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Reviews common kidney diagnostic procedures including IVP, cystoscopy, clean-catch urine, midstream culture, 24-hour urine collection, and kidney biopsy. Also covers pre- and post-procedure preparation, bleeding precautions, and smoking restrictions.
okay so this is where we are do you let's talk about the um the kidneys first before we talk about gu now we did cover i know i did cover all the diagnostic tests so we talked about theivp intravenous pylogram cystoscopy um clean catch midstream 24-hour urine kidney biopsy stop for a moment any question and these ivp is a big one for nclex so i'm going to say remember intravenous pylogram we typically do this onewhen patient has um kidney you know sudden kidney disease or kidney is failing fast and you know we don't know we really want to figure out what's going on now with this preparation is it's intravenous filogram is adye that's going to be given so of course they need to um sign a consent besides that they need and this is very important for ivp even though it's the kidneys we're looking at the patient needs bowel prep
ivp requires bowel prep the real purpose for that is because when they do the x-ray they inject the dye and do extra of the kidneys if the patient has too much stool in the gi tract that will actuallycast shadows on the kidneys and they won't be able to see what they want to see properly so they do need iv um bowel prep for ivp cystoscopy is only just using going up with a scope and usuallywe'll do this for bladder um for you know suspected like bladder um cancer bladder cancer is number one risk factor for bladder cancer is smoking cigarette smoking nicotine news and number one symptom is painless immaturia so the patientwill present with immaturia and no pain bloody urine and no pain the next question you want to ask them of course you want to know how long this has been going for but you all you want you want
to ask about smokingclean catch you can always clean catches just you know getting urine for your analysis it's not for urine culture so you can delegate that clean cash you can delegate to the uap you're in culture you don't because youneed to once you need to the word instruct or you need to tell the patient educate then you don't delegate mid light mainstream urine midstream is usually for uh culture and sensitivity and you get in the urine midstreamso in this case you have to instruct the patient to clean and start urinating in the toilet and midway into the urine stream collect the urine why do we have them collect during mid mid stream mahelio
because in the initial part of the urine i think it sometimes gets bacteria initially and the mainstream is kind of like more sterile like steroids and then the beginning probably touch like midstream is like a flow coming thenso it's less like chances of contacting bacteria or something so the urine the urinary system is sterile and urine is sterile so when the patient clean they might not have done a good job so when they start urinatingthat you know whatever is coming will wash off whatever they didn't clean and then you get the midstream which will be more sterile that's why and this is why you don't delegate this one because this is instruction youhave to give the the patient and once you have to instruct you see the word instruct is teach that's not for them 24 urine collection this is the one where we discard the first urine and you collect everything
from that point on until the 24 hours then you have the void and you end the urine we do this a lot we do this for different things but most of the time is for creatinine clearance
kidney biopsy but the kidney of course the kidney when we just go over it right now kidney is very vascular and it's responsible for a lot of different um function so with kidney biopsy patient can bleed so prekidney biopsy we're going to get cbc and coagulation studies we need p t p p t i and r if they're prolonged we may have to give vitamin k or you know fresh frozen plasma prior to doing thekidney biopsy because we don't want them to bleed after the biopsy it's invasive so they need to sign consentpost kidney biopsy the patient would lay on that side now it could be the right one or the left one so they would lay on that side for about six hoursand you're monitoring them closely for signs and symptoms of internal bleeding because you're not gonna see the frank bleeding outside outside so they can get some hematoma if they have hematoma at the site you want to you know
first thing you come on duty and you took over this station and they have some hematoma at the site you really want to get a marker an indelible and kind of put a you know where put a ringaround it so that if it's starting to get bigger and your first any diagnostic test or all of your diagnostic tests post diagnostic tests when they come back to you the first hour you're doing vital signs kill 15minutes you are doing this vital signs the first hour of vital signs few 15 minutes you do not delegate it to the uap or the lpnif they stable and and vital signs stable in that first 15 at first hour then you can delegate the next hour to the lpn but you don't delegate the post procedure vital signs to the uap until they're abouttwo three hours outside of the test
so remember the kidney biopsy also they need to hold any medication that they need to hold their nsaids and aspirin for seven to ten days and warfarin will be 72 hours cystoscopy this is another nclex moment if theysmoke they should not smoke the day of the morning off before the procedure
because remember until there's just most of your patients for bladder cancer are smokers so the big thing with the cystoscopy we don't want them to smoke the more than enough before the procedure so let's talk about acute renal
Explains acute renal failure as a reversible condition and breaks it into pre-renal, intra-renal, and post-renal causes. Emphasizes aggressive fluid replacement and the need to monitor patients closely after an episode.
failure and chronic renal failure let's talk about acute first now acute renal failure is reversible
chronic is irreversible chronic is progressing ckd is progressing so i'm going to talk about acute first and then we'll come back to ckd so acute renal failure is usually something that medical treatment or lack of proper assessment cancause acute renal failure so for acute renal failure we have three stages we call it pre-renal intra renal and post renal now pre-renal in acute renal failure is whatever is causing the kidney to fail acutely is outside ofthe urinary system and most likely it's i pull perfusion to the kidneys an example of that would be dehydration hypovolemia shock so anything that's causing the kidneys not to get enough blood supplies now if you can remember fromfundamentals the kidney is required is 20 up to 20 of the total cardiac output so once cardiac output drop kidney perfusion will diminish and that's why when you have patients going into shock you will see oliguria as an
early sign so pre-renal means that it's outside of the renal system and it's most likely i pull perfusion to the kidneys and that's why i said acute renal we can re reverse so in this case just reverse itby giving them fluids giving them blood you know whatever it is take care of that intra-renal it's usually like nephrotoxic drugs it's something that's affecting the kidneys um the glomerulus inside of it most of the time it's nepaltoxic drugs um also it could be muscles my myoglobin breakdown rhabdomyolysis so muscle cells are very um you know heavy like high protein and it's very hard for the glomerulus to filter it so that can cause intrarenal oraka acute renal failure as in your burn patient the patient who uh god forbid they let's say we have they fell at home and they laying in the same position and the muscle cells start to break down the
person who's overdoing it with the creatine and the bodybuilding and all these other stuff and breaking down too much muscle cells and that's hard for the kidneys very hard and the kidneys to filter that that so that's whatwe call intra-renal or the person who is taking nsaids or vancomycin magento myosin or any of those nephrotoxic drugs so again it's reversible because identify the cause stop it you reverse it post renal is outside of the kidneysand it's usually in the urinary system so post renal could be like in the bladder kidneys like stones um could also be a pregnant uterus something that's pressing on um the bladder so bph can also cause post renalso it's outside of the post is below the kidneys and that's because again it's affecting blood flow to the kidneys and that's why we you know we call it post renal now for acute renal failure the difference that
besides the fact that it's reversible acute renal failure your number one nursing intervention or your number one intervention is to flush the kidneys fluid fluids fluids flush out whatever this problem islots of fluids
and hopefully we reverse it because um uh acute renal failure is referred to as iachogenic and the word iatrogenic pretty much means medical therapy or if you look it up in the regular dictionary says doctor closet so thisis the kind of situation where patients can sue because it shouldn't have happened
so re it's reversible so please know what's pre-renal intra-renal post-renal
and again it's reversible the thing with acute acute renal failure though a patient developed acute renal failure they should always remind their provider that they say once they had surgery and they they bled out a lot and theyhad acute renal failure because this is the patient you want to be very careful with moving forward because if it happened once will happen again now that's it for acute renal failure let's talk about ckd chronic kidney disease
Covers chronic kidney disease risk factors, declining GFR, and progression to end-stage renal disease. Discusses diet, fluid needs, anemia, calcium and phosphorus imbalance, phosphate binders, and when dialysis or transplant planning begins.
now the kidneys take years to fail as in ckd and it can we have risk factors of course for ckd or anything to do with the cardiac if the heart is not working properly the heart goes out itwill take out the kidneys heart failure will take out the kidneys eventually so diabetes hypertension cad hypercholesterolemia all of those also chronic the chronic conditions like systemic lupus when we talk about uh rheumatic condition the systemic loop isthe number one cause of death for systemic lupus or the number one complication of systemic lupus is kidney failure
so these are your risk factors now you don't need if a ckb has five stages stage one to stage five you don't need to know that for nclex what you need to know though is your gfr the glomerularfiltration rate is the 125 ml per minute and as the kidneys start to fail that number start to drop once you get to 15 mls then we call that this is this would be stage five that you needto know and that's called end stage renal disease esrd
esrd needs to be on dialysisnow let me back up for a minute um so normal part of aging is that glomerular filtration rate slows down so stage one i told you we have one two five five is end stage one and two umcould we not necessarily will not need any adjustment necessarily because the gfr may be like 80 75 and by the way african-american patients naturally have has lower gfr than the regular population so it's usually when we get tolike stage three then it becomes more problematic so whenever the question said ckd chronic kidney disease that doesn't mean they're on dialysis so ckd patients needs to be on low protein diet protein is a big heavy molecule andit will work the kidneys too much so once they have ckd it's low protein diet they can drink normal um two to three liters more fluid all the better because they flush it if they have diabetes they need
to control the gluc the a1c if they have hypertension they need to control that blood pressure so to slow down the progressionso could you know control those disease to slow down the progression to end stage renal disease once they get to end stage renal disease now we are not going to do low protein anymore because end stage renal diseaseis on dialysisand they are going to need high protein dietwhy do you think they would need high protein diet if they're on if the end stage renal and they on dialysis
because the body isn't holding on to the protein at all body's not just yes that's true and from the dialysis from everything going out of the body yes the dialysis flushes out all a protein so once they goonce the dialysis they the dialysis flushes flushes out all the protein because the dialysate fluid is an hypertonic it's fluid and it takes everything with it so one so patients on dialysis their diet their diet now so thekidneys before i go into that the kidneys are responsible for the production as i said yesterday of urethra pollutant which is the hormone that produces red blood cells the kidney regulates the um sodium potassium and it's regulated runningangiotensin system so it um regulates the blood pressure i'm sorry you cut off a little bit you said the kidney controls the sodium and potassium yeah and the angiotensin system so it it maintains the blood pressure okay also
the kidneys produce um vitamin d in the raw form so without vitamin d they we can't we the body does not absorb calcium so they would be uh they will have low calcium so with kidney failure patient haslow calcium low vitamin d low calcium
so and they have low eraser for eating so typically a patient with ckd starting with ckd all the way to insert renal disease will be anemic they are all anemic and that's why they need the ipo
they also need calcium and vitamin d supplements
you say vitamin b or d d d is in dog okay got it vitamin d yeah calcium calcium so they need vitamin calcium and vitamin d supplements um also when calcium is low kim said it earlier what's highphosphate phosphate so they have high phosphorus so hyperphosphatemia so calcium by the way and um phosphorus although they're inversely related they're in the same food so i typically refer to them as they don't like each other but they'reon the theme they walk into the same restaurant to eat than on opposite end of the street so they don't like each other calcium and phosphorus inversely related but they're in the same foods and it's usually mostly dairyso we cannot use food to control their phosphorus or their calcium so we use medication so they so um renal failure patients are should not be in dairy hi dairy product we don't give them dairy products for two
reason the calcium in the phosphorus and berry products have saltand when you find a low sodium or salt free um cheese let me know because i'm still looking for it you said salt free cheese yes or low sodium cheese have you ever seen that i've seen i thinki've seen low sodium cheese but not like zero fat maybe i don't eat cheese on myself and tell her but i know my mom like she's always looking for something low in sodium and i'm like i guess idon't know i'm still looking for that low sodium cheese so pizza would be out you know photos for these fish because even though they need the calcium milk would be out they if they you know they're getting phosphorusand they don't need phosphorus so we give them calcium vitamin d and we give them a phosphate binder does anyone know the name of the drug that we give them for the phosphate binder alia
no i don't know i mean you remember which drug that is commonly used as a phosphate binder is it calcium is it snx calcium that's probably the generic name but have you heard of the name sevilla mir uhoh yeah yes sevilla mayor um render gel is the is the also the generic name brenda gel so that's a phosphate binder and they take that um with food and it's like an antacid so they should never takethat without their medications at the same time so we bind so this is how we get rid of the phosphorus and keep on hold on to the calcium so now remember because they're at risk for calcium you knowum low calcium they also um nc adrenal patients are also at risk for osteoporosis
so you've got a lot going on so by the time they get to stage four the discussion about dialysis or transplant should be taking place
Compares peritoneal dialysis and hemodialysis, including access, timing, fluid removal, and complications. Reviews pre- and post-dialysis assessment, fistula care, medication holds, and dialysis disequilibrium syndrome.
stage five once the gfr is 15 less or less that's the time it is nc adrenal and they're not able to excrete their waste at that point so they will have to go on dialysisany question on chronic versus acuteso remember ckd um is not end-stage renal disease they hid in there but they're not there yet so um end-stage renal disease they they're the ones that have a neuria they don't pee or if they do pee there'sno you know um osmolarity there's nothing in there there's no waste product in there in that urine so they need dialysis for uh for chronic kidney disease if they get a um a kidney transplant wouldn't would that likeuh before stage like fiber or whatever like stage two or three um that's still irreversible um very good point now ethically the discussion doesn't come up until they get to four um so they wouldn't give them a kidney
transplant at stage three two or three because if you look at the risk factors some patients outlive this whole thing before they get to five um als also they uh is like like the diabetics if they keep thata1c under six under seven the kidney they slow down that progression if they're obese and they lose weight they slow down that progression if they you know keep that um cholesterol level we didn't know them they slow downthat progression so the discussion they they will not have the discussion until they get to stage four about getting the kidney um get you know get going on the transplant list and so the question is it reversible uhit depends on what's causing it nevin if it's or if it's autoimmune like lupus that kidney is gonna fail again if it was because of diabetes or hypertension or see you know coronary artery disease that's reversible so like
um what's the singer name um that just recently had a kidney transplant selena gomez from from she had lupus now selena gomez is very young there's no doubt that selena gomez is going to need another kidney somewhere downthe road because she is autoimmune disease so you didn't cure the disease you just took great get rid of that so it's good that kidney is going to fail again rest assured if it was because um she hadtype 1 diabetes and she had poor glucose control and you know she controlled her glucose and then necessarily it wouldn't fail again does that answer your question nevin yeah yeah so that's usually the case so now once weget to emo dialysis um the discussion comes up about whether it's hd hemodialysis or pertinent dialysisso we kind of reserve the peritoneal dialysis for patients who are going to get a transplant so it's a temporary situation most likely and also they're like high functioning they can do everything on their own they don't you
know they just need a nurse to come in and set up the situation for them one time and the rest is that they can take care of it if you and that doesn't mean just a patient it meansa patient and a family member too if they have family members who said hey i'm gonna be in charge here and i'm going to do everything with dispersion analysis because we would rather do this than the hemodialysis thenthey'll go down that road now with personal dialysis this is usually um it's cheaper and it's easier for the patients but it has its complications too so this is the one where they get a catheter inside the peritoneumand they do um dialysis sometimes it could be three times a day sometimes once a day sometimes they do it at night so this is the this is it's ordered by the physician of course to dialysate so this
is how they will do this so the nurse a nurse will come like a visited nurse will come and do the dressing like they put a dress in like maybe once every three days and the patient is responsiblefor what we call the dwell so they have the dialysate fluid delivered to their house so they you know they'll connect all the dots and at the dwell time the fluid goes in the number of hours that thedwell is ordered by the physician and draining how long they should drain uh it's also ordered by the physician but what goes in most comes out with additional fluid so for personal dialysis they can go to work whilethey're doing their dialysisthis is why we say we reserve it for certain patients not everyone is a candidate for personal dialysis because during the time that they're going to um drain they could that's you know some people would take their break
or stop while they calls or not to meet with you know clients and just in their office and sit up and just dwell and just drain the fluid whenever they drain in though here is where you view thenurses to say they're in the hospital for dialysis whether it's hemodialysis or peritoneal dialysis prior to dialysis they need to weigh we need to weight them
we want to weigh them because weight is the best indicator fluid volume status
and you should have a value in your head that says we say 1 kg and how many pounds
2.2 2.2so then if you um so and if you want to do one pound it's 500 ml use use one formula pick one and move with it because they will ask you that an inflex patient had dialysis and priorto dialysis they weighed like say 152 pounds after dialysis they weigh 148 how much weight how much fluid was removed from the patient and then you got and if you see that on on on nclix that's not amath question people are confusing med calc with you know some of these nursing questions that's not a math question so way before or way after before bold for hd and pd p pd um they need to the fluidthat comes out they need to look it need to look like urine like straw color so it shouldn't be purulent shouldn't be bloody
if it's purulent it means they have peritonitis which is the most common complication of personal dialysis as a matter of fact if they get more than three pd um personal personitis in a three month period there they're goingto stop them and put them on emo dialysis because they obviously not doing they obviously doing something wrongso they need to sort of so um whatever comes out again they need to be more than what in what went in so if they had inflow of uh a leader then outflows should be at least 1200 becausewe're talking about urine output and again it should be so if it's not if it's less than um it could be obstruction before we consider it anything else you may have them move around walk change position they couldbe kinking of the two somewhere so we try all of that um other complications of personal dialysis they can get conservation because of course when they dwell in they can also get some shortness of breath while they're dwelling
they can have abdominal they're definitely going to have abdominal distension but the most common is peritonitis
now let's talk about hemodialysis hd so to go on hemodialysis um they need a fistula or a shunt a heavy fistula or a shunt these take times to develop so we can use like prior to to get thedeveloping the av fistular shunt we can use a shyly shyly looks like um a triple lumen catheter if you've ever seen it in the meantime while they're developing the fistula the av fistula are the shunt the av fistulatakes about maybe two depending on the patient and how you know functional they are because they're gonna be squeezing like a ball or something and making sure that the vein builds up the vein and the artery so thatthey can anastomosis put it together and create that av graft and then once that av graph is created they still need to let it get bigger so that takes another two weeks before we can use it
extra information probably don't need it for nclex what you need to know is when they have the av fistula what should you be assessing for
yes you want to listen to the
feel the thrill listen to rui so you listen over it you should and and you should also assess the pulse distally to the fistula shouldn't be cool and clammy and it shouldn't be diminishednow the the floor nurse doesn't do anything with the fistula except assess for um make sure it's functioning assess the put a thrill and a brewery and it pulls this to leave but you don't do anything you don'tdraw blood there you don't touch it you don't do as a matter of fact on that side no blood jaw no i've no no blood pressure you should also teach the patient not to wear any tight clothing overthe fistula and they shouldn't sleep on it they shouldn't sleep on that arm you know they can forget and then fall asleep on that side so you also want to teach them
that
when they come back from dialysis so dialysis hd is usually first we start out with you know maybe every day for the first week or two and then typically it's three times a week remember you're weighing them beforeprior to going to dialysis this is that next moment you want to hold their medications because it's going to get washed out especially the ones that are daily once a day blood pressure
medication
usually they come back from immodialysis they're usually very tired very lethargic now if they if you're the nurse if you because sometimes they'll make you the hdmi dialysis nurse and you're the dialysis nurse and they you're giving themdialysis and they become lightheaded and you feel like they flush and drop their blood pressure really fast you are going to stop you're going to position them in the trendelenburg position give them time and then of course notifythe provider and go from there
taking off the fluids too fast we call it dialysis disequilibrium
syndromethey do eat while they're at dialysis because most of them are diabetics it's not a myth diabetes ruin it will make the kidneys fail so they do eat while they're there uh we don't give them their long-acting insulinbut they're short-acting and still in the rapid acting sorry the rapid acting like the missed produce they can get before dialysis all the others you'll hold as it gets washed out they also get heparin at dialysis they alsoget some antibiotics at dialysis
and they get the appropriate after every dialysisor epo
Introduces glomerulonephritis, its symptoms, and the oliguric and diuretic phases. Also explains fluid restriction rules for end-stage renal disease and how to count ice as fluid intake.
any question on hd pd
kathy just talking it all in okay i was gonna i was gonna i was gonna ask when you said the the with the kidney that you wouldn't give them you would hold the medication beforehand so afterwards would youmedicate or you would wait when they come back you'll give them their medication after you do the vital sign then a festive because some of them are coming back very hypertensive so you may have to wait a littlebit with that because you took off fluids and you know so yeah but you can give it once a day once a day it could be any time but you you know give them an hour or two andthen you'll see that they're gonna need it okay a kidney transplant transplant is transplant is transplant so let's move on past that um and let's go down to the glomerular the nephrotic syndrome and nephrolic syndrome and nephritis we
don't have to talk about this these are like precursor to kidney failure acute kidney failure and we see this a lot of times like in patients who have uh and you know lupus or other situation or um aclot in the renal artery can get nephrotic syndrome what i want to talk about is glomerular nephritis because nclex love glomerular nephritis acute glomerulonephritis number one risk factor or we see it most commonly if you see a patientcomes in these are the symptoms of glomerulonephritis hypertension the blood pressure is very high they have facial edema perioperative edema oliguria smoky color urine and normally uh most of the time they uh they are recovering or recently recoveredfrom a strep infection strep throat
so when you get these symptoms and you get these patients you always want to ask them about any um recent sore throat or upper respiratory infection
so we're gonna acute glomerulonephritis um we have what's we have two stages we've got what's called the oliguric stage this is when they're not penis when they have the edema and basically it's an itis so we're going togive antibiotics the blood pressure is going to be very high so we need to take care of that so they're going to need antihypertensive unrest they will have protein luria because the glomerulus is not working properly now rememberand i know i didn't say this before protein nuria is bad plus two plus three plus four plus one is considered trace that's not a problem that's usually that couldn't be that's common that can be because someone workout hard and you know breaking down muscles or they eat high protein diet so they can have trace protein in the urine plus one but anything after that it means the kidneys are not filtering the protein the kidneys
are not working properly so with glomerulonephritis you'll see proteinuriaso during the oligarch phase when they're all and this is not only for pediatrics it's common in peds but we see it in adults too so you need to rest they need rest and symptomatic management so i toldyou their blood pressure is going to be high so we'll give them antipretensive and antibiotics because it's an itis and during the holy group phase we're going to restrict
fluids once they start urinating now they they're in the diaries diuretic faith they heal it they're recovering then you can start giving them back their fluids
by the way i um chronic um seek end stage renal disease patients are on fluid restriction i think i said three three patients we have in food restriction is siadh patient heart failure patient and end-stage renal disease visionnow do not confuse that with ckd ckd is not on fluid restriction ckd needs fluids so they don't advance to end stage renal disease but end-stage renal disease will be on food restriction fluid restriction is not a nursingorder by the way that's not a that's not an independent order the nurse you need the doctor to tell you how much fluid you need to restrict and you follow what he said so it may say one literfluid restriction and you make sure the patient is on one liter fluid restriction you um as far as encouraging fluid you don't need a doctor to tell you that but to restrict and how much they want restricted that's
their call
when they on fluid restriction make sure they do not get a ice feature one you tell your pca no ice feature because if you ever want people to drink you know how most people say i don't like drinkingwater just tell them their food restriction just put a sign over their bed and said you're on one little food restriction the person who didn't drink who you were forcing to drink a cup of water today is gonnadrink a gallon it's all in their head so do not make sure the pcas do not put ice pictures and and just remove it so there's a question they'll ask you if the highest picture is on the tableremove it because ice is considered fluids and if they ask for ice chips they can get ice chips but it's only going to be a small amount because it's because it's counted in their fluid intake and they're going
to be on food restriction remember ice is half the volume of whatever it is so if you have one cup of ice that's half a cup of
Reviews cystitis, urethritis, prostatitis, and pyelonephritis, with E. coli as the main organism. Covers prevention teaching, symptoms, progression to kidney infection, and confusion as a common sign in older adults.
waterquestion
kimstill here yes kathy still here yep i'm still here all right okay so that's let's go let's talk about um the urinary issues now uh go with cystitis bladder infection uti urethritis prostatitis all of these are lower trackand your biggest the number one organism here is e coli
and that's why women get more uti than men because of the shorter urethra
as a matter of fact uti in guys is a big deal they are more likely to get urosepsis so when a guy develop uti and they're usually older when a guy develops uti they need iv antibiotics for atleast 24 hoursnot a case in woman very common in women so you tell women um what are some of the instruction you give to the woman to avoid getting utiaelia um proper hygiene um also to drink fluid um what else what this define the hygiene break it down a little bit more for me oh so if you're the wiping you clean from front to back when you'reless specific instruction on the hygiene or cleaning
and the intake of fluid that will help with um urinary tract infectioni can't think about something else though we'll see um what i think kathy anything okay
i don't think so urinate immediately after intercourse yeah before and after before and after intercourse and also um see some of the things that can cause yeast infection can cause bladder infections so tight clothing wet clothes you knowit's summertime and they have they exercise and they keep the wet clothes on or they go to the beach and they have the wet clothes on those can also cause cystitis so those are also not wearing cotton underwearnot wearing cotton underwear so cotton seated underwear
and empty your bladder at least every two to three hours don't let the urine sit in there don't hold to your onto your urine not that you can hold on to it for much for long but don't holdon to it because anywhere fluid sits bacteria grows
so having chronic cystitis can lead to pyloritis and pyelonephritis is when that same bladder infection now moves up into the kidneys
so pilo is kidney and kidney infection and they are the ones that get the flank pain or the cva tenderness
it's all the nighties so they're going to have any time you see they ask your symptoms uh you know patient had itis anorexia loss of appetite vomiting likely fever for cystitis is suprapubic pain but pyelonephritis is flank painor cva tenderness
treated antibiotics pyelonephritis chronic can you back up a little bit sorry it cut off i don't know if it's my internet or yours at this pointum where where did where do you want me to go back to
what you were saying now just a little bit further back oh it's so it's cystitis and i saw the symptoms of both cystitis and pyelonephritis that they are it's all itis so you know if they ever ask youthose questions you're gonna go for loss of appetite anyone who is feeling sick will tell you i don't want to eat so anorexia nausea vomiting fever cystitis would be superpubic pain pyelonephritis is flank pain
chronic pyelonephritis can lead to eventually lead to kidney failure cystitis in is very common or uti is very common in elderly patients and they normally do not get a fever so don't look out for fever because they're oneof the reason why they don't get a fever is because as you get older the immune system doesn't function as well so the ability to get a temperature is lowered so the typical a typical symptom that you willsee in a patient an older person with bladder infection is
confusion
Explains how to recognize prostate-related hematuria and the symptoms of benign prostatic hypertrophy. Covers medications, TURP surgery, post-op irrigation, bleeding concerns, and prostate cancer screening.
got it kathy yeah i got it thanks okay now let's talk about the prostate for the guys the prostate is part of the urinary system but if you think about the anatomy of the prostate it's like literally outsideof the urinary system so this too that little thing it's right outside there but it's referred to as part of the urinary system now when you have a a guy comes in and he's having immaturia and this ishow we know it's the prostate it if it is the prostate the blood is going to come at the end of the urine stream because the prostate is kind of outside of the urinary system although it's part ofthe urinary system so the question you want to ask is in the blood before during while you're pain or at the end at the end of the urine stream then it's the prostate now normal part of asian as
they grow older the guy get older the prostate is a gland and it's an organ and it's the one thing i say that gets bigger as you get older prostate and as it gets bigger it kind of squeezedown on the urethra and cause urinary retention so the typical science of bph benign prostate hypertrophy is what we call urgency they feel like they gotta go gotta go gotta go and then they go they can't start theurine stream so they get hesitancy frequency urgency hesitancy they always go into the bathroom they feel like they gotta go like right now and when they go there they have a hard time starting the urine stream so it'sfrequency urgency hesitancy
now for the prostate we talked about the medication that we use yesterday so surgery is the last resort surgery the last resort for everything so we'll try the alpha blocker all those zosian terrazosine parazolicine and then we cantry to finestrate the zosins or just just to relax the bladder so that they can go easier the urine could flow and the finasteride can supposed to decrease minimally but they supposed to decrease the size of the prostatesome patient will respond very well to that some of them won't at all and then that would be your guy who would need surgerysurgery for the prostate is the terp transient ritual resection of the prostate terp surgery
they coming back to you post terp with a three-way foleyinside of that one of them is for irrigation fluid irrigation normal saline and one is for the urine so first in the first couple of hours the urine can be sanguinous in the first four hours but then afterthat it should be more serious or pink tingedif you so if you're up to 12 hours or a day later and your urine is still bloody you mean you may need to irrigate it more keep an eye on the vital signs it could be bleeding
poster surgery it is um normal to have mild watch the word mild spasm but severe fathom or severe bladder pain is not normal
also because it's surgery below the xiphoid process terp surgery increased risk for dvt and all the other complications of surgery
so have them turn in position leg exercises get them out of bed as soon as possible st um the sequential compression devices may be um definitely
lovenox
prostate cancer um is more common in when we do health promotion which is where we're going to that's the last thing we're going to do before the end of the session it's most common among african-american male and soevery guy starting at age 50 should start have it's getting screened for prostate cancer and that screening is the digital rectal exam annually andpsa
Briefly notes pediatric urinary issues before shifting to oncology nursing. Focuses on breast cancer location, post-mastectomy positioning, and exercises to prevent lymphedema.
so um i didn't speak any didn't say anything about kids and urinary system like hypospadia um all those other things because they they don't ask those kind of questions and then clicks and when they do they pretty straightforwardif they ever do i i remember it came i told you i said adults have too much problem to focus on kids you know kids grow stuff out or you can surgically repair them very fast and they're goodto go that's not the case with adults so you know that's why um i only do a little bit of gi peds a little bit of gi cardiac and a little bit of gi respiratory and and gi umand cardiac i told you it's the tetralogy of followed coordination of the order and vsd those are the three things that they like to talk about if they talk about anything otherwise the focus is on adults and they're
super problematic scenarios can you repeat those three again coordination of the aorta tof and bsd ventricular septal defect got it those are the three that they focus onso that's gu we did that we did the drugs already so any question on gu
if not we're going to talk about um what we what we need to add to hematology oncology immunology now we talked about chemo and we went over the chemo drugs so but um let's talk about radiation we didnot talk about radiation now as far as cancer breast cancer review that breast cancer they'll ask they'll ask about like for um where in the breasts location-wise is the cancer most common it's usually on the right it's usuallyover closer to the armpit and for the breasts we usually divide the breasts in clock 12 o'clock is right at the middle there so the breast cancer usually comes most around 11 11 o'clock so also they ask aboutfamily history for breast cancer they also us like to ask questions about post mastectomypositioning and make sure that the uh the side that they did the surgery on the arm is positioned at the level of the heart not above not below
also um interventions to reduce lymph lymphedema and those are like basically like crawling up the you know standing on the wall and crawling up it's not pumping the fist that's pumping the fist is for av graft you knowit's like pretend basically exercises to prevent lymphedema is you tell the patient to use their hands and like crawl up and come down up and come down to drain
Covers prostate cancer positioning and then explains external beam and brachytherapy radiation. Reviews fatigue, skin care, radiation safety, visitor limits, and handling radioactive implants.
but usually the big one is post when they come back to you um how do you position them now prostate prostate cancer uh will also get if they prostatectomy and they they coming back to you similar to theterm patient
and remember prostate cancer is more common do not mix this up i'm going to go over this again when we do health promotion prostate cancer is more common in older guys testicular cancer is more common in younger boystesticular cancer is high school kids 15 to 35.let's that's testicular cancer prostate older guys
so radiation therapy we have brachy and tele or internal beam an external beam external beam radiation they're not radioactive
so pretty much for external beam radiation they go to radiation oncology they get set up with um they um they can't get a tattoo for the area that they plan to radiate and the patient should not remove thetattoo it's not a permanent tattoo it's just a little mark so they can wash it off if they get aggressive about it so they shouldn't because if they do then they have to be set up all over againso with teletherapy it's um smaller dose and it's usually done five times a week for about four weeks four to five weeks so they go in the long er for very short they go in and they get radiatedand they go on about their business with radiation the number one side effect is radiation is fatigue that's an nclex moment
and as they continue as it as the treatment continue the fatigues gets worse and again even after radiation is completed they can get they can still feel fatiguealso they can get um skin breakdown because we're putting you know a radiation beam on the skin it's another side effect and another side effect is they can have a metallic taste in their mouththe metallic taste is due to of course the tissue dyeing from the tele from the radiation therapy and nursing intervention for that metallic taste is basically you would want to have them use like plastic utensils because they sayif they use regular utensils that they can actually taste it and then they stop eating but remember fatigue is the number one side effect also with radiation they should not apply any moisturizer to the skin unless it's orderedor is okayed by the doctor certainly not before because if they put on moisturizer before radiation the skin is going to fry if the doctor okays it then they need to wait and this is an nclex moment at
least two hours after radiation to apply the the moisture moisturizer
no tight clothing no tight bra um if it's in the chests area and they wear a seat belt they can buy like a soft covering for their seat belt so nothing is pressing up against the area after radiationthe skin at the skin that was the site that was radiated they need to protect it from the sun up to a year
for the fatigue do not fatigue gets worse if they just hang around and do nothing so they should um you know they should not do all of their activity at one time then they'll be tired so they shouldlike um spread it out scatter it out do things small small small throughout the day
brachytherapy or internal beam radiation they are radioactive
and normally the skin these are they're going to be in the hospital where they're going to be where you're taking care of them and where you have to be very careful because they're radioactive the brachytherapy um when theyin the in the hospital there should be a sign on their door that says radia radiation in use that door should be closed every single thing from that patient should stay in that room they're leaning their utensils nothingshould be in the in the hallway because everything is radioactive
this patient is the one that you can only expose yourself for maximum of 30 minutes for your entire shift five minutes increments so you shouldn't be in the room for more than five minutes and your total number ofhours x total number of time exposed to that patient for the ship should be no more than 30 minutes for male and female you were the lead apron do not turn your back to these patients do not getcloser than the three feetpregnant women and children should not visit so this beside the signs that said radiation in use there should be a stop visitors report to the nurses station
nurses taking our not just nurses but any health care workers taking care of these patients should have a radiation meter that we call it a dossier meter measuring how much radiation you've been exposed to it and that isjust not just this patient if you work on any unit that you've been exposed to radiation you need a dossier meter and that doesn't matter measures you shouldn't take it home you should leave it at work because ifyou forget it if you should go back home for it because after you have been exposed to a certain amount of radiation they'll your manager usually will put you in a non-radiation area for a cup for about sixmonths
how long should the visitors stay with the patient good question 15minutes and you got to go in there and take them out they're going to argue with you too
nobody sleeps in there they have um uh they juji lead so for these patients they should not be walking around in the room they're on bed rest because usually for bracket therapy it's in um the implant the radioactiveimplant is in an orifice so it's either endometrial it could be prostates it could be cervical so we don't have them moving around we don't have them walking so we normally we would bind them up would give themstuff so they could become constipated they will need to go to the bathroom they have a foley so if they need to urinate they don't have to and so that implant could stay in if the implant should fallout there's a long handle forcep in the room that was placed in there by the radiation department and a container and you're supposed to pick it up drop it in there and notify the radiation
Identifies the major oncologic emergencies: tumor lysis syndrome, SIADH, superior vena cava syndrome, and spinal cord compression. Summarizes key symptoms and urgent treatments such as steroids, radiation, and electrolyte management.
department so that's radiation we did chemo already let's talk about the oncological emergencies i think we have four of them anyone remembers the oncological emergencies kathy
you said the oncological emergencies yeah
um i feel like i know this one
i know one of them is the uh tumor lysis syndrome i think yes to molester syndrome
yes
sidh and spinal cord compression
superior vena cava syndrometumor lysis syndrome spinal cord compression and siadh siadh is common in cancer from chemo remember yesterday i told you that the phosphomytes can do it and also lung cancer small to be specific which you don't need um smallcell lung cancer so just lung cancer can cause siadh so any everything you know about siadh will apply there tls tubalisis syndrome by the way to of all the oncological emergency the only one we consider a good signis tls because if once the tumor bursts open even though it's it's an emergency it means that the chemo is going to work so for tls what we worry about there is hyperuricemia hyperkalemia and for if it's acancer that we know it's a big bulky tumor and this day we know they're likely going to get tls we'll give them allopurinol allopurinol is the drug of choice for uric acid you use it to treat gout and
then we wait to see what happened with the potassium which we know is going to go up so we'll give the polycystic sulforancy state or we can give dependent how high it is and this patient has symptoms that'sk-excellate but that's not the name they're going to use we can use calcium gluconate or what's the other one insulin and dextrose for hyperkalemiaspinal cord compression that's that's very scary if you've ever seen that they have airway issue and that's not sorry superior vena cava syndrome that's spinal cord compression airway issue because the tumor basically is a spread and it's likeum pressing on the superior vena cava so they have severe headache um this near shortness of breath and one side of their body is swollen big than the other than the other side these are all sudden that's whythey call it oncological emergencies
so for um superior vena cava syndrome we need to of course um manage the airway airway management how do we treatthis steroids and radiation
emergency radiation this is high dose radiation to shrink that tumor that is growing on the superior vena cava
spinal cord compression they are presenting with weakness in the lower extremity loss of bowel and bladder function we treat them similar to superior vena cava syndrome
so what i want you to know uh are the symptoms mostly if they present with this which one is is it more than the actual treatment because that's how they'll ask you that annclex
Explains when HIV becomes AIDS and how diagnosis is confirmed with antibody testing and Western blot. Also covers viral load monitoring, treatment effectiveness, and transmission risk when viral load is undetectable.
okay hiv aids what do we need to say about that
diagnosis
when do we consider them aids
when the barrel load is 200 no the the other word not the viral load
cd4 account cd4 count less than 200 than this consider aids now we always say all hiv um all aids patients or hiv or hiv but not all hivs aids because aids is when the viral load it's 200 orless and once they that once they had aids they always considered hiv aids even though the vir even though the cd4 count can go back up we still refer to them as hiv aids now if you watch commercialsyou see them advertising hiv 1 hiv 2 you don't need to know that for implants you just need just hiv hiv patients um the most important thing is you want to make sure that they take their medication andthat they keep their viral load undetectable undetectable viral load of course is going to keep the cd4 count up if the viral load gets too high and we're down the immune system that's when they had they start to
drop the acd-4 count so the goal is to keep the viral load on to get to undetectable and stay undetectable hiv is now a chronic disease and that's why they don't want to cure it because every time youturn around they have a new medication for hiv and patients are living a full life with hiv so the again the goal is to get to undetectable and stay undetectable question i have one question yeah i remember iremember we were talking about it the other day um with the hiv or aids like uh there's that question about like what test is like uh the most reliable to know if you're um i forgot exactly what itwas like which test is like the most reliable and detecting if like after they already have hiv or aids okay so you mean to to um to diagnose or to see if they're responding to treatment um i guess
both okay so to diagnose uh we do the antibody and if the antibody comes back positive then we do the western blot to confirm it you need until we need to follow it up because you know even thoughit's positive you don't want to just do one thing and then give them this bad news so we get we um so once the antibodies so the hiv antibody and by the way hiv antibody is part of yourannual physical and no one is discussing that with you since the affordable care act came into us into um play hiv antibody gets done on every patient as part of their annual physical and then if the antibody comesback positive of course they'll discuss that with you because now they have to do the western blot to confirm that it's you're actually hiv now if they're hiv and they're on treatment the viral load is what we use
to to see how to check for effectiveness after treatment and then that's a very good question because that's how they ask itso they're already diagnosed with hiv and they're on treatment so the viral load is what we te which we check each time they come in for effectiveness of treatment now it is true that if the viral load isundetectable that they have a very low there is so low the cdc can't give you a number risk of passing on this virus to sex or any other means so much so so that a pregnant woman um who'shiv and is on medication if she's undetectable she can deliver vaginallyand of course if she's undetectable she will not pass on the virus to her baby the unborn
child
Reviews diagnostic markers for rheumatoid arthritis and lupus, including CRP, ESR, rheumatoid factor, ANA, and complement levels. Discusses symptom patterns and the stepwise use of NSAIDs, steroids, and immunosuppressive therapy.
any other question
kathy is still here i know i like to bother youi'm herelet's do a little bit of rheumatology um and generalize them so rheumatoid arthritis systemic loop or scleroderma or any of those rumors uh rheumatic disorder so these things are very difficult to diagnose by the way because the patientsymptoms initially they start out very vague and usually they're younger and of course when they're younger and they have big symptoms they you know doctors always chop it up to you're active you're in school you're busy it's yourlife you need to rest and then you know they get overlooked so with rheumatoid with rheumatic disorder um we check c-reactive protein reactive protein we also checked um set rate esr erechocyte sedimentation rate we check room at rfrheumatoid factor and we check a a now c-reactive protein and sedrates are none um specific marker for inflammation so where any wherever there is an inflammation in the body those will be elevated whereas raf rheumatoid factor and a
a are more specific for like rheumatoid arthritis as systemic lupus a a actually is more is most specific for systemic lupus for the anti-nuclear antibody
so once we get these the ana and rheumatic factor and we check the c reactive proteins said rate also just you and clicks never asked about this though with serum complement low serum complement also mean you have lowimmunity so once we the dependent on the patient symptoms of course will make the diagnosis for rheumatoid arthritis they're going to be having joint pain morse unilateral they're gonna be having stiffness that's worse worse in the mornings andlasts longer than osteoarthritis and the patient usually tell you a warm shower usually help to loosen up their stiffness they're going to be fatigued tired almost like chronic fatigue syndrome so we treat them with all those medications wewent over yesterday immunosuppressive therapy and we know that these medications are working because the c reactive protein should be back to normal the sed rate should be back to normal and the serum complement should be normal the ana
and the rheumatoid factor will always be positive because that's those are the markers for rheumatic
disorder that's all the information i have for immunology
question nevin no yes what is the medication do we uh what medication um does afterwards is patient immediately i excited again i saw medication do they need to take
no what medication need to take for rheumatoiduh yeah yeah remember we said we start with um nsaids we start with we start low and go slow and then if they still have in symptoms and your syriac protein is still high said rate is still highpatients are still symptomatic then we may go to steroids and if steroids doesn't control it then we go to the immuno the immune modulators suppressive therapy the big gun the last resort the like like embroil and tarnocept ritoxinthose are the last the one that all the ones that end with the maboh we can also do metatraxate you can also do hydrochloroquine but we don't start with those first we leave those for last because once you go there you kind of reach the ceiling and with that if that therapyfails chemotherapy is the next point which which by the way it happened to be the case in a lot of situations because autumn you said um these are autoimmune diseases so we have no cure we're just treatment and
every patient is going to present differently and every patient um will have different degree of the illness so some patient will go straight to those biological responders because it's a waste of time they're not this you know thesteroid is not helping them where some patient could spend years on nsaids and that's helping and years on steroid low-dose steroids and that's helping before they advance to need in those um you know more of course the biggerdrugs like the biological responders so those are they that we use last resort and they immune their immunosuppressive therapy we call it so that so again the disease is an autoimmune disease so they're they're already um immunosuppressed andwe're giving them medication that's going to suppress the immune system even more but that's the nature of the game with that with those disorder
Covers iron deficiency anemia and pernicious anemia, including symptoms, causes, and treatment. Also explains oral iron administration, vitamin C for absorption, and the need for test dosing with parenteral iron.
and remember they need to have flu vaccine every year and pneumonia vaccine every five years
so the fact that the immune system drops wouldn't that worsen the condition um say it again let me just wrap my head around it i said the fact that you said the immune system drops even more with themedication wouldn't that be worsening the condition um yes and no the benefit of the risk the benefit of weighs the risk gotcha okay yeah the benefit outweighs the risk yes now um um hematology this is iron deficiency anemiathat's the most common anemia
worldwide we see that in women during their childbearing age very common young girls starting their menses in developing countries you could we see it also from um you know people um getting like uh parasites sucking out their bloodso it's very common it's the most common anemia and so anemia the anemia the patient is going to be having low now remember with anemia we we don't get bent out of shape until your hemoglobin is less than10.
less than 10 and
symptomatic
so how do we treat iron deficiency
anemia
give blood before that supplement the patient with iron and if we're giving them iron talk to me about iron oral iron let's say we're giving we start with oral iron we want to start least invasive it can causeconstipation yeah and how do you give it again
something empty stomach with
yeah iron should be on an empty stomach with vitamins with vitamin c so wash it down with some orange juice as they say you need in order to absorb what what i'm trying to get at in order toabsorb iron you need vitamin c
pernicious anemia which type of anemia is that
that's the b12 one b12 yeah that's the one that the people's alcoholic has yes coming in alcoholics and also common in anyone with gastric um surgery or gastric in you know anything to do with the stomach because it'sa loss of intrinsic factor and not producing that increase the risk of not gonna digest your b12 so those bariatric surgery patients increased risk for pernicious anemia i'm wondering why they chose the word pernicious but it's b12 deficiencyso they are going to have what's their symptom beside the anemia what's what's usually um specific about b12 anemia they're very fatigued very fatigued
and what's the classic one that they like to ask the tonguea pallor beefy if your red tongue yes with pernicious anemia beefy red tongue yes they have power and but they love to bring up that beefy red tongue so they depend on the degree they may need they mayjust need um beats um b12 supplements and if they're really um symptomatic severely symptomatic then they need b12 injectionsalso going back to iron deficiency anemia if they're giving iv iron let's say they're severely um having severe iv they usually they do iron studies we based on the base of iron studies which you don't need to knowfor nclex the iron studies you don't need to know the numbers you have enough numbers in your head already but if we're doing parental iron remember we need to do a test dose first because iron has a high
parenteral iron has a high risk for anaphylactic