Urinary elimination Flashcards
hypospadius
- Urethral opening is below normal placement on glans of penis (ventral surface-underside)
- May also have short chordee (fibrous band of the penis, will cause it to curve downward)
epispadius
Dorsal placement of urethral opening
chordee
undescended testes and inguinal hernia
surgical correction of hypospadius, epispadius, and chordee is preformed?
- 12-18 months of age
- no circumcision
- stent
cryptorchidism
- One or both testes fail to descend through the inguinal canal into the scrotal sac
- Testis may be retractable
- In 85% right testis is affected
- The affected side or bilateral scrotum appears flaccid or smaller than normal
- Unknown why this fails: Increased abd pressure, Hormonal influences
Cryptorchidism management?
- Observation for first year
- HCG - stimulates testosterone production and helps with descent
- If testis fail to descend between 1-2 years of age then surgical treatment: Orchiopexy
____________ necessary before child can control bowel and bladder function; occurs between 12-18 months
myelination of spinal chord
child is usually not ready for potty training until ?
- 18-24 months
- Waiting until 24-30 months makes the job easier
urinates regularly?
1.5 years
aware of voiding
2 years
can hold urine?
2.5 years
daytime control
3 years
nighttime control
3.5 years
primary enuresis
Never achieved dryness for 3 months
secondary enuresis
Dry for 3-6 months then resumes wetness
organic enuresis etiology
- Neurological delay
- UTI
- Structural disorder
- Chronic renal failure
- Disease with polyuria (DM)
- Chronic constipation
non-organic enuresis etiology
- Sleep arousal problem
- Sleep disorders from enlarged tonsils, sleep apnea
- Psychological stress
- Family history
- Inappropriate toilet training
DDAVP
Ditropan
Tofranil (Imipramine)
medications for enuresis
- Sequela of obstruction
- increased risk of infection
- Hydronephrosis
- Hydroureter: enargement of the bladder of the ureter
urinary stasis
- Alteration in neural innervation of the bladder
- Spastic bladder: ** SCI (above sacral vertebrae) Stroke, MS
- Flaccid bladder: ** SCI, Diabetic neuropathy, non-relaxing external sphincter
neurogenic bladdder
- Abnormal movement of urine from the bladder into ureters or kidneys
- frequently occurs during urination
- often occurs in those with frequent UTI
- malfomation of valves at the ureter and/or the bladder
Vesicoureteral Reflux (VUR)
- Genetic origin
- Girls > boys
- Symptoms: Frequent UTI’s (most common), Enuresis, Flank pain, Abdominal pain
vesicoureteral reflux etiology and symptoms
vesicoureteral reflux treatment
- Grades 1-3: will usually resolve on own
- Grades 4-5: valve repair
- Prophylactic ABX
- Teach child to double void
- Urine C & S q 2-4 months until 3 negative
Classified according to region and primary site affected
- Lower urinary tract?
- Upper urinary tract?
- urethritis, cystitis
- pyelonephritis
- Inflammation of the bladder
- Causes: Bacterial infection, Radiation, Chemotherapeutic agents, Metabolic disorder
cystitis
- Nonspecific
- Fever or hypothermia (neonate)
- Irritability
- Dysuria (crying when voiding)
- Change in urine odor or color
- Poor weight gain
- Feeding difficulties
infant s/s of uti
- Abdominal or suprapubic pain
- Voiding frequency
- Voiding urgency
- Dysuria
- New or increased incidence of enuresis
- Fever
- Malodorus urine
- Hematuria
children s/s of UTI
- An inflammation affecting the renal pelvis and parenchyma.
- Usually begins in lower urinary tract & ascends into kidneys.
- Organisms: E. coli (85%), Proteus, Klebsiella
- Acute: bacterial infection
- Chronic: non-bacterial inflammation
pyelonephritis
chronic pyelonephritis
- Urinary obstruction
- Vesicoureteral reflux
Inflammation from infection
↓
Destruction of the endothelial lining of the nephron
and/or
Destruction of the basement membrane
↓
Loss of tubular function
↓
Loss of ability to concentrate urine
↓
polyuria
dilute urine
patho: pyelonephritis
- Abrupt onset of fever
- Chills
- Back pain
- Costovertebral tenderness
- Leukocytosis
- Pyuria
- bacteriura
acute pyelonephritis clinical manifestations
- Vague
- Polyuria
- Nocturia
chronic signs of pyelonephritis
UTI: Pharmacological Management
- Sulfonamides
- Quinolones
- Urinary antiseptics
- Urinary analgesics
- Age related non-malignant enlargement of the prostate gland
- Expanding prostatic tissue compresses the urethra causing partial or complete obstruction of the outflow of urine from the bladder
Benign Prostatic Hyperplasia
- Urgency, frequency, hesitancy
- Change in size and force of urinary stream
- ↑ time to void
- Dribbling
- Nocturia
- Retention
- Hematuria
- UTIs
BPH Clinical Manifestations
BPH medications?
Alpha blockers:
- Flomax (tamsulosin)
- Minipress (prazosin)
- Cardura (doxazosin)
- Hytrin (terazosin)
*take these type of medications in the evening to reduce side effects of hypotension and fatigue
5-alpha reductase inhibitors
- Avodart (dutasteride)
- Proscar (finasteride)
*reduce the size of the prostate. Very slow in addressing problems they may be having
TURP
Transurethral Resection of Prostate:
-Obstructing prostate tissue is removed using a loop wire of a resectoscope & electrocautery inserted through the urethra
Surgical complications:
-Post-op hemorrhage or clots,inability to void, UTI, incontinence, impotence, retrograde ejaculation
TURP: Post-op Nursing Care
- Monitor color/ characteristics of urine
- Strict I & O, including amounts of irrigation fluid
- Monitor VS closely
- Belladonna and opium suppositories: help control bladder spasm
- Encourage liberal intake of fluids (2-3 liters) to decrease risk of UTI
- Stool softener
- Antibiotics
*big risk is clot causing obstruction. Keep area well flushed through hydration and an irrigation system
- Transurethral Microwave Thermotherapy (TUMT)
- Transurethral Needle Ablation (TUNA)
- Transurethral Laser Therapy or Interstitial Laser Coagulation (ILC)
BPH minimally invasive surgery
Urolithiasis
Urinary calculi
Nephrolithiasis
Kidney calculi
- Idiopathic
- Inadequate hydration
- Hypercalciuria
- Gout
- Urine stasis
- Urinary tract infection
- Genetic predisposition (cystinuria)
- Dietary excess of calcium, oxalates, purines
urinary calculi etiology
5 major types of urinary calculi
- Calcium phosphate
- Calcium oxalate
- Struvite (magnesium-ammonium phosphate)
- Uric acid
- Cystine
Nidus (nucleus) development–> Crystal precipitation–>
Obstruction of urine flow
renal calculi patho
Common Locations of Urinary Calculi
- Kidney
- Ureteropelvic junction
- Pelvic brim (over iliac vessels)
- Ureterovesical junction
- Bladder
- Urethra
*like to be in places where there are angles and junctions
- Stone movement
- Sharp & intermittent
- Flank and outer quadrant
Renal colic: urinary calculi
- Distention of the renal pelvis or calices
- Dull & achy
- Flank & back
Noncolicky pain: urinary calculi
urinary calculi pain management: pharm
- Narcotic agents (morphine, meperidine)
- NSAIDS (ketorolac)
- _Spasmolytic agents: _oxybutynin chloride (Ditropan), propantheline bromide (Pro-Banthine), methantheline bromide (Banthine)
- Antiemetics
urinary calculi post-op care
- Monitor VS; I & O; urine color & clarity.
- Maintain placement and patency of urinary devices.
- Never irrigate the catheter without physician’s order.
- Strain all urine; Teach client how to strain urine.
- Send stones for analysis.
assess for allergies of iodine and shellfish?
assessing for allergy to a dye if they’ve never had that proceedure done before
urinary calculi nutrition recommendations
-
Calcium stones:
- Limit high calcium foods, Milk, cheese, green leafy vegetables, yogurt- Limit Na intake - Limit intake of oxalate: rhubarb, spinach, strawberries, chocolate, wheat bran, nuts, beets, and tea - Avoid vitamin C supplements -
Uric acid stones:
- Limit intake of foods high in purines: Organ meats, beef, veal, pork, venison, chicken, goose, sardines, herring, crab, salmon
Pharm treatment of the different kinds of stones
Calcium stones
- sodium cellulose phosphate (Calcibind)
- Thiazide diuretics
Uric acid stones
- sodium bicarbonate
- allopurinol (Zyloprim)
Cystine stones
- penicillamine (Cuprimine)
- alpha-mercaptopriopionylglycine (AMPG)
- Tiopronin (Thiola )
- Inflammation in the kidneys which begins in the glomerulus
- Acute aka nephritic
- Antibody reaction with antigens in the glomerulus
- Entrapment of antigen-antibody complexes
glomerular disease
- Inflammation of capillary loops in glomeruli of kidneys
- Cause: group A beta-hemolytic streptococcus
- Risk:Upper respiratory infection, Skin infection, Autoimmune process
glomerular nephritis
acute glomerulonephritis
- Sudden inflammation of the glomeruli of the kidney resulting in acute renal failure
- Peak age 5-10 years, boys>girls
- Capillary walls of kidney become permeable; allows red blood cells and protein to pass into urine
- Usually seen 7-10 days after a strep infection (immune response to strep), may be other organisism
- APSGN (Acute Post Streptococcal Glomerulonephritis)
- etiology: Streptococcus A,
Viruses:Chicken pox, Mumps, Measles
- Severe glomerular injury without a specific cause
- Rapid decline in glomerular function over 2-3 months
- Etiology:Systemic or renal immunologic disorders
- SLE - Goodpasture’s Syndrome
Rapidly Progressive Glomerulonephritis
Streptococcal infection (group A Beta hemolytic)
↓
antigen-antibody reaction
↓
formation of antigen-antibody complexes
↓
entrapment in the glomerular basement membrane
↓
Cells lining the glomeruli proliferate
↓
Capillary membrane edema & increased permeability
↓
Hematuria, hypertension, proteinuria,
edema, azotemia, RBC breakdown
Glomerulonephritis Pathogenesis
- Gross hematuria
- Dark, smoky, cola-colored, cocoa-colored urine
- Oliguria or anuria
- Headache
- Abdominal / flank pain
- Chills & fever
- Fatigue & weakness
- Anorexia, nausea/vomiting
- Peripheral edema
- Hypertension
Glomerulonephritis: Clinical Manifestations
- Urinalysis
- Proteinuria, RBCs, WBCs
- ↑ BUN & creatinine
- ↓ Creatinine clearance
- ↑ antistreptolysin O titer
- Biopsy
glomerulonephritis dx tests
Glomerulonephritis: Achieving Fluid Balance
- Monitor vital signs, I & O & daily weight
- Monitor for fluid overload
- _Monitor serum studies: _Electrolytes, BUN, creatinine, Hemoglobin, hematocrit, WBCs
- Maintain fluid restriction
- Na+ / K+ restriction
- Diet – ↓ protein, ↑ CHO
- _Medications: _Antibiotics, Immunosuppressives, Steroids, Diuretics, Angiotensin II receptor blockers, Potassium-binding resins, Antihypertensives
- Massive proteinuria (>3.5 grams/day)
- -Hypoalbuminemia
- -Edema
- Hyperlipidemia
- Etiologies: Glomerular disease, Diabetes, SLE
nephrotic syndrome
antigen-antibody reaction
Sclerosis of the GBM (diabetes, hypertension)
↓
glomerular basement membrane permeability to plasma proteins
↓
proteinuria
↓
hypoalbuminemia
nephrotic syndrome patho
- Severe edema
- Hypertension
- Sequela: Pulmonary edema, Pleural effusion, Ascites, Hyperlipidemia and atherosclerosis, Infection, Poor nutrition, Growth retardation
Nephrotic SyndromeClinical Manifestations
Nephrotic SyndromeDiagnostics
- Proteinuria
- Hypoalbuminemia
- Hyperlipidemia
- Urine appears dark and frothy
- Negative ASO titer
Reduce edema in nephrotic syndrome pt. nursing interventions/pharm
- Prednisone 2mg/kg/day for 4-8 weeks
- Long term steroid use is concern
- Treat until child is in remission
- Diuretic therapy used only if poor response to steroids
- May need IV albumin
- Give parental support and education re: urine protein checks
Risk for fluid volume deficit r/t effects of diuretics in pts with nephrotic syndrome nursing interventions
- Watch for low BP & increased pulse
- Report if child has output of less than 1 ml/kg/hr of urine
- Increased Hbg, Hct and platelets
- Observe for s/s dehydration
