Urinary Quiz/Disorders and medications

Bethanechol (Urecholine) side effects

****Bradycardia***** *dizziness *drowsiness *lightheadedness *headache ****Nausea***** ****vomiting**** *Abdominal cramps/pain *Diarrhea

Flomax (tamsulosin) Alpha blocking agent (Can't go )

*BPH *Incontinent *Causes relaxation of the smooth muscle in the bladder outlet and prostate gland *Helps decrease pressure on the uretha, thereby re-establishing a stronger urine flow and decreasing the manifestation of BPH

Flomax (client education)

*Orthostatic hypotension *change position slowly *use concurrent with cimetidine can potentiate the htpotension effect

Oxybutynin client education

*Report palpitations and problem with voiding or constipation *Dizziness and dry mouth are common. Suck on hard candies to alleviate dry mouth

Pyridium Manifestation (pain)

*Treat symptoms of UTI *Relieve bladder discomfort; pain, burning, itching, urgency, and frequency *Cools you off

Oxybutynin (Ditropan)

*Used for overactive bladder (urge incontinence) *it alleviates pain by decreasing bladder spasms that can result from the renal calculi moving down the ureter into the bladder. *Genitourinary Medication, Anticholinergic

A client diagnosed with chronic renal failure is being treated at home with continuous ambulatory peritoneal dialysis. The client notes that there is a decrease in the catheter outflow following the prescribe 6 hour dwell time and calls the nurse to report this occurrence. The nurse should instruct the client to take which action

Ambulate in the home

stress incontinence

the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing

TURP

transurethral resection of the prostate gland

Oxybutynin side effects

typical anticholinergic side effects: *dry mouth is primary concern; *constipation *Urinary retention *Tachycardia *confusion older patients *Blurred vision *Anorexia, nausea, vomiting, and dehydration

inability to void despite an urge to void is called

urine retention

extracorporeal shock wave lithotripsy (ESWL)

uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract and pass from the body.

Pyridium Client education

*Will turn urine orange *Take medication with food to decrease gastrointestinal irritation *Drink at least 3 L of water a day *Urinate before and after sex *Drink cranberry juice to decrease risk of infection *Women (wipe front to back) *no tight clothes

Oxybutynin Nursing actions

*collect data for history of glaucoma, as this medication increases intraocular pressure *monitor for dizziness and tachycardia *monitor for urinary retention *monitor Intake and output

Bethanechol (Urecholine)

*helps the bladder muscles react *treats urinary retention and bladder problems by emptying the bladder and increasing urination

Bethanechol Nursing Considerations

*take medication on empty stomach 1 hour before or 2 hour after meal to prevent nausea and vomiting *take with full glass of water, helps with stimulating the Urination

Acute Kidney injury Phases

-(Onset) begins with the onset of the event, ends when oliguria develops, and last for hours to days -(Oliguria) begins with the kidney insult; urine output is to ml/ hr with or without diuretics; and lasts for 1 to 3 weeks. fluid volume overload can lead to heart failure, electrolyte imbalance, and the metabolic acidosis -(Diuresis) Begins when the kidney start to recover, diuresis of a large amount of fluid occurs, 1000 ml to 2000 ml per day; and dehydration and imbalances in serum sodium or potassium levels. -(Recovery) Continues until kidneys function is fully restored and can take up to 12 months, urine is more concentrated, and electrolytes return to expected reference range

A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis?

-A client who is at 32 weeks gestation -A client who has kidney calculi -A client who has a neurogenic bladder -A client who has diabetes mellitus

Chronic kidney disease medications and therapeutic procedures

-Ace inhibitors and angiotensin receptor blocker decrease proteinuria and can decrease the progression of CKD by lowering the clients blood pressure. -Sodium polstyrene it increase elimination of serum potassium -Furosemide a loop diuretic administer to excrete excess fluids, reduce blood pressure and decrease potassium levels. -Kidney transplant

A nurse is reviewing information with a female client who has frequent urinary tract infections. Which of the following information should the nurse include?

-Avoid sitting in a wet bathing suit -Empty the bladder when there is an urge to void -take a shower daily

A nurse is contributing to the plan of care for a client who received hemodialysis. Which of the following intervention should the nurse recommend?

-Check BUN and serum creatine -Administer medications the nurse withheld prior to dialysis - Observe for manifestations of hypovolemia -Monitor the access site for bleeding

Nurse action for infection of the access site (Peritonitis)

-Observe the site for wetness from a leaking catheter. -Monitor for infection (fever, purlent draingage, redness, swelling)

Kidney stones expected findings

-Pain intensifies as the calculus moves through the ureter -Fever -Diaphoresis -Nausea/vomiting due to the severity of the pain -Hematuria (dark brown or smoky-looking urine)

Types of Acute kidney injury

-Prerenal -Intrarenal -Postrenal

Prerenal acute kidney injury (risk factors)

-Sepsis -hypovolemia -Peripheral vascular resistance -liver failure

Lab test for Acute kidney injury

-Serum creatinine gradually increase 1 to 2 mg/dl every 24 to 48 hr, or 1 to 6 mg/dl in 1 week or less -Blood urea nitrogen (BUN) can increase to 80 to 100 mg/dl within a week

client education regarding kidney stones

-limit intake of food high in animal protein (reduction of protein intake decrease calcium precipitation) -Calcium oxalate (limit sodium intake, and oxlate sources)

nursing action for ESWl

-monitor for hematuria strain urine following the procedure and send the stones fragments to the lab. -expect bruising at the location where the shock waves are generated, generally through the soft tissue for the flank area.

A nurse is caring for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse plan to take?

-monitor serum glucose levels -report cloudy dialysate return -monitor for shortness of breath -check the access site dressing for wetness

glomerulonephritis (risk factors/expected findings/ lab test)

-recent infection, particulary of the skin or upper respiratory tract -Recent travel or other possible exposure to bacteria, virsues, fungi, or parasites -Dysuria -Oliguria -fatigue -reddish-brown or cola colored urine

chronic kidney disease (irreversible)

-the progressive loss of renal function over months or years. -As kidney dysfunction progresses, manifestations become apparent -older adults clients have increase risk for CKD related to aging process -drink at least 2 l water daily -limit alcohol intake -take all antibodies

Serum Creatinine

0.6-1.35 mg/dL (<2 in older adults)

GFR (glomerular filtration rate)

90-120 mL/min Renal function

condom catheter

A catheter that has an attachment on the end that fits onto the penis, also called an external or ''Texas'' catheter.

straight catheter

A straight tube inserted to drain urine then immediately removed

urinary tract infection

A urinary infection refers to any portion of the lower urinary tract (ureters, bladder, urethra, prostate) UTIs include the following -cystitis -Urethritis -prostatitis

Indications for Hemodialysis

Acute Kidney Disease Chronic kidney Disease Substance overdose Persistent hyperkalemia Hypovolemia that does not respond to Diuretics

A nurse is caring for a client who has urniary tract infection (UTI). which of the following is the priority intervention by the nurse?

Administer an antibiotic

With a kidney transplant you will be on

Anti medication for the rest of your life

labs for kidney/ renal disease

BUN, creatinine, GRF, Rennin, EPO

sulfamethoxazole/trimethoprim

Bactrim, Septra ( report any signs of a sore throat right away)

Prerenal

Begins before the demage to the kidney Occurs as a result of volume depletion and prolonged reduction of the blood flow to the kidneys, which leads to ischemia of the nephrons.

A nurse is reviewing the medical record of a client who has intrarenal acute kidney injury (AKI). Which of the following factors should the nurse identify as the cause of this form of AKI?

Cocaine use disorder

early detection of BPH

Decrease force of stream

oligaria

Decreased urine output

The primary objective of diet thearapy for kidney stones is to

Dilute the urine by increasing fluids

Therapeutic procedures for kidney stones

ESWL (extracorporeal shock wave lithotripsy)

After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Elevated blood urea nitrogen level 4. Decreased white blood cell count

Elevated blood urea nitrogen level

UTI medications

Flagul -antibody Phenazopyridine (Pyridium)- pain relief

A female client presents to the urgent care center with dysuria and hematuria. The client reveals that she has a history of cystitis. The nurse should also assess for which of the following clinical manifestations suggesting

Frequency and urgency of urination, suprapubic pain, and foul smelling urine

Disorders that contraindicated with Bethanachol chloride

Gastric atony

A nurse is caring for a client who was brought to the emergency room following an accident. The nurse suspect a rupture bladder. Which of the following findings is consistent with the diagnose?

Hematuria

What requires vascular access

Hemodialysis

A nurse is caring for a client with chronic renal failure (CRF). The nurse monitors for, which most frequent cardiovascular finding in the client with CRF?

Hypertension

A nurse is caring for a client with history of cystitis. Which of the following statements indicates that the client needs further reinforcement of the teaching about the condition?

I prefer to take bath instead of showers

An older adult male makes an appointment with a physician concerning urinary symptoms he is experiencing when the office nurse obtains the clients history which statement provides the best indication that the client has benign prostatic hypertrophy (BHP)

I wake up frequently during the night needing to urinate

the nurse is caring for a client who has just been given discharge instructions for kidney stones. Which statement by the client indicates a need for further instruction?

I will decrease my fluid intake

A nurse is caring for a client who has chronic renal failure. Which of the following client statement indicates an understanding of the dietary needs for lifestyle management of this disease?

I will limit my fluid intake

flagly Antibody

Treats UTI

pyelonephritis

Immunologic Kidney disorder that can start in the kidneys (genetic basis and immune-inducing inflammation) or occurs as a result of other heath disorders (lupus, erythematosus diabetic nephropathy) and result in glomerular injury *Acute glomerulonephritis often occurs following an infection *Chronic glomerulonephritis develops over a period of 20 to 30 years.

kidney stones risk factors

Increase oxalate production (genetic) or inability to metabolize oxalate from foods (black tea, spinach, beets, swiss chard, chocolate, peanuts.)

Bun labs (Blood, Uria, Nitrogen)

Increased BUN: DEHYDRATED Normal BUN: 10-20 Decreased BUN: Overhydrated

A nurse caring for a client who has ARF (acute renal failure. The nurse should administrate which medication to increase elimination of potassium

Lasix

Exsanguination

Loss of blood to the point where life can no longer be sustained.

Flagly

Metronidazole

Midstream clean catch

Most common procedure for collecting any type of urine specimen

Which of the following disorders presents with proteinuria, hypoalbuminemia, generalizededema, and oilguria?

Nephrotic syndrome

Urecholine is used for the treatment of which disorder

Nonobstructive urinary retention

A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take action?

Obtain a culture and sensitivity of the drainage

postrenal acute renal failure

Occurs as a result of bilateral obstruction of the ureters, bladder, or urethra that can cause a back up of urine into the kidneys -stone, tumor, bladder atony -Prostate hyperplasia, urethral stricture -Spinal cord disease or injury

Intrarenal acute kidney injury

Occurs as a result of direct damage to the kidney from lack of oxygen (acute tubular necrosis). ■ Causes ☐ Physical injury - trauma ☐ Hypoxic injury - renal artery or vein stenosis or thrombosis ☐ Chemical injury - acute nephrotoxins (e.g. antibiotics, NSAIDs, contrast dye, heavy metal, blood transfusion reaction) ☐ Immunologic injury - infection, vasculitis, acute glomerulonephritis ■ Nursing Care ☐ Assess for oliguria or anuria. ☐ Assess for edema and manifestations of heart failure or pulmonary edema. ☐ Restrict fluid intake as prescribed. ☐ Review laboratory values for elevated potassium, low calcium levels. ☐ Monitor for ECG dysrhythmias and changes (tall T waves). ☐ Assess for flank pain, nausea, and vomiting. ☐ Assess for lethargy, tremors, and confusion. ☐ Monitor daily weights.

Medication for kidney stones

Opiods Oxybutynin (peeing to much) Antibiotics

Complications of peritoneal dialysis

Peritionitis

Symptoms of UTI

Persistent desire to urinate, burning sensation during urination, lower back pain, strong smelling urine, pelvic pain, and low-grade fever Blood pressure low, heart rate high

An 84 year old male client has just returned to the nursing home after a transurethral resection. He has a 3 year old indwelling urinary catheter for continuous bladder irrigation connected to straight drainage. Immediately after surgery, the nurse would expect his urine to be

Pink cherry red

A nurse is checking urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection?

Positive for leukocyte esterase

Oxybutynin chloride is prescribe for a client with neurogenic blocker. Which sign would indicated a possible toxic effect related to this medication

Restlessness

A nurse is checking a clients laboratory findings. Which of the following findings is expected for a client who has stage 3 chronic kidney disease?

Serum potassium 6.0 mEq/l

hemodialysis

Shunts blood from the body through a dialyzer and back into circulation.

A nurse is assigned to care for a client who hasjust returned to the nursing unit following a renal biopsy. The nurse plans to do which of the following to properly care for this client for the remainder of the shift?

Test the urine of occult blood

people with on going infections are

not recommend for Kidney transplants

glomerulonephritis lab/nursing care

Urinalysis shows red blood cells and protein -coordinate care to conserve client energy -Administer antibiotics -Monitor blood pressure -Monitor respiratory status

Pyridium (phenazopyridine) (pain)

Urinary Tract Analgesic

Acute Kidney Injury

When the kidneys suddenly can't filter waste from the blood. Acute renal failure develops rapidly over a few hours or days. It may be fatal.

The nurse is teaching a client about the concept of dialysis and how it works for the body its the nurses understanding that dialysis is a technique that

Will move blood through a semipermable membrane into a dialysate that is used to remove waste products as well as correct fluid electrolyte imbalances

renal calculi (kidney stones)

are hard deposits of minerals and acid that stick together in concentrated urine. Painful when passing

nurse teaching for spontaneous passage of calcium phosphate renal calculus

avoid foods high in oxalate and calcium

UTI risk factors

being female, recent sex (abrasions), recent use of a diaphragm with spermicide, history of recurrent infection, urinary catheter

Hematoria

blood in the urine

BUN

blood urea nitrogen

dysuria

painful or difficult urination

The nurse is performing discharge teaching for a client who has admitted with pyelonephritis. the client asks the nurse, "what is pyelonephritis? Based on the nurse's knowledge of pyelonephritis, the best response would be

pyelonephritis is an infection of the kidney

polyuria

excessive urination

While assessing the functioning of the arteriovenous fistula, the nurse expects to

feel thrill over the fistula

Foley catheter

indwelling catheter inserted through the urethra and into the bladder that includes a collection system allowing urine to be drained into a bag; the catheter can remain in place for an extended period Sterile technique

Peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it) it is usually infectious and often life threatening. It's caused by leakage or a hole in the intestine (Monitor for infection, maintain surgical asepsis during procedure.

pyelonephritis

inflammation of the renal pelvis and the kidney -Escherichia coli organism are frequently the cause of acute pyelonephritis -repeat infection can create scarring that changes the blood flow to the kidney, glomerulus, and the tublar structure

peritoneal dialysis

is a treatment that uses the lining of your abdomen (belly area), called your peritoneum, and a cleaning solution called dialysate to clean your blood. Dialysate absorbs waste and fluid from your blood, using your peritoneum as a filter

Acute pyelonephritis

is an active bacterial infection that can cause the following -interstitial inflammation -Tubular cell necrosis -abcess formation in the capsule, cortex, or medulla

Chronic Pyelonephritis

is the result of repeated infections that cause progressive inflammation and scarring -high WBC -Higher respirations -low b/p