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Describe the anatomical location of the kidneys.
The kidneys lie retroperitoneally, just below the diaphragm
List key teaching points for a patient with a diagnosis of urolithiasis:
Stones are more likely to be passed if the patient remains active and increases fluid intake.All urine will be strained. Because stones may be any size, even the smallest speck must be saved for assessment. The nurse should encourage fluids and administer analgesics as ordered. Urine is assessed for possible hematuria. BUN and creatinine are monitored for indications of continuing urinary obstruction.
List nursing interventions for the proper care/handling of urine collection on a patient with the diagnosis of urolithiasis
All urine will be strained. Because stones may be any size, even the smallest speck must be saved for assessment. The nurse should encourage fluids and administer analgesics as ordered. Urine is assessed for possible hematuria. BUN and creatinine are monitored for indications of continuing urinary obstruction.
Describe the proper way to collect urine for a UA and Culture.
Urinalysis is completed on a clean-catch or catheterized specimen.
Describe the posterior pituitary\'s role in maintaining homeostatis with respect to the body\'s fluid balance.
The posterior pituitary gland releases antidiuretic hormone (ADH). ADH causes the cells of the distal convoluted tubules to increase their rate of water reabsorption. This action returns the water to the bloodstream, which increases the blood pressure to a more normal level and causes the urine to become concentrated.
Describe the proper procedure/equipment/solution for providing continuous bladder irrigation on a male patient who just underwent a TURP
Continuous irrigation is achieved by using a three-way catheter (one lumen for irrigation fluid, one for urine drainage, and one to the retention balloon) or by using two catheters (Foley and suprapubic—one for irrigation fluid and one for urine drainage). The irrigant is an isotonic solution. Catheter drainage tubes should be checked frequently for kinks that would occlude urine flow and cause bladder spasms
Explain the proper dietary restrictions for a patient with a diagnosis of chronic renal failure to prevent buildup of toxins
Potassium is retained, so foods high in potassium are restricted. Sodium is controlled at a level sufficient to replace sodium loss without causing fluid retention
Explain the various electrolytes that need to be monitored in a patient receiving a loop or thiazide diuretic and which is the most critical and why.
The loop diuretic effects electrolytes to cause hypokalemia, hypochloremia, hyponatremia, hypocalcemia (abnormally low blood calcium), and/or hypomagnesia (decreased magnesium in the blood). The thiazide diuretic, effects electrolytes to cause hypokalemia (extreme potassium depletion in blood), hyponatremia (decreased sodium concentration in blood), and/or hypercalcemia (excessive amounts of calcium in blood).
List pre-op teaching points for a patient who is about to undergo a TURP
The patient and family need to know that hematuria is expected after prostatic surgery. Vital signs and urine color will be monitored every 2 hours for the first 24 hours to detect early signs of complications
List post operative nursing interventions for a patient who just underwent a TURP with respect to maintaining proper catheter care
The patient should be advised not to try to void around the catheter because this will contribute to bladder spasms. The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots, which would cause bladder spasms.
List types of conditions which would cause one to spill large amounts of ketones into the urine. Think - conditions which cause large amounts of lipids to be broken down quickly
this condition may be seen with diabetes mellitus, starvation, or any other metabolic condition in which fats are rapidly catabolized.
List nursing interventions for ensuring the proper l/O\'s are recorded on a patient undergoing continuous bladder irrigation following a TURP
To determine urine output, the nurse will subtract the amount of irrigation fluid used from the Foley catheter output to calculate urine output. This is reported as “actual urine output.” To determine urine output, the nurse will subtract the amount of irrigation fluid used from the Foley catheter output to calculate urine output. This is reported as “actual urine output.”
List signs and symptoms you would see in a patient with Glomerulonephritis
anorexia, nocturia, malaise, and exertional dyspnea, hematuria, dysuria
When caring for any type of patient, where does \"pain\" fall in the priority of listing your nursing diagnosis/interventions?
interventions should focus on pain control and comfort measures as number one
List key teaching points that you will provide your patient who is about to receive Pyridium as part of her treatment regimen
Assess decrease in urinary symptoms. Urine may turn redorange. Report yellowing of sclera
Explain oliguria and what defines when this condition begins
A diminished capacity to form and pass urine (less than 500 mL in 24 hours); result is that the end products of metabolism cannot be excreted efficiently
List expected outcomes when providing a patient peritoneal dialysis. What are some things that might signal a problem
mimics kidney function, helping to restore balance when normal kidney function is interrupted temporarily or permanently. Peritoneal dialysis is contraindicated for those individuals with systemic inflammatory disease, previous abdominal surgery, and chronic back pain, among others
Describe how you would ensure a patient\'s vascular access for hemodialysis (AV graft) in patent
auscultate for bruits, observe site for skin color and condition, after dialysis, inspect needle puncture sites for bleeding
List goals for a patient receiving peritoneal dialysis:
remove toxins and metabolic waste
List s/s of UTI
The common signs and symptoms associated with UTI are urgency, frequency, burning on urination, and microscopic to gross (visible without aid of microscope) hematuria.
List proper nursing interventions when caring for a patient with incontinence.
Bladder training, establish a 2-hour schedule for the patient to go to the bathroom. Once continence has been achieved, the schedule goal may be raised to 3 hours. Use of protective undergarments may keep the patient and patient\'s clothing dry. For the female patient, Kegel exercises are helpful; 10 repetitions, 5 to 10 times a day is suggested to improve muscle tone
Describe/define - neurogenic bladder.
of voluntary voiding control, resulting in urinary retention or incontinence
List causes for urethral obstruction in the male, which is the most common?
In the aging male the prostate gland may become enlarged, leading to constriction of the urethra
Which lab study best reflects the functionality of glomerular filtration.
Creatinine Clearance, creatinine, a nonprotein nitrogen (NPN) substance, is present in blood and urine. Creatinine is generated during muscle contraction and then excreted by glomerular filtration.
What are the normal creatinine clearance levels?
Normal ranges follow: serum, 0.5 to 1.1 mg/dL (female), 0.6 to 1.2mg/dL (male); urine, 87 to 107 mL/min (female), 107 to 139 mL/min (male),
What is the proper instruction to provide to a female patient with regard to proper perineal care/hygiene?
Teach the female to cleanse perineal area anteriorly to posteriorly to prevent contamination of pathogens (especially Escherichia coli) from the rectum to the short urethra.
Describe the s/s of a patient who is diagnosed with end stage renal disease.
Common symptoms are headache; lethargy; asthenia (decreased strength or energy); anorexia; pruritus; elimination changes; anuria; muscle cramps or twitching; impotence; characteristic dusky yellow-tan, or gray skin color from retained urochrome pigments; and signs and symptoms characteristic of central nervous system involvement, such as disorientation and mental lapse
Define anuria
urinary output less than 100 mL/day
Which med is used to treat anemia?
(epoetin alfa [Epogen]) to treat anemia caused by a reduced production of erythropoietin. Iron deficiency anemia must be treated with ferrous sulfate orally or iron dextran (DexFerrum per Z-track IM method) before Epogen (EPO) will be effective
What are indicators that a patient is rejecting a newly transplanted kidney?
Postoperatively the patient is assessed for signs of rejection and infection: apprehension, generalized edema, fever, increased blood pressure, oliguria, edema, and tenderness over the graft site
In hemodialysis; Where is an AV graft/fistula device placed and why?
The nondominant forearm and the AV fistula is preferred for permanent access
Define renal insufficiency
characterized by the inability of the kidneys to remove wastes, concentrate urine, and conserve or eliminate electrolytes
What key teaching points do you need to provide a patient who is starting continuous ambulatory peritoneal dialysis?
Explanation of procedure, Signs of complications, Diet and/or fluid restrictions, Medication (schedule in relation to dialysis time) and Dialysate should be body temperature to lessen discomfort
What is blood in the urine
Hematuria
What is Excretion of an abnormally large quantity of urine.
polyuria
What are indications for use of Pyridium; desired effect?
patient complaints of pain or burning on urination, urgency, frequency, and nocturia
What is a normal serum potassium level? What would cause changes to this?
3.5 to 5 mEq/L. kidney failure resulting in acidosis
What occurs as a result of inability or unwillingness to toilet resulting from physical limitations, depression, or confinement to bed or use of restraints with dependence on a caregiver for assistance to the toilet.
Functional incontinence
What is the involuntary loss of urine during physical exertion or when coughing, sneezing, or laughing.
Stress Urinary incontinence
List types of urinary tract ostomies:
The most common urinary diversion procedure is the ileal conduit (Bricker\'s procedure or ileal loop). Occasionally a segment of the sigmoid colon is isolated and used instead of the ileum to form a sigmoid conduit.
Which catheter has a tapered tip and is selected for ease of insertion when enlargement of the prostate gland is suspected. The curved stylet is used to assist the physician in the insertion of a urethral catheter in a male patient
Coude
Which catheter has multiple openings in its tip to facilitate intermittent drainage.
Robinson
Which catheters are long and slender to pass into the ureters
Ureteral catheters
Which catheter is designed with a balloon near its tip so the balloon may be inflated after insertion, holding the catheter in the urinary bladder for continuous drainage
Foley
Which catheters are used to drain urine from the renal pelvis of the kidney.
Malecot and Pezzer, or mushroom
Which catheter has a slanted, larger orifice at its tip to be used if there is blood in the urine.
The whistle-tip catheter
This catheter is used to divert urine flow from the urethra as needed to treat injury to the bony pelvis, urinary tract, or surrounding organs; strictures; or obstruction.
The cystostomy, vesicostomy, or suprapubic catheter
This catheter is not actually a catheter but rather a drainage system connected to the external male genitalia.
An external (Texas or condom) catheter
What is a priority nursing action for a patient about to undergo an IVP?
It is vital that the nurse determine whether the patient has an allergy to iodine (or iodine-containing foods such as iodized salt, saltwater fish, seaweed products, vegetables grown in iodine-rich soils) because it is the base of the radiopaque dye that will be injected into a vein for this and other radiologic examinations
What are the major types of diuretics?
Loop, Thiazide, Osmotic and Postassium Sparing
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