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NSG 478 > Renal Infective disorders: UTI, Pyelonephritis, and stones > Flashcards

Renal Infective disorders: UTI, Pyelonephritis, and stones Flashcards

1
Q

UTI etiology

A
  • Leading cause of systemic infections in older adults
  • Women are more vulnerable
  • Seperated into upper and lower GU tract
  • Most common cause is E-coli (Stool)
  • Occurs mainly in sexually active women (Diaphram, pregnancy) and post menopausal women
  • Cath placement, straight or indwelling
  • DM
  • Older adults (Decreased bladder tone)
  • Neurogenic disorders (Stroke, neuro bladder)
  • Gout
  • Instrumentation
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2
Q

Upper UTI

A
  • Kidneys and ureters
  • Pyelonephritis
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3
Q

Lower UTI

A
  • Bladder and urethra
  • Cystitis
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4
Q

Diagnosis and S+S UTI

A
  • Done on a history and S+S
  • Labs: Urinalysis (Clean catch/sterile)
    • 100,000 organisms/ml of urine or less with S+S
    • CT and kidney scans, obstruction, abscess, tumors, cyst
  • S+S: Dysuria, urinary frequency or urgency, cloudy foul odor, hematuria, lower back pain
    • Urosepsis: Shock
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5
Q

Medical mgmt of UTI

A
  • Lower UTI: Short course antibiotic
  • Upper UTI: Longer antimicrobial therapy
  • Pain relief
    • Antispasmodic agents (Bladder irritability and pain (Ditropan))
    • Urinary anesthetic (Pyridium, (Phenazopyridine HCL), (AZO))

finish entire course of antibiotics even if they are feeling better

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6
Q

UTI prevention

A
  • Adequate hydration (Fluids and cranberry juice)
  • Perineal care
  • Afterintercourse care
  • Showers over baths
  • Cotton underwear, avoid tight and restrictive
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7
Q

What bevs increase risk of UTI

A
  • Coffee
  • Tea
  • Alc
  • Citrus
  • Cola
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8
Q

CAUTI prevention

A
  • Aseptic technique and hygiene
  • Keep cath bag below the level of bladder to enable flow
  • Cath care (Keep clean)
  • Hydration unless contraindicated
  • Early ambulation
  • Assess volume and characteristics of urine, S+S of infection
  • EBP guidelines on early cath removal
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9
Q

Acute Pyelonephritis

A
  • Upper GU infection, bacterial infection of renal pelvis, tubules and interstitial tissue of one or both kidneys
  • Can become chronic
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10
Q

Causes of Acute Pyelonephritis

A
  • Upwards spread of bacteria from the bladder
  • Systemic sources from blood stream (TB infection)
  • Urinary retention
  • Urinary obstruction (Bladder or prostate tumors, strictures, benign prostatic hyperplasia, urinary stones)
  • May progress to a chronic condition
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11
Q

Acute Pyelonephritis: Diagnostics

A
  • Urinalysis with culture and screen
  • Ultrasound
  • CT
  • IV pyelogram
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12
Q

Acute Pyelonephritis: Clinical manifestations

A
  • Chills
  • Fever
  • Leukocytosis
  • Bacteriuria
  • Pyuria
  • Low back pain/ flank pain
  • N+V
  • Headache/ malaise
  • Painful urination
  • Pain and tenderness in CVA
  • Urinary urgency and frequency
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13
Q

Acute Pyelonephritis: mgmt

A
  • Outpatient: 2 wk antibiotic therapy
  • Make sure they take the entire course of antibiotics
  • Hospital mgmt: S+S of sepsis, dehydration N+V
  • May need 6 wk antibiotic therapy with relapses (Repeat urine cultures after completion of antibiotics)
  • Adequate hydration (Oral or IV)
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14
Q

Urolithiasis

A
  • Stones (calculi) in the urinary tract
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15
Q

Nephrolithiasis

A

Stones (Calculi) in the kidney

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16
Q

Incidence of Renal Calculi

A

Starts ages 30-50
2x rate in men

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17
Q

Patho Renal Calculi

A
  • Stone formation from supersaturation of calcium oxalate/phosphate and uric acid
  • Can occur anywhere from kidney to bladder
  • Vary in size: From granular to orange size
  • Predisposing factors:
    • Dehydration, infection, stasis, immobility
    • Hypercalcemia
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18
Q

Renal Calculi: Calcium stones

A
  • 75% of all stones
  • Calcium oxalate/phosphate
  • Oxalate: Naturally occuring substance occurring in rhubarb, spinach, beets, nuts, chocolate (eating these can increase levels putting you at risk)
  • Liver produces oxalate
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19
Q

Risk factors for calcium stones

A
  • Hyperparathyroidism (Increases serum Ca)
  • Cancers (Leukemia, multiple myeloma)
  • Dehydration
  • Granulomatous diseases (Sarcoidosis, TB), Increases vitamin D production of granulomatous tissue
  • Excessive intake of vitamin D and milk
  • Myeloproliferative diseases (Polycythemia vera)
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20
Q

Renal Calculi: Struvite stones

A
  • 15% of incidence, occurring from an infection (UTI)
  • Can grow quickly, becoming large with few S+S with little warning
  • Form in persistently Alkaline, ammonia rich urine presence of urease splitting bacteria (Pseudo, klebsiella, staph, mycoplasma)
  • Predisposing factors neurogenic bladder, and recurrent UTI
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21
Q

Renal Calculi: Uric acid stones

A
  • 5-10% of incidence
  • Predisposing factors
    • Dehydration
    • High protein diet
    • Gout or other myeloproliferative disorder
22
Q

Renal Calculi: Cystine stones

A
  • 1-2% of incidence. rare and hereditary disorder
  • Causes the kidneys to reabsorb systine, an Amino acid
23
Q

Clinical manifestations: Kidney stones

A
  • Depends on presence of obstuction, infection and edema
  • Renal colic
  • N+V
  • Hematuria
  • Oligura or anuria
  • Bladder distension
24
Q

Kidney stones, clinical manifestations: Renal pelvis

A
  • Intense deep ache in Costovertebral region
  • Hematuria
  • Pyuria
25
Q

Kidney stones, clinical manifestations: Ureteral colic

A
  • Acute, excrutiating colicky
  • Wave like pain radiating down thigh to genitals
  • Ureter dilated, hydroureter, urine obstruction
  • Hematuria (From abrasiveness of the stone), can pass stone of 0.5-1 cm
26
Q

Kidney stones, clinical manifestations: Bladder

A
  • Frequency, urgency, irritation, uti (sepsis), hematuria
  • If the stone obstructs the bladder neck thats an emergency
27
Q

Assessment and diagnostic findings: Kidney stones

A
  • Dietary and med history
  • Family history of kidney stones
  • CT scan: Confirmatory
  • Blood chemistries
  • 24 hour urine test measures Ca, uric acid, creatinine, Na, pH
  • Chemical/stone analysis to determine composition
    • Calcium stones indicate disorders with oxalate or Ca metabolism
    • Urate stones: Disturbances on uric acid metabolism (Gout)
28
Q

Diagnostic test: Kidney stones

A
  • KUB (Flat plate): reveals visible calculi
  • IVP (Intravenous pyelogram) determines size and location of stones
  • Renal ultrasound: Reveal obstructive changes
  • UA: RBC, odor, turbidity, WBC
29
Q

Goals of kidney stones

A
  • Eradication of stone
  • Determine the stone type
  • Prevent nephron destruction
  • Control infection
  • Relieve any obstruction
  • Immediate objective of treatment is relief, Opiods and NSAIDS
30
Q

mgmt of kidney stones

A
  • Opioids (Initially) and NSAIDS (After)
  • Urine straining (to see stone)
  • Once stone is passed, pain is relieved
  • Lithotripsy (Monitor ECG and sedate pt) will cause bleeding for 4-5 days after
  • Stenting and nephrolithotomy
  • Hot baths/ moist heat to flank area help
  • Hydration, unless contraindicated to help passage of stone (2000-3000 ml)
  • Allopurinol, to reduce uric acid levels and urinary uric acid excretion (Gout)
31
Q

Kidney stones: Interventional procedures

A
  • Ureteroscopy: Visualizations and destruction of stone (Fragments and removes stone)
  • Stent may be inserted and left in place for 48 hours to keep ureter patent
  • ESWL: Extracorporeal shock wave lithotripsy (Breaks them into grain sized stone using pressure or shock)
  • Endo-urologic methods of stone removal
    • Percutaneous nephrostomy
    • Percuatneous nephrolithotomy
32
Q

ESWL considerations

A
  • Discomfort with multiple shock waves may occur, usually not causing dmg to other tissue
  • Observe for obstruction, infection from blockage of urinary tract by stone fragments
  • All urine is strained after procedure and sent to lab for analysis
  • Several treatments may be needed to ensure destruction of stone
33
Q

Percutaneous nephrostomy/percutaneous nephrolithotomy

A
  • Nephroscope introduced via percutaneous route into renal parenchyma
  • Stone may be extracted with forceps or by stone retrieval basket
  • If stone is too large, ultrasound can be used to pulverize the stone
34
Q

Electrohydraulic lithotripsy:

A
  • Electric discharge used to create a hydraulic shock wave to break up the stone
  • Probe passed through cystoscopy, tip of lithotriptor placed near stone, with the strength of pulses varying
  • Preformed under topical anesthesia
  • After stone is removed a nephrostomy tube is left in place to ensure ureter is not obstructed by edema or blood clots
  • After tube is removed nephrostomy tract closes spontaneously
35
Q

Complications of electrohydraulic lithotripsy

A

Hemorrhage, infection, urinary extravasation

36
Q

Chemolysis

A
  • Stone is dissolved in chemical solutions (Acid or base)
  • Indicated when the risk of other procedures is too great or stones that dissolve easily
  • Percutaneous nephrostomy then chemical solution allowed to flow continiously onto the stone
  • Solution exits the renal collecting system via the ureter or nephrostomy tibe
  • Pressure in the renal pelvis is monitored during the procedure
37
Q

Surgical mgmt of kidney stones

A
  • Indicated when the stone does not respond to other forms of treatment
    * Correct abnormalities in kidney anatomy to improve urinary drainage
  • Nephrolithotomy: Incision into the kidney and removal of stone
  • Nephrectomy: Kidney is nonfunctional secondary to infection or hydronephrosis
  • Pyeloithotomy: Removal of stones in the kidney pelvis
  • Ureterolithotomy: Removal of stones from ureter
  • Cystotomy: Stone removal from bladder
38
Q

Nephrolithotomy

A

Incision into the kidney with removal of stone

39
Q

Nephrectomy

A

Kidney is nonfunctional secondary to infection or hydronephrosis

40
Q

Pyelolithotomy

A

Removal of stones in kidney pelvis

41
Q

Ureterolithotomy

A

Removal of stones from ureters

42
Q

Cystotomy

A

Stone removal from bladder

43
Q

Prevention of kidney stones: Nutrition

A
  • Fluid intake (8-10 8 oz glasses daily), keeping urine output above 2L
  • Ca stones: restrict Ca
  • Uric acid: Decrease intake of purine (Organ meats, shellfish, anchovies, asparagus, mushrooms)
  • Cystine stones: Low protein diet
    • Urine alkalinized: Urocit -K
    • Hydration
  • Oxalate stones: Maintain dilute urine, limit intake of oxalate
44
Q

Assessment of kidney stones

A
  • Vitals, S+S of infection
  • Pain (Severity, location, radiation, sudden increases in pain can indicate an obstructed ureter)
  • N+V, Diarrhea, abd distention
  • S+S UTI (Chills fever, frequency, hesitation)
  • S+S obstruction (Frequent urination: small amounts, oliguria, anuria)
  • Urine: Blood strain, stones or gravel
  • History: factors that predispose
  • Patient knowledge
45
Q

Kidney stones: Nursing problems

A
  • Acute pain, from inflammation, obstruction or abrasion
  • Impaired urinary elimination
  • Knowledge deficit: Preventing future kidney stones
  • Anxiety
46
Q

Kidney stones: Planning and goals

A
  • Pain relief and discomfort
  • Prevention of recurrence of stones
  • Absence of complications
47
Q

Nursing interventions: Kidney stones

A
  • Pain: Opioids (IV/IM)
    • NSAIDS
    • Assume position of comfort
    • Ambulate as tolerated
    • Report increasing severity
  • Monitor and mgmt of potential complications
    • Hydration (PO/IV)
    • Ambulation
    • Strain urine
    • Treat UTI
48
Q

Kidney stones: Patient teaching

A
  • S+S to report
  • FOllow up care
  • Risk factors
  • Measures to prevent stones
  • Importance of fluid intake
  • Dietary teaching
  • PH monitoring
  • Ambulation: Prolonged immobilization slows renal drainage, altering Ca metabolism
  • Med teaching
49
Q

Kidney stones: Patient teaching, Post procedural stone removal:

A
  • Instruct S+S of complications (urinary retention, infection)
  • Importance of follow up
50
Q

Kidney stones: Patient teaching, ESWL

A
  • Instructions for home care/ follow up
  • Increase fluids to help pass stone fragments
  • S+S complications
  • Hematuria Anticipated in all patients for 4-5 days
  • Stent in ureter, hematuria until stent is removed
  • Check temp daily notify if 38 C, 101 F
  • Report unrelieved pain
  • Bruising on treated area
51
Q

Evaluation of mgmt of kidney stones

A
  • Reports relief of pain
  • Increased knowledge in prevention of future stones
  • Experiences no complications
    • No S+S infection or urosepsis
    • Voids 200-400 per voiding of clear urine with no blood
    • Absence of urgency frequency, hesitation
    • Maintains normal body temp

NSG 478 (23 decks)

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