Management of Urinary Disorders Flashcards
Urosepsis meaning?
When the UTI has spread systemically
Lower UTI regions
Cystitis - bladder
Prostatitis - prostate
Urethritis - urethra
Upper UTI regions
Pyelonephritis - UTI in kidneys
What is Uretervesical reflex or urethrovesical reflux
When urine flows backwards up urinary tract
When is the urinary tract sterile?
It is sterile once you are passed the uretha
What defenses do we have to make sure it stays sterile?
GAG or glycoproteins
Complete bladder emptying
Urinary flow going in correct direction
Acidic urine so less than 6.0 ph
Risk factors of UTI
urinary retention, why?
what can cause retention?
catheters, why?
fistulas, why?
urine reflux, why?
short uretha of women, why?
Aging and menopause, why?
Poor hygiene in general, why?
Immune response issues?
urinary retention is an issue because old urine stays in the urinary tract. prostate issues are a main cause
catheters are risky bc you may not insert them with sterile technique
a fistula can cause an abnormal opening of the urinary tract & allow bacteria in
urine reflux can cause uti because this can cause old urine to remain in the urinary tract
the short urethra in women allows for a shorter distance for bacteria to travel
Menopause and aging can cause continence issues & so hygiene could be compromised
People may wipe the wrong way. Need to wipe front to back.
People with Diabetes are at more risk for UTI’s
Common symptoms of uti:
UO
Painful sites
Elderly symptoms
Can there be no symptoms though?
Common symptoms
UO will be painful and frequent. May need to pee more at night (nocturia) and may not even be able to control the need to pee . Blood or hematuria in the urine also.
While peeing is painful, they will also have suprapubic, pelvic, or back pain
Elderly will probably present more confused
Yes, the patient may be asymptomatic.
What are some questions to ask if suspect a UTI?
UO
sex
contraceptive practices
How often do you urinate? Is it painful? Is there anything unusual for you that you notice?
Ask about sexual activity. Ask if they pee after sex?
IUD that is manually inserted in vagina for BC can cause uti so ask if they use any of these
Diagnostics/tests that they can do for UTI?
Urine analysis
culture and sensitivity
sti risk
cystoscopy or bladder check
ultrasound
What are some complications we want to avoid from a UTI?
Prevention?
can they risk of infection
Urosepsis and renal failure
Good way to prevent UTI is avoid catheters, pee after sex, don’t hold pee in, do good pericare. no bubble bath
yes, they may have a uti but they can be at risk for kidney infection
What to educate patients about wen taking antibiotics for their uti?
What is a good analgesic for soothing bladder lining? side effect?
Antispasmotic example?
Take all of the medicine
Piridium or AZio
side effect is orange urine
Ditripan
Should a uti patient drink coffee?
Can you put heat on perineal area?
no. avoid caffeine.
yes perineal heat can help pain
What are the main goals we are working towards with these interventions?
We want to help relieve some of the pain
We want to educate patient so this doesn’t happen again
Upper Urinary tract infections begin..
Upper infections begin in the renal pelvis.
How can ascending bacteria lead to upper uti?
How can an incompetent valve cause infection?
Urine stasis causing a uti?
systemic infection causing a uti?
The bacteria can ascend upwards and cause infection wherever it dwells
The urinary tract has valves to make sure urine flows in one direction and if a valve is not working urine can flow backwards
urine stasis can cause a uti bc the old urine stays in one spot and heards bacteria
systematic infection or sepsis can infiltrate and cause uti
What happens to the kidney in an upper uti?
The kidney develops edema and abscesses form from scar tissue
What is pyelonephritis?
This is when there is inflammation of pelvis and medulla which began in the lower urinary tract
- so it traveled
Common causes of pyelonephritis?
E. coli
Bladder reflux of urine
What is acute pyelonephritis?
When there is an active bacterial infection causing renal dysfunction
inflammation and necrosis occur to form abscess
What is chronic pyelonephritis?
Chronic pyelonephritis is a repeat of infection which leads to progressive damage that is permanent
Common cause of chronic pyelonephritis?
Obstruction of urinary tract
Reflux of urine
What can chronic pyelonephritis lead to in kidneys?
What are some complications of chronic pyelonephritis?
Chronic Kidney Disease
End stage renal disease
HTN
stones
Major risk factors of acute and chronic pyelonephritis?
Old age
Prostate issues
Stones
chronic illness
Best labs to check for pyelonephritis?
Urine analysis
Blood check
IVP
KUB or Kidney, ureter, bladder x ray
Symptoms of pyelonsphritis?
Similar to UTI symptoms
but with fever and chills
Pain on flanks or kidneys
What will probably be prescribed for pyelonephritis?
How much fluids should patient be getting?
Long term antibiotics - so tell patient to take them all.
Enough to keep them hydrated. Don’t want them to stop drinking
Surgeries done for pyelonephritis?
nephrectomy
ureteral diversion
uerteroplasty
What do do after surgery of pyelonephritis?
Basic post op interventions
Educate on antibiotics
Make sure they are drinking
Check UO
Which meds can affect urinary output and cause urinary incontinence?
What foods/drinks?
Diuretics
Ace inhibitors
Artificial sweeteners
Carbonated drinks
What is a bladder spasm?
Can it cause incontinence?
Bladder spasm is what it sound like. The spasm itself can cause urine to outflow.
T/F
multiple vaginal births can cause incontinence
true. this weakens pelvic floor muscles
What behaviors can cause leakage?
Laughing, coughing.
Straining
What is residual urine volume?
What is urodynamic testing?
This is when they check to see how much urine is left in the bladder after voiding.
Tests how well the urinary tract empties.
Stress incontinence
Example?
Stress causing intra-abdominal pressure. So laughing
Overactive bladder incontinence
This can cause a person to think they need to use the restroom due to a bladder that spasms and tightens.
But if it is overactive, it just means the urge to pee is overactive.
Iatrogenic incontinence
Incontinence from hospital fluids
Mixed incontinence
A mix of stress and overactive bladder
Overflow incontinence
When the nerves can’t sense that the bladder is full so then it begins to leak and overflow causing incontinence
Anatomical incontinence
Strictures
Fistulas
(I would think an enlarged prostate would be one too but idk)
Functional incontinence
not being able to get to the bathroom in time for whatever reason
maybe your slow
can’t walk etc
Why would we want someone who is continent to lose weight if they are obese?
Obesity can cause extra pressure
What is the point of timing fluids and amounts?
Time the fluid so a person doesn’t drink after a certain amount of time. Maybe they have nocturia and so no fluids after dinner
What are pessaries?
Ring that holds the bladder in position to prevent incontinence
Should you give a pure wick external catheter to a patient who is mobile?
No.
It sort of just sits in between labia and perineal area so it can easily be moved out of place. If they are mobile, best to just use it at night.
What is an external condom catheter also called?
Texas catheter.
It just works sort of like a condom.
Anticholinergics are used for incontinence. Why?
Examples?
Side effects?
Anticholinergics blocks acH which reduces bladder contraction
Oxybutynin
Tolterodine
Solifenacin
Fesoterodine
Think DRY meds. So dry mouth and constipation
Beta 3 adrenergic agonists are also used for incontinence. why?
Side effect?
It just relaxes the bladder so it can hold more urine
Common example is Mirabegron
Can raise BP, cause dizziness and headache
Botulinum Toxin A does what?
Side effects
Paralyzes the bladder. Will need yearly injections
Side effects:
UTI, respiratory arrest
Estrogen for incontinence age group?
Contraindication?
For older patients.
Contraindication for breast cancer
Which med would you use for mixed incontence specifically?
Impramine - 3x antidepressant
You need a med to relax the urethral spincter. Which do you choose?
Duloextine
Lift and stabilize urethra purpose? Using what? Injectables? Artificial? pacemaker?
Helps with incontinence by repositioning of the urethra by using tape or body tissue.
Can also use periurethral injectables of collagen to bulk it up
An artificial spincter can be inserted as well- a fluid filled ring with a valve
Pacemaker for the bladder that helps stimulate nerves
What is urinary retention?
When the bladder retains urine and does not empty
Causes of urinary retention:
age
other medical conditions
meds?
Old Age making detrusor muscle weak
Diseases like diabetes or prostate issues
neurological issues
pregnancy
Meds can do too good of job when trying to treat the urinary incontinence. Anticholinergis, Beta 3’s, botulin, etc
Assessments for urinary retention:
What will voiding be like?
Have they been on anesthesia?
Voiding will be frequent with little output. so check the I&O
Ask about anesthesia bc it can cause retention
What are some voiding triggers?
Start the water
Move around
Give them privacy
Causes of retention that may need surgery?
BPH
Bladder neck contracture
Urethral spincters
Cholinergics are used for retention. why?
Example
It does the exact opposite of anticholinergic and will stimulate urinary tract
Bethanechol/Urencholine
Why use an alpha adrenergic blocker for retention?
Examples
suffic
Reduces the resistance of sphincters involved with urination
And decreases prostatic hyperplasia (enlarged prostate can cause the retention)
Tamsulosin
Doxazosin
Alfuzosin
- osin
Urolithiasis and Nephrolithiasis
Kidney stones in ureter or nephron
Lithiasis
stone formation
How does Urolithiasis and Nephrolithiasis happen?
Salts stick together to form kidney stones
Main symptoms of kidney stones
pain
hematuria
cloudy urine with smells
renal colic or spasm
metabolic abnormalities that cause kidney stones?
increase in calcium uric acid citric acid and infection
how can summer months cause kidney stones?
Due to dehydration
What foods cause kidney stones
protein
tea or juice
no water
salt
Genetic factors of kidney stones
family hx of stones
family hx of gout
lifestyle choices that cause kidney stones
diseases
surgery?
inactivity and obesity which causes urine stasis
digestive diseases
really any surgery can cause decreased UO
Staghorns
Type of stone. Sort of sharp. Can be very painful if in ureters
Types of calculi/stones
3
Calcium oxalate
Cystine
Uric acid
calcium oxalate
examples
can cause stones.
it is naturally found in foods and sticks together to form crystals
nuts and grains
potatoes
chocolate
Hyperparathyroidism puts you at risk of stones. T/F
true. more common to develop calcium oxalate stone
digestive diseaes that can increase of stones?
crohns
ulcerative colitis
ibs
should you avoid calcium to avoid stones?
no. need to include 1000-1200 mg/day.
calcium and oxalate bind together to move through kidneys
What are cystine stones from
Amino acid that occurs in the body used for muscle and nerve building
what to avoid with cystine stones?
fatty foods
red meat
processed food
Uric acid stones are caused by?
associated with?
high purine intake leading to high amounts of uric acid and therefore acidic urine. assoicated with gout
foods with purines to avoid for uric acid sstones?
red meat alcohol sardines, anchovies, shellfish refined carbs sugary drinks
How to prevent stones:
water intake?
oxalate?
calcium?
protein?
salt?
stone prevention
water: 2-3 L a day
Limit foods with oxalate (nuts, potatoes, chocolate)
get enough calcium from dairy
eat moderate amounts of protein
low salt intake
Alpha blockers for stones?
examples
relaxes the ureter so the stone can pass
tamsulosin
dutasteride combo with tamsulosin to decrease prostate size
potassium citrate for stones?
exmaples
raises ph of urine
OJ, lemonade, apple cider vinegar
allopurinol for stones?
examples
allopurinol decreases uric acid level
zyloprim and aloprim
cellulose phosphate
example
prevents calcium from reaching kidneys to form stones
can be used for hyperparathyroidism
Calcibind
Lithroscopy
shock wave to break up stone
ESWL so more shock
or LASER
Percutaneous Nephrolithotomy
small back incision
nephrolithotripsy or sound waves
why might a strainer be sent home with patient?
To catch the stone so it can be used for biopsy
Bladder cancer cause?
Not clear.
Could be from smoking, carcinogen exposure, or familial
where does bladder cancer often travel?
liver, bones, and lungs
major symptoms of bladder cancer?
painless hematuria
UTI symptoms
pain where metasis is
Bladder cancer management
Transurethral resection of bladder tumor
Radiation
Chemo
Immunotherapy
Partial or total cystectomy (bladder removal)
reconstruction as a urinary diversion
incontinent urinary diversion?
control?
diversion to skin requiring appliance
patient control
tube is created from a piece of intestine. the tbe runs from ureters to outside of body to urostomy bag
continent urinary diversion?
Use of stoma , koch pouch, indiana pouch
use section of intestine to create small pouch in order to collect urine inside body
orthotopic neobladder
to construct a new bladder from intestines
after a bladder removal
nursing dx for urinary diversion
anxiety imbalanced nutrition defieicent knowledge risk for skin integrit acute pain disturbed body image sexual dysfunction deficient knowledge wound care
