week 9- GU Flashcards
(98 cards)
1
Q
anuria
A
tech. no urine less than 100 ml
etio- renal failure
2
Q
burning on urination
A
urtheral irritation, UTI
3
Q
dysuria
A
painful or difficult peeing
4
Q
ENURESIS-
A
INVOL NOCTURAL PEEING
5
Q
NOCTURIA
A
GETTING UP TO PEE
6
Q
PNEUMATURIA
A
PASSAGE OF URINE CONTAINING GAS
7
Q
POLYURIA
A
A LOT OF PEE
etio- diabetes
8
Q
The primary functions of kidneys are
A
- To filter wastes from blood
- to maintain fluid and electrolyte and acidbase balance in the body
- Excrete metabolic waste products.
9
Q
Secondary functions are
A
- Reg BP
- Reg bone density
- reg erythropoiesis
10
Q
20 to 25% of total cardiac output flows to the kidneys
A
.
11
Q
how the nephron moves around
A
Blood goes through semipermeable glomerulus then out the bowmans capsule then out the tubules.
Cap permeability is increase in renal diseases, enabling proteins to pass in urine
Reabsorption is the passage of substance from the lumen of the tubules through the tubule cells and into the caps.
Tub secretion is the passage of a substance from the caps through the tubular into the lumen of the tubule
12
Q
General – UTI
A
Women more susceptible
Very common bacterial infection
Bladder and urine is free from bacteria normally
Escherichia coli (E Coli) is most common
13
Q
Upper –
A
renal parenchyma, renal pelvis, ureters; tends to have systemic symptoms
14
Q
Lower –
A
bladder, urethra; not systemic
15
Q
Predisposing factors (Table 47 – 2)
A
older adults tend to have abdominal discomfort rather than localized symptoms, and often have cognitive changes
16
Q
UTI COLLAB CARE Uncomplicated
A
- Antibiotic, 1-3 days
- Bactrim, Septra
- Marodantin, Macrobid
- Increase fluids
- Urinary analgesic (Pyridium)
- Health teaching
17
Q
UTI COLLAB CARE complicated
A
C & S Antibiotic, 3-5 days, as guided by culture Suppressive antibiotics Increase fluids Urinary analgesic (Pyridium) Health teaching Imaging?
18
Q
uti
Goals of care – the client will have:
A
Relief from symptoms
Prevention of upper tract infection
Prevention of recurrence
19
Q
UTI Nursing Activities
A
Recognize those at risk
Avoid unnecessary catheterization
Early removal of catheters
Routine perineal care essential
Offering to assist clients to WR, or bedpan routinely
Suggest application of heat to suprapubic area
20
Q
Health Promotion/Teaching
A
Emptying bladder regularly
Wiping front to back
Adequate fluid intake
Consider pure cranberry juice as preventative
Take medications as ordered, complete course
Reporting symptoms ASAP
Urinate after intercourse
D/C use of diaphragm during infection
Avoid harsh soaps, bubble baths, powders etc
21
Q
Acute Pyelonephritis (AP)
A
- Inflammation of renal parenchyma and collecting system
- Usually bacterial infection
- Starts with a lower UTI, that moves upward
- Often due to obstruction, or backward movement of urine
22
Q
Note – can lead to urosepsis (systemic infection starting in urinary system) which can be very serious
A
FROM PYELNOEPHRITIS
23
Q
AP Acute symptoms
A
Chills, fever Vomiting Fatigue, malaise Flank pain UTI symptoms Costovertebral tenderness on affected side Bacteriuria, pyuria
24
Q
AP – Collaborative Care
A
Outpatient (mild) or hospitalized (severe) PO or IV antibiotics Increase rluid intake NSAIDS, antipyretics Urinary analgesics F/U C & S
25
AP Goals of Care – The client will have:
```
Relief from pain
Normal body temp
No complications
Normal renal function
No recurrence
```
26
Chronic Pyelonephritis
Kidney(s) that are shrunken and lost function due to scarring, fibrosis
Often an outcome of recurrent AP
27
Interstitial Cystitis
Chronic, painful
Inflammatory
Associated with autoimmune or allergic response
After age 40, more in women
Contributing factors – chronic inflammation of bladder wall, defective layer of mucosa
28
Assessment:
| Interstitial Cystitis
Pain – usually suprapubic, might be vaginal, labia, perineal
Moderate to severe
Worsens with bladder filling, emotions, physical activity
Bothersome LUTS – frequency, urgency
Often misdiagnosed as recurring UTI
Diagnosed as an ‘exclusion’
Not bacterial so s/s of UTI but no bacteria
May need cystoscopy – would show ulcerations, small bladder capacity
29
IC – Collaborative Care
* Note that etiology is unknown, so treatment may be variable
* Dietary – elimination of some foods known to irritate (should be low acid, low ETOH, less tea/coffee, avoid cheese/nuts, food with vinegars, curries)
* Prelief – OTC supplemt calcium glycerophosphate alkalinizes urine
* Tricyclic antidepressants reduce burning pain and frequency (amitriptyline and doxepin)
* Pentosan – drug that enhances protective layer of bladder
* Bladder instilling of agents to desensitize pain receptors
30
IC – Nursing Role
* Focus the assessment of pain on diet and lifestyle specifics
* Try voiding diary – with patterns of pain
* Reassure – some feel the burden of chronic pain
* Avoid clothing that may be snug on suprapubic area
* UTI may occur along with IC – teach to report sudden change in symptoms
* Multi vits – avoid high potency vitamins as they may exacerbate symptoms
* Supports – Sunnybrook Women’s Health Network
31
Glomerulonephritis
Immune related inflammation of the glomeruli
Proteinuria, hematuria, decreased urine production and edema
Classified according to:
- Extent of damage (diffuse, local)
- Initial cause (strep infection, SLE etc)
- Extent of changes (minimal or widespread)
32
Manifestations
| Glomerulonephritis
Varying degrees of hematuria
Urinary excretion of formed elements (RBCs, WBCs, casts)
Proteinuria, increased BUN and CR
If not treated – renal tissue destruction, marked renal insufficiency
33
Assessment –
| Glomerulonephritis
inquire about exposure to drugs, infections, immunizations; observe for other immune disorders that may have precipitated
34
Acute Post Streptococcal:Glomerulonephritis
* Occurs 5 – 21 days after an infection of the airway or skin
* Antibodies produced that create an inflammatory reaction in the glomeruli
* Generalized body edema, hypertension, oliguria, hematuria with smoky/rusty appearance, proteinuria; abdominal/flank pain
* May be asymptomatic
* Treated for symptoms – diuretics, antihypertensives, antibiotics if needed
35
Obstructive uropathies
Any anatomical or functional condition that blocks or impedes the flow of urine
Congenital, acquired
Includes – tumours, anomalies, benign growths, adhesions, prolapsed adjacent organs; narrowing of the ureteropelvic junction, bladder neck contracture, BPH, urethral stricture, urethral meatal stenosis, neurogenic bladder due to SCI
36
Urinary tract Calculi
* AKA kidney stones
* More common in men
* Often between ages 20 and 55
* Risk is higher if family history
* Recurrence is common
* More common in summer (? dehydration as a factor)
* Calcium stones most common
37
Manifestations occur when urinary flow is obstructed
| CALCULI
* Severe abdominal or flank pain; +/- nausea/vomiting
* Pain varies depending on where blockage is
* Hematuria
* Renal colic
* Urinalysis, urine C & S, IVP, retrograde pyelogram, US, cystoscopy
* BUN, Cr
* Ask about previous stone formation, fam hx, medications, dietary supplements
38
Collaborative Care
| CALCULI
Manage the acute attack
-Reduce pain, treat infection or obstruction
Some stones will pass on their own (< 4mm)(ouch)
Evaluate the cause
-Geographic residence, nutrition assessment, activity pattern, fluid intake/dehydration, history of disease/surgery of GI/GU tract
Endourological
-Stones in bladder can be removed through cystoscopy; if large, are broken up by a lithotrite
Scope inserted into urethra, bladder
Lithotripsy
-Sound waves to break up renal stones into small pieces
Via small incision in flank
Surgical removal
39
Urinary Tract Calculi
| PLANNING
The client will have:
Relief of pain
No urinary tract obstruction
An understanding of measures to prevent recurrence
40
Nursing Implementation
| CALCULI
* Ensure adequate fluid intake (as appropriate to client; should have 2 L/urine/day)
* Assist bed rest patients to sit/stand to maximize urine flow
* Encourage ambulation
* Dietary restrictions – (see Table 47 -13)
* Pain management –
* Provide a ‘hat’ or strainer so patients can retrieve passed stones
* Explain procedures
* Teach about symptoms of recurrence and early reporting
* Teach about s/s of UTI
41
Urinary Strictures
An abnormal narrowing of the lumen of a hollow organ
Permanent or temporary
Ureter or Urethra
42
Ureteral
Partial or entire length
Often d/t adhesions
Can cause kidney dysfunction
Mild to moderate colic
Increased pain if large volume fluids consumed
Stents may be placed to widen the path
Diverting urinary flow via a nephrostomy tube inkidney
Can be dilated with a balloon
43
Urethral
Fibrosis or inflammation of urethral lumen
From trauma, urethritis, or congenital defect
Ability of the urethra to open/close is compromised
Decreased urinary stream, spraying, split stream
Incomplete emptying feeling
Urinary frequency, nocturia
Dilation of urethra, progressively larger stents
Patient may need to self dilate and self catheterize
44
Urinary incontinence
uncontrolled loss of urine that is a problem
Not a natural consequence of aging
Affects QOL and socialization
45
Anything that interferes with bladder or urethral sphincter control can cause UI
Can be transient (from drugs, confusion, infection)
| Can be acquired (stress, urge, overflow, reflex, after trauma, functional)
46
Urinary Retention
the inability to empty the bladder despite voiding or the accumulation of urine in bladder with an inability to void
47
ACUTE AND CHRONIC RETENTION
Acute: total inability to empty bladder EMERGENCY
Chronic: post void residual 150ml or greater
Leads to UTI
48
Assessment
Focused history
Bladder log
Onset of UI, factors that provoke urinary leakage, associated conditions
Urinalysis
Determine residuals – post void catheter, or bladder scan
49
UI
| COLLAB CARE
```
80% curable/treatable (Table 47 – 18)
Reverse transient factors
Pelvic muscle training (Kegel’s)
Voiding regimes
Drugs – Detrol LA – relaxes bladder muscles and inhibits overactive contractions
Sx – urethral and bladder suspension
```
50
UR
| COLLAB CARE
Scheduled toileting
Self catheterization
Drugs – to relax smooth muscle
Sx -
51
Nursing management
| UI
* Respect the emotional side
* Dignity and privacy
* manage existing urinary leak
* plan of management
* Adequate fluids
* Reduce coffee/alcohol as they irritate bladder
* Regular toileting (q 2-3 hrs)
* Quit smoking
* Avoid constipation
* Use bladder incontinent pads, not feminine hygiene pads
* Voiding diary
* In hospital, offer toileting routinely
52
Nursing management
| UR
* Acute – catheterize as ordered
* Chronic:
* Avoid large intake of fluids at one time
* Warm up if chilled prior to toileting
* Avoid alcohol (polyuria, decreased sensation of fullness)
* Drink tea/coffee to create urgency
* Try a warm shower/bath and urinate then
* Self catheterization
* Scheduled toileting
* Double voiding
53
Kidney DIsease
Ranges from partial to complete impairment
Inability to excrete wastes, water, and impacts all body systems
Can be acute (sudden onset) or chronic (developing slowly)
If required, renal replacement therapy (dialysis) is required to simulate kidney function
54
AKI Also known/previously known as acute kidney failure
Abrupt decline in kidney function shown by:
A rise in creatinine
Decrease in u/o, or oliguria
Elevated BUN
Elevated K+
55
AKI
Prerenal – before the kidneys (decreased blood flow; decreased perfusion, medications)
Intrarenal – inside the kidneys (direct damage, ischemia, nephrotoxins)
Postrenal – after the kidneys (obstruction of flow, BPH, cancer/tumours)
56
AKI - Assessment
* Vital Signs
* Intake and Output
* Laboratory – Cr, K, BUN
* Urine characteristics
* General appearance of patient
* Mental status, LOC
* S/s dehydration, hypovolemia
* Lung auscultation –
* Consider potential causes
57
AKI -- Phases
Initiation
• Increased Cr and BUN, decrease in U/O
```
Maintenance
• Anuric, oliguric, or nonoliguric; longer oliguric = poorer outcome
• Fluid overload
• Metabolic acidosis
• Increased sodium excretion
• Potassium overload
• WBC’s altered/anemia
• Vit D deficit/Calcium deficit
• Waste accumulation
• Neuro changes
```
Recovery Phase
• Cr and Bun return to normal
• Acute diuresis
58
AKI Goals
Complete recovery without any loss of kidney function
Maintain normal fluid and electrolyte function
Have decreased anxiety
Understand and adhere to treatment plan
59
AKI – Collaborative Care
Focus on eliminating the cause
Manage the s/s
Prevent complications
Close monitoring of Cr
May require renal ultrasound, CT scan
Diuretics (loop or osmotic) –
Closely monitor fluid intake/output
Observe for elevated K+ (can be life threatening)
60
Indications for dialysis –
```
Volume overload with compromise
Elevated K+
Metabolic acidosis
BUN elevated significantly
Change in mental status
Pericarditis
```
61
AKI - Implementation
• Usually quite ill, co-morbidities affecting renal function
• Manage fluid and electrolyte balance
o Accurate intake/output, include vomiting, diarrhea etc
• Daily weights
• Monitor s/s of hypovolemia and hypervolemia
• Restrict Na to prevent overload
• Reduce foods high in K+
• Prevent infection – main cause of death
• Good skin and mouth care
62
AKI- Health Promotion
Preventing further AKI – high mortality
Those at higher risk include older age, massive trauma, major surgical procedures, extensive burns, cardiac failure, sepsis, obstetrical complications, and baseline renal insufficiency (diabetes, heart disease)
Be careful in patients having IV contrast – can be nephrotoxic
Teach about drugs that may contribute (to those at high risk) – NSAIDS, ACE – I
Healing – may take months to recover; good nutrition, rest, and balance of activity essential
63
Older adult more susceptible than younger adult
of functioning nephrons decreases with age
Impaired functioning of other organs
Less able to compensate for changes in fluid volume
64
Chronic Kidney disease (CKD)
```
Progressive, irreversible loss of kidney function
5 Stages
5th stage (end stage renal disease) requires dialysis
```
Early identification supports early intervention to delay progression
Often the patient does not realize he/she has CKD until testing for another condition is done
65
CKD - Assessment
```
Hx of renal disease?
Chronic conditions
Dietary habits
Fatigue? Lethargy? Pruritus?
Hypertension?
Changes in urine characteristics
Weight changes
Fluid excess s/s
Coping strategies
```
66
CKD – Planning/Goals
The patient will
Demonstrate knowledge and ability to follow treatment plan
Participate in decision making for plan of care (think back to PNH201 – self management of chronic disease)
Demonstrate effective coping strategies
Continue with ADL’s as able
67
CKD – Collaborative care
Treat potential causes (heart disease, infection etc)
| Aim to preserve existing function
68
Drug therapy
| CKD
```
Manage hyperkalemia
Polystyrene sulphonate (kayexalate)
```
Manage hypertension
Can delay progression (max SBP 140)
Should monitor BP at home
CKD and Bones
Requires binding of phosphate (TUMS, Caltrate)
Supplement with Vitamin D and calcium
Anemia
Decreased production of erythropoietin
Use of erythropoiesis stimulating agents
Careful – may increase BP
Dyslipidemia
Use of statins
```
Complications of drug therapy
Many drugs absorbed, distributed, and metablized, elminated by kidneys
May have delays in excretion
Watch for accumulation
Avoid NSAID’s
```
69
Nutritional Therapy
| CKD
Protein restriction
Moderate restriction as BUN is an end product of protein metab.
Sufficient calories needed from carbs and fats
Use a multivitamin to replace deficiencies caused by diet
Sodium and fluid restriction
Fluids may not be restricted, but sodium intake should be
Monitor in and out
Potassium restriction
Depends on ability to excrete K+
70
Health Promotion
| CKD
o Those at risk – diabetics, family hx, hypertension
Optimal management of risks
o Encourage regular renal checks – BUN, CR, urinalysis
o Observe for any change in urine appearance, frequency, or volume
o If prescribed a nephrotoxic drug, recommend kidneys checked during/after
o Smoking cessation
71
CKD - implementation
Ensure patient/family understand CKD
Ongoing and close monitoring is essential
Time to dialysis is patient dependant – begin discussions early to allow time to make an informed decision
72
Dialysis
Urea, creatinine, uric acid and electrolytes move from the blood to the dialysate with the overall effect of lowering their concentration in the blood
RBC’s, WBC’s, and proteins are too big and don’t diffuse
EXCESS FLUID IS REMOVED TOO
73
PD
Fluid removal depends on osmotic forces – glucose is the agent of choice
Inflow, dwell, and drain = 1 exchange
Inflow – about 2 L infused quickly
Dwell – depends, could be up to 8 hours
Drain – over 15 – 30 minutes
74
Complications (short list):
Catheter infection – observe for s/s
Peritonitis – infection progresses internally; effluent (drain) is cloudy, positive for bacteria
Abdominal pain –
Outflow problems – kinks, body position
Pulmonary problems – from large volume pushing on diaphragm – encourage DB and C
75
Prostatitis
Inflammation of prostate gland
| Usually results from organism getting to the prostate gland
76
s/s (similar to UTI)
| Prostatitis
Fever, chills
Back pain
Perineal pain
Acute urinary symptoms – dysuria, frequency, urgency, cloudy urine
May have acute urinary retention from swelling
Sexual functioning – may have post ejaculation pain, low libido, ED
Digital rectal exam (DRE) shows enlarged prostate, firm
77
Prostatitis CARE COLLAB
Urinalysis – WBCs and bacteria present
C&S
Antibiotics usually required (Cipro) for ~ 4 weeks
If high fever, admit to hospital with IV to prevent sepsis
Anti inflammatories
Watch for urinary retention if acute prostatitis
78
BPH
Enlargement of the prostate gland from an increase in number of epithelial cells and stromal tissue
Common – 50% of men over age 50
Does not lead to prostate cancer
79
BPH
| S/S
Urinary obstruction- Decrease in calibre and force of stream, difficulty initiating stream, intermittency, dribbling
Irritative- Frequency, urgency, dysuria, bladder pain, nocturia, incontinence
Gradual onset
80
Complications
| BPH
```
Urinary retention
UTI
Bladder calculi
Pyelonephritis
Renal failure (not common)
```
81
BPH
| Diagnostics
History and physical
DRE – enlarged symmetrically, firm, smooth
Urinalysis, C&S, PSA (r/o cancer), Cr
Transrectal U/S
82
Goals BPH
Restore bladder drainage
Relieve the symptoms
Prevent/treat complications
May ‘watch and see’ – symptoms come and go and may not worsen
83
Drugs
| BPH
Proscar – reduces size of prostate gland
Alpha adrenergic receptor blockers – used typically for high BP, these drugs relax smooth muscle (prostate)
Herbal – Saw Palmetto
84
BPH
| SX
TURP – trans urethral resection of the prostate
85
Planning/Goals
Restore urinary drainage
Treat any UTI
Ensure understanding of treatments
```
Post op:
No complications
Restore urinary control
Complete bladder emptying
Satisfactory sexual expression
```
86
BPH IMPLEMENTATION
Limit caffeine and alcohol – tends to increase symptoms (diuretic effect)
Cough and cold remedies often increase s/s (alpha adrenergic agonists cause contraction)
Urinate Q2-3hours
Do not restrict daily fluid intake
87
BPH POST OP
Blood clots expected in first 24 -36 hours
Large amounts bright red blood not normal
Bladder spasms – B&O supps, check for clots
Catheter out in 4-6 days, void within 6 hours
Sphincter tone may be diminshed post op – instruct re Kegels, practice starting/stopping stream
88
Endometriosis
Presence of endometrial epithelial and/or stromal cells in sites outside the uterine cavity
Typically females late 20’s, early 30’s, white, never had a full term pregnancy
Can be considerably painful
Can increase risk of ovarian cancer
89
ENDO -Etiology –
not sure; thought is retrograde menstrual flow passes through fallopian tubes into the pelvis carrying endometiral tissues which then attaches to other sites
90
ENDO S/S
Wide range of manifestations and severity
Dysmenorrhea after years of painfree periods
Infertility is a clue
Symptoms may/may not coincide to menstrual cycle
Creates a menstrual cycle in tissue outside of uterus causing intense pain
Dysmenorrhea
Infertility
Pelvic pain
Dyspareunia
Irregular bleeding
Possibly backache, painful BM’s, dysuria
91
Endo – Collaborative care
Hx
Laparascopy often needed to diagnose
DrugS:
To reduce symptoms: NSAID’s
Drugs to inhibit estrogen production, to shrink tissue
Create pseudomenopause with drugs
Surgical
To remove endometrial implants, lysing of adhesions
92
Endo – Nursing Considerations
Consider if wants to have pregnancies or not
Discuss non pharmacological means of comfort during less painful episodes
Full discussion on mechanism of medications
Support – may require time off work
93
PID
Infection of the pelvic cavity that may include the cervix, fallopian tubes, pelvic peritoneum
Often results form untreated infections (chlamydia and gonorrhea), can be silent
Can cause permanent damage
Major cause of female infertility
94
PID RISK
Less then 24 years, multiple sex partners, or new sex partner
95
PID MANIS
Lower abdominal pain – slowly increasing
Spotting after intercourse
Purulent cervical or vaginal discharge
Fever/chills
Some have no or minor symptoms and do not seek a MD
96
PID COMPLICATIONS
Can cause adhesions, strictures, ectopic pregnancies
| Infertility
97
PID DX
Patients story
s/s
Positive cultures for gonorrhea, chlamydia
On exam – low pelvic tenderness, tenderness of uterine organs, cervical motion tenderness
Urinary frequency, urgency
Abnormal vaginal bleeding, menstrual irregularity
Increased WBC
98
PID CARE
```
Outpatient treatment
Antibiotics
No intercourse x 3 weeks
Partner should be examined and treated
Rest, fluids
Corticosteroids to reduce inflammation
Hospitalization/surgery if abscess develops
```
