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Renal > Care of Patients with urinary problems ch 69 > Flashcards

Care of Patients with urinary problems ch 69 Flashcards

1
Q

reason UTI risk increases with age

pg 1492

A

Skin and mucous membrane changes from a lack of estrogen for women

prostate disease increases risk for UTIs in men

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2
Q

major preventative strategy used in health care to reduce cystitis

A

reducing use of indwelling urinary catheters

use strict sterile technique during insertion

discontinue as soon as possible

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3
Q

minimum fluid intake to prevent cystitis, if there are no other health concerns

A

1.5 to 2.5 Liters

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4
Q

common clinical manifestations of UTI

pg 1493

A 
frequency
urgency
dysuria
hesitancy or difficult in initiating urine
low back pain
nocturia
incontinence
hematuria
pyuria
bacteriuria
retention
suprapubic tenderness or fullness
feeling of incomplete bladder emptying
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5
Q

rare clinical manifestations of UTI

pg 1493

A 
fever
chills
n/v
malaise
flank pain
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6
Q

clinical manifestations that may occur in older adult with UTI

A

increasing mental confusion or frequent unexplained falls
sudden onset of incontinence or a worsening of incontinence
fever
increased HR
increased RR
hypotension
loss of appetite, nocturia, dysuria

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7
Q

“kind of know” drugs for UTIs

pg 1495

A 
Bactrim (trimethoprim/sulfamethoxazole)
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
amoxicillin (Amoxil)
Augmentin (amoxicillin/clavulante)
cefadroxil (Duricef)
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8
Q

nursing interventions for sulfonamides

Bactrim (trimethoprim/sulfamethoxazole)

A

ask about drug allergies, especially sulfa drugs (allergies to sulfa drugs are common and may require chaining drug therapy)

drink full glass of water with each dose and drink at lease 3L daily (sulfamethoxazole can form crystals in kidney tubules)

keep out of sun or wear protective clothing and use sunscreen (increases skin sensitivity to sun and can cause sunburns)

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9
Q

nursing interventions for fluroquinolones

ex: cipro, levaquin

A

do not take within 2 hrs of antacid (can interfere with drug absorption)

teach pt how to take pulse, monitor it twice daily (drug can induce cardiac dysrhythmias)

keep out of sun or wear protective clothing and use sunscreen (increases skin sensitivity to sun and can cause sunburns)

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10
Q

nursing interventions for penicillins

A

ask about drug allergies
take with food (can cause GI upset)
call provider if watery diarrhea develops (can cause colitis)
use additional birth control (reduces effectiveness)

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11
Q

nursing interventions for cephalosporins

A

ask about drug allergies to penicillin (structurally similar to penicillin)
call provider if watery diarrhea develops

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12
Q

fosftomycin (Monurol)

nursing interventions

A

mix contents of package with 1/2 cup cold water (granules must be dissolved)
avoid taking with metoclopramide or other drugs that increase GI motility (reduce absorption)

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13
Q

nitrofurantoin (Furadantin, Macrobid)

nursing interventions

A

type of urinary antiseptic

shake bottle well (drug is in suspension)
drink with full glass of water and drink 3L daily (drug precipitates in the kidney tubules and damage the kidneys)

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14
Q

bladder analgesic examples

A

phenazopyridine (Pyridium, Prodium, Pyridiate)

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15
Q

bladder analgesic nursing interventions

A

drug will not treat infection, just symptoms
take with food or following meal to reduce GI disturbances
urine will turn red or orange

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16
Q

antispasmodics used with UTIs

examples

A

hyoscyamine (Anaspaz, Cystospaz)

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17
Q

antispasmodics used with UTIs

nursing interventions

A

notify PCP if blurred vision or other eye problems, confusion, dizziness, fainting, fast HR, fever, difficulty passing urine occurs (these are manifestations of drug toxicity)
wear dark glasses in sunlight (drug dilates the pupil and increases sensitivity)

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18
Q

stress incontinence

A

most common type
loss of small amounts of urine during coughing, sneezing, jogging, lifting
its can’t tighten the urethra enough to overcome the increased bladder pressure caused by contraction of detrusor muscle
common after childbirth
low estrogen levels after menopause also contributes

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19
Q

urge incontinence

A

perception of an urgent need to urinate as a result of bladder contractions regardless of volume of urine in bladder
can’t suppress signal to urinate and have sudden strong urge to void and often leak large amounts of urine at this time
aka overactive bladder
can be related to stroke, neurologic problems, other urinary tract problems, irritation from concentrated urine or artificial sweeteners, caffeine, alcohol, citric intake
diuretics and nicotine can also irritate the bladder

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20
Q

mixed incontinence

A

presence of more than one type
urine loss related to both stress and urge incontinence
more common in older women

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21
Q

overflow incontinence

A

occurs when detrusor muscle fails to contract and bladder becomes distended
aka reflex incontinence
occurs when bladder has reached max capacity and some urine must leak out to prevent bladder rupture
urethra may be obstructed and fail to relax enough to urinate
incomplete bladder emptying or urinary retention from urethral obstruction results in overflow incontinence

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22
Q

functional incontinence

A

occurs as a result of factors other than abnormal function of bladder and urethra
common factor is loss of cognitive function in patients with dementia

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23
Q

definition/description of stress incontinence

pg 1498

A

involuntary loss of urine during activities that increase abd and detrusor pressure
patients can’t tighten the urethra sufficiently to overcome the increased detrusor pressure
leakage of urine results

24
Q

cause of stress incontinence

pg 1498

A

weakening of bladder neck supports; associated with childbirth.
intrinsic sphincter deficiency caused by such congenital condition like epispadias and myelomeningocele
acquired anatomic damage to the urethral sphincter (from repeated incontinence surgeries, prostectomy, radiation therapy, trauma)

25
Q

clinical manifestations of stress incontinence

pg 1498

A

urine loss with physical exertion, cough, sneeze exercise
usually only small amounts of urine
post-void residual usually

26
Q

definition/description of urge incontinence

pg 1498

A

involuntary loss of urine associated with a strong desire to urinate
patients can’t suppress signal from bladder muscle to brain that it s time to urinate

27
Q

causes of overflow incontinence

pg 1498

A 
diabetic neuropathy
side effects of medications
after radical pelvic surgery
spinal cord damage
enlarged prostate
large genital prolapse
multiple sclerosis
28
Q

estrogen (Cenestin, Enjuvia)

purpose/action pg 1502

A

reduces incontinence, possibly by improving vaginal and urethral blood flow and tone

29
Q

estrogen (Cenestin, Enjuva)

nursing interventions pg 1502

A

report unusual vaginal bleeding (estrogen increases risk for endometrial cancer)

avoid smoking and report calf pain or swelling (estrogen increase risk for thrombophlebitis, especially among women who smoke)

30
Q

what is classification and purpose of following drugs

oxybutynin (Ditropan)
tolterodine (Detrol)
propantheline (Pro-Banthine)
dicyclomine (Barmine, Bentyl)
trospium (Sanctrual)
A

anticholinergics/antispasmodics

reduce incontinence by causing bladder muscle relaxation and surpassing urge to void

31
Q

anticholinergics/antispasmodics - used to treat incontinence
nursing interventions

pg 1502

A

ask if pt has glaucoma (can increase intraocular pressure)
increase fluid intake and use hard candy (dry mouth common side effect)
increase fluid intake and dietary fiber (constipation is common side effect)
monitor urine output and report significantly lower than intake (can cause urinary retention)

32
Q

tricyclic antidepressants - purpose/action

pg 1502

A

have some anticholinergic actions and also block acetylcholine receptors. both actions can relieve urinary incontinence

33
Q

tricyclic antidepressants - nursing interventions

pg 1502

A

do not take with other tricyclic antidepressants or MAO inhibitors (drugs prolong effects of catecholamines and lead to hypertensive crisis)

change positions slowly, especially in the morning (cause dizziness and orthostatic hypotension)

use same interventions as anticholinergic drugs (these produce anticholinergic activities and side effects)

34
Q

nutrition therapy to help avoid incontinence

pg 1504

A

avoid foods that like caffeine and alcohol
space fluids at regular intervals
limit fluids after dinner hour

35
Q

behavioral interventions for incontinence (vague ones)

pg 1504

A

bladder training
habit training
exercise therapy
electrical stimulation

36
Q

bladder training

A

patient learns to control bladder
start a voiding schedule
can start with 30 minute interval (then void every 30 minutes)
avoid urge to void between set times
increase intervals by 15-30 minutes
follow schedule till achieve success
as interval increases, bladder gradually tolerates more volume

37
Q

habit training

A

scheduled toileting
helpful in cognitively impaired patients
caregivers assist at specific times (like q2hr)

38
Q

urinary incontinence - self management education

pg 1507

A

maintain normal body weight to reduce pressure
do not limit fluid intake
maintain sterile drainage system with catheter
following surgery: do not put anything in your vagina
do not have sex for 6 weeks following surgery
do not lift or carry anything heavier than 5 lbs until clearance has been given (up to 3 months)

39
Q

one major manifestations of renal stone

A

severe pain

flank pain suggest stone in kidney or upper ureter
pain that extends to abd or scrotum suggests stone in ureters or bladder

40
Q

s/s of urolithiasis (stone)

A 
pain
n/v
pallor
diaphoresis
frequency
dysuria
oliguria or anuria (suggest obstruction)
bladder distention
temp and pulse are elevated with infection
BP may decrease if severe pain cause shock
41
Q

diagnostic tests for kidney stones

A

easily seen on x-rays
IV urogram or CT
non contrast CT is most sensitive test

42
Q

when would IV urography not be used for high risk patients

who are these high risk patients

A

risk for acute kidney injury induced by contrast dye

older adults, DM, multiple myeloma, elevated serum creatinine

43
Q

what is lithotripsy

A

uses sound, laser, or dry shock waves to break up stones into small fragments

44
Q

lithotripsy procedure

A

cardiac rhythm is monitored by ECG
shock waves delivered in sync with R wave
500-1500 shock waves applied for 30-45 minutes
continuous ECG monitoring for dysrhythmias and fluoroscopic observation for stone destruction are maintained
strain urine following procedure

45
Q

minimal invasive surgical procedures to treat kidney stones

A

stenting
retrograde ureteroscopy
percutaneous ureterolithotomy
percutaneous nephrolithotomy

46
Q

retrograde ureteroscopy

A

endoscopic procedure
ureteroscope passed through the urethra and bladder into ureter
once stone is seen, it is removed by basket, forceps, or loop
foley can be placed to facilitate passage

47
Q

percutaneous ureterolithotomy or nephrolithotomy

A

removal of stone in kidney or ureter through the skin
patient lies prone or on side
under local or general anesthesia
needle passed into collecting system of kidney
endoscope can be attached to grasp stone
often a nephrostomy tube left in place to prevent stone fragments from passing through urinary tract

48
Q

drug therapy to prevent kidney stone obstruction

A

depends on stone type

for hypercalciuria - thiazide diuretics, orthophosphate, sodium cellulose phosphate

for hyperoxaluria - allopurinol and vitamin b6

for cystinuria - AMPG, captopril

49
Q

dietary interventions for calcium oxalate kidney stone

A

avoid spinach, black tea, rhubarb

decrease sodium intake

50
Q

dietary interventions for calcium phosphate kidney stones

A

limit intake of foods high in animal protein to 5-7 servings per week and never more than 2 per day

can reduce calcium, milk, dairy products

decrease sodium intake

51
Q

dietary interventions for struvite (magnesium ammonium phosphate)

A

limit daily products, organ meats, whole grains

52
Q

dietary interventions for uric acid stones

A

reduce purine sources

organ means, poultry, fish, gravies, red wines, sardines

53
Q

dietary interventions for cystine kidney stones

A

limit animal protein

fluid intake of 500 mL every 4 hrs while awake and 750 mL at night

54
Q

post op following bladder surgery for bladder cancer

A

external pouch covers ostomy to collect urine
will have penrose drain an medena catheter
pt with neobladder usually requires 2-4 days in ICU
irrigation can be done to ensure patency
no sensation of bladder fullness with neobladder

when drainage collects on the outside, report any decrease in urine amount or leakage

55
Q

To prevent and treat urolithiasis, patients are encouraged to

A

drink lots of fluids and eat lots of fruits and vegetables, a low amount of protein, and a balanced intake of calcium, fats, and carbohydrates.

56
Q

thiazide diuretics for stones

A

chlorothiazide or hydrochlorothiazide

promote calcium resorption from the kidney tubules back into the body.
reduces urine calcium loads

57
Q

orthophosphates for stones

A

alter calcium phosphorus metabolism

results in decreased urine saturation of calcium oxalate

Renal (5 decks)

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