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76 Cards in this Set
- Front
- Back
creatine
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is a waste product from muscle metabolism and is released into the bloodstream at a steady rate
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creatine levels are a good indication of?
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kidney function
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normal levels of creatine?
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0.6 mg/dl - 1.5 mg/dl
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level above 1.5 of creatine means there is?
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kidney dysfunction
the higher the level the more impaired kidney function |
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BUN=waste product of?
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protein metabolism
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BUN normal levels?
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8-20 mg/dl
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elevated BUN caused from?
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kidney dysfunction
kidney failure decreased kidney blood supply dehydration(decreased BUN with overhydration) high protein diet(urea formation increases) GI bleeding(bcs blood is absorbed as protein and converted into urea) steroid use(bcs steroids increase rate of protein breakdown in body) |
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sodium normal levels?
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134-145 mEq/L
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potassium normal levels?
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3.5-5.5 mEq/L
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calcium normal levels?
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4.5-5.5 mEq/L
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HCO3 levels?
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22-28
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magnisium normal levels?
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1.3- 2.1
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serum albumin normal levels?
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3.5-5.0
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urine culture levels
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<10,000=negative
100,000 positive |
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specific gravity levels
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1.05-1.35
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hematuria
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blood in urine
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dysuria
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painful urination
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nocturia
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voiding during the night
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obliguria
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decreased urine output <400 mL per 24 hours
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polyuria
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excessive urination >2000 mL per 24 hours
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anuria
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absence of urination
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pyuria
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pus in urine
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the renal pyramids make up which of the kidney structures?
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renal medulla
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the process of tubular resorption takes place in which part of the kidneys?
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from the renal tuble to the peritubular capillaries
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common symptom of bladder cancer
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hematuria
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observing for renal failure?
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decrease in urine output
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best diagnostic test for acute renal failure?
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24 hour creatine clearance of 5mL/minute
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after hemodialysis imperative that he patient is?
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weighed
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how does a continuous ambulatory peritoneal dialysis work?
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a permanent peritoneal catheter is inserted. the peritoneum acts as a semipermeable membrane through which solutes move by difusiion and osmosis
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symptoms of end stage renal disease?
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edema, possible convulsions, then coma
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3 important nursing assessments of chronic renal failure?
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daily weights,
I & O dangerous levels of electrolytes |
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diet for ranal failure
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diabetic diet
low sodium low potassium decrease protein and fluid restriction low phospherus diet very difficult to follow |
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azotemia
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accumulation of toxic waste from protein metabolism in the blood (serum urea)
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acute reanl failure
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<30 mL/hr or 400mL/day
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acute reanl failure caused by?
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hypotension
vascular obstruction glomerular disease acute tubular necrosis(ATN)=the tubules are damaged after administration of contrast dye |
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acute reanl failure
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waste products accumulate in the bloodstream
oliguria decresed urine of <20mL/hr dialysis is needed |
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acute reanl failure=can progress through 4 stages
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1. oliguria phase:
less than 400mL per 24 hours occurs from24 hrs to 7 days after intial phase can last up to 2 weeks to several months 2. Diurectic phase: kidneys begin to excrete waste products, 1 to 3 L/day of urine is produced osmotic diuresis occurs from elevated waste products(urea) which the body is attempting to eliminate kidneys are unable to concentrate urine ans so dehydration and hypotension are a concern may last 1 to 3 weeks 3. Recovery phase: as the glomerular filtration rate rises waste products levels(BUN, creatine levels) decrease within the first 2 weeks of this phase recovery can take up to 1 year |
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oliguria phase
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metabolic acidosis from H+ excretion and sodium bacarbonate levels.
increased phophate decreased calcium abnormal blood cells(RBC, WBC Platelets) confusion seizures to coma effects on all body system |
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accute renal failure is classified as?
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preresnal
intrarenal ed with the location of the cause |
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accute renal failure-prerenal failure?
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before the kidneys
interuption of blood supply to the kidneys causes: decreased BP(result of dehyration, blood loss, shock, trauma, to or blockage in the arteries that carry blood to the kidneys) Nephrons blood supply is inadequate=they are unable to make urine and waste products are not removed drugs used that can lead to prerenal failure: : NSAID's cyclooxygenase 2(COX)inhibitors |
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Intrarenal failure
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inside the kidney
damage to the nephrons inside kidneys causes: ischemia reduced blood flow toxins other causes from infectious process leadint to glomerulonephritis, allergic reactions to radiographic dyes severe muscle injury(releases substances harmful to the kidneys) |
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postrenal failure
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after the kidneys
associated with an obstruction that blocks the flow of urine out of the body common causes: kidney stones tumors of the ureters or bladder enlarged prostate |
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acute reanl failure is treated?
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by reliveing the cause
prevention of permanent damage is the goal of treatment S/SX are managed as they develop |
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continuous renal replacement therapy CRRT
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in unstable patients
to remove fluid and solutes in a controlled, continuous manner they are able to handle fluid shifts as in hemodailylsis, can be used along with hemodialysis, which is necessary if symptoms of uremia (hypokalemia) are present temporary vascular access is used can be done more than a month if needed |
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chronic renal failure
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on the rise...290,000 people in US
a progressive, irreversiable deterioration in renal function where the body is unable to maintain metabolism, fluid, and electrolyte balance |
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chronic renal failure
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as the nephrons die off, the damaged ones increase their work capacity-so Patient may not show signs of renal failure as they are experiencing kidney damage
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chronic renal failure-in the early or silent stage
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decreased renal reserve
usually without symptoms 50% of nephrons may have been lost-creatine levels 2X normal |
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chronic renal failure-renal insufficiency stage?
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75% of nephrons function and soms mild signs of renal failure.creatine levels 4X normal
anemia and inability to concentrate urine may occur |
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chronic renal failure-end-stage disease ESRD
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occurs when 90% of the nephrons are lost
chronic and persistant abnormal kidney function BUN & creatine are always elevated patient may make urine but not filter out the waste or urine production may cease dialysis or kidney transplant is required to survive |
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symptoms of renal failure
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fluid accumulation
edema early symptom of the extremities, sacral area, and abdomen SOB crackles & whezzing blood vessles in neck distended &hypertensive polyuria oliguria anuria |
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disturbances in electrolyte balance in renal failure
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sodium=hypernatremia-excess of sodium=water retention, edema & hypertension
sodium lost=hyponatrema=confusion Hyperkalemia=high levels of potassium=muscle weakness, abdomianal cramping, diarrhea. when it exceeds 5mEq/L monitor cor cardiac dyrhythmias |
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disturbances in electrolyte balance in renal failure-treatments
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sodium polystyrene(Kayexalate)
orally or retention enema, causes potassium to be eleminated through the stool hemodialysis is the definitive treatment-removes potassium from the body |
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disturbances in electrolyte balance in renal failure
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calcium levels are decreased bcs the kidneys are unable to produce the hormone that activates vitamin D(which is necessary for calcium to be absorbed)
hypocalemia=when levels fall below 8.5 mg/dl and hyperphosphatemia a level above 5mg/dl=causes the imbalance causes the bones to release calcium, causing the bones to be prone to fractures medication is given to bind phospherus with high levels: tums, caltrate, renagel, Phos-lo, fosrenol...with meals, to bind with stools to be eleminated high phospherus levels may cause itching, open sores from scraticng-infection risk'' muscle cramps & aches |
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disturbance in removal of waste
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azotemia:
weakness and fatique confusion siezures twitching movements of extremities(asterixis) N&V lack of appetite metallic taste in mouth smell of urin on breath yellowish pale skin itching due to urea crystals on the skin dialysis to remove the waste is only treatment |
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disturbance in maintaining acid-base balance
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renal failure effects Hydrogen ion excretion-results in metabolic acidosis.
headache fatigue weakness N&V lack of appetite as it progresses: lethargy,stupor and coma respirations become fast & deep as the lungs attempt to blow of carbon dioxide to correct the acidosis(Kussmauls respirations) |
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disturbance in the Hematological function (primarily seen in chronic renal failure CRF
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disturbances in the blood cells over time
failingt kidneys do not produce adequate erythropoeitn, the hromone that stimulates RBC' production treatment: regular injections of epoetin(Epogen, Procrit) a synthetic form of erythropoetin help restore RBC production and prevent anemia common side effect of erythropoetin is development of hypertension |
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diet for renal failure
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high calories to maintain weight and energy
restricted protein unless on dialysis(may be incresed bcs protein is lost) sodium restricted(fluid retention) potassium restricted calcium increased phospherus restricted saturated fats & cholesterol restricted for patients with hyperlipidemia fluids restricted to prevent overload |
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dialysis
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started when patients develops symptoms of fluid overlaod
high potassium acidosis pericarditis vomitting lethargy fatigue uremia-that are life threatening both peritoneal & hemodialysis involve the movement and diffusion of particles from an area of high concentration to and area of low concentration through a semipermable membrane. the substances move through the semipermable membrane into the dialysate can be used to treat drug over dose and correct fluid and electrolyote imbalnces |
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hemodialysis
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the use of a artificial kidney to remove waste products and excess water from patients blood
patients blood and the dialyzing solution move in opposite directions. the waste product of the blood move into the dialysate by diffusion through the membrane bcs of the differance of their concentrations It is carried away and the cleansed blood is returned into the blood with another tube takes 3-4 hours 3 to 4 X a week |
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side effects of hemodialysis
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following treatment:
fatigue & weak too tired to eat sudden drops in BP=weak, dizzy & nauseated cardiac dysrthyriams and angina muscle cramps & lethargy with electrolyte & fluid drops\ Heparin is given while blood is in artifical kidney_this may cause bleeding from puncture site |
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vascular access
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hemodialysis requires a permanent way to access the bloodstream for blood removal and return to the body:
1. vascular access graft 2. ateriovenous AV fistula they are place in the arm when possible *imperative the IV angiocaths are not placed in cephalic or basilic vein in a ptient who may need grafts or fistulas in the future *temporary access is used for patients requiring hempdialysis befroe the graft or fistula is placed or usable (a central venous catheter with 2 or 3 ports is placed in the subclavin vein, the jugular, or the femoral veins ) *central catheters cannot be used long term due to the rsik of infection * |
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vascular access graft
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arteriovenous graft AV
uses a tube of synthetic material to attach to an artery and a vein needles are inserted into the graft to access patients blood graft material is not sef-sealing so time is needed for tissue growth to plug up the needle puncture-1 to 2 weeks The Vectra is self-sealing and does not reguire tissue growth-used almost immediatley |
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ateriovenous AV fistula
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is made by sewing a vein and an artery together under the skin
may take up to2- 4 months to mature temporay access is needed until the fistual matures |
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vascular access care
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check for patency
palpating for a trill(a tremor) and auscultating for a bruit(swishing sound) athe the graft or fistula site |
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UTI
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most common nosocomial infection
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UTI predisposing factors
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stasis of urine in the bladder caused obstruction: clamped catheter bag or not going enough
contamination of perineal and uretheral areas can be fecal soiling, sexual intercourse, from infection in the area-vaginitits, epididymitis or prostatitis having intruments inserted into the urinary meatus(catheterization most common) reflux of urine from urethra to the bladder or the bladder to the ureter bcs of vaulty valves to maintain one way flow previous UTI provides a reservoir of persistant bacteria that causes reinfection women with a short lenght of the female urethra and close proximity to the anus |
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UTI's most common cause of acute bacterial sepsis in the patient over what age?
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65
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S/SX of UTI
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dysuria
urgency frequency incontinence nocturia hematuria back pain cloudy, foul smelling urine |
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S/SX of UTI in the elderly
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generalized fatigue
with a change in cognitive functioning-patients without demintia a decline in mental status and fever with an indwelling catheter meets the diagnosis for UTI |
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types of UTI's
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urethritis
cystitis pyelonephritis |
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urethritis
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inflammation of the urethra \
caused from: chemical irritant bacterial infection trauma sexually transmitted disease bubble bath and salts most common spermicidals gonorrhea and chlamydiosis can cause UTI in men |
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urethritis
symptoms |
urinary frequency
and dysuria male may have discharge |
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cystitis
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inflammation and infection of the bladder
caused by: bacteria, viruses, fungi, or parasites fungal after long term use of antibiotics E-coli catheters cloudy urine=presence of WBC's, bacteria and sometimes RBC nitrates usua;lly positive Treatment: sulfa meds=bactrim, septa |
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pyelonephritis
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is an infection of the renal pelvis, tubules and interstitual tissue of one or both kidneys
preexisting condition: obstruction strictures stones vesicoureteral reflux |
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pyelonephritis pathophysiology
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formation of small abscesses throughout the kidney and gross enlargement of the kidney]
urosepsis is a systemic infection arising from a source within the urinary system promt diagnoses and treatment is essential to prevent septic shock and death |
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pyelonephritis S/SX
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fatigue
urgency frequency dysuria FLANK PAIN fever chills costovertebral tenderness much sicker than cystitis and shows signs of systemic disease urinalysis=shows casts 100,000 colonies of bacteria per milliter presence of casts always indicates a problem with kidneys increased sedimentation rate CBC-elevated WBC complications: scarring and loss of kidney function when septicemia occurs-urosepsis |