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?

    <p>Vigorous hydration, analgesics, and antimicrobial therapy</p> Signup and view all the answers

    What should patients with renal calculi avoid consuming in excess?

    <p>Milk</p> Signup and view all the answers

    What is hydronephrosis?

    <p>Renal pelvis distension due to retained urine</p> Signup and view all the answers

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

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

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

    <p>To check for hematuria</p> Signup and view all the answers

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

    <p>Medications, immunizations, and microbial infections</p> Signup and view all the answers

    What is a common symptom of acute poststreptococcal glomerulonephritis?

    <p>Generalized body edema</p> Signup and view all the answers

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

    <p>5-21 days</p> Signup and view all the answers

    What is a common laboratory finding in patients with glomerulonephritis?

    <p>Elevated creatinine levels</p> Signup and view all the answers

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

    <p>Complete recovery in 95% of patients</p> Signup and view all the answers

    What is a characteristic feature of rapidly progressive glomerulonephritis?

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

    How does chronic glomerulonephritis typically present?

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

    What is a condition often evaluated in conjunction with glomerulonephritis?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

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

    <p>Providing symptomatic relief</p> Signup and view all the answers

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

    <p>To reduce edema</p> Signup and view all the answers

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

    <p>Renal failure</p> Signup and view all the answers

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

    <p>To reduce inflammation</p> Signup and view all the answers

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

    <p>To prevent APSGN</p> Signup and view all the answers

    What is the term for varying degrees of renal impairment?

    <p>Acute kidney injury</p> Signup and view all the answers

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

    <p>To reduce edema</p> Signup and view all the answers

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

    <p>To reduce the workload of the kidneys</p> 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?

    <p>To promote muscle relaxation and reduce urinary retention</p> Signup and view all the answers

    What is the primary function of a nephrostomy tube?

    <p>To drain urine from the kidney</p> Signup and view all the answers

    What is the purpose of stents in an ileoconduit?

    <p>To prevent occlusion of the ureters</p> Signup and view all the answers

    What is a characteristic of glomerulonephritis?

    <p>Inflammation of the glomeruli</p> Signup and view all the answers

    What is the purpose of a suprapubic catheter?

    <p>To test client ability to void</p> Signup and view all the answers

    What is the classification of glomerulonephritis based on?

    <p>The extent of damage, initial cause, and extent of changes</p> Signup and view all the answers

    What is the purpose of a urinary catheter?

    <p>To drain urine from the bladder</p> Signup and view all the answers

    What is a common complication of urinary retention?

    <p>Urinary tract infection</p> Signup and view all the answers

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

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

    What is the primary cause of urinary tract infections?

    <p>Bacterial infection</p> Signup and view all the answers

    What is a common symptom of lower urinary tract infections?

    <p>Hesitancy</p> Signup and view all the answers

    What is a gerontologic consideration for urinary tract infections?

    <p>All of the above</p> Signup and view all the answers

    What is a common nursing intervention for urinary alterations?

    <p>Monitoring urine output relative to intake</p> Signup and view all the answers

    What is a preventative measure for urinary tract infections?

    <p>Voiding every 2-3 hours</p> Signup and view all the answers

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

    <p>To ensure the infection clears completely</p> Signup and view all the answers

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

    <p>To create a less favorable climate for bacterial growth</p> Signup and view all the answers

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

    <p>2-3 L daily</p> Signup and view all the answers

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

    <p>To eliminate the causative organism</p> Signup and view all the answers

    What is a characteristic feature of Interstitial Cystitis?

    <p>All of the above</p> Signup and view all the answers

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

    <p>10-14 days</p> Signup and view all the answers

    What is a common symptom of Upper UTI - Pyelonephritis?

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

    What is the purpose of cranberry juice in managing UTIs?

    <p>To prevent bacteria from adhering to the bladder wall</p> Signup and view all the answers

    What is a common nursing intervention for patients with UTIs?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of analgesics in managing UTIs?

    <p>To alleviate symptoms</p> Signup and view all the answers

    What is a preventative measure for UTIs?

    <p>All of the above</p> Signup and view all the answers

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

    <p>To boost the immune system</p> Signup and view all the answers

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

    <p>To promote a regular voiding schedule</p> Signup and view all the answers

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

    <p>To stimulate the nerves controlling the bladder</p> Signup and view all the answers

    What is the primary cause of acute urinary retention?

    <p>Urethral obstruction</p> Signup and view all the answers

    What is the treatment of choice for chronic urinary retention?

    <p>Clean intermittent self-catheterization</p> Signup and view all the answers

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

    <p>To assess the effectiveness of treatment</p> Signup and view all the answers

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

    <p>Providing emotional support and education</p> Signup and view all the answers

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

    <p>To apply gentle pressure to the bladder during voiding</p> Signup and view all the answers

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

    <p>To flush out bacteria from the urinary tract</p> Signup and view all the answers

    What is the primary complication of urinary retention?

    <p>Urinary tract infection</p> Signup and view all the answers

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

    <p>To drain the bladder completely</p> Signup and view all the answers

    What is the primary function of the renal system?

    <p>To maintain fluid and electrolyte homeostasis</p> Signup and view all the answers

    What is the term for the absence of urine?

    <p>Anuria</p> Signup and view all the answers

    What is the normal pH of urine?

    <p>4.5</p> Signup and view all the answers

    What is the function of the hormone erythropoietin?

    <p>Stimulating red blood cell production</p> Signup and view all the answers

    What is the term for painful urination?

    <p>Dysuria</p> Signup and view all the answers

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

    <p>99%</p> Signup and view all the answers

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

    <p>Hematuria</p> Signup and view all the answers

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

    <p>1000-2000 ml</p> Signup and view all the answers

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

    <p>To evaluate the effectiveness of analgesic therapy</p> Signup and view all the answers

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

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

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

    <p>To check for hematuria or anuria</p> Signup and view all the answers

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

    <p>Surgery</p> Signup and view all the answers

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

    <p>To promote hydration and prevent further stone formation</p> Signup and view all the answers

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

    <p>To prevent urinary retention</p> Signup and view all the answers

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

    <p>Hydronephrosis</p> Signup and view all the answers

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

    <p>To treat underlying urinary tract infections</p> 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?

    <p>To promote muscle relaxation and reduce discomfort</p> Signup and view all the answers

    What is the primary function of a nephrostomy tube?

    <p>To divert urine from the kidney to the outside of the abdomen</p> Signup and view all the answers

    What is the purpose of stents in an ileoconduit?

    <p>To prevent occlusion of the ureters</p> Signup and view all the answers

    What is the classification of glomerulonephritis based on?

    <p>The extent of damage, initial cause, and extent of changes</p> Signup and view all the answers

    What is the primary purpose of a suprapubic catheter?

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

    What is the primary purpose of a urinary catheter?

    <p>To drain the urinary bladder and prevent trauma</p> Signup and view all the answers

    What is a common complication of urinary retention?

    <p>Urinary tract infections</p> Signup and view all the answers

    What is a characteristic feature of glomerulonephritis?

    <p>Affecting both kidneys equally</p> 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.

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