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Nursing 2 Exam 4 > Unit 15 Alterations of Urinary System > Flashcards

Unit 15 Alterations of Urinary System Flashcards

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1
Q

What are types of Urinary Disorders?

A

UTI
Benign Prostatic Hyperplasia (BPH)
Nephrolithiasis
Glomerulonephritis

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2
Q

What is Nephrolithiasis?

A

Kidney stones, renal calculi

-causes a lot of flank pain

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3
Q

Define the following terminology:

  • Cystisis
  • Prostatitis
  • Pyelonephritis
  • Urethritis
A
  • 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)
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4
Q

What are the classifications of Urinary Tract Infections?

A 
Lower
Upper
Uncomplicated 
Complicated 
Hospital acquired
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5
Q

What are symptoms of lower UTIs considered?

A

Localized

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6
Q

What are symptoms of upper UTIs considered?

A

Systemic

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7
Q

What is the most common type of UTI?

A

Lower uncomplicated, caused by UTI and nothing else (bladder and down)

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8
Q

What does complicated UTI mean?

A

Refers to UTI caused by another known reason such as a disease

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9
Q

What are the signs and symptoms of UTIs?

A 
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
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10
Q

What are gerontological considerations of UTIs?

A 
They lack typical symptoms 
AMS
Lethargy
Anorexia 
New incontinence 
Low grade fever
May still have frequency, urgency, and dysuria
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11
Q

What are 3 diagnostic tests for lower UTIs?

A

Urine Dipstick: bacteriuria
Urinalysis:UA
Urine Culture and sensitivity: C and S

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12
Q

How does a urine dipstick show infection?

A

WBCs and nitrates = infection

Specific gravity elevated

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13
Q

What can an Urinalysis show?

A

increased WBCs

Bacterial colonies

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14
Q

Describe urine culture and sensitivity (C and S).

A

It’s clean catch/catheterization

Culture- determines the infectious agent

Sensitivity- determines the susceptibility of bacteria to antibiotics

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15
Q

Name and describe the urinary analgesic.

A

Phenazopyridine

  • take when you have symptoms as needed
  • turns urine dark orange, make PT aware could look like blood
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16
Q

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?

A

C and S to identify bacteria before another Rx.

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17
Q

What 3 antibiotics are used for UTIs and describe them.

A

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
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18
Q

What are UTI educational and prevention points we can teach PTs?

A
  • 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
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19
Q

What is an Upper UTI also known as and where is the infection?

A

Pyelonephritis- infection of kidneys, urters, and renal pelvis

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20
Q

What are the signs and symptoms of [acute] Upper UTI/Pyelonephritis and what is a complicated of it?

A

-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

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21
Q

What two terms also mean stones in the urinary tract and kidney?

A

Urolithiasis and nephrolithiasis

22
Q

What is the urine that remains in the bladder after voiding?

A

residual urine

23
Q

What are the signs and symptoms of chronic Pyelonephritis and what is the complication of it?

A

Weight loss, polyuria, headache, poor appetite, excessive thirst

Complication: End Stage Renal Disease

24
Q

What are diagnostics for Complicated UTI (Pyelonephritis)

A

> 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

25
Q

What are the treatments for Pyelonephritis?

A

> 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

26
Q

What is the general management for Pyelonephritis?

A 
I and Os
Assess temperature q4h
Bed rest only acute phase
Prevention of further infection (education)
Medications as prescribed 
HCP follow upmpt
27
Q

What symptom is associated only with upper UTIs?

A

CVA flank tenderness- (place hand on back-side and lightly pound with other hand to assess)

28
Q

What is Benign Prostatic Hyperplasia?

A

obstruction of urinary flow from enlarged prostate

-NOT INFLAMMATION

29
Q

What are symptoms of BPH (Benign Prostatic Hyperplasia)?

A

Obstructive symptoms
-similar to urinary tract infection

Irritative symptoms

30
Q

What are diagnostic studies for BPH?

A

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)

31
Q

What 3 pharmacological medication categories are used to treat BPH and what are the medications?

A

5-alpha reductase inhibitors:

  • finasteride
  • dutasteride

Alpha-adrenergic receptor blockers

  • doxazosin
  • terazosin
  • tamsulosin

Herbal Therapy
-Saw palmetto

32
Q

Name the 5-alpha reductase inhibitors Rx’s and describe them.

A
  • 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

33
Q

Name the Alpha-adrenergic receptor blocker Rxs and describe them.

A
  • 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

34
Q

Name the Herbal therapy used for BPH and describe it.

A

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

35
Q

What are minimally invasive therapies for BPH?

A
  • Catheterization: Caude®catheter
  • Transurethral microwave thermotherapy (TUMT)
  • Transurethral needle ablation (TUNA)
  • Laser prostatectomy
  • Intraprostate urethral stents
36
Q

What are invasive therapies for BPH?

A

Transurethral:
• Transurethral resection of the prostate (TURP)***
• Transurethral incision of the prostate (TOIP)

Prostatectomy:
• Suprapubic prostatectomy
• Perineal prostatectomy
• Retropubic prostatectomy
• Robotic	or laparoscopic prostatectomy
37
Q

What is included in the post-operative assessment for the PT who had prostate surgery?

A

-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
38
Q

What is Urolithiasis?

A

Stones in the urinary tract

39
Q

What are the types of Calculi (stones)?

A

Calcium- majority of stones

Uric acid- PT w/ Gout likely to develop these stones

Struvite- associated with reoccurring UTIs

Cysteine- rare inherited defect causing

40
Q

What are the signs and symptoms of stones?

A

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

41
Q

Describe how pain will feel in the following areas regarding calculi.

Renal Pelvis
Ureter obstruction
Bladder
Renal colic

A

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

42
Q

What are diagnostics for calculi?

A 
H&amp;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
43
Q

What is the nursing management for calculi?

A

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
44
Q

What are the surgical options for calculi and describe them.

A

-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*

45
Q

What is the PT teaching for calculi?

A

-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
46
Q

What is acute Glomerulonephritis?

A

-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

47
Q

What is the biggest different between acute Glomerulonephritis and chronic?

A

Chronic is essentially kidney failure and be caused by lifelong conditions

48
Q

What are the clinical manifestations of acute Glomerulonephritis?

A

**Proteinuria
**Hypertension
**Edema
Hematuria
Oliguria
Neurological symptoms
Fluid overload particularly in elderly

49
Q

What is the best way to determine edema is decreasing?

A

daily weighing

50
Q

What is the management for Glomerulonephritis?

A
  • 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

Nursing 2 Exam 4 (5 decks)

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