Urinary tract infections, obstructions 3 b

Question 1

Pyelonephritis

causes

Answer 1

Inflammation of the renal pelvis, tubules and interstitial tissue
} Causes:
◦ Usually begins with infection of lower urinary tract via ascending
urethral route
◦ Bacterial Infection
◦ Secondary to vesico-ureteric reflux or urinary tract obstruction
} Can be acute or chronic

Question 2

Acute pyelonephritis
Clinical Manifestations:
medical and nursing management

Answer 2

Clinical Manifestations:
• Fever and chills
• Leucocytosis
• Bacteriuria and pyuria
• Flank pain and costovertebral tenderness
• Nausea and vomiting • Lower urinary tract symptoms (dysuria and frequency)
Medical & Nursing management:
• Outpatient or inpatient care
• Antibiotic therapy (oral and/or IV)
• Hydration (oral or IV)
• Non steroidal anti-inflammatory or antipyretic drugs, assessment of
temperature 4th hourly
• Urinary analgesics

Question 3

Acute pyelonephritis – Nursing Management

Nursing diagnosis: Risk for infection, related to bacteria in the urinary tract

Answer 3

Nursing interventions:
• Monitor urine character, malodour.
• Encourage oral fluids.
• Instruct to void when urge is felt.
• Encourage perineal hygiene.
• Health promotion measures – early treatment of cystitis to prevent ascending infections.
• Continue prescribed medications.
• Follow up urine culture.
• Recognise symptoms of relapse

Question 4

Chronic pyelonephritis (interstitial nephritis)
Definition:

Answer 4

Definition:
Kidney that has lost function due to scarring and
fibrosis
Causes:
Recurrent infections

Question 5

Chronic pyelonephritis (interstitial nephritis)
Clinical manifestations: Nursing Managment

Answer 5

• Fatigue, headache, anorexia, polyuria, excessive thirst,
weight loss
• Late stages: renal failure symptoms
Medical and Nursing Management:
• Antimicrobial agents
• Monitoring of renal function
• May require hospitalisation
• Teaching prevention of UTI’s

Question 6

Urinary Obstruction

Answer 6

“Urinary obstruction refers to any anatomical or
functional condition that blocks or impedes the
flow of urine”
Can adversely alter urinary tract function and
structure

Question 7

Urinary Obstruction

Associated condition

Answer 7

Associated conditions:
• Reflux – backflow of urine
• Hydronephrosis

Question 8

Hydronephrosis

Answer 8

Dilation of the renal pelvis and calyces of one or
both kidneys leading to distension and atrophy
caused by uretero-vesical reflux.
• Caused by obstructions in the urinary tract.
• Onset may be acute or gradual, unilateral or
bilateral.
• May develop chronic pyelonephritis and renal
atrophy

Question 9

Urinary Tract Calculi

types

Answer 9

Calculi (stones) in the urinary tract or kidney

• Vary in size or location

Question 10

Urolithiasis

• Nephrolithiasis -

Answer 10

– calculi (stones) in the urinary system
 kidney stones (renal calculi)

Question 11

Pathophysiology Urinary Tract Calculi

Answer 11

Multiple causes such as:
• Supersaturation of substances in the urine
• High urinary concentrations of calcium
oxalate, calcium phosphate and uric acid in
urine
• Absence of substances that prevent
formation such as citrate and magnesium
• Dehydration

Question 12

Conditions that favour calculi formation

Answer 12

• Infection
• Urinary Stasis
• Immobility
• Hypercalcaemia

Question 13

Clinical Manifestations

Answer 13

Clinical Manifestations
• Depends upon location and presence of obstruction or infection.
• Where stone is in urinary tract.
• Pain and haematuria.

Question 14

Renal Pelvis

Answer 14

o Dull aching flank pain to acute pain
o Manifestation of UTI
o Microscopic haematuria
o Abdominal discomfort, nausea and vomiting

Question 15

Ureters

Answer 15

o Excruciating colicky, wavelike pain (renal colic) radiating down the thigh and
genitalia, urge to void
o Nausea, vomiting, pallor, cool and clammy skin

Question 16

Bladder

Answer 16

o May be asymptomatic or have dull suprapubic pain
o Irritation associated with UTI and haematuria
o Urinary retention can occur if the stone obstructs the bladder neck

Question 17

Complications

Assessment and Diagnostic Findings

Answer 17

• Obstruction
• Hydronephrosis
• Infection

• X-ray (KUB)
• Ultrasound
• IVP (Intravenous Pyelogram)
• Blood chemistries and stone analysis
(may be asked to strain all urine and
save any stones that pass)

Question 18

Medical Management
Goals:
• Manage

Answer 18

• Manage acute attack
• Identify cause of stone formation
• Eliminate stone
• Control any infection
• Prevent nephron destruction
• Relieve any obstruction • Relieve pain

Question 19

Stones greater than 4mm

Answer 19

m are unlikely to pass

through ureter

Question 20

prevent obstruction

Answer 20

• A ureteral stent may need to be inserted

Question 21

Procedures include:

Answer 21

Medical Management
Procedures include:
•Ureteroscopy
•Percutaneous Nephrostomy or Percutaneous Nephrolithotomy (PCNL)
•Lithotripsy to fragment stones
o Cystoscopic laser lithotripsy
o Percutaneous ultrasonic lithotripsy
o Extracorporeal shock wave lithotripsy (ESWL)
•Open surgery for removal of stones
o Nephrolithotomy- incision into kidney
o Pyelolithotomy – incision into renal pelvis
o Ureterolithotomy – incision into ureter
o Cystotomy – incision into bladder
•Chemolysis
o Use of infusions of chemical solutions such as alkylating agents to dissolve the stone
•Nephrectomy
o Removal of kidney only if non-functional secondary to infection or hydronephrosis

Question 22

Patient education on preventing kidney

stones

Answer 22

Education regarding recurrence, understanding causes of renal calculi and following a regime
to avoid further stone formation.
Patient education includes:
• Drink enough fluid
• Increase mobility.
• Follow their prescribed diet- change diet to reduce intake of primary substance that forms calculi.
• Reduce salt intake.
• Ensure adequate rehydration when involved in activities that cause too much sweating and
dehydration.
• Contact doctor if developing symptoms of a UTI

Question 23

Nutrition & Fluids

Answer 23

Fluid intake is preferably 3000ml – 4000ml/day. Drink water every 1-2 hours, two glasses before bedtime and a glass each time when waking at night.
Aim for urine output exceeding 2L per day.

Question 24

Diet:

Answer 24

Modify diet to decrease foods high in causative factors (i.e. calcium stones – decrease dairy, chocolate, dried fruits and nuts)