Medical Quiz: Urolithiasis and Related Conditions

Urolithiasis/Nephrolithiasis

• Causes and Risk Factors: Supersaturation of urine (calcium, oxalate, uric acid, calcium phosphate), infection (UTI), urine stasis, immobility, hypercalcemia, structural defects.
• Assessment: Colicky pain (especially in ureter stones), hematuria, pyuria, nausea, vomiting, diarrhea, urinary retention/obstruction.
• Diagnosis: CT scan, intravenous pyelography (IVP), blood chemistry, 24-hour urine analysis, diet/medication/family history, stone analysis.
• Management: Pain relief (opioids, NSAIDs), heat/hot baths, increased fluid intake, ambulation, dietary changes (low calcium, low purine, low protein, low oxalate). Procedures include ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), nephrostomy.

Urinary Bladder Cancer

• Risk Factors: Age, male gender, race, tobacco use, chronic UTIs, high cholesterol, high urine pH, bladder stones.
• Assessment: Painless hematuria, changes in voiding patterns.
• Diagnosis: Cystoscopy, CT scan, ultrasound, biopsy, bimanual examination.
• Treatment: Transurethral resection or fulguration, BCG vaccine, radiation therapy, chemotherapy, cystectomy with urinary diversion, bladder transplant.

Benign Prostatic Hyperplasia (BPH)

• Mechanism: Obstructs urine flow, causing incomplete bladder emptying and urinary retention. Can block ureter and kidney flow.
• Consequences: Gradual dilation of ureters and kidneys, UTIs from urinary stasis.
• Assessment: Frequency, nocturia, urgency, hesitancy, decreased urinary stream volume and force, difficulty initiating urination.
• Diagnosis: Digital rectal exam (DRE), prostate-specific antigen (PSA), transrectal ultrasound (TRUS).
• Education: Aging is a cause, frequent ejaculation is beneficial, avoid large water intake at once, avoid caffeine and alcohol.
• Management: Medications like tamsulosin (Flomax) to relax bladder outlet, and finasteride (Proscar) to decrease testosterone production.

Prostate Cancer

• Risk Factors: African American ethnicity, aging, diet high in red meat and high-fat dairy.
• Clinical Manifestations: Initially asymptomatic, urinary obstruction symptoms, blood in urine or semen, painful ejaculation.

Surgical Interventions for BPH/Prostate Cancer

• Various procedures (TURP, suprapubic/retropubic prostatectomy, perineal prostatectomy, Da Vinci prostatectomy, brachytherapy) are used.

Continuous Bladder Irrigation (CBI)

• Use: Always used after TURP.
• Assessment: Monitor drainage color and amount, look for obstructions.
• Complications: Hemorrhage, infection, deep vein thrombosis (DVT), catheter blockage.
• Post-Op Expectations: Pain relief, fluid balance, ambulation, catheter care, avoid straining/heavy lifting, stable vitals, wound healing, normal urination.

Hysterectomy

• Purpose: Surgical removal of the uterus (laparoscopic or robotic).
• Pre-Op Test: Pregnancy test.
• Indications: Uterine cancer, fibroids, endometriosis, prolapse (uterine), hypermenorrhea.
• Post-Op Considerations: Monitor vaginal bleeding, Foley catheter for 24 hours, monitor vital signs, breath/bowel sounds, I&O, assess incision, watch for thromboembolism, monitor labs, watch for infection/shock.

CVA/Stroke

• Risk Factors: Cardiovascular risk factors.
• Types: Ischemic (thrombosis/embolism from atherosclerosis, atrial fibrillation, endocarditis), hemorrhagic (aneurysm), transient ischemic attack (TIA), reversible ischemic neurologic deficit, stroke in evolution, complete stroke.
• Assessment: Facial symmetry, swallowing, LOC, eye assessment, DTRs, communication loss, progression of symptoms, time of onset, increased intracranial pressure (ICP).
• Early ICP symptoms: Altered LOC, headache, nausea, projectile vomiting.
• Late ICP symptoms: Bradycardia, bradypnea, hypertension.
• Other Symptoms: Paralysis/weakness, communication loss (expressive, receptive, global), perceptual disturbances, sensory loss (visual changes), agnosia, alexia, agraphia.
• Diagnosis: CT scan, MRI, PET scan, cerebral angiography (allergy/kidney function checks, post-procedure: leg flat, head slightly elevated if ICP present).
• Management: Airway management (oxygen, intubation, suction), reduce ICP (HOB 30-45, neutral neck position, bed rest, avoid fluid overload/coughing/straining), ICP medications (Mannitol, dexamethasone, 3% NaCl), control blood pressure (max 180/100), maintain cardiac output, oral care, eye care, prevent immobility complications.
• Hemorrhagic Stroke Management: NO thrombolytics, prevent vasospasm (hydration, nimodipine), control hypertension (beta-blockers, vasodilators), surgery (craniotomy, aneurysm coiling/clipping).

Seizure Disorders

• Seizures: Abnormal motor, sensory, autonomic, or psychic activity from sudden neuronal discharge.
• Epilepsy: Two or more recurring seizure episodes.
• Causes: Idiopathic, acquired (e.g., hypoxemia, head trauma, hypertension, CNS infection, metabolic/toxic conditions).

Stroke Core Measures

• Thrombolytics: Administered within 3-4.5 hours (ischemic stroke only).
• Antithrombotic therapy: Initiated by hospital day 2 (ischemic stroke only).
• VTE prophylaxis: Implemented by hospital day 2.
• Anticoagulation: For atrial fibrillation/flutter at discharge.

Parkinson's Disease

• Cause: Decreased dopamine due to degeneration of nigrostriatal neurons.
• Symptoms: Tremors, rigidity, bradykinesia/akinesia, postural instability, muscle weakness, dysphagia.
• Diagnosis: History, physical assessment, response to levodopa.
• Management: Levodopa-carbidopa (before meals), deep brain stimulation (DBS).

Open-Angle Glaucoma

• Mechanism: Increased aqueous humor, decreased outflow.
• Assessment: Headache, mild eye pain, peripheral vision loss, increased intraocular pressure (IOP).
• Management: Miotics (pilocarpine), beta-blockers (timolol), carbonic anhydrase inhibitors (acetazolamide). Do NOT use atropine.
• Education: Avoid activities increasing IOP, do not lie on surgical side.

Angle-Closure Glaucoma

• Mechanism: Sudden angle closure obstructing outflow.
• Assessment: Rapid IOP increase, vision changes (blurred, halos).
• Management: Same as open-angle glaucoma.
• Education: Avoid activities increasing IOP, do not lie on surgical side.

Cataracts

• Mechanism: Lens cloudiness impairing vision.
• Assessment: Decreased visual acuity/blurring, double vision.
• Surgical Management: Mydriatics (atropine sulfate), antibiotics, and corticosteroids postoperatively.
• Post-Op Management: Monitor for bleeding and infection.
• Education: Wear sunglasses and other protective eyewear.

General Assessment (Skeletal Disorders)

• Components: Past medical/social/family history, exercise habits, diet (Calcium/Vitamin D), concurrent conditions, familial/genetic abnormalities.
• Symptoms: Pain, tenderness, tightness, swelling, paresthesias, muscle spasms.

Common Orthopedic Diagnostics

• Imaging: X-ray, CT, MRI, arthrography, bone densitometry (DXA), bone scan.
• Procedures: Arthroscopy, arthrocentesis.
• Testing: Electromyography (EMG), nerve conduction studies, labs (calcium, vitamin D, phosphorus, alkaline phosphatase (increased with bone damage), PTH/calcitonin).

Osteoporosis

• Characteristics: Metabolic bone disorder, often causing compression fractures.
• Symptoms: May be asymptomatic, spine typically affected (compression = pain); common in post-menopausal women and older adults.
• Risk Factors: Genetics, age, gender, small frame, postmenopause, low calcium/vitamin D, high phosphate intake, caffeine/alcohol/smoking, sedentary lifestyle, lack of weight-bearing exercise, medications (steroids), comorbidities.
• Diagnosis: Bone densitometry, labs, detectable x-ray loss occurs after bone demineralization 25-40%.
• Home Care: Identify calcium-rich foods, vitamin D, weight-bearing exercises, modify lifestyle choices (discontinue corticosteroids if necessary).

Rheumatoid Arthritis

• Cause: Autoimmune disorder, possibly triggered by a previous infection.
• Assessment: Primarily in small bones (hands), "morning stiffness."
• Diagnosis: Elevated erythrocyte sedimentation rate (ESR).
• Medical Management: NSAIDs, steroids, disease-modifying antirheumatic drugs (DMARDs) like methotrexate, antimalarials, gold compounds. Use cold compresses during flare-ups.

Osteoarthritis

• Cause: Degenerative disease, "wear and tear" due to aging.
• Assessment: Inflammation, crepitus.
• Diagnosis: X-ray, elevated ESR.
• Medical Management: Acetaminophen, NSAIDs, steroids, weight management, rest.

Fractures

• Types: Closed/simple, open/compound, complete/incomplete, simple, displaced, stress, compression, comminuted, greenstick.
• Causes: Trauma, severe muscle contractions, pathological conditions.
• Assessment: Pain, muscle spasms, edema, ecchymosis, deformity, shortening, crepitus, loss of function.
• Effects: Soft tissue damage, hemorrhage (joints/organs), joint dislocation, tendon/blood vessel/nerve damage.
• Fracture Healing: Factors promoting healing (immobilization, blood supply, Calcium/Vitamin D, isometric exercise, hormones) vs. inhibiting healing (trauma, improper immobilization, infection, irradiated bone, age, steroids).
• Complications: Early: shock, DVT, fat embolism, compartment syndrome; Late: delayed union, malunion, nonunion, avascular necrosis.
• Management: RICE (Rest, Ice, Compression, Elevation) – elevate limb above heart (except for compartment syndrome), neurovascular checks, prevent infection (open fractures) surgery (reduction), immobilization (casts, splints, traction).
• Cast Care: Explain treatment, maintain neuromuscular function, elevate extremity initial 24-48 hours.

Traction Management

• Types: Straight/running, balanced suspension, Buck's traction, skeletal traction.
• Purpose: Minimize spasms, reduce/align/immobilize fractures, reduce deformity.
• Maintenance: Continuous pull, good body alignment, no friction/weight must hang freely..
• Complications: Skin breakdown, nerve pressure, circulatory impairment (Buck's traction). Monitor device/complications.

Orthopedic Surgeries

• Types: Open reduction/internal fixation (ORIF), joint arthroplasty/replacement, meniscectomy, amputation, bone graft, fasciotomy, arthroscopy.
• Hip Arthroplasty: Replace damaged hip with artificial joint (acetabular cup, femoral head, stem). Indications include degenerative joint diseases, osteoarthritis, rheumatoid arthritis. Post-op: Prevent dislocation, positioning, pain management, bleeding, infection, DVT. Precautions: Abduction pillow, no crossing legs/bending at waist/crossing legs.
• Knee Arthroplasty: Replace damaged knee with metal and acrylic prostheses. Post-op: Pain management, continuous passive motion (CPM) machine. Precautions - no kneeling/deep knee bends.

Spinal

• Degenerative Disc Disease (DDD): Cause of most back problems; natural aging, trauma. Assessment: Muscle weakness/atrophy, loss of sensory/motor control, localized or sciatica pain, Surgery types: Microdiscectomy, Laminectomy, Partial Laminectomy, Discectomy fusion, Foraminotomy

Digestive Disorders

• Assessment: History (dietary habits, pain patterns, bowel/stool changes), physical exam (quadrant method, inspection/auscultation/percussion/palpation).
• Diagnostics: Imaging (endoscopy for EGD, Colonoscopy), Ultrasound (gallstones), CT/MRI.

Gastroesophageal Reflux Disease (GERD)

• Mechanism: Backflow of stomach contents due to incompetent lower esophageal sphincter (LES).
• Assessment: Pyrosis, dyspepsia, dysphagia, odynophagia, epigastric pain.
• Complications: Inflammation, erosion, esophageal cancer.
• Diagnosis: Esophageal pH monitoring, endoscopy, barium swallow.
• Management: Lifestyle (low-fat diet, avoid irritants, HOB elevation, meal timings, normal body weight), medications (antacids, H2 blockers, PPIs, prokinetics), surgery (Nissen fundoplication).

Gastritis

• Types: Acute/chronic, erosive/non-erosive.
• Causes: H. pylori, NSAIDs, alcohol, smoking, caffeine, autoimmune, age, comorbidities.
• Assessment: Abdominal pain, burning epigastric pain, anorexia, vomiting, heartburn, hematemesis, melena (dark, tarry stools).
• Complications: Pernicious anemia, GI wall perforation.
• Diagnosis: Endoscopy, biopsy, acid analysis.
• Management: Antacids, H2 blockers, PPIs, antibiotics (if H. pylori), antidiarrheals, prostaglandin analogs. Surgery (gastric resection, gastrojejunostomy/duodenostomy).

Peptic Ulcer Disease (PUD)

• Causes: H. pylori, NSAIDs, increased stomach acid (duodenal ulcers).
• Assessment: Dull, gnawing epigastric pain (indigestion, N/V, melena).
• Complications: Perforation, peritonitis, hemorrhage, pernicious anemia.
• Types: Gastric Ulcers (in stomach) and Duodenal Ulcers (in duodenum).
• Characteristics: Gastric ulcers: LUQ/mid-line pain, pain after eating. Duodenal ulcers: Right sided/mid-line pain, pain relieved by eating, pain more common 2 hours after eating.

Inflammatory Bowel Disease (IBD)

• Types: Crohn's disease (small intestine to ileum, all GI layers affected), ulcerative colitis (large intestine to rectum, mucosal inflammation).
• Assessment: RLQ pain (Crohn's, less severe diarrhea, scattered inflammation); LLQ/LUQ pain (Ulcerative Colitis, severe diarrhea, severe GI bleeding).
• Diagnosis: Barium studies (Crohn's), colonoscopy.
• Management: Antibiotics, steroids, immunomodulators (e.g., azathioprine, methotrexate), anticholinergics (propantheline bromide), analgesics, vitamin B12 injections (if pernicious anemia).
• Surgical Management: Strictureplasty, intestinal transplant, colon resection/hemi-colectomy, total colectomy/ileostomy/colostomy.

Diverticulitis/Diverticulosis

• Symptoms: LLQ pain, fever, inflammation of diverticula (sigmoid colon common), often in sedentary clients, N/V, abdomen distension.
• Complications: Peritonitis, abscess/fistula, bleeding, fluid/electrolyte imbalance.
• Diagnosis: CT scan with contrast (most common), barium enema, colonoscopy.
• Management: Analgesics (opioids), antispasmodics, antibiotics, bulk-forming laxatives, stool softeners. Dietary modifications during exacerbations (NPO, clear liquids, gradually introduce low-fiber foods).

Cholecystitis/Cholelithiasis

• Symptoms: RUQ pain radiating to shoulder, nausea, jaundice.
• Risk Factors: 4 F's (Forty, Female, Fertile, Fat), rapid weight loss, infection.
• Assessment: Fatty food intolerance, nausea/vomiting, RUQ sharp colicky pain radiating to right shoulder/midsternum, epigastric distress.
• Diagnostics: Ultrasound (most common), cholecystography, ERCP, abdominal x-ray.
• Labs: Elevated alkaline phosphatase, GGT/GGTP, LDH, bilirubin, cholesterol.
• Medical Management: Opioids for pain, antispasmodics, stone lysis (UDCA, Actigall), vitamin supplements, lithotripsy (ESWL).
• Surgical Management: Laparoscopic cholecystectomy, cholecystostomy, T-tube placement.
• Nursing Management: Low-fat, high-protein/carb diet, regular exercise, weight reduction.

Intestinal Obstruction

• Types: Mechanical (adhesions, tumors), non-mechanical (paralytic ileus).
• Mechanism: Blockage preventing normal stool passage.
• Small Bowel: Severe fluid/electrolyte imbalance, metabolic alkalosis, visible peristaltic waves, projectile vomiting, dehydration
• Large Bowel: Mild fluid/electrolyte imbalance, abdominal distention, intermittent cramping, diarrhea/ribbon-like stools, leakage.
• Management: Decompression (NGT/rectally), NPO/IV fluids, monitor bowel sounds/fluid/electrolytes, medications (prokinetics for increased peristalsis), antibiotics.

Enteral/TPN Feeding

• Enteral: Via NGT or PEG tube, monitor complications (aspiration, diarrhea, hyperglycemia), flush tubes, HOB 30-45 degrees, check residuals, monitor tolerance/labs.
• TPN: Central line, monitor for complications (hyperglycemia, infection, sepsis, fluid overload).