Chapter 10 Urinary Flashcards
1
Q
Urinary Retention
A
Inability to void even with an urge
2
Q
Urinary Retention causes
A
Stress Perineal surgery Calculi Infection Tumor Medication SEs Perineal trauma-vaginal delivery
3
Q
S/s Urinary Retention
A
Complaints of: frequency distended bladder discomfort anxiety
4
Q
Medical Management
A
Catheter
Surgery to release obstructions
Analgesias & Antispasmotics
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)
6
Q
Urinary Incontinence
A
Most common health problem in women and older adults
Involuntary loss of urine from the bladder
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
8
Q
S/S
A
Involuntary loss of urine, especially with cough, sneeze, lifting, intercourse
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.
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
11
Q
Nursing Interventions continued
A
Supportive Hydration Hygiene Administering Meds Sterile technique for Cath insertions Hand washing
12
Q
UTI
A
Presence of microorganisms in any urinary system strucutre
13
Q
Bacturia
A
Presence of bacteria in urine and is MOST COMMON CAUSE OF ALL NOSOCOMIAL INFECTIONS
*Usually associated with Catheters
14
Q
Etiology UTI
A
Obstruction Neurogenic bladder Ureterovesical reflux Intercourse Catheterization Diabetes, MS, spinal cord injury, HTN, kidney disease Retention
15
Q
S/S
A
Urgency Frequency Burning Nocturia Hematuria(microscopic) Identified by location of urinary system
16
Q
Diagnostic Tests
A
Urine Analysis
Culture and Sensitivity
17
Q
Medical Mangement
A
Eliminate bacteria
Anti-Infectives
Surgery for Obstructions
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)
19
Q
Pyridium “AZO”
A
Makes urine bright orange
Stains underwear bright orange
20
Q
Prostatitis
A
Inflammation and/or infection of the prostate gland
Can be bacterial or nonbacterial
21
Q
S/S
A
Burning low back pain low abdominal pain fever chills nocturia
22
Q
Medical Management
A
Antibiotics for bacterial
Anti-Inflammatory drugs
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
24
Q
Pyelonephritis
A
Inflammation of the structures of the kidney
Pelvis, tubules, interstitial
Usually caused by E.Coli
25
Caused from
```
Pregnancy
Chronic health problems(diabetes)
Insult to urinary tract through repeated caths
Infection
Obstruction
trauma
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26
S/s Pyelonephritis
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
Tests
Confirmed by pus and bacteria in urine
Clean catch/cath specimen for C&S
IVP identifies obstruction or degenerative changes
BUN/creatinine
28
Medical Management
Antibiotics for 14-21 days p.o.
Fluids
Pyridium(urinary analgesic-reduces burning)
29
Nursing Interventions
```
Monitor urine
Encourage fluids
Instruct to void when urge
Hygiene
Teach s/s of infection
Teach Med regimen and follow up care.
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30
Hydronephrosis
The dilation of the renal pelvis and calyces
Caused by obstructions in the urinary tract(unilateral or bilateral)
31
Obstruction
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
S/S
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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
Tests
UA
Serum renal functions(urea, creatinine)
Cystoscopy
IVP/IVU, KUB, CT, ultrasound, biopsy
34
Medical Management
Surgery for obstruction
Anti-Infectives
Antispasmodics
Pain Meds(opiods)
35
NSG interventions
```
Med Admin
I&O
Monitor VS
Cath Care
Drain Care
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36
Urolithiasis
Formation of urinary calculi
37
Etiology
Develop from minerals that have precipitated out of solution and adhere, forming stones
Predisposed people: immobile, hyperparathyroidism, recurrent UTIs
38
S/S
Flank pain radiating to groin, genitalia or inner thigh(mobile stone)
N,V
Hematuria
Intractable pain
39
Tests
KUB
IVP/IVU
ultrasound, cystoscopy
UA, 24 hour urine
40
Medical Management
Antiinfectives
Cystoscopy to remove stones
Litotripsy
Drug and diet therapy according to stone composition
41
NSG interventions
```
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
Benign Prostatic Hypertrophy
Enlargement of the prostate gland
43
Etiology BPH
Cause unclear
Seen in men over 50
Prostate enlarges= pressure on urethra and bladder neck=incomplete emptying of bladder
44
S/S
Many as with UTI
Nocturia(awakened more than 2 X)
Difficult to start stream
45
Tests
Palpation of prostate(boggy presentation)
Measure residual urine
cystoscopy or IVP
Cytologic evaluation
46
Medical Management
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
NSG Care
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
Nephrotic Syndrome
Characterized by marked proteinuria, hypoalbuminemia, and edema
usually precipiated by an Upper Resp infection or allergic reaction
49
S/S Nephrotic Syndrome
```
Anasarca(generalized edema)
Anorexia
Fatigue
Altered renal function
Foamy Urine
Oliguria(decreased urine output)
Swelling of face, hands, feet.
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50
Medical Management
Depends on tissue involvement
Corticosteroids
Immunosuppression, loop diuretics
Low sodium, high-protein diet
51
Tests
Blood chemistry: hypoalbuminemia,
hyperlipidemia
Renal biopsy
52
NSG interventions
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
Acute Clomerulonphritis
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
S/S
```
Swelling of face, esp eyes
Anorexia
Nocturia
Malaise
Exertional dyspnea
Cola-colored to frank sanguineous urine
```
55
Tests
BUN, creatinine
ESR
ASO titer
UA: RBCs, casts, protein
56
Medical Management
Primary symptoms and prevent brain, heart damage
Adjust K+ and Na+ in diet
Bed Rest, fluid adjustments until diuresis
57
NSG interventions
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
Chronic Glomerulonephritis
Slow, progressive destruction of glomeruli w/related loss of function; kidney atrophies
59
S/S
```
Malaise
Morning headaches
Dyspnea w/exertion
Visual/digestive disturbances
Edema
Fatigue
HTN
Anemia, proteinuria, anasarca...
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60
Tests
Albumin, RBCs in urine
Renal function tests are normal
Low creatinine clearance
61
Medical Management
Control of secondary SEs as with acute
| Renal dialysis
62
NSG interventions
```
Good hand washing, infection control
Monitor VS, tests
Watch for fluid excess
I&O
Assess level of activity
Teach:
Preventative health maintenance****
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