N317 Final Exam

Urolithiasis

Renal calculi are hard formations of minerals and salts that collect in the kidneys.

Risk factors of Renal calculi?

Dietary factors, genetic, environmental, and lifestyle, lack of adequate hydration, hyperparathyroidism. Obesity, medications such as diuretics or calcium-containing.

Clinical manifestations of Renal calculi?

dull/flank pain- depends where at or if moving. Blood in urine, nausea, frequency urge to urinate, difficult urinating, vomiting, fever.

Signs of complications of Renal calculi?

Can lead to obstruction, risk of infection and pain.

What labs are used to help identify Renal calculi?

Urinalysis

Foods to avoid for Uric acid stones?

Decreases purine sources: organ meats, poultry, fish, gravies, red wine, and sardines.

-Organ meats, sardines and herring, venison and goose.

Acute Kidney Injury (AKI)

Sudden loss of kidney function. Has sudden onset and typically reversible decrease in kidney function.

Types= Pre-renal, Inter-renal, Post-renal

Most commonly affects clients who are hospitalized

Pre-renal

Before kidney, severe hypertension, hypervolemia, sepsis.

Usually due to dehydration

Inter-renal

Impacts kidney directly

Usually due to NSAIDs

Post-renal

Problem below kidney not letting urine flow out

What labs would improve if Acute Kidney Injury is starting to go away?

Decrease Creatinine

What do labs typically look like in Acute Kidney Injury?

Blood crearinine slow increase by 1 to 2 mg/dL every 24 to 48 hr, or 1 to 6 mg/dL in 1 week or less.

BUN- increase of 80 to 100 mg/dL within 1 week.

Urinalysis= Proteinuria, hematuria, specific gravity, bacteria (when infection present)

Electrolytes= sodium can be decreased or increased, hyperkalemia, hyperphosphatemi, hypocalcemia.

Stages of kidney injury

Stage 1 (risk stage)= Creatinine 1.5 to 1.9 times baseline, output less than 0.5 ml/kg/hr for 6 hr or more.

Stage 2 (Injury stage)= Creatinine 2 to 2.9 times baseline, urine output less than 0.5 ml/kg/hr for 12 hr or more.

Stage 3 (Failure stage)= Creatinine 3 times baseline, urine output less than 0.3 ml/kg/hr for 12 hr or more.

What lab test is used to monitor liver function?

Albumin

Chronic Kidney Disease (CKD)

Gradual loss of kidney function over time that can lead to failure or End-Stage Renal Failure (ESRF).

Kidney damage is not reversible, chronic nephropathies progress to fibrosis and destruction of renal structures including glomeruli, tubules and vessels.

What are some risk factors of Chronic Kidney Disease (CKD)?

Modifiable= Hypertension, glomerulonephritis, obesity, smoking.

Non-modifiable= ethnicity, gender (males), age, lipus

Comorbidities= Hypertension, diabetes mellitus, hyperlipidemia, CHF, TB.

Chronic Kidney Disease manifestations and testing

Manifestations= related to fluid volume overload and kidney function overload. No manifestations until kidney function is significantly reduced or during times of stress

Imaging also done to rule out. Increase in potassium, phosphorus and magnesium. Increase in BUN and Creatinine. Decrease in H&H.

Medications given for Chronic Kidney Disease?

Diuretics

Sodium polystyrene- reduce potassium

Epoetin alpha- hormone for production of RBC

Calcium carbonate- Phosphorus binding agent- helps manage calcium.

Antihypertensives

Vitamins and minerals (vit D)= usually effected.

Glomerulonephritis (GN)

Group of kidney disease characterized by inflammation of the glomeruli, the tiny filtering units in the kidneys.

Primary= starts in kidneys (build up of antibodies in kidneys, due to strep or other infections)

Secondary= systemic cause- sepsis

Acute= strep infection, most recent immune response

Chronic= long-term 20-30 years)

Clinical manifestations of Glomerulonephritis?

Periorbital edema, peripheral edema, hypertension, Cola-colored urine, decreased output, fatigue and weakness, anorexia, older clients can show signs of confusion or CHF. Genetic factors, environmental

Risk factors of Glomerulonephritis?

Streptococcal infections, Autoimmune disorders. Genetic factors increase risk of disease development

Environmental exposures, recent travel.

Complexes formed by immune response damage kidney tissue.

Urinary incontinence

Is the inability to control urination, resulting in involuntary passage of urine. Can be caused by many factors.

Causes= reduced muscle tone, enlarged prostate, tumor, consumption of alcohol or caffeine, nerve damage, urinary tract infections. Bladder irritation.

Complication= skin breakdown, kidney injury, psychosocial effects- anxiety, high cost.

Stress incontinence

coughing, sneezing, laughing or physical activity that increases pressure on the bladder. Physical pressure.

Urge incontinence

strong urge to urinate, but leaking occurs before getting to the toilet

Mixed Incontinence

Combination of stress and urge (more common in female clients)

Reflex incontinence

urinary leakage, result of nerve damage

Overflow incontinence

incomplete bladder emptying which results in the bladder overfilling- bladder so full that spills

Functional incontinence

Physical inability to reach the toilet in time- mobility issues.

Nocturnal enuresis

nighttime bedwetting, incontinence (common in children)

Which type of Incontinence is common due to urinary retention?

Overflow incontinence

Nephrotic Syndrome

Significant loss of protein in urine causing excessive leading to hypoalbuminemia. Glomeruli are damaged and permeability is significantly increased.

Manifestations= edema, anemia, anorexia

Disequilibrium Syndrome

Rapid changes in blood osmolality and rapid lowering of BUN and fluid volume leads to increased intracranial pressure and cerebral edema.

Manifestations= seizures, mental status

Treatment= antconvulsives and barbiturates as ordered. Mannitol

Peritoneal Dialysis

Sterile hypertonic dialyzing solution, instilled in peritoneal cavity. (acts as filter)

Diffusion of excess toxins and electrolytes occurs while dialysate dwells. The peritoneum serves as filter.

Aseptic technique is crucial to prevent infection, Abdomen should be intactm without adhesions. Dwell time important for clients with Diabetes mellitus- monitor blood sugar due to high levels.

Assess dialysate qualities- check clear, not expired, straw color.

What are some complications of Peritoneal Dialysis/

Hyperglycemia, Hyperlipidemia (long-term use, leads to hypertension)

Loss of protein

Peritonitis- dangerous, infection of peritoneal cavity

Hypovolemia

Fistula formation- perforation of colon or other organs

Poor flow- obstruction of tubing, constipation, clot

Hemodialysis

Blood is shunted through a dialyzer and back into the body. AV fistula is accessed. Based on client’s symptoms

Indicators= signs of fluid overload, renal insufficiency, AKI, CKD, Drug toxicity, persistent hyperkalemia.

Inserted of two needles (vein and artery)

Sessions are 3 times per week, 3-5 hours each, times may very.

What is a AV Fistula?

is a connection between a vein and artery. Done to strengthen site used for dialysis multiple times a week, usually due to Hemodialysis.

Assess for bruit- lack of bruit indicates possible clot, immediate action needed.

Avoid B/P, IV, procedures on arm with _

Stoma care

Regularly assess _. Teach client to clean skin around the _. Teach client what signs and symptoms to report to provider

Ensure _ applience fits properly

Educate patient and caregiver on proper _ care.

Monitor patients output and provide emotional support.

Cystitis

Infection in bladder, type of UTI. caused by bacteria, most common E. coli

Manifestations= burning, frequency, urgency, fever, pain/pressure to pelvic region, malodorous urine, cloudy.

Phenazopyridine

Analgesics, turns urine orange and can stain clothing, manages bladder pain, does NOT treat infection, can effect urinalysis.

Helps with symptoms of UTI; Cystitis, does NOT treat.

Ileal Conduit

a surgical procedure that creates a new pathway for urine to leave the body after the bladder is removed. The surgeon isolates a small section of the small intestine (ileum), attaches the ureters to one end, and brings the other end out to a stoma on the abdomen. Urine continuously drains into an external pouch worn on the skin.

Nursing care- focuses on maintaining continuous urinary drainage, protecting the delicate peristomal skin from irritation, and educating the patient on appliance management.

Endometriosis

Chronic condition caused by endometrial tissue that has moved outside the uterus which causes pain and inflammation

Risk factors- family history, early menarche, shorter menstrual cycles, Nulliparous (higher estrogen levels)

Risk Reduction- breastfeeding and pregnancy related to hormone changes. Oral contraceptives use, tubal ligation.

Endometriosis manifestations?

Dysmenorrhea

Pelvic or back pain

Pain during intercourse

Diarrhea or constipation

Infertility

Heavy bleeding and spotting in between periods

Painful bowel movements and infertility

Pelvic Organ Prolapse (POP)

AKA “Pelvic Relaxation Syndrome”

Weakening of the pelvic muscles and structures, organs are displaced or tilt towards the vaginal orifice.

Types- uterine prolapse with Cystocele (anterior toward baldder) or Rectocele (posterior towards the rectum) (or both)

What are risk factors of Pelvic organ prolapse (POP)?

Obesity, aging, hormone deficiency, family history

multiparity, physical trauma from pregnancy or surgery. Strain, menopause, decreased estrogen, heavy lifiting and constipation.

Client education and manifestations for Pelvic organ Prolapse?

mild discomfort to a noticeable bulge and usually worsen after standing for long periods, coughing, or exercising. Urinary and bowel issues

Educate on lifestyle changes, pelvic floor physical therapy, pessary devices, or surgery. Encourage to stay hydrated and possible behavioral changes.

What are Clinical manifestations of Ovarian cancer?

Abdominal/pelvic pain or swelling

GI discomfort

Masses of the abdomen

Urinary symptoms

Total Hysterectomy and Post-Op complications?

Complete removal of female reproductive organs, Standard perioperative care.

Monitor for complications live; DVT- encourage early ambulation, pain management, prevent infections (temp and drainage). Advancing the diet, early mobility. Prevent atelectasis

Polycystic Ovarian Syndrome (PCOS) manifestations

Ovarian cycts form from hormone imbalance.

Hair loss, hairsuitism, pelvic pain, overweight, acne, irregular periods, fatigue

How is PCOS diagnosed?

Pelvic exam, LH, FSH, Testosterone and ultrasound.

Monitor GLUCOSE and HEMOGLOBIN A1C- to screen for prediabetes, guide early lifestyle or medication changes, and prevent long-term cardiovascular complications

Benign Prostatic Hyperplasia (BPH)

Is a non-cancerous growth of prostate tissue that compresses urethra and may result in retention or blockage of urine flow.

Clinical presentations= difficulty voiding, weak stream, retention, Nocturia, Dysuria, increased frequency and weak stream.

What is Flomax used for and other meds for treatment?

Used for enlarged prostate.

Other meds= Alpha-blocker and 5-alpha reductase

Surgical management= Prostatectomy, TUNA, TUIP, PVP, and TURP.

What are risk factors for Prostate cancer?

Over age 65 years old, family history, African American ethnicity, high-fat diet. Hereditary prostate cancer, rapid growth of the prostate. Exposure to enviromental toxins

Erectile Dysfunction

inability to achieve and sustain an erection. AKA Incompetence.

Organic ED= gradual decline in function caused by underlying medical conditions.

Comorbidities= diabetes, high cholesterol, high blood pressure- taking beta blockers

What are risk factors of Erectile Dysfunction?

Taking Beta Blockers ending in -lolol

Endocrine issues, neurological disorders, psychological factors, lifestyle choices, medications, age, sleep disturbances and obesity.

Epididymitis

Infection or inflammatory condition of the epididymis.

Most commonly caused by trauma or infection caused by Chlamydia trachomatis or Neisseria gonorrheae.

Manifestations- unilateral testicular pain and swelling, redness and warmth. Fever, nausea, and vomiting.

In Epididymitis what is common risk factor in younger males?

is engaging in sexual activity without a condom, which directly leads to Sexually Transmitted Infections (STIs) like Chlamydia trachomatis and Neisseria gonorrhoeae.

Initial herpes manifestations?

Small fluid-filled blisters appear near mouth, genitals, anus. Blisters open to form ulcers and take weeks to heal.

Flu-like symptoms= body aches, fever, and headache can come first outbreak.

What is treatment for Genital Herpes?

Not Cureable only to lessen outbreaks

Acyclovir and Valacyclovir- antiviral, reduce length and severity of episodes.

There is no cure, treatment decreases severity of episodes and reduces transmission risk.

Analgesics for pain, other comfort measures- loose clothing when lesions present.

Gonorrhea manifestations in females?

Caused by Neisseria gonorrheae.

Infects the cervix, uterus, fallopian tubes and urethra

-Dysuria, vaginal drainage, or vaginal bleeding between menstrual cycles, If left untreated, can lead to PID.

Gonorrhea manifestations in Males?

Caused by Neisseria gonorrheae.

Infects the urethra

-Dysuria, green, yellow, or white drainage from urethra or pain in the testicles.

GERD and manifestations

Acid travels up esophagus and erodes lining and causes problems.

-Chest pain (hallmark sign), hoarseness, chronic cough- due to acid effecting esophagus.

-Regurgitation, sour taste, dysphagia, dyspepsia, belching/nausea/vomiting.

Complications of GERD

Increased risk of Barrett’s esophagus and strictures- over time lining of esophagus changes and at risk for esophagus cancer.

Risk for development of esophageal adenocarcinoma

monitor for respiratory aspiration- aspiration pnumonia and rule out cardio issues0 due to chest pain.

Gastritis and causes?

Inflammation of lining of the stomach

-NSAID use and H. pylori infection. Alcohol use and spicy foods.

Manifestations= can be asymptomatic, loss of appetite, increased belching, nausea, vomiting, epigastric pain, emesis or stools that contain blood.

-Chronic cases may be asymptomatic and can lead to pernicious anemia.

Peptic Ulcer disease

Open sores that occur in the inner lining of the stomach.

Risk factors= H. pylori. Long term non-steroid anti-inflammatory drugs, family history, family history, alcohol and caffeine use and older than 60 years old.

How is Peptic ulcer disease diagnosed?

Occult blood in stool common sign.

Labs- CBC, Electrolytes, Liver function tests, amylase, lipase

Urea breath test

Blood test or stool antigen assay to detect H. pylori

Upper GI endoscopy

Bowel Obstruction Clinical manifestations

Can be partial or complete (medical emergency) blockage of small or large bowel.

May hear high-pitched sounds in upper quadrants and no bowel sounds in lower quadrants. Stools will be watery.

Clinical manifestations= nausea, vomiting, abdominal pain and distention, and severe constipation

Ulcerative Colitis

Inflammation and ulceration of the large intestines, affecting the colon and rectum. It is continious inflammation usually starting at the large intestine to rectum. TPN is given during exacerbations.

Monitor electrolytes for imbalance and dehydration

Crohn’s Disease

Inflammation in the GI tract but commonly affects the small intestine from mouth to anus. Has Patchy inflammation.

Monitor electrolyte levels, bowel rest as indicated, TPN during exacerbations.

Ulcerative colitis vs Crohn's disease

Crohn's can affect any part of the GI tract (mouth to anus) in uneven patches and through all intestinal layers, whereas UC is continuous and strictly limited to the colon

Metronidazole

is a front-line antibiotic used in combination therapies to treat H. pylori. Its overuse or misuse can lead to antibiotic resistance, making future eradication attempts significantly harder. When this happens, patients may experience persistent or worsening gastrointestinal symptoms like abdominal pain, bloating, or nausea due to ongoing gastric inflammation

Dumping Syndrome

Common complications after gastric resection, food moves too fast through. Occurs when the pylorus is bypassed, leading to rapid movement of food into the jejunum.

What are clinical manifestations of Dumping Syndrome?

Pain, unsettled feeling

Early sign= N/V, epigastric pain w/ cramping, hyperactive bowel sounds, diarrhea.

Late sign= pale, cool skin, anxiety, shakiness, irritability and hunger

Nursing care for Dumping Syndrome?

Slow gastric emptying, encourage to lay down after eating 30-60 min, not to drink too much when eating

Colonoscopy

involves insertion of _, flexible fiber optic scope, to visualize sigmoid, descending, transverse and ascending colon. Sedation is used

What sedation is used for colonscopy and age recommended?

moderate sedation (twilight sleep) or deep sedation. Starts at age 45 and every 5 years.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscope inserted into mouth and guided into the biliary tree via the duodenum.

diagnoses and treats disorders of the liver, gallbladder, bile ducts, and pancreas and Biopsy common pancreatic cancer.