Last Minute Exam Review (sets I know the worst)

UTI’s

2nd most common infection in the body

1 in 5

about ___ in ___ women get recurrent UTI’s

UTIs

most common nosocomial infection

complicated vs uncomplicated and upper vs lower

how are UTI’s classified?

pyelonephritis, nephritis, renal abscesses

these are considered upper UTIs and are typically more complicated (3)

cystitis, prostatits, urethritis

these are considered lower UTIs and are uncomplicated

pyelonephritis

inflammation of the renal pelvis

nephritis

inflammation of the kidney

cystitis

inflammation of the urinary bladder

prostatitis

inflammation of the prostate

urethritis

inflammation of the urethra

fever, flank pain, CVA tenderness, sicker patient hospitalized risk for sepsis

genera symptoms for upper UTI (4)

dysuria, frequency, urgency, usually not hospitalized

general symptoms of lower UTI (4)

pyelonephritis

“kidney infection”

pyelonephritis

bacterial infection in the renal pelvis, tubules, and interstitial tissues in the kidneys (one or both kidneys)

e-coli, stones, cancer, cystoscopy, BPH

what are things that can cause pyelonephritis (5)

nephrons end up replaced by scar tissue and can cause chronic renal failure

how can chronic pyelonephritis effect you?

high fever, chills, leukocytosis, bacteriuria, pyuria, low back/flank pain, cloudy/bloody foul smelling urine

symptoms of pyelonephritis (7)

symptoms, labs, UA/C&S, radiology

how is pyelonephritis diagnosed? (4)

vital signs (sepsis concern), I&O, maintain fluid & electrolyte balance, antibiotic therapy, analgesics (phenazopyridine), antispasmodics, increase fluid intake (3-4L/day)

nursing interventions for pyelonephritis (7)

cystitis

“bladder infection”

cystitis

inflammation in the lining of the bladder caused by bacteria

cystitis

most common type of UTI

E coli

most common bacterial cause of cystitis

inability to empty bladder completely, obstructed urinary flow, instrumentation of the urinary tract, inflammation or abrasion of the urethral mucosa, catheters (CAUTI), poor hygiene practices

what are some risk factors for cystitis? (6)

pain, burning, bladder spasms, frequency, confusion (elderly)

signs and symptoms of cystitis (5)

UA/C&S

what are the diagnostic tools for cystitis?

strict aseptic technique with catheter insertion, remove catheters ASAP, instruct on proper perineal hygiene, I&Os, force fluids

nursing interventions for cystitis (5)

B.

A patient returns to the doctor after finishing her antibiotic course, continuing to complain of UTI symptoms and now a high fever. What should the nurse suspect?

A. glomerulonephritis
B. pyelonephritis
C. BPH
D. renal failure

stress incontinence, urge incontinence, overflow incontinence

what are 3 types of urinary incontinence?

False

True or False: urinary incontinence is a normal part of aging

urinary incontinence decreases the ability to maintan independence

gerontologic consideration for urinary incontinence

UTI, constipation, medications, decreased estrogen levels, diabetes, weak pelvic floor muscles

what are some possible causes of urinary incontinence? (6)

rule out causes and residual urine checks

what are some diagnostic tools for urinary incontinence? (2)

electrical stimulation, medications (oxybutynin, tolterodine), bladder training/timed voiding, kegel exercises, surgery, fluid and dietary changes

what are some treatments/interventions for urinary incontinence (6)

urolithasis

kidney stone in the urinary tract

nephrolithiasis

kidney stone in the kidney specifically

calcium oxalate, calcium phosphate, or uric acid

what can kidney stones be made out of? (3)

75%

___% of kidney stones are calcium based

men 30-50 y/o, previous history, dehydration, living in “stonebelt”, high diet of purines, immobilization/sedentary lifestyle, medications (ex. calcium supplements)

what are some risk factors for kidney stones? (7)

organ meats, bacon, alcohol

what are some examples of foods high in purines (3)

PAIN in flank area, hematuria, urine retention, frequency, urgency, oliguria/anuria

signs and symptoms of kidney stones (6)

radiologic testing such as CT or IVP

how are kidney stones diagnosed?

analgesics & NSAIDs, strain urine, I&O, diet therapy (increase fluids and avoid causative foods)

what are some interventions for kidney stones? (4)

stone → obstruction → pressure → pain → possible hydronephrosis → kidney injury

how do kidney stones progress to other complications? (with arrows)

stent placement, percutaneous lithotripsy, extracorporeal shock wave lithotripsy, nephrostomy tube

what are some treatments for kidney stones? (4)

nephrostomy tube

tube to directly drain the kidney; bypass ureters

extracororeal shock wave lithotripsy

most common kidney stone treatment

assess urine/strain, manage pain, monitor fluid/electrolyte balance, monitor s/sx of infection, monitor kidney function, educate on possibility of bruising in flank for ESWL

post procedural interventions for kidney stones (6)

extracorporeal shock wave lithotripsy

non-surgical treatment where sound waves are used to break up kidney stones; bruising common

nephrostomy tube

bladder bypass

keep secure, bag below bladder level, monitor output

nephrostomy care (3)

A, B, D

What are risk factors of urolithiasis? (select all that apply)

A. diet high in alcohol and organ meats
B. calcium supplements
C. smoking
D. urinary stasis

>55 years old; rare under 40

who typically gets bladder cancer?

males

bladder cancer is usually more common in which gender?

15,000

bladder cancer accounts for _______ per year

tobacco use, toxins, family history

risk factors for bladder cancer (3)

painless hematuria, frequency, urgency, dysuria, changes in voiding patterns

what are some signs and symptoms of bladder cancer? (5)

biopsy and radiologic

what diagnostic tests are done for bladder cancer? (2)

cystectomy, radiation therapy, chemotherapy

treatment for bladder cancer (3)

ileal conduit

most common urinary diversion that allows urine to flow freely through a stoma to a pouch using a piece of intestine

cutaneous ureterostomy

urinary diversion where the ureters are brought out to the skin in one or more stomas

continent urostomy

ureters drain into reservoir that has a valved stoma that has to be cathed to remove urine

beefy red or pink, moist, and shiny, protruding slightly above the skin level

normal assessment findings of a stoma

patient education of expectations post surgery (changes in body image, show stoma pouches, discuss site of ostomy)

pre op care for a urinary diversion

assess stoma site, monitor I&O, monitor for S/S of stoma obstruction, education

what are some post op care for urinary diversions? (4)

stoma ischemia/necrosis, infection, irritation/yeast infection of stoma, skin breakdown

what are some complications of urinary diversions? (4)

begning prostatic hyperplasia

enlargement of the prostate gland that typically happens in men over 40

dihydrotestosterone

what hormone increases prostate cellular production?

frequency/hesitancy, inability to empty bladder completely, post-void dribbling, anuria, bladder distention, enlarged/firm/non-elastic feeling, elevated PSA

what are some s/sx of BPH? (7)

prostate specific antigen (PSA), digital rectal exam, transrectal ultrasonography (TRUS), CT/MRI, cystoscopy

what are some diagnostic tools for BPH? (5)

watchful waiting, medications, transurethral resection of the prostate, prostatectomy, transurethral heat ablasion, transurethral incision of the prostate, prostatic stent

what are some treatments for BPH? (7)

prostatectomy

removal of the prostate

doxazosin and tamsulosin

two examples of alpha 1 adrenergic blockers which help relax smooth muscle of the prostate, bladder neck, and proximal urethra

finasteride

example of a alpha reductase inhibitor which slows production of DHT

transurethral resection of the prostate

procedure where they send a scope through the penis and into the urethra; use a laser on the tool to cut away the blocking prostate tissue piece by piece; then flush tiny pieces out of the bladder

prevent and remove blood clots in the bladder

what is the goal of continuous bladder irrigation?

adjust flow rate to keep urine light pink/peach color, decrease flow if urine clear, increase flow if urine bloody, may need order for manual irrigation for large clots

explain the procedure for continuous bladder irrigation

prostate cancer

most common cancer in North American and NW European men

>50

prostate cancer is more common in men over what age?

slow

is prostate cancer slow or fast growing?

increases with age (60s), family hx, diet high in saturated animal fats, vitamin D deficiency, occupational risks, high levels of testosterone

what are some risk factors for prostate cancer? (6)

annual DRE/PSA starting at age 50; TRUS if abnormal

what is the prevention/screening for prostate cancer?

dysuria, hematuria, frequency, abnormal prostate on digital exam

what are the early symptoms of prostate cancer? (similar to BPH) (4)

bone pain, back pain, nerve pain, bowel/bladder dysfunction, weight loss, fatigue

what are the later symptoms of prostate cancer? (6)

abnormal PSA, abnormal DRE, TRUS exam, tissue biopsy

what is used to diagnose prostate cancer? (4)

hormone deprivation therapy (orchiectomy), prostatectomy, radiation (internal or external)

what are treatments for prostate cancer? (3)

orchiectomy

removal of testicles to deprive your prostate of testosterone

radioactive seeds

for internal radiation these are placed in the prostate to target just that organ

D.

What test will diagnose prostate cancer?

A. digital rectal exam
B. prostate specific antigen
C. MRI
D. biopsy

True

True or False: it is normal to see mucous threads in a urostomy pouch

20-30

what age group is most common to come in with burn injury?

men

this gender is twice as likely to get a burn

486,000; 40,000

of the ______ people treated for burns each year, _______ require hospitalization

smoking

leading cause of fire death in US

smoke detectors/CO monitors/fire extinguishers, keep matches and lighters out of reach of children, avoid extension cords/electrical cords under rugs, home exit plan/drill, community education (avoid alcohol/smoking)

what are some burn injury prevention recommendations? (5)

superficial

which burn type is this? top layer of epidermis (ex. sunburn)

partial thickness

which burn type is this? epidermis and part of dermis

full thickness

epidermis, dermis, deep tissue, muscles, bone

kids and elderly

these populations are at risk for worse burns because they have less fat