Exam 3 Study Guide - Urinary Problems Flashcards
1
Q
Factors Contributing to UTIs
A
- Obstruction
- Stones (calculi)
-
Vesicoureteral Reflux
> bacteria laden urine if forced backward from bladder up into ureters & kidneys -
Diabetes Mellitus
> excess glucose in urine provides a rich medium for bacterial growth -
Characteristics of Urine
> alkaline urine & concetrated urine promotes bacterial growth -
Gender
> incrd incidence in female -
Age
> incrd incidence in older adutls - Sexual activity
-
Recent use of antibiotics
> antibiotics change normal protective flora
2
Q
Cystitis
A
Inflammatory condition of bladder
3
Q
Infectious Cystitis
A
- Caused by pathogens from bowel or in some cases, the vagina
- 90% are caused by Escherichia coli
- Can lead to life-threatening comps including pyelonephritis & sepsis
4
Q
Noninfectious Cystitis
A
Results form chemical exposure (drugs), radiation therapy, & from immunologic responses (SLE)
5
Q
Interstitial Cystitis
A
Rare, chronic inflammation of entire lower urinary tract (bladder, urethra, & adjacent pelvic muscles) tht is not a result of infection
6
Q
Urosepsis
A
- Spread of infection from urinary tract to bloodstream
- Urinary tract is the infection source of severe sepsis or shock in abt 10-30% of cases
7
Q
Cystits Prevention
A
- Drink 2-3L daily
- Get enough sleep, rest, & nutrition daily
- If spermicides are used, consider chagning to another method of contraception
-
Women
> cleanse perineum area from front to back
> avoid using or wearing irritating substances
> empty bladder b4 & after intercourse
> gently was perineal are b4 & after intercourse - Do not routinely delay urination
- Notify PCP if S/S of UTI develop
-
Nutrition supplements to reduce risk of developing UTI
> cranberry substances
> ingest apple cider vinegar
> apply topical estrogen to perineal area
> ingest D-mannose -
Prevention (inpt care)
> reduce use of indwelling caths
> abt 50% of inpt become infected w/in 1wk of cath insertion
8
Q
Cystitis - Common CMs
A
- Most common: frequency, urgency, dysuria
- hesitancy or difficulty in initiating stream
- low back pain
- nocturia
- incontinence
- hematuria
- pyuria
- bacteriuria
- retention
- suprapubic tenderness or fullness
- feeling of incomplete bladder emptying
9
Q
Cystitis - Lab Assessment
A
- Urinalysis
> presence of 100,00 colonies/mL or 3 or more WBCs (pyuria) w/ RBCs (hematuria) indicates infection
> Urine culture: confirms type of organism & # of colonies
> Serum WBC count may be elevated
10
Q
Cystitis - Diagnostic Assessment
A
- Pelvis US or CT
- Voiding cystourethrography
> when urine reflux is suspected - Cystoscopy
> performed when pt has recurrent UTIs (3 or 4 in a yr)
> identifies abnormalities tht incr risk for cystitis
> needed to accurately diagnose interstitial cystitis
11
Q
Cystitis - Interventions
drug
fluids
comfort
A
-
Drug Therapy
> Antiseptics: used for relief of local symps; inflamm, hypermotilitu, & pain
> Antibiotics: used for bacterial UTIs
> Analgesics: reduce bladder pain & burning on urination by exerting a topical analgesic or local anesthetic effect on mucosa of urinary tract, Phenazypyridine (Pyridium) will turn urine red or orange
> Antispasmodics: dcr bladder spasm & promote complete bladder emptying -
Maintain adequate fluid intake
> incr intake -
Avoid fluids or food tht can irritate bladder
> caffeine & carbonated bevs
> tomato products -
Comfort measures
> warm sitz bath 2-3x/day for 20mins
12
Q
Urethritis in Men
A
- Manis include burning or difficulty urinating & a discharge from urethral meatus
- Causes: STIs (gonorrhea, chlamydia, trichomonas)
13
Q
Urethritis in Women
A
- Manis similar to those of cystitis
- Most common in postmenopausal women & caused by tissue changes r/t low estrogen lvls
14
Q
Urethritis - Assessment
assess
lab
treatment
A
-
Assessment
> hx of STI
> painful or difficulty urination
> discharge from penis or vagina
> discomfort in lower abdomen -
Lab
> urinalysis may show WBCs (pyuria) w/out large # of bacteria - Treatment: antibiotic therapy
15
Q
Urethral Strictures
A
Narrowed areas of urethra
16
Q
Urethral Strictures - Causes
A
- Complication of STD
- trauma during catheterization, urologic procedures, or childbirth
- 1/3 have no obvious cause
- occur more often in men
17
Q
Urethral Strictures
symps
comps
treatment
A
- Symptom: obstruction of urine flow
-
Complications
> at risk for developing UTI
> overflow incontinence: involuntary loss of urine when bladder is overdistended -
Treatment: (surgical)
> dilation of urethra (temporary)
> urethroplasty
18
Q
Urolithiasis Etiology
A
- Unknown
- 90% have a metabolic risk factor
> calcium & vit D supplementation
> high-dose ascorbic acid (vit C)
19
Q
Urolithiasis - Risk Factors
A
- Family hx
- Overweight
- Diet (animal proteins, dcr fluid intake)
- Hx of urinary tract infections
- stones usually don’t cause symps until they pass into lower urinary tract
20
Q
Urolithiasis - Assessment
A
- Hx
-
CMs
> severe pain (renal colic)
> hematuria
> N/V, pallor, diaphoresis
> frequency & dysuria occur when a stone reaches bladder
> flank pain suggests tht stone is in kidney or upper ureter
> flank pain tht extends toward abdomen or to scrotum & testes or vulva suggestions tht stones are in ureters or bladder
> pain is most intense when stone is moving or when ureter is obstructed
> oliguria (scant urine output) & anuria (absence of urine output) suggests obstruction; Obstructions is an emergency & must be treated immediately to preserve kidney func - hydronephrosis which is enlargemetn of kidney may occur
21
Q
Urolithiasis - Lab & Diagnostic
A
-
Lab
> urinalysis (hematuria is common)
> WBCs & bacteria may be present as a result of urinary stasis
> elevated serum WBC w/ infection - Diagnostic: KUB x-ray, CT, US
