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Urinary 1

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cdunbar4's version from 2016-10-30 02:41

UTI caues

Question Answer
#1 microorganism that causes UTI'se.coli d/t geography of anus
Other examples of microorganisms that cause UTI'senterobacter; pseduomonas; staph; candida; enterococcus
Women are more likely to get UTIs than men due to shorter urethra length and geography of anus. What else helps men?Prostate secretions have antibacterial effects
Host Factors (5)urinary stasis; foreign bodies; anatomical abnormalities; bladder compression; vesicoureteral reflux
Urinary stasis examplesBPH, urinary retention, renal impairment
Foreign bodies examplescalculi, indwelling catheters, ureteral stent, nephrostomy tube
Anatomical Abnormalities examplesfistula (ureter to skin or fecal stream); congenital defects; obesity; kinks; stenosis
Bladder compression (functional disorder) examplesusually caused by constipation; voiding dysfunction; tumors
Vesicourteral Refluxbackwards flow of urine into ureters
Upper Vs lowerUpper = anything above bladder; Lower = bladder, urethra
Complicated vs. noncomplicatedComplicated = damage to kidneys, can be systemic; Uncomplicated = usually lower tract infection, hasn't traveled up
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Dx & Mgmt

Question Answer
Dipstick urinalysis used to ID what in urine?WBCs and leukocyte esterase (enzyme in WBC which indicate pyuria)
Why is it hard to collect a sterile urine specimen?Contamination by perianal or perianal flora can cause a false +
Technique to getting a good urine specimen in women (what should they do in the bathroom?)"Clean-catch" Teach them to spread the labia and wipe the periurethral area from front to back with a moistened clean gauze pad (no antiseptic). Keep labia spread, pee for 1-2 seconds, then fill up cup.
Technique for men urine collection teaching?instruct the to wipe the glans penis around the urthera and collect urine 1-2 seconds after start of voiding
Additional diagnosis may be needed, what scan is used and why?Intravenous pyelogram (IVP) to ID anatomic abnormalities (obstruction) that contribute to UTI or kidney changes
Prognosis is good if UTI clears up and is not recurring, what can happen with repeated infections?renal scarring
What is hyrdopnephrosis?dilation /enlargement of renal pelvis and calyces
What causes hydronephrosis?There is an obstruction or kink and urine is backed up proximal to kink
Result of hyrdronephrosisdilating ureters can form a reservoir; can lead to destruction of renal parenchyma
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Matching

Question Answer
chordeeventral penis curvature
epispadiasdorsal meatal opening
hydrocelefluid in scrotum
hypospadiasurethral opening anywhere along ventral surface
inguinal herniaabdominal contents through inguinal canal
phimosisnarrowing (stenosis) of preputial opening
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LUTS

Question Answer
Symptoms of LUTs are experienced in patients who have UTIs of the ______ _______ ______, as well as....?upper urinary tract; and those confined to the lower tract
Symptoms of LUTs are r/t either bladder _________ or bladder _________.storage or emptying
Hesitancydifficulty/delay starting urine stream; diminished urine stream
Intermittencyinterruption of urinary stream while voiding
post void dribblingurine loss after completion of voiding
urinary retention or incomplete emptyinginability to empty urine from bladder; caused by atonic bladder or obstruction of urethra
dysuria (painful urination)difficulty voiding
Urinary frequency> 8Q24; often <200mL
Urgencysudden, strong or intense desire to void ASAP
Incontinenceinvoluntary/accidental urine loss or leakage
Nocturiaawakened by urge to void > or equal to 2x during sleep
nocturnal enuresis (adults)loss of urine during sleep
nocturnal enuresis (children)bedwetting
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General UTI Manis

Question Answer
In children, what could single a UTI?NEW urinary incontinence, or frequent
Low grade fever is classified at about what temps range?99.3-100.1
Upper UTI pain symtomabd flank pain/tenderness
pyuriapus in urine when voided
Characteristics of urineurine is dark, cloudy and odoirferous; hematuria
Collaborative main 3 effortsDiagnose the bug; diet; drugs
Nursing Intervention: fluids will help how?↑ frequency at first, but will help to dilute urine therefore ↓ irritation
Fluids to avoid?caffeinated beverages like coffee, tea and colas because they can irritate the bladder
Other nursing intereventionslocal heat pad on back or suprapubic area, warm shower or sit in tub of warm water
Things to avoid (patient teaching)harsh soaps, bubble baths, powders and sprays in genital area
Teaching good hygienecareful cleaning of genital region; wipe front to back after urinating; clean with soap/water after BM; void before/after sex
Unless contraindicated, force fluids up to how many milliliters a day? What important monitoring applies?3000ml/day (keep pushing until urine is clear); monitor I/O to determine if fluid replacement therapy is adequate
BOLO for what with women on antibiotic therapy?vaginal yeast infections
Monitor and assess toileting habits and hand washing, what intervention could you do to assist with this?If necessary, help clean perianal area after elimination (front to back)
If patient is in pain or discomfort, what intervention could you provide?A warm sitz bath
Acid-ash diet includesmeat, eggs, cheese, prunes, cranberries, plums, whole grains (to ↑ acidity of urine)
Foods NOT allowed in acid-ash dietMost fruits (too acidic), all vegetables except corn & lentils, milk and milk products, carbonated beverages and foods with banking soda or baking powder
"FULL" acronym for clinical findings associated with UTIsFrequent urges to void; Urine that is foul smelling/cloudy; Low grade fever; Lethargy
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Drug Therapy

Question Answer
Systemic Antibiotics used for how many days and which ones (4)?for 7-10days: cephalexin monohydrate; ampicillin; cephalosporins; aminoglycosides
Importance of taking full course of antibiotics?Even though symptoms may clear, it may still present
Patient Teaching if on Pyridium (phenazopryidine or urogesic)Will cause bright orange colored urine, warn patient it is normal
Pyridium drug classificationopioid analgesic, acts locally on urinary tract mucosa to produce analgesic or local anesthetic effects: NO ANTIMICROBIAL activity
Sulfonamidessulfamethozazole; sulfamethoxazole; tremethoprim-sulfamethoxazole (Bactrim)
Antibacterialsnitrofurantoin; methenamine mandelate; nalidixic acid
Complications of UTIscan lead to chronic infections, systemic sepsis and septic shock; If it reaches kidneys can lead to PYELONEPHRITIS
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Cystitis

Question Answer
cystitis - usually d/t e.coliinflammation of bladder wall (usually women's infection); most common american bacterial infection
What is the danger associated with cystitis?can lead to CRF
Risk for cystitis increases withage and multiple sex partners
Dxget a clean catch - look for the bug
Suprapubic pain symptom is described aspelvic pain that can be relieved by urination
Urine charcteristicsdark, odoriferous
other s/sfrequency, urgency, low grade fever, nocturia, pain during sex, pain worsening during menstruation
Prevention/TeachingSame as UTI! This time it is just in lower urinary tract
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Pyelonephritis

Question Answer
What is pyelonephritis?inflammation of renal pelvis and renal tisses via BUG!!
Caused by?invasion of microorganisms; typically bacteria, can be virus or fungi
Upper or lower urinary tract?Upper; starts low and moves up tract
Usual culprit?e.coli 90% of episodes
signs and symptoms?pain at costvertebral angle; fever/chills; n/v; severe flank pain or dull back ache; hematuria
What can it result in?permanent renal damage → which leads to acute & CRF → dialysis or kidney transplantation may be options if damage is significant enough
Predisposing factors, NI, and treatments are same asUTI's
How is pyelonephritis distinguished from cystitis?pyelo = kidney (blunt percussion pain); cyst = bladder
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Glomulernephritis

Question Answer
Glomeruli are where nephrons are housed (nutrients, oxygen, waste flows through and up to nephrons)
**EtiologyUsually secondary to beta-hemolytic streptoccocal infection occurring elsewhere in body
Glomerulonephritis is what type of disorder? **Immunologic complex disease resulting from an antigen-antibody reaction
Two types of antibody-induced injury can initiate glomerular damage:1) anti-GBM (anti-glomerular basement membrane) antibodies; 2) antibodies react with circulating nonglomerular antigens and are randomly deposited as immune complexes along GBM
Can be caused by _____ agents such as ___ ___, ____ ____, or rubella virus (or measles) (But mostly bacterial)viral; hep B; hep C
Glomeruli are "screens/filters", if damaged, there is a back up of debris, result.... stuff can't get through and get filtered out, can result in RF
Acute form usually only lasts about14 days and is self-limiting
Occurs more frequently in what gender/age group?boys b/t 6-7yo
What should you ask about as far as health history if someone comes into ER with signs/symptoms?Ask if they have had bronchitis, impetigo, streptococcal infection, URI within the last 2wks. (can cause inflamm. in kidneys & ↓ GFR).
signs/symptoms (think fluid retention)oliguria, scant; dark urine; ↑ SG; proteinuria; hematuria
s/s of bloodazotemia (↑ toxins); ↑ serum BUN & creatinine & ↓Hct/Hgb
Normally BUN/Creatinine is (↑or↓) in urine and (↑or↓) in serum?higher in blood and lower in urine
Normal serum BUN10-20mg/dL
Normal serum Creatinine 0.7 F and 1.0 M
How much potassium do you usually pee out?A LOT, so if you don't pee it out, it accumulates in your blood.
**Hallmark sign/symptom?Edema → PERI-ORBITAL edema
Other signs/symptomsHTN; H/A (nitrogen, fluid); weight gain (fluid retention); low-grade fever; lethargy/malaise/fatigue
If it was indeed precipitated by a bug, what is the priority?Go kill the strep infection for SURE, then have symptomatic relief, may need to go on dialysis
In reference to BUN/Creatinine: if you are not peeing, what happens to these in the serum?they go up
In reference to BUN/Creatinine: if you clear up the infection and start peeing a lot, what happens to the count in the urine and blood?Urine it goes up and ↓'s in the blood
Collaborative Care main goalsmanage pt. while try to treat underlying cause
Treatment: antihypertensivesif BP is severely elevated
Treatment if there is circulatory overloaddigitalis
Tx if there is renal insufficiencyfluid restriction
Tx if severe renal or cardiopulmonary problems developperitoneal dialysis: take diacylate and put it in abd caviity for a few hours, fluid pulled out of mysentery
Prevention is difficult, but if you can...seek tx for strep, prevent HIV/hepititis infections (safe sex, avoid IV drug use); if diabetic, control blood sugar; if HTN control BP
Why proteinuria, hematuria, oliguria?usually PRO/Blood do not get through kidneys into urine, but if glomeruli screen breaks down, big things can then get through.
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Nephrotic Syndrome

Question Answer
Nephrotic syndrome is the result ofmembranous proliferative glomerulonephritis (glomerulus is excessively permeable to plasma protein → proteinuria → low plasma albumin and tissue edema)
If more protein is being exreted and there is less left in the vascultaure = hypoalbuminemia which results in the massive loss of plasma oncotic pressure in vasculature = 3rd spacing
Many causes of nephrotic syndrome, some examples?Diabetes; heart failure; NSAIDs; Clots; lupus...
Progressive edema results inperipheral edema and ascites
Hyperlipidemia, why?the ↓ in serum proteins stimulates hepatic lipoprotein synthesis
Hypercoagulability because of the loss of?clotting factors, a clot in the renal vein is possible and is the most common site for thrombus formation
Usually occurs in what age groups?Children and young adults from following a strep infection → get history!
What titer should be checked?antistreptolysin: measures strep to see if it is still around
Treatment goals are mainlysymptomatic, support patient & tx underlying cause
Nutrition therapypatient losing a lot of protein can be very malnourished, maintain a low-moderate portein diet that is also low in sodium
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Urinary Tract Calculi

Question Answer
Nephrolithiasiskidney stone disease
urolithiasisurinary tract stone
Locations of lodged stoneskidney pelvis; kidney ureter junction; ureter bend (1/3 of way down); ureter bladder junction; bladder urethra junction
Facts (gender, ethnicity, age)M>F; whites > blacks; ages 20-55 most common; familial predisposition
Risk factor: metabolicabnormalities that cause ↑urine levels of calcium, oxaluric/uric/citric acid
RF: climatewarm climates that cause ↑ fluid loss, low urine volume and ↑ solute concentration in urine
RF: dietlarge intake of dietary proteins that ↑ uric acid excretion; excessive amounts of tea or fruit juices that ↑ urinary oxalate level; large intake of calcium and oxalate; low fluid intake that ↑'s urinary concentration
RF: geneticfamily hx of stone formation, cystinuria, gout or renal acidosis
RF: lifestylesedentary occupation; immobility
Which type of stone is the most common?Calcium
5 types of stonesCalcium oxalate, calcium phosphate, struvite, uric acid, cystine
Nutritional therapy for uric acid stones:Limit purine: sardines, herring, mussels, liver, kidney, goose, venison, meat, soups, sweetbreads
Nutritional therapy for calcium stones, what should be limited?Limit oxalates: dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, chocolate, cocoa, instant coffee, Ovaltine, tea, Worcestershire sauce
Nutritional therapy for calcium stones, what should be increased in diet?Calcium (it used to be restricted, now it is recommended as it may ↓ risk): milk, dairy, beans, fish with bones, dried fruits, nuts, chocolate, cocoa
Diagnosis viagood H&P; urinalysis/culture; IVP; ultrasound; cystoscopy
Treatment is mainly focused onPAIN = frequent narcotics
Treatment also includesanti-spasmodics (Ditropan); ↑ fluids (90% will wash out, if not, then surgery); watch for infection; watch for obstruction
For stones >4mm and in bladder of urethral-bladder junction → lithrotripsy (Which does what?)instrument through urethra, into bladder, stone is crushed or grabbed, then removed
If stone is imbedded in renal pelvissurgery
Also can use Extracorporeal shockwave lithotripsy (ESWL)Pt. reclines in water bath while shock waves are transmitted; xray or ultrasound to pinpoint stone and actually shatter the stone without damaging the surrounding tissues
Care Plan for pt. with acute urinary calculusPain (DRUGS); elimination (fluids); ↓anxiety; TEACH: nutritional therapy depends on composition;
Does it matter what kind of fluids to use?Not as much as UTI, more important to get volume with calculi
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