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What is a nephrectomy?
A surgical removal of the kidney
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How often is a pt repositioned after a nephrectomy?
Every 2 hours
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What is a nephrostomy?
An incision to drain the pelvis of the kidney
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What can happen if a nephrostomy catheter is clamped?
Acute pyelonephritis
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What happens to the non-functioning kidney during a transplant?
It remain in place until the donor kidney is positioned
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What are the signs and symptoms of transplant rejection or infection?
Increased blood pressure, oliguria, edema
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What is an effective drug used to prevent tissue rejection, yet maintain system immunity?
Cyclosporine
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What is a cystectomy?
Surgical removal of the bladder
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What is the most common urinary diversion?
Ileal conduit (Bricker's procedure)
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Where are the ureters implanted in an ileal conduit?
Into a loop of the ileum that is isolated and brought to the surface of the abdominal wall
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How often is urine flow measured after an ileal conduit?
Hourly - if less than 30 ml/hour it's reported to the doctor
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What should a nurse watch for in a patient with an ileal conduit?
Peritonitis
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What does the presence of ketones in the urine indicate?
Diabetes, starvation
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What does the presence of albumin in the urine indicate?
Increased blood pressure or toxicity of the kidneys
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What type of diet is appropriate for a pt with acute renal failure?
Protein-sparing, high carbs, low potassium & sodium
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What is necessary to identify the level of renal function?
Accurate documentation of urine output
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What is chronic renal failure?
End-stage; kidneys unable to regain normal function
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What are the signs and symptoms of chronic renal failure?
Headache, lethargy, asthenia
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How is a diagnosis of ESRD confirmed?
Bun of 50+ and creatinine of 5+
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What type of diet is important for a pt with ESRD?
High in calories from carbs
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What medical management is instituted for a pt with ESRD?
Conserve renal function as long as possible
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What is dialysis?
The filtration of blood
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What is hemodialysis?
The process of filtering a pt's blood through a mechanical kidney, then returned to the patient's circulatory system
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Why must blood levels of drugs be closely monitored in a pt on hemodialysis?
To prevent toxic accumulation
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How often is hemodialysis scheduled?
3 times a week for 3-6 hours
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What type of pt would utilize peritoneal dialysis?
One who is ambulatory
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How often is peritoneal dialysis performed?
4 times per day for 7 days
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What is peritoneal dialysis?
Dialysis through a semipermeable membrane
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Who is peritoneal dialysis contraindicated for?
A pt with previous abdominal surgery or chronic back pain
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What is prostatism?
Any condition of the prostate gland that causes retention of urine in the bladder
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What is prostatectomy?
Removal of the prostate gland
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How is benign prostatic hypertrophy treated?
With an antihypertensive
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What type of surgery is less invasive and less stressful for a pt with BPH?
TURP
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How is tissue removed during TURP?
Through the urethra
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What type of catheter is used on a pt with TURP?
Closed bladder irrigation
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What type of solution is used in a closed bladder irrigation?
An isotonic solution
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What should the pt expect after prostatic surgery?
Hematuria
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Why should catheter drainage tubes be checked frequently?
For kinks that would occlude urine and cause bladder spasms
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What is nephritic syndrome?
A group of signs characterized by marked proteinuria, hypoalbuminuria, and edema
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What is oliguria?
Decreased urine output
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What diet is important for a pt with nephrotic syndrome?
Protein replacement, low salt
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What meds are used to treat nehprotic syndrome?
Corticosteroids, loop diurectics
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What is acute renal failure?
Renal failure from sudden onset such as from trauma, infection, inflammation or toxicity
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What happens during the oliguric phase of acute renal ailure?
BUN and creatinine increase and urine decreases
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What are the signs and symptoms of ARF?
Anorexia, nausea, vomiting, edema
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What is the primary function of the kidney?
Excretion of waste products
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What is the urinary system composed of?
2 kidneys, 2 ureters, 1 urethra, 1 bladder
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What is the responsibility of a nephron?
It filters blood and processes urine
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How do the kidneys control fluids and electrolytes?
By excretion, secretion, and reabsorption
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How do the kidneys maintain acid-base balance?
By directly excreting H+ ions and forming bicarbonate for buffering
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How do the kidneys regulate blood pressure?
By controlling circulating volume and rennin secretion
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Where do the kidneys excrete waste from?
The glomerlar filtrate
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How do the kidneys stimulate the production of RBC's?
Erythropoietin secreted by the kidneys stimulates bone marrow to produce RBC's
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What happens to the kidneys when the body has suffered increased fluid loss?
The amount of filtrate produced by the kidneys is decreased
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What happens when the posterior pituitary gland releases ADH?
The ADH causes distal tubules to increase the rate of water reabsorption
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What happens when the distal tubules increase water reabsorption?
It returns water to the bloodstream and increases blood pressure to a more normal level
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What is the pH of urine?
4.6-8.0
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What is the most common urinary diagnostic study?
Urinalysis
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What does a specific gravity w/a measure?
The pt�s hydration status and the ability of the kidneys to concentrate urine
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What is the normal serum range for a BUN?
10-20 mg
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What does a BUN determine?
The kidneys ability to rid the blood of nonprotein nitrogen waste and urea
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What is the normal range for serum creatinine?
0.5-1.2
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What is creatinine?
A product used in skeletal muscle contraction excreted entirely by the kidney
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How are creatinine levels measured?
for a 24-hour period
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What do elevated prostate specific antigen levels indicate?
Prostate cancer, benign prostatic hypertrophy, prostatitis
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What does the assessment of osmolality measure?
The weight of he solute � determines the kidneys concentration ability
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What does a KUB radiograph assess?
The size, structure, and position of the urinary tract structures
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What is the normal color of urine?
Pale yellow to amber
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What can an abnormal creatinine clearance indicate?
Renal disease
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What I an IVP/IVU?
A test to evaluate the structure of the urinary tract, filling of the renal pelvis with urine, and transport of urine to the bladder
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What should the nurse assess prior to an IVP?
Any iodine allergies
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How is a pt prepared for an IVP?
NPO for 8 hours
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What can be examined in a retrograde pyelography?
The upper and lower urinary tract
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What can be examined in a retrograde cystography?
The urinary blader
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What can be examined in a retrograde urethrography?
The status of the urethral structure
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What takes place during a voiding cystourethrography?
x-rays are taken while a pt voids to detect abnormalities of the urinary bladder and urethra
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What is an endoscopic procedure?
A visual exam of a hollow organ using an instrument
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What is cystoscopy?
A visual exam to inspect, treat or diagnose disorders of the urinary bladder
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What does a renal angiography evaluate?
Blood supply to the kidneys, masses, and detects possible complications after a kidney transplant
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How is a pt placed after a renal angiography?
Flat in bed for several hours
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What info does a renal venogram provide?
The kidneys venous drainage
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When is dye not used in a CT scan?
If inadequate renal function is noted
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What type of nurse cannot care for a pt who has had a renal scan?
The pregnant nurse
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What can be seen in a transrectal US?
The prostate gland
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What are the nursing measures for a pt who has undergone a renal biopsy?
Bed rest w/bathroom privileges for 24 hours
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When is a urodynamic study indicated?
When neurological disease is suspected of being and underlying cause of incontinence
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What is the function of a thiazide diuretic?
It impairs sodium and chloride reabsorption which leads to the excretion of electrolytes and water
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What is the function of a lop or high-ceiling diuretic?
It inhibits the reabsorption of sodium and chloride
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What is the most potent of all diuretics?
Loop or high-ceiling
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What is the function of potassium-sparing diuretics?
They inhibit sodium reabsorption and potassium secretion
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When are osmotic diuretics used?
To manage edema
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What is the main use of a thiazide diuretic?
Management of systemic edema and control of mild/moderate hypertension
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What is a carbonic anhydrase inhibitor used for?
To lower intraocular pressure; also has a diuretic effect on the urinary system
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What drug is used to reduce bladder spasms?
Oxybutynin chloride (ditropan)
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What drug is used to relieve nocturia, incontinence and dysuria?
Flavoxate (Urispas)
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What drug is used to stimulate the bladder?
Bethanechol chloride (urecholine)
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What is used as an anesthetic on the mucosa of the urinary tract?
Phenazophyridine (Pyridium, Urogesic)
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What drug is used to prevent BPH?
Finasteride (Proscar)
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What drug causes relaxation of smooth muscle and improves urine flow in a pt with BPH?
Tevazosin hydrochloride (Hytrin)
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When is Quinolone used?
To treat UTI�s caused by gram-neg microbes
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What is used to treat both gram-positive and gram-negative microbes in the urinary tract?
Nitrofurantoin (Macrodantin)
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What pt�s use methenamine?
Those with chronic recurrent urinary tract infections as a preventive measure
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What does fluroquinolone/Norfloxacin treat?
UTI�s gonorrhea, gonococcal urethritis
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When is a coude` catheter used?
For suspected enlargement of the prostate gland
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Which catheter is the most common with a balloon to hold it in the bladder?
Foley
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What catheters are used to drain urine from the renal pelvis of the kidney?
Malecot, pezzer, or mushroom
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Which catheter has multiple openings to facilitate intermittent drainage?
Robinson
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What catheter is used if there is blood in the urine?
Whistle tip
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What catheter is introduced through the abdominal wall above the symphysis pubis?
Cystostomy, vesicostomy, suprapubic
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How many times a day is catheter care performed?
2 times
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What should the nurse do FIRST if urine flow falls to less than 50 ml/hr in a catheter pt?
Check drainage system for proper placement
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When is self catheterization used?
For pt�s with spinal cord injuries
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How often are kegel exercises performed when bladder training?
Groups of 10-20 four times a day
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What is urinary retention?
The inability to void even with the urge to void
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What are the signs and symptoms of urinary retention?
Distend and can be palpated
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What is the primary goal of nursing intervention for incontinence?
Reinstitution of normal voiding patterns
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What muscles are developed to improve voluntary control over voiding?
The perineal muscles
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What can influence voiding patterns?
Fluid intake and meds
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When continence is established, how much residual urine should be retained?
Less than 50 ml
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What is incontinence?
The involuntary loss of urine from the bladder
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What is the loss of voluntary voiding control, resulting in urinary retention or incontinence?
Neurogenic bladder
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What causes a neurogenic bladder?
A lesion of the nervous system that interferes with the normal nerve conduction to the urinary bladder
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What is a UTI?
The presence of microorganisms in any urinary system
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What is bacteruria?
Presence of bacteria in the urine
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Why are females more prone to UTI�s?
Because the urethra is short
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What are the common signs and symptoms of a UTI?
Urgency, frequency, burning on urination
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What is nocturia?
Excessive urination at night
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What is asthenia?
A general feeling of tiredness & listlessness
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What is hematuria?
Blood in the urine
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What is pyuria?
Pus in the urine
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What is cystitis?
Inflammation of the wall of the urinary bladder
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What are the signs and symptoms of cystitis?
Dysuria, urinary frequency and pyuria
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Cystitis is confirmed by a u/a that reveals a bacterial count greater than what?
100,000
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What is interstitial cystitis?
A chronic pain disorder in the urinary bladder and surrounding region
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What is pyelonephritis?
Inflammation of the structures of the kidney
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What is azotemia?
Excessive nitrogenous compounds in the blood
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What is almost always the cause of pyelonephritis?
E.Coli
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How is pyelonephritis diagnosed?
Bacteria & pus in the urine and leukocytosis
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How long is a patient on antibiotics to treat pyelonephritis?
14-21 days
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What is urolithiasis?
Formation of urinary calculi
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How do urolithiasis develop?
From minerals that have precipitated out of solution & adhere, forming stones
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What type of pt�s are predisposed to urolithiasis?
People who are immobile or have recurrent UTI�s
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Where is the pain associated with urolithiasis?
Flank, radiating to the groin, genitalia, and the inner thigh
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What diagnostic tests are used to determine urolithiasis?
KUB, IVP, ultrasound, u/a, cystoscopy
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How are stones in the lower tract removed?
surgical incision or cystoscopy
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How can a nurse help a pt pass stones?
Increase activity level and fluid intake
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What must a nurse do to all urine from a patient with stones?
STRAIN IT
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What are the risk factors of renal tumors?
Smoking, familial incidence and preexisting renal disorders
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What are the signs and symptoms of advanced renal tumors?
Weight loss, dull flank pain and a palpable mass
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What is polycystic kidney disease?
A genetic disorder characterized by the growth of numerous cysts which can slowly replace much of the kidney
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Where is the most common site of cysts?
The collecting ducts
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What happens to BUN and creatinine levels in a patient with renal cysts?
They are raised
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What medical management is aimed at a patient with renal cysts?
Relief of pain and symptoms
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What is benign prostatic hypertrophy?
Enlargement of the prostate gland
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What happens to the bladder during BPH?
As the prostate enlarges, it puts pressure on the bladder & prevents complete emptying
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What patient assessment is priority in a pt following a renal angiography?
Puncture site
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Which group of muscles are used during kegel exercises?
Perineal floor
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What activity is harmful for the incontinent patient
Restricting fluid intake
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What is the most important factor to foster patient compliance with a treatment plan?
Provide the pt with an active role in the planning
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When is the best time to give a patient lasix?
9 am
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What foods are highest in potassium for the ESRD pt?
Grapefruit, tomatoes, oranges and bananas
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What symptom will show that Pyridium is effective?
Decreased burning sensation
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How does the nurse calculate the actual urine output during continuous bladder irrigation?
Measure the total output and deduct the amount of irrigation solution used
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What statement indicates the need for further instruction before a renal angiography?
�I�m glad I don�t have to stay in bed after the test.�
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What is the goal for peritoneal dialysis?
To remove toxins and metabolic waste
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What would the nurse do in postoperative care of the patient with an arteriovenous shunt?
Use strict surgical asepsis for dressing changes
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What is the teaching priority for the pt with acute renal failure?
Prevention of infection
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What is the ESRD pt receiving hemodialysis at risk for?
Anemia
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What is the primary short term goal for disorders of the urinary system?
Normal patterns of urinary elimination
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What is the nurses first action when discovering there is nor urine drainage from a post op pt�s foley catheter?
Ensure patency
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What is the most common cause of renal failure?
Diabetes
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