June 18, Simplifying the Urinary System
Urinary System NCLEX Review
[youtube http://youtu.be/CpdRW6a5bNg w=400&h=300]Urinary System NCLEX Review (By: AllNursingNotes)
Urinary Calculi/ Urilithiasis
URINARY CALCULI is also called urilothiasis or KIDNEY STONES, and it can results from anything from immobility, cancer, increased intake of Vitamin D, or an over-activity of the Parathyroid gland.
Kidney stones is made up of:
- calcium
- magnesium
- phosphorus
- oxalate.
– High urine acidity or alkalinity contributes to stone formation.
SYMPTOMS (Urinary Calculi)
- Flank pain
- fever
- nausea and vomiting
- changes in the urinary output.
*** There will be an increase in RBC’s, WBC’s and bacteria.
DIAGNOSTIC TESTS for urinary calculi would include x-ray, blood tests and a 24 hour urine test.
INTERVENTIONS:
Non Surgical Management:
– ↓ Incudes the use of laser to break the stone fragments
(Extracorporeal shock wave lithotripsy (ESWL).
- patient is given a local anesthetic .
- pt. is placed in a water bath or on a soft cushion.
-
shock waves are transmitted through the stones inside the kidney.
-
shock waves cause the calculi to break up into smaller pieces.
- * Encourage fluid intake after the procedure.
- * Assess for any hemorrhage
Discharge Teaching (DIET) *Know for NCLEX:
If Uric Acid Stone:
- Alkaline Ash & Low Purine Diet (limit wine, cheese & meat)
- Give Allopurinol as prescribed
If Calcium Stone:
- Calium Restricted Diet (Limit Dairy Foods)
Surgical Interventions:
– Uretherolithotomy
– Nephrolithotomy
- Removal of renal calculi using a nephroscope.
POLYCYSTIC KIDNEY DISEASE
– A cyst develops in the nephron (kidneys)
– It is an inherited disease of the kidneys.
- IN THE DOMINANT FORM- ONLY FEW NEPHRONS HAVE CYSTS.
- IN THE RECESSIVE FORM-100% OF NEPHRONS HAVE CYSTS FROM BIRTH.
– Cysts in kidneys would look like a cluster of grapes
– Patients would have hypertension. (Due to Renin Angiotensin System)
MANIFESTATIONS IN THE PATIENT:
- PAIN IS THE FIRST MANIFESTATION
- FLANK PAIN IS DULL, SHARP OR INTERMITTENT
DULL ACHING PAIN- is caused by increase kidney size, from infection from the cyst.
SHARP INTERMITTENT PAIN- is when a cyst is rupture or when a stone is present.
BERRY ANEURYSM
– can occur (bleeding into brain from ruptured intracranial vascular cysts)
– causes severe headaches, with or without vision changes (pay extra attention
to patients with severe headaches, since it can be a sign of a ruptured cyst).
DIAGNOSTIC TESTS:
– renal sonogrophy
– computed tomography
– MRI
INTERVENTIONS:
- BE VERY CAUTIOUS IN USING NSAIDS, BECAUSE IT CAN CAUSE BLEEDING
- ANTIHYPERTENSIVES AND DIURETIC AGENTS (ACE INHIBITOR, CALCIUM CHANNEL BLOCKER, BETA BLOCKER)
- IS USED FOR HYPERTENSION.
If during in the NCLEX exam, it talks about a sharp pain, followed by blood in the urine= it usually is a ruptured cyst.
♣ Berry Aneurysm= main symptom is severe headaches.
♦ Urinanalysis in patients with PKD:
- Protienuria
- Hematuria
- Bacteremia
Protienuria in pt. indicates PKD disease progression.
NSAIDS should be avaoided= it can cause bleeding in pts.
PAIN from PKD- apply dry heat to the abdomen or flank area.
ACE Inhibitors– the best medication to control hypertension (PKD).
Glomerulonephritis
- A NON BACTERIAL INFLAMMATION OF THE KIDNEY’S GLUMEROLUS.
- Usually a result of an antigen antibody response to a beta hemolytic streptococci
- (this means that the patient usually had strep throat 2-3 weeks prior).
- SERUM CREATININE LEVEL
- BLOOD UREA NITROGEN BUN
ASSESSMENT
– Monitor the patient for dark color, cloudy appearance and foul odor urine.
– WBC blood count will be above 10,000/ mm3
– Blood culture will be positive for presence of bacteria.
– Azotemia= presence of nitrogenous waste products in the blood.
Wilms Tumor (Nephroblastoma)
– a common intraabdominal tumors of the childhood.
– usually associated with genitourinary anomalies.
Assessment:
– patient will have a swelling or mass within the abdomen.
– the patient will have hypertension, hematuria, pallor and anorexia
NEVER AND DO NOT palpate the abdomen of the patient.
Urine Culture and Sensitiviy
CREATININE CLEARANCE TEST
- CREATININE CLEARANCE TEST, EVALUATES HOW WELL THE KIDNEYS REMOVE CREATININE
- BLOOD IS DRAWN AFTER TAKING THE URINE SAMPLE.
Bladder Ultrasonography
Intravenous Pyelography
- AN X RAY PROCEDURE
- USES A RADIOPAQUE DYE
- ASSESS FOR ALLERGIES
Renal Angiography
– an IV injection of radiopaque dye is inserted into the renal artery
- – INJECTION OF A RADIOPAQUE DYE
- – OBTAIN INFORMED CONSENT.
- – ASSESS FOR ALLERGIES
- – WITHOLD FOOD AFTER MIDNIGHT
- – INFORM PT. ABOUT THROAT IRRITATION
Uric Acid Test
- URIC ACID TEST IS A 24 HR. URINE COLLECTION TO DIAGNOSE FOR GOUT.
Interventions:
- Manage Pain- (give analgesics)
- Administer Antibiotics
- Increase the patients’s fluid intake (2-3 L/day)
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- Posted under Medical-Surgical
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