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Med Surg > Chapter 10 Urinary > Flashcards

Chapter 10 Urinary Flashcards

1
Q

Urinary Retention

A

Inability to void even with an urge

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2
Q

Urinary Retention causes

A 
Stress
Perineal surgery
Calculi
Infection
Tumor
Medication SEs
Perineal trauma-vaginal delivery
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3
Q

S/s Urinary Retention

A 
Complaints of:
frequency
distended bladder
discomfort
anxiety
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4
Q

Medical Management

A

Catheter
Surgery to release obstructions
Analgesias & Antispasmotics

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5
Q

Nursing Interventions

A 
Private relaxed environment
Bladder training
Warm shower/sitz baths
Warm beverages
Natural position for voiding
Check for residual urine(less than 30mL is good)
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6
Q

Urinary Incontinence

A

Most common health problem in women and older adults

Involuntary loss of urine from the bladder

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7
Q

Etiology Urinary Incontinence

A 
Infection
Loss of sphincter control
Sudden change of pressure in abdominal pressure
Spinal cord trauma(permanent)
Pregnancy
Seen in older adult more
Physical exertion
Obesity
Chronic lung disease and smoking
Pelvic floor injury
Surgery
Lack of estrogen
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8
Q

S/S

A

Involuntary loss of urine, especially with cough, sneeze, lifting, intercourse

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9
Q

Medical Management

A

Depends on cause
Surgery, implants, pessary(hold bladder up higher by the pelvic bone) estrogen replacement, self cath systems, Depends underwear.

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10
Q

Nursing Interventions

A 
Assess pt recognition of urge to void
Encourage fluids-may try to avoid to avoid going to the bathroom
Establish a voiding schedule( q 2h)
Protective undergarments
Kegel exercises
Decrease caffeine intake
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11
Q

Nursing Interventions continued

A 
Supportive
Hydration
Hygiene
Administering Meds
Sterile technique for Cath insertions
Hand washing
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12
Q

UTI

A

Presence of microorganisms in any urinary system strucutre

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13
Q

Bacturia

A

Presence of bacteria in urine and is MOST COMMON CAUSE OF ALL NOSOCOMIAL INFECTIONS
*Usually associated with Catheters

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14
Q

Etiology UTI

A 
Obstruction
Neurogenic bladder 
Ureterovesical reflux
Intercourse
Catheterization
Diabetes, MS, spinal cord injury, HTN, kidney disease
Retention
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15
Q

S/S

A 
Urgency
Frequency
Burning
Nocturia
Hematuria(microscopic)
Identified by location of urinary system
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16
Q

Diagnostic Tests

A

Urine Analysis

Culture and Sensitivity

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17
Q

Medical Mangement

A

Eliminate bacteria
Anti-Infectives
Surgery for Obstructions

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18
Q

Interventions

A

Educate: adequate hydration, hygiene
Administer antiinfectives, urinary analgesics(Pyridium anti spasmodic “AZO”)
Be alert for urosepsis(septic posioning due to retention and absorption of urinary products in the tissues)

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19
Q

Pyridium “AZO”

A

Makes urine bright orange

Stains underwear bright orange

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20
Q

Prostatitis

A

Inflammation and/or infection of the prostate gland

Can be bacterial or nonbacterial

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21
Q

S/S

A 
Burning
low back pain
low abdominal pain
fever
chills
nocturia
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22
Q

Medical Management

A

Antibiotics for bacterial

Anti-Inflammatory drugs

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23
Q

Nursing Interventions

A

Comfort measures: sitz baths, stool softeners
Teaching(Avoid intercourse in acute, but encourage in chronic)
Teach to take full medication regimen

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24
Q

Pyelonephritis

A

Inflammation of the structures of the kidney
Pelvis, tubules, interstitial

Usually caused by E.Coli

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25
Q

Caused from

A 
Pregnancy
Chronic health problems(diabetes)
Insult to urinary tract through repeated caths
Infection
Obstruction
trauma
26
Q

S/s Pyelonephritis

A

Unilateral or bilateral
Chills
Fever
prostration-excessive perspiration, fever.
flank pain
Can lead to chronic condition in which azotemia occurs(retention of excessive amount of nitrogen in the blood)

27
Q

Tests

A

Confirmed by pus and bacteria in urine
Clean catch/cath specimen for C&S
IVP identifies obstruction or degenerative changes
BUN/creatinine

28
Q

Medical Management

A

Antibiotics for 14-21 days p.o.
Fluids
Pyridium(urinary analgesic-reduces burning)

29
Q

Nursing Interventions

A 
Monitor urine
Encourage fluids
Instruct to void when urge
Hygiene
Teach s/s of infection
Teach Med regimen and follow up care.
30
Q

Hydronephrosis

A

The dilation of the renal pelvis and calyces

Caused by obstructions in the urinary tract(unilateral or bilateral)

31
Q

Obstruction

A

Pressure from accumulated urine that can’t flow past obstruction=functional and anatomical damage to renal system

Can occur without signs and symptoms as long as kidney function adequate and urine can drain

32
Q

S/S

A 
Pain-dull flank pain if dev slowly; sharp, stabbing abd. Pain if quickly developing
Difficulty starting a stream
Dribbling
Nocturia
Burning
Vomiting
Bladder distention
33
Q

Tests

A

UA
Serum renal functions(urea, creatinine)
Cystoscopy
IVP/IVU, KUB, CT, ultrasound, biopsy

34
Q

Medical Management

A

Surgery for obstruction
Anti-Infectives
Antispasmodics
Pain Meds(opiods)

35
Q

NSG interventions

A 
Med Admin
I&O
Monitor VS
Cath Care
Drain Care
36
Q

Urolithiasis

A

Formation of urinary calculi

37
Q

Etiology

A

Develop from minerals that have precipitated out of solution and adhere, forming stones

Predisposed people: immobile, hyperparathyroidism, recurrent UTIs

38
Q

S/S

A

Flank pain radiating to groin, genitalia or inner thigh(mobile stone)
N,V
Hematuria
Intractable pain

39
Q

Tests

A

KUB
IVP/IVU
ultrasound, cystoscopy
UA, 24 hour urine

40
Q

Medical Management

A

Antiinfectives
Cystoscopy to remove stones
Litotripsy
Drug and diet therapy according to stone composition

41
Q

NSG interventions

A 
Assess pain
Fluids(2000 mL in 24 hours)
Activity unless on opiods
Manage pain
IV fluids
Strain all urine, check for stones
Monitor UA, BUN, creatinine
I&O
Facilitate bladder emptying
If stones are calcium in nature, reduce dietary CA along with animal protein and salt
42
Q

Benign Prostatic Hypertrophy

A

Enlargement of the prostate gland

43
Q

Etiology BPH

A

Cause unclear
Seen in men over 50
Prostate enlarges= pressure on urethra and bladder neck=incomplete emptying of bladder

44
Q

S/S

A

Many as with UTI
Nocturia(awakened more than 2 X)
Difficult to start stream

45
Q

Tests

A

Palpation of prostate(boggy presentation)
Measure residual urine
cystoscopy or IVP
Cytologic evaluation

46
Q

Medical Management

A

Based on degree of occlusion
Medications to shrink prostate
Surgery: Prostatectomy(removal of prostate)
Transurethral Resection of Prostate (TURP)-less invasive
Supra pubic
Radical perineal
Retro-pubic

47
Q

NSG Care

A

Turp care:
Monitor for return, clots during continuous irrigation
Routine post op care
Relieve bladder spasms
Calculate “actual urine output” subtract the amount of irrigation fluid used from the Foley catheter output

48
Q

Nephrotic Syndrome

A

Characterized by marked proteinuria, hypoalbuminemia, and edema

usually precipiated by an Upper Resp infection or allergic reaction

49
Q

S/S Nephrotic Syndrome

A 
Anasarca(generalized edema)
Anorexia
Fatigue
Altered renal function
Foamy Urine
Oliguria(decreased urine output)
Swelling of face, hands, feet.
50
Q

Medical Management

A

Depends on tissue involvement
Corticosteroids
Immunosuppression, loop diuretics
Low sodium, high-protein diet

51
Q

Tests

A

Blood chemistry: hypoalbuminemia,
hyperlipidemia
Renal biopsy

52
Q

NSG interventions

A

Monitor fluid balance(daily weight, abd girth, I&O)
BR in presence of extreme edema
Skin care
Diet with high protein value(meat, fish, poultry, cheese, eggs); restrict Na+
Teach:
Medication regimen
nutrition
Self-assessment of fluid status
S/S indicating need for medical attention(edema, fatigue, HA, infection)

53
Q

Acute Clomerulonphritis

A

Inflammation of the glomeruli of the kidney

Usually r/t strep infection 2-3 weeks earlier(infection triggers immune response that reesults in inflammation of glomeruli)

Seen in children and young adults more

54
Q

S/S

A 
Swelling of face, esp eyes
Anorexia
Nocturia
Malaise
Exertional dyspnea
Cola-colored to frank sanguineous urine
55
Q

Tests

A

BUN, creatinine
ESR
ASO titer
UA: RBCs, casts, protein

56
Q

Medical Management

A

Primary symptoms and prevent brain, heart damage
Adjust K+ and Na+ in diet
Bed Rest, fluid adjustments until diuresis

57
Q

NSG interventions

A

Protein restrictions
Increased carbs
I&O, VS
Level of activity according to edema, HTN, proteinuria, and hematuria(activity increases these)
Pt Teaching:
Follow medical regiment even when you might feel better
s/s for immediate medical treatment hematuria, HA, edema,HTN.

58
Q

Chronic Glomerulonephritis

A

Slow, progressive destruction of glomeruli w/related loss of function; kidney atrophies

59
Q

S/S

A 
Malaise
Morning headaches
Dyspnea w/exertion
Visual/digestive disturbances
Edema
Fatigue
HTN
Anemia, proteinuria, anasarca...
60
Q

Tests

A

Albumin, RBCs in urine
Renal function tests are normal
Low creatinine clearance

61
Q

Medical Management

A

Control of secondary SEs as with acute

Renal dialysis

62
Q

NSG interventions

A 
Good hand washing, infection control
Monitor VS, tests
Watch for fluid excess
I&O
Assess level of activity
Teach:
Preventative health maintenance****

Med Surg (2 decks)

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