GU Disorders Primer Flashcards
Most common bacterial disease in women is…
• E. coli
What is Pyelonephritis?
- Upper UTI
- Inflammation of the upper tract involving renal parenchyma and collecting system
What are the types of lower UTIs?
- Cystitis (bladder)
- Urethritis (urethra)
What is Urosepsis?
• UTI spread to systemic circulation (requiring emergency treatment)
What are complicated UTIs?
• UTIs with pre-existing conditions such as: obstruction, stones, urinary catheter ,existing diabetes, neurologic conditions, pregnancy or recurrent infection
Normal physiological defenses against UTI include:
- Normal voiding with complete emptying of bladder
- Peristaltic activity that propels urine towards the bladder
Normal urine pH is…
• < 6
What is the number one cause of nosocomial UTIs?
• Catheterization
What are some common factors of UTI for women?
- Post menopause causes a rise of vaginal pH allowing an environment for bacterial growth
- Sex can lead to minor urethral trauma in women
How may women combat the post menopause rise in vaginal pH?
• Low dosage intra-vaginal estrogen, which will help lower the pH
Catheter infection can lead to comications such as
- renal abscess
- arthritis
- epididymitus
- periurethral gland infections
- bacturemia
What are some preventative measures that can be taken against UTI?
- Emptying bladder regularly & completely
- Evacuating bowels regularly
- Wiping perineal area from front to back
- Stay hydrated
- Daily intake of cranberry juice
What are some general s/s of UTI?
- Dysuria
- Hesitancy
- Urinary retention, freq, urgency
- Nocturnal emisis
- Nocturia
- Incontinence
- Fatigue and anorexia
- Hematuria/ Sediments in urine
What are some causes of atonic bladder that leads to urinary retention?
- Surgery
- Spinal problems
What are the specific s/s of pyelonephritis?
- Suprapubic discomfort/pressure
- Flank pain
- Chills
- Fever
What are some clinical manifestations of UTI for older adults?
- Non localized abdominal discomfort
- Cognitive impairment
- Generalized clinical deterioration
True or False
Fever is unreliable as they are less likely to present with fever
- Urine Analysis
- Urine Culture & Sensitivity
- Clean-catch Urine
What results of a dipstick urinalysis indicate UTI?
- Positive Nitrites,
- Positive WBCs,
- Positive Leukocyte Esterase
What is the purpose of the Urine Culture & Sensitivity?
- Identify organism
- Determine bacteria’s susceptibility to antibiotics
Explain the process of a clean-catch urine sample.
- Women: Wipe periurethral area from front to back w/ clean gauze
- Men: Wipe glans penis around the urethra
- Collect specimen 1-2 seconds after voiding begins
- Refrigerate urine immediately on collection
What are the nursing assessment items for UTIs?
- Nutrition and fluid intake
- Previous UTIs
- Pain
- GI problems
- Elimination pattern
- Urine appearance – smell, color, amount
- Diagnostic findings
What are some hospital UTI prevention measures?
- Hand washing between patients,
- Aseptic technique
- Early removal of indwelling catheters
- Routine & thorough perineal hygiene
- Offer bedpan or urinal to bedridden patients at frequent intervals
What are some ambulatory/homecare UTI prevention measures?
- Compliance with drug regimen
- Adequate daily fluid intake
- Regular voiding
- Appropriate hygiene
- Urinating before & after intercourse
- Temporarily discontinuing diaphragm use
- Relapse need further evaluation
Where does pyelonephritis generally begin?
• In the lower GU tract as a lower UTI
What are some usual pre-existing conditions to pyelonephritis?
- Pregnancy
- Renal calculi
- Urinary catheterization
Why is an obstruction at the lower neck of the bladder of concern?
- It will cause retention of urine with high residual urine.
- The increasing pressure can led to backflow and as a consequence chronic pyelonephritis and renal atrophy.
- Correction is required
What are the chemicals that contribute to urinary calculi formation?
- Calcium
- Oxaluric acid
- Uric acid
- Citric acid
What diet component can increase uric acid excretion?
• Protein
What type of food will increase oxaluric acid?
• Tea and fruit juices
What environmental situations may contribute to development of urinary calculi formation?
- Warm climate & dehydration
- Sedentary lifestyle
- Genetics (gout, renal acidosis)
Lower urine pH will produce what type of stones?
• Uric acid & cystine stones
Higher urine pH will produce what type of stones?
• Calcium & phosphate stones
What is the patho for struvite stones?
• Urinary obstruction/UTIs cause higher pH thus produce struvite stones
Where can urinary stones develop?
• in the bladder, kidneys, ureters or urethra
What are some clinical manifestations of bladder stones?
- Abdominal pain
- Dull costovertebral flank pain
- Hematuria
- Renal Colic from increase ureteral peristalsis
- Nausea/Vomiting
- Mild shock
- Groin pain
What dx studies are done for bladder stones?
- Urine studies
- CT
- IVP
- Retrograde pyelogram
- Ultrasound
- Cystoscopy
True or False
We should avoid an IVP with renal failure pts.
• True
What labs are we looking at for development of bladder stones?
- Ca
- PO
- Na
- K
- HCO3
- Uric acid
- BUN
- Creatinine
- Urine pH
What is the general collaborative care for stones?
- Manage pain
- Treat infection
- Treat obstruction
Many stones pass spontaneously, however, stones > __mm cannot pass through the ureter.
• 4mm
What are the main indications for surgical removal of stones?
- Stones too large for spontaneous passage
- Stones associated w/ bacteriuria or symptomatic infection
- Stones causing impaired renal function
- Stones causing persistent pain, nausea, ileus
- Inability of patient to be treated medically
- Patient with one kidney
What are two common surgical procedures used for removal of urinary stones?
• Laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL)
What are some possible complications of lithotripsy procedures?
- Hematuria
- Retained stone fragments
- Infection
What is the dietary guidance regarding sodium for pts with urinary caliculi?
• Keep it low, don’t add to sodium amounts
What is the dietary guidance regarding calcium for pts with urinary caliculi?
- Reduce dietary intake of calcium
- Take thiazide diuretics to reduce calcium serum levels
- Take potassium citrate to maintain alkaline (high pH) urine
What common electrolyte do Thiazide diuretics and potassium citrate help reduce?
• Sodium
Why would a pt that a predisposing factor for stones (gout) take potassium citrate?
• Because it increases urine pH
Why do we want to limit dietary purines for pts w/ urinary caliculi?
• Because purines break down into uric acid
What types of food are high in Purine?
• Sardines, mussels, liver, sweetbreads, goose, venison, meat soups
What types of food are high in Calcium?
• Dairy, beans (except green), fish w/ bones, dried fruits, nuts, chocolate, ovaltine
What types of food are high in Oxalate?
• Darke roughage, spinach, cabbage, asparagus, beets, celery, chocolate
What is Urinary Incontinence (UI)?
• Uncontrolled leakage of urine
Why is there a higher prevalence of stress and urge incontinence w/ older women?
• Pregnancy
True or False
Urinary incontinence is not a natural consequence of aging.
• True
What are some causes of urinary incontinence?
- Confusion
- Depression
- Infection
- Atrophic Vaginitis
- Urinary Retention
- Restricted Mobility
- Fecal Impaction
- Drugs/alcohol
What drugs may cause incontinence and how may it manifest?
- Loop diuretics, calcium channel blockers, ACE inhibitors
- Cough triggering stress urinary incontinence
What is overflow incontinence?
- Overflow incontinence occurs when you are unable to completely empty your bladder
- This leads to overflow, which leaks out unexpectedly
- You may or may not sense that your bladder is full
What is stress incontinence?
• This happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine.
True or False
Stress incontinence is not related to psychological stress
• True
What is Urge incontinence?
- Urge incontinence occurs when you have a strong, sudden need to urinate that is difficult to delay.
- The bladder then squeezes, or spasms, and you lose urine.
What is Functional incontinence?
• Occurs when an individual with normal bladder and urethral function has difficulty getting to the toilet before urination occurs
Those with impaired mobility or mental confusion may have what type of incontinence?
• Functional
What are some dx studies/methods used for incontinence?
- H&P
- Bladder log or voiding record
- Incontinence tests
- Pelvic exam of perineal skin
In our care of pts w/ urinary incontinence, we maintain a patient’s…
- Dignity
- Privacy
- Feelings of self-worth
What are two types of bladder irritants that should be avoided for pts with incontinence?
- Alcohol
- Caffeine
What are some methods for helping pt’s overcome incontinence?
- Scheduled voiding regimens and bladder training
- Pelvic floor muscle training
Acute urinary retention is a…
• Medical emergency
What is urinary retention?
• Incomplete bladder emptying despite urination or accumulation of urine in the bladder b/c cannot urinate
Besides bladder outlet obstruction, enlarged prostate, or deficient detrusor contraction strength, what are some other factors that cause urinary retention?
- Neurological Diseases
- Diabetes Mellitus
- Over-distention
- Chronic Alcoholism
- Anticholinergic Drugs
What methods of dx are used for urinary retention?
- H&P
- Ultrasound
- Volume study: Urinate, followed by catheterization 10-20 mins later
Urinary retention can trigger what condition for spinal injury patients?
• Autonomic dysreflexia
What is autonomic dysreflexia?
- An abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation.
- This reaction may include:
- Change in heart rate
- Excessive sweating
- High blood pressure
- Muscle spasms
- Skin color changes (paleness, redness, blue-gray skin color)
