Renal Dx/HA
Name the normal values for each urine test (spec grav., osmol., pH, protein, glu., BUN, creat., bicarb., GFR)
Spec grav: 1.005-1.025, Osmol: 200-800, pH: 4.5-8, Protein: <150, Glu: 0-0.8, BUN: 8-20, Creat: 0.6-1.2(m) & 0.4-1(f), Bicarb: 22-28, GFR: 90-120
Define STRESS incontinence and name its interventions
Caused by weakness in the external sphincter and pelvic floor -> loss of small amounts of urine during coughing/sneezing/changing position/jogging/lifting
Kegel exercises, Weight reduction, Estrogen therapy, continue prescribed diuretics
What are the complications of a renal transplant?
Rejection & Long-term immunosuppression
What are the diagnostic criteria for ADHD?
S/S: hyperactivity, inattention, impulsivity
Dx: symptoms before 7 y/o, symptoms noted for 6m+, symptoms present in 2+ settings
take full course of abx; difference btw adjunct/abx; void every 2-3hrs; drink 2-3L/day; avoid coffee/tea/ alcohol/other fluids that are urinary irritants; Wipe front to back; Avoid bubble baths, nylon underwear, and scented toilet tissues; Wear loose-fitting cotton underwear; Empty bladder before and after intercourse; Avoid vigorous cleaning of the perineum with harsh soaps; Avoid douching; Urinate when you feel the need, Don’t “hold it in.”
Name some examples of a client's hx that would make the nurse suspect they are having a GU issue.
location, character, duration of pain; fever/chills; hx of indwelling catheters; (f) # & types of deliveries; swelling/bruising/tenderness in CVA; dysuria; hesitancy/straining/pain after urination; incontinence; hematuria
Define FUNCTIONAL incontinence and name its interventions
Incontinence due to factors that have nothing to do with the bladder or urethra (cognitive funct.)
Containment of urine using pads/etc, Requires meticulous skin care, Frequent toileting
What are the common immunosuppressants used for renal transplants?
tacrolimus and cyclosporine
What is Autism and common s/s?
Spectrum disorder
Difficulty with social interactions, limited eye contact, difficulty/nonverbal communication, sensory sensitivities (intense light/sound), intense/specific interests, repetitive movements/actions (lining up objects), struggle with changes in routine/environments
What is the renal diet? (not on dialysis)
Increase: iron, calcium, vit. D
Decrease: protein, sodium, potassium, phosphorus
What is the difference between lower UTI (cystitis, urethritis) and upper UTI (pyelonephritis) s/s
Lower: Burning, Frequency, Urgency, Nocturia, Incontinence, Bladder/Pelvic Pain, hematuria
Upper (systemic): chills, fever, leukocytosis, bacteriuria, pyuria, back pain, flank pain (CVA tenderness), n/v/HA, painful urination
Define OVERFLOW incontinence and name its interventions
Detrusor fails to contract (neurogenic/hypotonic bladder; SCI, stroke, seizures)
Bladder compression (Crede/Valsalva), Intermittent catheterization
Bethanechol (Urecholine), Alpha blockers (men)
What are some indications for a renal transplant?
End Stage Renal Disease (ESRD), Chronic Kidney Disease (CKD), Polycystic Kidney Disease, GFR below 20
Q1: A nurse is communicating with a child diagnosed with ASD. Which approach is most appropriate?
A. Use abstract language and metaphors.
B. Speak rapidly to maintain attention.
C. Give short, simple, concrete instructions.
D. Avoid visual aids.
Q2: An 8-year-old child with ADHD is prescribed methylphenidate. During a follow-up visit, the nurse notes the following findings:
Which nursing actions are appropriate? (Select all that apply.)
A. Recommend administering the medication earlier in the day.
B. Encourage calorie-dense meals and snacks.
C. Tell the parents to stop the medication immediately.
D. Continue monitoring growth and weight.
E. Recommend taking the medication at bedtime.
C: Children with ASD often understand concrete, direct language better than abstract concepts
A,B,D: Common stimulant side effects include insomnia and decreased appetite. Administering the medication early, monitoring growth, and encouraging high-calorie nutrition help manage these effects.
What are teachings surrounding ADHD medications?
take in the morning, provide a high-calorie breakfast before medication & high-calorie snacks later in the day,
common SE: appetite suppression, insomnia, weight loss
What are the RF for pyelonephritis and what are the specific RF/presentation of pyelonephritis in an older adult?
RF: Vesicoureteral reflux; Obstructions; Long-term indwelling urinary catheters; Pregnancy; Sexual activity in women
Older adults:
RF: Not the same urgency and frequency symptoms; lowered sensation of thirst; Lack of ability for Peri care; Immobility;
S/S: Generalized fatigue; Change in cognitive functioning (agitation); New incontinence; Low grade fever
Name the types of SCIs and their associated incontinence
Above (S2-4): areflexic (flacid) bladder; urge
Below (S2-4): spastic bladder (spontaneous voiding); overflow
What should the nurse teach a patient taking tacrolimus for a recent renal transplant?
The medication MUST be taken at the same EXACT time daily
Swallow tablets whole (do not crush/chew)
avoid grapefruit juice
What are the alternative medications used to treat ADHD and their specific SE?
Strattera (SNRI): same as class 2, but is NOT a controlled substance
Tricyclic antidepressants (nortriptyline, desipramine): anticholinergic/cardiac effects
Tetracyclic antidepressants (Buproprion): lowers seizure threshold
What are NC while caring for a child with ADHD?
Provide positive reinforcement and structured routines, monitor medication SE, teach appropriate social interactions, monitor weight/growth
What are the antibiotics and adjunct meds used to treat UTIs?
Bonus: name the SE/NC along with the drug
Abx: (Bacterial) Trimethoprim/sulfamethoxazole [Bactrim] assess for sulfa allergy, can cause crystalluria (drink 2-3L, void 2-3 hrs), Nitrofurantoin, Fosfomycin (one dose), Ciprofloxacin (not used d/t tendon ruptures/QT prolongation); (Fungal) Fluconazole
Adjunct:
PhenAZOpyridine [Pyridium] relieves urgency/ frequency/pain/discomfort; May turn urine/sweat/contact lenses red-orange.
HYOscyamine [Anaspaz] Anticholinergic, Has antispasmodic effects on the detrusor muscle
Define URGE incontinence and name its interventions
overactive bladder; involuntary detrusor contractions -> Large amounts of urine are leaked, associated with a sudden, strong urge to void
Avoid caffeine/alcohol, Bladder/habit training, Limit evening fluids
Meds:
Anticholinergics (oxybutynin, tolterodine)
Beta-3 agonist (mirabegron)
Alpha blockers (men): tamsulosin [se: N/V/D, cramps, fecal incontinence]
Botox
Name nephrotoxic drugs
Chronic use of NSAIDs, Aminoglycosides (gentamicin, tobramycin), Vancomycin, Contrast dye, ACE/ARBs, immunosuppressants (cyclosporine, tacrolimus)
What are the class 2 controlled substances to treat ADHD and their specific SE?
Adderall XR (amphetamine): emotional lability, psychosis
Concerta(Methylphenidate): HA
Focalin: Nausea
Ritalin (Methylphenidate): HA, psychosis
ALL: decreased appetite, insomnia, abd pain, exacerbate motor/vocal tics
What are NC for a child with Autism?
use simple, concrete communication and visual supports, reduce sensory overload, maintain routines, reduce stimuli, allow extra time to process, promote social interaction through structured play