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Adult Health Exam 4: Renal
Terms in this set (147)
What are the regulatory functions of the kidneys?
What are the hormonal functions of the kidneys?
What is an upper urinary tract infection?
What are lower urinary tract infections?
What factors contribute to a UTI?
Obstruction→ incomplete bladder emptying (Calculi)
Diabetes (excess glucose in urine→ bacteria growth)
Age (decreased renal function with age)
Sexual activity (diaphragm, spermicides)
Recurrence of antibiotics
What is cystitis?
Inflammation/infection of the bladder
Most commonly caused by bacteria that move up the urinary tract from the external urethra to the bladder
What is infectious cystitis?
Caused by pathogens in pts bowel or vagina (usually E. coli)
Immunosuppressed or compromised (corticosteroids, DM, HIV/AIDS) may be at risk for fungal UTI
Can lead to life threatening conditions (pyelonephritis or sepsis)
What is viral and parasitic cystitis?
What is non-infectious cystitis?
Chemicals (feminine hygiene products, spermicides), radiation
Complications may be PID, gyn cancers, or endometriosis
What are s/s of cystitis?
Frequent urge to urinate
Blood tinged urine
Hx of UTI (management and prevention)
Hx of DM (Regularly checking BS)
Discomfort in pelvic/lower abdominal area
Geriatric: Increased confusion (urosepsis→ low BP & high HR)
What are labs/diagnostics for cystitis?
Urinalysis: Leukocyte esterase, nitrates, WBCs, RBCs
Type of organism confirmed by urine culture (Also tells us how to treat)
Pelvic US/CT (urinary retention or urinary stone)
Cystoscopy (images of the urinary tract→ if pt has frequent UTIs)
What is non-surgical management for cystitis?
Focus on comfort and teaching about drug therapy, fluid intake (increase to 2-3 L/day), and prevention measures (avoid caffeine and carbonated beverages to prevent bladder irritation)
Diet therapy includes all food groups, calorie increase because of increase in metabolism caused by the infection, fluids, possible intake of cranberry juice (pure), apple cider vinegar preventively
Other pain-relief measures, such as warm sitz baths (2-3x day for 20 mins) (Burning with urination)
What is drug therapy for cystitis?
What is antibiotics are used for tx of cystitis?
Ciprofloxacin (Cipro) and Levofloxacin (Levaquin)
Amoxicillin (Amoxil) and Amoxicillin/Clavulanate (Augmentin)
What is important to know for Trimethoprim-Sulfamethoxazole (Bactrim)?
Take with full glass of water
Stay out of sun
What is important to know for Ciprofloxacin (Cipro) and Levofloxacin (Levaquin)?
Stay out of sun
What is important to know for Amoxicillin (Amoxil) and Amoxicillin/Clavulanate (Augmentin)?
Take with food
Use an additional birth control method
What is urinary antiseptic are used for tx of cystitis?
Nitrofurantoin (Macrobid, Macrodantin)
Take with full glass of water
What is analgesics are used for tx of cystitis?
For bladder pain and burning with urination
Will turn urine orange-red color
Will stain clothing/commode
What is antispasmodics are used for tx of cystitis?
Hyoscyamine (Anaspaz, Cystospaz)
For bladder spasms
Ensure pt reports vision changes, confusion, or tachycardia to physician (drug toxicity)
Wear sunglasses (dilates pupils)
What are nursing diagnoses for cystitis?
Acute Pain r/t bladder spasms
Deficient Knowledge (risk factors for cystitis and drug regimen) r/t information misinterpretation or unfamiliarity with information resources
Urge Urinary Incontinence r/t irritation of bladder stretch receptors causing spasm (e.g., bladder infection)
Risk for Impaired Skin Integrity r/t moisture from incontinence
Ineffective health maintenance (sepsis)
What is urethritis?
Inflammation of urethra causing symptoms similar to UTI
Most common cause in men is STDs
Most common in postmenopausal women (low estrogen levels)
S/s are similar to cystitis: dysuria, pain
What is important to know regarding history/assessment for urethritis?
Lower abdomen/pelvic pain
What are labs/diagnostics for urethritis?
UA: may not have leukocyte esterase or nitrates in urine
Urethral culture (STD)
What meds are used for urethritis?
Antibiotics (same as cystitis)
Postmenopausal→ estrogen cream
What is urolithiasis?
Risk factors: Caucasians, men, obese, elderly, hyperparathyroidism (high Ca and low P), urinary tract obstruction, immobility, urinary retention, dehydration, and hx of gout
Low Ca diet does NOT prevent stone formation
Presence of calculi (stones) in the urinary tract
Ureterolithiasis: Formation of stones in the ureter
Nephrolithiasis: Formation of stones in the kidney
What is important to know for history regarding urolithiasis?
Prior management/prevention of calculi
What are s/s of urolithiasis?
Pain (renal colic)
Worse when stone is moving
Large staghorn calculus rarely causes pain because it is not moving
Oliguria (<30cc/hour or <400cc/day) or anuria (no UOP) needs to be addressed immediately to preserve kidney function
What are labs for urolithiasis?
Urinalysis (WBC, RBC, and bacteria)
Increased turbidity (cloudiness)
WBC (systemic infection)
Calcium (high), Phosphate, Uric acid (high)
What are diagnostics for urolithiasis?
KUB (kidneys, ureter, bladder) X-ray
CT (non-contrast because dye is nephrotoxic)
What is drug therapy for urolithiasis?
Ketorolac (Toradol)→ NSAIDs (lithotripsy needs to be delayed due to risk for bleeding)
Drugs used to aid in stone expulsion: Thiazide diuretic (decreases urinary Ca) and Allopurinol (decreases uric acid)
What are pain-relief measures for management of urolithiasis?
Avoid under dehydration and overhydration (in acute phase can cause more painful passage of stone)
What is minimally invasive surgery for urolithiasis?
Stenting (aids in passing stone)
Ureteroscopy (use ureter scope to assist in passage)
Percutaneous ureterolithotomy or nephrolithotomy (going through pts skin)
Nephrostomy tube is left in place initially
Complications: bleeding at the site, pneumothorax, infection
Monitor urine volume in nephrostomy bag
Assess for presence of blood (normal in first 24hr) in nephrostomy bag
Nephrostomy tube care
What are open surgical procedures for urolithiasis?
Open ureterolithotomy (into the ureter)
Pyelolithotom (into the kidney pelvis)
Nephrolithotomy (into the kidney)
What is lithotripsy?
Extracorporeal shock wave lithotripsy (ESWL) uses sound, laser, or dry shock wave energy to break the stone into small fragments
Shock waves are delivered in sync with patient's R wave
Patient undergoes conscious sedation
Topical anesthetic cream is applied to skin site of stone
Continuous monitoring by EKG
May have a stent placed in ureter prior to procedure (helps with passage of stone)
What are interventions for urolithiasis?
Prevention of infection
Prevention of obstruction
Increase fluid intake
Drugs to treat hypercalciuria→ Thiazide diuretics
For patients with hyperoxaluria→ Allopurinol
For patients with chronic gout→ Allopurinol
Increase caloric intake
Check urine pH
What is urothelial cancer?
Malignant tumors of urothelium-the lining of transitional cells in kidney (2nd most common), renal pelvis (2nd most common), ureters, urinary bladder (most common), and urethra
What are risk factors for urothelial cancer?
Exposure to chemicals (tobacco), chronic cystitis, chronic foleys, >60yo
What are s/s for urothelial cancer?
Clarity of urine (cloudiness, blood)
Urine changes in color, dysuria, urgency, frequency, and amount
What are diagnostics for urothelial cancer?
UA (microscopic hematuria)
What are nonsurgical management for urothelial cancer?
What are preoperative management for urothelial cancer?
Types of urinary diversions
Discuss sites for stoma
Teach self-management for stoma
What is surgical management for urothelial cancer?
Complete (total removal of bladder) or partial cystectomy
Neobladder (bladder reconstruction)
Ureterosigmoidostomy (urine comes out when patient has a bowel movement)
What are postoperative management for urothelial cancer?
Collaboration with enterostomal therapist (ET)
External patch over ostomy
Surgeon removes the cancerous bladder (cystectomy)
Then they must isolate and reshape a section of the small intestines.
Patient must have full kidney function
No sensation of bladder fullness (sensory nerves are not attached) → void routinely
This section of intestine is made into a spherical shape and becomes the neobladder
Diet (avoid gas producing foods)
Catheterization/ stoma care
Neobladder→ significant weight loss may occur→ collaborate with dietician
Teaching plan upon discharge→ Return demonstration
What is polycystic kidney disease (PKD)?
Inherited disorder (autosomal dominant/recessive) in which fluid-filled cysts develop in the nephrons
Polycystic kidneys become 2-3 times larger than normal- like a football, weigh 10 or more lbs
Autosomal dominant (most common)
Symptoms do not develop till age of 30
Renal failure by 50 yo
Affected at birth
Infant dies in early childhood
Cysts may occur in kidneys but can also occur in liver (low liver function) and blood vessels (risk for aneurysm→ bleeding→ death)
Fluid filled cysts can lead to infection
Cysts can rupture and bleed→ increased pain
Early management of HTN (may slow the progression of kidney disease)
Most common in caucasians, M = F
What are key features of polycystic kidney disease (PKD)?
Abdominal or flank pain
Increased abdominal girth
Bloody or cloudy urine
What is important for hx for polycystic kidney disease (PKD)?
When problems started occurring
Family history of sudden death (stroke)
What are s/s of polycystic kidney disease (PKD)?
Signs of infection
What are labs for polycystic kidney disease (PKD)?
UA (hematuria, proteinuria, and bacteria)
What are interventions for pain and prevention of infection in polycystic kidney disease (PKD)?
Dry heat on abdominal area
Complimentary additional therapies
Aspiration & drainage of cysts (they usually fill back up)
What are interventions for constipation in polycystic kidney disease (PKD)?
Increase fluid intake
High fiber diet
What are interventions for controlling HTN and preventing ESRD in polycystic kidney disease (PKD)?
Drug therapy: ACE inhibitor (reduces microalbuminuria)
What is a urinary obstruction?
Blockage of urine outflow leads to progressive dilatation of urinary tract proximal to obstruction, eventually causes compression atrophy of kidneys
Goal is to promptly identify and treat to prevent further kidney damage
Problems of urine outflow obstruction
Hydronephrosis (dilation of renal pelvis) → caused by obstruction in the UPPER part of the ureter
Hydroureter (enlargement of ureter) → caused by obstruction in the LOWER part of the ureter
What are causes of a urinary obstruction?
What is involved in assessment in a urinary obstruction?
Pattern of urinary elimination
Recent flank/abdominal pain
What are labs for a urinary obstruction?
Na, K, Phos
Metabolic defects (acidosis)
What are interventions for a urinary obstruction?
Urinary retention and potential for infection are the primary problems
Failure to treat the cause of obstruction leads to infection and ESRD
Urologic Interventions: Stenting
What are radiologic interventions for a urinary obstruction?
Hydronephrosis if urologic procedure does not work→ nephrostomy
NPO for 4-6hr
Must have normal clotting studies
Pt is given drugs to reduce HTN
Procedure: Prone position
Assess amount of drainage in collection bag (first 24hr may be blood tinged)
Notify physician if drainage decreases or stops (clogged/dislodged) or if drainage looks cloudy or foul smelling (infection) or if site leaks blood or urine
Notify physician if pt has back pain
What is pyelonephritis?
Bacterial infection in kidney and renal pelvis (upper urinary tract)
What are acute s/s of pyelonephritis?
Active bacterial infection
Fever, chills, tachycardia, tachypnea
Flank or back pain
Abdominal discomfort, N/V
Burning, urgency, frequency, nocturia
General malaise or fatigue
Recent cystitis or tx for UTI
What are chronic s/s of pyelonephritis?
Urinary tract defect or urine reflux
HTN, decreased urine, Inability to conserve sodium
Decreased ability to concentrate urine
Development of hyperkalemia and acidosis
What are labs/diagnostics of pyelonephritis?
Urinalysis (WBC, bacteria)
BUN, Creatinine, GFR, Ca, Phos, Na
What is nonsurgical management for pyelonephritis?
Goal is to control the source of infection
Diet therapy: Increase fluid intake
What is surgical management for pyelonephritis?
Pyelolithotomy (removal of a large stone in renal pelvis)
Nephrectomy (removal of kidney)
Ureteroplasty (ureter repair or revision)
What is glomerulonephritis?
Immunologic processes involving the urinary tract affect the glomerulus
Third leading cause of ESRD
Hematuria and urinary excretion of various formed elements—RBCs, WBCs, and proteins
What are s/s of glomerulonephritis?
What are risk factors of glomerulonephritis?
Lupus, diabetic nephropathy, HIV associated nephropathy, sickle cell, HepC, HepB, Strep throat
What is chronic glomerulonephritis?
Develops over period of 20 to 30 years or longer
The glomerular damage allows proteins to enter the urine→ Chronic glomerulonephritis always leads to ESRD
What is important for assessment in chronic glomerulonephritis?
Systemic diseases that are damaging to kidney
Changes in urine
What are diagnostics for chronic glomerulonephritis?
UA (protein, RBC)
What are interventions for chronic glomerulonephritis?
Slowing progression, preventing complications (ESRD)
Drug therapy (control HTN, control Ca/Phos)
Dialysis or transplantation
What is renal cell carcinoma?
Most common type of kidney cancer AKA Adenocarcinoma of the kidney
Renal cell tumors are highly vascularized
What are risk factors for renal cell carcinoma?
Smoking, tobacco use
What are s/s for renal cell carcinoma?
Hypercalcemia (parathyroid hormone)
Liver dysfunction with elevated liver enzymes
Increased ESR and C-Reactive protein
What are paraneoplastic syndromes for renal cell carcinoma?
Liver dysfunction with elevated liver enzymes
Increased sedimentation rate
What are complications for renal cell carcinoma?
Metastasis, UTI, spreading to adrenal glands, liver, lungs
What is important in assessment for renal cell carcinoma?
Obvious blood in urine (late sign)
Breast enlargement (changes in hormones)
What are labs/diagnostics for renal cell carcinoma?
What is nonsurgical management for renal cell carcinoma?
What is surgical management for renal cell carcinoma?
Monitor for hemorrhage (drop in BP)
Monitor for infection
Look at adrenal insufficiency (steroid replacement)
What are the functions of the kidneys?
A - Acid - Base Balance
W -Water Removal
E - Electrolyte Balance
T -Toxin Removal
B -Blood Pressure Control
E - Erythropoietin Production
D -Vitamin D Metabolism
What are causes of renal failure?
Kidney disease is progressive and irreversible
HTN/large vessel disease
Medications (NSAIDs, contrast dye, anti-rejection drugs, and recreational drugs)
How to slow kidney disease progression?
Blood Pressure Control
Diet (Na restriction)
Blood sugar control
Lower Cholesterol levels
Do NOT overuse over-the-counter pain pills and recreational drugs
Minority population are more at risk
Avoid exposure to chemical and environmental pollutants
What are consequences of kidney disease?
Increase in blood urea nitrogen (BUN) levels
Increase in blood creatinine levels
Elevated blood electrolyte levels and fluid retention
Low vitamin D levels → low blood calcium levels → elevated parathyroid hormone
Renal osteodystrophy (falls, fractures, tooth decay)
Loss of serum proteins
What is chronic kidney disease?
A progressive, irreversible disorder and kidney function does not recover
Develops slowly over months to years
Azotemia (build up of N waste products)
Uremia (clinical manifestations of azotemia)
Uremic syndrome (uremia has gotten severely worse)
What are causes of chronic kidney disease?
Diabetes, hypertension, lupus, glomerulonephritis, infections, medications, toxins
What are s/s of chronic kidney disease?
Weakness, loss of appetite, N/V
Toxic manifestations from retained waste products (confusion)
Edema: retention of salt and water (SOB)
What is tx for chronic kidney disease?
What is stage 1 of kidney disease?
GFR: >90 mL/min
At risk, normal kidney function but urine findings or structural abnormalities point to kidney disease
What is stage 2 of kidney disease?
GFR: 60-89 mL/min
Mild CKD, reduced kidney function, labs and other findings point to kidney disease
Focus on reduction of risk factors (BP, fluid control, diet)
What is stage 3 of kidney disease?
GFR: 30-59 mL/min
Moderate decrease in GFR
Fatigue, Anemia, Edema
Strategies to slow progression of CKD
What is stage 4 of kidney disease?
GFR: 15-29 mL/min Severe decrease in GFR
Manage complications of CKD, educate, possible dialysis
What is stage 5 of kidney disease?
GFR: <15 mL/min Kidney Failure (ESRD); Begin dialysis or kidney transplant
What are kidney changes with chronic kidney disease?
Abnormal urine production
Poor water excretion
Increased BUN and creatinine
What are metabolic changes with chronic kidney disease?
What are electrolyte changes with chronic kidney disease?
Late→ HTN and edema
Imbalances of Ca and Phos (PTH): High Phos: itchiness
What are cardiac changes with chronic kidney disease?
What are hematologic changes with chronic kidney disease?
What are GI changes with chronic kidney disease?
What is important in history for chronic kidney disease?
Family hx of CKD, DM, HTN
What are important neurological s/s in chronic kidney disease?
What are important cardiovascular s/s in chronic kidney disease?
Extra heart sounds
Rate and rhythm
What are important respiratory s/s in chronic kidney disease?
What are important hematologic s/s in chronic kidney disease?
Black tarry stools
What are important GI s/s in chronic kidney disease?
What are important urine s/s in chronic kidney disease?
What are important skin s/s in chronic kidney disease?
Uremic froths (due to build up of toxins)
What are diagnostics for chronic kidney disease?
What are comobidities for chronic kidney disease?
What are complications of chronic kidney disease?
MBD (mineral bone disease)
What are MBD complications of chronic kidney disease?
Secondary to hyperparathyroidism
Watch Phos intake
Phos binders may or may not contain Ca (must be taken with food)
Active vitamin D
What are anemia complications of chronic kidney disease?
Synthetic erythropoietin (lowest dose possible so it doesn't increase BP)
Iron (take with a stool softener and high fiber diet)
What are nutrition complications of chronic kidney disease?
Watch Phos intake (foods high in Phos: dairy, whole grains, peas, beans, dark sodas)
Limited protein (unless on dialysis→ then need more protein)
What are acid-base complications of chronic kidney disease?
Bicarb is needed due to acidosis
What medications are used to tx kidney failure?
Vitamins and supplements
Erythropoietin-stimulating agents (ESAs)
What loop diuretics are used to tx kidney failure?
Monitor I&Os and electrolytes
What phosphorus-lowering medications are used to tx kidney failure?
Calcium acetate (PhosLo)
Calcium carbonate (Caltrate)
Lanthanum carbonate (Fosrenol)
Sevelamer (Renagel, Renvela)
Take with food
What vitamins and supplements are used to tx kidney failure?
Multivitamin and Folic acid
Iron: Ferrous sulfate (Feosol); iron sucrose (Venofer)
Vitamin D: Calcitriol (Rocaltrol); paricalcitol (Zemplar); doxercalciferol (Hectorol)
Take after dialysis tx
What Erythropoietin-stimulating agents (ESAs) are used to tx kidney failure?
Epoetin alfa (Epogen, Procrit) → Darbepoetin (Aranesp)
Lowest dose possible
Parathyroid hormone modulator→ Cinacalcet (Sensipar) (Not for severe hypocalcemia)
What is dialysis?
The process of cleaning the blood by removing waste and fluid build-up when the kidneys fail through a semipermeable membrane
Both blood and dialysate are pumped through the dialyzer at the same time
Dialysis only replaces 15% of kidney function
What are the benefits of peritoneal dialysis?
Self-care Treatment: Can be done alone or with a partner
Training usually takes a couple of weeks
Fits into the patients lifestyle
Allows working patients to keep their jobs
Fewer diet and fluid limits
Can be done while patient sleeps
What is peritoneal dialysis?
Uses the peritoneum for removal of wastes, toxins, and excess fluids
After catheter inserted, skin is cleaned with antiseptic solution and sterile dressing applied
Waiting period of 7 to 14 days preferable
2 -4 weeks after implantation exit site should be free of redness and tenderness
Patient may shower and pat dry once site is healed
Slower process, but less incidence of electrolyte imbalance as with hemodialysis
Dialysis Additives (electrolytes, intraperitoneal heparin, insulin)
2 most common types of PD
Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis (APD)
What is hemodialysis?
Uses a dialyzer
Done 3x/week and treatment usually lasts about 3-5 hrs
Most frequently used to replace the function of the kidneys
Substitutes for the functions of the kidneys by removing waste products from patient's blood
Waste products in patient's blood diffuse across a semipermeable membrane into a solution (dialysate) into the other side of the membrane
Patient selection- home hemo vs community/ freestanding dialysis center
What is a PD catheter?
Patient selection→ Not allowed to have intra-abdominal surgery
Fill peritoneal cavity with dialytic fluid
Number and cycle depends on prescription
What is continuous ambulatory peritoneal dialysis (CAPD)?
CAPD is performed by the patient with the infusion of four 2-L exchanges of dialysate into the peritoneal cavity
Each time, the dialysate remains for 4 to 8 hours, and these exchanges occur 7 days a week
What is automated peritoneal dialysis?
APD uses a cycling machine for dialysate inflow, dwell, and outflow according to preset times and volumes
Done while patient sleeps: 8-12 hours
Less chance of peritonitis
Machine has a warmer for the fluid (helps with irritation)
What does normal PD effluent look like?
Clear, light yellow
What does cloudy PD effluent signify?
What does brown PD effluent signify?
What does amber PD effluent signify?
What does bloody PD effluent signify?
Common for first few treatments (clear up within 1-2 weeks)
What are complications of PD?
Peritonitis: Cloudy or opaque effluent is the earliest indication
Fibrin in fluids
Exit site and tunnel infection
Exit site infection: Redness at site and drainage
Tunnel infection: Red streak along catheter tract
Yeast grows or deep cuff infection→ catheter is removed
Poor dialysate flow (constipation, needs repositioning, or catheter is kinked)
Dialysate leakage (obesity): Must resolve before returning to PD
What is peritonitis?
Major complication of peritoneal dialysis
Most common cause is connection site contamination
To prevent peritonitis, use meticulous sterile technique when caring for the PD catheter and when hooking up or clamping off dialysate bags
Use mask, hand washing, turn fan off when connecting/disconnecting, remove pet from room
Cloudy effluent, elevated temp, abdominal pain, >100,000 culture count (most often Staph epidermidis and Staph aureus)
Treated at home or hospital
What are types of hemodialysis accesses?
Central Venous Catheters (Quinton/VasCath) (temporary)
Fistula (own pts vein and artery are connected)→ Two humps
Graft (synthetic connection of vein and artery)→ Looped or straight
Feel the thrill, hear the bruit
What are the advantages of AV fistulas?
Less chance of Infection
What are the disadvantages of AV fistulas?
Slow to develop
Stenosis may develop
Takes longer to mature (2-4 months)
What are the advantages of AV graft?
Takes less time to mature (few weeks)
Easier to cannulate
What are the disadvantages of AV graft?
More prone to Thrombosis (clotting)
More likely to develop a stenosis
What are the advantages of catheters?
Good for urgent use
Can be hidden under clothing
Pt able to move more freely
What are the disadvantages of catheters?
Lower blood flow leading to poor adequacy
Leads to infection
Thrombosis or stenosis
What is involved in caring for a patient with AV graft/fistula?
Do not take blood pressure readings using the extremity in which the vascular access is placed.
Do not perform venipunctures or start an IV line in the extremity in which the vascular access is placed.
Palpate for thrills and auscultate for bruits over the vascular access site every 4 hours while the patient is awake.
Assess the patient's distal pulses and circulation in the arm with the access.
Elevate the affected extremity postoperatively.
Encourage routine range-of-motion exercises.
Check for bleeding at needle insertion sites.
Assess for manifestations of infection at needle sites.
Instruct the patient not to carry heavy objects or anything that compresses the extremity in which the vascular access is placed.
Instruct the patient not to sleep with his or her body weight on top of the extremity in which the vascular access is placed.
What is involved in caring for a patient undergoing hemodialysis?
Weigh the patient before and after dialysis.
Know the patient's dry weight.
Discuss with the health care provider whether any of the patient's drugs should be withheld until after dialysis.
Be aware of events that occurred during previous dialysis treatments.
Measure blood pressure, pulse, respirations, and temperature.
Assess for manifestations of orthostatic hypotension.
Assess the vascular access site.
Observe for bleeding.
Assess the patient's level of consciousness.
Assess for headache, nausea, and vomiting.
What are complications of hemodialysis?
Dialysis disequilibrium syndrome (DES)
Reactions to dialyzers
The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply)
A. Cleanse the perineum from back to front after using the bathroom.
B. Try to take in 64 ounces of fluid each day.
C. Be sure to complete the full course of antibiotics.
D. If urine remains cloudy, call the clinic.
E. Expect some flank discomfort until the antibiotic has worked.
The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first?
A. A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C)
B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours
C. A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy
D. A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
After receiving change-of-shift report on the urology unit, which client does the nurse assess first?
A. Client post radical nephrectomy whose temperature is 99.8° F (37.6° C)
B. Client with glomerulonephritis who has cola-colored urine
C. Client who was involved in a motor vehicle crash and has hematuria
D. Client with nephrotic syndrome who has gained 2 kg since yesterday
When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? (Select all that apply)
A. Suprapubic pain
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