Unit 15 Alterations of Urinary System Flashcards
What are types of Urinary Disorders?
UTI
Benign Prostatic Hyperplasia (BPH)
Nephrolithiasis
Glomerulonephritis
What is Nephrolithiasis?
Kidney stones, renal calculi
-causes a lot of flank pain
Define the following terminology:
- Cystisis
- Prostatitis
- Pyelonephritis
- Urethritis
- Cystisis (bladder inflammation and infection in any part of the urinary system, the kidneys, bladder, or urethra)
- Prostatitis (prostate inflammation)
- Pyelonephritis (kidney inflammation due to bacterial infection)
- Urethritis (urethra inflammation)
What are the classifications of Urinary Tract Infections?
Lower Upper Uncomplicated Complicated Hospital acquired
What are symptoms of lower UTIs considered?
Localized
What are symptoms of upper UTIs considered?
Systemic
What is the most common type of UTI?
Lower uncomplicated, caused by UTI and nothing else (bladder and down)
What does complicated UTI mean?
Refers to UTI caused by another known reason such as a disease
What are the signs and symptoms of UTIs?
Dysuria- burning pain when urinating Urgency- sudden need to urinate Frequency Nocturia- waking at night to urinate Suprapubic or pelvic pain Hematuria (just a little) Back pain Incontinence (usually elderly) Dullness on percussion
What are gerontological considerations of UTIs?
They lack typical symptoms AMS Lethargy Anorexia New incontinence Low grade fever May still have frequency, urgency, and dysuria
What are 3 diagnostic tests for lower UTIs?
Urine Dipstick: bacteriuria
Urinalysis:UA
Urine Culture and sensitivity: C and S
How does a urine dipstick show infection?
WBCs and nitrates = infection
Specific gravity elevated
What can an Urinalysis show?
increased WBCs
Bacterial colonies
Describe urine culture and sensitivity (C and S).
It’s clean catch/catheterization
Culture- determines the infectious agent
Sensitivity- determines the susceptibility of bacteria to antibiotics
Name and describe the urinary analgesic.
Phenazopyridine
- take when you have symptoms as needed
- turns urine dark orange, make PT aware could look like blood
If a PT is treated for a UTI with a dose of Rx and in 1-3 days it does not go away, what would be the next step?
C and S to identify bacteria before another Rx.
What 3 antibiotics are used for UTIs and describe them.
floroquinolone: *cirpoflaxicin *levoxicin
-treatment of choice for uncomplicated (3days)
S.Effects: *C-DIFF, *Tendonitis/tendon rupture, diarrhea, GI discomfort and rash, seizures
Taken-1 hour before meals or 2 hrs after meals
Nitrofurantoin
- ineffective in PTs with GFR <50 (kidney failure)
- can cause peripheral neuropathy
Penicillin’s: Amoxicillin
- Check for PT allergies
- high likelihood of resistance with Rx misuse
What are UTI educational and prevention points we can teach PTs?
- Shower and post coital(intercourse) voiding
- Cleaning the perineum from front to back
- Increase amounts of fluid
- Avoid coffee, tea, alcohol, colas
- Empty bladder Q 2-3 hrs.
- Take meds EXACTLY as prescribed
- Vitamin C 1000 mg and *cranberry juice
What is an Upper UTI also known as and where is the infection?
Pyelonephritis- infection of kidneys, urters, and renal pelvis
What are the signs and symptoms of [acute] Upper UTI/Pyelonephritis and what is a complicated of it?
-Lower UTI signs and symptoms + fever, chills, serum leukocytosis (elevated WBC), low back pain, flank pain, n and v, headache (systemic symptoms)
Complication: could relapse and become asymptomatic and chronic
What two terms also mean stones in the urinary tract and kidney?
Urolithiasis and nephrolithiasis
What is the urine that remains in the bladder after voiding?
residual urine
What are the signs and symptoms of chronic Pyelonephritis and what is the complication of it?
Weight loss, polyuria, headache, poor appetite, excessive thirst
Complication: End Stage Renal Disease
What are diagnostics for Complicated UTI (Pyelonephritis)
> BUN and Creatinine
- normal bun 7-18
- normal creatinine 0.6-1.2
> IV urogram (injection of dye)
> Voiding cystouretheorgraphy VCUG (dye injected, xrays taken as PT voids, very uncomfortable)
*check for dye allergy
What are the treatments for Pyelonephritis?
> Possible hospitalization
>Antibiotic therapy orally or IV -TMP-SMX -ciprofloxacin -gentamicin -third generation cephalosporin parenteral in hospital to rapidly establish drug levels
> NSAIDs and Acetaminophen
-for fever and discomfort
> 3-4 L a day
What is the general management for Pyelonephritis?
I and Os Assess temperature q4h Bed rest only acute phase Prevention of further infection (education) Medications as prescribed HCP follow upmpt
What symptom is associated only with upper UTIs?
CVA flank tenderness- (place hand on back-side and lightly pound with other hand to assess)
What is Benign Prostatic Hyperplasia?
obstruction of urinary flow from enlarged prostate
-NOT INFLAMMATION
What are symptoms of BPH (Benign Prostatic Hyperplasia)?
Obstructive symptoms
-similar to urinary tract infection
Irritative symptoms
What are diagnostic studies for BPH?
H and P w/ digital rectal exam
Urinalysis
Labs- (PSA[prostate stimulate antigen] and creatinine
Transrectal ultrasound (TRUS)
Uroflowmetery
Post void residual
Cystourethroscopy- (tube entering urethra to visually observe bladder)
What 3 pharmacological medication categories are used to treat BPH and what are the medications?
5-alpha reductase inhibitors:
- finasteride
- dutasteride
Alpha-adrenergic receptor blockers
- doxazosin
- terazosin
- tamsulosin
Herbal Therapy
-Saw palmetto
Name the 5-alpha reductase inhibitors Rx’s and describe them.
- finasteride
- dutasteride
Interfere with the conversion of testosterone to dihydroxytestosterone(DHT), decreases size of prostate
SE: decreased libido, decreased ejaculation volume, and erectile dysfunction
Don’t touch med with bare hands!
Used for BPH
Name the Alpha-adrenergic receptor blocker Rxs and describe them.
- doxazosin
- terazosin
- tamsulosin
Relaxes smooth muscle, DOES NOT decrease hyperplasia, increases symptom relief
SE: orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion
Used for BPH
Name the Herbal therapy used for BPH and describe it.
Saw Palmetto
Symptom relief and decreases conversion of testosterone to DHT therefor decreasing size
SE: GI, increase risk for bleeding, stop prior to dental or surgical procedures
*better tolerated, less expensive and may be as effective as medication
What are minimally invasive therapies for BPH?
- Catheterization: Caude®catheter
- Transurethral microwave thermotherapy (TUMT)
- Transurethral needle ablation (TUNA)
- Laser prostatectomy
- Intraprostate urethral stents
What are invasive therapies for BPH?
Transurethral:
• Transurethral resection of the prostate (TURP)***
• Transurethral incision of the prostate (TOIP)
Prostatectomy: • Suprapubic prostatectomy • Perineal prostatectomy • Retropubic prostatectomy • Robotic or laparoscopic prostatectomy
What is included in the post-operative assessment for the PT who had prostate surgery?
-maintenance of fluid volume balance (I and Os), relief of pain and discomfort, ability to perform self-care activities, and absence of complications:
- Complications include hemorrhage, infections, catheter obstruction, DVT, and sexual dysfunction
- Transurethral Resection (TUR)Syndrome
What is Urolithiasis?
Stones in the urinary tract
What are the types of Calculi (stones)?
Calcium- majority of stones
Uric acid- PT w/ Gout likely to develop these stones
Struvite- associated with reoccurring UTIs
Cysteine- rare inherited defect causing
What are the signs and symptoms of stones?
They are mild to extreme and are severely painful as stone travels through ureter. ex: CVA tenderness
-depends on degree of obstruction, infection, and edema
Describe how pain will feel in the following areas regarding calculi.
Renal Pelvis
Ureter obstruction
Bladder
Renal colic
Renal pelvis- Intense, deep aching costeovetebral area (CVA) radiating pain from kidneys toward bladder
Ureter obstruction- acute excruciating wave like pain
Bladder- irritation and UTI, hematuria
Renal colic- sudden pain, CVA tenderness, N/V, pallor cold clammy skin
What are diagnostics for calculi?
H&P: Dietary, medications, and family hx KUB Ultrasound IV urography Retrograde pyelography VCUG **24 hr urine test -calcium, uric acid, creatinine, sodium, ph and total volume **Stone analysis Blood chemistry
What is the nursing management for calculi?
Pain management
- Adequate hydration*
- main point of therapy
- greater than 2L or urine output recommended
Dietary changes depending on stone Control of infection Strain all urine I and Os VS Cessation of Rx's increasing stone development Limit sodium 3-4g/day Rx's for uric acid if appropriate
What are the surgical options for calculi and describe them.
-Ureteroscopy
-Extracorporeal shock wave lithotripsy (ESWL)
shock wave breaks up calculi and they pass through tract
SE: urinary obstruction*
-Endourologic (percutaneous) stone removal
-Nephrolithotomy/Cystotomy
SE: Hemorrhage*
What is the PT teaching for calculi?
-Avoid meds that increase stone development:
antacids,Vitamin D, Laxatives, High doses of aspirin
- Limit sodium intake
- Avoid Oxalate containing foods: spinach, strawberries, rhubarb, tea, peanuts, wheat bran
- Drink 2 glasses of water at bedtime to prevent concentration of urine overnight
- avoid dehydration
- notify HCP of signs of infections
What is acute Glomerulonephritis?
-Not infection
-Autoimmune, precursor to kidney failure
-inflammatory disease of glomeruli
-antigen-antibody response to infection such as:
strep, shingles, HIV, etc.
-could lead to chronic
*result is inflammation of the glomerular capillaries and GFR
What is the biggest different between acute Glomerulonephritis and chronic?
Chronic is essentially kidney failure and be caused by lifelong conditions
What are the clinical manifestations of acute Glomerulonephritis?
**Proteinuria
**Hypertension
**Edema
Hematuria
Oliguria
Neurological symptoms
Fluid overload particularly in elderly
What is the best way to determine edema is decreasing?
daily weighing
What is the management for Glomerulonephritis?
- Assess for previous infection: sore throat, skin lesions
- Physiological assessments: fluid and electrolyte status, cardiac status, and neuro status
- Strict I and Os plus DAILY WEIGHTS
- Monitoring VS
- Diet restrictions: protein, sodium, and fluids
- Medications as indicated: antihypertensives, diuretics, biologics
