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Module 4 > UNIT 3- RENAL & UROLOGIC PROBLEMS > Flashcards

UNIT 3- RENAL & UROLOGIC PROBLEMS Flashcards

1
Q

What is the patho of a UTI?

A
  1. Bacteria enters the sterile bladder causing inflammation
  2. Cystitis vs. Pyelonephritis Vs. Urosepsis
  3. May be caused by a variety of disorders
    -Bacterial infections most common
    - Fungal and parasitic infections may cause UTIs
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2
Q

What is the most common pathogen of UTI infections?

A
  1. Escherichia Coli (E.Coli)
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3
Q

What is the patho of catheter-associated urinary tract infection?

A

Causes:
1. E.coli
2. Less frequently: pseudomonas sepcies

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4
Q

Most CAUTI infections are underrecognized and undertreated?

A

Yes

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5
Q

What are the classifications of UTI

A

Lower UTI– urethritis or cystitis

Upper UTI– pyelonephritis

Urosepsis

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6
Q

What is pyelonephritis?

A

Inflammation of renal parenchyma and collecting system (usually caused by infection)

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7
Q

What is urethritis

A

Inflammation of the urethra

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8
Q

What is cystitis?

A

Inflammation of the bladder

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9
Q

What is urosepsis?

A

A UTI that has spread systemically (this is life threatening) requiring emergency treatment

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10
Q

What are risk factors for UTIs?

A
  1. Immunosuppressed/immunocompromised
  2. Diabetes
  3. Hx of kidney problems
  4. have undergone multiple antibiotic courses
  5. Have traveled to developing countries
  6. Catheterization
  7. Cystoscopy examination
  8. Occupation/habitual delay
  9. STI
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11
Q

Multiple sex partners (women), poor hygiene, menopause, bubble baths, feminine sprays and pregnancy are all risk factors for what?

A

True

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12
Q

What is the patho of a lower tract UTI

A
  1. Usually, no systemic manifestations
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13
Q

What are two types of lower tract UTIs

A
  1. Urethritis
  2. Cystitis
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14
Q

What are s/s of urethritis?

A
  1. Pain/burning/difficult urination (dysuria)
  2. Frequency
  3. Urgency
  4. Males: clear mucous-like discharge
  5. Females: lower abdominal discomfort
  6. Nocturia
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15
Q

What are s/s of cystitis?

A
  1. Pain/burning/difficult urination (dysuria)
  2. Frequency
  3. Urgency
  4. Males: clear mucous-like discharge
  5. Females: lower abdominal discomfort
  6. Nocturia
  7. BLADDER IRRITABILITY
  8. HESITANCY
  9. SUPRAPUBIC PAIN
  10. INCONTINENCE
  11. NOCTURNAL ENURESIS
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16
Q

What will a lower UTI UA show?

A

1.+Nitrates: indicate bacteriuria

    • WBC, +Leukocyte esterase– enzyme present in WBCs, indicating pyruia
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17
Q

What does the Urine c/s determine for UTIs

A

Determine bacteria’s susceptibility to antibiotic drugs

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18
Q

Uncomplicated UTI antibiotics typically run for?

A

3 days

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19
Q

Complicated UTI’s antibiotics typically run for?

A
  1. Longer treatment (usually 7-14 days)
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20
Q

What is our goal for lower UTI’s

A

To have relief from bothersome symptoms; prevent upper UTI/involvement, and have no recurrence

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21
Q

What is the patho of an Upper Tract infection

A
  1. Renal parenchyma, pelvis and ureters can be effected
  2. typically causes fever, chills, flank pain
  3. Usually begins with lower UTI
  4. Pre-existing factor may present
    • Vesicoureteral reflex
    • Retrograde (backward) movement of urine from lower to upper urinary tract
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22
Q

Besides pre-existing factors what other things can cause upper tract UTI?

A

Dysfunction of lower urinary tract
1. Obstruction from BPH
2. Stricture
3. Urinary stone

  1. CAUTI

Recurring episodes lead to scarred, poorly functioning kidney and chronic pyelonephritis.

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23
Q

What are the classic manifestations of pyelonephritis?

A
  1. Fever/chills
  2. N/V
  3. Fatigue/Malaise
  4. Flank pain/pain at costovertebral angle
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24
Q

True or false: Pyelonephritis may require hospitalization?

A

True

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25
Q

True or false: you don’t have to worry about urosepsis with pyelonphritis?

A

False- monitor for urosepsis– close observation and VS monitoring

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26
Q

What is the patho of Urosepsis?

A
  1. UTI that has spread systemically
  2. Life- threatening condition requiring emergent treatment.
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27
Q

What should we know about urosepsis?

A
  1. Systemic infection from urologic source
  2. Prompt diagnosis/treatment critical
  3. Usually begins lower tract and ascends urethral route
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28
Q

What are frequent causes of urosepsis?

A
  1. E.coli
  2. Proteus
  3. Klebsiella
  4. Enterobacteria
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29
Q

What are clinical manifestations of urosepsis?

A
  1. Malaise/fatigue
  2. Chills/fever
  3. N/V
  4. Characteristic of cystitis
    -dysuria, urgency, frequency
  5. Costovertebral tenderness of affected side
  6. Elderly present with delirium
  7. Vs changes (fever, HR increase, BP decreases)
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30
Q

What are UTI treatments and preventions?

A
  1. Antibiotics (IV vs PO)
  2. NSAIDs or antipyretic drugs
  3. Vitamin C
  4. Urinary analgesics
    -Phenazopyridine (Pyridium)
  5. Fluids
    -IV
    • Cranberry juice— low sugar
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31
Q

What teaching should you include with UTIs/urosepsis?

A
  1. Disease process
  2. Prevention of UTI
  3. Medication use
  4. Pain management
  5. Follow up appointment
  6. Rest
  7. Dietary education and fluid intake
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32
Q

How can you prevent cystitis?

A
  1. Drink 8-10 glasses of fluid per day… encourage unsweetened cranberry juice
  2. Women should wipe front to back
  3. Avoid vaginal douches, bubble baths, powders, or sprays
  4. Urinate after intercourse
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33
Q

How can we prevent CAUTI?

A
  1. Avoidance of unnecessary catheterization
  2. Early removal of indwelling catheters
  3. Follow aseptic technique for procedures
  4. Handwashing before and after patient contact
  5. Wear gloves for care of urinary catheters
34
Q

What analgesic might we use for UTIs?

A
  1. Phenazopyridine/Pyridium
  2. For pain associated with UTI
35
Q

What should we know about the antibiotic Nitrofurantoin (macrodantin) used to treat UTIs?

A
  1. Given 3 or 4 times a day
  2. Long-acting prep (Macrobid) is taken daily
36
Q

What should we know about the antibiotic Ampicillin, Amoxicillin, cephalosporins used to treat UTIs?

A

Treat uncomplicated UTI– no functional or anatomical anomalies/ no renal functional impairment, no disease that caused or promoted UTI?

37
Q

What should we know about the antibiotic Fluoroquinolones used to treat UTIs?

A
  1. Treat complicated UTIs- can lead to kidney injury
    • associated with fevers, stones, sepsis, obstruction, catheters, AKI, CKD, renal transplant, diabetes, neurologic disease
      -structural or functional problem in the urinary tract exists
  2. Example: ciprofloxacin (cipro)
38
Q

What antifungals may be used to treat UTIs?

A
  1. Amphotericin
  2. Fluconazole

UTIs secondary to fungi

39
Q

What is the patho of glomerulonephritis (GN)?

A
  1. Inflammation of the glomeruli
    -triggered by an immunological mechanism
  2. 3rd leading cause of renal failure
  3. Classified as acute or chronic
40
Q

What is acute GN

A

Comes suddenly and may be reversible

41
Q

What is chronic GN?

A

Chronic: slowly progressive and can lead to irreversible renal failure

42
Q

What is GN?

A

Inflammation of the filtering system of the nephron (AKA the glomeruli)–this is the functional unit of the kidney that helps you produce urine.

43
Q

What are the risk factors of GN?

A
  1. Kidney infections
  2. Nephrotoxic drugs
  3. Immunocompromised system (SLE)
  4. Systemic disease
44
Q

True or false: GN in a patient with SLE has a poor prognosis?

45
Q

What assessments and clinical manifestations are important for Acute GN?

A
  1. General body edema- seen a lot around eyes or face

2.Oliguria/hematuria/proteinuria

  1. Hypertension
  2. Increased BUN/Creatinine- will tell us the extent of renal impairment.
  3. History of group A strep
  4. Evidence of immune-
    mediated response- to streptococci found on titers- renal biopsy may be done to confirm dx.
46
Q

As the nurse what should we assess or monitor in a patient with GN?

A
  1. Daily weight & I/O
  2. Measure abdominal girth
  3. Medication
    -antihypertensive
    -diuretics
    -corticosteroids
  4. Dietary
    -LOW-sodium/LOW to MODERATE-Protein/fluid restriction
47
Q

What teaching as the nurse should we do for GN?

A
  1. Disease process
  2. Medication
  3. Follow-up appointment
  4. Avoid infections
  5. Rest
48
Q

Using the acronym HAD STREP what are the s/s of GN?

A

H: Hypertension
A: ASO titer (+) - this is a test for STREP
D: Decreased GFR

S: Swelling in face/eyes
T: Tea-colored urine
R: Recent strep infection
E: Elevated BUN and CR
P: Proteinuria

49
Q

What should we know about renal calculi?

A
  1. More common in men
  2. Average age at onset: 20-55 years
  3. White
  4. Family history of stone formation
  5. Previous history (personal)
  6. Summer months
50
Q

What is the patho of Kidney Stones?

A

Occur in kidneys, ureter, and bladder with renal stones being most prevalent.

  1. Calcifications in the urinary system
  2. Commonly referred to as kidney stones
  3. Microscopic crystals in the urinary tract aggregate together causing a stone to occur
51
Q

What are the clinical manifestations of kidney stones?

A
  1. Pain
  2. N/V
  3. UA
    +RBC
  4. UTI like symptoms
52
Q

True or false: A KUB/CT may show stone formation?

53
Q

What medication might you see be used for kidney stones?

A
  1. Narcotics & NSAIDs
  2. Antiemetic
  3. Alpha-adrenergic blockers
54
Q

What lab would you check with kidney stones?

A
  1. BUN/CR (increased BUN)
  2. UA
  3. CBC
55
Q

Alpha-blockers have been demonstrated to increase _____ rates of distal ureteral stones, decrease time to ____, and decrease need for analgesia during stone passage.

56
Q

What should the nurse monitor with a patient with kidney stones?

A
  1. Vital signs
  2. Fluid management
  3. I/O
57
Q

What should the nurse teach her kidney stone patient?

A
  1. Strain use
  2. Symptoms of infection/obstruction
  3. prevention
58
Q

What would we evaluate as the nurse to see if our kidney stone patient improved?

A
  1. Maintain free flow of urine with minimal hematuria
  2. Report satisfactory pain relief
  3. Verbalize understanding of disease process and measures and measures to prevent recurrence
59
Q

What is the patho of bladder cancer?

A
  1. Tumor formation is attributed to genetic changes in target cells
  2. Smoking is the most important risk factor
60
Q

What are clinical manifestations of bladder cancer?

A
  1. Painless hematuria
  2. Urine cyst ology
  3. Lab looking for tumor markers.
  4. imaging
61
Q

As the nurse what are we monitoring in bladder cancer patients?

A
  1. Vital signs
    2.Medications (chemo & immunotherapy)
  2. Continuous bladder irrigation (murphy drip)
  3. I&O
62
Q

What is a murphy drip

A

3 way catheter

63
Q

Superficial or low-grade bladder cancers can be treated how?

A
  1. Consist of excision or removal through fulguration of laser ablation?
64
Q

What is fulguration

A

Procedure using heat to destroy abnormal cells

65
Q

How is invasive bladder cancer treated?

A
  1. Radical cystectomy
  2. Combined with neoadjuvant and adjuvant chemo
66
Q

What age and gender does renal cancer typically affect?

A

Males- age 50-70

67
Q

What is the patho of renal cancer?

A
  1. Usually found in the cortex or pelvis of the kidney
68
Q

What are the clinical manifestations of renal cancer?

A
  1. Initially asymptomatic
  2. Classic triad
    -flank mass, flank pain, and hematuria
  3. Weight loss
  4. hypertension
  5. Fever
  6. Anemia
69
Q

What are diagnostic tests for renal cancer?

A
  1. IVP
  2. Ultrasound
  3. CT/MRI
  4. Urine Cytology
70
Q

What is the treatment for renal cancer?

A
  1. Biological immunotherapy or cytokinesis
  2. Radical nephrectomy
71
Q

Nursing management of renal cancer is?

A
  1. Pain management
  2. Iv hydration
72
Q

Post-op care of renal ca includes

A
  1. monitor bleeding, incision, site for infection, ensure patency of catheter and tubes, strict I/O
73
Q

What is the patho of incontinence?

A
  1. involuntary or uncontrolled loss of urine in any amount
74
Q

What are types of incontinence?

A
  1. Stress incontinence: sudden increase in intraabdominal pressure causes involuntary passage of urine. Can occur during coughing, laughing, sneezing or physical activities, such as heavy lifting exercising.
  2. Urge: often referred to as overactive bladder. Occurs randomly when involuntary urination is preceded by urinary urgency
  3. Overflow: Occurs when pressure of urine in overfull bladder overcomes sphincters control.
  4. Functional: loss of urine resulting from cognitive, functional, or environmental factors-inability to get up (arthritis, dementia)
75
Q

What imaging would you expect with incontinence?

A
  1. KUP, IVP, Cystometrogram
76
Q

What is the treatment goal for incontinence?

A

Goal of treatment is to prevent or stop urinary leakage

77
Q

What should we know about anticholinergic medications used to treat incontinence?

A
  1. Reduces overactive bladder contractions; improves storage capacity of bladder

–Oxybutynin (ditropan)

78
Q

What should we know about alpha-adrenergic blockers used to tx incontinence?

A
  1. Reduce urethral sphincter resistance to urinary outflow

Doxazosin (cardura)
Tamsulosin (flomax)

79
Q

What should we know about tricyclic antidepressant used to treat incontinence?

A
  1. Reduce sensory urgency and burning pain

Amitriptyline (Elavil)

80
Q

What are some teaching points for incontinence?

A
  1. Medication
  2. Kegel exercises
  3. Skin Care
  4. Voiding dairy
  5. Emotional support
81
Q

Urinary-renal trauma what should we know?

A
  1. Males less than 30 years old
  2. Penetrating injury
    -stabbing
    -gunshot wound
    -objects piercing the abdominal wall
  3. blunt force trauma
    -compression of the abdominal wall and bladder
    -Injuries to the renal system can range from contusion or hematoma to a shattered kidney

Module 4 (29 decks)

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