NUR114 Exam 1 Study Guide

NUR 114 Exam 1 Study Guide


RENAL CALCULI
 urolithiasis: formation of stones in the urinary tract; majority composed of calcium phosphate or
calcium oxalate
 nephrolithiasis: formation of stones in kidney; usually found in renal pelvis; acute pain in
controvertebral region
 ureterolithiasis: formation of stones in ureter; pain often describes as wave-like/excrutiating
Types of stones:
 Calcium phosphate/oxalate (75-80%)
o Risk factors: hypercalciuria, hypercalcemia, immobility, steroid use (prolonged), alkaline
urine, dehydration, IBD
o Prevention: adequate fluid intake, avoid foods high in oxalate (spinach, nuts, wheat, bran,
beets, chocolate, peanuts, black tea)
o Treatment: thiazide diuretics, potassium citrate, low sodium, low protein diet, maintain
calcium intake, increase hydration, exercise
 Struvite
o Risk factors: UTI’s (especially Proteus)
o Management: antibiotics, surgery, lithotripsy
 Uric acid
o Risk factors: gout, increased purine intake, acidic urine
o Management: potassium citrate, allopurinol, low protein diet, increase hydration
 Cystine (uncommon)
o Risk factors: genetic defect, acidic urine
o Management: mercaptopropionyl glycine, potassium citrate, penicillamine, sodium
restriction, increase hydration
Risk factors:
 Idiopathic (most), greatest risk factors are family history and prior personal history, decreased fluid
intake/dehydration (elderly), urinary stasis/retention, immobility, urine flow
decreased/concentrated/contains calcium particles.
Expected findings:
 Severe pain (renal colic)
o pain intensifies as calculus move through ureter
o flank pain: calculi in kidney or ureter; if it radiates to abdomen, scrotum, testes, vulva:
calculi in ureter or bladder
 Urinary frequency/dysuria (calculi in bladder)
 Fever
 Diaphoresis
 Pallor
 N/V
 Tachycardia, tachypnea, increased BP (pain), decreased BP (shock)
 Oliguria/anuria
 Hematuria
Complications:
 Obstruction: calculus can block passage of urine into kidney, ureter, bladder; diminishes urinary
output; predisposes pt to hydroureter (enlargement of)
o notify provider, prepare for stone removal
 Hydronephrosis: calculus has blocked portion of urinary tract; urine backs up, kidney distends;
can cause permanent kidney damage
o notify provider, prepare for stone removal
 Urosepsis: occurs with struvite stones; UTI spreads to bloodstream; can lead to organ
failure/shock

, o encourage adequate fluid/nutrition intake, monitor for shock, antibiotic administration, C&S,
monitor for UTI (fever, tachycardia, increased urine turbidity, urine odor, elevated WBC,
pain with urination)
Labs:
 Urinalysis : analyzed for pH (decreased=uric acid, cystine stones; increased=struvite stones),
specific gravity, and osmolarity (hydration status)
Diagnostics:
 UA
 Chem analysis of stone passed
 Urine calcium, uric acid, oxalate levels
 KUB (confirms presence/location of stones)
 IVP (contraindicated if urinary obstruction)
 Renal ultrasonography
 CT scan
 Cytoscopy
Pharmacology:
 Morphine (opioid analgesic)
o used in first 24-36 hr for acute onset
o assess frequently, watch for S/S respiratory depression, monitor for hypotension and
decreased RR, assess LOC
 Ketorolac (NSAID)
o used to treat mild/moderate pain, fever, inflammation
o monitor for S/S of bleeding
 Oxybutynin (spasmolytic)
o decreases bladder spasms, alleviating pain
o monitor for urinary retention, dizziness, tachycardia
o increases intraocular pressure; assess for history of glaucoma
 Gentamicin/Cephalexin (antibiotics)
o treats UTIs
o administer med with food to decrease GI distress
o gentamicin: monitor for nephron/ototoxicity
Nursing Interventions:
 Monitor: pain status, I/O, urinary pH
 Admin IV fluids, pain medications, antibiotics, anti-emetics
 Encourage ambulation
 Encourage increased fluid intake (at least 3 L/day)
 Provide pre-post op care
 Deep breathing, heat, cold, positioning
Lifespan Considerations:
 Children/Adolescents:
o dysuria, hematuria, sharp back/groin/lower abdomen pain, N/V, fever, chills
o children with defects of the urinary tract or with metabolic disorders such as hypercalciuria.
Other risk factors include a family history of kidney stones, dietary factors, and certain
disorders, such as cystic fibrosis, obesity, and repeated UTIs
 Pregnant Women:
o symptoms may be misdiagnosed as appendicitis, diverticulitis, or placental abruption
o renal ultrasonography is the imaging modality of choice
 Elderly:
o usually present with atypical or no pain, fever, diarrhea, pyuria, UTIs, and bacteremia
o more likely to require surgical intervention

, BENIGN PROSTATIC HYPERTROPHY (BPH)
 Enlargement of the prostate gland, causing urinary dysfunction; common condition in
older adult male
Risk Factors:
 increased age, smoking, chronic alcohol use, sedentary lifestyle, obesity, western diet (high
fat/protein/carb; low fiber), DM, heart disease
Expected Findings:
 Urinary frequency, urgency, hesitancy, incontinence
 Incomplete emptying of bladder
 dribbling post-voiding
 nocturia
 diminished urinary stream
 straining with urination
 hematuria
 UTIs (from persistent stasis/retention)
 kidney damage (from backflow of urine into ureters/kidneys)
Complications:
 TURP complications
o urethral trauma, urinary retention, bleeding, infection
o monitor, intervene for bleeding, administer antibiotics
 Complications of procedures to treat BPH include regrowth of prostate tissue and
recurrence of bladder neck obstruction
Labs:
 U/A, culture (UTI = elevated WBC, hematuria, bacteria)
 CBC (WBC elevated)
 BUN/Creatinine (elevated)
 PSA (rule out prostate cancer)
 C&S of prostatic fluid
Diagnostics:
 Digital Rectal Exam
 Transrectal ultrasound with needle aspiration biopsy
 Early prostate cancer antigen
Pharmacology:
 Finasteride (5-alpha reductase inhibitor) (DHT-lowering med)
o decrease testosterone production in prostate
o often decreases size of prostate
o teratogenic in male fetus
o potentially absorbed through skin
 Tamsulosin (alpha-adrenergic receptor antagonist)
o relaxes bladder outlet and prostate gland
o decreases pressure on urethra; re-establishes stronger urine flow
Education:
 frequent ejaculation can decrease prostate size
 avoid intake of large fluid amounts at one time; urinate when urge initially felt
 avoid bladder stimulants (caffeine, alcohol)
 avoid meds that decrease bladder tone (anticholinergics, antihistamines, decongestants)
 smoking cessation
 limit alcohol intake
 regular exercise