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Nursing > Urinary Disorders > Flashcards

Urinary Disorders Flashcards

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1
Q

Urinary Tract Infections (UTI)

A

inflammation of the sterile urinary tract caused by the introduction of bacteria most commonly through the urethra

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2
Q

Lower UTI’s

A

Cystitis, Prostatitis, Urethritis

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3
Q

Upper UTI’s

A

Pyelonephritis, Ureteritis, Renal Abscess

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4
Q

Is a lower or upper UTI more common?

A

lower

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5
Q

What is an uncomplicated UTI?

A
  • involves the normal urinary tract
  • Community acquired
  • Healthy, non-pregnant young women
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6
Q

What is a complicated UTI?

A

Associated with a structural/functional abnormality of the urinary tract

  • Hospital Acquired
  • Pregnancy, men, catheters, diabetes, stones
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7
Q

Why are UTI’s more common in women than men?

A

Females have a shorter urethra and there is a shorter distance b/t urethra and vagina/rectum

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8
Q

When does the risk for UTI’s in males increase?

A

increases with age secondary to enlarging of the prostate

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9
Q

What are the major causes of UTI’s?

A
  • Honeymoon cystitis
  • Pregnancy
  • Diabetes
  • Poor hygiene
  • Deficiency of estrogen
  • Obstructions (stones)
  • Condition leading to incomplete bladder emptying
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10
Q

How does Honeymoon cystitis cause a UTI?

A
  • secondary to sexual activity

- introduces bacteria from the vagina to the urethra

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11
Q

How does pregnancy cause a UTI?

A

As the uterus enlarges it can lead to incomplete bladder emptying and urine in the bladder acts as a reservoir

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12
Q

How can diabetes cause a UTI?

A
  • nerve damage to bladder
  • Increased sugar in the urine
  • Decreased immunity
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13
Q

Urethrovesical Reflux

A
  • urine goes down into the urethra and back into the bladder

- coughing, sneezing, squatting, voiding abruptly interrupted

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14
Q

What are two other causes of UTI’s?

A

Urethrovesical and Ureterovesical Reflux

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15
Q

Ureterovesical Reflux

A

urine goes up into the ureters and back into the bladder

-Structural abnormalities

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16
Q

S/S of Cystitis (Lower UTI)

A
  • Dysuria -hematuria
  • Frequency -Suprapubic pain
  • Burning with urination
  • Nocturia
  • Urgency
  • Cloudy/Foul smelling
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17
Q

S/S of Acute Pyelonephritis (Upper UTI)

A
  • Fever
  • Nausea/Vomiting
  • Flank pain
  • Bacteriuria
  • Pyuria
  • Headache
  • Malaise
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18
Q

Where would the patient experience flank/costovertebral pain?

A

B/t the 12th rib and costovertebral angle

*On your back where your kidneys sit

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19
Q

How would a UTI be diagnosed?

A
  • Urinalysis

- Urine culture w/ Sensitivity

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20
Q

What would indicate a UTI after a Urinalysis?

A
  • Bloody/cloudy urine
  • WBC’s and RBC’s >5
  • Positive for Nitrites and Bacteria
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21
Q

What would indicate a UTI after a Urine Culture?

A

> 100,000 bacteria

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22
Q

What tests are used specifically used for an Upper UTI (pyelonephritis)?

A
  • CT scan
  • Laboratory (BUN and Creatinine)
  • Diagnostic (IV pyelogram)
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23
Q

What two antibiotics are commonly used for an UNcomplicated UTI and for how long?

A

Cipro or Levaquin

-3 day course

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24
Q

What antibiotics are commonly used for a COMPLICATED UTI and how long?

A

IV: Ancef, Rocephin, Maxipime, Cipro
Oral: Cipro, Keflex
-7-10 day course

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25
Q

What are additional treatments used for a UTI?

A
  • Antiemetics for N/V

- Bladder Analgesics

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26
Q

What are some precautions for bladder analgesics?

A
  • Numbs bladder so you can NOT use it for more than 3-4 days
  • Can mask worsening symptoms
  • turns urine orange
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27
Q

What else can be done for a UTI?

A

-Increase fluid intake (8-10 8 oz glasses of water)
-High rate IV fluid
-Cranberry juice/supplements
-Do NOT drink coffee, alcohol, aspartame
Do NOT smoke

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28
Q

What should you not take Cranberry juice/ supplements with?

A

Anticoagulants

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29
Q

When would Pyelonephritis require hospitalization?

A
  • Symptomatic and complicated
  • Unable to tolerate oral meds/fluids
  • Uncontrollable fever
  • Sever uncontrollable pain
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30
Q

What are some complications a patient may have if UTI is not treated/ treated effectively?

A
  • End stage kidney disease
  • Kidney Failure
  • Sepsis
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31
Q

What are some ways to prevent UTI’s?

A
  • Remove catheters ASAP
  • Use antibiotics only when necessary
  • Wipe front to back
  • Avoid prolonged baths
  • Drink WATER
  • Void when feel the urge
  • Avoid bladder irritants
  • Take all antibiotics when prescribed
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32
Q

Nursing Care for UTI

A
  • Assess vitals, pain, symptoms, UA/culture
  • Administer meds as ordered
  • Administer IV fluids/ Push oral fluids
  • Educate S/S, when to call doc, meds, and prevention
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33
Q

Overactive Bladder

A
  • Can be w/ or w/o incontinence

- Client Experiences: urgency, frequency, Nocturia

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34
Q

Incontinence

A

loss of bladder control = urine is lost involuntarily in large or small amounts

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35
Q

Risk Factors for Incontinence

A
  • Pregnancy/ previous vaginal birth
  • Immobility
  • Impaired Cognition
  • Medications/Diuretics
  • Obesity
  • Preexisting Conditions (Diabetes, Stroke)
  • Low estrogen
  • smoking
  • Long term catheter use
  • High impact exercise
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36
Q

What are the types of incontinence?

A

Stress, Urge, Reflex, Mixed, Overflow, Functional

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37
Q

Stress Incontinence

A

pelvic floor muscles are weakened causing leaking w/ laughing, coughing, sneezing

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38
Q

Urge Incontinence

A

sudden urge to void secondary to irritation/damage to bladder nerves; aware of need to void but can NOT make it to the toilet in time

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39
Q

Reflex Incontinence

A

bladder muscled contract on their own secondary to a disruption in the nerve impulses for voiding; NO awareness of need to void

40
Q

Mixed Incontinence

A

mix of stress and urge

41
Q

Overflow Incontinence

A

inability to empty the bladder completely secondary to flaccid/enlarged bladder causing involuntary loss of urine secondary to over distention

42
Q

Functional Incontinence

A

CONTINENT; however, mental/physical deficits prevent the ability to get to the bathroom on time

43
Q

How is Incontinence diagnosed?

A
  • By neurological, urological, or reproductive abnormalities

- UA/Cultures, WBC’s, Diabetes

44
Q

What are some client cues of Incontinence?

A
  • Avoid social situations
  • Depression
  • Perineal skin inflammation
  • Avoid talking urinary concerns
  • Urine odor
  • Frequent bathroom trips
45
Q

What are the primary goals for incontinence?

A
  • Prevention or correction

- Skin protection and odor elimination

46
Q

What can be done to help with incontinence?

A
  • NO surgery
  • Kegel exercises
  • Clean intermittent catheterization
  • Condom/Petal catheter
  • Pessary Device
  • Bladder training
  • Weight loss
  • Drink fluids b/t breakfast and evening meal in small amounts
  • STOP drinking an hour before bed
47
Q

Surgical Interventions for Incontinence

A
  • Vaginal/Bladder Sling
  • Bladder augmentation
  • Bladder-neck suspension
48
Q

What medications are used for incontinence?

A
  • Alpha-Adrenergic Blockers
  • Antispasmodics
  • Anticholinergics
49
Q

Alpha-Adrenergic Blockers

A

Stress, Reflex, and Overflow

50
Q

Antispasmodics

A

Urge and Reflex

51
Q

Anticholinergics

A

Urge ONLY

52
Q

Nursing Care for Incontinence

A

Assess

  • Vitals
  • Activities that lead to incontinence
  • UA/Culture
  • Voiding Diary
53
Q

Nursing Actions for Incontinence

A
  • Administer meds as ordered
  • Assist w/ self care needs
  • Encourage and support
  • Educate
54
Q

What should the nurse include in patient education for incontinence?

A
  • NO diuretics after 4 pm
  • Stop fluid intake 1 hour before bed
  • Drink bulk fluids b/t meals
  • Avoid constipation and bladder irritants
  • Void regularly
  • Stop smoking
55
Q

Urinary Retention

A

bladder does not empty completely when voiding, and residual urine remains

56
Q

Common Risk Factors for Urinary Retention

A
  • Men (enlarged prostate)
  • Meds (anticholinergics)
  • Anesthesia
57
Q

Nursing Care for Urinary Retention

A
  • Recognize the problem
  • Assist w/ promotion of normal urination
  • Catheterization if not contraindicated
58
Q

Neurogenic Bladder

A

name given to a number of urinary conditions in people who lack bladder control due to brain, spinal cord, or nerve problems
-Flaccid or Spastic

59
Q

Flaccid Neurogenic Bladder

A
  • lower
  • reflexes of bladder muscles are sluggish or absent leading to over distention
  • generally in lumbar area
60
Q

Spastic Neurogenic Bladder

A
  • Upper
  • bladder empties on reflex w/ little to no control by the patient
  • prob generally above T12 vertebrae
61
Q

Neurogenic Bladder Treatments

A

Catheter

  • Condom/Petal
  • Self Intermittent
  • Indwelling
  • Suprapubic
62
Q

What are some self care tips for self intermittent catheterization?

A
  • Clean technique

- Every 4-6 hours and before bed

63
Q

What is a Suprapubic Catheter and why is it better?

A
  • inserted through incision/ puncture above the pubis
  • lower rate of infection
  • easier to use/remove
64
Q

Nursing Management for Neuro Bladder

A
  • Assess urine
  • Place Catheter and Remove ASAP if possible
  • Catheter should be changed every 30 days or upon admission to the hospital
  • Patient may take up to 8 hours to void after removal
65
Q

What should the nurse assess/do after catheter removal?

A
  • Patient may take up to 8 hours to void
  • After void scan bladder to assess for residual urine
  • If > 100 may need to do an in and out cath
  • If NONE after 8 hours or pain may need in and out , indwelling is left in place
66
Q

Urolithiasis Stones (Bladder)

A

calcifications that form in the urinary tract

67
Q

Nephrolithiasis Stones (Kidney)

A

calcifications that form in the kidney

68
Q

How are kidney stones formed?

A

When urine is super concentrated, small crystals in the urinary tract clump together, forming a stone/calculus

69
Q

Risk Factors for stones

A
  • Men
  • Hereditary
  • Gout
  • Summer months (Dehydrated)
70
Q

S/S of Stones

A
  • Colicky (wavelike) pain
  • N/V
  • Referred Pain
  • Gross/Microhematuria
  • Irritative voiding symptoms
71
Q

Where would the stones be with referred pain to the abdomen or genitals?

A

Urolithiasis (Bladder)

72
Q

Where would the stones be with referred pain as flank pain?

A

Nephrolithiasis (Kidney)

73
Q

What is the diagnostic exam of choice for stones and what should you check before it?

A
  • CT scan

- Check BUN

74
Q

What are other diagnostic tests for stones?

A
  • KUB X-ray
  • Ultrasound
  • IV Pyelogram
75
Q

What must you do for a IV Pyelogram?

A

Stop Metformin 24 hours before and 48 hours after

76
Q

CT Scan

A
  • Quick, noninvasive
  • Shows all types of stones
  • Detects obstructions
77
Q

KUB

A
  • Quick, noninvasive
  • Inexpensive
  • Does NOT detect Uric acid or Pure Xanthine stones
78
Q

Ultrasound

A
  • Recommended for children and pregnant women

- Detects obstructions

79
Q

What type of stones are allowed to try and pass on their own with little assistance?

A
  • Stones less than 1 cm (10 mm)
  • Minimal pain
  • No infection
  • No hydronephrosis
80
Q

What is used to help pass a stone?

A 
Narcotics or NSAIDs
-Tramadol/Ultram               -Mobic
-Morphine                           -Ketorolac
-Dilaudid 
Antiemetics 
-Metoclopramide/Reglan
-Promethazine/ Phenergan
Alpha-Adrenergic Blockers
-Tamsulosin (Flomax) or Terazosin (Hytrin)
81
Q

When would a patient need surgery for stones?

A
  • Not passed in 4-6 weeks
  • Uncontrollable pain
  • N/V
  • Infection
  • Stone > 10 mm
  • Obstruction
82
Q

What are the surgical options for stones?

A

Ureteroscopy, Percutaneous Nephrolithotomy, Extracorporeal Shockwave Lithotripsy (ESWL)

83
Q

Ureteroscopy

A

under anesthesia, scope inserted through the urethra and into the ureters to remove stone

84
Q

Percutaneous Nephrolithotomy

A

Under anesthesia, nephroscope inserted through the skin into the kidney

85
Q

ESWL

A

conscious sedation, shockwave applied to break up the stone so it can be passed

86
Q

Nursing Care for Stones

A
  • Medicate patient as ordered
  • Encourage increased fluid intake
  • Catheter if needed
  • Strain urine
87
Q

Low Sodium/Protein diet

A

Calcium stones

88
Q

Low Purine Diet

A

Uric Stones

-high purine food: organ meat, seafood, lima beans, chicken, mushrooms

89
Q

Low Oxalate Diet

A

Xanthine Stones

high oxalate foods: dark chocolate, nuts/beans, razzberries, potatoes

90
Q

Urinary Diversion

A

Urine is diverted from the bladder to a surgically created exit site
-usually result from cystectomy

91
Q

Two Diversion Categories

A
  • Cutaneous- urine drains through an opening in skin

- Continent-intestine is used to create a new reservoir for urine

92
Q

Ileal Conduit

A

Most common Cutaneous

  • short segment of the small intestine is placed at an opening made on the surface of the abdomen to create a stoma and the ureters are attached
  • Drainage bag is placed over opening
93
Q

Nephrostomy Tube

A

Short Term

-inserted into the kidney that needs drained

94
Q

Indiana Pouch

A
  • segment of the ileum and cecum is used to form a new reservoir for urine to be collected in
  • Continent stoma is formed flush with the skin
  • Drained by catheter at regular intervals (about q 4 hours)
95
Q

Nursing Care for Urinary Diversions

A
  • Monitor Stoma
  • Skin around stoma
  • Emotional support
  • Provide high levels of independence and self-care

Nursing (21 decks)

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