Nursing Diagnostic Testing Interventions

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Questions and Answers

What is the term for a stone within the ureter?

Ureterolith (correct)

Pyelolith

Nephrolith

Renolith

What is the classic symptom of renal calculi?

Numbness in the lower extremities

Severe, sharp flank pain that radiates to the suprapubic area and external genitalia (correct)

Mild back pain that radiates to the abdomen

Difficulty starting to urinate

What is the primary goal of nursing care for patients with renal calculi?

To relieve pain and nausea

To monitor levels of BUN, creatinine, and electrolytes

To encourage ambulation and fluid intake

All of the above (correct)

What is the treatment of choice for small renal calculi?

Vigorous hydration, analgesics, and antimicrobial therapy Signup and view all the answers

What should patients with renal calculi avoid consuming in excess?

Milk Signup and view all the answers

What is hydronephrosis?

Renal pelvis distension due to retained urine Signup and view all the answers

Why is it essential to encourage patients with renal calculi to void every 2-3 hours?

To maintain patency of catheters/nephrostomy tubes Signup and view all the answers

What is the purpose of straining urine in patients with renal calculi?

To check for hematuria Signup and view all the answers

What is an important aspect of assessing a patient's medical history in relation to glomerulonephritis?

Medications, immunizations, and microbial infections Signup and view all the answers

What is a common symptom of acute poststreptococcal glomerulonephritis?

Generalized body edema Signup and view all the answers

What is the typical time frame for the development of acute poststreptococcal glomerulonephritis after an infection?

5-21 days Signup and view all the answers

What is a common laboratory finding in patients with glomerulonephritis?

Elevated creatinine levels Signup and view all the answers

What is the typical outcome for patients with acute poststreptococcal glomerulonephritis?

Complete recovery in 95% of patients Signup and view all the answers

What is a characteristic feature of rapidly progressive glomerulonephritis?

Rapid, progressive loss of renal function over days to weeks Signup and view all the answers

How does chronic glomerulonephritis typically present?

Incidentally, on a urinalysis or with elevated blood pressure Signup and view all the answers

What is a condition often evaluated in conjunction with glomerulonephritis?

Systemic lupus erythematosus Signup and view all the answers

What is the primary focus of management for patients with glomerulonephritis?

Providing symptomatic relief Signup and view all the answers

What is the purpose of restricting sodium and fluid intake in patients with glomerulonephritis?

To reduce edema Signup and view all the answers

What is the term for the inability of nephrons to maintain fluid, electrolyte, and acid-base balances?

Renal failure Signup and view all the answers

What is the purpose of administering corticosteroids in patients with glomerulonephritis?

To reduce inflammation Signup and view all the answers

Why is early diagnosis and treatment of a sore throat important?

To prevent APSGN Signup and view all the answers

What is the term for varying degrees of renal impairment?

Acute kidney injury Signup and view all the answers

What is the purpose of administering diuretics in patients with glomerulonephritis?

To reduce edema Signup and view all the answers

What is the purpose of restricting dietary protein intake in patients with glomerulonephritis?

To reduce the workload of the kidneys Signup and view all the answers

What is the purpose of a 15- to 20-minute sitz bath two to three times a day in chemotherapy?

To promote muscle relaxation and reduce urinary retention Signup and view all the answers

What is the primary function of a nephrostomy tube?

To drain urine from the kidney Signup and view all the answers

What is the purpose of stents in an ileoconduit?

To prevent occlusion of the ureters Signup and view all the answers

What is a characteristic of glomerulonephritis?

Inflammation of the glomeruli Signup and view all the answers

What is the purpose of a suprapubic catheter?

To test client ability to void Signup and view all the answers

What is the classification of glomerulonephritis based on?

The extent of damage, initial cause, and extent of changes Signup and view all the answers

What is the purpose of a urinary catheter?

To drain urine from the bladder Signup and view all the answers

What is a common complication of urinary retention?

Urinary tract infection Signup and view all the answers

What is an essential aspect of patient teaching when it comes to diagnostic testing interventions?

Providing a description of the tests and procedures in language the patient can understand Signup and view all the answers

What is the primary cause of urinary tract infections?

Bacterial infection Signup and view all the answers

What is a common symptom of lower urinary tract infections?

Hesitancy Signup and view all the answers

What is a gerontologic consideration for urinary tract infections?

All of the above Signup and view all the answers

What is a common nursing intervention for urinary alterations?

Monitoring urine output relative to intake Signup and view all the answers

What is a preventative measure for urinary tract infections?

Voiding every 2-3 hours Signup and view all the answers

Why is it essential to emphasize the importance of finishing a prescribed course of medication?

To ensure the infection clears completely Signup and view all the answers

What is the purpose of acidifying the urine in urinary tract infection management?

To create a less favorable climate for bacterial growth Signup and view all the answers

What is the recommended fluid intake for a patient with Pyelonephritis?

2-3 L daily Signup and view all the answers

What is the primary goal of antibiotic therapy in treating Urethritis?

To eliminate the causative organism Signup and view all the answers

What is a characteristic feature of Interstitial Cystitis?

All of the above Signup and view all the answers

What is the recommended duration of antibiotic therapy for patients with Pyelonephritis?

10-14 days Signup and view all the answers

What is a common symptom of Upper UTI - Pyelonephritis?

Flank pain/tender costovertebral angle Signup and view all the answers

What is the purpose of cranberry juice in managing UTIs?

To prevent bacteria from adhering to the bladder wall Signup and view all the answers

What is a common nursing intervention for patients with UTIs?

All of the above Signup and view all the answers

What is the purpose of analgesics in managing UTIs?

To alleviate symptoms Signup and view all the answers

What is a preventative measure for UTIs?

All of the above Signup and view all the answers

What is the purpose of good diet and plenty of rest in managing UTIs?

To boost the immune system Signup and view all the answers

What is the primary goal of behavioral therapy for urinary incontinence?

To promote a regular voiding schedule Signup and view all the answers

What is the purpose of neuromodulation in the management of urinary incontinence?

To stimulate the nerves controlling the bladder Signup and view all the answers

What is the primary cause of acute urinary retention?

Urethral obstruction Signup and view all the answers

What is the treatment of choice for chronic urinary retention?

Clean intermittent self-catheterization Signup and view all the answers

What is the purpose of assessing post-void residual (PVR) in patients with urinary retention?

To assess the effectiveness of treatment Signup and view all the answers

What is the primary focus of nursing care for patients with urinary retention?

Providing emotional support and education Signup and view all the answers

What is the purpose of Crede's maneuver in patients with urinary retention?

To apply gentle pressure to the bladder during voiding Signup and view all the answers

What is the purpose of encouraging fluid intake in patients with urinary retention?

To flush out bacteria from the urinary tract Signup and view all the answers

What is the primary complication of urinary retention?

Urinary tract infection Signup and view all the answers

What is the purpose of intermittent catheterization in patients with urinary retention?

To drain the bladder completely Signup and view all the answers

What is the primary function of the renal system?

To maintain fluid and electrolyte homeostasis Signup and view all the answers

What is the term for the absence of urine?

Anuria Signup and view all the answers

What is the normal pH of urine?

4.5 Signup and view all the answers

What is the function of the hormone erythropoietin?

Stimulating red blood cell production Signup and view all the answers

What is the term for painful urination?

Dysuria Signup and view all the answers

What percentage of filtrate is reabsorbed back into the venous system?

99% Signup and view all the answers

What is the term for the presence of blood in the urine?

Hematuria Signup and view all the answers

What is the average volume of urine produced per day under normal conditions?

1000-2000 ml Signup and view all the answers

What is the primary reason for assessing pain in patients with renal calculi?

To evaluate the effectiveness of analgesic therapy Signup and view all the answers

What is the recommended daily fluid intake for patients with renal calculi?

2000-2200 mL/day Signup and view all the answers

What is the purpose of straining urine in patients with renal calculi?

To check for hematuria or anuria Signup and view all the answers

What is the treatment of choice for larger stones that are causing obstruction or damage to the kidneys?

Surgery Signup and view all the answers

What is the primary goal of nursing care for patients with renal calculi?

To promote hydration and prevent further stone formation Signup and view all the answers

What is the purpose of encouraging patients with renal calculi to ambulate?

To prevent urinary retention Signup and view all the answers

What is the term for the distension of the renal pelvis?

Hydronephrosis Signup and view all the answers

What is the purpose of administering antimicrobial therapy in patients with renal calculi?

To treat underlying urinary tract infections Signup and view all the answers

What is the primary goal of administering a 15- to 20-minute sitz bath two to three times a day in chemotherapy?

To promote muscle relaxation and reduce discomfort Signup and view all the answers

What is the primary function of a nephrostomy tube?

To divert urine from the kidney to the outside of the abdomen Signup and view all the answers

What is the purpose of stents in an ileoconduit?

To prevent occlusion of the ureters Signup and view all the answers

What is the classification of glomerulonephritis based on?

The extent of damage, initial cause, and extent of changes Signup and view all the answers

What is the primary purpose of a suprapubic catheter?

To test the client's ability to void once the obstruction is resolved Signup and view all the answers

What is the primary purpose of a urinary catheter?

To drain the urinary bladder and prevent trauma Signup and view all the answers

What is a common complication of urinary retention?

Urinary tract infections Signup and view all the answers

What is a characteristic feature of glomerulonephritis?

Affecting both kidneys equally Signup and view all the answers

Study Notes

Diagnostic Testing Interventions

Patient teaching: provide descriptions of tests and procedures in language the patient can understand
Use appropriate and correct terminology
Encourage fluid intake unless contraindicated
Instruct patients on methods to reduce discomfort, such as Sitz baths and relaxation techniques
Administer analgesics and antispasmodics as prescribed
Assess voiding and provide instruction on voiding practices and hygiene
Provide privacy and respect

Urinary Tract Infections

Affect upper and lower urinary tract
Inflammation of urinary tract, usually caused by bacterial infection (E. coli)
Classified as: complicated or uncomplicated, initial or recurrent, unresolved or bacterial persistence
Predisposing factors include:
- High incidence of chronic illness
- Frequent use of antimicrobials
- Presence of infected pressure ulcers
- Immunocompromised
- Cognitive impairment
- Immobility and incomplete emptying of bladder
- Use of bedpan rather than toilet

Common Lower UTI Symptoms

Emptying symptoms:
- Hesitancy
- Intermittency
- Post-void dribbling
- Retention (complete or partial)
- Dysuria
- Pain
- Weak stream
Storage symptoms:
- Urgency
- Incontinence
- Nocturia
- Nocturnal enuresis
- Frequency

Common Nursing Interventions

Urinary alterations:
- Monitor urine output relative to intake (at least 0.5 ml/kg/hr)
- Monitor levels of BUN, creatinine, electrolytes
- Encourage ambulation and maximal fluid intake permitted
- Clean hygiene practices (wipe front to back with women, good peri-care, hand hygiene)
- Monitor urine for changes in color, clarity, sediment, odor
- Avoid indwelling catheters if possible; exercise proper care of catheters
- Avoid urinary tract irritants, including coffee, tea, alcohol, colas, spices
- Acidify the urine and provide a less favorable climate for bacterial growth if no contraindication
- Emphasize the importance of finishing the prescribed course of medication

Clinical Manifestations

Symptoms vary with size, location, and cause of calculi
Usually sudden, sharp, severe flank pain radiating to the suprapubic area and external genitalia
Accompanied by renal or ureteral colic
Pain severity inversely proportional to stone size
The pain causes nausea, vomiting, and shock
Urinary retention or dysuria (if obstructed)

Collaborative Care

If stone is 4mm or less, moving, and no obstruction:
- Vigorous hydration, analgesics, antimicrobial therapy, drugs that dissolve the stone or alter promoting conditions
For larger stones:
- Extracorporeal shock wave lithotripsy (ESWL)
- Laser lithotripsy; cystoscopy/basket extraction
Surgery:
- For larger stones, presence of obstruction, UTI, kidney damage, or constant bleeding
- Ureterolithotomy, pyelolithotomy, nephrolithotomy (suprapubic incisions to remove stone)

Nursing Care

Assess and relieve pain, nausea, and vomiting
Monitor levels of BUN, creatinine, electrolytes
Encourage ambulation and fluid intake (2000-2200 mL/day)
I&O; strain urine; check for hematuria, anuria (if bilaterally obstructed)
Encourage patients to void q 2-3 hours and maintain patency of catheters/nephrostomy tubes
Strict asepsis to prevent microbes entering the urinary tract
Emotional support and teaching
Avoid excessive milk intake, increase acid-forming foods

Urinary Diversion

Urinary catheter:
- Keep drainage bag lower than bladder
- Choose the right size of catheter
- Use lubricant
- Insert far enough to prevent trauma
- Avoid manipulation (traumatize the urethra and bacteria invade)
Suprapubic catheter:
- Client ability to void is tested once obstruction is resolved
- Clamped until can void, then removed
Nephrostomy tube:
- Tube from kidney to outside abdomen/flank
Ileoconduit:
- Implanting ureter into 12-cm loop of ileum to abdominal surface with attached urostomy bag
- Stents placed in ureters to prevent occlusion (care like any ostomy)

Glomerulonephritis

Immune-related inflammation of the glomeruli
Characterized by proteinuria, hematuria, decreased urine production, and edema
Affects both kidneys equally
Can be classified by:
- Extent of damage (diffuse or focal)
- Initial cause of the disorder (e.g., systemic lupus erythematosus, scleroderma, streptococcal infection)
- Extent of changes (minimal or widespread)
Assess patient's exposure to medications, immunizations, microbial infections, and viral infections
Evaluate patient for more generalized conditions involving immune disorders

Clinical Manifestations of Glomerulonephritis

Hematuria (ranging from microscopic to gross) and urinary excretion of various formed elements
Proteinuria and elevated creatinine levels
In most cases, recovery from the acute illness is complete
However, if progressive involvement occurs, the result is destruction of renal tissue and marked renal insufficiency

Acute Poststreptococcal Glomerulonephritis

Develops 5-21 days after an infection of the pharynx or skin
Generalized body edema, hypertension, oliguria, hematuria with a smoky or rusty appearance, and proteinuria
Fluid retention occurs as a result of decreased glomerular filtration
Edema appears initially around the eyes (periorbital edema), but later progresses to involve the total body
HTN, abdominal/flank pain
95% of patients with APSGN recover completely or improve rapidly with conservative management

Rapidly Progressive Glomerulonephritis

Glomerular disease associated with rapid, progressive loss of renal function over days to weeks

Chronic Glomerulonephritis

Develops insidiously and progresses over many years
Often found coincidentally as an abnormality on a urinalysis or when elevated blood pressure is detected
Common to find that the patient has no recollection or history of acute nephritis or any renal disorders

Nursing Management

Management focuses on symptomatic relief
Rest is recommended until signs of glomerular inflammation (proteinuria, hematuria) and hypertension subside
Edema is treated by restricting sodium and fluid intake and by administering diuretics
Severe hypertension is treated with antihypertensive medications
Dietary protein intake may be restricted
Sodium and fluid restriction, corticosteroids, cytotoxic agents, dialysis, and antibiotics should be given if the streptococcal infection is still present
One of the most important ways to prevent the development of APSGN is to encourage early diagnosis and treatment of a sore throat and skin lesions

Renal System Function

Maintains fluid and electrolyte homeostasis
Excretes urine
Acts as a buffering system to control pH
Critical for producing:
- Active vitamin D for blood calcium balance
- Erythropoietin to stimulate red blood cell production
- Renin to regulate blood pressure
- Growth hormone
- Prostaglandins

Fun Facts

Kidneys filter 1.2 liters of blood per minute, creating 180 liters of filtrate daily
Each kidney has approximately 800,000 to 1 million nephrons
99% of the filtrate is reabsorbed back into the venous system, leaving only 1000-2000 ml of urine daily
Urine pH is 4.5
Bladder holds 400-500 ml
Overfilling can cause the bladder to lose its natural shape and elasticity, affecting urination

Common Terms

Anuria: absence of urine
Diuresis: increase in urine volume
Dysuria: painful urination
Enuresis: involuntary nocturnal urination
Frequency: voiding more frequently than usual
Nephritis: inflammation of the kidney
Hematuria: blood in the urine
Hesitancy: difficulty initiating urination
Incontinence: inability to control urination or defecation
Lithiasis: presence or formation of stones
Nocturia: excessive urination at night
Oliguria: decrease in urine formation or passing
Polyuria: passing an abnormally large amount of urine
Proteinuria: presence of an abnormally large amount of protein in the urine

Medical Management

Cystitis: antimicrobial therapy (e.g., Septra), 7 days
Urethritis: antibiotic therapy, increased fluid intake (e.g., water, cranberry juice), and analgesics
Pyelonephritis: adequate fluid intake, antibiotics (e.g., Septra, Cipro), antispasmodics, anticholinergics, and pain management

Nursing Management

Cystitis: instruct client on preventive measures, void at regular intervals, shower instead of bathe, and clean perineum properly
Urethritis: preventive measures, sterile/gentle technique with catheterization, and frequent perineal care
Pyelonephritis: encourage fluid intake, monitor for pain and fever, and provide support and education

Clinical Manifestations

Upper UTI (Pyelonephritis):
- Acute: flank pain, tender costovertebral angle, colicky abdominal discomfort, nausea, vomiting, chills, fever, and malaise
- Chronic: asymptomatic or low-grade fever, vague GI complaints, increased BP, fatigue, polyuria, and nocturia
Interstitial Cystitis: chronic, painful inflammatory disease of the bladder wall, causing disintegration of the lining and loss of bladder elasticity

Urinary Retention

Acute: sudden inability to void, distended bladder, lower abdominal pain and discomfort
Chronic: inability to completely empty the bladder, may void frequently in small amounts or dribble
Assessment: postvoid residual (PVR) urine, monitor for signs of cystitis, and determine voiding frequency

Medical-Surgical Management

Acute Urinary Retention: immediate catheterization (intermittent or indwelling), and may need instruments to dilate urethra
Chronic Urinary Retention: permanent drainage with a urethral catheter or suprapubic cystostomy, clean intermittent catheterization (CIC), and condom catheter for men

Urinary Retention - Nursing Care

Acute: monitor for discomfort, palpate for distended bladder, and collaborate with physician regarding catheterization
Chronic: assess voiding frequency, encourage fluid intake, and teach self-catheterization and catheter care

Clinical Manifestations - Urinary Calculi

Symptoms vary with size, location, and cause of calculi
Sudden, sharp, severe flank pain radiating to the suprapubic area and external genitalia
Accompanied by renal or ureteral colic
Pain severity inversely proportional to stone size

Collaborative Care

If stone is 4mm or less: vigorous hydration, analgesics, antimicrobial therapy, and drugs to dissolve or alter promoting conditions
For larger stones: extracorporeal shock wave lithotripsy (ESWL), laser lithotripsy, or surgery

Nursing Care

Assess and relieve pain, nausea, and vomiting
Monitor levels of BUN, creatinine, and electrolytes
Encourage ambulation and fluid intake (2000-2200 mL/day)
Monitor for hematuria and anuria
Teach and provide emotional support

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Description

This quiz covers diagnostic testing interventions in nursing, including patient teaching, pain management, and voiding practices. It assesses a nurse's ability to provide care and support during diagnostic testing procedures.