnant) & alpha-adrenergic blockers (muscle relaxation - flomax/cardura/mini press)

Erectile Dysfunction (ED)

-inability to maintain erection for sexual performance -risk increase with age, substance abuse, DM, HTN DX: sex hx, psych/neuro eval, PSA, DRE TX: viagra (drops BP - avoid nitrates SE: HA, congestion, flushing), counseling

Glomerulonephritis

-inflammation of glomeruli, affects both kidneys -acute (sudden symptoms) & chronic (slowly progressive - renal failure) Acute Poststreptococcal Glomerulonephritis (APSPN): most common in young; from A beta hemolytic strep; CM (decrease GFR, HTN, smoky urine, abdominal pain, no symptoms); DX: UA, CBC, BUN, Cr, renal biopsy; TX: rest, sodium and fluid restriction, tx HTN, protein restriction, abx for strep

Prostatitis

-inflammation of prostate gland -young to middle aged men -four categories: acute/chronic bacterial, chronic prostatitis, asymptomatic inflammatory CM: -perineal discomfort, burning, urgency, dysuria, cloudy urine, pain with ejaculation, back pain, urinary retention DX: UA, PSA (rule out cancer), ultrasound TX: -antibiotics (bactrim, cipro) -fluids -manage fever/pain -anti inflam; and alpha adrenergic blockers

cystitis

-inflammation of the bladder -lower urinary tract infection CM: -frequency, urgency, dysuria, foul-smelling urine, fever,N/V -older adults tend to have atypical symptoms -50% ppl no symptoms DX test: -UA (clean catch) to look at leukocytes for infection -CT/ultrasound if recurrent UTI TX: -antibiotic therapy (bacrtim, septra, macrodantin, monurol) -oral pyridium NI: -admin fluids (3-4 L) -antibiotics -educate: front to back wiping, cranberry juice, adequate fluids, complete abx regime

Pyelonephritis

-inflammation of the renal pelvis and the kidney -acute (result active bacterial infection) & chronic (result repeated UTI) -an "ascending uti" CM: ACUTE: sudden onset chills/fever, flank pain, vomiting, lower UTI symptoms, CVA tenderness CHRONIC: HTN, acidosis, nocturia, inability to conserve sodium DX: UA, ultrasound (look for stones), CBC TX: -antibiotic therapy (start broad spectrum - vanco -- cipro) -NSAIDS, Incrs fluids, follow up UA

AKI

-lack of kidney function, rapid onset, increase CR and decrease UO -hypotension, hypovolemia, nephrotoxic agents PRERENAL: -no kidney damage -impaired blood flow -hypovolemia (dehydration, GI losses, hemorrhage), decres CO (HF/MI), vasodilation, hypotension/hypoperfusion INTRARENAL: -direct damage to kidneys (nephron malfunction) -causes: acute tubular necrosis, glomerulonephritis, rhabdomylosis POSTRENAL: -due to obstruction of urine flow (cause back flow) -cuases: BPH, calculi, cancer, trauma, tumors

Prostate Cancer

-malignant tumor in prostate; slow growing -spread: direct, lymph, bloodstream risk factors: age, ethnicity, fam hx, diet (high red meat/fat/dairy) CM: -asymptomatic early, similar to BPH, -Prostate hard, enlarged (unilateral), and fixed -lower back pain DX: PSA (norm 0-4) (high indicates cancer) DRE (hard, asymmetric, enlarged) Biopsy and TRUP, CT, TNM to stage TX: -active surveillance -yearly PSA/DRE -surgery/radiation (external beam or brachytherapy) -drug therapy (adrogen deprivation) -- can cause decrease libido, gynecomastia, hot flashes -chemo is palliative

polycystic kidney disease (PKD)

-multiple renal cysts that enlarge and destroy tissue -childhood pkd: autosomal recessive, rapidly progressive -adult pkd: autosomal dominant, latent for years CM: -HTN -Hematuria -Black/flank pain and heaviness -nocturia -constipation -incrs abdominal girth -no symptoms DX: CT/ultrasounds, fam hx TX: -no specific, goal prevent/treat UTIs/HTN pain, monitor weight/BP, dialysis, transplant, genetic counseling (50% pass to children)

Chronic Kidney Disease (CKD)

-onset: gradual -cause: diabetic nephropathy -diagnostic: GFR lower than 60 for more than 3 months; kidney damage -reversibility: progressive and irreversible -cause of death: cardiovascular disease

Acute kidney injury

-onset: sudden -cause: acute tubular necrosis -diagnostic: acute reduction in urine output, elevation in serum Cr -reversibility: high (60%) -cause death: infection

Chronic Kidney Disease

-progressive, irreversible -nephrons are destroyed and replaced by scar tissue -GFR <60 for longer 3 months causes: DM & HTN CM: anemia, fatigue, bleeding infections, gradual onset, tachycardia, dysrhythmias, HF, pericarditis, HTN, hypervolemia, incrs RR, risk respiratory infection, dyspnea, pulmonary edema uremic frost DX: UA/cultures CT/ultrasound GFR, Cr, BUN, electro Hgb/Hct TX: preserve kidney function, reduce cvd risk, prevent complications, control symptoms drugs: HTN, hyperkalemia, anemia, CKD protein restrict, sodium/phos/potas restrict fluid control: fluid restrict and dialysis

Kidney Function

1. maintain homeostasis of blood pressure, volume and composition 2. filter the blood and excrete waste 3. RBC production -erythropoietin (triggered with decreased O2)

GFR

125 ml/min

Upper GU

Pyelonephritis Glomerulonephritis

Kidney Cancer

Renal cell Carcinoma: -most common, 50-70 y/o, men risk factors: obesity, smoking, exposure to gasoline, fam hx CM: -weight loss, HTN, fever, anemia -hematuria -- LATE sign -metastasis: lung, liver, long bones DX: CT, ultrasound, UA, decrease Hct, Hgb TX: quit smoking, healthy weight, avoid toxins, nephrectomy (partial/full), radiation (palliative), no chemo

Which data would indicate that discharge teaching has been effective for the patient who is postoperative TURP? a) "I will call the surgeon if I experience any difficulty urinating." b) "I will take my Proscar daily, the same as before my surgery." c) "I will continue restricting my oral fluid restriction." d) "I will need to take my pain medication routinely even if I don't hurt."

a) "I will call the surgeon if I experience any difficulty urinating."

You are caring for a 21-year-old client who had a left orchiectomy for testicular cancer on the previous day. Which nursing activity will be best to delegate to an LPN? a. answering the client's questions about postorchiectomy radiation b. administering the ordered "as needed" (PRN) oxycodone (Roxicodone) to the client c. teaching the client how to perform testicular self-examination on the remaining testicle d. assessing the client's knowledge level about the use of sperm banking

b. administering the ordered "as needed" (PRN) oxycodone (Roxicodone) to the client

A NURSE IS CARING FOR AN 88 YEAR OLD FEMALE SUSPECTED OF HAVING A UTI. WHICH OF THE FOLLOWING, IF NOTED IN THE CLIENT, WOULD ALERT THE NURSE TO THE POSSIBILITY OF THE PRESENCE OF A UTI? a. Fever b. Frequency of urination c. Confusion d. Urgency

c. confusion -older adults often present with an atypical presentation when they have a UTI

Lower GU

cystitis and prostatitis

The day after a radical prostatectomy for prostate cancer, your client has blood clots in the urinary catheter and complains of bladder spasms. The client says that his right calf is sore, and complains that he feels short of breath. Which action should you take first? a. irrigate the catheter with 60 ml of sterile saline b. administer oxybutynin (Ditropan) 5 mg orally c. apply warm packs to the client's right calf d. measure oxygen saturation using pulse oximetry

d. measure oxygen saturation using pulse oximetry

Nephrons

functional units of kidneys -bowmans capsule, glomerulus, tubular system

Dialysis

hemodialysis - AV Fistula, rapid fluid removal, remove K+, frequent VS during, 3-4 days a week peritoneal - portable/ done at home, patient control, less dietary restrictions, better for DM CRRT - continuous gentle dialysis; used for critically ill

Kidney failure

kidney unable to excrete waste and maintain fluid/electrolyte balance -less than 25% nephrons functioning -acute or chronic

CM of AKI

prerenal and postrenal typically resolve quickly with treatment -if renal damage occurs, AKI progresses through different phases: Oliguric: less 400 ml/day; problems (fluid overload, metabolic acidosis, Na+/K+ imbalance) Diuretic: gradual increase urine (1-3 L), nephrons healing, kidneys excrete waste not concentrate, uremia, risks (hypovolemia, hypotension, hyponatremia, hypokalemia) Recovery: GFR increases, stablizes BUN and Cr, takes up to 12 months

Bladder Cancer

risk factors: smoking, exposure to dyes, chronic recurrent renal calculi CM: -dysuria, frequency, urgency, painless hematuria DX: UA, CT/ultrasound/MRI, cystoscopy/biopsy, TNM (staging) TX: -laser or electrical current via scope -chemo - direct into bladder

TURP

transurethral resection of the prostate Pre-op: -restore urinary drainage -educ se -tx uti if present post-op: -continuous bladder irrigation (24 hr with NS or until no clots) GOAL: light pink without clots urine -prevent bladder spasms -kegel exercises, incrs fluids