Genitourinary Flashcards
Urinary Tract Infection
UTI
Infection of the urethra and the bladder
Pyelonephritis
Kidney Infection
Signs and symptoms of UTI
Fever
Dysuria “Burning during urination”
Urinary frequency: constant feeling of having to void
UTI Diagnosis
Urinalysis:
Cloudy and Smelly urine
Filled with WbC
Nitrites - indicates kidney infection
Urine Culture and Sensitivity
Over 10,000 organisms/ml indicates UTI, anything less is typically normal
* Cultures always taken first then give antibiotics
cloudy urine specimen is an indication of:
Bacteria in urine
Patient reporting dysuria and frequency… which test does the nurse anticipate to be ordered
Urine culture
Client with signs and symptoms of UTI collected a mid-stream urine specimen 2 hours prior and left it sitting in the bathroom…what is the nurses priority action?
Discard the specimen and obtain a new specimen
Cystitis
Bladder Infection
If this infection gets bad enough it can climb the ureters to infect the kidneys known as pyelonephritis (kidney infection)
Acute Glomerulonephritis
It is the inflammation of the glomerulus which is the main filtering unit of the kidney.
Toxins, metabolic wastes and excess fluid are not properly filtered = build up in the body causing swelling and fatigue. Protein and red blood cells will be present in the urine (hematuria, proteinuria)
May be caused by infections such as strep throat
Complications of Acute Glomerulonephritis
Hematuria: patient will present with cola colored or tea colored urine
Proteinuria (mild): this can lead to low amounts of protein found in the blood
Fluid overload: at risk for heart failure, renal failure, and respiratory distress due to congestion of fluid in lungs (retaining salt and water), hypertension
Decrease glomerular filtration rate
Low Urine Output: Oliguria (watch potassium levels…hyperkalemia…the potassium will start to build-up in the blood
Hypertension: decreased filtration rate of the kidneys, increased blood volume, and retaining sodium.
At risk for hypertensive encephalopathy due to prolonged/untreated high blood pressure which can affect the brain…watch for neuro changes, headaches, and seizures
Signs and symptoms of Acute Glomerulonephritis
“HAD STREP”
Hypertension
ASO (antistreptolysin titer positive)
Decrease GFR - low urine output
Swelling in face and eyes
Tea coloured urine (from hematuria)
Recent strep infection
Elevated BUN and Creatinine
Proteinuria
Nursing Interventions for Acute Glomerulonephritis
Monitor fluid status
Daily weights
Strict calculation of intake and output
Monitor BUN and Creatinine levels ….renal failure
Sodium restriction along with fluid restriction diet (helps with edema and hypertension) and if oliguria is present restrict potassium-rich foods until recovered
*Since the disorder mainly affects the pediatric population remember these patients should void 1mL/kg/hr.
Administering diuretics and antihypertensives or antibiotics to treat presenting strep infection (if needed…not always ordered) per MD order
What happens when there is a low amount of protein the blood?
Swelling in the interstitial tissue…hence EDEMA. The swelling mainly presents in the face/eyes and will be mild.
What is the nephron?
The functional unit of the kidney that filters the blood and reabsorbs/secretes mineral, water, and waste, which is urine.
Role of Glomerulus
it filters the blood and removes ions, water, waste EXCEPT proteins and bloods cells (they are too big to pass through)
Facts about Acute Glomerulonephritis
It tends to present 14 days after a strep infection of the throat or skin (impetigo).
It mainly affects the pediatric population ages 2-10.
It is not caused from the strep bacteria attacking the glomerulus but the immune system’s response to the bacteria by creating antigen-antibody complexes, which inflames the glomerulus.
This is why you see it AFTER a strep infection
Renal Calculi
Kidney Stones
What are kidney stones
Hard insoluble crystallized minerals and salts that have formed out of the filtrate produced by the nephron.
Kidney stones can vary in size: they can be very small (like a fine grain of salt) or large (like a walnut….very painful), and are composed of various materials.
Passing kidney stones
Most stones can be passed (very painful) if they are less than 5 mm (Diagnosis And Initial Managment Of Kidney Stones 8). If they are larger than this, they can become stuck within the urinary system.
Where can kidney stones be located
Inside the kidney
Ureters (top, middle, or bottom of ureter before entering bladder)
Bladder
Causes of Kidney Stones
“CRYSTAL”
Consuming high amounts of oxalates, purine, animals protein, salt (eating too much salt keeps the body from reabsorbing calcium in the urine), and taking excessive amounts of calcium supplements with Vitamin D (calcium oxalate, uric acids type stones)
Recurrent UTIs (struvite stones)
hYpocitraturia, hYpercalemia/uria, hYperparathyroidism
Structural blockage or stasis of the urine (prostate problems, strictures, deformities)
Too much uric acid (gout, dehydration, high diet in purine/animal proteins)
Absorption problems: gut doesn’t absorb fats as with ulcerative colitis or crohn’s diseae…fats bind with calcium and leaves oxalates behind
Low activity: immobile patients tend to have an increased amount of minerals and salts compared to people who are physically active and the urine stays stagnant in the kidney…
Signs and Symptoms of Renal Calculi
Asymptomatic: until stone moves within the kidneys and to the ureters
Pain: characteristics of the pain depend on the location of the stone and it can change as the stone moves through the urinary system
Renal colic: stone in the renal pelvis…dull, deep aching in the flank or costovertebral area
Ureteral colic: stone residing in the ureter and as it moves it can cause intense, sharp, radiating, wavelike pain to the genitalia (scrotum, vaginal area)
The patient may feel like they need to void but a small amount is voided.
Can have blood in the urine due to stone scraping the ureter (hematuria)
Nausea and vomiting (due to the intense pain)
Signs and symptoms of infection: fever, cloudy, odorous urine
Urinary retention: especially if stone is stuck in neck of bladder
Complications of Kidney stones
Obstruction
Damage of the nephrons hence renal failure
Infection
Kidney Stone treatment
Extracorporeal shock save
The kidney stone is removed by a urologist and doesn’t have to be passed by the patient as with EWSL.
Urinary Incontinence
Urination happens involuntarily
Affects personal hygiene and social life
Depression, social isolation, skin break down
Types of Urinary Incontinence
Stress urinary incontinence
Urge urinary incontinence
Mixed urinary incontinence (combination of both stress and urge incontinence)
Treatment of Stress incontinence
Pelvic floor exercises: Kegel
Losing weight
Surgical options
Stress urinary incontinence Causes
This is due to a weakened pelvic floor or weakened urinary sphincter muscles
Urge urinary Incontinence
Over active bladder
Sudden strong urge to urinate
Associated with an overactive detrusor muscle (smooth muscle in wall of the bladder)
Muscle contracts at wrong times no matter how much urine is in your bladder
Urge urinary Incontinence causes
Damage to the nerves in the bladder, disorders like MS, spinal cord injuries and stroke
Bladder irritation due to UTI, caffeine or certain medications
Can be associated with enlarged prostate (BPH)
Urge urinary Incontinence Treatment
Bladder training
Maintaining a set toileting schedule and gradually increasing amount of time between voting
Avoid caffeine and alcohol
Botox injections
Surgical options (severe risks)
Weakened pelvic floor women
Can occur due to pregnancy, child birth, menopause as well as previous pelvic surgeries
Weakened pelvic floor in men
Prostate surgery can cause damage or weaken the urinary sphincter muscles, which can lead to stress urinary incontinence
Acute Kidney Injury
It is the SUDDEN decrease or loss in renal function that will lead to the buildup of waste in the blood, fluid overload, and electrolyte imbalances. AKI can be reversible.
If not treatment can led to ESRD
Role of The kidneys
Filters the blood which creates a filtrate called urine. In addition, the kidneys regulate electrolyte levels, removes waste, and excessive fluid in the body. The kidneys normally do NOT filter blood cells or proteins.
How do the kidneys create urine?
Via the nephrons in the kidneys (the heart also plays a role in this, specifically the blood flow given by the heart to supply the kidneys with blood).
Each kidney contains millions of nephrons. Each nephron receives fresh blood from the heart via an afferent arteriole.
Damaged nephrons
When the nephrons are damaged as in INTRARENAL failure this mechanism is damaged and the patient will experience electrolyte imbalances, decreased glomerular filtration rate, decreased urinary output, azotemia (increase of BUN and creatinine in the blood…waste products).
Urine consists of:
Water
Ions: sodium, chloride, calcium, potassium, magnesium, phosphate, bicarbonate
Creatinine*
Urea
Glomerular filtration rate
Glomerular Filtration Rate: rate of blood flow through the kidneys (ml/min). This shows how well the glomerulus is filtering the blood….great for determining kidney function.
Normal GFR in adults: 90 or higher ml/min (remember this depends on the patient’s age, weight, creatinine, sex, and race)
Normal GFR = normal urine output, normal BUN and creatinine, normal electrolyte and water balance
Decreased GFR = low urinary output along with an increase in waste products in the blood (creatinine and BUN), electrolyte/fluid imbalances, and buildup of fluid
BUN
BUN (blood urine nitrogen): urea (measured as blood urea nitrogen) is a waste product from protein breakdown in the liver. It is secreted in the blood and filtered out through the kidneys.
Normal BUN: 6-20 mg/dL (in AKI this level becomes greater than 20 mg/dL)
Causes of AKI
Prerenal Injury: issue with perfusion to the kidneys (any injury BEFORE the kidneys)
This leads the kidney function to decrease. The kidneys are deprived of nutrients to function properly and the amount of blood it can filter. This can eventually lead to intrarenal damage where nephrons become damaged.
What can lead to decreased perfusion to the kidney
Issues with the heart in conditions that decrease cardiac output as with an acute myocardial infarction. In this condition, the heart muscle is damaged and can’t pump sufficient amounts of blood to the kidney.
Other causes: massive bleeding (internally or externally), dehydration (hypovolemia…diarrhea, vomiting), burns etc.
What can lead to the damage of the nephrons in the kidneys?
Intrarenal Injury: damage to the nephrons of the kidney (injury in WITHIN the kidneys)
When the nephrons are damaged the kidneys can’t filter the blood, maintain electrolyte levels, and remove excessive waste and fluid from the body.
Nephrotoxic drugs: NSAIDS
Antibiotics “aminoglycosides
Chemo drugs
Contrast dyes used in procedures
Infection “glomerulonephritis”
Injury
Injury found after the kidneys
Postrenal Injury: blockage in the urinary tract after the kidneys to the urethra (injury found AFTER the kidneys)
This prevents urine from draining out of the kidneys, which leads to build up pressure and waste in the kidney and decreases their function.
What can cause a blockage in this area?
Renal calculi
Enlarged prostate
A bladder doesn’t empty properly due to neuro damage “stroke”
Stages of Acute kidney injury
Initiation: a cause creates injury to the kidney and then signs and symptoms start to appear which leads to the next stage. This stage lasts a few hours to several days.
Oliguric: *some patients skip this stage and go straight into the diuresis stage
Urine output will be less than 400 ml/day
Signs and Symptoms AKI
Decreased GFR
Increased BUN and Creatinine = low protein diet
Increased potassium
Increased fluid in the body = edema
Metabolic acidosis
Mild hyponatremia
High phos and low calcium
High concentrated urine >1.020
Treatment AKI
dialysis…this is where the blood will be filtered through a special machine that will act as the nephron to remove excessive waste, water, and electrolytes from the body
Difference between AKI and ESRD
Acute kidney injury and kidney failure are two conditions that cause a decline in kidney function. Acute kidney injury has a rapid, sudden onset and results from illness or injury. It is often reversible with prompt treatment. In contrast, kidney failure is irreversible.
Chronic Renal Failure/End stage Renal Disease
Long term chronic damage to the kidneys
Years and years of destruction resulting in permanent damage
5 Stages of ENRD
GFR: Glomerular filtration rate. Over 90ml/min = normal
as GFR decreases less and less blood Is being washed, fills up with waste and electrolytes
End stages we focus on stage 4 and 5
stage 4: 29-15 GFR
Stage 5: 15 or less = ESRD. Kidneys are dead, no way to bring kidneys back to life = dialysis and kidney transplant
Causes of ESRD
Old age
Uncontrolled diabetes from hyperglycaemia for years
Uncontrolled hypertension for years
autoimmune diseases
Infection
AKI that worsens
Polycystic kidney disease
ESRD Diagnostic
Creatinine >1.3
Creatinine clearance test (how well GFR is working)
24 hours: collect all urine in container, discard 1st specimen when test begins
(don’t need sterile container)
What is the correct understanding of creatinine clearance test?
Save all urine samples in a container for a designated period after discarding the first urine
ESRD Signs and symptoms
Oliguria: Low urine output
ESRD critical complications
fluids are and electrolytes are trapped inside of the body
Can cause dangerously high BP which can lead to stroke, heart attack and further kidney damage
Monitor for
hypertensive crisis: Headache, N/V, change in mental status (requires immediate assessment)
Fluid volume overload: crackles, JVP, bounding pulses
Waste:
H+ ions (acid)
Metabolic avidosis pH belopp 7.35
Urea
Uremic frost
Pruritus
High Electrolytes
Na HIGH
Phos HIGH
Potassium HIGH
Client with kidney disease is weak lethargic and bradycardia what is an expected finding
K+ 8.5 is lab value to be expected
Potassium Values
Peaked T waves: 6-7
ST elevation: 7-8
Wide QRS complex: over 8
Treatment: lower potassium and protect the heart
Treatment for High potassium
IV calcium Gluconate = Dysrhythmias
IV 50% dextrose and regular insulin
Kayexalate
Dialysis
A patient with ESRD missed 3 dialysis sessions. Potassium level 8.1.. wide QRS complex, heart rate f 58 and lethargy. Which order should the nurse implement first?
IV calcium gluconate
ESRD potassium 7.2, creatinine of 3.8 and urine output of 300ml in 34 hours. Which order is priority?
IV regular insulin and 50% dextrose
ESRD Nursing Interventions
Daily wights
1kg = 1L of fluid retained
Avoid
NSAIDS
Milk for Magnesia (antacid)
Antibiotics: Vancomycin + Gentamicin
CT contrast Dye
ESRD Procedures
Dialysis
Kidney Transplant
ESRD Patient education
Diet:
Restrict sodium and potassium
consume low phos and low protein
apples = Best choice
No salt substitutes
No leafy veggies
No avocados , carrots, tomatoes
No strawberries, oranges or bananas
Best food choice for potassium of 6.5
Apple slices or apple juice
Pyelonephritis Signs and Symptoms
Same symptoms as a UTI but far worse
Key difference is the pain location
Dull (not sharp) Flank pain extending toward umbilicus
A patient with temperature of 102.5 (39) grabbing on to her left side and complaining of dull pain. The urine specimen appears concentrated with a cloudy appearance. Findings are associated with?
Pyelonephritis
Diagnosis Pyelonephritis
Obtain blood and urine cultures before starting antibiotics
Take cultures first so we can identify the organism causing the problem and determine the most effective antibiotics
Causes of Pyelonephritis
Urinary Retention
BPH
Renal calculi
Foley catheters
E.coli (female) whipping back to front
Physiological changes in elderly male admitted with UTI? SATA
Prostate enlargement may lead to urinary retention
Urinary retention increases the risk of UTI
Ineffective bladder contraction leads to urinary retention
“I can go all day without emptying my bladder”
This statement needs further teacher
UTI Complications
Elderly patients with UTIs quickly turn into urosepsis (infection of the blood that affects the brain) = clinical manifestation is confusion, this requires immediate follow up could indicate stoke or other complications
72 y/o patient suddenly becomes disoriented to person, place and time
asses signs and symptoms of UTI
= acute delirium
UTI Medications
Trimethoprim
Sulfamethoxazole (Bactrim)
* avoid sun
urine specific gravity increases + may cause kidney stones
2-3L per day
Take folic acid daily
Not pregnancy safe
*if you have a rash while on Glyburide = potential allergy to sulpha drugs
UTI Medications
Fluoroqinolones
Levofloxacin (levaquin)
Ciprofloxacin
given to pneumonia and UTI patients
*avoid sun, direct exposure
Achilles tendon Rupture
Patients should report new muscle pain
contraindications: Tendonitis
Pyelonephritis Education
Increase fluid intake, 2000ml water daily
Void after sex
Take cranberry supplements
Avoid caffeine and alcohol
No douching
No spermicidal contraceptives
No perineal deodorants
Not synthetic fabrics “nylon” “spandex”
Not bubble baths
Wipe front to back
Instructions to maximize UTI recovery?
Drink cranberry juice daily too acidify urine
Urinary frequency caused by cystitis most helpful advice? SATA
recommend cranberry juice
Encourage increased fluid intake
Limit coffee and alcohol
The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate (TURP). What should the nurse tell the client?
“Expect blood in your urine in the first couple of days following the procedure.”
A client has cystitis. The nurse should ask the client about experiencing which symptom?
foul-smelling urine
A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?
increasing fluid intake to 3 L/day
The nurse is assessing a client with kidney failure. Which finding is concerning?
decreased urine output
A nurse is reviewing a client’s medical history. Which factor indicates the client is at risk for candidiasis?
corticosteroids use
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?
Increase your carbohydrate intake
A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?
foul-smelling discharge from the penis
The nurse is teaching a client who is receiving hemodialysis how to recognize infection in the shunt. What sign should the nurse tell the client to assess each day?
swelling at the shunt site
A client with type 2 diabetes mellitus who is taking metformin is scheduled for a computed tomography (CT) with contrast of the abdomen tomorrow. Which priority nursing assessment is done before the procedure?
ensuring that the metformin has been withheld for 48 hours prior to the scan
Iodine-based CT contrast can cause kidney damage in clients taking metformin. To prevent possible renal failure, metformin needs to be discontinued 48 hours prior to the scan. A CT of the abdomen with contrast does not require NPO status or an empty colon.
A 30-year-old client is being treated for epididymitis. What information should the nurse include in the teaching plan about the likely cause of epididymitis?
sexually transmitted infection
A male client enters the oncology clinic for an evaluation. The nurse explains that the healthcare provider has ordered a prostate-specific antigen (PSA) test. The client asks the nurse, “How will this test tell if I have prostate cancer?” What is the nurse’s best response?
“Individuals who have a PSA higher than 10 have a 60–70% chance of having prostate cancer.
A 65-year-old male client with erectile dysfunction (ED) asks the nurse, “Is all this just in my head? Am I crazy?” What should the nurse tell the client?
“More than 50% of the cases are attributed to organic causes.”
A female client with cystitis is to take a 10-day prescription of an antibiotic. The client asks the nurse if they can continue to have sexual intercourse. What should the nurse tell the client?
As long as you are comfortable, you can have intercourse as often as you wish, but be sure to urinate within 15 minutes after intercourse.”
The nurse is teaching a client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective?
Maintain a daily fluid intake of 68 to 101 oz (2000 to 3000 mL.).
A nulliparous client says that they and their spouse plan to use a diaphragm with spermicide to prevent conception. Which should the nurse include as the action of spermicides when teaching the client?
destruction of spermatozoa before they enter the cervix
A client is scheduled for hemodialysis three times a week. The nurse is explaining complications to the client. Which complications are related to hemodialysis treatments? Select all that apply.
Bleeding
Leg Cramps
Hypotension
When providing discharge teaching for a client with uric acid calculi, the nurse would include an instruction to avoid which type of diet?
high purine
Normal Urine pH
Normal urine pH is 4.5 to 8
Normal Urine specific gravity
Urine specific gravity normally ranges from 1.002 to 1.035,
A client is voiding small amounts of urine every 30 to 60 minutes. What should the nurse do first?
Palpate for a distended bladder.
chronological order the phases of acute renal failure
initial insult
oliguric phase
diuretic phase
recovery phase
A nurse is providing instruction about peritoneal dialysis to a client. Which action warrants immediate action by the nurse?
The client keeps the dialysate cold until ready for use
Dialysate should be warmed before use
A client with benign prostatic hypertrophy (BPH) is being treated with terazosin 2 mg at bedtime. What should the nurse tell the client to monitor regularly?
blood pressure
A nurse is caring for a client who had an ileal conduit 3 days earlier. Which assessment finding, if made by the nurse, would indicate a need for a further consultation with the enterostomal nurse?
Red, sensitive skin around the stoma site may indicate an ill-fitting appliance.
Beefy redness at a stoma site that isn’t sensitive to touch is a normal assessment finding.
Urine mixed with mucus is also a normal finding.
Which statement best describes the therapeutic action of loop diuretics?
They block sodium reabsorption in the ascending loop and dilate renal vessels.
The client asks the nurse, “How did I get this urinary tract infection?” What should the nurse tell the client causes cystitis?
an ascending infection from the urethra
A client has experienced excessive losses of bicarbonate and has subsequently developed an acid–base imbalance. How will this lost bicarbonate be replaced?
Renal tubular cells will generate new bicarbonate.
A 28-year-old female client is prescribed danazol for endometriosis. The nurse should instruct the client to report which symptoms to the health care provider?
headaches
The nurse is observing an unlicensed assistive personnel (UAP) give care to a client after gynecologic surgery. When should the nurse discuss the care with the UAP?
Massaging the legs postoperatively is contraindicated because it may dislodge small clots of blood, if present, and cause even more serious problems.
When assessing a client prescribed hemodialysis, the nurse notes the client’s blood pressure is 140/82 mm Hg, heart rate is 82 beats/min, and respirations are 12 breaths/min. The nurse also notes a continuous vibration over the client’s fistula. What is the appropriate action by the nurse?
Document presence of a thrill.
Which clinical finding should a nurse look for in a client with chronic renal failure?
uremia
Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure.
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:
continuous inflow and outflow of irrigation solution
A client scheduled for hemodialysis is prescribed an oral antihypertensive daily. What is the correct action by the nurse regarding the medication?
Administer it after the hemodialysis treatment.
