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kidney > urinary misc > Flashcards

urinary misc Flashcards

1
Q

Define CAUTI

A

Catheter-acquired urinary tract infection

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2
Q

What is an “Upper UTI”?

A

involves parenchyma, pelvis or uretersaccompanied by fever, chills and flank Pain

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3
Q

What is another name for Flank Pain?

A

CVA tenderness or costovertebral angel tenderness

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4
Q

What is a Lower UTI?

A

associated with cystitis, no systemic manifestations

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5
Q

What is Pyelonephritis?

A

inflammation (usually r/t infection) of renal parenchyma and collecting system

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6
Q

What is Cystitis

A

inflammation of bladder wall

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7
Q

Define Urosepsis

A

UTI that has spread to systemic circulation, can be life threatening

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8
Q

What predisposes someone to UTI’s?

A
  • neurogenic bladder
  • kidney stones
  • female urethra
  • aging, DM
  • constipation
  • pregnancy
  • poor hygiene
  • habitual delay in urination (nurse’s bladder)
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9
Q

What are clinical manifestations of UTI’s

A
  • Bladder emptying symptoms: hesitancy, intermittency, post void dribbling, urinary retention/ incomplete emptying, dysuria
  • Bladder storage symptoms: urinary frequency, urgency, incontinence, nocturia, nocturnal enuresis
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10
Q

What is the most common bacterial infection and type of bacterial found in women?

A

UTI’s and gram negative bacteria (E-coli)

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11
Q

How would an older adult present with a UTI?

A

non-localized abdominal discomfort

cognitive impairment or generalized clinical deterioration

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12
Q

What diagnostic test are used for UTI’s

A

urinalysis

  • quick dipstick
  • microscopic urinalysis
  • urine culture
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13
Q

What will you expect to see on your urinalysis

A
    • nitrates (indicating bacteriuria)
  • increased WBC (pyuria)
    • leukocyte esterase
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14
Q

What are some risk factor Reductions for UTI’s

A

patient teaching, empty bladder regularly and completely, wipe perineal area from front to back, drink adequate amounts of fluid daily (2-3 liter daily)

sexually active females should urinate prior to and following sexual intercourse

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15
Q

Risk Factor Reductions for Nosocomial/HAI UTI

A
  • avoid or early removal of urinary catheterization
  • careful aseptic technique w/ urinary tract instrumentation
  • excellent hand washing and glove wearing when giving perineal care
  • Avoid incontinence episodes
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16
Q

What are interventions for UTI’s

A
  • adequate fluid intake (water is best)
  • Pain relief ( warm bath, no bubbles), local heat to area
  • ABX ( take full course, seek follow up care if symptoms do not resolve)-
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17
Q

How will the patient diagnosed with pyelonephritis present?

A

mild fatigue to sudden onset of chills, fever, vomiting and flank pain (CVA tenderness)

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18
Q

what additional diagnostic test will you perform for pyelonephritis

A

WBC w diffimaging tests

Blood culture

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19
Q

How do you manage Mild symptoms of pyelonephritis?

A

adequate fluid intake
NSAIDs or antipyretic
follow up urine culture and imaging studies

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20
Q

How do you manage severe symptoms of Pyelonephritis?

A

Hopitalization
-adequate fluid intake (parenterally initially; switch to oral when N/V/dehydration subside)
-NSAID’s or antipyretic drugs
-follow up urine culture and imaging studies
Parenteral ABX
- switch to oral when tolerates intake

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21
Q

Why would a patient have a nephrostomy tube?

A

total obstruction of ureter

22
Q

What is a Nephrostomy Tube

A

A device surgically inserted into the renal pelvis via a small flank incision. It is attached to a external bag for closed drainage and considered temporary.

23
Q

What could excessive pain or drainage around the exit site of nephrostomy tube indicate?

A

possible blockage

24
Q

Do I need an order to irrigate Nephrostomy Tube?

A

Yes, MUST have a order from HCP.

25
Q

How much fluid can I irrigate the nephrostomy tube with?

A

No more than 5 ml of sterile NS

26
Q

How are kidney stones diagnosed?

A 
Careful H&P
non contrast spiral CT (CT/KUB)
- gold standard exam
Ultrasound
IVP
Urinalysis (assessing hematuria, crystalluria &ph)
Retrieval/analysis of stones
27
Q

What are the five major categories of Kidney stones?

A 
Calcium oxalate
Calcium phosphate
Uric acid
Cystine
Struvite
28
Q

How do you manage an acute attack of r/t kidney stones?

A

Treat the symptoms

  1. Pain-NSAIDS &opiods
    - Priority
  2. N/V
  3. Infection
    - systemic ABX
  4. obstruction-pass spontaneously, >4mm usually do not pass, need stent placement, removal of stones
29
Q

Kidney Stones Collaborative Care

A
  • evaluate cause of stone formation and prevent further development-teach patient adequate hydration & how to strain urine-dietary changes, depending on content of stone
    ex: Low oxalate, Low calcium( controversial because stones may not come from dietary calcium source), Low purine
30
Q

What kidney stone would require a Low purine Diet

A

Uric Acid

31
Q

What stone would require a low oxalate diet?

A

Calcium oxalate

32
Q

What is another name for pain caused by kidney stones

A

Renal colic

33
Q

what procedure is used for kidney stones

A

Lithotripsy

34
Q

explain the process of a Lithotrpsy

A 
Outpatient
Disintegrates(pulverizes) stones via shock waves
2 approach options internal (direct), external (indirect)
35
Q

what is internal (direct)

A
  • cystoscopic approach
  • percutaneous approach
  • Laser
36
Q

what is external (indirect)

A
  • stones broken down and washed out

- major advantage: not-invasive

37
Q

what are possible complications of a Lithotripsy procedure

A

Hemorrhage
infection
retention of stone fragments

38
Q

Post-Procedure, is hematuria an expected finding?

A

Yes, hematuria is common

39
Q

what would not be an expected finding after a Lithotripsy procedure

A

Decrease urine output, could indicate obstruction

40
Q

What is placed post-procedure to facilitate passage of fragments?

A

Stent and is removed after 1-2 weeks

41
Q

What are nurse implementations for kidney stones?

A

-Patient education
-lower risk factors through lifestyle and dietary changes
-Fluid intake 3L/day with the exception of an obstructed stone
FF(forced fluid) not advised, Water preferred
-Dietary restrictions
-Reduction of risk factors
-sedentary/immobilized
- adequate fluid intake
-Turn q2
-Stand/sit up to void bladder on regular basis
- encourage ambulation-monitor passing of stones
-control pain

42
Q

Why would the patient need a urinary diversion

A

when the patient no longer has a reservoir (bladder)

43
Q

What are the types of urinary diversions?

A

ileal conduit-incontinent diversion to skin
continent cutaneous reservoir-continent diversion to skin
orthotopic neobladder- continent diversion to urethra

44
Q

incontinent-Ileal conduit

A

Ileal conduit

  • urine is constantly coming out, permanent external collecting device needed
  • gold standard for urinary reconstruction before continent diversion
  • stoma visible
  • skin integrity & body image concerns
45
Q

continent-Cutaneous Diversion

A

Cutaneous diversion

  • must catharize stoma for urine output
  • don’t have to wear a bag because continent
  • different diversions (Indiana, Kock,Miami pouches)
46
Q

Is it an expected finding to have mucous with a Ileal conduit?

A

yes

47
Q

What is a continent- Orthotopic Neobladder?

A

orthotopic Neobladder

  • internal reservoirs connected to native urethra (fake bladder)
  • most closely approximates normal voiding
48
Q

How is the orthotopic neobladder constructed

A

The internal reservoir is constructed from a segment of intestine (usually ileum) that is separated from bowel & anastomosed to the native urethra

49
Q

What would you do preoperatively a cystectomy?

A

address anxiety and fear
address teaching needs for post op care
include wound ostomy and continence nurse WOCN)

50
Q

What would you do postoperatively after cystectomy

A
  • NPO and NG to LWS for a few days to rest the gut
  • Patient teaching

ileal conduit: ensure properly fitting appliances & provide METICULOUS skin care

  • expect mucous in urine
  • stoma assessment

Continent diversion: cath every few hours at first, then 4-6 hrs

Neobladder: void by relaxing sphincter and bearing down ever 2-4 hr
- practice pelvic floor muscle relaxation to aid voiding

51
Q

What should the Stoma look like

A

Moist and Beefy red

kidney (12 decks)

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