RENAL/UROLOGIC

Question 1

What are the two UTIs of the lower urinary tract?

Answer 1

Cystitis (bladder)

Urethritis (urethra)

Question 2

What is the upper urinary tract infection

Answer 2

Pyelonephritis (kidney)

Question 3

Difference between complicated and uncomplicated UTI

Answer 3

Uncomplicated occurs in otherwise healthy urinary tract and usually only involve the bladder

Complicated includes infections w/ coexisting obstruction, stones, or catheters. Includes UTIs in pts w/ neurologic changes, pregnancy, recurrent infections, ect.

Question 4

Predisposing factors for UTIs

Answer 4

Urinary statis (urine flow obstruction), foreign bodies, anatomic features, compromised immune response, functional disorders

Question 5

What might be present in a urine specimen that indicates a UTI?

Answer 5

WBC, Nitrates, leukocyte esterase

Culture indicates bacteria present

Question 6

What symptoms indicate the pt is experiencing a UTI?

Answer 6

Emptying symptoms, storage symptoms

Question 7

Emptying symptoms

Answer 7

Hesitancy, intermittency, post-void dribbling, urinary retention/incomplete emptying, dysuria

Question 8

Storage symptoms

Answer 8

Frequency, urgency, incontinence, nocturia, nocturnal enuresis (bedwetting)

Question 9

How do you treat a pt with an uncomplicated UTI?

Answer 9

Adequate fluid intake,

Use TRIMETHOPRIM & SULFAMETHOAZOLE or just Trimethoprim if they’re allergic to sulfa drugs.

Nitrofurantoin (Macrobid) dyes urine orange. Can be used prophylactically and is not prone to bacterial resistance.

Fosfomycin is used for lower tract infections only.

Fluconazole for fungal infections

Phenazopyridine: Pain management specific to UTI pain

Question 10

What would you do in additional to normal treatment of UTI when it becomes recurrent

Answer 10

Repeat urinalysis, potential imaging, sensitivity guided antibiotic therapy (see what bacteria is causing infection and give antibiotics to treat), 3-6 months of antibiotics, post-coital antibiotic prophylaxis

Question 11

What is pyelonephritis

Answer 11

Kidney infection (inflammation of the renal parenchyma and collecting system.

MOST COMMON CAUSE: Ascending UTI (An ascending UTI is a type of urinary tract infection that starts in the lower urinary tract (bladder and urethra) and travels up to the upper urinary tract (ureters and kidneys))

Can be acute or chronic

Question 12

What physical assessment can indicate pyelonephritis

Answer 12

Put hand over affected kidney. Make other hand into a fist and hit hand over kidney. If in extreme pain, that kidney is affected by polynephritis.

Question 13

How do you diagnose pyelonephritis

Answer 13

Urinalysis that contains bacteria, blood, WBCs, pyuria (purulent)

Positive urine/blood cultures

CBC indicates left shift of WBCs

Ultrasound indicates anatomic abnormalities/hydronephrosis/abscesses/stones

LATE STAGE: IV pyelogram (urinary tract xray), CT scan w/ IV contrast

Question 14

What nursing Dx would you use for urinary elimination

Answer 14

Impaired urinary elimination

Readiness for enhanced self-management

Question 15

What can you do to help treat your pt’s symptoms?

Answer 15

local heat to suprapubic/lower back area

Warm shower

Adequate fluid intake

Antibiotic teaching

Appropriate use of urinary catheters

Question 16

When would you tell your pt to contact their doctor about their UTI symptoms

Answer 16

Once antibiotics are completed the pt is still experiencing symptoms

Onset of major flank pain

Fever

Question 17

What do you have to teach your pt when receiving treatment for UTI?

Answer 17

All antibiotics must be taken as prescribed, no matter if your symptoms go away

Appropriate hygiene (cleanse perineal region by separating labia), wiping front to back, cleansing with warm, soapy water after each bowel movement

Pee after sex

Maintain fluid intake

No harsh soaps, vaginal douches, bubble paths, or powders down there

Cranberry juice (8oz x3/day) OR 300-400mg tabs/day

Question 18

Define stress incontinence

Answer 18

Involuntary loss of urine during activities that increase
abdominal and detrusor (bladder muscle) pressure

Question 19

Define Urge Incontinence

Answer 19

Involuntary loss of urine associated with a strong urge to urinate

Question 20

Define Overflow Incontinence

Answer 20

Involuntary loss of urine associated with over-distention of the
bladder when bladder capacity has reached its maximum due to
urethral obstruction/spasm

Question 21

Define reflex incontinence

Answer 21

 Involuntary loss of urine that occurs without
warning
 Associated w/ CNS disorders

Question 22

Define Functional Incontinence

Answer 22

Loss of urine resulting from cognitive,
functional, or environmental factors

Question 23

What can you teach your pt to improve their incontinence

Answer 23

Smoking cessation, weight reduction, regular bowel elimination,
reduction of bladder irritants

Scheduled voiding regimens

Pelvic floor muscle rehabilitation (stress)

Anti-incontinence devices such as a urethral plug, penile compression device, pessaries

Containment devices (urge)

Question 24

What therapy would you use for stress incontinence

Answer 24

Pelvic floor muscle rehabilitation

 Kegels, Physical Therapy
 Vaginal weight training (Kegels with weight inserted in the
vagina)

Question 25

What therapy would you use for urge incontinence

Answer 25

Containment devices  Condom catheter  Absorbent products

Question 26

What drugs would you use for urine incontinence

Answer 26

Muscarinic Receptor Antagonists and Anticholinergics  Reduce overactive bladder contractions  Used for urge incontinence and overactive bladder  Oxybutynin (Ditropan)  Tolterodine (Detrol)  Solifenacin (VESIcare)  Dicyclomine (Bentyl)  α-Adrenergic Antagonists  5α-Reductase Inhibitors  Used when incontinence is related to BPH

Question 27

When would you use an indwelling catheter

Answer 27

 Urinary retention  Bladder decompression before or after lower abdominal or pelvic surgery  Genitourinary surgery  Accurate measurement of I/O in critically ill patients  To prevent contamination of stage III or IV pressure ulcers  Terminal illness, when positioning is associated w/ significant discomfort

Question 28

When would you use a Straight (in and out) catheter

Answer 28

 Study of anatomic structures of urinary system  Urodynamic testing  Collection of sterile specimens in selected situations  Instillation of medications into the bladder  Measurement of residual urine after urination (post void residual -PVR) if portable ultrasound is not available

Question 29

What is BPH

Answer 29

Benign Prostatic Hyperplasia  As men age, the glandular units in the prostate begin to undergo hyperplasia (abnormal increase in the number of cells), resulting in prostate enlargement (hypertrophy)  The enlargement causes narrowing of the urethra and results in partial or complete obstruction

Question 30

What are the two types of BPH

Answer 30

 Obstructive (due to urinary retention)  Difficulty initiating voiding  Changes in size and force of urinary stream  Dribbling at end of urination  Irritative (associated w/ inflammation and infection)  Urgency, frequency  Nocturia  Dysuria  Incontinence

Question 31

How do you diagnose BPH

Answer 31

 Digital Rectal Exam (DRE)  To estimate size, symmetry, consistency of prostate gland  Additional tests depending on symptom severity  Urine culture  Prostate-specific antigen (PSA) blood test  Serum creatinine  Transrectal Ultrasound (TRUS)

Question 32

What would you tell your patient to avoid when diagnosed with BPH

Answer 32

 Decrease caffeine and artificial sweeteners  Avoid spicy and acidic foods  Avoiding decongestants and anticholinergics  Restricting PM fluid intake  Timed voiding schedule

Question 33

What medications would you use for BPH

Answer 33

 5 alpha-Reducatase Inhibitors  Finasteride (Proscar)  Reduces the size of the prostate gland to improve urine flow  Blocks the 5α-reductase isoenzyme (type 2), which is needed to convert testosterone to dihydroxytestosterone  Takes 4-6 months to be effective  Dutasteride (Avodart)  Same effect, dual inhibitor of 5α-reductase isoenzyme 1 and 2  SE: decreased libido, decreased volume of ejaculate, ED  Monitor liver function tests  Alpha Blockers  Blocks the α1-adrenergic receptors in the prostate smooth muscle to improve urinary flow  May cause orthostatic hypotension  Exam

Question 34

Alpha blockers can cause

Answer 34

orthostatic hypotension

Question 35

Besides medication, how might your treat BPH?

Answer 35

 Transurethral Microwave Thermotherapy (TUMT)  Transurethral Needle Ablation (TUNA)  Laser Prostatectomy  Transurethral Electrovaporization of Prostate (TUVP)  Intraprostatic Urethral Stents  Transurethral Resection of the Prostate (TURP)  The portion of the prostate that is blocking the urethra is removed  Procedure  A resectoscope is inserted into the urethra via the penis and into the bladder  The portion of the prostate that has become enlarged is then removed  No external incision SIGNIFICANT RISK FOR BLEEDING  Bleeding is common following the TURP procedure  A continuous bladder irrigation (CBI) will be prescribed postoperatively with a LARGE indwelling Foley  To decrease bleeding and keep the bladder free of clots

Question 36

WHAT MATERIAL WOULD YOU USE FOR A CONTINUOS BLADDER IRRIGATION

Answer 36

A 3-way (3-lumen) Foley catheter  One lumen for inflating balloon (30 mL)  One lumen for outflow  One lumen for instillation (inflow)