Exam 5 - GU Flashcards
T or F. the urinary tract is sterile above the urethra.
True
most common bacteria r/t UTI
e. coli
2 locations for UTI
upper (complicated)
lower (uncomplicated)
upper UTI involves which 2 structures
kidney
ureter
lower UTI involves with 2 structures
bladder
urethra
methods that keep the urinary tract sterile
normal voiding
bladder emptying
acid urine
urea concentration
peristalsis
physiologic competence
alterations that can lead to a UTI
gram (-) bacilli
CAUTI
stones
incomplete voiding
urethrovesical reflux
sexual intercourse
s/sx of a lower UTI
malodorous urine
hazy urine
hematuria
hesitancy, intermittency
incomplete emptying
dysuria
suprapubic/low back pain
frequency, urgency
nocturia
incontinence
upper UTI s/sx
same as lower PLUS
fever
flank pain
sepsis
s/sx of UTI in elderly
vague
lethargy/fatigue
confusion
non-localized abdominal pain
how is a UTI dx
clinical s/sx
UA
dipstick
C/S
imaging
CVA tenderness
blood cultures (sepsis)
when should a C/S be performed
before administering abx
benefits for dx with a dipstick
cost effective
quick
less sensitive
timing
UTI self/home testing
DUS 10
empiric therapy for UTI
based on HCP judgement
C/S
uncomplicated UTI treatment
short term antimicrobials (x3 days)
complicated UTI treatment
antimicrobial therapy (7-10 days)
more potent med
sometimes IV
review UTI meds on slide 13
review UTI meds on slide 13
when is prophylactic therapy used for UTI
repeated UTI
low dose TMP/SMX, nitrofurantoin, or abx
phenazopyridine education
will turn bodily fluids orange
those who are at risk for UTI
immunocompromised
poor health conditions
elderly
obstructions/catheters
residual urine
constipation
sexually active females
post-menopausal
primary prevention re: UTI
empty bladder regularly, completely
regular BM
wipe front to back
cranberry juice, pills
void before, after intercourse
good perineal hygiene
avoid harsh soaps, douche, powder
shower, not bathe
report s/sx ASAP
drink 1/2 weight in fluid daily
how to avoid CAUTI
remove ASAP
aseptic technique
good cath care
what to avoid during UTI
caffeine
chocolate
spicy foods
alcohol
citrus juices
what is pyelonephritis
acute, upper UTI (begins as lower UTI)
infection of renal parenchyma and collecting system
frequent factors r/t pyelonephritis
vesicoureteral reflux
obstructions
-stone, BPH, catheter
s/sx of pyelonephritis
lower UTI s/sx
fever
chills
flank pain
N/V
malaise
fatigue
how to dx pyelonephritis
UA
UA with C/S
CBC with diff
US/CT
IVP (dye used to see movement through kidneys)
mild pyelonephritis abx length
abx for 14-21 days
chronic pyelonephritis is caused by…
frequent bouts of acute pyelonephritis
chronic pyelonephritis can lead to…
ESRD
HTN
kidney stones
T or F. chronic pyelonephritis pts are usually asymptomatic
True
Normal post void residual
50-75 mL
when is post void residual concering
> 100 mL
causes of urinary retention
obstructions
DM
ETOH
Neuro deficits
some medications
deficient detrusor muscle
urinary retention management
voiding schedule
double voiding
catheter
meds (alpha blockers)
surgery
implant
have pt blow bubbles into a cup via straw to relax the muscles
urinary retention education
drink small amounts throughout the day
limit ETOH
warm bath
drink caffeine
intermittent, indwelling cath (aseptic technique)
solid particles in the urinary system
renal calculi
renal calculi s/sx
pain (mild, severe)
N/V
hematuria
chills, fever (r/t secondary infection)
urgency, frequency, hesitancy
where can renal calculi occur?
anywhere in the urinary tract
what are the 5 types of calculi
calcium oxalate (most common)
struvite (least common)
calcium phosphate
uric acid
cystine
what is sturvite formed
urine becomes alkaline creating the stone
Mag + ammonium + phosphite
calculi risk factors
hx of
dehydration
warm climate
infections
obstructions
metabolic disorders (kidney, GI)
diet (excessive CA, alkali)
urinary pH
acidic urinary pH can cause which 2 stones
uric acid
cystine
basic urinary pH can cause which 2 stones
Calcium
Phosphate
how to Dx calculi
noncontrast CT
UA (pH, blood)
analysis of stone
serum: electrolytes, uric acid, BUN, crt
24 hour urine
what should be done with all urine
strained
size to let a calculi pass naturally
< 4mm
alpha blockers for calculi
tamsulosin
terazosin
dietary changes r/t calculi
low sodium
low calcium
drink enough water to void 2 L daily
Calcium oxalate stone medications
thiazide diuretics
K citrate
cholestyramine
phosphate
uric acid stone meds
K citrate
allopurinol
uric acid stone diet
low purine
cystine stone meds
K citrate
A-penicillamine
tiopronin
most common urinary diversion
ileal conduit
what is an ileal conduit
form a stoma in the skin with one end; attach ureters to the other end
ureterostomy
ureters are directed through the abdominal wall
5 W’s for postop
wind (air, breathing)
water (fluids, electrolytes, UOP)
walking (DVT)
wound (infection)
wonder (drugs)
T or F. hematuria and mucous are normal finds in postop care for urinary diversions
True
hematuria for the first 48 hours
how long will urinary stents stay in place
10-21 days
do not want stoma to become tight around stents
how often to inspect a new stoma
q4h
when to change a stoma/urinary bag
1/3 to 1/2 full
when to change a stoma/urinary bag
in the AM (d/t long interval without fluid)
reusable stoma/urinary bag education
rinse
soak in vinegar water or deodorizing solution
rinse
air dry
indiana pound
urine collection pouch create from pieces of the colon and the ureters attach
drained with a catheter
ureterosigmoidostomy
ureters are attached to the sigmoid colon
urine flow is controlled by the anal sphincter
indiana pouch postop care
irrigate stoma 2-3 times daily
monitor I&O
drain q4-6 hours
indiana pouch postop care
irrigate stoma 2-3 times daily
monitor I&O
drain q4-6 hours
cover with light dressing
keep stoma clean, dry
you must empty ___ frequently with a ureterosigmoidostomy
bowels
ureterosigmoidostomy diet
low chloride
avoid gas forming foods
increase K
if a large part of the ileum is removed, what type of vitamin deficiency may be present
vitamin b12
peritonitis s/sx
abdominal pain, distension
muscle rigidity, guarding
N/V
paralytic ileus
