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
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2
Q

Cystitis

A

Inflammatory condition of bladder

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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
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4
Q

Noninfectious Cystitis

A

Results form chemical exposure (drugs), radiation therapy, & from immunologic responses (SLE)

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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

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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
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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
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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
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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
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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
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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
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12
Q

Urethritis in Men

A
  • Manis include burning or difficulty urinating & a discharge from urethral meatus
  • Causes: STIs (gonorrhea, chlamydia, trichomonas)
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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
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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
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15
Q

Urethral Strictures

A

Narrowed areas of urethra

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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