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N474 FINAL EXAM STUDY SET
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N474 FINAL EXAM STUDY SET...
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- Fever, chills, N/V, tachycardia, tachypnea- Flank, back, loin pain, abdominal discomfort
- Evidence of UTI or urinalysis and culture
- Urgency, frequency, nocturia
- General malaise or fatigue
- Possible increased WBC
are all evidence of - ANSWER pyelonephritis
goals of pyelonephritis care - ANSWER - Control pain
- Resolution of infection
- Prevent chronic kidney damage
- Monitor BP, teach client, treat HTN coming from kidneys
interventions for pyelonephritis - ANSWER - Administer analgesics
- Assess patient pain often
- Encourage 2-3 L of fluid intake per day
- Administer antibiotics as prescribed
do you need to take a daily urinalysis for pyelonephritis? - ANSWER no
T/F: you still have peristaltic waves with urinary diversion - ANSWER true
what will drain into the pouch of a urinary diversion? - ANSWER mucous and
protein
what is a urinary diversion? - ANSWER - Surgical alteration of urinary tract
- Nursing care, client teaching will vary depending on procedure
- Ileal conduit- urostomy
- Tunnel ureters into piece of bowel that acts as a tunnel for urine to leave body
through a stoma
what is an orthotopic ileal neobladder - ANSWER borrow small intestine to make a
new bladder pouch
what do patients with an orthotopic ileal neobladder need to be able to do? -
ANSWER self cath
what will be done to an orthotopic ileal neobladder to ensure it stretches to the size it
needs to be? - ANSWER periodic clamping so it fills with pee
,- Glandular units in prostate undergo nodular tissue hyperplasia, resulting in
enlargement of prostate gland
- Prostate surrounds urethra, which makes urethra narrow
describes - ANSWER benign prostatic hyperplasia
what could BPH cause if it's not fixed? - ANSWER tubular necrosis
sx of BPH - ANSWER - Bladder outlet obstruction
- Increased residual urine (stasis)- cystitis
- Chronic urinary retention
- Overflow urinary incontinence - not emptying properly
what tool is used to assess BPH? - ANSWER the I-PSS
lmao
international prostate symptom score
labs to assess BPH - ANSWER CBC, prostate specific antigen test, serum
phosphatase (prostate cancer)
men over what age should have a yearly prostate exam? - ANSWER 50
meds for BPH - ANSWER - Alpha reductase inhibitor
- Alpha blockers - relaxes smooth muscle of urethra
- Saw palmetto - not a lot of evidence. Need to ask about nutritives that pts are
taking
non pharm management of BPH - ANSWER - Double-voiding technique
(After the void, deep breath, relax, and void again)
- Avoid meds that cause urinary retention (anticholinergic, antihistamines,
decongestants)
- Avoid diuretics (plus caffeine and alcohol)
TURP is appropriate for - ANSWER severe BPH obstruction
debulking to open things up
radical prostatectomy is appropriate for - ANSWER prostate cancer
AUA recommendations for BPH - ANSWER - Detailed HH (sx burden)
- Imaging studies for sizing- CT/MRI
- Post void residual studies
- Urodynamic/flow studies
,- Reserve for renal insufficiency
greatest risk post op of BPH surgery - ANSWER frank blood, clotting and blocking
the bladder, putting a clot in the bladder with nowhere to go
how do we monitor the urinary cath placed after BPH surgery? - ANSWER every 30
minutes empty the bag and measurement
look for frank bleeding
tight tension of the tube to the leg- pulls the balloon down far enough to compress
bleeding at the exit (gross)
what assessment finding would we see with BPH? - ANSWER distended bladder
for someone who underwent TURP surgery, what is priority concern? - ANSWER
hemorrhage
risk factors for AKI - ANSWER Damaging meds, diuretics, NSAIDS, contrast dye,
dehydrated
AKI is diagnosed with - ANSWER urine output and creatinine level
nursing interventions for AKI - ANSWER -Monitor I/O closely
-Close monitoring of weight
-Follow labs (BUN, Cr, electrolytes)- if elevated, need dialysis
-Maintain fluid balance
-Maintain BP- protect kidneys
kidney injury is irreversible when the GFR is below - ANSWER 90
what are the two most common risk factors for CKD? - ANSWER diabetes and HTN
others
- Heart disease
- Smoking
- Obesity
- High cholesterol
- Fam hx of kidney disease
- Age 65+
- May result from infections, obstructions and nephrotoxic meds
stage 1 of CKD - ANSWER GFR is 90 mL/min
- Screen for risk factors and manage care to reduce risk
- Diminished renal reserve
- Chronic renal failure (CRF)
, Kidney fx somewhat normal, but damage present
Control BP
24 hours urine sample for CrCl
Screen for nocturia
stage 2 of CKD - ANSWER GFR is 60-89 mL/min
- Focus on reduction of risk factors
- Renal insufficiency
stage 3 of CKD - ANSWER GFR is 30-59 mL/min
- Implement strategies to slow disease progression
Renal diet
- Renal insufficiency
- Headaches, decreased ability to concentrate urine
- Polyuria oliguria
- Increase in BUN/serum creatinine
- Edema from fluid retention
- Mild anemia
- High potassium, HTN
- Weakness and fatigue
stage 4 of CKD - ANSWER GFR is 15-29 mL/min
- Manage complications, talk about future preferences, options
- Renal insufficiency
stage 5 of CKD - ANSWER - GFR <15 mL/min
- Implement renal replacement therapy or transplant
- End stage renal disease
- Neuro weakness/confusion
- HTN, pitting edema, periorbital edema, pericarditis
- SOB, depressed cough, thick sputum
- Ammonia odor to breath, metallic taste, mouth/gum ulcers, anorexia, N/V
- Withdrawn, depression
- Anemia, bleeding risk, high K
- Dry flaky skin, pruritis, ecchymosis, purpura, yellow-gray skin
- Cramps, renal osteodystrophy
- Bone pain
- Evaluate dialysis site for patency, infection
what should we not do with an extremity with a dialysis access site? - ANSWER
take BP or blood sample
a 55 year old male with CKD has a GFR of 25 mL/min. What stage of CKD is he in? -
ANSWER stage 4
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