Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Upper UTI

A
  • Kidneys and ureters
  • Pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lower UTI

A
  • Bladder and urethra
  • Cystitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

UTI prevention

A
  • Adequate hydration (Fluids and cranberry juice)
  • Perineal care
  • Afterintercourse care
  • Showers over baths
  • Cotton underwear, avoid tight and restrictive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What bevs increase risk of UTI

A
  • Coffee
  • Tea
  • Alc
  • Citrus
  • Cola
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acute Pyelonephritis: Diagnostics

A
  • Urinalysis with culture and screen
  • Ultrasound
  • CT
  • IV pyelogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Urolithiasis

A
  • Stones (calculi) in the urinary tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nephrolithiasis

A

Stones (Calculi) in the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Incidence of Renal Calculi

A

Starts ages 30-50
2x rate in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Kidney stones, clinical manifestations: Ureteral colic
* 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
Kidney stones, clinical manifestations: Bladder
* Frequency, urgency, irritation, uti (sepsis), hematuria * If the stone obstructs the bladder neck thats an **emergency**
27
Assessment and diagnostic findings: Kidney stones
* 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
Diagnostic test: Kidney stones
* 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
Goals of kidney stones
* 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
mgmt of kidney stones
* **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
Kidney stones: Interventional procedures
* 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
ESWL considerations
* 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
Percutaneous nephrostomy/percutaneous nephrolithotomy
* 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
Electrohydraulic lithotripsy:
* 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
Complications of electrohydraulic lithotripsy
Hemorrhage, infection, urinary extravasation
36
Chemolysis
* 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
Surgical mgmt of kidney stones
* **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
Nephrolithotomy
Incision into the kidney with removal of stone
39
Nephrectomy
Kidney is nonfunctional secondary to infection or hydronephrosis
40
Pyelolithotomy
Removal of stones in kidney pelvis
41
Ureterolithotomy
Removal of stones from ureters
42
Cystotomy
Stone removal from bladder
43
Prevention of kidney stones: Nutrition
* 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
Assessment of kidney stones
* 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
Kidney stones: Nursing problems
* Acute pain, from inflammation, obstruction or abrasion * Impaired urinary elimination * Knowledge deficit: Preventing future kidney stones * Anxiety
46
Kidney stones: Planning and goals
* Pain relief and discomfort * Prevention of recurrence of stones * Absence of complications
47
Nursing interventions: Kidney stones
* 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
Kidney stones: Patient teaching
* 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
Kidney stones: Patient teaching, Post procedural stone removal:
* Instruct S+S of complications (urinary retention, infection) * Importance of follow up
50
Kidney stones: Patient teaching, ESWL
* 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
Evaluation of mgmt of kidney stones
* 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions