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N474 ADULT HEALTH MATERIAL EXAM 2 QUESTIONS AND 100% VERIFIED ANSWERS
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N474 ADULT HEALTH MATERIAL EXAM 2 QUESTIONS AND 100% VERIFIED ANSWERS...
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what a kidney does - ANSWER affects many systems, not just urinarywater: ensures there is not too much or too little in the body
BP: makes sure that pressure isn't too high or too low
wastes: gets rid of urea, uric acid, toxins, and other wastes via urine
bones: activates vitamin D, which helps the body absorb Ca
acid-base balance: makes sure that the body isn't too acidic or too
alkaline
heart: maintains a balance of electrolytes (like K, Na, Ca) which is critical
for heart rhythm
blood: releases erythropoietin, which tells bone marrow to make RBCs
pyelonephritis and s/s - ANSWER bacterial infection in kidney and
renal pelvis (upper urinary tract)
assessment: fever, chills, tachycardia, tachypnea
flank, back, or loin pain
tenderness at CVA
abdominal discomfort
burning, N/V, urgency, frequency, nocturia
general malaise or fatigue
recent cystitis or treatment for UTI
evidence of UTI in urinalysis and culture (positive leukocyte esterase,
nitrite dipstick test, and presence of WBCs and bacteria--occasional
RBCs and protein may be present)
possible increased WBC
people at risk for pyelonephritis - ANSWER incompletely treated UTI
(don't finish antibiotic course)
indwelling catheter
,anatomical abnormality that allows urinary stasis or reflux (vesicoureteral
reflux)
immunosuppressed
key for prioritization questions - ANSWER patient is in front of me, what
am I going to do first?
ABCs
most dangerous issue that you should address
actual problems take precedence over "risk for" problems
goals and interventions for pyelonephritis - ANSWER controlled pain
resolution of infection (w/antibiotics)
prevent CKD (interventions need to happen in prompt/efficient manner--
control BP)
priority interventions: analgesics, assess pain, 2-3 L fluids/day,
administer antibiotics (don't do urinalysis every day)
evaluation for pyelonephritis - ANSWER what does your client look like
if your plan of care was effective
no pain
adequate UO without pain (normal urine appearance)
want abnormal assessment findings to become normal
benign prostatic hyperplasia (BPH) - ANSWER common health
problem
exact cause is unknown
glandular units (tissue) in the prostate that undergo nodular tissue
hyperplasia, resulting in enlargement of prostate gland
prostate is posterior to bladder, urethra passes through it
if it is enlarged, urethra is squeezed-->this causes the s/s of BPH
s/s of BPH - ANSWER bladder outlet obstruction (get obstruction of
urine flow through urethra b/c of enlarged prostate)
increased residual urine (stasis)
chronic urinary retention which can lead to overflow urinary incontinence
(so much urine is being held in bladder that you get overflow
incontinence)
,no pain is associated with prostatic enlargement (if having pain in
prostate, this is prostitis)--BPH does not cause dysuria (painful urinating)
but rather difficulty passing urine b/c of what the prostate is pressing on
difficulty in starting (hesitancy) and continuing urination
reduced force and size of urinary stream (weak)
sensation of incomplete bladder emptying
straining to begin urination
post-void dribbling or leaking
potential complications of BPH - ANSWER urinary stasis that can lead
to infection
urinary retention that can become so profound that you can have
overflow incontinence
if you have so much urine being held in bladder/retained, besides
overflow incontinence, you can get reflux up into ureters which can lead
to problems with dilation/enlargement of the kidneys/ureters--this is
called hydroureter and hydronephrosis
BPH assessment - ANSWER hx of symptoms: international prostate
symptom score (I-PSS)
physical and psychosocial assessment
laboratory assessment
other diagnostic studies: transabdominal u/s, transrectal u/s
we rely on their description of their s/s
don't necessarily need to diagnostic tests--may do u/s to visualize
enlarged prostate--provider is just going to ask a lot of really good
questions and collect hx on s/s for diagnosis
BPH treatment - ANSWER ranges from non-invasive to invasive
medical management: alpha reductase inhibitors (e.g., finasteride--
reduces enlarged prostate) and alpha blockers (e.g., tamsulosin--relaxes
smooth muscles in prostate gland, creating less urinary resistance and
improved urinary flow--also cause peripheral vasodilation and reduced
peripheral vascular resistance)--don't automatically need antibiotics if
you have BPH--there isn't necessarily an infection
complementary therapy: saw palmetto (herbal remedy--not a lot of
evidence that it's super helpful but patients report improved s/s)
, non-pharmacologic: frequent intercourse/ejaculation (could masturbate
too--keeping seminal fluid out decreases volume and pressure in area),
double-voiding technique (urinate and when finished, wait and theny try
again), avoid meds that cause urinary retention (avoid anticholinergics
antihistamines, and decongestants such as cold/flu relief meds, allergy
meds, etc.--don't take OTC meds w/out consulting your provider), avoid
diuretics (increases volume in urinary bladder)
avoid drinking large amounts of fluid in a short amount of time--avoid
alcohol and caffeine
surgical treatment - ANSWER transurethral resection of prostate
(TURP)
instrument is put in urethra to make "donut hole" bigger--do
drilling/circular type of maneuver to debulk the prostate
post-operative care for surgical intervention for BPH - ANSWER often
only in hospital for 1-2 days
urinary catheter placed into bladder (balloon=much larger, ~30 mL or
more)--then get traction via taping to patient's abdomen or thigh to
pull/create traction against the prostate--do this to try to provide pressure
on operative site to decrease bleeding
will have blood in urine--occasional clots in urine are okay-->this is
expected--urine will be cherry red immediately after surgery and then
should get progressively lighter the further post-op you get (just like
lochia after birth)
continuous bladder irrigation (CBI)
remind patient that because of urinary catheter's large diameter and
pressure of retention ballon on internal sphincter of bladder, he will feel
the urge to void continuously--this is normal--advise him not to try to void
around the catheter
continuous bladder irrigation (CBI) - ANSWER 3-way urinary catheter:
for urine outflow, for balloon syringe, and port where fluid goes in
(irrigation fluid, typically use normal saline which is sterile)
sometimes may do CBI for other reasons--may have challenging or
unusual UTIs and want to do CBI of antibiotic or antiseptic into bladder
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