PALS Tutoring Week 4 - Urinary System PDF

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PALS NOTES TUTORING FOR WEEK 4 OF URINARY SYSTEM...

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PALS Tutoring Week 4 

What is urinary catheterization used for? o o o o o o

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Chronic urinary retention Strict INO Trauma patients Temporary: surgery Bladder medication insertion NOTE: Don’t use catheters for incontinence  If someone is incontinent, you want to promote ambulation because it’s less invasive How many licensed nurses are needed for catheter insertion? o 2 licensed nurses: 1 will insert, 1 will pump balloon Do you need separate consent for urinary catheterization? o You do not need consent for urinary catheterization because it’s one of the standard consent actions from initial consent – you just need verbal consent What is the bladder scan used for? o To see if there is any retention o Will be done 3 times What is normal urine specific gravity? o 1.010 – 1.030 o The higher the specific gravity of the urine, the more dehydrated the person is and the more concentrated the urine is What are common signs of UTI?

There is an elderly patient who is initially admitted to the floor, then becomes confused the next day. What do you check for?

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o Check for UTI (and pneumonia) Who is at risk for UTIs? o Diabetic patients o More common in women because urethra is shorter What are some interventions for UTI? o Increase fluid intake to 2 – 3 L o Wipe front to back o Void after sexual intercourse o Don’t take long baths or use douches o What juice is used to treat UTIs?  Sugar-free cranberry juice o What antibiotic would we give for UTI?  Cipro  What is an adverse drug reaction of Ciprofloxacin that we need to watch out for and educate the patient?  It can cause tendon inflammation o Educate pt notify the provider if they are having any tendon pain  Can cause phototoxicity o Educate pt to stay out of sun or wear hat/sunscreen  Pyridium  Can cause urine to turn orange Any time the kidneys are affected, what are the lab values do you check for? o Normal findings  BUN: 7 – 20 mg/dL  Creatinine: 0.6 – 1.2 mg/dL o Increased BUN/creatinine suggests kidney injury What is cystitis? o Infection of the bladder What is nephritis? o Infection of the kidneys What is pyelonephritis? o Infection of the entire kidney o Can be caused by E. coli o If a pregnant woman gets pyelonephritis, it can cause pre-term labor  To somewhat stop the pre-term labor, magnesium can be administered to the patient What is urolithiasis? o Kidney stones  Nephrolithiasis: stones in the kidneys  Ureterolithiasis: stones in the ureter o Signs and symptoms  Flank pain (costovertebral tenderness)  Hematuria

Risk factors:  More common in males  Dehydration What is the most common type of kidney stones? o Stones made of calcium  Calcium oxalate (most common)  Calcium phosphate o What is treatment?  Increase fluid intake  Can use lithotripsy  Ultrasound waves break down stones into smaller pieces  Bruising is normal with lithotripsy What do we use IVP (intravenous pyelogram) to diagnose? o

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Enables visualization of any obstruction in urinary track starting at level of kidney  Contrast will move into kidney from blood filtrate  Contrast obstructed o Diagnose kidney stones o Need informed consent o Need to keep NPO for 6 – 8 hours o Make sure pt is not allergic to shellfish or iodine o Post intravenous pyelogram: once the pt’s gag reflex comes back, you want to encourage fluids to flush the dye out What are signs and symptoms of polycystic kidney disease? o Flank pain o High BP o Hematuria  Educate pt that the most common symptom is hematuria o Treatment: maintaining and preventing polycystic kidney disease from getting worse What is acute kidney injury? o Sudden renal damage  Causes a build-up of waste, fluid, and electrolyte imbalance What are the 4 stages of acute kidney injury? o Initiative stage  Something is initiated/something is happening to the kidney o Oliguric phase  Producing less than 400 mL of urine per day o Diuretic phase  Producing more than 400 mL of urine per day o Recovery phase  When the kidney stabilize itself again and BUN + creatinine levels go back to their normal levels What is glomerulonephritis? o Inflammation of the glomeruli o

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Acute  Caused by Staphylococcus infection  Nursing interventions:  Priority: Ask the pt if they recently had a Staphylococcus infection  Treat with penicillin or erythromycin  Monitor their BUN and creatinine levels and make sure it doe not go past its normal range to prevent chronic glomerulonephritis o Chronic  Takes roughly 20 – 30 years to develop What is interstitial cystitis? o Also known as painful bladder syndrome o What are some signs and symptoms?  Pelvic pressure  Pain  Nocturia o NOTE: every time you get that urine culture/urine specimen, it will come back negative every single time What is nephrotic syndrome? o In a normal glomerulus, it doesn’t allow protein to go through; all that waste crosses that membrane and exits out in urine o With nephrotic syndrome, that membrane will become permeable to those membranes, so it will allow protein to pass that membrane so you will see protein in the urine o SUMMARY:  Inflammatory response in the glomerulus  Damage to membrane  Loss of protein (albumin)  Hypoalbuminemia (low albumin/protein levels) o What would you treat nephrotic syndrome with?  High-dose Corticosteroids  NOTE: corticosteroids can cause hypokalemia  Nursing intervention: o Monitor patient’s potassium levels o What is patient teaching for nephrotic syndrome?  Encourage to increase protein intake and lower sodium diet o What do teach patients to reduce sodium intake?  Patient’s will be urinating more, so they will be urinating out more protein, increasing their sodium levels What would happen to a person if they went into hypovolemic shock? o If their kidneys are making the patient lose a lot of water o Signs and symptoms:  Low BP  Oliguria  Less than 30 mL of urine per hour  Cold, clammy skin o

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 Tachycardia  Hypoxia  Tachypnea  Patient will urine less because body o Treat with normal saline IV to stabilize electrolytes and get fluid back in o If there was significant blood loss as well, pt can get blood transfusion What are common potassium-wasting diuretics? o Furosemide (Lasix) What do you need to watch out for in a patient taking the diuretic, Lasix (furosemide)? o Observe for hypokalemia What are signs and symptoms of hypokalemia? o Low heart rate o Paresthesias in the extremities o Weakness, fatigue o Muscle cramps and pain o Dysrhythmias What are common potassium-sparing diuretics? o spironolactone What do you need to watch out for in a patient taking spironolactone? o Observe for hyperkalemia Lab values o NOTE: Know normal lab values (BUN, creatinine, etc.) as generally lab values will be very elevated/out of range in the quiz...