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