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Module 4 (MedSurg 2) > Urology Diseases > Flashcards

Urology Diseases Flashcards

(109 cards)

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1
Q

UTI is most commonly caused by

A

E coli bc grows in feces
- POSSIBLE fungal or parasitic

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2
Q

UTI

A

Bacteria enters the sterile bladder causing inflammation
Cystitis vs pyelonephritis vs urosepsis

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3
Q

Cystitis

A

inflammation of bladder

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4
Q

Pyelonephritis

A

inflamed kidneys parenchyma and collecting system

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5
Q

Urosepsis

A

sepsis caused by UTI
-emergent
- painful urination to abdominal pain and fever

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6
Q

What is the most common hospital-acquired infection and preventable?

A

CAUTI
most underrecognized and undertreated

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7
Q

Who gets a UTI more in gender?

A

females

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8
Q

Lower UTI included

A

Urethritis
Cystitis

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9
Q

Upper UTI included

A

Pyelonephritis

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10
Q

UTI Risk Factors

A

Immunosuppressed/Immunocompromised (steroids)
Diabetes (sugar)
History of kidney problems
Have undergone multiple antibiotic courses (good and bad)
Have traveled to developing countries
Catheterization
Cystoscopic examination (anything foreign inside)
Occupation/Habitual delay (nurses/day workers)
STI
multiple sex partners
poor hygiene
bubble baths
sprays
pregnancy
cystoscopy

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11
Q

Are there usually manifestations in Lower UTI?

A

no

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12
Q

If toxins are occluding the urethra, the kidneys do what to the BP and erthythopoetin?

A

BP high
Fever
Erythro low along with RBCs
K high

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13
Q

S/S of Urethritis

A

Pain/burning/difficult urination (Dysuria)
Frequency
Urgency
Males: clear mucous-like discharge (STI)
Females: lower abdominal discomfort
Nocturia

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14
Q

Frequency is

A

voiding more than 2 hours
more than 8 times in 24 hours

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15
Q

S/S of Cystitis

A

Urethritis symptoms) PLUS +
Bladder irritability
Hesitancy
Suprapubic pain
Incontinence (elderly)
nocturnal enuresis (while sleeping)

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16
Q

Hesitancy

A

difficulty starting a urine stream; delay between initiation of urination and beginning of flow of urine

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17
Q

Dx Studies for Lower UTIs

A

H&P (kidney problems, risk factors)
UA (things not filtered)
+ Nitrites
+ White Blood Cells (WBCs)
+ Leukocyte esterase
Urine culture and sensitivity (recurrent)
Determine bacteria’s susceptibility to antibiotic drugs
Imaging Studies (if indicated)

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18
Q

What shows up as positive in a UA for lower UTIs?

A

+ Nitrites (bacteria)
+ White Blood Cells (WBCs)
+ Leukocyte esterase
- not filtered

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19
Q

Uncomplicated UTIs

A

short term 3 days antibiotic

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20
Q

Urine Culture needs to be taken

A

mid-stream in a clean catch washing the penis with alcohol in between
finish in the cup

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21
Q

Medications/Preventions for UTIs

A

antibiotic
NSAIDs and pain analgesics
Cranberry juice with low sugar
Increase fluids
Vitamin C
help with bladder spasms (Pyridium)

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22
Q

Complicated UTIs

A

longer tx 7-14 days

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23
Q

UA and culture need to be done before

A

antibiotics are given

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24
Q

Systemic effects usually take place in what UTI

A

pyelonephritis
BP temp

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25
Upper Tract includes
Renal parenchyma, pelvis, and ureters Typically causes fever, chills, flank pain **Pyelonephritis**: inflammation of renal parenchyma and collecting system
26
Parenchyma
outermost part of the kidney and renal medulla
27
Renal pelvis
center of kidneys
28
Pyelonephritis can lead to
kidney injury
29
The UTIs work
backward up the tubes from the lower to the upper
30
A preexisting factor can be present such as
vesicoureteral reflux: Obstruction from Benign Prostatic Hyperplasia Stricture Urinary stone CAUTI
31
Recurring acute episodes of Upper UTIs can lead to
scarred, poorly functioning kidney and chronic pyelonephritis
32
ACUTE pyelonephritis often starts in the
renal medulla and spreads through cortex pregnancy
33
S/S of Pyelonephritis
Fever/Chills Nausea/Vomiting Fatigue/Malaise **Flank pain**/Pain at costovertebral angle S/S Lower (pain when urine, urgency and frequency)
34
Pyelonephritis classic sign in elderly
confusion
35
Dx/ Assess of Pyelonephritis
H&P UA Urine culture and sensitivity **Imaging studies (US, CT scan, cystoscopy)** CBC Blood culture (if bacteriemia is suspected) Percussion for flank pain (CVA)
36
Pyelonephritis can lead to what quickly
urosepsis
37
Pyelonephritis Nursing Care
Antibiotics possible hospitalization fluid intake increase monitor urosepsis (VS) promote prevention techniques like good hygiene
38
Urosepsis has both
bacteriuria bacteremia
39
Frequent Causes of Urosepsis
**Escherichia coli** Proteus Klebsiella Enterobacteria
40
S/S of Urosepsis
Malaise/fatigue **Chills/fever** Nausea/vomiting Characteristic of cystitis Dysuria, urgency, frequency **Costovertebral tenderness on the affected side** *Elderly present with delirium* **VS changes (fever, HR increase, BP decrease)**
41
What color does Pyridium turn your urine?
reddish orange
42
Teach the pt on UTIs
Disease Process Prevention of UTI Medication use Pain management Follow-up appointments Rest Dietary Education and Fluid intake What urine should look like
43
To Prevent Cytstitis
high water front to back avoid douches, bubble baths or sprays urinate after intercourse
44
Prevention of CAUTI
Avoidance of unnecessary catheterization Early removal of indwelling catheters Follow aseptic technique for procedures Handwashing before and after patient contact Wear gloves for care of urinary catheters
45
Antibiotics for UTIs
Nitrofurantoin, ampicillin, amoxicillin, cephalosporins, Fluoroquinolones
46
Analgesic for UTIs
Phenazopyridine
47
Antifungals for UTIs
Amphotericin or fluconazole
48
Antibiotic Therapy is dependent on
urine culture
49
Pyridium is used for
bladder spasms and pain associated
50
Nitrofurantoin (Macrodantin)
**Treat and prevent UTIs** Given three or four times a day Long-acting preparation (Macrobid) is taken twice daily
51
Ampicillin, amoxicillin, cephalosporins
Treat **uncomplicated** (only bladder) UTI broad range and **low toxicity to kidneys** cheap
52
Fluoroquinolones
Treat **complicated** UTIs Example: ciprofloxacin (Cipro)
53
Complicated UTIs are associated with
fevers, stones, sepsis, obstruction, catheters, AKI, CKD, renal transplant, diabetes, neurologic diseases The structural or functional problem in the urinary tract exists
54
Ciprofloxacin caution with
severe renal impairment with food and glass of water
55
Complicated UTIs lead to
renal injury
56
Amphotericin or fluconazole
Flu = 1st line choice
57
Amphotericin not given with
ns due to imcompatibility
58
Glomerulonephritis Patho
Caused by strep (infection)/ Lupus (autoimmune) and inflammation of the glomeruli bilaterally
59
Acute Glomerulonephritis
come suddenly and may be reversible
60
Chronic Glomerulonephritis
slowly progressive and can lead to irreversible renal failure
61
Risk Factors of GN
**STREP** Kidney infections (HIV, HEP B AND C) Nephrotoxic drugs Immunocompromised system - SLE Systemic disease HTN
62
S/S of GN
General body edema (facial and neck 1st) Decreased urine output (Retain) Oliguria/hematuria/proteinuria Hypertension HIGH BUN/creatinine **History of group A strep*** (sore throat) - renal bx to confirm Evidence of immune-mediated response
63
Gn can ultimately lead to
heart failure HTN renal issues respiratory distress **fluid accumulation**
64
Assess daily wt by
same time, day, clothes, and scale I&O abdominal girth or edema size
65
Medications for GN
Antihypertensives Diuretics Corticosteroids - PREDNISONE effective immunosuppression for some nephrotic syndrome
66
Dietary for GN
LOW-Sodium/LOW to MODERATE-Protein/Fluid restriction * if urine loss is high then more protein is recommended*
67
Antibiotics should ONLY be given if
strep infection is present full course of antibiotics
68
Teaching of GN
Disease process Medication Follow-up appointment Avoid infections Rest **Severity**
69
Another way to remember GN S/S with mnemonic HAD STREP
Hypertension ASO titer (+) –this is a test for **STREP** Decreased GFR **Swelling in face/eyes Tea-colored urine Recent strep infection** Elevated BUN and Creatinine Proteinuria
70
Urolithiasis means
Kidney stones
71
Risk Factors of Kidney Stones
More common in men Average age at onset: 20–55 years White Family history of stone formation Previous history (personal) - infection, stasis, retention, immobility Summer months (DEHYDRATION)
72
Patho of Kidney Stones
Calcifications in the urinary system Commonly referred to as kidney stones Microscopic crystals in the urinary tract aggregate together causing a stone to occur
73
S/S of kidney stones
**PAIN sharp sudden and severe*** N/V Urinalysis + RBC (shards) blood in urine UTI like symptoms
74
High Uric Acid can cause
kidney stones
75
Dx of Kidney stones
Ultrasound CT IVP RENAL STONE ANALYSIS RETROGRADE PYELOGRAM CYSTOSCOPY pH
76
Medications of Kidney Stones
Narcotics and NSAIDS Antiemetic Alpha-adrenergic blockers help pass
77
Labd of kidney stones
high BUN and Creatinine UA CBC
78
Nurse MGMT of Kidney Stones
Vital signs – bp and p Fluid management I&O Teaching Strain urine to pass Symptoms of infection/obstruction Prevention
79
What happens when you can not pass a stone?
ultrasound waves break up and easier to pass -fluids - avoid uric acid
80
Uric Acid Foods to Avoid in Stone pt
mushrooms, shellfish, beets, oxylate, teas, chocolate preventions
81
Goal of Renal Calculi care
Maintain free flow of urine with minimal hematuria Report satisfactory pain relief Verbalize understanding of disease process and measures to prevent recurrence
82
What is the most common cause of Bladder CA
smoking
83
S/S of Bladder CA
***Painless hematuria*** Urine cytology Lab looking for tumor markers Cystoscopy (ABnormal cells) -if hematuria is present Imaging
84
Nursing Mgmt of Bladder CA
Vital signs Medication Chemo Immunotherapy Continuous bladder irrigation** (Murphy drip)** I&O
85
Murphy Drip is used for
Bladder CA 3 way irrigation and drainage
86
Superficial or low-grade bladder cancers tx
Consist of excision or removal through fulguration or laser ablation
87
Invasive bladder cancer
Radical cystectomy Combined with neoadjuvant or adjuvant chemotherapy (before and after)
88
Fulguration
procedure using heat to destroy abnormal cells
89
Renal CA most likely will affect
males 50-70
90
Renal CA PATHO
Usually found in the cortex or pelvis of the kidney
91
S/S of Renal CA
Initially asymptomatic **Classic triad** Flank mass, flank pain, and hematuria **Weight loss** Hypertension **Fever** Anemia **feel with palpation**
92
Renal CA classic triad
Flank mass, flank pain, and hematuria
93
Dx Renal CA
IVP? Depends on function Ultrasound CT/MRI Urine cytology
94
Tx of Renal CA
Biological immunotherapy or cytokinesis Radical nephrectomy
95
Nursing Mgmt Post-Op nephrectomy
Pain management IV hydration JP Drain Post-op Bleeding***** Incision Patency of tubes/catheters I&O
96
If a pt has low BP, they could have
internal bleeding
97
Incontience
Involuntary or uncontrolled loss of urine in any amount
98
Stress incontience
Sudden increase in intraabdominal pressure causes involuntary passage of urine = Can occur during coughing, laughing, sneezing, or physical activities, such as heavy lifting, exercising Leakage usually is in small amounts and may not be daily
99
Urge incontinence:
Often referred to as overactive bladder Occurs randomly when involuntary urination is preceded by urinary urgency
100
Overflow:
Occurs when pressure of urine in overfull bladder overcomes sphincter control = post-op or tumor
101
Functional:
Loss of urine resulting from cognitive, functional, or environmental factors- inability to get up (arthritis, dementia)
102
Tx goal of incontinence
prevent or stop urinary leakage*
103
Medications for Incontinence
Anticholinergic (reduce overactive) Alpha-adrenergic blockers (increase resistance) Tricyclic Antidepressants (sensory urgency low) Hormone Therapy (lower irritation and increase host against UTIs)
104
Lifestyle Modifications of Incontience
reduce caffeine intake, artificial sweeteners Good bowel regimen Weight reduction Smoking cessation Fluid modification Skin CARE SUPPORT Bladder Kegels and scheduled bathroom
105
Anticholinergic (OXYBUTIN)
Reduces overactive bladder contractions; improves storage capacity of bladder
106
Alpha (Doxazosin and Tamulosin)
Reduce urethral sphincter resistance to urinary outflow
107
Tricyclic antidepressant (Amitriptyline)
Reduce sensory urgency and burning pain
108
Renal Trauma
Penetrating injury -Stabbing -Gunshot wound -Objects piercing the abdominal wall Blunt force trauma -Compression of the abdominal wall and bladder -Injuries to the renal system can range from -contusion or hematoma to a shattered kidney
109
Renal Trauma occurs in males less than
30

Module 4 (MedSurg 2) (36 decks)

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