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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
Q

Renal Calculi: Evaluation consists of

A
  • Urinalysis
  • 24 hr urine to identify constituents
  • Intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB)
  • Spiral abdominal CT
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26
Q

Renal Calculi: Goal of Treatment

A

Reduce size of stones already formed & prevent new stone formation

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27
Q

Renal Calculi: Components of Treatment

A
  • High fluid intake
  • Decreasing dietary intake of stone-forming substances
  • Stone removal
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28
Q

Patients with uric acid stones should be on what kind of diet?

A

uric acid stones should be on low purine diet – stay away from red meat, shellfish, and alcohol

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29
Q

Urinary Tract Infection

A

Inflammation of the urinary epithelium caused by bacteria.

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30
Q

Urinary Tract Infection can occur where?

A

Anywhere along the urinary tract.

Most common site is the bladder.

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31
Q

Most common pathogen that causes UTI is

A

Escherichia coli

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32
Q

UTI: Clinical Manifestations

A

Often asymptomatic

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33
Q

Common Symptoms of UTIs

A

Frequency
Urgency
Dysuria
Suprapubic/low back pain

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34
Q

Sever Symptoms of UTI

A

Hematuria
Cloudy Urine
Flank Pain

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35
Q

Elders have the highest risk for developing clinical manifestations of UTIs including

A
  • May be asymptomatic
  • Confusion, Vague abdominal discomfort
  • Recurrent + concurrent Illness = increased mortality
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36
Q

UTI: Evaluation

A

Diagnosis via urine Culture
Antibiotics
Repeat Urine Cultures

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37
Q

UTI: Diagnosed via urine culture

A

Microorganism counts 10,000/ml or more

Urine dipstick testing: Uncomplicated UTI

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38
Q

UTI: Antibiotics

A

Bactrim

Macrobid

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39
Q

Bactrim

A

3 day course
For uncomplicated UTI
Not a safe antibiotic for pregnant women!

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40
Q

Macrobid

A

7-14 day course
For complicated MI
Safe to give someone who is pregnant

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41
Q

UTI: Repeat urine cultures

A

1 week after Rx: Every month for three months

Recurrent infection: Q3-4 months for 1 year

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42
Q

Acute Cystitis

A

Inflammation of the bladder

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43
Q

Acute Cystitis: Manifestations

A

Frequency
Dysuria
Urgency
Lower abdominal and/or suprapubic pain

44
Q

Treatment for Acute Cystitis

A
  1. Antibiotic Therapy
  2. Increased Fluid intake
  3. Avoidance of bladder irritants
  4. Urinary analgesics (Pyridium)
45
Q

Antibiotic Therapy to Treat Acute Cystitis

A 
Amoxicillin
Cephalosporins
Ciprofloxacin or Levofloxacin
Doxycycline
Nitrofurantoin (Macrobid)
Sulfonamides (Bactrim)
46
Q

Types of Acute Cystitis

A
  • Bladder inflammation
  • Mild
  • More Advanced
  • Prolonged Infection
  • Most Severe
47
Q

Acute Cystitis: Bladder inflammation

A

Most common site of UTI

48
Q

Mild acute Cystitis

A

Mucosa is red

49
Q

More Advanced Acute Cystitis consists of

A
  1. Diffuse Hemorrhage: hemorrhagic cystitis
  2. Suppurative Exudates: suppurative cystitis
  3. Pus formation
50
Q

Acute Cystitis: Prolonged infection leads to

A

Sloughing of mucosa -> ulceration : ulcerative cystitis

51
Q

Most Sever Acute Cystitis consists of

A

Necrosis of bladder wall: gangrenous cystitis

52
Q

What are the types of organisms that cause acute cystitis?

A
  1. E. Coli: Most common
  2. Staphylococcus Saprophyticus: 2nd most common
  3. Schistosomiasis: strong association w/ bladder cancer
53
Q

Interstitial Cystitis

A

Persistent and chronic form of “non bacterial” cystitis

54
Q

Clinical Manifestations: Interstitial Cystitis

A 
Most common in women 20-30 years old
Bladder fullness
Frequency
Small urine volume
Chronic pelvic pain
55
Q

Interstitial Cystitis: Treatment Goal

A

No single treatment is effective

Symptom Relief

56
Q

What causes interstitial cystitis?

A

Cause is unknown

57
Q

What are the types of interstitial cystitis?

A
  1. Ulcerative Interstitial Cystitis

2. Non-ulcerative Interstitial Cystitis

58
Q

Ulcerative Interstitial Cystitis

A

Affects middle-age to older females

Bladder capacity is low (< 1 ½ cups) – decrease is thought to result in part from fibrosis

59
Q

Non-ulcerative Interstitial Cystitis

A

Most common type

Affects young to middle-age females

60
Q

Treatment for Interstitial Cystitis

A

Diet modification
Bladder Training
Drugs

61
Q

Interstitial Cystitis Treatment: Diet Modification

A

Avoid spicy and high potassium foods
Alcohol (ETOH)
Tobacco

62
Q

Interstitial Cystitis Treatment: Bladder Training includes

A

Kegel exercises

63
Q

Interstitial Cystitis Treatment: Drugs include

A
  • Pentosan polysulfate sodium (Elmiron) - restores bladder’s surface lining
  • Tricyclic antidepressants and NSAIDs for pain
64
Q

Acute Pyelonephritis

A

Infection of the renal pelvis and interstitium

65
Q

What is the most common risk factor for acute pyelonephritis?

A

Urinary Obstruction and reflux of urine from bladder

66
Q

Clinical Manifestations of Acute Pyelonephritis

A 
Acute onset of symptoms
Fevers/chills
Flank/groin pain
N/V
Symptoms of UTI
67
Q

Acute Pyelonephritis Antibiotic Treatment

A
  • Penicillins (Ampicillin or Amoxicillin-clavulanate/Augmentin)
  • Cephalosporins (Ceftriaxone/Rocephin)
  • Fluoroquinolones (Levofloxacin or Ciprofloxacin)*
  • Aminoglycosides (Gentamicin)
  • Sulfonamides (Bactrim DS)
68
Q

Causes of Acute Pyelonephritis

A 
Calculi
Urine Reflex
Pregnancy
Neurogenic Bladder
Catheterization
69
Q

What organisms can cause acute pyelonephritis?

A

E. Coli

Proteus or Pseudomonas: infections after instrumentation or UT surgery

70
Q

Both E. Coli and Proteus organisms

A

Split urea into ammonia.

Creates alkaline urine = increases calculi

71
Q

Pathophysiology of Acute Pyelonephritis

A
  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
Q

Acute Pyelonephritis: Clinical Manifestations

A

Usually acute
Fever, chills, flank/groin pain, dysuria, N/V
UTI symptoms (Usually precede systemic symptoms)

73
Q

Clinical Manifestations of Pyelonephritis in Older Adults

A

Nonspecific symptoms:
Confusion
Low grade fever
Malaise

74
Q

Acute Pyelonephritis: Evaluation

A

Diagnosed via urine culture, urinalysis, signs/symptoms:
WBC casts
Complicated
Blood cultures & imaging

75
Q

Treatment of Uncomplicated Acute Pyelonephritis

A
  • 2-3 weeks antibiotics (fluoroquinolone)
  • Ciprofloxacin +/- ceftriaxone IV one time dose
  • Repeat cultures 1 & 4 weeks post antibiotics
76
Q

Chronic Pyelonephritis

A

Persistent or recurring episodes of acute pyelonephritis that leads to scaring

77
Q

Risk of chronic pyelonephritis increases in

A

Individuals with renal infections and some time of obstructive pathologic condition

78
Q

Clinical Manifestations of Chronic Pyelonephritis

A

Early symptoms often minimal
HTN
Frequency, dysuria, flank pain
Progression leads to renal failure

79
Q

Chronic Pyelonephritis: Treatment

A

Antibiotics with prolonged use for recurrent infection

80
Q

Pathophysiology of Chronic Pyelonephritis

A
  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
Q

Clinical Manifestations of Early Chronic Pyelonephritis

A 
Often minimal
HTN
Frequency
Dysuria
Flank pain
82
Q

Clinical Manifestations of Progressive Chronic Pyelonephritis

A

Kidney failure: especially w/ obstructive uropathy or DM

83
Q

Chronic Pyelonephritis: Evaluation

A

Diagnose
Urinalysis
IV pyelography
Ultrasound

84
Q

Chronic Pyelonephritis: Treatment

A

Related to underlying cause
Relief of obstruction
Long-term antibiotic therapy

85
Q

Urinalysis indicates

A 
Specific Gravity 
Urinary PH
Hematuria
Proteinuria
Glycosuria
Ketonuria
Nitrates 
Leukocytes
86
Q

Specific Gravity

A

Patients hydration status

87
Q

Specific Gravity: Normal Range

A

1.003 - 1.030

88
Q

Specific Gravity: Dehydration Range

A

> 1.020

89
Q

Low Specific Gravity could be d/t

A

Diuretic Use
Diabetes insipidus
Impaired Renal Function

90
Q

Urinary pH is useful for

A

dx of UTIs, calculi, and Renal Tubular Acidosis (RTA):
UTI with Alkaline=Struvite calculi
Acidodic =Uric Acid calculi
Bacteria creates alkaline urine

91
Q

Urinalysis: Hematuria

A

Dx needs 2-3 urine samples

92
Q

What are the causes of hematuria?

A

Various causes: glomerular, renal, and urologic (calculi, infections)

93
Q

Urinalysis: Proteinuria

A

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
Q

Urinalysis: Glycosuria

A

Too much for reabsorption by proximal tubule.

DM, Cushing’s, Liver and Pancreatic dx

95
Q

Ketonuria is common in

A

DKA
Pregnancy
Carb-free diets
Starvation

96
Q

Urinalysis: Nitrates

A

Presence of infection (gram-negative and gram-positive organisms)
Can have UTI dx without nitrates

97
Q

Urinalysis: Leukocyte

A

May signal infection

Should correlate with symptoms

98
Q

What are antibiotics used to treat UTIs and Pyelonephritis?

A
  • Trimethoprim-Sulfamethoxazole (TMP-SMZ, Bactrim)
  • Nitrofurantoin (Macrobid)
  • Fluoroquinolone (Ciprofloxacin)
99
Q

What are analgesics and antipyretics used to treat UTIs and Pyelonephritis?

A
  • Phenazopyridine (Pyridium)
  • Relieves UT pain and symptoms
  • OTC
100
Q

Antimicrobial Drugs used to treat UTIs in Women

A 
Trimethoprim-Sulfamethoxazole (TMP-SMZ, Bactrim)

Nitrofurantoin (Macrobid)

Fluoroquinolone (Ciprofloxacin)
101
Q

Antimicrobial Drugs used to treat a UTI in Men

A

Fluoroquinolone (Cipro)

TMP-SMZ

102
Q

Antimicrobial drugs used to treat pyelonephritis in an outpatient

A

Fluoroquinolone (Cipro)

Levofloxacin (Levaquin)

103
Q

Antimicrobial drugs used to treat pyelonephritis in inpatients

A

TMP-SMX + Ceftriaxone (Rocephin) IV

Fluoroquinolone (Cipro) IV

104
Q

Antimicrobial Drugs used in pregnant with with a UTI

A

Nitrofurantoin (Macrobid)

Cephalexin (Keflex)

105
Q

Antimicrobial drugs are extended how long for patients with a COMPLICATED UTI

A

7-10 days

106
Q

What are 2nd line Antimicrobial drugs for men with a UTI?

A

Amoxicillin/clavulanate (Augmentin)—1st line in children

NURS 320 (28 decks)

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