Kidney/Pudenda - Unit 4 - Care of Patients with Urinary Disorders Flashcards
What is pyelonephritis?
Infection of the kidney (upper UTI)
What is urethritis?
Infection of the urethra (lower UTI)
What is cystitis?
Infection of the bladder
What is prostatitis?
Infection of the prostate (UTI’s in men are typically associated with the prostate)
What is the typical causative organism for a UTI?
E. Coli
What are some risk factors for a UTI?
age, gender, history
What are some symptoms for a UTI?
burning w/urination (dysuria), cloudy urine, pain, odor, confusion in the elderly)
What is pyridium?
A bladder analgesic
What is macrodantin?
Urinary antiseptic
What are some antimicrobials used to treat UTI’s?
Cipro, bactrim, amoxicillin, septra
What does anaspaz do?
It’s an antispasmodic!
What are some symptoms for acute pyelonephritis?
Flank pain, fever/chills, H/A, malaise, anorexia, nausea, vomiting, cloudy urine with ammonia odor, urgency, frequency, nocturia
What is the difference between acute and chronic pyelonephritis?
Acute = active bacterial infection.
Chronic = repeated infections.
How do we treat pyelonephritis?
Meds (analgesics, antibiotics, antiemetics, antidiarrheal, increase fluids, check UA, treat underlying cause.
What are some key features of chronic pyelonephritis?
HTN, inability to conserve sodium, decreased concentrating ability, development of hyperkalemia and acidosis
If someone has a UTI, what might be elevated?
Elevated BUN, positive leukocyte esterase
What do cranberries and blueberry juice do to prevent UTI’s?
Help prevent bacterial from attaching to urinary tract.
What is a condition that an older patient with acute glomerularnephritis is often misdiagnosed with?
Congestive heart failure
What is stress incontinence?
Loss of small amounts of urine with sneezing, laughing, or lifting (after pregnancy)
What is urge incontinence?
Inability to stop urine flow long enough to reach the toilet.
What is mixed incontinence?
Involuntary unpredictable loss of urine that does not generally respond to treatment
What is overflow incontinence?
Urinary incontinence related to bladder overdistention
What is functional incontinence?
Inability to get to the toilet to urinate
What are some risk factors for urinary incontinence?
Multiple pregnancies and vaginal births, aging, urinary bladder spasm, neurological disorders (parkinson’s, etc), medication therapy, obesity, confusion, dementia, etc.
What are some signs and systems of incontinence?
Loss of urine, enuresis (bed wetting), bladder spasms, urinary retention, frequency, urgency, nocturia
Should we assess I/O with people who have urinary incontinence?
YES
What is a voiding cysto-urethrography?
X-ray taken while patient is voiding to assess size/shape/ of bladder.
What is urodynamic testing?
Measures pressure inside bladder.
We should have less than ___ CC after voiding.
100
What are some surgical interventions for incontinece?
Vaginal repair, retropubic suspenion, catheters, etc
What are some nursing interventions for incontinence?
Assess I/O, teach kegels, establish a toileting schedule, minimize a delay in toileting, incontinence garments, etc.
When should patients with incontinence take diuretics?
In the AM or mid-afternoon!
What are some meds for urinary incontinence?
Antibiotics, antidepressants, urinary antispasmodics or anticholinergics (ditroban, prodanthe), calcium channel blockers (men – prostate), alpha-adrenergic antagonists, HRT (might send more blood to the pelvis)
Are skin breakdown and social isolation complications of urinary incontinence?
YES
What are urolithiasis?
Kidney stones!
What are stones made up of?
Calcium oxalate, phosphate (phosphorus in kidney), struvite (from infection), uric acid (high protein diet, gout)
What cause kidney stones?
Immobility, family, reduced vitamin D, urine stasis
What are symptoms of kidney stones?
Pain (sharp), sudden, severe (colic), pain gets worse upon movement, N/V, chills, fever, diaphoresis, urinary frequency, dysuria, oliquria/anuria, pallor, hematuria
What are some diagnostic tests for kidney stones?
Urinalysis (increased RBC, WBC + bacteria), radiology, Ct/MRI, ultrasound or cystoscopy
What are some non-surgical interventions for kidney stones?
Increase fluid to 3000 mL/day, medications that prevent the absorption of calcium (thiazide diuretics and phosphates), allopurinol for uric acid stones, opioids, cystoscopy, etc.
What is lithotripsy?
Shockwaves that break up the stones!
What do we do after lithotripsy?
Strain the urine!
Is it normal to have some hematuria and bruising after lithotripsy?
Yes
What are some surgical options for kidney stones?
Stents, nephrostomy, lithotomy (open up kidney, yuck!)
What’s a ureterolithotomy?
They go into the ureter
What’s a pyelolithotomy?
They go into kidney pelvis
What is a nephrolithotomy?
They go into the kidney.
What do we do pre-op for surgical management of a kidney stone?
Prepare client, teach about procedure, report abnormal findings, etc.
What do we do post-op for surgical management of kidney stones?
Assess pain, I/O, vitals, urinary pH, meds, strain all urine, ambulation, education, etc.
What are two complications of surgical management of kidney stones?
Obstruction and Hydronephrosis (back up of the kidney)
Who is at high risk for bladder and urothelial cancer?
Males over 50, smokers, exposure to chemicals
What are symptoms of bladder/urothelial cancer?
Painless early, hematuria, frequency, change in urine color, burning with voiding, difficulty voiding
What is a cystectomy?
removal of bladder
What is an ileal conduit?
Ureters into ileum, stoma w/pouch
What is a uretero-sigmoidostomy?
Ureters into sigmoid, urine exits rectume
What is an ileal reservoir/kock’s pouch?
Internal pouch from ileum, nipple valve - place catheter in to drain urine (self-cath)
What is a nephrostomy?
External tubes drain renal pelvis
What is a complication of an ileal conduit?
Urine is CAUSTIC! So make sure everything fits well.
What do we do pre-op bladder cancer surgery?
Type of diversion?, discuss urine control
What do we do post-op bladder cancer surgery?
Assess drains/output, I/O, stoma care, support system-family
What does a uroflowmetry test do?
Rate + fill degree
What does an electromyography (EMG) test do?
Strength of pelvic muscle contraction.
How much urine should be left in the bladder after voiding?
Less than 100 CC
What are some surgical interventions for bladder problems?
Vaginal repair, retropubic suspension, artificial sphincter, catheters, collagen injections in the periurethral area
What are some nursing interventions for the bladder?
Assess I/O, teach kegels, establish toileting schedule, initiate bladder training program, minimize delays in toileting, incontinence garments, limit beverages after evening meals, if diuretics are prescribed, take them in the morning or mid afternoon
What are some meds used with urinary incontinence?
Antibiotics, antidepressants, urinary antisposmodics or anticholinergics (ditroban, prodanthe), Calcium channel blockers (men – decreases prostate), alpha-adrenergic antagonists, HRT (could increase blood supply to pelvis)
Are skin breakdown and social isolation complications of urinary incontinence?
YES
What are kidney stones made up of?
Calcium oxalate, phosphate, struvite (come from infection & grow fast), uric acid
What are causes of kidney stones?
Immobility, family history, reduced vitamin D, urine stasis
What are some symptoms of kidney stones?
Sharp pain that’s sudden, severe - pain gets worse when the stone is moving.
Flank pain = stone in kidney or ureter, N/V, chills, fever, diaphoresis, urinary frequency, dysuria, oliquria/anuria, pallor, hematuria
what are some diagnostic tests for kidney stones?
Urinalysis, KUB/IVP, CT or MRI, ultrasound or cystoscopy
What’s some non-surgical treatment for kidney stones?
Increase fluid intake to 3000 mL/day, take meds, treat uric acid stones with allopurinol, pain relievers, cystoscopy, percutaneous neprhostomy, lithotripsy
What are some surgical treatments for kidney stones?
Stents, nephrostomy, lithotomy (if all else fails!)
Ureterolithotomy (?), pyleolithotomy (?), nephrolithotomy (?)
Ureterolithotomy (ureter), pyleolithotomy (kidney pelvis), nephrolithotomy (into the kidney)
Renal Cell Cancer (Adenocarcinoma) - Stages 1 & 2 are ___ kidney, and 3 &4 are ___ kidney.
Inside —> outside.
What causes the symptoms for renal cell cancer?
Stretching, compressing or invasion of structure in and near kidney.
What are some symptoms of renal cancer?
Hematuria, flank pain, palpable flank mass, fever, weakness, anemia, fluid/electrolyte imbalance, HTN
How do we treat renal cancer?
Palliative radiation therapy, biologic therapy, cryoblation, radical nephrectomy
Should a patient who had surgery for renal cancer limit activity, do dressing changes, avoid lifting and sports, etc?
yes.
What is glomerulonephritis?
Inflammation of the glomerular capillaries
What happens with acute glomerulonephritis?
Immune complexes develop and become trapped in glomerular tissue - prognosis varies.
What happens in chronic glomerulonephritis?
Can occur without previous history, progressive destruction of glomeruli and eventual hardening, 3rd leading cause of ESRD (end stage renal disease)
Nephrotic Syndrome - a disease. T/F?
False - it is not a disease.
What is nephrotic syndrome?
Comes from glomerular damage - permeable to proteins.
What are risk factors for nephrotic syndrome?
Immunologic disorders, toxic injury, multi-system diseases, infection & neoplasms
What is the sequence of events for patients with glomerular nephritis (put edema, salt and water retention, glom. membrane damage, hematuria & proteinuria and immune response in order)
- Immune response
- Glomerular capillary membrane damage
- Hematuria and proteinuria
- Salt and water retention
- Edema
What are some clinical findings for patients with glomerularnephritis?
Fever, peripheral edema, proteinuria, headache, dyspnea
What are the events of nephrotic syndrome? (Put proteinuria, generalized edema, renal insult, increased glomerular permeability and decreased serum protein - in order!)
- renal insult.
- Increased glomerular permeability.
- Proteinuria.
- Decreased serum protein.
- Generalized edema.
What are some signs and symptoms that the nurse should monitor for with nephrotic syndrome?
Malnutrition, hematuria, infection, peritonitis, hyperkalemia, fever
Will serum lipid levels be low or high in nephrotic syndrome?
YES
