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Calcium phosphate ( prelief
Alkalinizating agent
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-
-
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KUB
- Xray of kidneys ureters and bladder
- bowl prep maybe ordered
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IVP
- Visualizes urinary tract after iv contrast
- Not for CRF patients because dye is nephrotoxic
- Iodine allergies?
- Bowel prep
- warn them that it will be warm
- seeing if there is a blockage, hydroonephrosis
- ic,
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VCUG
Voiding cystourethrogram
- Opening of urethra neck
- bladder filled with contrast media
- Fluroscopic films are taken, patient pees then another film to look for residual. Can detect abnormailities of the lower urinary tract , uretheral stenosis, bladder neck obstruction, prostatic enlargement
- Checking for reflex
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Cystoscopy
- inspects interior of bladder with tubular lighted scope
- complications include urinary retention, urinary tract hemmorrage, bladder infect. and perforation of the bladder
- Inoffice steril procedure, monitor urine output and will have some blood tinged urine for 24 hour peird, orthostatic hypotention is normal so risk of falls
- Invasive, informed consent, no dye
- IC, Pyelonephritis
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Loop of henley decreases what electroylte
Potassium
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If someone has diabetes or hypertention, what does that mean for the kidneys?
Not getting adequate blood supply, will have deterioration
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Normal PH of the urine
3 or \4
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What is the one symptom that diferentiates interstital cystitis from uti?
pain relieved by urination
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What antidepressant is used for ic?
Elavil is the most common
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What 3 types of medications are instilled for treatment of ic?
- DMSO- desensitizes pain receptors
- Heperin and hyluronic acid- use linocain before, inhances protective properties.
- Bacille Clamette-Guerin (BCG)
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What should patients avoid with IC
- High potencty vitamins
- caffeine, alcohol. chocolate, juice, cheeses, peppers
- Make sure they are compliant because they will be in pain
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Classic symptom of pyelonephritis
CVA tenderness
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Involves interstitial inflammation, tubular cell necrosis, and possible abscess formation
Ingection is scattered in the kidney
fibrosisi AND SCARE TISSURE DEVELOP
calices thicken and scars develop in interstitial tissure
Pyelonephritis
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What would constitute as a positive urinalysis?
Greater that 100,000 colonies of bacteria
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What is the usual type of bacteria infecting the kidneys
Gram neg rods, which is endotoxic and can lead to ureasepsis
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Symptoms of pyelonephritits
ACUTE
- Fever, chills,
- Flank, back, groin pain
- Tender CVA
- Nausea, and vomiting
- general malaise, fatigue
- burning, urgency, frequency (not always)
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Symptoms of pyelonephritits
Chronic
- Nocturia
- Hypertension
- Inability to conserve sodium
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Medical management of pyelonephritis
- Asses the cause first
- Antibiotics- oral or iv
- long term urinary antiseptics
- surgical intervention -possible reflux fix
- fluid therapy: acute phase- large amount, they can get dehydrated
- Diet therapy- stones
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Trimethoprim/sulfamethoxazole (TMP/SMX)
- used to treat inital or uncomplicated pyelonephritits
- inexensive
- taken bid
- e. coli resistance to tmp-smx
- sulfer based: MUST make sure they are not allergic! and MUST drink tons of fluids because will crystallized in the blood
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Nitrofurantoin(Macrodantin)
- Treats pyelonephritis
- three or 4 times a day
- long-term use pulmonary fibrosis and neuropaties
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Cipro- fluroquinolones
Treat uncomplicated uti's
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Pyridium
- analgesic
- soothes the urintary tract
- urine is reddish orange
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Urised
- used to relieve uti symptoms
- blue to green urine
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If on long term antibiodics what do you need to keep in mind?
What BUN and creatinine
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Nursing interventions with pyelonephritis
- Monitor I&Os
- Temperature management
- Assess labs- BUN/Creatinine/Specific gravity/WBC
- Compliance with medication- finish antibodics!
- EDUCATION
- FOLLOW UP
- Pain Management
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Symptoms of BPH
- Urgency
- Nocturia
- Hesitancy and Intermittency
- reduced force and size of stream
- post void dribbling
- hematuria (may have)
- Increase uti
- nontender enlargement by digital exam
- feeling of bladder fullness
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Diagnosics of BPH
- Digital rectal exam
- urinalysis
- cbc
- bun/creatinine
- psa and acid phosphatase- rule out cancer
- kub
- ivp
- flowmetrics via cystoscope-how much blockage
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Conservative treatment for BPH
- Proscar (shrinks prostate)
- Hytrin and Flomax: alpha-adrenergic blockers (constricts prostate, improve urine flow)
- Hormonal agents: estogens and androgens
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Surgical treatment for BPH
Turp-
- TURP: closed surgical procedure using scope. rotorudder the prostate, huge catheter after procedure (30french) with 30 ml ballon. 2 ports, flush bladder- prevents clots and reduces the bleeding.
- Patient will have decrease hematocrit, hemoglobin
- MUST Have a CBI (CONTINOUS BLADDER IRRIGATION)
- Dr may use traction
- If clots will be in severe pain, bright red pee, you need to speed up the irrigation flow.
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B&O
medication to stop bladder spasms
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BPH
Bladder incision
Suprapubic prostatectomy
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BPH
Abdominal incision
Retro prostatectomy
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Crede method
For paralysed people, massaging the bladder down to help pee
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Androgen-dependant adenocaricoma
Prostate cance
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What 3 routes does prostate cancer spread
- Direct extension
- Through lymph system
- Through bloodstream
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PSA Diagnostics
- Prostate-specific antigen
- Elevated level indicate prostatic pathology-not definative diagnosis of cancer
- Marker of tumor volume when cancer exists
- Also used to montior treatment
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DRE Diagnostics
- Digitial rectal exam
- abnormal prostate finding include hard, nodular, and asmmetric prostate.
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Elevated levels of PAP(prostatic acid phosphatase) indicateds what
cance
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What test shall be done to definatively diagnose prostate cancer
- Biopsy
- Bone scan, CT, MRI with endorectal probe and TRUS(transrectal ultrasound)
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Signs and Symptoms of prostate cancer
- frequent urination, esp. at night
- difficult starting urination, or holding back urine
- Weak or inturrupted flow of urine
- painful or buring urination
- difficultiy haveing an erection
- painful ejaculation
- blood in urine and semen
- frequent pain or stiffness in the lower back, hips, or upper thighs
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Prostate cancer
medical mangement
Conservative managemet
- Watchful waiting when life expectancy is less that 10years
- resence of significant co morbid disease
- Presense of low-grade, low stage tumor
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Prostate cancer
Medical Management
Radiation Therapy
- Most widely used method of ratdiation for prostate cancer
- Used to treat cance confined to prostate and or surrounding tissures
- side effects can be acute or delayed
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Prostate Cancer
Medical Management
Bradytherapy
- Implantation of radioactive seed into the prostate gland
- Spares surrounding tissure
- placement guided by transrectal ultrasound
- best suited for stage Aor B
- irritative or obstructive urinary problems are common side effects
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What is the primary therapeutic approach to homornal therapy in prostate cancer?
Androgen deprivation
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Prostate cancer
Luteinizing hormone- most common? Side effects?
- Lupron most common
- hot flashes, gynecomastia, loss of libido, ed
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Prostate cancer
Androgen receptor blocker- Most common? se
- Casodex very common
- loss of libedo, ed, hot flashes, breast pain, gynecomastia
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Chemotherapy- First drug to produce some increased survival rates for prostate cancer, but very expensive. What is also used?
-
Removal of entire prostate gland, Seminal vesicals, and part of bladder neck are moved?
Radical prostatectomy
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Surgical technique that destroys cancer cells by freezing the tissure. Initial and second line treatment after ratdiation fails
Cryosurgery
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What should you monitor post op for major surgury of prostate?
- Urine output
- Peritonitis
- Bleeding
- bladder patency (irrigation or flushes)
- bladder spasms
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