Disorders of the urinary system Flashcards
1
Q
Classification of Urinary Tract Infection (UTI)
A
1. Upper Urinary Tract Infection (UTI): Pyelonephritis 2. Lower Urinary Tract Infection (UTI): Cystitis UTIs are the most common hospital-acquired infection
2
Q
Lower UTI causes
A
- BPH
- Calculi
- Urethral strictures
- Tumors
- Sexual intercourse
- Blood born infection
3
Q
Upper UTI causes
A
- Calculi
- Trauma
- Tumor
- Aneurysm
- Congenital anomaly
4
Q
Other causes
A
- Noninfectious :
- Chemical exposure: Drugs: Cyclophosphamide (Cytoxan) - Radiation therapy
- Foreign bodies
- Urinary calculi
- Indwelling catheter - Factor compromising Immune response
- HIV
- Diabetes - Hematogenous route
- Complications
- Pyelonephritis
5
Q
UTI: Cystitis : manifestations
A
- Dysuria
- Urinary: Frequency; Urgency; Hesitancy
- Suprapubic: Pain; Discomfort; Pressure
- Hematuria
- Pyuria (WBC)
- Urethral discharge : Cloudy/foul smelling urine
- Perineal itching
- Mental status changes
- Hydronephrosis
5
Q
UTI: Cystitis: TX
A
- Drugs - aim to reduce bacteria in urinary tract / pain: Bactrim, Lexaquin, Amoxil, Macrobid, Cipro
- Education about antibiotics: take entire prescribed dose;
- Prevention of recurrence
- Sensitivity to those with anxiety/ embarrassment.
6
Q
Preventing a UTI
A
- Drink 2-3 L every day - 8-10 glasses
- Sleep, rest, nutrition
- W: clean from front to back; avoid bubble bath, nylon underwear; scented tissues; wear cotton underwear ! empty before and after intercourse.
- Empty as soon as feel urge (every 4 hr)
- Home therapies: cranberries juice, apple cider vinegar, vitamin C to acidify the urine!!
- prevent recurrence: complete antibiotics ;follow appointment ;
7
Q
Pyelonephritis
A
Bacterial infection in the kidney and renal pelvis.
Could be:
- Acute pyelonephritis
- Chronic pyelonephritis
Usually begins with ascending infections from the lower tract into the renal pelvis and
parenchyma
Blood borne infections
8
Q
Acute Pyelonephritis: appearance
A
kidney is swollen with multiple abscesses (yellowish gray streaks)
9
Q
Acute Pyelonephritis: manifestations
A
Chills Fever Nausea/Vomiting Malaise Flank, back pain !!!! Nocturia
10
Q
Acute Pyelonephritis: complications
A
Chronic Pyelonephritis
Temporary altered kidney function
Rarely progresses to renal failure
11
Q
Chronic Pyelonephritis: manifestations
A
Hypertension
Inability to conserve sodium
Decreased urine concentrating ability/Nocturia
Hyperkalemia and acidosis
12
Q
Chronic Pyelonephritis: complications
A
Scar tissue
Hypertension
Renal failure
13
Q
Urinalysis: Color
A
dark amber; very pale; dark red
14
Q
Urinalysis: Odor
A
foul smell: possible infection
15
Q
Urinalysis: Turbidity
A
Cloudy urine: urinary protein; infection
16
Q
Urinalysis: spesific gravity
A
1.005-1.030
17
Q
Urinalysis: pH
A
average: 6 : range: 4.6-8
18
Q
Urinalysis: Protein
A
0.8 mg/dL
19
Q
Urinalysis: RBC
A
0-2 per high power field
20
Q
Urinalysis: WBC
A
M: 0-3; F: 0-5
21
Q
Voided urine
A
first specimen voided in the morning; send as soon as possible - if not refrigerate
22
Q
Clean - catch specimen
A
self clean before voiding ( front to back) ,(head of the penis downward); initiate voiding; stop; resume into container; 1 oz (30 ml).
23
Q
24 hour urine collection
A
initial: void, discard, note time; Foley:empty bag at the start time; collect urine for the next 24 hr; signs! let know!
24
KUB
radiography ( x-ray) of kidneys, ureter, and bladder; plain film of the abdomen obtain without any specific preparation; shows: gross anatomic features and obvious stones, strictures, calcifications or obstructions of urinary tract.
25
using contrast media
reaction?; asthma?; hay fever?; food or drug allergies (seafood, eggs, milk, chocolate);history of renal insufficiency?; taking metformin (Glucophage)?; check hydration; last ate or drank ?
26
Intravenous (IV) Urography ( excretory urography, IV pyelography)
outlines urinary tract and helps determine any problems; measure kidney size, detect obstruction, assess parenchymal mass.
1. Contrast medium - allergic reaction in iodine sensitive patients.
2. Hypertonic contrast agent - risk for acute renal failure when SC > 1.5 mg/dL
3. Nephrotoxic complications can be prevented by parenteral fluid administration.
27
Excretory Urogram : patient education
1. shell fish or iodine allergies ?;
2. metformin (Glucophage) ?;
3. asthma?;
4. bowel preparation;
5. laying on x-ray table with x-ray machine above;
6. pressure band around stomach
7. IV contrast agent: feel heat , metallic taste (few min);
8. series of x-rays will be taken; empty bladder - more x-rays; 9.normal activities after.
28
Excretory Urogram: contrast reactions
1. minor: N/V, urticaria, itching, sneezing;
2. moderate: nephrotoxic effects, congestive heart failure, pulmonary edema;
3. severe: bronchospasm, anaphylaxis
Minor allergy - give steroids and antihistamines before procedure
29
Excretory Urogram : follow up care
1. Monitor for altered renal function
2. Ensure adequate hydration : oral fluids or IV fluids - reduces the risk of renal damage;
3. Monitor blood creatinine levels
30
Excretory Urogram : Metformin
Risk for lactic acidosis; discontinued at time of procedure and 48 hr after.
31
UTI: drug therapy
Usually starts with Broad-spectrum antibiotics
| Then switch to sensitivity guided therapy
32
UTI: drugs
1. Sulfanomides : Trimethoprim/sulfamethoxazole (Bactrim, septra) - sulfa drug allergies; full glass of water;keep out of sun; complete drug.
2. Quinolones : Ciprofloxacin (Cipro) - swallow whole, 2 hr after antacid; keep out of sun.
3. Penicillin : Amoxicillin (Amoxil) -allergies; take with food; diarrhea - call; interacts with birth control; take all not to develop resistance.
4. Bladder analgesic : Phenzopyridine (Pyridium) - reduces pain
33
Surgical Management
Cystoscopy
Correction of Obstruction
Correction of structural problems
Eradication of infectious source
34
Perioperative Care
Preoperative: Antibiotic therapy, client Teaching
Operative: Pyelolithotomy, nephrectomy, ureteroplasty
Postoperative
35
Nursing Diagnoses
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Acute pain
Deficient knowledge
Urge urinary incontinence
Risk for impaired skin integrity
Risk for sepsis
Impaired urinary elimination
Anxiety
Activity Intolerance
Fear of development of CRF
Hyperthermia
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36
Glomerulonephritis (GN)
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Inflammation of the glomeruli. Both the structure and the function of the glomerulus is affected
Classification :
1.Acute Glomerulonephritis (AGN)
2. Rapidly Progressive GN
3. Chronic GN
Initiating event: strep infection
```
37
Azotemia
build up of wastes in the body
38
GN: etiology
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Infectious:
1. Group A beta hemolytic Streptococcus
2. Hepatitis B
3. Measles/Mumps
Related to other diseases:
1. Systemic lupus erythematosus (SLE)
2. Diabetic Mellitus
3. Sickle cell disease
```
39
Chronic GN
Slow progressive destruction of the glomeruli
Results in impairment of renal function
Etiology:
1. Typically the end stage of other glomerular disorders
2. Develops over 20 - 30 years
40
GN
Antigen -antibody complex from recent strep infection - glomeruli - causing inflammation; decrease glomerular filtration rate - headache ; high BP; facial edema; malaise; low grade fever, weigh gain; proteinuria , hematuria, oliguria .
41
GN:Laboratory and Diagnostic Tests
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24-hour urine collection
Specimens culture
Renal Biopsy
Plasmapheresis
Antistreptolysin-O titers
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42
GN:Laboratory and Diagnostic Tests
1, Urinalysis
2. Serum electrolytes : high Sodium,Potassium,Phosphate;
3. Acidosis
4. Serum Creat >6mg/dL
5. GFR high
6. Protein: <2g/24hour collection
43
GN: treatment
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Diet changes
Fluid intake
Drug therapy
Dialysis
Transplantation
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44
GN: treatment
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1.To prevent spread on infection:
Antibiotics may be prescribed for persons in contact with client
Basic infection control principles
2. Diuretics
3.Sodium and water restriction
4.Antihypertensives
5. Potassium and protein intake restriction
6. Plasmapheresis
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45
GN: client education
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Purpose and desired effects of prescribed medications
Dietary and fluid modifications
Daily weight
Daily B/P monitoring
Peritoneal or vascular access care
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46
Nephrotic syndrome
A condition of increased glomerular permeability that allows larger molecules to pass
through the membrane into the urine and be removed from the blood.
47
NS: etiology
Immune or inflammatory processes
Altered liver activity may occur with NS: increased lipid production and Hyperlipidemia
Also occurs as a result of genetic defects.
48
NS: manifestations
1. Massive proteinuria
2. Hypoalbuminemia
3. Edema
4. Lipiduria
5. Hyperlipidemia
6. Increased coagulation
7. Renal insufficiency
49
NS: treatment
Suppressive therapy
O Steroids
O Cytotoxic
O Immunosuppressive agents
50
NS: treatment
1. Angiotensin Converting Enzyme (ACE):
Decrease protein loss in the urine
2.Cholesterol lowering drugs:Improve lipid blood levels
3.Heparin: May reduce urine protein and reduce renal insufficiency
4.Mild diuretics
51
NS: diet changes
1. Normal GFR: Dietary intake of protein is needed
2. Decreased GFR: Dietary protein intake must be decreased
3. Sodium restrictions
