UI and Kidney Stones Flashcards
patient population at greatest risk for UI
females, older adults
Risk factors for UI
◦ Pregnancy
◦ Obesity –> pressure on pelvic floor, weakening –> stress UI
◦ Diabetes Mellitus –> neurogenic bladder
◦ May or may not be related to another disorder
◦ All people over 65 should be screened for UI
5 types of UI
- Stress Incontinence
- Urge Incontinence
- Overflow Incontinence
- Functional Incontinence
- Mixed Incontinence
type of incontinence: Loss of small amounts of urine when detrusor muscle pressure increases and is greater than the pressure of the urethra (aka Unable to tighten the urethra to overcome the pressure of the bladder)
stress incontinence
causes of stress incontinence + 2 biggest risk factors
◦ Coughing
◦ Sneezing
◦ Jogging
◦ Lifting
-Risk factor: child birth, and decrease estrogen with aging causes loss of tone in pelvic floor
stress incontinence interventions
- Kegel Exercises
- Vaginal Cone
- Electrical Stimulation
- Urethral Occlusion Devices
- Magnetic Resonance
- Nutrition— urge incontinence, avoid bladder irritant s in the dietL: coffee, artificial sweeteners, alcohol, tobacco
- Pharmacological
• End goal is to strengthen the pelvic floor!
type of incontinence: Perception of an urgent need to urinate regardless of amount of urine in the bladder
urge incontinence aka overactive bladder
causes of urge incontinence
◦ Neurological disorders
◦ Urinary tract problems
◦ *Bladder irritants
urge incontinence interventions
• Neuromodulation • Pharmaceuticals • Nutritional Modifications • Avoid Bladder Irritants ◦ Caffeine ◦ Alcohol ◦ Artificial Sweeteners ◦ Tobacco • Behavioral Interventions ◦ Bladder Training- go every hour and try to stretch that time out
which type of incontinence is managed by removing bladder irritants and doing bladder training ?
urge incontinence
which type of incontinence is greatly improved by pelvic floor strengthening exercises like kegels?
stress incontinence
type of incontinence: Detrusor muscles fail to contract and bladder becomes over-distended (no urge to go) and has involuntary release of urine when bladder reaches its maximum capacity (dribbling)
-overflow incontinence aka underactive or reflex incontinence
causes of overflow incontinence
◦ obstructed urethra
◦ urinary retention, BPH
Interventions: Reflex/Overflow Incontinence
• Removal of obstruction ◦ Prostate removal ◦ Uterine Prolapse • Pharmaceutical Therapy ◦ Short-term ◦ Urecholine • Behavioral Interventions ◦ Bladder Compression ◦ Self-Catheterization if have neurogenic bladder
which type of incontinence is managed by removing an obstruction or self cathing?
overflow incontinence
preferred method of bladder emptying for neurogenic bladder
Intermittent Self-Catheterization
education for Intermittent Self-Catheterization
- Hand Hygiene/ Technique
- Small Lumen and lubrication
- Schedule
• Don’t teach people to do sterile intermittent cath- it is a clean procedure and they can reuse the catheter
type of incontinence : Incontinence is related to something other than dysfunction of bladder or urethra
functional incontinence
causes of functional incontinence
◦ Loss of Cognitive function
◦ Physical Disability
functional incontinence interventions?
• Treatment of reversible causes • Habit Training (Cause not reversible) • Containment- use a brief but best thing is habit training ◦ Protect Skin • Indwelling Catheterization- if they have a bad wound • Applied Devices ◦ Urethral occlusion ◦ Pessary- device that holds bladder up ◦ Penile clamp
which type of incontinence is treated by reversing cause or habit training and largely managed by containment like a brief?
functional incontinence
type of incontinence: Presence of more than one type of urinary incontinence
mixed
which population is most likely to have mixed UI? what is most common combo?
older women , stress/urge
UI assessment
- Urine color/ odor—> rule out infection
- Cough test/ pad—> test for stress ui
- Patient may need pelvic floor exam—> pt can help w/
- Urine stream interruption test— say stop peeing and see if can stop
- Digital rectal exam—> tells us if nerves are intact, if sphincter of rectum works bladder likely work too
- Stool Impaction— put pressure on bladder
- Prostate exam –> obstruction due to enlarged prostate?
diagnostics for UI?
• Urinalysis -> rule out infection
• “Culture if indicated” –> means collect as a clean catch!!
• Bladder Scan: Post-residual Void –> if retaining urine, often associated with overflow incontinence
• CT Scan
• Urodynamic testing/ Electromyography testing of pelvic muscles
◦ Cystourethroscopy
◦ Cystometrogram (CMG)
◦ Urethral pressure Profolometry (UPP)
◦ Uroflow testing
what does cough test/pad test for?
stress UI
why do digital rectal exam to assess UI?
tells us if nerves are intact, if sphincter of rectum works bladder likely work too
why do prostate exam to assess UI?
obstruction due to enlarged prostate?
if patient answers yes to a UI screening question RN should do a …..
focused assessment!!
community based care for UI
- Consider support/ caregiver
- Factors that will contribute to plan adherence
- Non-drug interventions provide benefits but can be difficult to follow
- Medications may provide benefit but have lots of side effects
- Leads to poor adherence
Home environment interventions for UI
- Assess barriers to getting to bathroom
- Remove barriers
- Facilitate access to bathroom when barriers cannot be removed
- Toilet extenders
- Portable toilet
- PT/OT
WTF does urolithiasis mean?
kidney stone!
different things kidney stones are made out of
calcium, struvite, uric acid, and cystine
why do i care what the kidney stone is made out of?
informs treatment!
-dietary recommendations or need for abx
Nephrolithiasis vs Ureterolithiasis
- Nephrolithiasis- stone forms in kidney
* Ureterolithiasis- stone forms in ureter
causes of kidney stones
• Not entirely understood
May be associated with:
• Metabolic Risk Factor
• Dehydration
• Slow Urine Flow
• Damage to the lining of the urinary tract
• High urine acidity (uric acid and cystine) or alkalinity (calcium phosphate and struvite stones)
• Obesity
• Diabetes
• Gout- uric stones
• Hyperparathyroidism- Ca stones
• Urinary tract obstruction leads to stasis and formation of stones
• Inflammatory Bowel disorders/ History of GI problems
Hydroureter vs Hydronephrosis
Hydroureter =Enlargement of the ureter
Hydronephrosis=Enlargement of the kidney
when does hydroureter occur? what can it lead to?
◦ Occurs when a stone occludes the ureter and blocks urine flow
pain and hematuria
what causes hydronephrosis ? what can it lead to?
- Caused by blockage below kidneys, causing urine to backflow into kidneys
- Can lead to permanent kidney damage/failure
assessment for kidney stones?
• History • Severe pain: Renal Colic ◦ Nausea & Vomiting • Bladder distension • Frequency • Dysuria • Oliguria= the production of abnormally small amounts of urine • Anuria = failure of the kidneys to produce urine. • Hematuria • Skin: Pale, Ashen, Diaphoresis
Oliguria vs Anuria
- Oliguria= the production of abnormally small amounts of urine
- Anuria = failure of the kidneys to produce urine.
Kidney issue that causes n/v from renal colic?
kidney stones
diagnostics for kidney stone
• Urinalysis • Urine pH ◦ Low uric acid & cystine ◦ High CaPhosphate & Struvite • WBC • X-ray • CT • Ultrasound
interventions for kidney stone
• *Pain management
◦ Opioids
◦ NSAIDS
• Strain urine –> Send stone to lab
• Meds: Thiazide diuretic, Allopurinol, Citrate
• *Prevention of infection
◦ Antibiotics- struvite stone or urinary stasis
• *Prevention of obstruction
◦ Avoid dehydration/ over-hydration if in renal failure
◦ Hydration 2-3 liters/ day (3 or more to prevent obstruction)
◦ Walking to prevent obstruction
• Monitor Urine pH
• Anxiety Management
what is lithotripsy for?
send shock waves to where stone is. Locate stone with radiology.
◦ Stones is broken up. Moderately sedated. Pass fragments of stone.
expected outcomes from lithotripsy?
Bloody urine may be present . Will have bruising afterwards
what do we do with ice and heat for lithotripsy?
Ice packs for 24 hours then heat after that
surgical interventions for kidney stone
- Stent Placement
- Ureteroscopy
- Percutaneous ureterolithotomy or nephrolithotomy
- Open ureterolithotomy or nephrolithotomy
- Infection
- Bleeding
interventions for infection management w/ kidney stone
- Antibiotics before surgery
- Antibiotics used with all struvite stones
- Culture and Sensitivity
what kimd of stones do we use ABX for?
struvite
