UNIT 9 Urinary Incontinence, Cystitis, Urethritis, Urolithiasis/ Kidney Stones CHAPTER 61 Flashcards

Question

What is the drug class of choice to treat inflammatory disorders

Answer 1

glucocortorsteriods or steroid they reduce inflammation

Answer 2

A. c- reactive protein over 6mg sign of inflammation

Answer 3

frequency, urgency , dysuria , foul urine, fever, chills, nausea and vomiting, hematuria, elevated WBC, confusion- elderly

Answer 4

Dx- clean catch, sterile, pelvic ultrasound or CT

Answer 5

Tx- antibiotics if bacterial, fluids, hygiene, cranberry juice

Answer 6

Although infectious cystitis is common, in many cases it is preventable. When catheters must be used in institutional seings, strict aention to sterile technique during insertion is essential to reduce the risk for UTIs (see the Best Practice for Patient Safety & Quality Care: Minimizing Catheter-Associated Urinary Tract Infection box). Long-term placement of urinary catheters requires aseptic technique for insertion. When intermient catheterization was used in home care seings, the use of clean technique resulted in a similar rate of UTI compared with sterile technique. Clean technique, using single-use catheters, for catheter insertion is recommended in home seings where multiple resistant organisms are less likely to be present. Multiuse catheters for home use are no longer recommended. Sterile technique must be used in health care facilities to reduce the risk for infection (Beauchemin et al., 2018).

Answer 7

* Drink fluid liberally, as much as 2 to 3 L daily if not contraindicated by health conditions. * Be sure to get enough sleep, rest, and nutrition daily to maintain immunologic health. * If spermicides are used, consider changing to another method of contraception. * [For women] Clean your perineum (the area between your legs) from front to back. * [For women] Avoid using or wearing irritating substances such as douches, scented lubricants for intercourse, bubble bath, tight-fiing underwear, and scented toilet tissue. Wear loose-fiing coon underwear. * [For women] Empty your bladder before and after intercourse. * [For both women and men] Gently wash the perineal area before intercourse. * Do not routinely delay urination because the flow of urine can help remove bacteria that may be colonizing the urethra or bladder. * If you experience burning when you urinate, if you have to urinate frequently, or if you find it difficult to begin urinating, notify your primary health care provider right away, especially if you have a chronic medical condition (e.g., diabetes) or are pregnant.

Answer 8

Fluconazole is the drug of choice for treatment of Candida (fungal) infections. Guidelines for uncomplicated cystitis recommend nitrofurantoin, trimethoprim/sulfamethoxazole, or fosfomycin as first-line therapy for those patients at low risk of resistance to antimicrobials (Hooten & Gupta, 2018). Longer antibiotic treatment (7 to 21 days) and sometimes different agents are required for hospitalized patients and those with complicated UTIs (e.g., men, pregnant women, and patients with anatomic, functional or metabolic derangements that affect the urinary tract).

Answer 9

Sulfamethoxazole/trimethoprim should be stopped at the first appearance of a skin rash. A rash may indicate the onset of Stevens-Johnson syndrome (aching joints and muscles; bilateral blistering skin) or toxic epidermal necrolysis (redness, blistering, and peeling skin and mucous membranes). Antibiotics are one of the drug categories most frequently involved in the error of administration to patients who have documented allergies to these drugs.

Answer 10

Urethritis is an inflammation of the urethra and can result from infectious and noninfectious conditions. The incidence is highest among adults ages 20 to 24 years. The most common cause of infectious urethritis is sexually transmied infections (STIs).

Answer 11

C. STI Highest incidence is adults in early 20’s – Most common cause is STI – Test for STIs and pregnancy These include gonorrhea or nonspecific urethritis caused by Ureaplasma (a gram-negative bacterium), Chlamydia (a sexually transmied gram-negative bacterium), or Trichomonas vaginalis (a protozoan found in both the male and female genital tract). Urethritis is also known as pyuria-dysuria syndrome, frequency-dysuria syndrome, trigonitis syndrome, and urethral syndrome.

Answer 12

-Use cotton underwear, no nylon – Clean the perineum from front to back – Urinate before and after intercourse – Void every 4 hours and as needed – Advise to take medications – Drink plenty of water Urinalysis may show pyuria (white blood cells [WBCs] in the urine)

Answer 13

Symptoms of urethritis include discharge of mucopurulent or purulent material, dysuria, and itching or discomfort of the area (urethral pruritus). The discharge can be any color, depending on the infecting organism or source of irritation. Additional symptoms may include fever (with or without chills) and urgent or frequent urination.

Answer 14

All patients with urethritis should be tested for N. gonorrhoeae and C. trachoma with an endourethral (in men) or endocervical (women) smear. Testing for Chlamydia may be done with the same sample. STI testing for VDRL serology and HIV is suggested by the Centers for Disease Control and Prevention (Barrow et al., 2020; CDC, 2016 ). A pregnancy test is performed for women who have had unprotected intercourse. In women, a pelvic examination may reveal tissue changes from low estrogen levels in the vagina. Urethroscopy may show low estrogen changes with inflammation of urethral tissues.

Answer 15

B.Antibiotics improvement in urethral symptoms with the use of estrogen vaginal cream. Estrogen cream applied locally to the vagina increases the amount of estrogen in the urethra as well, reducing irritating symptoms. Urethritis from STIs is treated with antibiotic therapy.

Answer 16

Urolithiasis is the presence of calculi (stones) in the urinary tract. Stones often do not cause symptoms until they pass into the lower urinary tract, where they can cause excruciating pain. Stones in urinary tract * Common cause – dehydration, urinary stasis * Result is obstruction in urinary tract * Genetic * Infection * Diet – calcium and Vit D, high vit C intake * Immobility (breakdown of bones increases circulating Ca which leads to stones

Answer 17

-immobility diet high in vitamin calcium -dehydration -Diet may be considered a risk for stone formation. Increased sodium intake has been associated with stone formation -Patients who have a family history of stones, are obese, or have diabetes or gout (hyperuricemia) have increased risk for initial stone formation -Because a metabolic problem is so strongly associated with stone formation and is a nonmodifiable risk factor, an adult of any age who develops a stone is always at high risk for future stone development. -hyperparathyroidism -hyperuricemia

Answer 18

The major symptom of stones is severe pain, commonly called renal colic. Flank pain suggests that the stone is in the kidney or upper ureter. Flank pain that extends toward the abdomen or to the scrotum and testes or the vulva suggests that stones are in the ureters or bladder. Pain is most intense when the stone is moving or the ureter is obstructed. Renal colic begins suddenly and is often described as “unbearable.” Nausea, vomiting, pallor, and diaphoresis often accompany the pain. However, a large stationary stone in the kidney (staghorn calculus) rarely causes much pain because it is not moving. Frequency and dysuria occur when a stone reaches the bladder. Oliguria (scant urine output) or anuria (absence of urine output) suggests obstruction, possibly at the bladder neck or urethra. s/s- renal colic, bladder distention, hematuria, flank pain (CVA), Nausea, Vomiting, Pallor, s/s of infection Urinary tract obstruction is an emergency and must be treated immediately to preserve kidney function.

Answer 19

Nursing interventions focus on pain relief and preventing infection and urinary obstruction Other management techniques include avoiding overhydration and underhydration in the acute phase to help make the passage of a stone less painful. Strain the urine and teach the patient to strain it to monitor for stone passage. Send any stone passed to the laboratory for analysis because preventive therapy is based on stone composition.

Answer 20

Drug therapy is needed in the first 24 to 36 hours when pain is most severe. Opioid analgesics are used to control the severe pain caused by stones in the urinary tract and may be given IV for rapid pain relief. NSAIDs such as ketorolac or ketoprofen in the acute phase may be effective. When NSAIDs are used, there is an increased risk for kidney impairment from reduced perfusion. NSAIDs interfere with renal autoregulation, and the risk for impairment is greater among patients with pre-existing kidney dysfunction. Risk for bleeding is also increased from platelet inhibition when NSAIDs are used. Bleeding risk is particularly concerning when surgical intervention for stones is needed.

Answer 21

Dx – urinalysis, urine specific gravity, 24-hour urine, CT, KUB, IVP Tx –pain management – ketorolac (Toradol), -strain urine, -thiazide diuretic/allopurinol, -ambulation, I&O, - Increase fluid intake -Lithotripsy, stent Teaching – avoid the risk factors Increase fluids Increase ambulation

UNIT 9 Urinary Incontinence, Cystitis, Urethritis, Urolithiasis/ Kidney Stones CHAPTER 61 Flashcards

(45 cards)