Showing posts with label Genitourinary. Show all posts

The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination.. The presence of a boggy mass

The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination?

A. A low-riding prostate
B. The presence of a boggy mass
C. Absent sphincter tone
D. A positive Hemoccult

Of the listed options, only B. The presence of a boggy mass is further evidence of a urethral injury in a male client during rectal examination.

Let's analyze each option:

A. A low-riding prostate:

This finding is not indicative of a urethral injury. In fact, a low-riding prostate is more likely seen in conditions like enlarged prostate or prostatitis.

B. The presence of a boggy mass:

This is a potential sign of a hematoma, which can be caused by bleeding associated with a urethral injury.

C. Absent sphincter tone:

While this can be a symptom of various conditions, it's not specific to urethral injury and requires further investigation.

D. A positive Hemoccult:

A positive Hemoccult test indicates the presence of blood in the stool, which isn't directly related to urethral injury and could have other causes.

Therefore, the most relevant finding for urethral injury during a rectal exam is the presence of a boggy mass, suggesting a potential hematoma. It's important to remember that a single finding is not enough for diagnosis, and other symptoms and diagnostic tests are necessary for definitive confirmation.

Nurse Hazel is ware that the following is an appropriate nursing diagnosis for a client with renal calculi?

A. Ineffective tissue perfusion
B. Functional urinary incontinence
C. Risk for infection
D. Decreased cardiac output

Out of the options you provided, the most appropriate nursing diagnosis for a client with renal calculi for Nurse Hazel to consider is: C. Risk for infection

Here's why:

- Ineffective tissue perfusion (A):

While kidney stones can affect blood flow to the kidneys, it's not typically the primary concern unless there are serious complications.

- Functional urinary incontinence (B):

This typically refers to involuntary loss of urine due to bladder muscle weakness or other factors, which isn't directly related to kidney stones.

- Decreased cardiac output (D):

This isn't a common consequence of kidney stones and wouldn't be the main focus of care.

Infection:

Risk for infection is a common concern with kidney stones because:

The stones can irritate the urinary tract, increasing the risk of bacteria entering and causing infection.

Obstruction caused by the stones can lead to stagnant urine, creating a breeding ground for bacteria.

Prevent or Manage Infections:

Some types of kidney stones, like struvite stones, are associated with chronic urinary tract infections.

Therefore, C. Risk for infection is the most relevant nursing diagnosis for Nurse Hazel to consider for her client with renal calculi. This will guide her to implement appropriate interventions to prevent or manage infections, such as:

Encouraging adequate fluid intake to flush out the kidneys and urinary tract.
Administering medications to manage pain and prevent spasms.
Monitoring for signs and symptoms of infection, such as fever, chills, and burning urination.
Providing education about the importance of good hygiene and early recognition of infection symptoms.

Remember, this is just a general guideline, and the specific nursing diagnosis and interventions will depend on the individual client's situation and medical history. Nurse Hazel should use her clinical judgment and collaborate with the healthcare team to provide the best possible care for her client.

A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client’s 24-hour urine output totals 240 ml, nurse Andy suspects that the client is at risk for:

A. cardiac arrhythmia.
B. paresthesia.
C. dehydration.
D. pruritus.

The correct answer is C. dehydration. Here's why:

- Acute renal failure (ARF):

This condition occurs when the kidneys suddenly lose their ability to filter waste products from the blood.

- Nephrotoxic antibiotic:

Certain antibiotics can damage the kidneys, contributing to ARF as in this case.

24-hour urine output of 240 ml: This is significantly less than the normal range of 1.5-2 L, indicating oliguria, a symptom of ARF and dehydration.

- Cardiac arrhythmia (A):

While ARF can affect electrolytes and potentially contribute to arrhythmias, oliguria in this context is a more direct indicator of dehydration and a more likely immediate concern.

- Paresthesia (B):

While this can be a symptom of electrolyte imbalances associated with ARF, it's not a primary concern based on the presented information.

- Pruritus (D):

This can be a symptom of chronic kidney disease, but not typically associated with acute episodes or dehydration.

Therefore, based on the client's ARF, oliguria, and the potential for dehydration due to the reduced urine output, nurse Andy is correct in suspecting dehydration as the primary immediate concern.

It's important to note that ARF can have various complications, and monitoring for other potential issues like electrolyte imbalances and infections is also crucial. However, in this specific scenario, dehydration is the most likely consequence of the low urine output and should be addressed promptly.

A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion.

While changing this client’s pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude?

a. The skin wasn’t lubricated before the pouch was applied.
b. The pouch faceplate doesn’t fit the stoma.
c. A skin barrier was applied properly.
d. Stoma dilation wasn’t performed.

Answer B.

If the pouch faceplate doesn’t fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn’t be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn’t performed with an ileal conduit, although it may be done with a colostomy if ordered.

Nurse Katrina should conclude that b. the pouch faceplate doesn't fit the stoma is the most likely explanation for the red, weeping, and painful area around the client's stoma.

Here's why:

Red, weeping, and painful skin are common symptoms of peristomal skin irritation, which can occur due to several factors, including:

- Improper pouch fit:

A poorly fitting faceplate can cause leakage of urine onto the skin, leading to irritation and inflammation. This is especially likely if the stoma is irregular or has changed size since the pouch was applied.

- Skin barrier issues:

While not the most likely cause in this case, an improperly applied skin barrier could also contribute to irritation.

- Lubrication:

While lack of lubrication can cause discomfort, it's less likely to cause the specific symptoms of redness, weeping, and pain.

- Stoma dilation:

This procedure is typically performed immediately after stoma creation and wouldn't be relevant to the current situation.

Therefore, considering the specific symptoms and the context of a recently created ileal conduit, a poorly fitting pouch faceplate is the most likely culprit.

Additional Points:

Here are some additional points to consider:

Nurse Katrina should assess the pouch and stoma carefully to determine the specific nature of the problem. Is the faceplate too small, too large, or the wrong shape?
She should also inquire about the client's recent activities and any changes in their urine output or consistency, which could contribute to leakage and irritation.
Based on her assessment, Nurse Katrina should recommend appropriate interventions, such as changing the pouch to a better-fitting one, using a different type of skin barrier, or applying a protective barrier to the irritated skin.

It's important to remember that every client is unique and the cause of peristomal skin irritation can vary. A thorough assessment and individualized care plan are essential for managing this common complication of ostomy surgery.

A female client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole).

Nurse Don should provide which medication instruction?

a. “Take the medication with food.”
b. “Drink at least eight 8-oz glasses of fluid daily.”
c. “Avoid taking antacids during co-trimoxazole therapy.”
d. “Don’t be afraid to go out in the sun.”

Answer B.

When receiving a sulfonamide such as co-trimoxazole, the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

The correct medication instruction for a female client with a urinary tract infection prescribed co-trimoxazole is: b. “Drink at least eight 8-oz glasses of fluid daily.”

Here's why the other options are not recommended:

a. “Take the medication with food.”

While taking co-trimoxazole with food can reduce stomach upset, it's not the most essential instruction in this case. Adequate hydration is crucial to flush out bacteria from the urinary tract, hence the priority on fluid intake.

c. “Avoid taking antacids during co-trimoxazole therapy.”

While some interactions between antacids and co-trimoxazole exist, it's not a universal concern. If the client needs antacids, consulting the doctor for potential adjustments or alternative medications is more appropriate.

d. “Don’t be afraid to go out in the sun.”

While co-trimoxazole can increase sun sensitivity in some individuals, it's not a major concern for everyone. Avoiding excessive sun exposure is good practice for general health but not necessarily a specific instruction for this medication.

Therefore, option b directly addresses the primary goal of increased fluid intake for effective urinary tract infection treatment with co-trimoxazole.

Remember, it's always crucial for nurses to consult with doctors and refer to medication guidelines for specific instructions based on individual patient needs and potential contraindications.

A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first?

a- Blood pressure
b- Respirations
c- Temperature
d- Pulse

Answer D.

An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse.

The client’s blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later.

The nurse also can delay assessing respirations and temperature because these aren’t affected by the serum potassium level.

What is hypokalemia?

Hypokalemia is an electrolyte imbalance, with a low level of potassium in the blood. The normal value of potassium in adults is 3.5 to 5.3 mEq / L.
Potassium is one of the body's many electrolytes. It is found inside the cells. Normal potassium levels are important for the functioning of the heart and nervous system.

What causes hypokalemia?

The body regulates blood potassium levels by moving it in or out of cells. When there is a degradation or destruction of the cells, potassium leaves the cell into the bloodstream and its exaggerated excretion causes hypokalemia. Trauma or excess insulin, especially if you are diabetic, can cause a movement of potassium to the cells and blood levels drop (hypokalemia).
Potassium is excreted (or "purged" from the body) by your kidneys. Certain medications or conditions can cause the kidneys to excrete excess potassium. This is the most common cause of hypokalemia.

Other causes include:

Loss of potassium from the body.
Some medications, such as loop diuretics (furosemide) can cause a loss of potassium. Other medications include steroids, licorice, sometimes aspirin and certain antibiotics.
Renal dysfunction (kidney failure): The kidneys may not work well due to a condition called Renal Tubular Acidosis (ATR). In this case the kidneys will excrete too much potassium. Medications that cause ATR include Cisplatin and Amphotericin B.
Faced with the loss of body fluids due to vomiting, diarrhea or excessive sweating.
Endocrinological or hormonal problems (such as an increase in aldosterone levels): aldosterone is a hormone that regulates potassium levels. Certain diseases of the endocrinological system, such as Aldosteronism or Cushing's Syndrome, can cause potassium loss.
Insufficient potassium intake.

What are the symptoms of hypokalemia that should be taken into account?

It is possible to have no symptoms, unless blood potassium levels are very low.
You may have muscle weakness, fatigue or cramping.
The doctor may notice a decrease in reflexes.
You may have changes in the electrocardiogram (ECG or EKG).

What you can do if blood test results indicate hypokalemia:

Follow the doctor's instructions to increase the level of potassium in the blood. If the results of your blood tests show that the levels are too low, your doctor may prescribe potassium supplements, either in pills or intravenously (IV).
If you take heart medication and have a chronic low blood potassium level (long term), you may be recommended a high potassium diet. Foods high in potassium include most fresh fruits and vegetables. Some specific examples include:

Oranges and orange juice.
Green leafy vegetables, such as spinach and vegetables (cabbage and kale).
Potatoes.

Avoid caffeine and alcohol, as they can cause electrolyte disorders.
Follow all the doctor's recommendations regarding laboratory tests.

Medicines that your doctor may prescribe for hypokalemia:

The doctor may prescribe medications to increase blood potassium levels, including:

Potassium-sparing diuretics: they are also known as "water retention pills" as they help increase blood potassium levels by allowing your kidneys to retain potassium while you urinate more. A widely used example of this medicine may be spironolactone.
Potassium and magnesium supplements: to correct the level of potassium in the blood and bring it to a "normal" level. You should also take magnesium. These medications can be taken in pills or intravenously (IV) if you have a severe deficit of these electrolytes.

When to call the doctor:

If you have the following symptoms, consult your doctor:

Increased urinary frequency, painful urination, weight loss.
If you notice symptoms of low blood sugar levels, such as tremor, sweating and tiredness.
If you develop signs of confusion. Shortness of breath, chest pain or discomfort; Swelling of the lips or throat should be evaluated immediately, especially if you started with a new medication.
If you feel your heart beating quickly or if you feel palpitations.
Nausea that affects the ability to eat and is not relieved by prescription medications.
Diarrhea (4 to 6 episodes in 24 hours) that is not relieved with antidiarrheal medications or with a change in diet.

Note:

We recommend that you talk with your doctor about your condition and your treatment. The information presented here is for practical and educational purposes only, and does not replace your doctor's opinion.

A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys’ ability to remove a substance from the plasma in:

a. 1 minute.
b. 30 minutes.
c. 1 hour.
d. 24 hours.

Answer A.

The renal clearance test determines the kidneys’ ability to remove a substance from the plasma in 1 minute. It doesn’t measure the kidneys’ ability to remove a substance over a longer period.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client’s uremia.

Which finding signals a significant problem during this procedure?

a. Potassium level of 3.5 mEq/L
b. Hematocrit (HCT) of 35%
c. Blood glucose level of 200 mg/dl
d. White blood cell (WBC) count of 20,000/mm3

Answer D.

An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it’s readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn’t abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

Nurse Agnes is reviewing the report of a client’s routine urinalysis.

Which value should the nurse consider abnormal?

a. Specific gravity of 1.03
b. Urine pH of 3.0
c. Absence of protein
d. Absence of glucose

Answer B.

Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine specific gravity normally ranges from 1.002 to 1.035, making this client’s value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber.

A female client is admitted for treatment of chronic renal failure (CRF)

Nurse Juliet knows that this disorder increases the client’s risk of:

a- water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
b- a decreased serum phosphate level secondary to kidney failure.
c- an increased serum calcium level secondary to kidney failure.
d- metabolic alkalosis secondary to retention of hydrogen ions.

Answer A.

A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys’ inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

The glomerular filtration rate (GFR, IFG or GFR) is the volume of fluid filtered per unit of time from the renal glomerular capillaries into the Bowman's capsule.
Normally It is measured in milliliters per minute (ml / min).
In the clinic, this index is usually used to measure renal function at the glomerulus level.

Concept:

The rate or rate of glomerular filtration or effective filtration pressure is physical force and produces the transport of water and solutes through the glomerular membrane.
This phase depends on:

Hydrostatic pressure of the glomerular capillary.
Hydrostatic pressure at the level of Bowman's capsule.
Oncotic pressure at the glomerular capillary level.

Measurement techniques:

There are different techniques to calculate or estimate the glomerular filtration rate, these techniques in general make use of an endogenous or added substance that filters almost completely at the glomerular level and that is then almost not reabsorbed or secreted at the tubular level.

Measurement using inulin:

GFR can be determined by injecting inulin into the blood plasma.

Since inulin is not reabsorbed or secreted by the tubule system after having been filtered at the glomerular level, its rate of excretion is directly proportional to the filtration rate of water and solutes through the glomerulus. (Dr. Amir Anton).

Although in most cases inulin is harmless, it has a small risk of triggering an allergic reaction. In addition there is always the risk of contamination during manipulation, which, in addition to the fact that it is generally applied to patients with a certain degree of renal involvement, adds risks that are not compensated for by the accuracy of the technique.

Estimation by means of the creatinine evacuation index:

Although the measurement method using inulin is considered the "gold standard" for measuring GFR, in clinical practice, it is much more common to use the creatinine evacuation rate to estimate IFG.

Creatinine is an endogenous molecule that appears in the body as a product of the degradation of creatine (a high-energy compound) in the muscles, and has a remarkably constant rate of excretion throughout the day for each patient.

The advantage of this technique is that since creatinine is an endogenous product, it does not require introducing a foreign substance into the patient's organism.

Creatinine is freely filtered at the glomerular level, although unlike inulin, it is also secreted in small amounts by the renal tubules. These characteristics make the measurement using the creatinine evacuation index, although not exact, a good approximation of the GFR. This estimate can be improved by visualizing and evaluating the frequency and duration of each urination.

Example: A person has a plasma creatinine concentration of 0.01 mg / ml and in one hour excretes 75 mg of creatinine in the urine. The IFG is calculated as M / P (where M is the mass of creatinine excreted per unit of time and P is the plasma concentration of creatinine).

Normal Ranges:

The normal ranges of GFR in healthy young adults, adjusted to the surface of the body, are:
- 120 to 130 mL / min / 1.73m2 and declines with age, at around 75 mL / min / 1.73m2 at 70 years of age.
- Chronic kidney disease is defined by having less than 60 mL / min / 1.73m2 for 3 or more months.
GFR may increase due to hyperproteinemia and a constriction of the efferent arteriole.

How can you help patients feel hopeful about life on dialysis?

Take them to dialysis treatment

Helping your loved one get to their appointments on time and being there with them is one of the best ways you can offer support. Dialysis treatment, particularly for the first time, can be overwhelming. Having a familiar face alongside them can help ease the fear and anxiety.

What are the main goals of nursing care of a client with CRF?

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The goals for a patient with chronic renal failure include: Maintenance of ideal body weight without excess fluid. Maintenance of adequate nutritional intake. Participation in activity within tolerance.

How can you help patients feel hopeful about life on dialysis?

Take them to dialysis treatment

What are the GFR values in the progression of CRF?

G1: GFR 90 ml/min per 1.73 m2 and above. G2: GFR 60 to 89 ml/min per 1.73 m2. G3a: GFR 45 to 59 ml/min per 1.73 m2. G3b: GFR 30 to 44 ml/min per 1.73 m2.

Normal Results

A normal result is 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) for men and 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L) for women. Women often have a lower creatinine level than men. This is because women often have less muscle mass than men. Creatinine level varies based on a person's size and muscle mass.

How do you comfort someone with kidney failure?

Here are five ways you can support a loved one with kidney failure.

Understand their treatment plan. ...
Share resources. ...
Help them find a living donor. ...
Be specific. ...
Keep an eye out for depression.

What can you teach a patient with renal failure?

Choose foods with less salt (sodium) Control your blood pressure; your health care provider can tell you what your blood pressure should be. Keep your blood sugar in the target range, if you have diabetes. Limit the amount of alcohol you drink.

What is most challenging about dialysis patient care?

What is most challenging about dialysis patient care? To manage patient care well, one has to manage the patient holistically and all angles involved. Some of these angles are out of the patient's control like support at home, financial support, etc.

What are 3 nursing priorities for patient care?

Prioritization begins with determining immediate threats to life as part of the initial assessment and is based on the ABC pneumonic focusing on the airway as priority, moving to breathing, and circulation (Ignatavicius et al., 2018).

Which nursing actions are most important for a patient with renal failure?

Regardless of CKD stage, the three main nursing care goals are: prevent or slow disease progression. promote physical and psychosocial well-being. monitor disease and treatment complications.

What are 3 nursing interventions you are likely to perform to help the client manage her blood pressure?

Nursing Management

Monitor blood pressure frequently. ...
Administer antihypertensive medications as prescribed.
Have two large-bore IVs.
Provide oxygen f the saturations are low (less than 94%)
Limit fluid intake if the patient is in heart failure.
Assess ECG to ensure the patient is not having a heart attack.

A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure?

a- Phosphate binders
b- Insulin
c- Antibiotics
d- Cardiac glycosides

Answer D.
Cardiac glycosides such as digoxin should be withheld before hemodialysis.

Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity.

Phosphate binders and insulin can be administered because they aren’t removed from the blood by dialysis.

Some antibiotics are removed by dialysis and should be should be administered before or after dialysis.

Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're addicted, you may continue using the drug despite the harm it causes.

Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins when they take prescribed medicines or receive them from others who have prescriptions.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill. These are called withdrawal symptoms.

Help from your health care provider, family, friends, support groups or an organized treatment program can help you overcome your drug addiction and stay drug-free.

Symptoms

Drug addiction symptoms or behaviors include, among others:

Feeling that you have to use the drug regularly — daily or even several times a day
Having intense urges for the drug that block out any other thoughts
Over time, needing more of the drug to get the same effect
Taking larger amounts of the drug over a longer period of time than you intended
Making certain that you maintain a supply of the drug
Spending money on the drug, even though you can't afford it
Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm
Doing things to get the drug that you normally wouldn't do, such as stealing
Driving or doing other risky activities when you're under the influence of the drug
Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
Failing in your attempts to stop using the drug
Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing unhealthy drug use in family members

Sometimes it's difficult to distinguish normal teenage moodiness or anxiety from signs of drug use. Possible signs that your teenager or other family member is using drugs include:

Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
Neglected appearance — lack of interest in clothing, grooming or looks
Changes in behavior — major efforts to bar family members from entering the teenager's room or being secretive about going out with friends; or drastic changes in behavior and in relationships with family and friends
Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

Marijuana, hashish and other cannabis-containing substances

People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

A sense of euphoria or feeling "high"
A heightened sense of visual, auditory and taste perception
Increased blood pressure and heart rate
Red eyes
Dry mouth
Decreased coordination
Difficulty concentrating or remembering
Slowed reaction time
Anxiety or paranoid thinking
Cannabis odor on clothes or yellow fingertips
Major cravings for certain foods at unusual times

Long-term use is often associated with:

Decreased mental sharpness
Poor performance at school or at work
Ongoing cough and frequent lung infections

A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine.. phenazopyridine - Pyridium

A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She’s placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible infection.

Another medication is prescribed to decrease the pain and frequency.
Which of the following is the most likely medication prescribed?

a- nitrofurantoin (Macrodantin)

b- ibuprofen (Motrin)

c- acetaminophen with codeine

d- phenazopyridine (Pyridium)

Answer D.
Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort.
Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain.
Nitrofurantoin is a urinary antiseptic with no analgesic properties.
While ibuprofen and acetaminophen with codeine are analgesics, they don’t exert a direct effect on the urinary mucosa.

When performing a scrotal examination, nurse Paul finds a nodule. What should the nurse do next.. Transilluminate the scrotum

When performing a scrotal examination, nurse Paul finds a nodule. What should the nurse do next?

a- Notify the physician.
b- Change the client’s position and repeat the examination.
c- Perform a rectal examination.
d- Transilluminate the scrotum.

Answer D.
A nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn’t transilluminate and may appear as a dark shadow. Although the nurse should notify the physician of the abnormal finding, performing transillumination first provides additional information. The nurse can’t uncover more information about a scrotal mass by changing the client’s position and repeating the examination or by performing a rectal examination.

When examining a female client’s genitourinary system, nurse Sally assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist.. A dull sound

When examining a female client’s genitourinary system, nurse Sally assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. Normally, this percussion technique produces which sound?
a- A flat sound
b- A dull sound
c- Hyperresonance
d- Tympany

Answer B.
Percussion over the costovertebral angle normally produces a dull, thudding sound, which is soft to moderately loud with a moderate pitch and duration. This sound occurs over less dense, mostly fluid-filled matter, such as the kidneys, liver, and spleen. In contrast, a flat sound occurs over highly dense matter such as muscle; hyperresonance occurs over the air-filled, overinflated lungs of a client with pulmonary emphysema or the lungs of a child (because of a thin chest wall); and tympany occurs over enclosed structures containing air, such as the stomach and bowel.
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The genitourinary or urogenital apparatus is formed by the urinary system, which is common in both sexes, plus the genital apparatus of each of them, male genitals and female genitals.

Definition:
The urinary and genital devices have different functions, however, anatomically, they have very close relationships, in addition to having a common embryonic origin. In the male, the urinary and genital tract share the urethral duct, to excrete both semen and urine.

Urinary system:
Group of organs and ducts whose function is to filter the blood to separate metabolic waste products, urine and transport it to the outside to be excreted. The urinary system consists of:
- Kidneys
- Ureters
- Bladder
- Urethra

Male Genitals:

Definition:
Male genitals, also known as genital or reproductive system is composed of a set of visible and non-visible organs also called, external and internal. The male genitals have two main functions:
- Allows the arrival of sperm or semen in the vagina, allowing fertilization of the ovule.
- Share the urethral canal with the urinary tract, being part of the genitourinary tract.

Classification:
The organs that make up the male genital tract are usually divided into:

Internal Genitals:
Located inside the body. Here we find:
- Testicles
- Epididymis
- Deferential ducts
- Seminal vesicles
- Prostate
- Urethra

External genitals:
Located in the external area of the body, visible to the naked eye.
- penis
- Scrotum

Female genitals:

Definition:
Also known as the genital or reproductive system is composed of a set of organs that form a tubular structure, communicates an internal serous cavity with the outside.

Physiology:
Female genitals have two main functions:
- Allows the entry of sperm or semen into the vagina making possible the fertilization of the ovule and its subsequent nesting, which is known as pregnancy.
- Protect the internal genital organs from possible infections by disease-bearing pathogenic microorganisms.
- Since as we said the female genital system has a hole that connects the internal organs with the outside, infectious agents can penetrate producing gynecological infections or sexually transmitted diseases (STDs). These diseases are usually transmitted during intercourse.
- Share the urethral canal with the urinary tract, being part of the genitourinary tract.

Classification:
The organs that make up the female genital tract are usually divided into:

Internal Genitals:
Located inside the body. Here we find:
- Vagina
- Uterus
- Cervix
- Fallopian tube
- Ovaries

External genitals:
Located in the external area of the body, visible to the naked eye.
- Vulva
- Big lips
- Minor lips
- Mamas Clitoris

Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra–high-frequency sound waves to shatter renal calculi

Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra–high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
a- limit oral fluid intake for 1 to 2 weeks.
b- report the presence of fine, sandlike particles through the nephrostomy tube.
c- notify the physician about cloudy or foul-smelling urine.
d- report bright pink urine within 24 hours after the procedure.

Answer C.
The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy.

The cloudy urine is most often caused by urinary tract infections, but many other diseases can also cause it. This is why it is important to consult a doctor to receive appropriate treatment.

Description of the cloudy urine:
Urines are normally clear and yellow in color, ranging from light to dark. A cloudy appearance is due to a change in the composition of the urine or the presence of bacteria.

Causes of cloudy urine:
Six main elements can be responsible for a cloudy appearance of the urine:
epithelial cells of the urinary tract;
- white blood cells: we speak of leucocyturia. These cells of the immune system are normally less than 10,000 / ml;
crystals (phosphates, carbonates, urates);
- proteins (proteinuria);
- sugar (glucose): we talk about glycosuria;
- bacteria (bacteriuria): above 1000 bacteria per milliliter of urine, an infection is suspected.

Many diseases can be responsible for the presence or increase of these elements in the urine. These include:
- urinary tract infections: these are the most common cause of cloudy urine;
- diabetes: it causes the increase of sugar or ketone bodies in the urine;
- kidney stones: they can release minerals that disturb the urine;
- kidney failure: when the kidneys do not filter the urine enough, it can contain more protein;
- maple syrup disease or keto-acid decarboxylase deficiency: it is a rare genetic disease that prevents the metabolism of three amino acids: leucine, isoleucine and valine (also known as leucinosis). It is easily identifiable by the strong smell of maple syrup that emits urine.
During pregnancy, some women develop so-called gestational diabetes and their glycosuria (ie the presence of glucose - sugar - in the urine) can then increase.
Some drugs also have the side effect of disturbing the urine when they are eliminated by the body.
If the cloudy appearance of the urine is associated with any of the following symptoms or signs, it is recommended to consult a doctor:
- the presence of blood in the urine;
- an abnormal color of the urine;
- pain during urination, lower abdomen or groin;
- an increase in the frequency of urination (pollakiuria);
- difficulty urinating or emptying the bladder;
- loss of control of the bladder;
- or fever.

Evolution and possible complications of cloudy urine:
Disturbed urine is often one of the first symptoms of a urinary tract disease or condition. To ignore it is to risk seeing the disease worsen.

Treatment and prevention: what solutions?
To make a diagnosis and to propose an adapted treatment, the doctor will prescribe a cytobacteriological examination of the urine (ECBU). It makes it possible to identify and quantify the cells and the germs possibly present in the urine. These being naturally sterile, the presence of bacteria is the formal indication of an infection.
A biochemical analysis can also be requested by the doctor to measure the different components that constitute the urine.
As we have seen, urinary tract infections are the main cause of cloudy urine, but there are simple measures to limit their occurrence:
- drinking regularly increases the frequency of urination in the day and thus expel bacteria that could be installed in the urinary tract and cause infection;
- in women, wiping from front to back after urinating helps to prevent bacteria from the - anal area from spreading to the vagina and urethra;
- urinate after sex;
- Avoid personal hygiene products such as deodorants, showers or scented soaps as they can irritate the urethra.

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate.. Continuous inflow and outflow of irrigation solution

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include:
a- Continuous inflow and outflow of irrigation solution.
b-Intermittent inflow and continuous outflow of irrigation solution.
c- Continuous inflow and intermittent outflow of irrigation solution.
d- Intermittent flow of irrigation solution and prevention of hemorrhage.

Answer A.
When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

Transurethral resection of the prostate is a surgery used to treat urinary problems due to an enlarged prostate.
A combined instrument that is visual and surgical (resectoscope) is inserted through the tip of the penis and into the duct that carries urine from the bladder (urethra). The prostate surrounds the urethra. Using the resectoscope, the doctor trims the excess prostate tissue that blocks the flow of urine.
In general, transurethral resection of the prostate is considered an option for men with moderate to severe urinary problems who do not respond to medication. Traditionally, it is considered that transurethral resection of the prostate is the most effective treatment for enlarging the prostate.
However, thanks to improved surgical techniques and instruments, many other minimally invasive procedures become increasingly effective. In general, these minimally invasive procedures cause fewer complications and have a faster recovery period than transurethral resection of the prostate. The risk of bleeding is generally higher in transurethral resection of the prostate, so it may not be the best option for men taking anticoagulant medications.

Why it is done:
Transurethral resection of the prostate helps to reduce the urinary symptoms caused by benign prostatic hyperplasia, including:
- Frequent and urgent need to urinate
- Difficulty starting to urinate
- Slow urine (prolonged)
- Urinating more often during the night
- Stop and start urinating again
- Feeling of not being able to empty the bladder completely
- Urinary infections
Transurethral resection of the prostate can also be performed to treat or prevent complications due to blocked urine flow, such as:
- Recurrent urinary infections
- Kidney or bladder injury
- Inability to control urination or total inability to urinate
- Bladder stones
- Blood in the urine

Risks:
The risks of transurethral resection of the prostate may include:
- Difficulty urinating temporarily:
You may have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a catheter inserted into the penis to expel urine from the bladder.
- Urinary infection:
This type of infection is a possible complication after any prostate procedure. The longer you have the catheter in place, the more likely it is that an infection will occur. Some men who undergo a transurethral resection of the prostate have recurrent urinary tract infections.
- Dry orgasm:
A frequent and long-term effect of any type of prostate surgery is the release of semen into the bladder, rather than through the penis, during ejaculation. Dry orgasm, also known as "retrograde ejaculation," is not painful and usually does not affect sexual pleasure. However, it can interfere with your ability to father a child.
- Erectile dysfunction:
Although the risk is very low, an erectile dysfunction may occur after prostate treatments.
- Intense bleeding:
In exceptional cases, men lose so much blood during transurethral resection of the prostate that they need a blood transfusion. Men who have larger prostates seem to be more prone to significant blood loss.
- Difficulty in containing urine:
Loss of bladder control (incontinence) is a rare long-term complication of transurethral resection of the prostate.
- Low blood sodium level. Rarely, the body absorbs too much of the fluid that is used to wash the area of the surgery during transurethral resection of the prostate. This disorder, known as "transurethral resection syndrome of the prostate" or "transurethral resection syndrome," is potentially fatal if left untreated. A technique called "bipolar transurethral resection of the prostate" eliminates the risk of suffering the syndrome of transurethral resection of the prostate.
- Need to redo the treatment. Some men may need follow-up treatment after transurethral resection of the prostate because the symptoms reappear over time or never improve adequately. Sometimes, it is necessary to repeat the treatment because the transurethral resection of the prostate causes a narrowing (constriction) of the urethra or neck of the bladder.

How do you prepare:

Food and medications:

Several days before surgery, the doctor may recommend that you stop those medications that increase the risk of bleeding, including:

- Anticoagulants such as warfarin (Coumadin) or clopidogrel (Plavix)

- Over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB and others) or naproxen sodium (Aleve and others)

You may be prescribed an antibiotic to prevent urinary tract infections.

Other precautions:

Organize the transport, because that day you will not be able to drive back home after the procedure or, in general, the same happens if you have a bladder catheter.

You may not be able to work or do strenuous activities for up to six weeks after surgery. Ask the doctor how much recovery time you might need.

What you can expect:

Transurethral resection of the prostate usually lasts 60 to 90 minutes. Before surgery you will be given general anesthesia, which means you will be unconscious during the procedure, or intradural anesthesia, which means you will remain conscious. You may also receive a dose of antibiotics to prevent infections.

During the procedure:

The resectoscope is inserted into the tip of the penis and passed through the urethra to the prostate. The doctor will not have to make any cuts (incisions) on the outside of the body.

The doctor will use the resectoscope to cut the tissue inside the prostate from a small section at a time. As the small sections of tissue inside the prostate are cut, the irrigated fluid carries them to the bladder. These are eliminated at the end of the operation.

After the procedure:

You are likely to stay in the hospital for a day or two.

You will have a urinary catheter placed, since the passage of urine is blocked by the swelling. Generally, the catheter is left for at least 24 to 48 hours, until the swelling subsides and you can urinate on your own.

You may also notice:

- Blood in the urine:

It is normal to see blood immediately after surgery. But if the blood in the urine is thick like ketchup, the bleeding seems to get worse or the flow of urine is blocked, contact the doctor. Blood clots can block the flow of urine.

- Irritant urinary symptoms:

You may feel pain when you urinate or have a sense of urgency or frequent need to urinate. Generally, pain during urination is relieved between six and eight weeks.

The doctor may recommend that you:

-You drink a lot of water to clean the bladder.

-You eat foods rich in fiber, to avoid constipation and effort during a bowel movement. The doctor may also recommend a stool softener.

- Wait to take any anticoagulant medication again until the doctor allows it.

- Avoid strenuous activities, such as lifting heavy loads, for four to six weeks or until the doctor allows it.

- Refrain from having sex for four to six weeks.

- Avoid driving until the catheter is removed and you no longer take the prescribed analgesics.

Contact your doctor if:

- You can not pee.

- You see bright red blood or an increase in clots in the urine that do not go away after drinking more fluid and resting for 24 hours.

- Having more than 100.4 ° F (38 ° C) of fever.

A female client with suspected renal dysfunction is scheduled for excretory urography. mildly hypovolemic (fluid depleted) before excretory urography.. Multiple myeloma

A female client with suspected renal dysfunction is scheduled for excretory urography.
Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography.
Which history finding would call for the client to be well hydrated instead?
a- Cystic fibrosis.
b- Multiple myeloma.
c- Gout.
d- Myasthenia gravis.

Answer B.
Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don’t necessitate changes in client preparation for excretory urography.

Multiple myeloma of bones (also known as Kahler's disease, Kahler-Bozzolo's disease1, or, simply, myeloma) is a hematologic cancer (meaning that it develops from the cells of hematopoiesis, those -which are the origin of the blood cells, formed in the bone marrow).
The affected cells are plasma cells (which are end-differentiated B-lymphocytes), cells of the immune system producing antibodies (immunoglobulins) to fight infections and diseases. Myeloma is a disease characterized by the development in the skeleton of multiple osteolytic plasma cell tumors (plasmocytomas) secreting in most cases either a monoclonal immunoglobulin type G (52% of cases) or type A (21% of cases ), a light chain Kappa or Lambda (12%).

Epidemiology:
In France, the incidence is 4,000 cases per year. In the United States, 45,000 people live with myeloma with approximately 20,000 new cases each year. Its incidence tends to increase. It is more common among African-Americans and rarer in China. In Canada, approximately 2,000 people each year are diagnosed with multiple myeloma.
After diagnosis, incident-free survival is estimated at 5 months, total survival at 56 months5.
Myeloma is the second most common hematological disorder (10%) after non-Hodgkin's lymphoma. It accounts for about 1% of all cancers and 2% of all cancer deaths.
The average age of onset of myeloma is 65 to 70 years, but tends to decrease.
Myeloma affects a few more men than women.
The causes of multiple myeloma are poorly understood. Exposure to certain organochlorines (chlordecone used as a pesticide for example) seems to be one of the risk factors. For example, in Martinique, an InVS-controlled InVS cancer risk analysis found a "statistically significant over-incidence of multiple myeloma" in adult men residing in the area where chlordecone was most prevalent. used and would still be most present in soils (according to the BRGM). In addition, the gradient in myeloma incidence gradually increased from the areas believed to be the least polluted to those that are potentially most affected.

Circumstances of diagnosis:

Multiple myeloma is often detected incidentally during a routine blood test.

The most common symptoms guiding this biological discovery are:

- bone pain or pathological fractures (spontaneous or after too little stress) 7,8;

- asthenia, which may be related to anemia, hypercalcemia or renal failure;

- tingling in the extremities and neuropathic pain.

Diagnostic:

Biological diagnosis:

The main consequence of myeloma is the presence of a very large amount of immunoglobulins in the blood. These immunoglobulins are proteins, which are manifested by:

- the elevation of the sedimentation rate;

- hyperprotidemia;

a peak in the gamma-globulin zone at electrophoresis of serum proteins in full-chain forms. The immunofixation makes it possible to prove the monoclonal character of the peak (that is to say deriving from the same tumor cell clone). In light chain forms, hypogammaglobulinemia is observed, the amount of light chains being almost never sufficient to produce a visible monoclonal peak.

Hypercalcemia, which is common, is linked to bone destruction.

There is also an excess of protein in the urine; this proteinuria consists of monoclonal immunoglobulin light chains, also called Bence-Jones protein. Immunoelectrophoresis or immunofixation of urinary proteins determines the type of chain, kappa or lambda. This peak is detected in beta-globulins.

Benign monoclonal gammopathy does not include anemia, bone lesions or visceral complications. As its name suggests, it does not have the same character of gravity as myeloma and requires only simple monitoring.

Other exams:

A solitary lytic plasmocytoma located in the lower third of the femur.

Multiple osteolysis and pathological fracture of the ulna.

The myelogram studies the bone marrow cells, taken by puncture, in search of an excess of plasma cells. In myeloma, the marrow is infiltrated by plasma cells, which usually have many morphological abnormalities and are frequently in mitosis.

Radiographs of the skeleton very frequently show bone lesions such as osteolysis.

In medullary sponge kidney.. There is a recognized association with poly cystic renal disease

In medullary sponge kidney:
A- The dilatation can affect any part of the collecting tubule within the pyramid. False (Terminal).
B- One pyramid only needs to be affected to establish the diagnosis. False (Two).
C- There is a recognized association with poly cystic renal disease... True
D- Patients rarely develop renal failure. False (5%).
E- Cases are usually familial and not sporadic. False (Not familial).

Medullary sponge kidney.. Presentation is usually in childhood. Haematuria is a presenting feature

Medullary sponge kidney:
A- Renal function is usually normal... True
B- There is association with hepatic fibrosis... False
C- Presentation is usually in childhood... False
D- There is an overall increase in renal size... True
E- Haematuria is a presenting feature... True

When caring for a male client with acute renal failure (ARF), Nurse Fatima expects to adjust the dosage or dosing schedule of certain drugs.. acetaminophen - Tylenol

When caring for a male client with acute renal failure (ARF), Nurse Fatima expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment?
a. acetaminophen (Tylenol)
b. gentamicin sulfate (Garamycin)
c. cyclosporine (Sandimmune)
d. ticarcillin disodium (Ticar)

Answer A.
Because acetaminophen is metabolized in the liver, its dosage and dosing schedule need not be adjusted for a client with ARF. In contrast, the dosages and schedules for gentamicin and ticarcillin, which are metabolized and excreted by the kidney, should be adjusted. Because cyclosporine may cause nephrotoxicity, the nurse must monitor both the dosage and blood drug level in a client receiving this drug.