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Flashcards in Disorders of the urinary system Deck (52):
1

Classification of Urinary Tract Infection (UTI)

1. Upper Urinary Tract Infection (UTI):
Pyelonephritis
2. Lower Urinary Tract Infection (UTI):
Cystitis
UTIs are the most common hospital-acquired infection

2

Lower UTI causes

1.BPH
2.Calculi
3. Urethral strictures
4.Tumors
5. Sexual intercourse
6. Blood born infection

3

Upper UTI causes

1.Calculi
2.Trauma
3.Tumor
4.Aneurysm
5.Congenital anomaly

4

Other causes

1. Noninfectious :
- Chemical exposure: Drugs: Cyclophosphamide (Cytoxan)
2. Radiation therapy
3. Foreign bodies
- Urinary calculi
- Indwelling catheter
4.Factor compromising Immune response
- HIV
- Diabetes
5. Hematogenous route
6. Complications
- Pyelonephritis

5

UTI: Cystitis : manifestations

1.Dysuria
2. Urinary: Frequency; Urgency; Hesitancy
3. Suprapubic: Pain; Discomfort; Pressure
4. Hematuria
5. Pyuria (WBC)
6.Urethral discharge : Cloudy/foul smelling urine
7. Perineal itching
8. Mental status changes
9. Hydronephrosis

5

UTI: Cystitis: TX

1. Drugs - aim to reduce bacteria in urinary tract / pain: Bactrim, Lexaquin, Amoxil, Macrobid, Cipro
2. Education about antibiotics: take entire prescribed dose;
3. Prevention of recurrence
4.Sensitivity to those with anxiety/ embarrassment.

6

Preventing a UTI

1. Drink 2-3 L every day - 8-10 glasses
2. Sleep, rest, nutrition
3. W: clean from front to back; avoid bubble bath, nylon underwear; scented tissues; wear cotton underwear ! empty before and after intercourse.
4. Empty as soon as feel urge (every 4 hr)
5. Home therapies: cranberries juice, apple cider vinegar, vitamin C to acidify the urine!!
6.prevent recurrence: complete antibiotics ;follow appointment ;


7

Pyelonephritis

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

Acute Pyelonephritis: appearance

kidney is swollen with multiple abscesses (yellowish gray streaks)

9

Acute Pyelonephritis: manifestations

Chills
Fever
Nausea/Vomiting
Malaise
Flank, back pain !!!!
Nocturia

10

Acute Pyelonephritis: complications

Chronic Pyelonephritis
Temporary altered kidney function
Rarely progresses to renal failure

11

Chronic Pyelonephritis: manifestations

Hypertension
Inability to conserve sodium
Decreased urine concentrating ability/Nocturia
Hyperkalemia and acidosis

12

Chronic Pyelonephritis: complications

Scar tissue
Hypertension
Renal failure

13

Urinalysis: Color

dark amber; very pale; dark red

14

Urinalysis: Odor

foul smell: possible infection

15

Urinalysis: Turbidity

Cloudy urine: urinary protein; infection

16

Urinalysis: spesific gravity

1.005-1.030

17

Urinalysis: pH

average: 6 : range: 4.6-8

18

Urinalysis: Protein

0.8 mg/dL

19

Urinalysis: RBC

0-2 per high power field

20

Urinalysis: WBC

M: 0-3; F: 0-5

21

Voided urine

first specimen voided in the morning; send as soon as possible - if not refrigerate

22

Clean - catch specimen

self clean before voiding ( front to back) ,(head of the penis downward); initiate voiding; stop; resume into container; 1 oz (30 ml).

23

24 hour urine collection

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

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

36

Glomerulonephritis (GN)

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

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

24-hour urine collection
Specimens culture
Renal Biopsy
Plasmapheresis
Antistreptolysin-O titers

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

Diet changes
Fluid intake
Drug therapy
Dialysis
Transplantation

44

GN: treatment

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

45

GN: client education

Purpose and desired effects of prescribed medications
Dietary and fluid modifications
Daily weight
Daily B/P monitoring
Peritoneal or vascular access care

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