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Situation: Ms. Elsa Cruz has fever with severe flank pain was brought to the ER.
1. Urinalysis was ordered for her, with instruction about the examination, when can you collect urine specimen for culture?
a) noon time if specimen is available
b) evening before retiring
c) anytime as soon as there is specimen
d) A.M. only
2. Intravenous pyelography was ordered, your nursing preparation would include the following. Except:
a) enema on the morning of the test
b) check for history of allergies
c) hydrating Mrs. Cruz orally four hours before the procedure
d) NPO 8 hours before the test
3. By doing IVP, this would visualize her:
2) ureter and bladder
3) bladder and kidneys
4) ureter and kidneys
a) 1 and 5
c) 1 and 4
4. The physician suspects acute pyelonephritis based on the patient's physical examination. Which clinical manifestation should the nurse expect to assess?
a) lower abdominal pain, dysuria and urinary frequency
b) pyuria, hematuria and groin pain
c) flank pain, urinary frequency and an elevated WBC count
d) urinary frequency and casts in the urine
5. The physician orders a combination of Sulfamethoxazole and Phenazopyridine hydrochloride (Azogantrisol) for the patient. Which therapeutic effect should this combination drug have:
a) plain relief and a decreased WBC count
b) equal fluid intake and output
c) polyuria with reddish stain
d) increased complaints of bladder spasm after 20 minutes
6. Diagnosis of acute pyelonephritis has been established your nursing intervention includes the following except:
a) provide health teaching and discharge planning
b) administer antibiotic
c) measure I and O
d) provide adequate comfort and rest
7. The least that you would include in your health teaching is:
a) low sodium diet compliance
b) medication regimen
c) follow-up culture
d) signs and symptoms of recurrence and the need to report
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ANSWERS AND RATIONALE
- urine specimen can be collected anytime as soon as it is available, if it is to be used to identify possible microorganisms, it should be collected by midstream or clean catch technique.
Urine culture and sensitivity is the most accurate diagnostic test for UTI but it takes 24-72 hours to complete. Urine culture is done to identify the infecting microorganisms and the most appropriate antibiotic to give the patient.
Rapid tests to detect bacteria in the urine include:
- nitrite dipstick - turns pink in the presence of bacteria
- leukocyte esterase test - identifies lysed or intact WBC which appears in the urine when there is infection
- WBC with differential - infection causes leukocytosis (increased WBC count) and elevated neutrophils
- Gram stain - to detect if infection is caused by gram positive or gram negative bacteria
- bacteuria - a bacteria count greater than 100,000 is a sign of infection
- hematuria or presence of red blood cells
- Nursing Interventions when a patient is to have an IVP include:
- assess patient for allergy to iodine, shellfish, or radiologic contrast dye. If allergy is present, notify physician before the test
- IVP should be performed before barium test or gall bladder test using contrast material
- with hold foods for 8 hours before the test. Allow clear fluids: water, coffee and tea
- perform patient bowel preparation (laxative and cathartic) a night before the test to remove feces and gas from the intestines. Give enema or suppository on the morning of the test
- check renal and fluid status. Report to physician any abnormality in the serum osmolality, creatinine, and blood urea nitrogen levels
- make sure informed consent is signed
- during the test, tell patient that she will feel flushing sensation, nausea and metallic taste when contrast media is injected
- increased fluid intake after the test to promote excretion of the dye
- notify physician right away if patient show reaction to the dye such as: rash, dyspnea, tachycardia, itching or hives during or after the test.
- IVP is also known as excretory urography. It is a diagnostic test used to visualize the kidney, bladder and ureter in which a contrast media is administered intravenously. X-ray of the said organs will show any functional and structural abnormalities present.
- The manifestations of acute pyelonephritis are:
- high fever
- flank pain on the affected side - may radiate to the epigastrium or towardthe ureter
- tenderness on palpation of costovertebral angle
- muscle pain
- voiding problems - dysuria, frequency and urgency
- urine - cloudy or bloody, foul smelling, high WBC count and casts
- sulfamethoxazole is a sulfonamide antibiotic used to treat infection. When infection has been treated, naturally the WBC count will go down to normal.
- avoid sun exposure; use wide brimmed hat and sunscreen when under the sun
- take oral form on empty stomach with 8 ounces of water
- advise to report discomfort at IV insertion site if given parenterally. Do not administer IM
- notify physician immediately if the following signs appear: sore throat, fever, cough, mouth sores, or iris lesions. This may be signs of blood dyscrasias as sulfonamides may decrease hemoglobin, platelets, granulocytes and WBC
- sulfonamides are contraindicated in patients with renal impairment (don't give if creatinine clearance is abnormal), porphyria, megaloblastic anemia, pregnant at term and breastfeeding, infants below 2 months
- Pyelonephritis is inflammation/infection of the kidney and renal pelvis. It is the most common upper urinary tract infection (UTI).
Nursing Care for UTI include:
- health teaching regarding antibiotic therapy
- practice aseptic technique when inserting catheter. Position collection bag below the bladder
- avoid irritants to the bladder such as caffeinated beverages, spicy foods, tomatoes, artificial sweeteners, citrus juices and alcohol. These substances can irritate the bladder and increase urgency and bladder spasms
- increased fluid intake to flush out the microorganisms
- practice proper perineal hygiene
- provide adequate rest and sleep during the acute phase when patient experiences pain to promote healing
- pain management - with medication such as phenazopyridine (pyridium) to treat pain, the patient will be able to void without discomfort within 24 hours after initiation of treatment and normal voiding pattern returns in three days. Hot sitz bath may also help to decrease urethral smooth muscle spasm.
- emphasize the need for follow up - urine culture should be repeated after one week of completion antibiotic therapy to ensure that the infection has been successfully eradicated
- teach prevention of UTI: such as:
- proper perineal hygiene
- liberal fluid intake
- void before and after intercourse
- void frequently
After you reviewed your answers through its rationale, you can now proceed to the next set of questions:
Online Nursing Practice Test about Renal Disorders (8-11)