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Nursing 2 Exam 4 > Unit 15 Alterations of Urinary System > Flashcards

Unit 15 Alterations of Urinary System Flashcards

1
Q

What are types of Urinary Disorders?

A

UTI
Benign Prostatic Hyperplasia (BPH)
Nephrolithiasis
Glomerulonephritis

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2
Q

What is Nephrolithiasis?

A

Kidney stones, renal calculi

-causes a lot of flank pain

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3
Q

Define the following terminology:

  • Cystisis
  • Prostatitis
  • Pyelonephritis
  • Urethritis
A
  • Cystisis (bladder inflammation and infection in any part of the urinary system, the kidneys, bladder, or urethra)
  • Prostatitis (prostate inflammation)
  • Pyelonephritis (kidney inflammation due to bacterial infection)
  • Urethritis (urethra inflammation)
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4
Q

What are the classifications of Urinary Tract Infections?

A 
Lower
Upper
Uncomplicated 
Complicated 
Hospital acquired
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5
Q

What are symptoms of lower UTIs considered?

A

Localized

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6
Q

What are symptoms of upper UTIs considered?

A

Systemic

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7
Q

What is the most common type of UTI?

A

Lower uncomplicated, caused by UTI and nothing else (bladder and down)

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8
Q

What does complicated UTI mean?

A

Refers to UTI caused by another known reason such as a disease

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9
Q

What are the signs and symptoms of UTIs?

A 
Dysuria- burning pain when urinating 
Urgency- sudden need to urinate
Frequency
Nocturia- waking at night to urinate
Suprapubic or pelvic pain
Hematuria (just a little)
Back pain
Incontinence (usually elderly)
Dullness on percussion
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10
Q

What are gerontological considerations of UTIs?

A 
They lack typical symptoms 
AMS
Lethargy
Anorexia 
New incontinence 
Low grade fever
May still have frequency, urgency, and dysuria
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11
Q

What are 3 diagnostic tests for lower UTIs?

A

Urine Dipstick: bacteriuria
Urinalysis:UA
Urine Culture and sensitivity: C and S

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12
Q

How does a urine dipstick show infection?

A

WBCs and nitrates = infection

Specific gravity elevated

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13
Q

What can an Urinalysis show?

A

increased WBCs

Bacterial colonies

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14
Q

Describe urine culture and sensitivity (C and S).

A

It’s clean catch/catheterization

Culture- determines the infectious agent

Sensitivity- determines the susceptibility of bacteria to antibiotics

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15
Q

Name and describe the urinary analgesic.

A

Phenazopyridine

  • take when you have symptoms as needed
  • turns urine dark orange, make PT aware could look like blood
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16
Q

If a PT is treated for a UTI with a dose of Rx and in 1-3 days it does not go away, what would be the next step?

A

C and S to identify bacteria before another Rx.

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17
Q

What 3 antibiotics are used for UTIs and describe them.

A

floroquinolone: *cirpoflaxicin *levoxicin
-treatment of choice for uncomplicated (3days)
S.Effects: *C-DIFF, *Tendonitis/tendon rupture, diarrhea, GI discomfort and rash, seizures
Taken-1 hour before meals or 2 hrs after meals

Nitrofurantoin

  • ineffective in PTs with GFR <50 (kidney failure)
  • can cause peripheral neuropathy

Penicillin’s: Amoxicillin

  • Check for PT allergies
  • high likelihood of resistance with Rx misuse
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18
Q

What are UTI educational and prevention points we can teach PTs?

A
  • Shower and post coital(intercourse) voiding
  • Cleaning the perineum from front to back
  • Increase amounts of fluid
  • Avoid coffee, tea, alcohol, colas
  • Empty bladder Q 2-3 hrs.
  • Take meds EXACTLY as prescribed
  • Vitamin C 1000 mg and *cranberry juice
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19
Q

What is an Upper UTI also known as and where is the infection?

A

Pyelonephritis- infection of kidneys, urters, and renal pelvis

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20
Q

What are the signs and symptoms of [acute] Upper UTI/Pyelonephritis and what is a complicated of it?

A

-Lower UTI signs and symptoms + fever, chills, serum leukocytosis (elevated WBC), low back pain, flank pain, n and v, headache (systemic symptoms)

Complication: could relapse and become asymptomatic and chronic

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21
Q

What two terms also mean stones in the urinary tract and kidney?

A

Urolithiasis and nephrolithiasis

22
Q

What is the urine that remains in the bladder after voiding?

A

residual urine

23
Q

What are the signs and symptoms of chronic Pyelonephritis and what is the complication of it?

A

Weight loss, polyuria, headache, poor appetite, excessive thirst

Complication: End Stage Renal Disease

24
Q

What are diagnostics for Complicated UTI (Pyelonephritis)

A

> BUN and Creatinine

  • normal bun 7-18
  • normal creatinine 0.6-1.2

> IV urogram (injection of dye)

> Voiding cystouretheorgraphy VCUG (dye injected, xrays taken as PT voids, very uncomfortable)

*check for dye allergy

25
What are the treatments for Pyelonephritis?
>Possible hospitalization ``` >Antibiotic therapy orally or IV -TMP-SMX -ciprofloxacin -gentamicin -third generation cephalosporin parenteral in hospital to rapidly establish drug levels ``` >NSAIDs and Acetaminophen -for fever and discomfort >3-4 L a day
26
What is the general management for Pyelonephritis?
``` I and Os Assess temperature q4h Bed rest only acute phase Prevention of further infection (education) Medications as prescribed HCP follow upmpt ```
27
What symptom is associated only with upper UTIs?
CVA flank tenderness- (place hand on back-side and lightly pound with other hand to assess)
28
What is Benign Prostatic Hyperplasia?
obstruction of urinary flow from enlarged prostate -NOT INFLAMMATION
29
What are symptoms of BPH (Benign Prostatic Hyperplasia)?
Obstructive symptoms -similar to urinary tract infection Irritative symptoms
30
What are diagnostic studies for BPH?
H and P w/ digital rectal exam Urinalysis Labs- (PSA[prostate stimulate antigen] and creatinine Transrectal ultrasound (TRUS) Uroflowmetery Post void residual Cystourethroscopy- (tube entering urethra to visually observe bladder)
31
What 3 pharmacological medication categories are used to treat BPH and what are the medications?
5-alpha reductase inhibitors: - finasteride - dutasteride Alpha-adrenergic receptor blockers - doxazosin - terazosin - tamsulosin Herbal Therapy -Saw palmetto
32
Name the 5-alpha reductase inhibitors Rx's and describe them.
- finasteride - dutasteride Interfere with the conversion of testosterone to dihydroxytestosterone(DHT), decreases size of prostate SE: decreased libido, decreased ejaculation volume, and erectile dysfunction *Don't touch med with bare hands!* Used for BPH
33
Name the Alpha-adrenergic receptor blocker Rxs and describe them.
- doxazosin - terazosin - tamsulosin Relaxes smooth muscle, DOES NOT decrease hyperplasia, increases symptom relief SE: orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion Used for BPH
34
Name the Herbal therapy used for BPH and describe it.
Saw Palmetto Symptom relief and decreases conversion of testosterone to DHT therefor decreasing size SE: GI, increase risk for bleeding, stop prior to dental or surgical procedures *better tolerated, less expensive and may be as effective as medication
35
What are minimally invasive therapies for BPH?
* Catheterization: Caude®catheter * Transurethral microwave thermotherapy (TUMT) * Transurethral needle ablation (TUNA) * Laser prostatectomy * Intraprostate urethral stents
36
What are invasive therapies for BPH?
Transurethral: • Transurethral resection of the prostate (TURP)*** • Transurethral incision of the prostate (TOIP) ``` Prostatectomy: • Suprapubic prostatectomy • Perineal prostatectomy • Retropubic prostatectomy • Robotic or laparoscopic prostatectomy ```
37
What is included in the post-operative assessment for the PT who had prostate surgery?
-maintenance of fluid volume balance (I and Os), relief of pain and discomfort, ability to perform self-care activities, and absence of complications: * Complications include hemorrhage, infections, catheter obstruction, DVT, and sexual dysfunction * Transurethral Resection (TUR)Syndrome
38
What is Urolithiasis?
Stones in the urinary tract
39
What are the types of Calculi (stones)?
Calcium- majority of stones Uric acid- PT w/ Gout likely to develop these stones Struvite- associated with reoccurring UTIs Cysteine- rare inherited defect causing
40
What are the signs and symptoms of stones?
They are mild to extreme and are severely painful as stone travels through ureter. ex: CVA tenderness -depends on degree of obstruction, infection, and edema
41
Describe how pain will feel in the following areas regarding calculi. Renal Pelvis Ureter obstruction Bladder Renal colic
Renal pelvis- Intense, deep aching costeovetebral area (CVA) radiating pain from kidneys toward bladder Ureter obstruction- acute excruciating wave like pain Bladder- irritation and UTI, hematuria Renal colic- sudden pain, CVA tenderness, N/V, pallor cold clammy skin
42
What are diagnostics for calculi?
``` H&P: Dietary, medications, and family hx KUB Ultrasound IV urography Retrograde pyelography VCUG **24 hr urine test -calcium, uric acid, creatinine, sodium, ph and total volume **Stone analysis Blood chemistry ```
43
What is the nursing management for calculi?
Pain management * Adequate hydration* - main point of therapy - greater than 2L or urine output recommended ``` Dietary changes depending on stone Control of infection Strain all urine I and Os VS Cessation of Rx's increasing stone development Limit sodium 3-4g/day Rx's for uric acid if appropriate ```
44
What are the surgical options for calculi and describe them.
-Ureteroscopy -Extracorporeal shock wave lithotripsy (ESWL) shock wave breaks up calculi and they pass through tract SE: urinary obstruction* -Endourologic (percutaneous) stone removal -Nephrolithotomy/Cystotomy SE: Hemorrhage*
45
What is the PT teaching for calculi?
-Avoid meds that increase stone development: antacids,Vitamin D, Laxatives, High doses of aspirin - Limit sodium intake - Avoid Oxalate containing foods: spinach, strawberries, rhubarb, tea, peanuts, wheat bran - Drink 2 glasses of water at bedtime to prevent concentration of urine overnight - avoid dehydration - notify HCP of signs of infections
46
What is acute Glomerulonephritis?
-Not infection -Autoimmune, precursor to kidney failure -inflammatory disease of glomeruli -antigen-antibody response to infection such as: strep, shingles, HIV, etc. -could lead to chronic *result is inflammation of the glomerular capillaries and GFR
47
What is the biggest different between acute Glomerulonephritis and chronic?
Chronic is essentially kidney failure and be caused by lifelong conditions
48
What are the clinical manifestations of acute Glomerulonephritis?
**Proteinuria **Hypertension **Edema Hematuria Oliguria Neurological symptoms Fluid overload particularly in elderly
49
What is the best way to determine edema is decreasing?
daily weighing
50
What is the management for Glomerulonephritis?
- Assess for previous infection: sore throat, skin lesions - Physiological assessments: fluid and electrolyte status, cardiac status, and neuro status - Strict I and Os plus DAILY WEIGHTS - Monitoring VS - Diet restrictions: protein, sodium, and fluids - Medications as indicated: antihypertensives, diuretics, biologics

Nursing 2 Exam 4 (5 decks)

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