RENAL/UROLOGIC Flashcards
What are the two UTIs of the lower urinary tract?
Cystitis (bladder)
Urethritis (urethra)
What is the upper urinary tract infection
Pyelonephritis (kidney)
Difference between complicated and uncomplicated UTI
Uncomplicated occurs in otherwise healthy urinary tract and usually only involve the bladder
Complicated includes infections w/ coexisting obstruction, stones, or catheters. Includes UTIs in pts w/ neurologic changes, pregnancy, recurrent infections, ect.
Predisposing factors for UTIs
Urinary statis (urine flow obstruction), foreign bodies, anatomic features, compromised immune response, functional disorders
What might be present in a urine specimen that indicates a UTI?
WBC, Nitrates, leukocyte esterase
Culture indicates bacteria present
What symptoms indicate the pt is experiencing a UTI?
Emptying symptoms, storage symptoms
Emptying symptoms
Hesitancy, intermittency, post-void dribbling, urinary retention/incomplete emptying, dysuria
Storage symptoms
Frequency, urgency, incontinence, nocturia, nocturnal enuresis (bedwetting)
How do you treat a pt with an uncomplicated UTI?
Adequate fluid intake,
Use TRIMETHOPRIM & SULFAMETHOAZOLE or just Trimethoprim if they’re allergic to sulfa drugs.
Nitrofurantoin (Macrobid) dyes urine orange. Can be used prophylactically and is not prone to bacterial resistance.
Fosfomycin is used for lower tract infections only.
Fluconazole for fungal infections
Phenazopyridine: Pain management specific to UTI pain
What would you do in additional to normal treatment of UTI when it becomes recurrent
Repeat urinalysis, potential imaging, sensitivity guided antibiotic therapy (see what bacteria is causing infection and give antibiotics to treat), 3-6 months of antibiotics, post-coital antibiotic prophylaxis
What is pyelonephritis
Kidney infection (inflammation of the renal parenchyma and collecting system.
MOST COMMON CAUSE: Ascending UTI (An ascending UTI is a type of urinary tract infection that starts in the lower urinary tract (bladder and urethra) and travels up to the upper urinary tract (ureters and kidneys))
Can be acute or chronic
What physical assessment can indicate pyelonephritis
Put hand over affected kidney. Make other hand into a fist and hit hand over kidney. If in extreme pain, that kidney is affected by polynephritis.
How do you diagnose pyelonephritis
Urinalysis that contains bacteria, blood, WBCs, pyuria (purulent)
Positive urine/blood cultures
CBC indicates left shift of WBCs
Ultrasound indicates anatomic abnormalities/hydronephrosis/abscesses/stones
LATE STAGE: IV pyelogram (urinary tract xray), CT scan w/ IV contrast
What nursing Dx would you use for urinary elimination
Impaired urinary elimination
Readiness for enhanced self-management
What can you do to help treat your pt’s symptoms?
local heat to suprapubic/lower back area
Warm shower
Adequate fluid intake
Antibiotic teaching
Appropriate use of urinary catheters
When would you tell your pt to contact their doctor about their UTI symptoms
Once antibiotics are completed the pt is still experiencing symptoms
Onset of major flank pain
Fever
What do you have to teach your pt when receiving treatment for UTI?
All antibiotics must be taken as prescribed, no matter if your symptoms go away
Appropriate hygiene (cleanse perineal region by separating labia), wiping front to back, cleansing with warm, soapy water after each bowel movement
Pee after sex
Maintain fluid intake
No harsh soaps, vaginal douches, bubble paths, or powders down there
Cranberry juice (8oz x3/day) OR 300-400mg tabs/day
Define stress incontinence
Involuntary loss of urine during activities that increase
abdominal and detrusor (bladder muscle) pressure
Define Urge Incontinence
Involuntary loss of urine associated with a strong urge to urinate
Define Overflow Incontinence
Involuntary loss of urine associated with over-distention of the
bladder when bladder capacity has reached its maximum due to
urethral obstruction/spasm
Define reflex incontinence
Involuntary loss of urine that occurs without
warning
Associated w/ CNS disorders
Define Functional Incontinence
Loss of urine resulting from cognitive,
functional, or environmental factors
What can you teach your pt to improve their incontinence
Smoking cessation, weight reduction, regular bowel elimination,
reduction of bladder irritants
Scheduled voiding regimens
Pelvic floor muscle rehabilitation (stress)
Anti-incontinence devices such as a urethral plug, penile compression device, pessaries
Containment devices (urge)
What therapy would you use for stress incontinence
Pelvic floor muscle rehabilitation
Kegels, Physical Therapy
Vaginal weight training (Kegels with weight inserted in the
vagina)
What therapy would you use for urge incontinence
Containment devices
Condom catheter
Absorbent products
What drugs would you use for urine incontinence
Muscarinic Receptor Antagonists and
Anticholinergics
Reduce overactive bladder contractions
Used for urge incontinence and overactive bladder
Oxybutynin (Ditropan)
Tolterodine (Detrol)
Solifenacin (VESIcare)
Dicyclomine (Bentyl)
α-Adrenergic Antagonists
5α-Reductase Inhibitors
Used when incontinence is related to BPH
When would you use an indwelling catheter
Urinary retention
Bladder decompression before or
after lower abdominal or pelvic
surgery
Genitourinary surgery
Accurate measurement of I/O in
critically ill patients
To prevent contamination of stage III
or IV pressure ulcers
Terminal illness, when positioning is
associated w/ significant discomfort
When would you use a Straight (in and out) catheter
Study of anatomic structures of
urinary system
Urodynamic testing
Collection of sterile specimens in
selected situations
Instillation of medications into
the bladder
Measurement of residual urine
after urination (post void residual
-PVR) if portable ultrasound is not
available
What is BPH
Benign Prostatic Hyperplasia
As men age, the glandular units in the prostate
begin to undergo hyperplasia (abnormal increase
in the number of cells), resulting in prostate
enlargement (hypertrophy)
The enlargement causes narrowing of the urethra
and results in partial or complete obstruction
What are the two types of BPH
Obstructive (due to urinary retention)
Difficulty initiating voiding
Changes in size and force of urinary stream
Dribbling at end of urination
Irritative (associated w/ inflammation and infection)
Urgency, frequency
Nocturia
Dysuria
Incontinence
How do you diagnose BPH
Digital Rectal Exam (DRE)
To estimate size, symmetry, consistency of prostate gland
Additional tests depending on symptom severity
Urine culture
Prostate-specific antigen (PSA) blood test
Serum creatinine
Transrectal Ultrasound (TRUS)
What would you tell your patient to avoid when diagnosed with BPH
Decrease caffeine and
artificial sweeteners
Avoid spicy and acidic foods
Avoiding decongestants and
anticholinergics
Restricting PM fluid intake
Timed voiding schedule
What medications would you use for BPH
5 alpha-Reducatase Inhibitors
Finasteride (Proscar)
Reduces the size of the prostate gland to improve urine flow
Blocks the 5α-reductase isoenzyme (type 2), which is needed
to convert testosterone to dihydroxytestosterone
Takes 4-6 months to be effective
Dutasteride (Avodart)
Same effect, dual inhibitor of 5α-reductase isoenzyme 1 and
2
SE: decreased libido, decreased volume of ejaculate, ED
Monitor liver function tests
Alpha Blockers
Blocks the α1-adrenergic receptors in the prostate
smooth muscle to improve urinary flow
May cause orthostatic hypotension
Exam
Alpha blockers can cause
orthostatic hypotension
Besides medication, how might your treat BPH?
Transurethral Microwave Thermotherapy (TUMT)
Transurethral Needle Ablation (TUNA)
Laser Prostatectomy
Transurethral Electrovaporization of Prostate
(TUVP)
Intraprostatic Urethral Stents
Transurethral Resection of
the Prostate (TURP)
The portion of the prostate
that is blocking the urethra is
removed
Procedure
A resectoscope is inserted
into the urethra via the penis
and into the bladder
The portion of the prostate
that has become enlarged is
then removed
No external incision
SIGNIFICANT RISK FOR BLEEDING
Bleeding is common following the TURP
procedure
A continuous bladder irrigation (CBI) will be
prescribed postoperatively with a LARGE
indwelling Foley
To decrease bleeding and keep the bladder free of
clots
WHAT MATERIAL WOULD YOU USE FOR A CONTINUOS BLADDER IRRIGATION
A 3-way (3-lumen) Foley
catheter
One lumen for inflating
balloon (30 mL)
One lumen for outflow
One lumen for instillation
(inflow)
