Med-Surg #8

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1. Urinary Incontinence

involuntary release of urine; in some patients indwelling catheter is inserted into bladder for continuous urine drainage.

could be r/t:
stress
urge
overflow
reflex
functional

diagnostics:
post void residual
bladder scan
cystometrography - an examination performed to evaluate bladder tone durring filling and voiding
uroflowmetry - Records flow rate of urinary stream.

1. Urinary Incontinence: Medications

Detrol - tolterodine, a/cholinergic and a/spasmotic

Ditropan - oxybutynin / antispasmodic, anticholinergic / bladder instability. dizziness, drowsiness, photophobia.

2. Urinary Retention

abnormal accumulation of urine in the bladder because of an inability to urinate. could be caused by:
benign prostatic hypertrophy
surgery
drugs
neurologic diseases
trauma

manifests with overflow voiding, incontinence, firm distended bladder that may be displaced.

can result in hydronephrosis, acute renal failure, urinary tract infection.

diagnostics: bladder scan

treatment depends on cause: surgery (remove obstruction, resection of prostate), medications, stimulation techniques, catheterization (prevents overdistention after surgery).

3. Cystitis

a type of UTI. Inflammation of the urinary bladder characterized by pain, urgency, dysuria, hematuria, pyuria and frequency of urination.

diagnostics: U/A + C&S, CBC + diff, IVP, voiding cystourethrography, cystoscopy

treated with antibiotics which would be three to seven days of treatment.

4. Pyelonephritis

inflammation of the kidney and its pelvis caused by bacterial infection. there can be acute symptoms (from e.coli) or chronic symptoms (other disorders).

manifests acutely as chills/fever, malaise/vomiting, flank pain/costovertebral tenderness, cystitis
manifests chronically with fibrosis, scarring, renal failure

5. Glomerulonephritis

a form of nephritis that involves primarily the glomeruli; also known as Bright's disease. primary kidney disorder or secondary to systemic disease. it affects the function of the glomerulus and damages the capillary membranes. because of this, blood cells and protein escape into the filtrate.

manifests as hematuria, proteinuria, azotemia

acutely, it usually follows infection with manifestations of hematuria, proteinuria, edema, HTN, fatigue, anorexia, mausea, vomiting, HA, elevated Creatinine clearance

chronically, it is usually and end-stage kidney damage patient. gradual loss of nephrons, kidney increase in size, symptoms from acute develop more slowly.

6. Nephrotic Syndrome

a condition in which very high levels of protein are lost in the urine and abnormally low levels of protein are present in the blood. results in damage to glomerular membranes.

manifests with significant proteinuria, low serum albumin levels, high blood lipids, edema, thromboemboli

7. Urinary Calculi

stones (or urolithiasis) in the urinary tract that are often caused by dehydration, excessive calcium/protein, gout, hyperparathyroidism, genetics and immobility and they may obstruct urine flow.
in the kidney/pelvis: it may be asymptomatic, or a dull aching flank pain
in the ureters: acute severe flank pain, may radiate, nausea/vomiting, pallor, hematuria
in the bladder: may be asymptomatic or dull suprapubic pain, hematuria

tests: U/A, KUB x-ray, IVP, renal ultrasound, CT scan, MRI, cystoscopy

treats with medications, dietary management, or surgery. different types of surgeries include lithotropsy, ESWL, cystoscopy, nephrolithotomy, nephrectomy

8. Hydronephrosis

pooling of urine in dilated areas of the renal pelvis and calyces of one or both kidneys caused by an obstructed outflow of urine or backflow of urine
acutely: colicky flank pain, hematuria, pyuria, fever, n/v, abdm pain
chronic: intermittent dull flank pain, hematuria, pyuria, fever, palpable mass

tests: ultrasound, CT scan, cystoscopy

treated with stents. the stents are positioned during surgery or cystoscopy and can be temporary or long term.

9. Polycystic Kidney Disease

a genetic disorder characterized by the growth of numerous (and multiply) fluid-filled cysts in the nephrons of the kidneys, which become enlarged. the kidneys eventually stop functioning but is slowly progressive.
manifests with flank pain (due to the enlargement of the kidneys), hematuria, proteinuria, polyuria, nocturia

the treatment is supportive. a renal ultrasound confirms, fluid and meds should be given.

10.Bladder Cancer

Malignant tumor of the urinary gland. Most common site of malignancy in urinary system. More common in men (often smokers) and in person over 50, especially in industrial workers exposed to dyes and leather. Can also be due to chronic inflammation or infection of bladder mucosa. Symptoms are hematuria, dysuria, and increased urinary frequency. Staging of tumor is based on depth it has penetrated bladder wall and extent of metastasis. Superficial tumors are removed by electrocauterization. More evasive tumors require cystectomy, chemotherapy, and radiation therapy.

S/S include: painless intermittent hematuria, increase urine frequency, flank pain, dec. stream of urine. Most common malignancy of urinary tract.

11. Kidney Tumors

Uncommon, renal cell carcinoma is the most common tumor. Risk factors include smoking, obesity, renal calculi. These tumors often metastasize.
s/s: it may be silent, or there might be: flank pain, palpable mass, fever/fatigue, weight loss, anemia, polycythemia, hypercalcemia, HTN, hyperglycemia

diagnostics: kindey biopsy, CT scan/renal ultrasound.

treatment is a radical nephrectomy.

-ectomy

surgical removal

-octomy

surgical incision

12. Benign Prostatic Hyperplasia

nonmalignant, excessive growth of the prostate gland that results in construction of the urethra; symptoms include nocturia (nighttime urination) urinary retention, can lead to hydronephrosis and a frequent need to void.

diagnostics: UA, digital rectal exam, PSA, uroflowmetry

can be treated with surgery (TUIP, TURP) and medication.

12. TUIP

Trans Urethral Incision of the Prostate. goes through urethra and make tiny incisions in prostrate, stretch the gland and pull in away from the urethra. less invasive than a TURP.

12. TURP

Transurethral resection of the prostate; uses to remove prostatic tissue by passing a cystoscope through the urethra to the prostate and cutting out the significant amounts of prostate.

13. Prostate Cancer

a malignant, metastasizing tumor of the prostate gland, and the second most common cause of cancer deaths in males. risk factors include race, family history, occupational exposure, and excessive fatty foods. it is curable if dxed early, but can grow either slowly or aggressively.

early stages: no symptoms
as it grows: urinary obstruction, metastasis, GU, musculoskeletal, neurological, systemic

annual DRE and serum PSAs should be done on males, especially high risk males such as african americans or with strong family history. can also be seen with a TRUS (transrectal ultrasonography) or a bone scan.

can be treated with hormone therapy for advanced, radiation therapy (external beam or implant), or surgery: prostatectomy, cryosurgery

14. Renal Failure

kidneys do not function, are severely impaired, waste products are not removed, body retains fluids, heart failure & hypertension easily result. Maybe acute or chronic person is very ill.

14. Azotemia

accumulation in the blood of nitrogen-bearing waste products (urea) that are usually excreted in the urine, common in renal failure

14. Acute Renal Failure

reversible. caused by major trauma, surgery, infection, hemorrhage, severe heart failure, lower urinary tract obstruction.

Prerenal disorders are nonneurologic conditions that disrupt renal blood flow to the nephrons, affecting their filtering ability. This is the most common type of ARF. Intrarenal conditions are conditions in the kidney itself that destroy nephrons. Postre- nal disorders usually are obstructive problems in structures below the kidney(s) that have damaging repercussions for the nephrons above.

s/s oliguria, rising BUN or serum creatinine levels.
three phases: initiation, maintenance, recovery.

14. End Stage Renal Disease

ESRD - progressive, irreversible, deterioration of renal function resulting in retention of uremic waste products. uremia eventually develops. when this develops, s/s occur like nausea, apathy, weakness, fatigue, confusion. diabetic nephropathy and HTN are the leading causes in the US.

diagnostic tests: serum creatinine/BUN, serum electrolytes, ABGs, CBC, U/A, kidney biopsy

treatment includes diet, fluid management, medications, and renal replacement therapies like:
dialysis
hemodialysis
continuous renal replacement therapy
peritoneal dialysis
continuous ambulatory peritoneal dialysis

14. Dialysis

the process by which uric acid and urea are removed from circulating blood by means of a dialyzer.

14. Hemodialysis

Method to remove impurities by pumping the patient's blood through a dialyzer, the specialized filter of the artificial kidney machine.

• Inspects the skin over the fistula or graft for signs of infection.
• Palpates for a thrill (vibration) over the vascular access or listens for a bruit, a loud sound caused by turbulent blood flow. If absent, the nurse postpones further use and reports findings.
• Notes the color of skin and nailbeds and mobility of fingers.
• Washes the skin over the fistula or graft with soap and water or antiseptic.
• Avoids puncturing the same site that was used previously.
• After dialysis is completed, does not administer injections for 2 to 4 hours. This allows time for the metabolism and excretion of heparin, which is administered during dialysis, to reach safe levels.
• Before discharging the client, observes for disequilibrium syndrome, a potential complication.

14. Peritoneal Dialysis

method of removing impurities using the peritoneum as the filter; a catheter inserted in the peritoneal cavity delivers cleansing fluid (dialysate) that is washed in and out in cycles

14. Continuous Renal Replacement Therapy

CRRT: For acute renal failure
Allows slower removal of toxins and fluids (over days vs hours)
Less hemodynamic instability
Does not require dialysis nurse, does require special training (ICU)
Vascular access with double lumen catheter in femoral, jugular or subclavian vein
Uses good pump to move blood thru system
Monitor ultrafiltrate--should be clear yellow (if blood stop infusion could be rupture of filter membrane)
Monitor wt, I/O hourly, VS, lab values
Monitor potency of access

14. Continuous Ambulatory Peritoneal Dialysis

CAPD: provides ongoing dialysis as the patient goes about his or her daily activities. in this procedure, a dialysate solution is instilled from a plastic container worn under the patient's clothing. about every 4 hours, the used solution is drained back into this bag and the bag is discarded. a new bag is then attached, the solution is instilled, and the process continues

14. Kidney Transplant

The removal of a kideny from a living donor or cadaver and implantation into the patient. It's performed due to acute or chronic endstage renal failure. In this surgery, only the upper part of the ureter (supplied by the renal artery) is transplanted with renal vessels and the kidney--> upper part of the ureter is attached to the bladder and the renal artery is jointed to the external iliac artery.

14. Intermittent Peritoneal Dialysis

Treatments for IPD are performed with the same type of machine as that used for CCPD; however, the process occurs periodically, with perhaps several days between dialysis treatments. Whe n IPD is done, sessions may last 24 hours. The total time spent on IPD is between 36 and 42 hours per week.

14. Checking for patency of the stent:

thrill/bruit. You feel (palpate) a thrill--which feels like a purring vibration and listen (auscultate with the bell) for a bruit, which sounds like a swooshing sound

14. Thrill/Bruit

You look for the dialysis fistula on the arm, which looks like a huge lumpy vein. You should be able to easly palpate the thrill, which is a strong vibtation of blood going bettween the vein and artery. The bruit is merely the sound you hear over that same spot, heard with a stethescope.

14. Immunosuppressive Drugs for Kidney Transplants

Azathioprine (Imuran)
Corticosteroids (Prednisone)
• Cyclosporine—available as a microemulsion (Neoral), which provides a more sustained concentration
• Tacrolimus (Prograf)—similar to cyclosporine but more potent
• Other combinations, including:
• Mycophenolate mofetil (CellCept)—specifically for preventing kidney transplant rejection
• Sirolimus(Rapamune)
• Antithymocyte mofetil (Thymoglobulin)
• Muromonab-CD3 (Orthoclone OKT3)—a monoclonal antibody

14. S/S of Chronic Renal Failure

Cardiovascular
Congestive heart failure, hyperten- sion, cardiac dysrhythmias, edema

Metabolic
Electrolyte imbalance, metabolic acidosis

Respiratory
Shortness of breath, pulmonary edema

Gastrointestinal
Malnutrition, vitamin deficiencies, anorexia, nausea, bleeding

Integumentary
Dry skin, pruritus

Neurologic
Lethargy, confusion, depression, seizures, coma

Sensory
Peripheral neuropathies

Musculoskeletal
Bone demineralization, muscle cramps, joint pain

Immunologic
Impaired immune function, decreased antibody production, increased incidence of hepatitis B and other infections

15. Meds For Urinary System: Diuretics

Loop (Bumex, Lasix)

Potassium Sparing (Aldactone)

Osmotic (Mannitol)

Thiazide (Microzide, Zaroxolyn)

15. Meds For Urinary System: Electrolytes

Potassium

Sodium

Calcium

15. Meds For Urinary System: Urinary Anti-Infectives

Bactrim - this is a sulphanomide used to treat Cystitis. The client should be checked for allergies to Sulpha's before administering this. monitor blood glucose.

Pyridium - Drug used for UTI that changes urine color to red/orange rust color

16. Cryptochidism

undescended testes/ the condition in which the testes do not descend to the scrotum as they during during prenatal development. because the testes are warmer in the abdomen, sperm cells begin to deteriorate and can lead to sterility. often accompanied by inguinal hernia.

treatment: spontaenous closure is possible. hormonal management - admin of human chorionic gonadotropin (hCG), ochiopexy

increased risk of testicular tumors as an adult.

17. Hypospadias

congenital defect in which the urinary meatus is located on the underside of the penis

18. Epispadias

a congenital abnormality in males in which the urethra is on the upper surface of the penis

19. Hydrocele

accumulation of serous fluid in a saclike cavity, especially the testes and associated structures. usually corrects itself within 1 year, but if longer it is corrected with surgery.

20. Enuresis

Involuntary urination; most often used to refer to a child who involuntarily urinates during the night

21. Vesicoureteral Reflux

Disorder caused by the failure of urine to pass through the ureters to the bladder, usually due to impairment of the valve between the ureter and bladder or obstruction in the ureter.

22. Phimosis

narrowing of the opening of the foreskin so it cannot be retracted or pulled back to expose the glans penis

16. Orchiopexy

operation to bring an undescended testicle into the scrotum

23. Exstrophy of the Bladder

A congenital anomaly characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall., bladder lies open and exposed on the abdomen at birth; caused by failure of the midline to close during embryonic development; requires surgical intervention within 24 hours of birth.

24. Formula for a child's bladder capacity

age in years + 2 = ounces of bladder volume

Bacteriuria

presence of bacteria in the urine

Urethritis

inflammation of the urethra

Ureteritis

inflammation of the ureter

Wilm's Tumor

Most common renal tumor in kids. Presents with huge palpable flank mass and/or hematuria. WT1 gene deletion. WAGR complex= Wilm's Tumor, Aniridia, Genitourinary malformation, and mental-motor Retardation., hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types

Flomax for BPH

alpha adrenergic blocker-blocks alpha adrenergic receptors in the veins and arteries of the bladder outlet and prostate causing relaxation of the prostate capsule and bladder neck thus increasing ease of urine outflow. taken daily at night. SE: orthostatic hypotension, decreased libido, insomnia

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