Urinary Disorders Flashcards
Urinary Tract Infections (UTI)
inflammation of the sterile urinary tract caused by the introduction of bacteria most commonly through the urethra
Lower UTI’s
Cystitis, Prostatitis, Urethritis
Upper UTI’s
Pyelonephritis, Ureteritis, Renal Abscess
Is a lower or upper UTI more common?
lower
What is an uncomplicated UTI?
- involves the normal urinary tract
- Community acquired
- Healthy, non-pregnant young women
What is a complicated UTI?
Associated with a structural/functional abnormality of the urinary tract
- Hospital Acquired
- Pregnancy, men, catheters, diabetes, stones
Why are UTI’s more common in women than men?
Females have a shorter urethra and there is a shorter distance b/t urethra and vagina/rectum
When does the risk for UTI’s in males increase?
increases with age secondary to enlarging of the prostate
What are the major causes of UTI’s?
- Honeymoon cystitis
- Pregnancy
- Diabetes
- Poor hygiene
- Deficiency of estrogen
- Obstructions (stones)
- Condition leading to incomplete bladder emptying
How does Honeymoon cystitis cause a UTI?
- secondary to sexual activity
- introduces bacteria from the vagina to the urethra
How does pregnancy cause a UTI?
As the uterus enlarges it can lead to incomplete bladder emptying and urine in the bladder acts as a reservoir
How can diabetes cause a UTI?
- nerve damage to bladder
- Increased sugar in the urine
- Decreased immunity
Urethrovesical Reflux
- urine goes down into the urethra and back into the bladder
- coughing, sneezing, squatting, voiding abruptly interrupted
What are two other causes of UTI’s?
Urethrovesical and Ureterovesical Reflux
Ureterovesical Reflux
urine goes up into the ureters and back into the bladder
-Structural abnormalities
S/S of Cystitis (Lower UTI)
- Dysuria -hematuria
- Frequency -Suprapubic pain
- Burning with urination
- Nocturia
- Urgency
- Cloudy/Foul smelling
S/S of Acute Pyelonephritis (Upper UTI)
- Fever
- Nausea/Vomiting
- Flank pain
- Bacteriuria
- Pyuria
- Headache
- Malaise
Where would the patient experience flank/costovertebral pain?
B/t the 12th rib and costovertebral angle
*On your back where your kidneys sit
How would a UTI be diagnosed?
- Urinalysis
- Urine culture w/ Sensitivity
What would indicate a UTI after a Urinalysis?
- Bloody/cloudy urine
- WBC’s and RBC’s >5
- Positive for Nitrites and Bacteria
What would indicate a UTI after a Urine Culture?
> 100,000 bacteria
What tests are used specifically used for an Upper UTI (pyelonephritis)?
- CT scan
- Laboratory (BUN and Creatinine)
- Diagnostic (IV pyelogram)
What two antibiotics are commonly used for an UNcomplicated UTI and for how long?
Cipro or Levaquin
-3 day course
What antibiotics are commonly used for a COMPLICATED UTI and how long?
IV: Ancef, Rocephin, Maxipime, Cipro
Oral: Cipro, Keflex
-7-10 day course
What are additional treatments used for a UTI?
- Antiemetics for N/V
- Bladder Analgesics
What are some precautions for bladder analgesics?
- Numbs bladder so you can NOT use it for more than 3-4 days
- Can mask worsening symptoms
- turns urine orange
What else can be done for a UTI?
-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
What should you not take Cranberry juice/ supplements with?
Anticoagulants
When would Pyelonephritis require hospitalization?
- Symptomatic and complicated
- Unable to tolerate oral meds/fluids
- Uncontrollable fever
- Sever uncontrollable pain
What are some complications a patient may have if UTI is not treated/ treated effectively?
- End stage kidney disease
- Kidney Failure
- Sepsis
What are some ways to prevent UTI’s?
- 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
Nursing Care for UTI
- 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
Overactive Bladder
- Can be w/ or w/o incontinence
- Client Experiences: urgency, frequency, Nocturia
Incontinence
loss of bladder control = urine is lost involuntarily in large or small amounts
Risk Factors for Incontinence
- Pregnancy/ previous vaginal birth
- Immobility
- Impaired Cognition
- Medications/Diuretics
- Obesity
- Preexisting Conditions (Diabetes, Stroke)
- Low estrogen
- smoking
- Long term catheter use
- High impact exercise
What are the types of incontinence?
Stress, Urge, Reflex, Mixed, Overflow, Functional
Stress Incontinence
pelvic floor muscles are weakened causing leaking w/ laughing, coughing, sneezing
Urge Incontinence
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
Reflex Incontinence
bladder muscled contract on their own secondary to a disruption in the nerve impulses for voiding; NO awareness of need to void
Mixed Incontinence
mix of stress and urge
Overflow Incontinence
inability to empty the bladder completely secondary to flaccid/enlarged bladder causing involuntary loss of urine secondary to over distention
Functional Incontinence
CONTINENT; however, mental/physical deficits prevent the ability to get to the bathroom on time
How is Incontinence diagnosed?
- By neurological, urological, or reproductive abnormalities
- UA/Cultures, WBC’s, Diabetes
What are some client cues of Incontinence?
- Avoid social situations
- Depression
- Perineal skin inflammation
- Avoid talking urinary concerns
- Urine odor
- Frequent bathroom trips
What are the primary goals for incontinence?
- Prevention or correction
- Skin protection and odor elimination
What can be done to help with incontinence?
- 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
Surgical Interventions for Incontinence
- Vaginal/Bladder Sling
- Bladder augmentation
- Bladder-neck suspension
What medications are used for incontinence?
- Alpha-Adrenergic Blockers
- Antispasmodics
- Anticholinergics
Alpha-Adrenergic Blockers
Stress, Reflex, and Overflow
Antispasmodics
Urge and Reflex
Anticholinergics
Urge ONLY
Nursing Care for Incontinence
Assess
- Vitals
- Activities that lead to incontinence
- UA/Culture
- Voiding Diary
Nursing Actions for Incontinence
- Administer meds as ordered
- Assist w/ self care needs
- Encourage and support
- Educate
What should the nurse include in patient education for incontinence?
- 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
Urinary Retention
bladder does not empty completely when voiding, and residual urine remains
Common Risk Factors for Urinary Retention
- Men (enlarged prostate)
- Meds (anticholinergics)
- Anesthesia
Nursing Care for Urinary Retention
- Recognize the problem
- Assist w/ promotion of normal urination
- Catheterization if not contraindicated
Neurogenic Bladder
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
Flaccid Neurogenic Bladder
- lower
- reflexes of bladder muscles are sluggish or absent leading to over distention
- generally in lumbar area
Spastic Neurogenic Bladder
- Upper
- bladder empties on reflex w/ little to no control by the patient
- prob generally above T12 vertebrae
Neurogenic Bladder Treatments
Catheter
- Condom/Petal
- Self Intermittent
- Indwelling
- Suprapubic
What are some self care tips for self intermittent catheterization?
- Clean technique
- Every 4-6 hours and before bed
What is a Suprapubic Catheter and why is it better?
- inserted through incision/ puncture above the pubis
- lower rate of infection
- easier to use/remove
Nursing Management for Neuro Bladder
- 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
What should the nurse assess/do after catheter removal?
- 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
Urolithiasis Stones (Bladder)
calcifications that form in the urinary tract
Nephrolithiasis Stones (Kidney)
calcifications that form in the kidney
How are kidney stones formed?
When urine is super concentrated, small crystals in the urinary tract clump together, forming a stone/calculus
Risk Factors for stones
- Men
- Hereditary
- Gout
- Summer months (Dehydrated)
S/S of Stones
- Colicky (wavelike) pain
- N/V
- Referred Pain
- Gross/Microhematuria
- Irritative voiding symptoms
Where would the stones be with referred pain to the abdomen or genitals?
Urolithiasis (Bladder)
Where would the stones be with referred pain as flank pain?
Nephrolithiasis (Kidney)
What is the diagnostic exam of choice for stones and what should you check before it?
- CT scan
- Check BUN
What are other diagnostic tests for stones?
- KUB X-ray
- Ultrasound
- IV Pyelogram
What must you do for a IV Pyelogram?
Stop Metformin 24 hours before and 48 hours after
CT Scan
- Quick, noninvasive
- Shows all types of stones
- Detects obstructions
KUB
- Quick, noninvasive
- Inexpensive
- Does NOT detect Uric acid or Pure Xanthine stones
Ultrasound
- Recommended for children and pregnant women
- Detects obstructions
What type of stones are allowed to try and pass on their own with little assistance?
- Stones less than 1 cm (10 mm)
- Minimal pain
- No infection
- No hydronephrosis
What is used to help pass a stone?
Narcotics or NSAIDs -Tramadol/Ultram -Mobic -Morphine -Ketorolac -Dilaudid Antiemetics -Metoclopramide/Reglan -Promethazine/ Phenergan Alpha-Adrenergic Blockers -Tamsulosin (Flomax) or Terazosin (Hytrin)
When would a patient need surgery for stones?
- Not passed in 4-6 weeks
- Uncontrollable pain
- N/V
- Infection
- Stone > 10 mm
- Obstruction
What are the surgical options for stones?
Ureteroscopy, Percutaneous Nephrolithotomy, Extracorporeal Shockwave Lithotripsy (ESWL)
Ureteroscopy
under anesthesia, scope inserted through the urethra and into the ureters to remove stone
Percutaneous Nephrolithotomy
Under anesthesia, nephroscope inserted through the skin into the kidney
ESWL
conscious sedation, shockwave applied to break up the stone so it can be passed
Nursing Care for Stones
- Medicate patient as ordered
- Encourage increased fluid intake
- Catheter if needed
- Strain urine
Low Sodium/Protein diet
Calcium stones
Low Purine Diet
Uric Stones
-high purine food: organ meat, seafood, lima beans, chicken, mushrooms
Low Oxalate Diet
Xanthine Stones
high oxalate foods: dark chocolate, nuts/beans, razzberries, potatoes
Urinary Diversion
Urine is diverted from the bladder to a surgically created exit site
-usually result from cystectomy
Two Diversion Categories
- Cutaneous- urine drains through an opening in skin
- Continent-intestine is used to create a new reservoir for urine
Ileal Conduit
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
Nephrostomy Tube
Short Term
-inserted into the kidney that needs drained
Indiana Pouch
- 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)
Nursing Care for Urinary Diversions
- Monitor Stoma
- Skin around stoma
- Emotional support
- Provide high levels of independence and self-care
