Exam#3 Flashcards
What are UTI’s caused by?
-Pathogenic microorganisms in the urinary tract
-Can be uncomplicated of complicated depending on patient complications
Lower UTI’s
Bacterial cystitis
Prostatitis
Urethritis
Upper UTI’s
Acute and chronic pyelonephritis
Interstitial nephritis
Renal nephritis
Uncomplicated Lower or Upper UTI’s
Common in young women but not usually recurrent
Complicated Lower and Upper UTI’s
Usually occur in people with urologic abnormalities or recent catheterization
Often acquired during hospitalization
Access method of UTI
Occurs first when the bacteria gains access inside the urinary tract
Attachment method of UTI
Bacteria attach to the epithelium of the urinary tract and colonize to avoid being washed out
Inflammation method of UTI
As a defense mechanism to the bacteria, inflammation starts to set along with other signs of infection
What does UTI cause
Inability or failure to empty bladder
Catheterization or cystoscopy
Obstructed urinary flow
Immunosuppression
Clinical manifestations of UTI
Dysuria (painful urination)
Frequency (more than Q3hrs)
Nocturia
Suprapubic/Pelvic pain
Urgency
How to prevent UTI’s
Avoid bath tubs
Perineal hygiene
Increase fluid intake
Voiding habit
Medications
Avoid urinary tract irritants
Complications of UTI’s
Renal failure
Urosepsis
How to diagnose UTI’s
Urine cultures
STD tests
CT scan
Ultrasonography
Medical management of UTI’s
Acute pharmacologic therapy- antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora
Long-term pharmacologic therapy- Re-infection with new bacteria is the reason for recurrence; patients are instructed to self treat when symptoms occur
Nursing assessments of UTI’s
Assess for frequency, urgency, or hesitancy
Assess patients knowledge about antimicrobials and preventative care
Assess urine color, odor, concentration, volume, and cloudiness
Nursing diagnosis of UTI’s
Acute pain related to infection within urinary tract
Deficient knowledge related to factors and preventions of disease
Nursing interventions of UTI’s
Relieve pain- Analgesics and heat help relieve pain and spasm
Fluids- increased fluids promotes renal blood flow to flush bacteria
Voiding- Q2-3hrs
Irritants- avoid coffee, tea, colas, and alcohol
What is Pyelonephritis?
Infection in the kidneys and is caused by a bacterial infection of the lower urinary tract
Can be acute or chronic
Most common organism causing pyelonephritis
Escherichia coli
Signs and Symptoms of Pyelonephritis
Flank pain
Dysuria
Polyuria
Urinary urgency
Urinary frequency
Malaise
Fever
Nausea
Vomiting
Complications of Pyelonephritis
Kidney failure
Renal scarring
Sepsis
What to assess in pyelonephritis
Symptoms
Description of pain
CVA
Labs (UA, CX, Ultrasound, CT)
Nursing interventions for pyelonephritis
Mangage pain
Mangage fever
Give meds
Increase fluids
Encourage avoidance of soda, tea, alcohol, coffee, spices
Encourage voiding frequently
Assist in non-pharmacologic techniques for pain
Educate
What is Urolithiasis (Renal Calculi)
Stones in the urinary tract
Are formed when calcium oxalate, calcium phosphate, and uric acid increase
Vary in size
Increases risk of infection, urinary stasis, and immobility
What is nephrolithiasis
Stones forming in the kidney
What is ureterolithiasis
Stones formed in the ureters
Clinical manifestations of stones in renal pelvis
Hematuria
Polyuria
Pain that radiates toward bladder(female), testicles(male)
Acute pain
Nausea
Vomiting
Abdominal discomfort
Diarrhea
Pain in costovertebral region
Clinical manifestations of ureteral colic (stones in ureter)
Acute, excruciating wavelike pain that radiates down thigh and pelvic region
Frequent desire to void
Usually contains blood
Clinical manifestations of stones in bladder
Irritation
Urinary retention
Possible urosepsis
How to diagnose urolithiasis
KUB
Ultrasound
IVP
CT (non-contrast)
UA
BUN
CBC
PTH
Nursing priorities for urolithiasis
Alleviate pain
Maintain adequate renal functioning
Prevent complications
Educate
Medical management of urolithiasis
Increase fluids
Increase calcium for calcium stones
HCTZ for calcium stones
Low purine and low protein for uric acid
Allopurinol for uric acid
Medical management for urolithiasis
Stone removal
Ureteroscopy- stones fragmented with use of laser, ultrasound, and electrohydraulicn lithotripsy
Extracorporeal shock wave lithotripsy
Electrohydraulic lithotripsy
Chemolysis- alternative for those at risk with other therapies
Surgical removal
Nursing assessment
Assess for pain (severity, location, radiation)
Associated symptoms (abdominal pain, NVD)
Observe, for (hematuria, strain, urine for stones.)
Complications of urolithiasis
Infection
Urinary tract obstruction
Acute renal failure
Hydronephrosis
Nursing interventions for urolithiasis
Administer opioid analgesics
Encourage positions of comfort
Assist with ambulation
Monitor pain
Encourage increased fluids
Begin IV fluids
Monitor output
Strain urine
Nursing interventions
Instruct patient to report, decreased volume, bloody or cloudy urine, fever, pain
Monitor vital signs for infection
What is glomerulonephritis?
Auto immune condition that triggers inflammation and proliferation of globular tissue that can result in damage to the basement membrane or capillary endothelium
Most often caused by group a beta hemolytic streptococcal infection
