Urinary Flashcards
Urinary tract infection
Clinical Mx
dysuria, frequency, urgency, nocturia, nocturnal enuresis, foul smell, hematuria, suprapubic pain, cognitive impairment
Lower Urinary Tract Symptoms
post void dribbling, frequency, urinary retention, hesitancy, lower back pain, cloudy, foul smelling urine
UTI dx.
dipstick to identify presence of nitrites
Urine culture sensitivity- clean catch or mid stream
Uncomplicated UTI Collaborative Care
Septra, Bactrim-
make sure no allergies to sulfa drugs
Macrodantin, Macrobid-
usually given 7-10 days; May turn urine brown; May cause GI upset so take with meal; avoid sun exposure; do not take with antacids
Complicated UTI care
anti-fungal or antibiotics depending on what lab shows
UTI nursing Interventions
patient needs to wipe front to back
avoid unnecessary catheters
Catheter removal
Sterile procedure when putting in catheter
avoid bladder irritants
Avoid harsh soaps, bubble baths
Apply local heat; (pt can take warm bath)
Acute Pyelonephritis
onset
longterm use of catheters; colonization and infection of the lower urinary tract
Acute Pyelonephritis
Clinical MX
CVA hematuria fever (102 or higher) chills mild fatigue to sudden onset of chills mailase, vomiting, nausea U/A will show hematuria, bacteria, WBC casts
Acute Pyelonephritis
Dx
Urinary analysis urine culture and sensitivity blood cultures no IVP or CT diagnosis will show bacteria in urine and culture that is greater that 100,000 organisms
Acute Pyelonephritis
Collaborative Care
same as UTI antibiotic 14-21 days NSAIDS for pain fluid intake can progress to chronic due to inflammation and scarring
Glomerulomphritis
Clinical Mx
result of acute Strep infection somewhere else in body
edema, hypertension, oliguria, smoky colored urine
Glomerulomphritis
DX
U/A- protein, hematuria, and urine more concentrated
WBS will be elevated
BUN and creatine is increases
Glomerulomphritis
Collaborative Care
increase fluid
diuretics
antihypertensives
sodium and fluid restriction
protein restriction but amount is based on how much kidney failure there is
daily weighs; if 2lb increase contact doctor
NEphrotic Syndrome
Clinical Mx
hyperlipidemia proteinuria low albumin low osmotic pressure--> peripheral edema hypertension elevated serum cholesterol and LDL Ascites and Anasarca WEIGHT GAIN
NEphrotic Syndrome
Collaborative Care
ACE inhibitors limit sodium (2-3gram diet) Limit protein (0.5-0.6) find underlying cause thiazide/loop diuretic NO antibiotics
NEphrotic Syndrome
Nursing Interventions
daily weighs
I/Os
measure abdominal girth
cleanse edematous skin gently
avoid injury by monitoring while on diuretic
Patient at risk for malnutrition due to protein loss (protein is needed for wound healing)
Small frequent feeds
Pt. at risk for skin breakdown
Urinary Tract Calculi
Risk Factors
o Abnormalities that result in increased urine levels of calcium, oxaturic acid, uric acid, citric acid
o WARM climates- that cause increased fluid loss
o LARGE intake of PROTEIN that increase uric acide, tea or fruit juices that elevate urinary oxalate
o LARGE intake of CALCIUM- only is susceptible
o LOW Fluid intake
o Family history, GOUT, renal acidosis
o Sendentary ocuupation, immobility, high sugar diets
Urinary Tract Calculi
Causes
- Calcium phosphate, calcium oxalate, uric acide, cysteine, struvite (magnesium ammonium phosphate)
- 75% are composed of calcium phosphate or calcium oxalate
Urinary Tract Calculi
Clinical Mx
PAIN
abdominal or flank pain
urinary obstruction
Urinary Tract Calculi
DX
- urinalysis- may or may not be normal; they may show blood or cyrstals
- KUB: X-ray for kidney and bladder and reveal stones
- No IVP bc of renal obstruction
- Increased hydration will help kidney stones pass on their own
- 90% are smaller than 5mm; if smaller they will pass on their own with hydration and/or diuretic
Urinary Tract Calculi
Nursing Intervention
- meds for pain: opiods, morphine (moderate- severe)
- mild-moderate: NSAIDs
- spams- antispamsatic drugs
- encourage fluid intake;
- pt will be sent home with strainer
- If infection you need to administer antibiotics
- Provide pre and post op teaching
- If stone too big pt. will need surgical removal
- Nutrition
Urinary Tract Calculi
Treatment
• Cystoscopy
o Done to remove small stones from the bladder;
• Lithostripsy-
o Used for large stones
o stones are pulverized prior to removal (when home they will strain urine as well); hematuria is common after procedure; some require stents
• Percutaneous nephrolithomy-
o through skin from outside of body to get to kidney stones
Urinary Tract Calculi
Nutrition
adequate fluids
avoid caffeine
