Exam 2 fundamental

A female client reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and finding is: a. Cystitis b. Hemorrhage c. Incontinence d. a renal stone

a. Cystitis

A client undergoes a kidney ultrasound examination. The nurse providing postprocedure care remembers: ______________________ a. That there are no special precautions b. To assess each urine specimen for blood for 24 hours c. To save all urine in a radiation-safe container for 12 hours d. Limit contact with the client to 10 minutes each hour for 6 hours

a. That there are no special precautions

Mid-stream urine collection

- (clean-voided urine specimen) - pee in a cup - page 1142-1144

Urinary retention

- an accumulation of urine due to the inability of the bladder to empty - the urethral sphincter will open and will allow very little urine out - patient will use the restroom frequently but will never empty out bladder completely Cause: Abstraction in the urethra Surgical or child birth trauma Bladder motor and sensory nerves don't function properly Medication Anxiety Affects: Urinary tract infection

After a transurethral prostatectomy a client returns to his room with a triple-lumen indwelling catheter and continuous bladder irrigation. The irrigation is normal saline at 150 mL/hr. the nurse empties the drainage bag for a total of 2520 mL after an 8-hour period. How much of the total is urine output? ___________

1320 mL urine for the 8-hour period

The urine appears concentrated and cloudy because of the presence of white blood cell or ______________

Bacteria

Nephrostomy

Nephrostomy is performed in several different circumstances: The ureter is blocked by a kidney stone. The ureter is blocked by a tumor. There is a hole in the ureter or bladder and urine is leaking into the body. As a diagnostic procedure to assess kidney anatomy. As a diagnostic procedure to assess kidney function.

Maintaining a Foley catheter drainage bag in the dependent position prevents: a. Urinary reflux b. Urinary retention c. Reflex incontinence d. Urinary incontinence

a. Urinary reflux

A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude? a. The skin wasn't lubricated before the pouch was applied. b. The pouch faceplate doesn't fit the stoma. c. A skin barrier was applied properly. d. Stoma dilation wasn't performed.

b. The pouch faceplate doesn't fit the stoma

To minimize nocturia, clients should avoid fluids: a. After lunch b. In the late afternoon c. 2 hours before bedtime d. 4 hours before bedtime

c. 2 hours before bedtime (according to the book)

Elimination change that result from obstruction to the flow of urine in the urinary collecting system may cause which of the following (choose all that apply) a. Blood clots b. Dehydration c. Renal damage d. Urinary retention e. Urinary tract infection

c. Renal damage d. Urinary retention e. Urinary tract infection

When applying a condom catheter, it is important to secure the catheter on the penile shaft in such a manner that the catheter is: a. Tight and draining well b. Dependent and draining well c. Secured with adhesive tape applied in a circular pattern d. Snug and secure, but does not cause constriction to blood flow

c. Secured with adhesive tape applied in a circular pattern

Some medications change the color of urine pyridium color the urine : a. Blue b. Brown c. Yellow d. Bright orange to rust

d. Bright orange to rust

Health care-acquired UTIs are often related to poor hand washing and : a. Poor urinary output b. Poor perineal hygiene c. Urinary drainage bags d. Improper catheter care

d. Improper catheter care

Urinary tract infection

- Most common HAI's in US - Caused by catheterization or surgical manipulation - Urinary tract infections (UTIs) are usually caused by Escherichia coli - Women are more susceptible due to shorter urethra Teaching/ prevention • Increased fluid intake results in increased diluted urine formation, which reduces the risk of urinary tract infection. • Do not hold urine for a long period of time. • Surgical asepsis while preforming a urinary catheter

Calculating Urine Output

1) Adult expected urine output = .5 -1 mL/kg/hr a. Minimum normal adult urine output = 35mL/hr or 840 mL/day); needs more fluids if producing less than 30mL/hr or 720 mL/day) b. Too much if urine output ≈ 1.2 mL/kg/hr or 80-100mL/hr for 70kg adult; reduce fluids c. Minimum adult trauma urine output = 50mL/hr 2) Infant/child expected urine output = 1-2mL/kg/hr a. 10kg child should produce at least 10mL/hr or 240 mL/day) 3) Bolus for adults (i.e if not peeing enough) = 10mL/kg a. 70kg adult, give bolus of 700mL or 23oz of fluid b/c 30mL in 1oz) b. in acute distress, can give up to 20mL/kg bolus 4) Bolus for children in acute distress, can give up to 20mL/kg a. 10kg child, give bolus of 200mL or 6.6oz)

ureterostomy

A ureterostomy is the creation of a stoma (a new, artificial outlet) for a ureter or kidney. The procedure is performed to divert the flow of urine away from the bladder when the bladder is not functioning or has been removed Client needs be instructed that when changing the ostomy bag he/she should observe skin for signs of irritation caused by urinary drainage in the area surrounding the ostomy.

Nephrostomy tube

A percutaneous (per-ku-TA-ne-us) nephrostomy (ne-FROS-to-me) tube is a catheter (plastic tube) that is inserted through your skin into your kidney. The nephrostomy tube is placed to drain urine from your body into a collecting bag outside your body. You may need one nephrostomy tube, or two tubes if you need one for each of your kidneys.

pyelonephritis

AN INFECTIOUS DISEASE CAUSING INFLAMMATION OF THE KIDNEY ORGAN AND TISSUE. E. Coli- has been the main organism that causes most cases Symptoms: - Chills - Flank Pain - Fever - Fatigue - Fever Treatment: Antibiotics Commonly used antibiotics include the following: Amoxicillin Cephalosporin - Cephalosporins are very similar to penicillins. Most commonly used Cephalosporins include: Keflex, Ceprozil (Cefzil), Cefadroxil (Duricef) Most Cephalosporins starts with a (cef or cep)* Other Antibiotics includes: Levofloxacin and ciprofloxacin Sulfa drugs such as sulfisoxazole/trimethoprim Levofloxacin- a type of fluoroquinolones Side Effects (Levofloxacin): dizziness sudden pain on joints diarrhea confusion hallucinations

urinary ostomies

An ostomy is a surgical procedure performed when normal bowel or bladder function is lost due to birth defects, disease, treatment for disease, or injury. Conditions that may require an ostomy include colorectal cancer, traumatic injury to the bowel or bladder, diverticulitis, inflammatory bowel disease, and removal of the bladder. Cancer necessitates nearly 80% of ostomy procedures. Ostomy procedures are performed in a hospital and patients are admitted for several days or longer, depending on the severity of the condition and complications that occur.

When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a. The client sets the drainage bag on the floor while sitting down. b. The client keeps the drainage bag below the bladder at all times. c. The client clamps the catheter drainage tubing while visiting with the family. d. The client loops the drainage tubing below its point of entry into the drainage bag.

Answer B. To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because it could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. limit oral fluid intake for 1 to 2 weeks. b. report the presence of fine, sandlike particles through the nephrostomy tube. c. notify the physician about cloudy or foul-smelling urine. d. report bright pink urine within 24 hours after the procedure.

Answer C. The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy.

A client comes to the doctor's office with the complaints of going to the bathroom all the time, pain on urination, small amounts of urine being passed when voiding, and a foul smell to the urine. A urine specimen has been sent for analysis. Based on the signs and symptoms expressed by the client, which of the following health problems would be anticipated? Acute renal failure Renal stone Urinary tract infection Chronic renal failure

C. Urinary tract infection

A health care provider may suspect that a patient is experiencing urinary retention when the patient has A. Large amounts of voided cloudy urine. B. Pain in the suprapubic region. C. Spasms and difficulty during urination. D. Small amounts of urine voided 2 to 3 times per hour.

D. Small amounts of urine voided 2 to 3 times per hour.

Personal hygiene:

teach client to maintain cleanliness by washing perineal area with soap and water daily, or after defecation; instruct female clients to wipe from front to back (urinary meatus toward the anus) after voiding and discard after each wipe; if recurrent infections are occurring, avoid tub bath.