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NUR123 > Unit 15 - Urinary > Flashcards

Unit 15 - Urinary Flashcards

1
Q

Lower UTIs

A

Cystitis, prostatitis, urethritis

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2
Q

Upper UTIs

A

Acute pyelonephritis, chronic pyelonephritis, renal abscess, interstitial nephritis, perirenal abscess

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3
Q

Uncomplicated Lower UTI

A

Community-acquired infection; common in young women and not usually recurrent

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4
Q

Compliated Lower or Upper UTI

A

Often nosocomial (acquired in the hospital) and related to catheterization; occur in patients with urologic abnormalities, pregnancy, immunosuppression, diabetes mellitus, and obstructions and are often recurrent

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5
Q

Pyelonephritis

A

Inflammation of kidney and renal pelvis

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6
Q

Interstitial nephritis

A

inflammation of spaces between kidney tubules

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7
Q

renal abscesses

A

pus filled cavity of kidney

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8
Q

Urethrovesical reflux

A

reflux of urine from urethra into bladder (coughing, sneezing, straining causes pressure forcing urine from bladder to urethra and then back when pressure recedes)

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9
Q

Ureterovesical reflux

A

reflux of urine from bladder to ureters, can cause bacteria to reach kidneys

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10
Q

UTI Risk factors

A

Inability or failure to empty the bladder completely Obstructed urinary flow: Congenital abnormalities Urethral strictures
Contracture of the bladder neck
Bladder tumors
Calculi (stones) in the ureters or kidneys Compression of the ureters
Neurologic abnormalities Decreased natural host defenses or immunosuppression Instrumentation of the urinary tract (e.g., catheterization, cystoscopic procedures) Inflammation or abrasion of the urethral mucosa Contributing conditions: Diabetes mellitus (increased urinary glucose levels create an infection-prone environment in the urinary tract)
Pregnancy
Neurologic disorders
Gout
Altered states caused by incomplete emptying of the bladder and urinary stasis

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11
Q

S+S of UTI

A 
Dysuria
• Urgency
• Frequency
• Nocturia
• Suprapubic	or pelvic	pain
• Hematuria
• Back pain
• Incontinence
• Dullness on	percussion
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12
Q

Gerontologic Considerations

A 
Lack typical symptoms
• Altered	mental status
• Lethargy
• Anorexia
• New incontinence
• Low grade fever
• May still have	frequency, urgency and	dysuria
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13
Q

Urosepsis

A

Sepsis resulting from infected urine, usually a UTI. Indwelling catheter. Can cause signs of septic shock

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14
Q

Septicemia from UTI

A

Kidneys receive 25% cardiac output, with pyelonephritis can lead to bacteremia. Septicemia syndrome (vasodilatation, microvascular permeability, massive inflammatory response)

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15
Q

S+S of urosepsis

A 
hypo/hyperthermia
tachycardia
tachypnea
leukocytosis/leukopenia
>10% immature band forms``
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16
Q

Urine dipstick:

A

bacteriuria

Leukocyte markers for leukocyte esterase and nitrites (Greiss test) (WB + Nitrites = infection). Elevated SG.

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17
Q

Urinalysis (UA)

A

> WBC , bacteria >10^5

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18
Q

Urine C&S

A

Clean catch + catheterization
Culture - determines infectious agents
Sensitivity - determines susceptibility of bacteria to Abx

Also differential dx: test for STDs

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19
Q

Groups needing cultures when bacteriuria is present

A

All men (because of the likelihood of structural or functional abnormalities)
Women with a history of compromised immune function or renal problems
Patients with diabetes mellitus
Patients who have undergone recent instrumentation (including catheterization) of the urinary tract
Patients who have been recently hospitalized or who live in long-term care facilities
Patients with prolonged or persistent symptoms
Patients with three or more UTIs in the past year
Pregnant women
Postmenopausal women

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20
Q

Pt Education for UTI

A

Shower rather than bath

After BM clean front to back

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21
Q

Pt Education for UTI (Fluid intake)

A

Drink liberal fluids to flush

Avoid coffee tea colas alcohol and other irritants

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22
Q

Pt education for UTI (Voiding habits)

A

Void q2/3 hr during day and completely empty bladder to prevent overdistention and compromised blood supply to bladder wall which can predispose to UTI.
Void after sex.

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23
Q

Pt education for UTI (Therapy)

A

Take meds exactly as prescribed (short term 3-4 d, 7-10 d)
Long term Abx may be required (4-12 mo)
Special timing of admin may be required (bedtime)
Acidification of urine (OJ or cranberry juice)
Notify HCP if fever occurs or s+s persist
Consult PCP for follow up

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24
Q

Tx for UTI

A

Uncomplicated 1-3 day resolution
Suppressive/prophylactic tx
Culture first if Sx persist

25
Q

Floroquinolones

A

ciprofloxacin (Cipro)
levofloxacin (Levaquin)

Tx of choice for uncomplicated (3 days)
SE: Tendonitis/rupture, Rash, GI discomfort, *C-diff diarrhea, seizures
Take 1 hr before or 2 hr after meals

26
Q

Sulfonamides for UTI

A

nitrofurantoin (Macrodantin)

Ineffective with pts GFR < 50
Can cause periph. neuropathy

27
Q

Penicillins

A

Amoxicillin (Amoxil, Augmentin)

PCN Allergies
Highly resistant

28
Q

Urinary Analgesics

A

phenazopyridine (Pyridium)

Turns urine dark orange, might be confused with blood.

29
Q

Acute Pyelonephritis

A

Lower UTI S+S: Fever, chills, leukocytosis, lower back pain , flank pain, NV, HA, malaise, CVA tenderness

Englarged kidneys, abcesses on renal capsule.

Complication - could relapse and become asymptomatic and chronic

30
Q

Chronic Pyelonephritis

A

Asymptomatic unless acute exacerbation
S+S: HA, fatigue, poor appetite, polyuria, excessive thirst, wt loss
Complication: ESRD (kidneys scar and contract and nonfunctional)

31
Q

Dx Complicated UTI

A

IV urogram and degree of renal dysfunction via measurements of BUN, creatnine, creatnine clearance. CT scan for obstruction. Urine C+S.

Voiding cystouretherography

32
Q

Tx for Pyelo

A

Outpatient if no dehydration, n/v, or sepsis sx. 2 week abx .

Parenteral admin in hosp. to rapidly est. drug levels

trimethoprim-sulfamethoxazole (Bactrim,
TMP/SMX)

Cipro
gentamicin
3rd gen cephalosporin.
**Use with caution of pt has renal or liver dysfunction.

NSAID and Tylenol for fever and discomfort

Fluids 3-4 L /day

33
Q

BPH Sx

A

Obstructive sx, similar to UTI
Frequency, nocturia, urgency, hesitancy, straining, decrease in volume and force of stream, dribbling, sensation of incomplete emptying, acute retention, recurrent UTI.

34
Q

Dx Studies for BPH

A 
H+P w/ digital rectal exam
UA
Labs: PSA + Creatinine
Transrectal Ultrasound TRUS
Uroflowmetry
Post Void Residual PVR
Cystourethroscopy
35
Q

Risk factors for BPH

A

AA younger, smoking, ETOH, HTN, heart disease, DM, diet.

36
Q

BPH Pharma

A

5-alpha reductase inhibitors
finasteride (Proscar), dutasteride
Interfere with conversion of testosterone to DHT to decrease size
SE: decreased libido and ejaculate volume, ED

Alpha Blockers
amsulosin (Flomax)
doxazosin (Cardura)
terazosin (Hytrin)
prazosin (Minipress)
Relax smooth muscle, does not decrease hyperplasia, sx relief
SE: Ortho hypo, dizzy, retrograde ejaculation, nasal congestion

Herbal:
Saw palmetto
Sx relief, reverses hyperplasia
SE: GI, bleeding risk (stop before dental/surgical)
Better tolerated and cheaper, may be as effective

37
Q

BPH Minimally Invasive Therapy

A 
Coude (curved) catheter for uroretention
Transurethral microwave thermotherapy  TUMT
Transurethral needle Ablation TUNA
Laser prostatectomy
Intraprostate urethral stents
38
Q

Invasive therapy BPH

A

Transurethral Resection of Prostate TURP
Transurethral incision of prostate TUIP

Suprapubic/
Perineal/
Retropubic/
Robotic/
Laparoscopic prostatectomy
39
Q

Prostatectomy Preop care

A

: Reduce anxiety, relieve discomfort (bedrest, analgesics). Watch void pattenrs, bladder distention, assist w/ catheterization.

40
Q

Prostatectomy Postop care

A

Maintenance of fluid volume balance,- irrigation causes excess fluid retention. Observe for JVD, S3 gallop, crackles. Monitor UO record. Electrolyte imbalances (Na), increased BP, confusion, resp. distress. Hemorrhage monitor for tachy, hematuria, restlessness, pallor, dec. hct and hgb. UO should be 0.5ml/kg/hr

pain relief - determine cause (incisional or bladder spasm - severe cramping suprabpubic). Feeling of pressure and fullness in bladder. Secure drainage to leg to decrease tension. Dont sit for prolonged time, will increase intrabdominal pressure (bleeding and discomfort)

41
Q

Prostatectomy Postop complications

A

Hemorrhage: clots can obstruct flow. Bright red blood is aterial (surgical intervention), dark red is venous (can be stopped by PCP inflation). HOB slightly elevated to avoid incr. pressure. Monitor VS, admin meds, fluids, and blood. Accurate IO, monitor drainage system patency.

Infection - avoid rectal thermos and tubes. sitz baths. Monitor for sx of infection.

DVT - LMWH, assess for DVT, stockings.

Cath obstruction - admin diuretic to keep patent. observe for abd distention which could indicate blockage. Suprapubic dullness. Monitor urine color, VS, restlessness, pallor, diaphoresis. Fluid in drainage bag must = fluid infused.

Sexual dysfunction
Self care . Perform Kegel exercises, as they may help with regaining urinary control:
Tense the perineal muscles by pressing the buttocks together; hold this position; relax. This exercise can be performed 10 to 20 times each hour while sitting or standing.
Try to interrupt the urinary stream after starting to void; wait a few seconds and then continue to void.
While the prostatic fossa heals (6 to 8 weeks), avoid activities that produce Valsalva effects (straining, heavy lifting), as this may increase venous pressure and produce hematuria.
Avoid long motor trips and strenuous exercise, which increase the tendency to bleed.
Note that spicy foods, alcohol, and coffee may cause bladder discomfort.
Maintain fluid intake to avoid dehydration, which increases the tendency for a blood clot to form and obstruct the flow of urine.
Report signs of complications, such as bleeding, passage of blood clots, a decrease in the urinary stream, urinary retention, or symptoms of UTI, to the urologist.

42
Q

Nephro/urolithiasis

A

Stones in kidney/urinary tract

FOrmed with high concentrations of calcium oxalate, calcium phosphate, and uric acid.

S+S depend on location, obstruction, infection. Similar regardless of cause

43
Q

Calcium calculi

A 
Majority of stones
Hypercalcemia
Hyperparathyroidism
Renal tubular acidosis
Tumors that increase Vit D prod
Dehydration
44
Q

Uric acid stones

A

Gout
Alteration in purine metabolism
Increaed uric acid prod

45
Q

Struvite

A

Recurrent UTIs
Neurogenic bladder
Foreign bodies
Increased urine alkalinity

46
Q

Cysteine stones

A

Rare inherited defect in renal absorption of cysteine

47
Q

Renal pelvis stone pain

A

Intense deep aching in CVA
Hematuria and pyuria
Radiating downward

48
Q

Ureter obstruction from stone

A

Ureteral colic - acute excruciating colicky wavelike pain radiating down to thigh

49
Q

Bladder stone pain

A

Bladder irritation and uti

Hematuria

50
Q

Renal colic

A

Sudden acute pain
CVA tenderness
NV diarrhea and discomfort
Pallor and cold clammy skin

51
Q

Stones Dx

A 
H+P: Diet, meds, and history
KUB Xrays
Ultrasound
IV Urography
Retrograde pyelography
VCUG
24h urine test for Ca, uric acid, urine creatnine, Na, pH, total volume
Stone chemical analysis
Blood: WBC  BUN creatnine
52
Q

Stones nursing mgmt

A 
Pain mgmt - opiods and NSAIDs
Hydration to increase prssure to drive stone down , mainstay of therapy, >2L UO recommended. 
Dietary changes per type of stone. 
Conrol infection
Strain urine for stones
I/O, VS
Cessation of stone generating meds. 
Limit Na to 3-4g/day
Possible uric acid meds
53
Q

Stones surgeries

A

Ureteroscopy
Extracorporeal shock wave lithotripsy (ESWL) SE: possible obstruction from fragments
Percutaneous stone removal
Nephrolithotomy, cystotomy SE: hemorrhage

54
Q

Stones Pt teaching

A

Avoid stone causing meds: Antacids, Vit D, Laxatives, high dose aspirin

Limit Na intake
Avoid oxalate foods: spinach, rhubarb, tea, panuts, wheat bran

Drink 2 glasses H20 at night to prevent urine concentration

Avoid dehydration

Notify HCP of S+S of infection

55
Q

Acute glomerulonephritis

A

Inflammatory disease of glomeruli

Antigen-antibody response to infection: Group A Beta-hemolytic strep, impetigo,shingles, EBV, hep, HIV
Result is inflamation of glomerular capillaries and GFR

Mild to severe
Azotemia and uremia
Proteinuria
Hematuria
HTN
Periorbital and peripheral edema
Increased BUN and cretnine
Oliguria
Fluid Overload
Neurologic sx
Elderly - circulatory overload
56
Q

CHronic glomerulonephritis

A 
Glomerular destruction from repeated injury
HTN, DM, Hyperlipidemia, SLE
Major complications: Renal failure or ESRD
Hyperkalemic
Metabolic acidosis
Anemia
Hypoalbuminemia
Increased phosphorous level
Decreaed Vit D and Ca
Decreased GFR
Mental status changes
Impaired Nerve conduction
Cardiac enlargement and pulmonary edema
57
Q

Glomerulonephritis Mgmt

A

Assess for previous infections (sore throat, skin lesions)
Physiologic assessments: fluid and electrolyte , cardiac and neuro status
Strict IO and daily weight
Monitor VS
Diet restrict Protein Na and fluid
Meds as indicated: antiHTN, diuretics, biologics,
Teach importance of followup care.

58
Q

TUR Syndrome

A

absorption of irrigation fluid interoperatively, can lead to bradycardia, hyponatremia, confusion

NUR123 (6 decks)

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