Jenna Cohen Exam 5 Study Guide Renal and Urological Conditions RENAL CALCULI UROLITHIASIS Physiology Etiology Renal Calculi Renal Calculi Urolithiasis o The Presence of Calculi Stones in the Urinary Tract foods depending on what kind of stones o Stones comprised of either 75 Calcium Oxalate or Calcium Phosphate Other include Uric Acid Struvite or Cystine Etiology unknown Risk Factors can run in families dehydration not drinking enough fluids o Males more likely o Reoccurrence with family history have stones before age 25 o History of Gout o Excess consumption of alcohol o Bed confinement bed rest Risk Factors RENAL CALCULI Environment o Dehydration o Infection o Immobilization o Obstruction o Urinary stasis or retention o High Alkalinity or Acidity of the Urine Metabolic o and clearance of Purines o Oxalate Production genetic o Intestinal Absorption o Renal Excretion of Calcium System Specific Procedures If Client cannot pass stone May need to prepare client for maybe stone to large may have to break it down may be blocking urinary flow usually give patient a strainer to try to catch the stone use in hat toilet try to collect them if possible but if we don t pass them they are excruciating pain and they can start to block the ureters or kidneys and that can lead to major problems make sure to increase fluids or maybe a laxative like colace Extracorporeal Shock Wave Lithotripsy ESWL Stenting Retrograde Ureteroscopy Percutaneous ureterolithotomy nephrolithotomy Open surgery o Ureterolithotomy Into the Ureter o Pyelolithotomy Into the Renal Pelvis o Nepholithotomy Into the Kidney Concepts Renal Calculi Pain also take something for constipation Infection as not peeing urinary elimination can get blocked bc of the stone and where it may be Impaired Urinary Elimination Fluid and Electrolyte Alterations Nutrition when we know what the stone is made of keep on top of pain it s severe importance of taking meds if they re hurting they don t move or drink so keeping pain under control bc ambulation can help pass the stone increase fluid intake ambulate when they get home as well what to report like if not able to void may need to put a stent in to keep ureter open First Priority Interventions Altered Nutritional Medication for Renal Calculi Administer Prescribed Medications Renal Calculi Aminoglycosides Gentamycin have to worry about renal and liver function and also ototoxicity cranial nerve 8 Thiazide Diuretics Anti gout agents NSAIDS Toradol Narcotic Analgesics Alkalizing Agents Sodium Bicarb To alkalize the Urine when too acidic Physiology Potential Complications RENAL CALCULI Renal Obstruction Can Lead to Renal Failure o Emergency Report immediately to HCP o Prepare the client for removal of stone Hydronephrosis urine backs up into kidney because of partial blockage Teaching Moment Which intervention is a priority of a client experiencing severe pain from renal calculi a Encourage fluid intake to help flush the stone b Ask the client to ambulate to promote draining the bladder c Irrigate the bladder to maintain urinary patency d Administer pain medication as often as ordered Which of these clients would be most appropriate for the RN to assign to the LPN LVN a A 33 year old client who has kidney stones and has an order for lithotripsy b A 43 year old client with cystitis taking PO antibiotics c A 53 year old client with pyelonephritis presenting with acute pain d A 63 year old client with urinary incontinence starting bladder training Renal and Urological Disorders Benign Prostatic Hypertrophy Physiology Benign Prostatic Hypertrophy BPH Enlarged prostate gland impairs outflow of urine from bladder squeeze on ureters and constantly going to the bathroom getting up going often but feel as if they never quite empty because always having compression on the bladder Lead to infection and retention Most common benign tumor in older men May cause problems with urination incidence age 50 Labs and Diagnostics BPH Labs o Prostate Specific Antigen PSA Measures amount of protein produced by prostate gland in blood in level 4 to 10ng ml may indicate cancer o BUN and Creatinine increased could indicate renal damage Diagnostic Tests Procedures o Digital rectal exam DRE enlarged smooth prostate o Transrectal ultrasound TRUS and needle biopsy to R O prostate cancer Surgical Intervention o Transurethral resection of prostate TURP resectoscope go in thru urethra trim excess prostatic tissue enlarges passageway of urethra thru prostate gland First Priority Interventions BPH TURP Transurethral resection of the enlarged segment via a resectoscope closed procedure Newer surgical procedures include o Transurethral needle ablation TUNA o Balloon dilation of the prostate o Transurethral laser incision o Transurethral electrovaporization of the prostate TUVP o Prostatic Stents Safety BPH System Specific Assessments SLOW Slowly symptoms of BPH begins with urinary retention PSA count increase Leaking of urine voiding small amounts frequently Look for the renal function BUN Creatinine Often hard to start urinating and urine stream may be hesitantand interrupted Waking in night nocturia to void First Priority Interventions PEE Pee when feel the urge encourage them to go when they feel the need to go Eliminate drinking large amounts of fluid at one time meds that decrease bladder tone i e anticholinergic decongestants antihistamines etc Ejaculation has been found to release prostatic fluid decreasing size of prostate Concepts BPH Pain Impaired Urinary Elimination Health Promotion Post TURP Infection Risk for Teaching Moment The nurse is caring for a client with BPH which of the following clinical findings are expected Select all that apply a Nocturia b Burning with urination UTIs c Post urination dribbling d Hematuria could have but not expected e Urinary frequency A nurse is preparing a client with a diagnosis of BPH for discharge Which of the following statements by the client alerts the nurse that additional teaching is needed I will urinate on a timed schedule yes you will I will increase my fluid intake to 2 5 3L through out the day don t have too much fluids I will limit consumption of coke red wine and hot peppers a b c d I will continue to take dyphehydromine Benedryl as needed for my allergies anticholinergic Which statement by the client scheduled to have a TURP would indicate a need for further teaching a If I have this surgery I will become impotent b A catheter will be in place to drain my bladder c I