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ADULTs 1 > RENAL/UROLOGIC > Flashcards

RENAL/UROLOGIC Flashcards

1
Q

What are the two UTIs of the lower urinary tract?

A

Cystitis (bladder)

Urethritis (urethra)

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2
Q

What is the upper urinary tract infection

A

Pyelonephritis (kidney)

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3
Q

Difference between complicated and uncomplicated UTI

A

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.

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4
Q

Predisposing factors for UTIs

A

Urinary statis (urine flow obstruction), foreign bodies, anatomic features, compromised immune response, functional disorders

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5
Q

What might be present in a urine specimen that indicates a UTI?

A

WBC, Nitrates, leukocyte esterase

Culture indicates bacteria present

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6
Q

What symptoms indicate the pt is experiencing a UTI?

A

Emptying symptoms, storage symptoms

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7
Q

Emptying symptoms

A

Hesitancy, intermittency, post-void dribbling, urinary retention/incomplete emptying, dysuria

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8
Q

Storage symptoms

A

Frequency, urgency, incontinence, nocturia, nocturnal enuresis (bedwetting)

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9
Q

How do you treat a pt with an uncomplicated UTI?

A

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

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10
Q

What would you do in additional to normal treatment of UTI when it becomes recurrent

A

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

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11
Q

What is pyelonephritis

A

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

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12
Q

What physical assessment can indicate pyelonephritis

A

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.

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13
Q

How do you diagnose pyelonephritis

A

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

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14
Q

What nursing Dx would you use for urinary elimination

A

Impaired urinary elimination

Readiness for enhanced self-management

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15
Q

What can you do to help treat your pt’s symptoms?

A

local heat to suprapubic/lower back area

Warm shower

Adequate fluid intake

Antibiotic teaching

Appropriate use of urinary catheters

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16
Q

When would you tell your pt to contact their doctor about their UTI symptoms

A

Once antibiotics are completed the pt is still experiencing symptoms

Onset of major flank pain

Fever

17
Q

What do you have to teach your pt when receiving treatment for UTI?

A

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

18
Q

Define stress incontinence

A

Involuntary loss of urine during activities that increase
abdominal and detrusor (bladder muscle) pressure

19
Q

Define Urge Incontinence

A

Involuntary loss of urine associated with a strong urge to urinate

20
Q

Define Overflow Incontinence

A

Involuntary loss of urine associated with over-distention of the
bladder when bladder capacity has reached its maximum due to
urethral obstruction/spasm

21
Q

Define reflex incontinence

A

 Involuntary loss of urine that occurs without
warning
 Associated w/ CNS disorders

22
Q

Define Functional Incontinence

A

Loss of urine resulting from cognitive,
functional, or environmental factors

23
Q

What can you teach your pt to improve their incontinence

A

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)

24
Q

What therapy would you use for stress incontinence

A

Pelvic floor muscle rehabilitation

 Kegels, Physical Therapy
 Vaginal weight training (Kegels with weight inserted in the
vagina)

25
Q

What therapy would you use for urge incontinence

A

Containment devices
 Condom catheter
 Absorbent products

26
Q

What drugs would you use for urine incontinence

A

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

27
Q

When would you use an indwelling catheter

A

 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

28
Q

When would you use a Straight (in and out) catheter

A

 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

29
Q

What is BPH

A

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

30
Q

What are the two types of BPH

A

 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

31
Q

How do you diagnose BPH

A

 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)

32
Q

What would you tell your patient to avoid when diagnosed with BPH

A

 Decrease caffeine and
artificial sweeteners
 Avoid spicy and acidic foods
 Avoiding decongestants and
anticholinergics
 Restricting PM fluid intake
 Timed voiding schedule

33
Q

What medications would you use for BPH

A

 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

34
Q

Alpha blockers can cause

A

orthostatic hypotension

35
Q

Besides medication, how might your treat BPH?

A

 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

36
Q

WHAT MATERIAL WOULD YOU USE FOR A CONTINUOS BLADDER IRRIGATION

A

A 3-way (3-lumen) Foley
catheter
 One lumen for inflating
balloon (30 mL)
 One lumen for outflow
 One lumen for instillation
(inflow)

ADULTs 1 (21 decks)

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