Patho reply posts.
Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2).
Instructions:
In your reply posts, include how the information you learned from your peer’s initial post will help you to provide care to a patient.
In your reply to each of your peers, discuss content that you learned while exploring the website and a resource they might find helpful as well. The expectation is not that you “agree” or “disagree” with your peers but that you develop a reply post with information that is validated via citations to encourage learning and to bring your own perspective to the conversation.
– Utilize at least two scholarly references per peer post.
Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.
– Minimum of 300 words per peer reply.
– TURNITIN ASSIGNMENT (FREE OF PLAGIARISM)
Background: I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work at a Psychiatric Hospital.
POST # 1 DANIKA
Topic: Hydronephrosis The purpose of this initial post is to expand on hydronephrosis. Hydronephrosis occurs when a non-obstructive or obstructive manifestation prevents the normal drainage of urine from the kidneys causing the kidneys to swell and dilate (Nuraj & Hyseni, 2017). The condition most frequently occurs as a secondary complication to obstructions, like renal caculi, strictures or external compression by a tumor, scar tissue, blood clots, and prostatic hypertrophy (Alshoabi, 2018; Nuraj & Hyseni, 2017; VanMeter & Hubert, 2018). Kidney stones are the most common cause of hydronephrosis in young adults and can develop when there are excessive amounts of relatively insoluble salts or insufficient fluid intake leading to high concentrations of urinary filtrate (Iqbal et al., 2017; VanMeter & Hubert, 2018). Older adults develop hydronephrosis from a variety of issues like BPH, carcinoma, retroperitoneal or pelvic neoplasms, neurogenic bladder, bladder neck obstruction, urethral stricture, and bladder stones (Iqbal et al., 2017). Non-obstructive hydronephrosis can occur from excessive fluid intake caused by nephrogenic diabetes insipidus and psychiatric polydipsia. Persistently large volumes of intake can lead to bladder distention and hypertrophy with intramural obstruction of the ureters. When the bladder contractility and ureter peristalsis diminish, a large residual of urine causes urine reflux into the kidneys leading to non-obstructive hydronephrosis (Maroz et al., 2012). Mild hydronephrosis in pregnancy is a common finding because progesterone causes smooth muscle relaxation and dilation of the renal pelvises and calyceal systems and the expanding uterus compresses the ureters (Mandal et al., 2017). Pregnant women have a 40% increase in development of pyelonephritis due the increased urine volume and stasis. This is significant because pyelonephritis has shown to increase the risk of preterm delivery up to 50% (Mandal et al., 2017). Renal calculi are also common in pregnancy due to increased excretion of uric acid. Hydronephrosis in pregnancy is usually managed conservatively with appropriate hydration and analgesia but may require the insertion of double J stents if severe (Mandal et al., 2017). The kidneys are constantly creating urine and when the flow is disrupted for an extended amount of time the pressure of the built-up fluid compresses the blood vessels causing necrosis of the renal tissue (VanMeter & Hubert, 2018). The renal impairment from hydronephrosis can cause hypertension, sepsis, urinary infection, hematuria, and ultimately renal failure (Iqbal et al., 2017). The condition may be asymptomatic at first and if allowed to worsen people may experience “flank pain, abdominal mass, nausea and vomiting, urinary tract infection, fever, painful urination (dysuria), increased urinary frequency, and increased urinary urgency” (Nuraj & Hyseni, 2017, p. 159). Hydronephrosis is diagnosed by ultrasound of the kidneys, MRI of the abdomen, a CT of the kidneys or abdomen, or intravenous pyelogram (IVP) Nuraj & Hyseni, 2017. The intravenous pyelogram uses contrast to visualize the structure and abnormalities of the urinary system under X-ray (Radiological Society of North America, 2019). The treatment and prognosis of hydronephrosis is dependent on the underlying cause. Knowledge of the various ways hydronephrosis can develop is essential for APRNs. As an FNP, I will be caring for patients of all ages so a thorough assessment and history of the patient will aid in determining a diagnosis and plan of care. For example, if an older man presents with frequent UTIs, trouble voiding, flank pain, or other urinary symptoms, an ARPN will evaluate for BPH or possibly cancers and assess the risk of the development of hydronephrosis. Young adults experiencing frequent renal calculi will need counseling on how to prevent them in order to reduce the trauma on the urinary tract and prevent hydronephrosis. There are five main types of kidney stones: calcium stones, magnesium ammonium phosphate stones, uric acid stones, cystine stone, and drug induced stones (Alelign & Petros, 2018). If stones can be passed, they should be collected and analyzed to determine the contents of the stone. Vegetarians are more prone to calcium oxalate stones due to high levels of oxalate in the diet (VanMeter & Hubert, 2018). Guaifenesin, triamterene, atazanavir, and sulfa drugs can induce stones so changes in medications may be necessary if drug-induced stones are thought to be the culprit (Alelign & Petros, 2018). Hydronephrosis is a secondary complication so APRNs will first need to find the primary cause to treat it. References Alelign, T., & Petros, B. (2018). Kidney stone disease: An update on current concepts. Advances in Urology, 2018, 1-12. doi:10.1155/2018/3068365 Alshoabi, S. A. (2018). Association between grades of hydronephrosis & detection of urinary stones by ultrasound imaging. Pakistan Journal of Medical Sciences, 34(4), 955-958. doi:10.12669/pjms.344.14602 Iqbal, S., Raiz, I., & Faiz, I. (2017). Bilateral hydroureteronephrosis with a hypertrophied, trabeculated urinary bladder. Malaysian Journal of Medical Sciences, 24(2), 106-115. doi:10.21315/mjms2017.24.2.14 Mandal, D., Saha, M., & Pal, D. (2017). Urological disorders and pregnancy: An overall experience. Urology Annals, 9(1), 32-36. doi:10.4103/0974-7796.198901 Maroz, N., Maroz, U., Iqbal, S., Aiyer, R., Kambhampati, G., & Ejaz, A. A. (2012). Nonobstructive hydronephrosis due to social polydipsia: A case report. Journal of Medical Case Reports, 6(1), 1-4. doi:10.1186/1752-1947-6-376 Nuraj, P., & Hyseni, N. (2017). The diagnosis of obstructive hydronephrosis with color doppler ultrasound. Acta Informatica Medica, 25(3), 178. doi:10.5455/aim.2017.25.178-181 Radiological Society of North America. (2019). IVP – Intravenous Pyelogram. Retrieved June 23, 2020, from https://www.radiologyinfo.org/en/info.cfm?pg=ivp
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