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Disorders of the urinary system Flashcards

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1
Q

Classification of Urinary Tract Infection (UTI)

A 
1. Upper Urinary Tract Infection (UTI): 
 Pyelonephritis 
2. Lower Urinary Tract Infection (UTI):
 Cystitis
  UTIs are the most common hospital-acquired infection
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2
Q

Lower UTI causes

A
  1. BPH
  2. Calculi
  3. Urethral strictures
  4. Tumors
  5. Sexual intercourse
  6. Blood born infection
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3
Q

Upper UTI causes

A
  1. Calculi
  2. Trauma
  3. Tumor
  4. Aneurysm
  5. Congenital anomaly
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4
Q

Other causes

A
  1. Noninfectious :
    - Chemical exposure: Drugs: Cyclophosphamide (Cytoxan)
  2. Radiation therapy
  3. Foreign bodies
    - Urinary calculi
    - Indwelling catheter
  4. Factor compromising Immune response
    - HIV
    - Diabetes
  5. Hematogenous route
  6. Complications
    - Pyelonephritis
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5
Q

UTI: Cystitis : manifestations

A
  1. Dysuria
  2. Urinary: Frequency; Urgency; Hesitancy
  3. Suprapubic: Pain; Discomfort; Pressure
  4. Hematuria
  5. Pyuria (WBC)
  6. Urethral discharge : Cloudy/foul smelling urine
  7. Perineal itching
  8. Mental status changes
  9. Hydronephrosis
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5
Q

UTI: Cystitis: TX

A
  1. Drugs - aim to reduce bacteria in urinary tract / pain: Bactrim, Lexaquin, Amoxil, Macrobid, Cipro
  2. Education about antibiotics: take entire prescribed dose;
  3. Prevention of recurrence
  4. Sensitivity to those with anxiety/ embarrassment.
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6
Q

Preventing a UTI

A
  1. Drink 2-3 L every day - 8-10 glasses
  2. Sleep, rest, nutrition
  3. W: clean from front to back; avoid bubble bath, nylon underwear; scented tissues; wear cotton underwear ! empty before and after intercourse.
  4. Empty as soon as feel urge (every 4 hr)
  5. Home therapies: cranberries juice, apple cider vinegar, vitamin C to acidify the urine!!
  6. prevent recurrence: complete antibiotics ;follow appointment ;
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7
Q

Pyelonephritis

A

Bacterial infection in the kidney and renal pelvis.
Could be:
- Acute pyelonephritis
- Chronic pyelonephritis
Usually begins with ascending infections from the lower tract into the renal pelvis and
parenchyma
Blood borne infections

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8
Q

Acute Pyelonephritis: appearance

A

kidney is swollen with multiple abscesses (yellowish gray streaks)

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9
Q

Acute Pyelonephritis: manifestations

A 
Chills
Fever 
Nausea/Vomiting
Malaise
 Flank, back pain !!!!
Nocturia
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10
Q

Acute Pyelonephritis: complications

A

Chronic Pyelonephritis
Temporary altered kidney function
Rarely progresses to renal failure

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11
Q

Chronic Pyelonephritis: manifestations

A

Hypertension
Inability to conserve sodium
Decreased urine concentrating ability/Nocturia
Hyperkalemia and acidosis

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12
Q

Chronic Pyelonephritis: complications

A

Scar tissue
Hypertension
Renal failure

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13
Q

Urinalysis: Color

A

dark amber; very pale; dark red

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14
Q

Urinalysis: Odor

A

foul smell: possible infection

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15
Q

Urinalysis: Turbidity

A

Cloudy urine: urinary protein; infection

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16
Q

Urinalysis: spesific gravity

A

1.005-1.030

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17
Q

Urinalysis: pH

A

average: 6 : range: 4.6-8

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18
Q

Urinalysis: Protein

A

0.8 mg/dL

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19
Q

Urinalysis: RBC

A

0-2 per high power field

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20
Q

Urinalysis: WBC

A

M: 0-3; F: 0-5

21
Q

Voided urine

A

first specimen voided in the morning; send as soon as possible - if not refrigerate

22
Q

Clean - catch specimen

A

self clean before voiding ( front to back) ,(head of the penis downward); initiate voiding; stop; resume into container; 1 oz (30 ml).

23
Q

24 hour urine collection

A

initial: void, discard, note time; Foley:empty bag at the start time; collect urine for the next 24 hr; signs! let know!

24
Q

KUB

A

radiography ( x-ray) of kidneys, ureter, and bladder; plain film of the abdomen obtain without any specific preparation; shows: gross anatomic features and obvious stones, strictures, calcifications or obstructions of urinary tract.

25
Q

using contrast media

A

reaction?; asthma?; hay fever?; food or drug allergies (seafood, eggs, milk, chocolate);history of renal insufficiency?; taking metformin (Glucophage)?; check hydration; last ate or drank ?

26
Q

Intravenous (IV) Urography ( excretory urography, IV pyelography)

A

outlines urinary tract and helps determine any problems; measure kidney size, detect obstruction, assess parenchymal mass.

  1. Contrast medium - allergic reaction in iodine sensitive patients.
  2. Hypertonic contrast agent - risk for acute renal failure when SC > 1.5 mg/dL
  3. Nephrotoxic complications can be prevented by parenteral fluid administration.
27
Q

Excretory Urogram : patient education

A
  1. shell fish or iodine allergies ?;
  2. metformin (Glucophage) ?;
  3. asthma?;
  4. bowel preparation;
  5. laying on x-ray table with x-ray machine above;
  6. pressure band around stomach
  7. IV contrast agent: feel heat , metallic taste (few min);
  8. series of x-rays will be taken; empty bladder - more x-rays; 9.normal activities after.
28
Q

Excretory Urogram: contrast reactions

A
  1. minor: N/V, urticaria, itching, sneezing;
  2. moderate: nephrotoxic effects, congestive heart failure, pulmonary edema;
  3. severe: bronchospasm, anaphylaxis
    Minor allergy - give steroids and antihistamines before procedure
29
Q

Excretory Urogram : follow up care

A
  1. Monitor for altered renal function
  2. Ensure adequate hydration : oral fluids or IV fluids - reduces the risk of renal damage;
  3. Monitor blood creatinine levels
30
Q

Excretory Urogram : Metformin

A

Risk for lactic acidosis; discontinued at time of procedure and 48 hr after.

31
Q

UTI: drug therapy

A

Usually starts with Broad-spectrum antibiotics

Then switch to sensitivity guided therapy

32
Q

UTI: drugs

A
  1. Sulfanomides : Trimethoprim/sulfamethoxazole (Bactrim, septra) - sulfa drug allergies; full glass of water;keep out of sun; complete drug.
  2. Quinolones : Ciprofloxacin (Cipro) - swallow whole, 2 hr after antacid; keep out of sun.
  3. Penicillin : Amoxicillin (Amoxil) -allergies; take with food; diarrhea - call; interacts with birth control; take all not to develop resistance.
  4. Bladder analgesic : Phenzopyridine (Pyridium) - reduces pain
33
Q

Surgical Management

A

Cystoscopy
Correction of Obstruction
Correction of structural problems
Eradication of infectious source

34
Q

Perioperative Care

A

Preoperative: Antibiotic therapy, client Teaching
Operative: Pyelolithotomy, nephrectomy, ureteroplasty
Postoperative

35
Q

Nursing Diagnoses

A 
Acute pain
Deficient knowledge
Urge urinary incontinence 
Risk for impaired skin integrity
Risk for sepsis  
Impaired urinary elimination
Anxiety
Activity Intolerance
Fear of development of CRF 
Hyperthermia
36
Q

Glomerulonephritis (GN)

A 
Inflammation of the glomeruli. Both the structure and the function of the glomerulus is affected
 Classification :
1.Acute Glomerulonephritis (AGN)
2. Rapidly Progressive GN
3. Chronic GN
Initiating event: strep infection
37
Q

Azotemia

A

build up of wastes in the body

38
Q

GN: etiology

A 
Infectious: 
1. Group A beta hemolytic Streptococcus
2. Hepatitis B
3. Measles/Mumps
 Related to other diseases: 
1. Systemic lupus erythematosus (SLE)
2. Diabetic Mellitus
3. Sickle cell disease
39
Q

Chronic GN

A

Slow progressive destruction of the glomeruli
Results in impairment of renal function
Etiology:
1. Typically the end stage of other glomerular disorders
2. Develops over 20 - 30 years

40
Q

GN

A

Antigen -antibody complex from recent strep infection - glomeruli - causing inflammation; decrease glomerular filtration rate - headache ; high BP; facial edema; malaise; low grade fever, weigh gain; proteinuria , hematuria, oliguria .

41
Q

GN:Laboratory and Diagnostic Tests

A 
24-hour urine collection 
 Specimens culture
 Renal Biopsy
Plasmapheresis
 Antistreptolysin-O titers
42
Q

GN:Laboratory and Diagnostic Tests

A

1, Urinalysis

  1. Serum electrolytes : high Sodium,Potassium,Phosphate;
  2. Acidosis
  3. Serum Creat >6mg/dL
  4. GFR high
  5. Protein: <2g/24hour collection
43
Q

GN: treatment

A 
Diet changes
 Fluid intake
 Drug therapy
 Dialysis
  Transplantation
44
Q

GN: treatment

A 
1.To prevent spread on infection:
 Antibiotics may be prescribed for persons in contact with client
 Basic infection control principles
2. Diuretics
3.Sodium and water restriction
4.Antihypertensives 
5. Potassium and protein intake restriction
6. Plasmapheresis
45
Q

GN: client education

A 
Purpose and desired effects of prescribed medications
 Dietary and fluid modifications
 Daily weight
 Daily B/P monitoring
Peritoneal or vascular access care
46
Q

Nephrotic syndrome

A

A condition of increased glomerular permeability that allows larger molecules to pass
through the membrane into the urine and be removed from the blood.

47
Q

NS: etiology

A

Immune or inflammatory processes
Altered liver activity may occur with NS: increased lipid production and Hyperlipidemia
Also occurs as a result of genetic defects.

48
Q

NS: manifestations

A
  1. Massive proteinuria
  2. Hypoalbuminemia
  3. Edema
  4. Lipiduria
  5. Hyperlipidemia
  6. Increased coagulation
  7. Renal insufficiency
49
Q

NS: treatment

A

Suppressive therapy
O Steroids
O Cytotoxic
O Immunosuppressive agents

50
Q

NS: treatment

A
  1. Angiotensin Converting Enzyme (ACE):
    Decrease protein loss in the urine
    2.Cholesterol lowering drugs:Improve lipid blood levels
    3.Heparin: May reduce urine protein and reduce renal insufficiency
    4.Mild diuretics
51
Q

NS: diet changes

A
  1. Normal GFR: Dietary intake of protein is needed
  2. Decreased GFR: Dietary protein intake must be decreased
  3. Sodium restrictions

Nursing (18 decks)

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