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Urinary System NCLEX Review

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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.
–  ♦It is very important to strain the urine after the ESWL Procedure.
  • * 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

  1. CREATININE CLEARANCE TEST, EVALUATES HOW WELL THE KIDNEYS REMOVE CREATININE
  2. 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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