NR 570 Final Exam Study Guide with 100- correct answers

What is nephrolithiasis? renal calculi (kidney stones) How does Renal calculi form? formed d/t elevated levels of minerals in the body Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:01 / 0:15 Full screen Brainpower Read More What minerals in excess can cause renal calculi? calcium oxalate (most common), phosphate uric acid struvite cystine Urolithiasis stone in the bladder Ureterolithiasis condition of stones in the ureter Risk Factor & complications of renal calculi -Male, 20-50yo, previous stones, obesity, HTN, diabetes, low fluid intake. -complications of stones: obstructions, pyelonephritis (kidney infection), CKD Classic Kidney stone presentation acute onset of severe, colicky flank pain that wax and wane in intensity. Severe pain is associated with the movement of the stone and can cause n/v. pt may seem anxious and unable to sit still history and physical for nephrolithiasis (kidney stones) Irritative Bladder symptoms -dysuria (painful or difficulty urinating), urgency, & frequency Vague flank pain or acute colicky pain with increasing intensity Radiation of pain into the groin Costovertebral angle (CVA) tenderness Hematuria Diaphoretic, tachycardic, appear extremely uncomfortable CVA tenderness tell your the stone is located where? caused by passing of the stone through the ureter with obstruction & spasm Where is the stone located if the patient has pain in the groin region? pain that radiates downward into the groin indicates the stone has passed into the lower third of the ureter Vague flank pain or acute colicky pain with increasing intensity means the stone is located where? stones in renal pelvis Differential Diagnosis for abdominal pain and/or flank pain: Nephrolithiasis (kidney stones) Pyelonephritis (kidney infection) Ectopic pregnancy Ovarian or testicular torsion Appendicitis Bowel obstruction Diverticulitis Rupture of aortic aneurysm Right lower abdominal tenderness with a +Blumberg sign. What should be suspected? Blumberg sign: Rebound tenderness in the RLQ, caused by acute peritonitis. *Appendicitis What labs do we run to diagnose a kidney stone? UA dipstick, urine microscopy and urine C&S Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function. What radiology methods are preferred for outpatient treatment and why inexpensive, easily accessible. in combo its more practical -KUB xray -Renal Ultrasound What stones can be seen on a KUB? What stone can you not see on a KUB CAN see: Calcium oxalate - most common type of stone CANNOT see: uric acid stones (radio translucent) What is a Renal Ultrasound used for when testing for kidney stones? good for assessing for hydronephrosis (excess fluid in the kidney d/t back up of urine that can be caused by an obstruction). Bad for identifying a stone. What is the GOLD STANDARD for diagnosing a kidney stone? Non-contrast CT scan. Goal of renal calculi treatment focused on symptomatic relief pain medications -NSAID or narcs antiemetics -n/v facilitate stone passage-Thiazide diuretics, alpha-blockers or calcium channel blockers to help facilitate the passage of a stone. Terazosin -alpha blockers used for BPH. 5 mm renal calculi can be passed through the urine. may only require NSAIDs for management. 5 mm renal calculi requires what? urology consult. this may cause an obstruction or kidney failure. this type of stone may need surgical intervention to be removed. when is a Urology Referral indicated? stone 5mm recurrent stones When is a hospital admission appropriates for a patient with nephrolithiasis? Hospital admission is indicated when: -Inability to control pain -Impaired renal function with an obstructing stone -Infection (pyelonephritis or sepsis) -Intractable n/v What does a 24 hour urine collection analyze? -total volume -urine pH -calcium oxalate -uric acid -citrate -sodium -potassium -creatinine Factor Regarding hospital DC for nephrolithiasis -Pain is reasonably controlled -n/v controlled Treatment depends on: Stone type Location of the stone Extent of obstruction Kidney function Progress of stone passage.