urinary disorders Flashcards
what are the two classifications of UTIs
- complicated (UTI tat doesnt respond to usual treatment)
- uncomplicated
what are some upper UTIs
- pyelonephritis = inflammation of the renal pelvis
- nephritis = inflammation of the kidney
- renal abscess
these are usually complicated
name some lower UTIs
- cystitis = inflammation of the urinary bladder
- prostatitis = inflammation of the prostate
- urethritis = inflammation of the urethra
describe pyelonephritis
- bacterial infection of the renal pelvis, tubules, and interstitial tissues in the kidneys of one or both kidneys
- acute or chronic
- associated ith abscesses, obstructions, and tumors
- nephrons replaced by scar tissue in chronic infection
what are some common causes of pyelonephritis
- ecoli infection (usually comes from shit getting into the urethra)
- renal calculi
- malignancy
- catheter/cystoscopy
- BPH
what are some acute symptoms of pyelonephritis
- high fever/chills
- leukocytosis
- bacteriuria
- pyuria
- low back/flank pain
- cloud/blood, foul smelling urine
- painful urination
what are soem chronic symptoms of pyelonephritis
- may have no symptoms
- may have fatigue, headache,poor appetite, polyuria, excessive thirst, and weight loss
- less painful
- discovered when HTN being evaluated
what tests are used in the diagnosis of pyelonephritis
- symptoms
- labs (increased WBCs)
- UA/C&S (bacteria in urine, gross urine, culture b4 antibiotics)
- radiology (find root cause)
what are some nursing interventions for pyelonephritis
- vital signs (hgih risk of sepsis)
- I+O
- maintain fluid balance and electrolyte balance
- antibiotic therapy
- analgesics
- antispasmodics
- increase fluid intake (3-4L/day)
- renal diet
describe cystitis
- inflamamtion in the lining of the urinary tract caused by bacteria
- “bladder infection”
- most common type of UTI
- most common bacteria: ecoli
what are some risk factors for cystitis
- inability to empty bladder completely
- obstructed urinary flow
- instrumentation of the urinary tract
- inflammation or abrasion of the urethral mucosa
- poor hygiene practices
what ae some symptoms of cystitis
- pain
- burning
- bladder spasms
- frequency
- atypical for elderly
what are some diagnostic tools for cystitis
- UA/C&S
- CT scan
- US
what are some nursing interventions for cystitis
- strict aseptic technique for catheter insertion
- instruct on proper perineal hygiene
- I+Os
- force fluids (3-4L/day)
- educate (take all antibiotics)
a patient returns to the doctor after finishing her antibiotic course continuing to complain of uti symptoms. what classification of uti is this?
complication
name some types of urinary incontinence
- stress
- urge
- functional
- iatrogenic
- mixed urinary
- overflow
what are some gerontologic considerations for urinary incontinence
- not a normal part of aging
- decrease ability to maintain independence
- transient episodes with abrupt onset
- possible causes include UTI, constipation, meds, decreased estrogen levels, diabetes
what are some diagnostic tools for urinary incontinence
- history
- I+O
- radiologic tests
- residual urine checks
- UA/C&S
what are some treatments/interventions for urinary incontinence
- electrical stimulation
- meds
- bladder training/timed voided
- kegal exercises
- surgery
- fluid and dietary changes
- decrease caffiene and alcohol intake
describe urolithiasis/nephrolithiasis
- presence of a stone anywhere in the urinary tract/kidney. stones may be composed of calcium oxalate, calcium phosphate, or uric acid
- 75% of stones are calcium based
what are some risk factors for urolithiasis/nephrolithiasis
dehydration and meds like calcium supplements
what are sme signs and symptoms of urolithiasis/nephrolithiasis
- pain in flank area
- hematuria
- urine retention, frequency, urgency
whats used in diagnosis of urolithiasis/nephrolithiasis
- UA
- radiologic testing
- ct
- ivp
what are some interventions are used for urolithiasis/nephrolithiasis
- analgesics and NSAIDs
- I+O
- strain urine (catch any stone passed for lab)
- increase fluid intake
what are some procedures for urolithiasis/nephrolithiasis
- stent placement
- percutaneous lithotripsy
- extracorporeal shock wave lithotripsy
- open removal (rare)
describe percutaneous lithotripsy
small puncture in flank, gets stone out
good for bigger stones
describe extracorporeal shock wave lithotripsy
- most common one
- shocks and breaks up the stone
- no incision but may be bruising
what are some post procedural interventions for urolithiasis/nephrolithiasis
- manage pain and fluid and elctrolyte balance
- monitor signs and symtpoms of infection
- monitor kidney function
- assess urine and strain
- educated on possibility of bruising in the flank area for ESWL
describe nephrostomy
bypasses all lower urinary tract, needs to be flushed
what are risk factors for urolithiasis? choose all that apply
1) diet high in alcohol and organ meats
2) calcium supplements
3) smoking
4) urinary stasis
1) diet high in alcohol and organ meats
2) calcium supplements
4) urinary stasis
what are soem risk factors for bladder cancers
- tobacco use
- toxins
- family history
what are some signs and symptoms of bladder cancer
- painless hematuria
- frquency, urgency, and dysuria
- changes in voiding patterns
whats used for diagnosis of bladder cancer
- radiologic
- biopsy
whats included in the treatment of bladder cancer
- cystectomy (complete removal of bladder)
- radiation therapy
- chemotherapy
- may be a combo
name some urinary diversions
- illeal conduit
- cutaneous ureterostomy
- continent urostomy
describe illeal conduit
- most common, permanent
- urine flows freely through stoma to a pouch
describe cutaneous ureterostomy
ureters are brough out to skin in one or more stomas
describe continent urostomy
- ureters drain into reservoir that has a valved stoma
- the stoma is cathed to remove urine
describe pre op care for urinary diversion
patient education of expectations post surgery
- changes in body image
- show stoma pouches
- activities
- exercise, diet, and clothing
- discuss site of ostomy
describe post op care/patient education for urinary diversion
- assess stoma site
- monitor I+O
- monitor for S/S of stoma obstruction
- education
- ostomy nurse
what are some complications of urinary diversion
- stoma ischemia/necrosis
- infection
- stoma - irritation - yeast infection
- skin breakdwon
describe BPH
- enlargment of prostate gland
- men primarily over 40 years
- prostate size increases with age
- yearly exams
what are some signs and symptoms of BPH
- frequency/hesitancy
- hematuria
- inability to empty the bladder fully
- post void dribbling
- anuria
- bladder distention
- enlarged, firm, non elastic feeling upon digital exam
- elevated PSA
what are some diagnostic tools for BPH
- digital rectal exam
- PSA (not super accurate)
- transrectal ultrasonography (TRUS)
- CT/MRI
- cystoscopy
describe treatment for BPH
- watchful waiting
- meds like alpha1 adrenergic blockers or alpha reductase inhibitors
- surgery (transurethral resection of the prostate and prostatectomy)
- minimally invasive procedures (transurethral heat ablation, TULIP, prostatic stent)
is prostate cancer deadly
yep
2nd in death rate only to lung cancer
what are some risk factors for prostate cancer
- increases with age (60s)
- african american men - higher risk
- family hx
- diet high is saturated animal fat
- vit D deficiency
- occupational risks
- high levels of testosterone
describe prevention and screening for prostate cancer
- annual DRE
- PSA (starting at age 50)
- ultrasound guided TRUS
what are some signs ans symptoms of prostate cancer
- dysuria, nocturia, hematuria
- frquency
- abnormal prostate on digital exam
- bone pain, pack pain, nerve pain
- bowel and bladder dysfunction
- weight loss
- fatigue
whats used for the diagnosis of prostate cancer
- subjective S/S
- prostate specific antigen, DRE
- TRUS exam
- tissue biopsy
what are some treatments of prostate cancer
- hormone deprovation (ADT therapy) (not curative but can slow growth)
- orchiectomy (cut those balls off, castration)
- surgery
- radiation (external or internal)
what are some complications to prostate cancer treatment
- hemorrhage
- infection
- venous thromboembolism
- catheter issues
- erectile dysfunction
- urinary incontinence
- urethral stricture
what does TURP do
scrapes and sucks prostate tissue out
what is the goal of continuous bladder irrigation (CBI)
prevent and remove blood clots in the bladder
describe continuous bladder irrigation (CBI)
- adjust flow rate to keep urine light pink/peach color
- decrease flow rate if urine clear
- increase flow rate if urine bloody
- may need order for manual irrigation for large clots
what test will diagnose prostate cancer?
biopsy
true or false?
is it normal to see mucous threads in a urostomy pouch?
true
