NURSING MISC - PATHO EXAM 4 REVIEW.

NURSING MISC - PATHO EXAM 4 REVIEW. Patho exam 4 Renal System 1. Acute Unilateral Renal Obstruction and HTN a. What amount of cardiac output to the kidneys is required? i. At least 20-25% cardiac output- MAP b. What does reduced perfusion of kidneys cause? (2) i. Activation of the RAAS ii. Constriction of peripheral arterioles c. What is the most common type of renal stone? i. Calcium oxalate d. Passage of kidney stones can be extremely painful- what may they produce? Why? (2) i. “referred pain” to umbilicus ii. Due to the sensory innervation of the upper part of the ureter arising from the 10th thoracic nerve root 2. Urinary Tract Infections: a. What are the 2 common clinical manifestations of a urinary tract infection in an older adult? (2) i. Confusion ii. Poorly localized abdominal discomfort b. Why can they be difficult to diagnosis? i. Vague symptoms 3. Pyelonephritis a. What is pyelonephritis? i. An infection of one or both upper tracts (ureter, renal pelvis, and kidney intersititium) b. What are the 2 most common underlying risk factors of pyelonephritis? (@) i. Urinary obstruction ii. Reflux of urine from the bladder (vesicoureteral reflux) c. Name 3 microorganisms usually associated with acute pyelonephritis. (3) i. E. Coli ii. Proteus iii. Pseudomonas d. How does pyelonephritis associated microorganisms increase the risk of stone formation? i. They split into ammonia, making alkaline urine 4. Painful bladder syndrome/interstitial cystitis a. What does PBS/IC include? (2) i. Nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal) ii. Noninfectious cystitis (radiation, chemical, autoimmune, hypersensitivity) b. What is the cause of PBS/IC? i. Exact cause is unknown, but an autoimmune reaction may be responsible for the inflammatory response c. What 4 autoimmune reactions are included in the inflammatory response in PBS/IC? (4) i. Mast cell activation ii. Altered epithelial permeability iii. Neuroinflammation iv. Increased sensory nerve sensitivity d. What is difficult when looking at S/S of cystitis and pyelonephritis? i. Differentiating symptoms by clinical assessment alone e. How is the specific diagnosis established? (3) i. Urine culture ii. Urinalysis iii. Clinical signs and symptoms f. What indicates pyelonephritis, but are not always present in the urine? i. WBC casts