Upgrade to remove ads
MSII Exam 6 Ch 42, 47
Terms in this set (45)
Hormonal Stimulation of Red Blood Cell Production
Some decline occurs in the erythropoietin, a factor that may contribute to anemia
Age related changes in the urinary system
Loss of nephrons, thickening of membranes in the nephrons, and sclerosis of renal blood vessels.
This causes renal blood flow and glomerular filtration decline.
Physical Examination with Urologic Disorders
Inspection of the skin for color/crystals
Examine the area around the eyes for
periorbital edema, which suggests fluid retention
. Inspect the mouth for moisture and odor.
The rate at which the kidney removes creatinine from the blood, is
the best test of overall kidney function
Urine collection from 12-24hours
Blood Tests: BUN, Serum Creatinine
BUN is a general indicator of the kidney's ability to excrete urea. In the oliguric stage of renal disease BUN increases
Common Therapeutic Measures: Catheterization, Ureteral Cath
Catheterization provides the potential for introduction of bacteria in the normally sterile bladder. This is the primary cause of HAIs. Aseptic technique is essential. Watch for catch patency.
Urologic surgery: Post-Op Care
Closely monitor output. Urine output of less than 30mL/h should be reported to the MD. Foods and fluids are withheld until bowel sounds are present.
Medications for Urinary Disorders: Diuretics General/Lasix, Phosphate Binder, Aminoglycoside
Diuretics: monitor pt's I&O, BP, and wt. Assess for electrolyte imbalances. Monitor serum potassium level.
Phosphate Binder: (treats hypocalcemia) binds with phosphate in the intestines to prevent absorption.
Aminoglycoside: can cause ototoxicity, hepatotoxicity, nephrotoxicity, neurotoxicity; Be sure to assess the patient's hearing. Drug should be stopped if patient has tinnitus or subject hearing loss.
Commonly caused by bacterial contamination.
Signs/Symptoms, medical treatment of Cystitis
S/S: urgency, frequency, dysuria, hematuria, nocturia, bladder spasms, incontinence, and low-grade fever.
Medical Tx: Pyridium medication ordered for 2-3 days to decrease discomfort and bladder spasms.
Interventions for Cystitis
Encourage pt to drink 30mL/kg of fluid per day and to void often.
Advise pt that phenazopryidine can cause orange-red urine and can stain clothing.
Patient Teaching for Cystitis
Wear cotton underwear, avoid tight fitting clothing in perineal area, avoid drinks (caffeinated and acidic) that irritate the bladder, maintain high fluid intake and empty bladder often, women - wipe front to back, drink a glass of water before and after intercourse to "flush" the urethra
Signs/Symptoms of pyelonephritis
Acute: High fever, chills, nausea, vomiting, and dysuria. Severe pain or a constant dull ache occurs in the flank area.
Chronic: bladder irritation, chronic fatigue, and a slight aching over one or both kidneys
Immunolgic Renal Disease: Acute Glomerulonephritis
A common type follows an infection of the respiratory tract caused by A-negative hemolytic streptococcus
Glomerular filtration decreases, mild to sever hypertension occurs and hypervolemia results.
Medical Diagnosis, Medical Treatment of Glomerulonephritis
Dx is based on assessment and lab results.
Abx are indicated if evidence of current streptococcus infection exists.
As long as UA shows protein and BP is elevated, pt should be on bedrest
Ineffective Self-Health Management with glomerulonephritis
Pts need to understand that rest, dietary restrictions, and medications promote recovery.
Urinary Tract Obstruction: Renal Calculi - Prevention
High fluid intake to keep urine dilute, dietary restrictions for specific elements depending on the type of stones, regular exercise, and occasionally medication to alter the urine pH. 2L/day
Bruising over the flank and lower back that occurs with retroperitoneal bleeding is called Grey Turner sign.
Elevated serum potassium: interferes with normal cardiac function, causing cardiac dysrhythmias (potentially fatal). Pt may become apathetic and confused and may have nausea, abdominal cramps, muscle weakness, and numbness of extremities.
Normal range: 9-11 mg/dL or 4.5-5.5 meq/L
Serum potassium greater than 6 mg/dL requires cardiac monitoring.
Neurologic System, Musculoskeletal System issues R/T urologic disorders
Neurologic effects of chronic kidney disease at mental status changes (lethargy, irritability, confusion) and peripheral neuropathy.
Musculoskeletal system changes 1) metastatic calcification 2)
bone demineralization (directly related to hypocalcemia - which puts pt at risk for injury)
and 3) osteitis fibrosa.
Hemodialysis: Access Sites
Check pulses below the shunt to ensure adequate circulation. Check for thrill (rippling sensation) and buit (swoosh)
An internal connection between the pt's artery and vein is called a fistula. This requires approximately 6 to 8 weeks to mature and may be used for 3 - 5 years.
Advantages of peritoneal dialysis over hemodialysis include less anemia, reduced cost of equipment, fewer dietary and fluid restrictions, independence, and
closer resemblance to normal kidney function
Kidney donors must be at least 18 years of age, be free of systemic disease or infection, have not history of cancer or renal disease, have normal renal function, and be without major medical problems.
Post-Operative Nursing Care: Impaired Urinary Elimination
Urine is pink to bloody initially and then gradually clears.
Anatomy & Physiology of the Thyroid Gland
When the metabolic rate falls, the hypothalamus stimulates the pituitary glad to secrete thyroid-stimulating hormone (TSH). This hormone in turn stimulates the thyroid gland to secrete hormones that affect the production and use of energy.
Age Related Changes in Thyroid function
Mild thyroid dysfunction may, in fact, reflect the body's decreased use of thyroid hormone because of the age related decline in lean body mass.
= lower dose TH
Disorders of the Thyroid Gland: Hyperthyroidism
Also known as thyrotoxicosis, is characterized by abnormally
increased synthesis and secretion of thyroid hormones.
S/S restlessness, irritable behavior, sleep disturbances, emotional lability, personality changes, hair loss, and fatigue.
Diagnostic Test & Procedures: Serum T3/T4, Radioactive Iodine, Thyroid Scan
Serum T3 and serum T4
Elevated T3- Grave's Disease
Elevated T4- Hyperthyroidism
Low T3/T4- Hypothyroidism
Pharmacology Capsules for Endocrine Disorders
Patients on antithyroid drugs must be monitored for hypothyroidism
Iodine solutions can stain the teeth! They should be mixed with a beverage and sipped through a straw.
Drug Therapy: Thyroid Condition- Antithyroid Drugs, Iodides- Interventions
Radioactive iodine - used in thyroid scans. A higher therapeutic dose destroys thyroid tissue in hyperthyroidism and thyroid malignancies. May cause nausea and vomiting.
Precautions with urine 24 hours after the test. Monitor pt for signs of hypothyroidism (fatigue, wt gain)
Surgical Treatment: Thyroid Storm/Thyroid Crisis
Removal of the thyroid gland (subtotal thyroidectomy) may be done endoscopically or through a larger incision across the top of the clavicles.
Antithyroid therapy given several weeks before surgery to prevent thyroid crisis.
Nursing Diagnoses/Goals & Outcome Criteria: Disturbed Sleep Pattern
Improved sleep pattern: absence of insomnia, pt describes feeling rested on awakening.
Disturbed Sleep Pattern, Hyperthermia, Imbalanced Nutrition
Encourage bedtime rituals which may help preparing for sleep, wear light clothing, frequent bathing
Risk for Injury, Impaired Comfort, Diarrhea
It helps to elevate the head of the bed, to reduce bright lighting, and advise the use of tinted glasses
-Hyperthyroid and hypothyroid pt may require adjustments in calorie intake that are appropriate to metabolic needs
-Lack of iodine is associated with development of goiter
-Iodized salt or seafood important source of iodine
-Parathyroid hormone and thyrocalitonin maintain serum calcium levels.
Assessment - Pre-op & Post-op Care: Thyroidectomy
Teaching is primary preop nursing intervention - what does the pt know? Are they anxious? What can we do as nurses to reduce the anxiety? Demonstrate how to avoid straining the neck incision by supporting the head when rising. Evaluate effectiveness of teaching.
assess and document respiratory status
, level of consciousness, wound drainage or bleeding, voice quality, comfort, and neuromuscular irritability (muscle twitching, spasms).
Interventions: Ineffective Airway Clearance
Before the pt returns from surgery, suction equipment, and laryngoscope, an endotracheal tube, oxygen (O2), and
an emergency tracheotomy tray must be available
Thyroid Crisis/Thyroid Storm post thyroidectomy
~12 hrs post op, a pt in thyroid crisis shows signs of severe hyperthyroidism (tachycardia, cardiac dysrhythmias, vomiting, fever, confusion). If not treated properly, the pt will die as a result of heart failure.
Cause & Risk Factors for Hypothyroid
Atrophy of the thyroid gland, treatment of hyperthyroidism, dietary iodine deficiency, high intake of goitrogens, and defects in thyroid hormone synthesis.
Goitrogens (things that suppress thyroid hormone production):
soybeans, turnips, and rutabagas
propylthiouracil, methimazole, and iodine
Medical Diagnosis of hypothyroidism
Dx is based on laboratory determination of free T4 and TSH.
Treated with hormone replacement therapy, most commonly levothyroixine (synthroid).
Severe, untreated hypothyroidism can progress to myxedema coma. S/S of this are: hypothermia, hypotension, and hypoventiliation
Nursing Diagnosis, Goals & Outcome Criteria: Deficient Knowledge
Improved knowledge: pt describes therapy, self-care, and intent to comply with instructions; pt understands that changes in mental and emotional status are symptoms of his or her condition and that they will improve with treatment.
Risk of Impaired Skin Integrity
Dry skin (common with hypothyroidism) is prone to breakdown. Liberally apply lotions and creams to help maintain moisture and control itching. Reduce frequency of bathing to prevent additional drying of the skin.
Nursing Assessment of Parathyroid Function: Physical Exam
Assess for positive Chvosteck or Trousseau signs which would indicate hypocalcemia.
Chvosteck - spasm of facial muscle when face is tapped over facial nerve
Trousseau - carpopedal spasm that occurs when a BP cuff is inflated above the pt's systolic BP and left in place for 2 -3 minutes.
Signs & Symptoms of hyperparathyroidism
Vague at first - pt may report weakness, lethargy, depression, anorexia, and constipation. Other findings might include mental and personality changes, cardiac dysrhythmias, weight loss, and urinary calculi.
Table 47-4, Comparison of S/S of Hypo/Hyperthyroidism
HYPO: fatigue, weakness, cramps, twitching, urinary frequency
HYPER: poor muscle tone, weakness, bone pain, demineralization, fractures, polyuria, renal calculi
YOU MIGHT ALSO LIKE...
Med-Surg Final Exam
Endocrine system Med-surg
OTHER SETS BY THIS CREATOR
adaptive quizzing chapter 12 central nervous system
Pharm chapter 31
Cushing syndrome and Cushing Disease