Renal/Urinary Flashcards
Is urinary incontinence a normal part of aging?
- Incontinence isn’t a “normal part of aging” but is more prevalent in the older adult
- Some changes in the urinary tract as we age can contribute: (1) bladder capacity, (2) contractility and (3) ability to postpone voiding can decline as wel age
- Some things may enlarge (such as prostate)
What questions do you ask to determine the patient is incontinent?
- Ask about the onset of incontinence and for a description of the incontinence pattern.
- Obtain a description of normal urinary pattern and fluid intake. Inquire about other urinary problems, such as hesitancy, frequency, urgency, nocturia, dysuria, and decreased force or interruption of the urine stream.
- Ask about a history of urinary tract infection (UTI), prostate conditions, spinal injury or tumor, stroke, COPD, chronic cough, diabetes, obesity, or surgery involving the bladder, prostate, or pelvic floor.
- Ask a female patient about the number of pregnancies and childbirths.
- Ask about smoking, alcohol, and caffeine use.
- Obtain a complete drug history.
What is incontinence?
Uncontrollable passage of urine
Can be transient or permanent
Possibly involving large volumes of urine or scant dribbling
Classified as stress, overflow, urge, or functional
Normal bladder capacity
Normal functional bladder capacity in adults ranges from approximately 300 to 400 ml
What is anuria?
Lack of urine production
What is dyuria?
Painful or difficult urination
What is urinary frequency?
Urinary frequency is the need to urinate many times during the day, at night (nocturia), or both but in normal or less-than-normal volumes.
What is hematuria?
Presence of blood in the urine
What is nocturia?
Nocturia is a condition that causes you to wake up during the night to urinate. This can be thought of as nocturnal urinary frequency.
What is oliguria?
Oliguria is a medical term for low urine output (how much you pee). In the case of an adult, this means less than 400 milliliters (mL) to 500 mL (around two cups) of urine per 24 hours. The numbers depend on weight in terms of children and infants.
What is proteinuria?
Elevated levels of protein in the urine
What is microalbumin?
Less than 30 mg is normal. From 30-300 mg indicates microalbuminaria.
What is pyuria?
Pyuria is a condition defined by the increased presence of white blood cells in urine. Although a urinary tract infection is the most common cause of sterile pyuria, other conditions may be involved. the presence of 10 white blood cells in each millimeter cube of the urine. Sterile pyuria, in contrast, is a type of pyuria in which no bacteria are present in the urine. This could be due to a medical condition, non-detected bacteria, or another germ, such as a virus.
What is enuresis?
Involuntary urination at night
What medications help with urinary/renal disorders?
Estrogen •Oxybutynin •Dicyclomine •Tolterodine
What are some causes of UTI?
Community vs CAUTI (catheter associated) •Urinary stasis •More common in woman •Lower UTI ◦Urethritis ◦Cystitis ◦Prostatitis •Pyelonephritis
What are the symptoms of a UTI?
• Dysuria •Polyuria •Coudy urine •Urgency and frequency •LOC changes
How do you test for UTI?
- U&A C&S - CBC
How are UTIs treated?
- ABX - push fluids - cranberry juice - education
What is pyelonephritis?
Upper UTI involving the kidneys - symptoms incl lower back pain and fever - Can be acute or chronic
Describe the differences between acute and chronic pyelonephritis?
Acute:
- bacterial in origin
- will improve with antibiotics, fluids
- symptoms usually moderate-severe
- chronic diseases like diabetes
Chronic:
- Nonbacterial in origin
- Caused by unresolved UTI, long-term HTN, vesicoureteral reflux, urinary obstruction
- may progress into renal failure
- symptoms usually manifest mildly
- chronic diseases like diabetes
What tests are available for pyelonephritis?
◦UA C&S ◦Specific gravity ◦GFR ◦Creatinine
What is the treatment for pyelonephritis?
◦Same as UTI but likely need IV and/or longer therapy ◦Educate
Urolithiasis/ Nephrolithiasis/Ureterolithiasis
•Obstruction •Calculi (stones) ◦Calcium ◦Uric acid and cystine ◦Bacteria •Dehydration
What are some potential sites of urinary calculi?
-Right & Left kidney - renal stones - ureters -bladder
What are the S/S of urinary calculi?
- Pain
- Frequency/dyuria/anuria
- hydronephrosis
- hydroureter
How is urinary calculi diagnosed?
◦UA
◦WBC, Ca, Phos, uric acid, BUN, Creatine
◦CT scan
What methods of treatment are available for kidney stones?
Extracorporal shock wave lithotripsy
Scope (uteroscope)
Why would a urinary diversion be used?
- bladder cancer or other pelvic malignancies
- birth defects
- Trauma strictures
- neurogenic bladder
- chronic infection or intractable cystitis
- used as a last resort for incontinence
What are the types of urinary diversions?
- Cutaneous urinary diversion: ileal conduit, cutaneous ureterostomy, vesicostomy, nephrostomy
- Continent urinary diversion: Indiana pouch, Kock pouch, uretherosigmoidostomy
What is chronic kidney disease?
- Worsening kidney function over time
- Hypertension
- Diabetes
- Loss of ability to produce diluted urine
- Nephrosclerosis
- AKA Hypertensive nephropathy
- Diabetic Nephropathy
What are the manifestations of CKD?
Decreased GFR
Oliguria or anuria
Uremic frost
Anemia
FVO
Electrolyte imbalances
◦See lab values on page 1379
Effects on every body systems
◦See chart KEY FEATURES pg 1388
What are the stages of CKD?
- Stage 1 with normal or high GFR (GFR > 90 mL/min)
- Stage 2 Mild CKD (GFR = 60-89 mL/min)
- Stage 3 Moderate CKD (GFR = 30-59 mL/min)
- Stage 4 Severe CKD (GFR = 15-29 mL/min)
- Stage 5 End Stage CKD (GFR <15 mL/min)
What is the tx of CKD?
Medication management chart page 1391
Frequent labs
Diet
◦Watch fluid, K, NA, Phosphorus, and protein
◦see table 63.8 page 1392
F/E balance
Manage comorbidities
Peritoneal dialysis
◦At home
◦May cause peritonitis with pink or bloody discharge
◦Clear Dialysate
Hemodialysis
◦Settings and anticoagulation
Transplant
What are considerations for hemodialysis?
Fistula
◦No bp cuff
◦Palpate and auscultate
◦Takes months to heal from placement
Common care considerations
◦F/E
◦Meds to hold
Post dialysis assessment
Disequilibrium
What is a renal cell carcinoma?
Renal cell carcinoma is a malignant neoplasm of the kidney; it comprises several distinct morphologic types, some of which are familial
Patients may be symptomatic (eg, hematuria, flank pain), but very often the lesion is found incidentally on imaging for unrelated reasons
Treatment of localized disease is primarily surgical. Nephron-sparing treatment (partial nephrectomy) is favored for stage I and, when feasible, for stages II and III; radical nephrectomy is recommended for surgical candidates with large or complex tumors
Thermal ablation is an option for smaller lesions in patients who cannot undergo surgery; active surveillance without immediate intervention is also an option for selected patients with small lesions (stage I, less than 2 cm 1)
What is BPH?
Enlargement of the prostate
Effects half of men over age 50 and 80% of men over age 80
What are the s/s of BPH?
s/s- looks like urinary obstruction, retention, and UTI
◦Hyrdroureters and hydronephrosis
May experience overflow incontinence
What is prostatitis and how is it treated?
◦Inflammation caused by an infectious agent
◦Treatment
Antibiotics
Pain management
Spasm control
What labs and tests are ordered for BPH?
Labs- ua, cbc, psa, bun/creat, prostatic fluid
Diagnostics- DRE and Transabdominal or transrectal ultrasound, cytoscopy
How is BPH treated?
Treatment
◦Meds chart page 1474
Finasteride
Tasulosin
Tadalafil
- doxazosin
◦Catheter
◦Prostate surgery-TURP
What is Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate.
An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that’s blocking urine flow.
TURP is generally considered an option for men who have moderate to severe urinary problems that haven’t responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP.
What does management look like after TURP?
- Monitor urinary drainage and keep catheter patent
- Assessment of pain
- Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter.
- Medication and warm compresses or sitz baths to relieve spasms
- Administer analgesics and antispasmodics as needed
- Encourage patient to walk, but to avoid sitting for prolonged periods.
- Prevent constipation
- Irrigate catheter as prescribed
What is CBI?
often done after TURP
Continuous bladder irrigation (CBI) is a medical procedure that flushes your bladder with a sterile liquid. It also removes urine (pee) from your body at the same time. Healthcare providers often use it to prevent or remove blood clots after surgery on the urinary system. The procedure takes place in a hospital over several days.
What is pt teaching about BPH and after TURP?
Diet low in fat and red meat, high in protein and vegetables
Adequate hydration; avoid drinking too much fluid in a short period.
Avoid alcohol, diuretics, caffeine, artificial sweeteners, spicy or acidic foods.
Avoid medications that cause urinary retention – antihistamines, decongestants, anti-cholinergic, anti-depressants
Post-TURP teaching:
◦Normal to feel the urge to void while the catheter is in place.
◦Do not void around the catheter to avoid bladder spasms.
◦Urine will be blood-tinged, can pass small clots for several days – increase fluid intake to at least 2-2.5 L daily (unless contraindicated).
◦Monitor for infection and incontinence.
◦Reproduction ability should not be affected.
◦Report severe spasm and decreased urinary output → possible obstruction
Signs and symptoms of acute urinary retention
What is erectile dysfunction?
Inability to achieve or maintain an erection for sexual intercourse.
May be organic (gradual deterioration of function) or functional (rapid onset, usually have normal nighttime and morning erections, follows a period of high stress).
Has a strong correlation with hypertension and BPH and spinal issues
Medications- most common intervention for ED ▪ Phosphodiesterase-5 inhibitors (PDE-5) – relaxes the smooth muscle in corpora cavernosa –box) table 67.4 page 1488
What are the three ways that erectile dysfunction can be managed?
- Pharmacologic agents
- oral meds (sildenafil)
- side effects: HA, flushing, dyspepsia
- Caution with retinopathy
- contraindicated with nitrate use
- Injected vasoactive agents
- Complications include priapism (persistent abnormal erection)
- urethral suppository
- oral meds (sildenafil)
- Penile implants
- Negative pressure devices - vacuum
What medications causes urinary retention?
antihistamines, decongestants, anti-cholinergic, anti-depressants
What is urolithiasis?
Urinary calculus
