Care of Patients with Urinary Problems Flashcards by Kelsey Klipfel

UTI’s are the most common health care-acquired infection
Acute infections in the lower urinary tract include:
Acute infection in the upper urinary tract (kidney) include:

Infectious disorders of the urinary system

How well did you know this?

Not at all

Perfectly

Cystitis (bladder) - can lead to pyelonephritis is concern
Urethritis (urethra)
Prostatitis (prostate gland)

Acute infections in the lower urinary tract include:

How well did you know this?

Not at all

Perfectly

Acute pyelonephritis - kidney infection

Acute infection in the upper urinary tract (kidney) include:

How well did you know this?

Not at all

Perfectly

Obstruction
Stones (calculi) - obstruct flow and cause retention
Vesicoureteral reflux
Diabetes mellitus
Characteristics of urine
Gender
Age
Sexual activity
Recent use of antibiotics

Factors contributing to UTI’s

How well did you know this?

Not at all

Perfectly

Bacteria laden urine is forced backward from the bladder up into the ureters and kidneys

Vesicoureteral reflux

How well did you know this?

Not at all

Perfectly

Excess glucose in urine provides a rich medium for bacterial growth

Diabetes mellitus

How well did you know this?

Not at all

Perfectly

Alkaline urine and concentrated urine promotes bacterial growth

Characteristics of urine

How well did you know this?

Not at all

Perfectly

Increased incidence in female - shortened urethrae

Gender

How well did you know this?

Not at all

Perfectly

Increased incidence in older patients

Age

How well did you know this?

Not at all

Perfectly

Antibiotics change normal protective flora

Recent use of antibiotics

How well did you know this?

Not at all

Perfectly

Maintain good hand hygiene
Insert for appropriate use only
Assess daily for need, assess appropriate alternatives
Use sterile technique when inserting
When emptying the urine bag, do not allow the tip of the outflow tube to touch the urine collection container
Select a small-size catheter, and do not overfill the balloon
Maintain a closed system
Keep tubing patent and collection bags below the level of the bladder at all times, elevation of bag causes reflux
Monitor and report CAUTI rates
Secure the catheter
Perform daily catheter care
Consider the use of coated catheters for patients requiring indwelling catheters for more than 3 to 5 days

Minimizing catheter-related infections

How well did you know this?

Not at all

Perfectly

Avoid dependent loops in catheter tubing

Keep tubing patent and collection bags below the level of the bladder at all times, elevation of bag causes reflux

How well did you know this?

Not at all

Perfectly

Increasing mental confusion or frequent, unexplained falls
Sudden onset of incontinence or worsening incontinence
Loss of appetite
Nocturia
Dysuria

CM that may occur in the older adult: Manifestations can be vague

How well did you know this?

Not at all

Perfectly

Fever
Tachycardia
Tachypnea
Hypotension
May not have any urinary manifestations

CM that may occur in the older adult: Urosepsis manifestations

How well did you know this?

Not at all

Perfectly

Inflammatory condition of the bladder
Infectious cystitis
Noninfectious cystitis
Interstitial cystitis
Urosepsis

Cystitis

How well did you know this?

Not at all

Perfectly

Caused by pathogens from the bowel or in some cases, the vagina
90% are caused by Escherichia coli
Can lead to life-threatening complications including pyelonephritis and sepsis

Infectious cystitis

How well did you know this?

Not at all

Perfectly

Results from chemical exposure (drugs), radiation therapy, and from immunologic responses (SLE)

Noninfectious cystitis

How well did you know this?

Not at all

Perfectly

Rare, chronic inflammation of the entire lower urinary tract (bladder, urethra, and adjacent pelvic muscles) that is not a result of infection

Interstitial cystitis

How well did you know this?

Not at all

Perfectly

Spread of the infection from the urinary tract to the bloodstream
Urinary tract is the infection source of severe sepsis or shock in about 10% to 30% of the cases

Urosepsis

How well did you know this?

Not at all

Perfectly

Drink 2-3 L daily
Get enough sleep, rest, and nutrition daily
If spermicides are used, consider changing to another method of contraception
Women
Do not routinely delay urination
Notify provider if signs/symptoms of UTI develop
Nutritional supplements to reduce the risk for developing UTI
Prevention (inpatient care)

Cystitis - prevention

How well did you know this?

Not at all

Perfectly

Cleanse perineum area from front to back
Avoid using or wearing irritating substances
Empty bladder before and after intercourse
Gently wash the perineal area before and after intercourse

Women

How well did you know this?

Not at all

Perfectly

Cranberry substances
Ingest apple cider vinegar
Apply topical estrogen to the perineal area
Ingest D-mannose

Nutritional supplements to reduce the risk for developing UTI

How well did you know this?

Not at all

Perfectly

Reduce the use of indwelling catheters
About 50% of inpatient clients become infected within 1 week of catheter insertion

Prevention (inpatient care)

How well did you know this?

Not at all

Perfectly

Most common - frequency, urgency, dysuria
Hesitancy or difficulty in initiating stream
Low back pain
Nocturia
Incontinence
Hematuria
Pyuria
Bacteriuria
Retention
Suprapubic tenderness or fullness
Feeling of incomplete bladder emptying

Common clinical manifestations - Cystitis - assessment

How well did you know this?

Not at all

Perfectly

Urinalysis Presence of 100,000 colonies/mL or three or more WBCs (pyuria) with RBCs (hematuria) indicates infection Urine culture – confirms type of organism and number of colonies Serum WBC count may be elevated

Laboratory assessment - Cystitis - assessment

Pelvic US or CT Voiding cystourethrography Cystoscopy

Diagnostic assessment

when urine reflux is suspected

Voiding cystourethrography

Performed when the patient has recurrent UTIs (more than three or four a year) Identifies abnormalities that increase the risk for cystitis Needed to accurately diagnose interstitial cystitis

Cystoscopy

Drug therapy Maintain adequate fluid intake Avoid fluids or food that can irritate bladder Comfort measures

Cystitis - interventions

Antiseptics Antibiotics Analgesics Antispasmodics

Drug therapy - Cystitis - interventions

used for relief of local symptoms, such as inflammation, hypermotility, and pain

Antiseptics

used for bacterial UTI’s

Antibiotics

reduce bladder pain and burning on urination by exerting a topical analgesic or local anesthetic effect on the mucosa of the urinary tract Phenazypyridine (Pyridium) will turn urine red or orange

Analgesics

decrease bladder spasm and promote complete bladder emptying

Antispasmodics

Increase intake

Maintain adequate fluid intake - Cystitis - interventions

caffeine and carbonated beverages tomato products

Avoid fluids or food that can irritate bladder - Cystitis - interventions

Warm sitz bath 2-3 times a day for 20 minutes

Comfort measures - Cystitis - interventions

Inflammation of the urethra In men In women Assess Lab: Treatment – antibiotic therapy

Urethritis

Manifestations include burning or difficulty urinating and a discharge from the urethral meatus Causes: STIs (gonorrhea, chlamydia, trichomonas)

In men - Urethritis

Manifestations similar to those of cystitis Most common in postmenopausal women and caused by tissue changes related to low estrogen levels

In women - Urethritis

History of STI Painful or difficult urination Discharge from the penis or vagina Discomfort in the lower abdomen

Assess - Urethritis

Urinalysis may show WBCs (pyuria) without a large number of bacteria

Lab: - Urethritis

Urethral Strictures Urolithiasis Urothelial cancer

Non-infectious disorders of the urinary system

Narrowing of the urethra Narrowed areas of the urethra Causes: Occur more often in men Symptom: Complications: Treatment: (surgical)

Urethral Strictures

Complications of a STD Trauma during catheterization, urologic procedures, or childbirth 1/3 have no obvious cause

Causes: - Urethral Strictures

obstruction of urine flow

Symptom: - Urethral Strictures

At risk for developing a UTI Overflow incontinence: involuntary loss of urine when the bladder is overdistended

Complications: - Urethral Strictures

Dilation of urethra (temporary) Urethroplasty

Treatment: (surgical) - Urethral Strictures

Calculi or stones in the urinary tract Presence of calculi (stones) in the urinary tract Etiology: Risk factors: Stones usually do not cause symptoms until they pass into the lower urinary tract Most patients can expel the stone without invasive procedures Size, composition, and location of stone an important factor regarding whether it will pass on its own Large stones higher up in the urinary tract, less likely to pass on their own

Urolithithiasis

Stones in the kidney: nephrolithasis Stones in the ureter: ureterolithiasis

Presence of calculi (stones) in the urinary tract - Urolithithiasis

Unknown 90% have a metabolic risk factor Calcium and vitamin D supplementation High-dose ascorbic acid (Vitamin C)

Etiology: - Urolithithiasis

Family history Overweight Diet (animal proteins, decrease fluid intake) History of urinary tract infections

Risk factors: - Urolithithiasis

History Clinical manifestations Lab Diagnostic: KUB x-ray, CT, US

Urolithiasis - assessment

Severe pain (renal colic) Hematuria N/V, pallor, diaphoresis Frequency and dysuria occur when a stone reaches the bladder Flank pain suggests that the stone is in the kidney or upper ureter Flank pain that extends toward abdomen or to the scrotum and testes or the vulva suggestions that stones are in the ureters or the bladder Pain is most intense when the stone is moving or when the ureter is obstructed Oliguria (scant urine output) and anuria (absence of urine output) suggests obstruction; obstruction is an emergency and must be treated immediately to preserve kidney function – hydronephrosis which is enlargement of the kidney may occur

Clinical manifestations - Urolithiasis - assessment

Urinalysis (hematuria is common) WBCs and bacteria may be present as a result of urinary stasis Elevated serum WBC with infection

Lab - Urolithiasis - assessment

IV opioid analgesics NSAIDs such as ketorolac (Toradol) or ketoprofen (Nexcede) Give at regularly scheduled intervals or continuous delivery system for best control of pain Spasmolytic drugs Tamulosin (Flomax) and nifedipine (Procardia) to relax the urethra and aid in expulsion

Drug therapy - Urolithiasis - interventions; pain management

Strain the urine If the stone does pass, send to lab for analysis

Other - Urolithiasis - interventions; pain management

Drug therapy Assess for symptoms of infection Urinalysis and C&S Nutrition therapy

Urolithiasis - interventions; preventing infection

Broad spectrum antibiotics

Drug therapy - Urolithiasis - interventions; preventing infection

Chills Fever Altered mental status

Assess for symptoms of infection - Urolithiasis - interventions; preventing infection

Adequate calorie intake with a balance of all food groups Encourage fluid intake of 2 to 3 L/day unless on a fluid restriction

Nutrition therapy - Urolithiasis - interventions; preventing infection

High intake of fluids of 3 L/day or more Accurate measures of I/O Drug therapy Nutrition therapy Other measures

Urolithiasis - interventions; preventing obstruction

Depends on the type of stone

Drug therapy - Urolithiasis - interventions; preventing obstruction

Depends on the type of stone

Nutrition therapy - Urolithiasis - interventions; preventing obstruction

Walk as often as possible Check urine pH daily Strain all urine

Other measures - Urolithiasis - interventions; preventing obstruction

SWL (shock wave lithotripsy) Post procedure: Minimally invasive surgical procedures are used if urinary obstruction occurs or if the stone is too large to be passed

Urolithiasis - interventions; lithotripsy

Use of sound, laser, or dry shock waves to break the stone into small fragments Done under fluoroscopy with moderate sedation and local anesthesia A stent can be placed in ureters if needed

SWL (shock wave lithotripsy) - Urolithiasis - interventions; lithotripsy

Strain urine to monitor the passage of stone fragments Bruising may occur on the flank of the affected side after procedure (expected) May have blood in urine after procedure Monitor for increase pain, fever, chills, difficulty with urination

Post procedure: - Urolithiasis - interventions; lithotripsy

Ex. stenting, retrograde ureteroscopy, percutaneous ureterolithotomy or nephrolithotomy

Minimally invasive surgical procedures are used if urinary obstruction occurs or if the stone is too large to be passed - Urolithiasis - interventions; lithotripsy

Malignant tumors of the urothelium lining of the kidney, renal pelvis, ureters, urinary bladder and urethra Most common in the bladder Symptoms: Diagnostic assessments: Nonsurgical management:

Urothelial cancer

Hematuria often the first major sign Dysuria, frequency, and urgency occur when infection or obstruction present

Symptoms: - Urothelial cancer

urinalysis, cystoscopy, biopsy, cystoureterography, CT, US, MRI

Diagnostic assessments: - Urothelial cancer

Prophylactic immunotherapy (BCG), a live virus compound, instilled in the bladder for 2 hours, live virus is excreted with the urine Teach patients to prevent contact of the live virus with family members by not sharing a toilet with others for at least 24 hours after instillation Chemotherapy Radiation therapy

Nonsurgical management:- Urothelial cancer

Type of surgery depends on the type and stage of the cancer and the patient’s general health Cystectomy Four alternatives for urine elimination are used after cystectomy

Urothelial cancer - interventions: surgical management

Compete bladder removal Additional removal of surrounding muscle and tissue offers the best change of a cure for large, invasive bladder cancers

Cystectomy - Urothelial cancer - interventions: surgical management

Ileal conduit Continent pouch Bladder reconstruction Ureterosigmoidostomy

Four alternatives for urine elimination are used after cystectomy - Urothelial cancer - interventions: surgical management

Care of Patients with Urinary Problems Flashcards

(76 cards)