Disorders of the urinary system Flashcards
Classification of Urinary Tract Infection (UTI)
1. Upper Urinary Tract Infection (UTI): Pyelonephritis 2. Lower Urinary Tract Infection (UTI): Cystitis UTIs are the most common hospital-acquired infection
Lower UTI causes
- BPH
- Calculi
- Urethral strictures
- Tumors
- Sexual intercourse
- Blood born infection
Upper UTI causes
- Calculi
- Trauma
- Tumor
- Aneurysm
- Congenital anomaly
Other causes
- Noninfectious :
- Chemical exposure: Drugs: Cyclophosphamide (Cytoxan) - Radiation therapy
- Foreign bodies
- Urinary calculi
- Indwelling catheter - Factor compromising Immune response
- HIV
- Diabetes - Hematogenous route
- Complications
- Pyelonephritis
UTI: Cystitis : manifestations
- Dysuria
- Urinary: Frequency; Urgency; Hesitancy
- Suprapubic: Pain; Discomfort; Pressure
- Hematuria
- Pyuria (WBC)
- Urethral discharge : Cloudy/foul smelling urine
- Perineal itching
- Mental status changes
- Hydronephrosis
UTI: Cystitis: TX
- Drugs - aim to reduce bacteria in urinary tract / pain: Bactrim, Lexaquin, Amoxil, Macrobid, Cipro
- Education about antibiotics: take entire prescribed dose;
- Prevention of recurrence
- Sensitivity to those with anxiety/ embarrassment.
Preventing a UTI
- Drink 2-3 L every day - 8-10 glasses
- Sleep, rest, nutrition
- W: clean from front to back; avoid bubble bath, nylon underwear; scented tissues; wear cotton underwear ! empty before and after intercourse.
- Empty as soon as feel urge (every 4 hr)
- Home therapies: cranberries juice, apple cider vinegar, vitamin C to acidify the urine!!
- prevent recurrence: complete antibiotics ;follow appointment ;
Pyelonephritis
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
Acute Pyelonephritis: appearance
kidney is swollen with multiple abscesses (yellowish gray streaks)
Acute Pyelonephritis: manifestations
Chills Fever Nausea/Vomiting Malaise Flank, back pain !!!! Nocturia
Acute Pyelonephritis: complications
Chronic Pyelonephritis
Temporary altered kidney function
Rarely progresses to renal failure
Chronic Pyelonephritis: manifestations
Hypertension
Inability to conserve sodium
Decreased urine concentrating ability/Nocturia
Hyperkalemia and acidosis
Chronic Pyelonephritis: complications
Scar tissue
Hypertension
Renal failure
Urinalysis: Color
dark amber; very pale; dark red
Urinalysis: Odor
foul smell: possible infection
Urinalysis: Turbidity
Cloudy urine: urinary protein; infection
Urinalysis: spesific gravity
1.005-1.030
Urinalysis: pH
average: 6 : range: 4.6-8
Urinalysis: Protein
0.8 mg/dL
Urinalysis: RBC
0-2 per high power field
Urinalysis: WBC
M: 0-3; F: 0-5
Voided urine
first specimen voided in the morning; send as soon as possible - if not refrigerate
Clean - catch specimen
self clean before voiding ( front to back) ,(head of the penis downward); initiate voiding; stop; resume into container; 1 oz (30 ml).
24 hour urine collection
initial: void, discard, note time; Foley:empty bag at the start time; collect urine for the next 24 hr; signs! let know!
KUB
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.
using contrast media
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 ?
Intravenous (IV) Urography ( excretory urography, IV pyelography)
outlines urinary tract and helps determine any problems; measure kidney size, detect obstruction, assess parenchymal mass.
- Contrast medium - allergic reaction in iodine sensitive patients.
- Hypertonic contrast agent - risk for acute renal failure when SC > 1.5 mg/dL
- Nephrotoxic complications can be prevented by parenteral fluid administration.
Excretory Urogram : patient education
- shell fish or iodine allergies ?;
- metformin (Glucophage) ?;
- asthma?;
- bowel preparation;
- laying on x-ray table with x-ray machine above;
- pressure band around stomach
- IV contrast agent: feel heat , metallic taste (few min);
- series of x-rays will be taken; empty bladder - more x-rays; 9.normal activities after.
Excretory Urogram: contrast reactions
- minor: N/V, urticaria, itching, sneezing;
- moderate: nephrotoxic effects, congestive heart failure, pulmonary edema;
- severe: bronchospasm, anaphylaxis
Minor allergy - give steroids and antihistamines before procedure
Excretory Urogram : follow up care
- Monitor for altered renal function
- Ensure adequate hydration : oral fluids or IV fluids - reduces the risk of renal damage;
- Monitor blood creatinine levels
Excretory Urogram : Metformin
Risk for lactic acidosis; discontinued at time of procedure and 48 hr after.
UTI: drug therapy
Usually starts with Broad-spectrum antibiotics
Then switch to sensitivity guided therapy
UTI: drugs
- Sulfanomides : Trimethoprim/sulfamethoxazole (Bactrim, septra) - sulfa drug allergies; full glass of water;keep out of sun; complete drug.
- Quinolones : Ciprofloxacin (Cipro) - swallow whole, 2 hr after antacid; keep out of sun.
- Penicillin : Amoxicillin (Amoxil) -allergies; take with food; diarrhea - call; interacts with birth control; take all not to develop resistance.
- Bladder analgesic : Phenzopyridine (Pyridium) - reduces pain
Surgical Management
Cystoscopy
Correction of Obstruction
Correction of structural problems
Eradication of infectious source
Perioperative Care
Preoperative: Antibiotic therapy, client Teaching
Operative: Pyelolithotomy, nephrectomy, ureteroplasty
Postoperative
Nursing Diagnoses
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
Glomerulonephritis (GN)
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
Azotemia
build up of wastes in the body
GN: etiology
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
Chronic GN
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
GN
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 .
GN:Laboratory and Diagnostic Tests
24-hour urine collection Specimens culture Renal Biopsy Plasmapheresis Antistreptolysin-O titers
GN:Laboratory and Diagnostic Tests
1, Urinalysis
- Serum electrolytes : high Sodium,Potassium,Phosphate;
- Acidosis
- Serum Creat >6mg/dL
- GFR high
- Protein: <2g/24hour collection
GN: treatment
Diet changes Fluid intake Drug therapy Dialysis Transplantation
GN: treatment
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
GN: client education
Purpose and desired effects of prescribed medications Dietary and fluid modifications Daily weight Daily B/P monitoring Peritoneal or vascular access care
Nephrotic syndrome
A condition of increased glomerular permeability that allows larger molecules to pass
through the membrane into the urine and be removed from the blood.
NS: etiology
Immune or inflammatory processes
Altered liver activity may occur with NS: increased lipid production and Hyperlipidemia
Also occurs as a result of genetic defects.
NS: manifestations
- Massive proteinuria
- Hypoalbuminemia
- Edema
- Lipiduria
- Hyperlipidemia
- Increased coagulation
- Renal insufficiency
NS: treatment
Suppressive therapy
O Steroids
O Cytotoxic
O Immunosuppressive agents
NS: treatment
- 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
NS: diet changes
- Normal GFR: Dietary intake of protein is needed
- Decreased GFR: Dietary protein intake must be decreased
- Sodium restrictions
