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NURS 320 > Exam 2: Urinary Tract Disorders > Flashcards

Exam 2: Urinary Tract Disorders Flashcards

1
Q

Urinary Tract Obstruction

A

An interference with the flow of urine at any site along the urinary tract

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2
Q

Urinary Tract Obstruction can be caused by an

A

An anatomical or functional defect

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3
Q

Obstructive Uropathy

A

Urine cannot drain through a ureter.

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4
Q

Obstructive Uropathy can

A
  1. Affect one or both kidneys

2. Can occur suddenly or be a long-term problem

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5
Q

Severity of Urinary Tract Obstruction is based on

A 
Location
Completeness
Involvement of one or both upper urinary tracts
Duration
Cause
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6
Q

Urinary Tract Obstruction can lead to

A
  1. Hydroureter

2. Hydronephrosis

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7
Q

Hydroureter

A

Dilation or distention of the ureter with fluid

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8
Q

Hydronephrosis

A

Urine backs up into the kidney and causes it to become swollen

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9
Q

In what ways can the body partially counteract negative consequences of unilateral obstruction?

A
  1. Compensatory Hypertrophy

2. Post Obstructive Diuresis

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10
Q

Compensatory Hypertrophy

A 
Causes contralateral (unobstructed) kidney to increase glomeruli and tubules.
Process is reversible with relief of obstruction.
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11
Q

Post obstructive diuresis

A
  • Following the relief of urinary tract obstruction this may occur – period of significant polyuria
  • Urine output > 200mL/hour or greater may be encountered
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12
Q

Post obstructive diuresis occurs primarily with

A

Occurs primarily with bilateral obstruction and is self-limiting

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13
Q

Calculi or Urinary Stones

A

Masses of crystals, protein, or other substances from within and may obstruct the urinary tract.

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14
Q

What are risk factors for developing calculi or urinary stones?

A

Family history
Dehydration
Diet (high in protein, sodium, and sugar)
Overweight and obesity
Digestive diseases and surgery (IBS, chronic diarrhea, gastric bypass surgery)
Other medical conditions (Polycystic kidney disease, hyperparathyroidism)
Medications (diuretics and calcium-based antacids)

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15
Q

How are kidney stones classified?

A

According to the minerals compromising the stones

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16
Q

Types of Renal Calculi

A
  1. Calcium or Phosphate
  2. Struvite
  3. Uric Avid
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17
Q

Calcium or Phosphate Renall Calculi

A

Most Common: most require treatment.

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18
Q

What can cause calcium or phosphate renal calculi?

A

Idiopathic calcium absorption (hypercalciuria, hyperparathyroidism, plus prolonged immobilization)

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19
Q

Struvite Renal Calculi

A

Includes Mg, Ammonium, Phosphate

Forms in alkaline urine during infection.

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20
Q

Uric Acid Renal Calculi

A

Excessive amount from endogenous purines and food.

Consistent acidic urine increases risk.

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21
Q

Clinical Manifestations of Renal Colic

A
  • Moderate to Severe Pain: can be incapacitating; N/V can be present.
  • Usually indicates obstruction: renal pelvis or proximal ureter.
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22
Q

Renal Colic pain originates

A

In the flank and radiates to groin

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23
Q

Renal Calculi: Lower Urinary Tract Symptoms

A

Urgency
Frequent Voiding
Urge incontinence
Lower ureter obstruction

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24
Q

Clinical Manifestations of Renal Calculi

A

Renal Colic
Lower Urinary Tract Symptoms
Gross or Microscopic Hematuria

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25
Renal Calculi: Evaluation consists of
- Urinalysis - 24 hr urine to identify constituents - Intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB) - Spiral abdominal CT
26
Renal Calculi: Goal of Treatment
Reduce size of stones already formed & prevent new stone formation
27
Renal Calculi: Components of Treatment
- High fluid intake - Decreasing dietary intake of stone-forming substances - Stone removal
28
Patients with uric acid stones should be on what kind of diet?
uric acid stones should be on low purine diet -- stay away from red meat, shellfish, and alcohol
29
Urinary Tract Infection
Inflammation of the urinary epithelium caused by bacteria.
30
Urinary Tract Infection can occur where?
Anywhere along the urinary tract. | Most common site is the bladder.
31
Most common pathogen that causes UTI is
Escherichia coli
32
UTI: Clinical Manifestations
Often asymptomatic
33
Common Symptoms of UTIs
Frequency Urgency Dysuria Suprapubic/low back pain
34
Sever Symptoms of UTI
Hematuria Cloudy Urine Flank Pain
35
Elders have the highest risk for developing clinical manifestations of UTIs including
- May be asymptomatic - Confusion, Vague abdominal discomfort - Recurrent + concurrent Illness = increased mortality
36
UTI: Evaluation
Diagnosis via urine Culture Antibiotics Repeat Urine Cultures
37
UTI: Diagnosed via urine culture
Microorganism counts 10,000/ml or more | Urine dipstick testing: Uncomplicated UTI
38
UTI: Antibiotics
Bactrim | Macrobid
39
Bactrim
3 day course For uncomplicated UTI Not a safe antibiotic for pregnant women!
40
Macrobid
7-14 day course For complicated MI Safe to give someone who is pregnant
41
UTI: Repeat urine cultures
1 week after Rx: Every month for three months | Recurrent infection: Q3-4 months for 1 year
42
Acute Cystitis
Inflammation of the bladder
43
Acute Cystitis: Manifestations
Frequency Dysuria Urgency Lower abdominal and/or suprapubic pain
44
Treatment for Acute Cystitis
1. Antibiotic Therapy 2. Increased Fluid intake 3. Avoidance of bladder irritants 4. Urinary analgesics (Pyridium)
45
Antibiotic Therapy to Treat Acute Cystitis
``` Amoxicillin Cephalosporins Ciprofloxacin or Levofloxacin Doxycycline Nitrofurantoin (Macrobid) Sulfonamides (Bactrim) ```
46
Types of Acute Cystitis
- Bladder inflammation - Mild - More Advanced - Prolonged Infection - Most Severe
47
Acute Cystitis: Bladder inflammation
Most common site of UTI
48
Mild acute Cystitis
Mucosa is red
49
More Advanced Acute Cystitis consists of
1. Diffuse Hemorrhage: hemorrhagic cystitis 2. Suppurative Exudates: suppurative cystitis 3. Pus formation
50
Acute Cystitis: Prolonged infection leads to
Sloughing of mucosa -> ulceration : ulcerative cystitis
51
Most Sever Acute Cystitis consists of
Necrosis of bladder wall: gangrenous cystitis
52
What are the types of organisms that cause acute cystitis?
1. E. Coli: Most common 2. Staphylococcus Saprophyticus: 2nd most common 3. Schistosomiasis: strong association w/ bladder cancer
53
Interstitial Cystitis
Persistent and chronic form of “non bacterial” cystitis
54
Clinical Manifestations: Interstitial Cystitis
``` Most common in women 20-30 years old Bladder fullness Frequency Small urine volume Chronic pelvic pain ```
55
Interstitial Cystitis: Treatment Goal
No single treatment is effective | Symptom Relief
56
What causes interstitial cystitis?
Cause is unknown
57
What are the types of interstitial cystitis?
1. Ulcerative Interstitial Cystitis | 2. Non-ulcerative Interstitial Cystitis
58
Ulcerative Interstitial Cystitis
Affects middle-age to older females | Bladder capacity is low (< 1 ½ cups) – decrease is thought to result in part from fibrosis
59
Non-ulcerative Interstitial Cystitis
Most common type | Affects young to middle-age females
60
Treatment for Interstitial Cystitis
Diet modification Bladder Training Drugs
61
Interstitial Cystitis Treatment: Diet Modification
Avoid spicy and high potassium foods Alcohol (ETOH) Tobacco
62
Interstitial Cystitis Treatment: Bladder Training includes
Kegel exercises
63
Interstitial Cystitis Treatment: Drugs include
- Pentosan polysulfate sodium (Elmiron) - restores bladder’s surface lining - Tricyclic antidepressants and NSAIDs for pain
64
Acute Pyelonephritis
Infection of the renal pelvis and interstitium
65
What is the most common risk factor for acute pyelonephritis?
Urinary Obstruction and reflux of urine from bladder
66
Clinical Manifestations of Acute Pyelonephritis
``` Acute onset of symptoms Fevers/chills Flank/groin pain N/V Symptoms of UTI ```
67
Acute Pyelonephritis Antibiotic Treatment
- Penicillins (Ampicillin or Amoxicillin-clavulanate/Augmentin) - Cephalosporins (Ceftriaxone/Rocephin) - Fluoroquinolones (Levofloxacin or Ciprofloxacin)* - Aminoglycosides (Gentamicin) - Sulfonamides (Bactrim DS)
68
Causes of Acute Pyelonephritis
``` Calculi Urine Reflex Pregnancy Neurogenic Bladder Catheterization ```
69
What organisms can cause acute pyelonephritis?
E. Coli | Proteus or Pseudomonas: infections after instrumentation or UT surgery
70
Both E. Coli and Proteus organisms
Split urea into ammonia. | Creates alkaline urine = increases calculi
71
Pathophysiology of Acute Pyelonephritis
1. Spread of infection: Ascending uropathic microorganisms; Typical 2. Severe infections: Localized abscess (Form in medulla & extend to cortex) 3. Tubules primarily affected (Glomeruli usually spared) 4. Necrosis of renal papillae can develop 5. Healing occurs with fibrosis & tubule atrophy (Post acute phase)
72
Acute Pyelonephritis: Clinical Manifestations
Usually acute Fever, chills, flank/groin pain, dysuria, N/V UTI symptoms (Usually precede systemic symptoms)
73
Clinical Manifestations of Pyelonephritis in Older Adults
Nonspecific symptoms: Confusion Low grade fever Malaise
74
Acute Pyelonephritis: Evaluation
Diagnosed via urine culture, urinalysis, signs/symptoms: WBC casts Complicated Blood cultures & imaging
75
Treatment of Uncomplicated Acute Pyelonephritis
- 2-3 weeks antibiotics (fluoroquinolone) - Ciprofloxacin +/- ceftriaxone IV one time dose - Repeat cultures 1 & 4 weeks post antibiotics
76
Chronic Pyelonephritis
Persistent or recurring episodes of acute pyelonephritis that leads to scaring
77
Risk of chronic pyelonephritis increases in
Individuals with renal infections and some time of obstructive pathologic condition
78
Clinical Manifestations of Chronic Pyelonephritis
Early symptoms often minimal HTN Frequency, dysuria, flank pain Progression leads to renal failure
79
Chronic Pyelonephritis: Treatment
Antibiotics with prolonged use for recurrent infection
80
Pathophysiology of Chronic Pyelonephritis
1. Chronic urinary tract obstruction starts progressive inflammation -> Ultimately leads to chronic kidney failure 2. Lesions: Chronic interstitial nephritis d/t inflammation & fibrosis of interstitial space between tubules
81
Clinical Manifestations of Early Chronic Pyelonephritis
``` Often minimal HTN Frequency Dysuria Flank pain ```
82
Clinical Manifestations of Progressive Chronic Pyelonephritis
Kidney failure: especially w/ obstructive uropathy or DM
83
Chronic Pyelonephritis: Evaluation
Diagnose Urinalysis IV pyelography Ultrasound
84
Chronic Pyelonephritis: Treatment
Related to underlying cause Relief of obstruction Long-term antibiotic therapy
85
Urinalysis indicates
``` Specific Gravity Urinary PH Hematuria Proteinuria Glycosuria Ketonuria Nitrates Leukocytes ```
86
Specific Gravity
Patients hydration status
87
Specific Gravity: Normal Range
1.003 - 1.030
88
Specific Gravity: Dehydration Range
>1.020
89
Low Specific Gravity could be d/t
Diuretic Use Diabetes insipidus Impaired Renal Function
90
Urinary pH is useful for
dx of UTIs, calculi, and Renal Tubular Acidosis (RTA): UTI with Alkaline=Struvite calculi Acidodic =Uric Acid calculi Bacteria creates alkaline urine
91
Urinalysis: Hematuria
Dx needs 2-3 urine samples
92
What are the causes of hematuria?
Various causes: glomerular, renal, and urologic (calculi, infections)
93
Urinalysis: Proteinuria
Excretion of >150mg/day Hallmark of renal dx Transient: CHF, dehydration, exercise, stress Primary: IG nephropathy Secondary Glomerular: DM, SLE, Drugs, Cancer Tubular: Drugs, HTN, nephrosclerosis
94
Urinalysis: Glycosuria
Too much for reabsorption by proximal tubule. | DM, Cushing’s, Liver and Pancreatic dx
95
Ketonuria is common in
DKA Pregnancy Carb-free diets Starvation
96
Urinalysis: Nitrates
Presence of infection (gram-negative and gram-positive organisms) Can have UTI dx without nitrates
97
Urinalysis: Leukocyte
May signal infection | Should correlate with symptoms
98
What are antibiotics used to treat UTIs and Pyelonephritis?
- Trimethoprim-Sulfamethoxazole (TMP-SMZ, Bactrim) - Nitrofurantoin (Macrobid) - Fluoroquinolone (Ciprofloxacin)
99
What are analgesics and antipyretics used to treat UTIs and Pyelonephritis?
- Phenazopyridine (Pyridium) - Relieves UT pain and symptoms - OTC
100
Antimicrobial Drugs used to treat UTIs in Women
``` Trimethoprim-Sulfamethoxazole (TMP-SMZ, Bactrim)   Nitrofurantoin (Macrobid)   Fluoroquinolone (Ciprofloxacin) ```
101
Antimicrobial Drugs used to treat a UTI in Men
Fluoroquinolone (Cipro)   TMP-SMZ
102
Antimicrobial drugs used to treat pyelonephritis in an outpatient
Fluoroquinolone (Cipro) | Levofloxacin (Levaquin)
103
Antimicrobial drugs used to treat pyelonephritis in inpatients
TMP-SMX + Ceftriaxone (Rocephin) IV Fluoroquinolone (Cipro) IV
104
Antimicrobial Drugs used in pregnant with with a UTI
Nitrofurantoin (Macrobid) | Cephalexin (Keflex)
105
Antimicrobial drugs are extended how long for patients with a COMPLICATED UTI
7-10 days
106
What are 2nd line Antimicrobial drugs for men with a UTI?
Amoxicillin/clavulanate (Augmentin)—1st line in children

NURS 320 (28 decks)

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