urinary misc Flashcards
Define CAUTI
Catheter-acquired urinary tract infection
What is an “Upper UTI”?
involves parenchyma, pelvis or uretersaccompanied by fever, chills and flank Pain
What is another name for Flank Pain?
CVA tenderness or costovertebral angel tenderness
What is a Lower UTI?
associated with cystitis, no systemic manifestations
What is Pyelonephritis?
inflammation (usually r/t infection) of renal parenchyma and collecting system
What is Cystitis
inflammation of bladder wall
Define Urosepsis
UTI that has spread to systemic circulation, can be life threatening
What predisposes someone to UTI’s?
- neurogenic bladder
- kidney stones
- female urethra
- aging, DM
- constipation
- pregnancy
- poor hygiene
- habitual delay in urination (nurse’s bladder)
What are clinical manifestations of UTI’s
- Bladder emptying symptoms: hesitancy, intermittency, post void dribbling, urinary retention/ incomplete emptying, dysuria
- Bladder storage symptoms: urinary frequency, urgency, incontinence, nocturia, nocturnal enuresis
What is the most common bacterial infection and type of bacterial found in women?
UTI’s and gram negative bacteria (E-coli)
How would an older adult present with a UTI?
non-localized abdominal discomfort
cognitive impairment or generalized clinical deterioration
What diagnostic test are used for UTI’s
urinalysis
- quick dipstick
- microscopic urinalysis
- urine culture
What will you expect to see on your urinalysis
- nitrates (indicating bacteriuria)
- increased WBC (pyuria)
- leukocyte esterase
What are some risk factor Reductions for UTI’s
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
Risk Factor Reductions for Nosocomial/HAI UTI
- 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
What are interventions for UTI’s
- 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)-
How will the patient diagnosed with pyelonephritis present?
mild fatigue to sudden onset of chills, fever, vomiting and flank pain (CVA tenderness)
what additional diagnostic test will you perform for pyelonephritis
WBC w diffimaging tests
Blood culture
How do you manage Mild symptoms of pyelonephritis?
adequate fluid intake
NSAIDs or antipyretic
follow up urine culture and imaging studies
How do you manage severe symptoms of Pyelonephritis?
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
Why would a patient have a nephrostomy tube?
total obstruction of ureter
What is a Nephrostomy Tube
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.
What could excessive pain or drainage around the exit site of nephrostomy tube indicate?
possible blockage
Do I need an order to irrigate Nephrostomy Tube?
Yes, MUST have a order from HCP.
How much fluid can I irrigate the nephrostomy tube with?
No more than 5 ml of sterile NS
How are kidney stones diagnosed?
Careful H&P non contrast spiral CT (CT/KUB) - gold standard exam Ultrasound IVP Urinalysis (assessing hematuria, crystalluria &ph) Retrieval/analysis of stones
What are the five major categories of Kidney stones?
Calcium oxalate Calcium phosphate Uric acid Cystine Struvite
How do you manage an acute attack of r/t kidney stones?
Treat the symptoms
- Pain-NSAIDS &opiods
- Priority - N/V
- Infection
- systemic ABX - obstruction-pass spontaneously, >4mm usually do not pass, need stent placement, removal of stones
Kidney Stones Collaborative Care
- 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
What kidney stone would require a Low purine Diet
Uric Acid
What stone would require a low oxalate diet?
Calcium oxalate
What is another name for pain caused by kidney stones
Renal colic
what procedure is used for kidney stones
Lithotripsy
explain the process of a Lithotrpsy
Outpatient Disintegrates(pulverizes) stones via shock waves 2 approach options internal (direct), external (indirect)
what is internal (direct)
- cystoscopic approach
- percutaneous approach
- Laser
what is external (indirect)
- stones broken down and washed out
- major advantage: not-invasive
what are possible complications of a Lithotripsy procedure
Hemorrhage
infection
retention of stone fragments
Post-Procedure, is hematuria an expected finding?
Yes, hematuria is common
what would not be an expected finding after a Lithotripsy procedure
Decrease urine output, could indicate obstruction
What is placed post-procedure to facilitate passage of fragments?
Stent and is removed after 1-2 weeks
What are nurse implementations for kidney stones?
-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
Why would the patient need a urinary diversion
when the patient no longer has a reservoir (bladder)
What are the types of urinary diversions?
ileal conduit-incontinent diversion to skin
continent cutaneous reservoir-continent diversion to skin
orthotopic neobladder- continent diversion to urethra
incontinent-Ileal conduit
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
continent-Cutaneous Diversion
Cutaneous diversion
- must catharize stoma for urine output
- don’t have to wear a bag because continent
- different diversions (Indiana, Kock,Miami pouches)
Is it an expected finding to have mucous with a Ileal conduit?
yes
What is a continent- Orthotopic Neobladder?
orthotopic Neobladder
- internal reservoirs connected to native urethra (fake bladder)
- most closely approximates normal voiding
How is the orthotopic neobladder constructed
The internal reservoir is constructed from a segment of intestine (usually ileum) that is separated from bowel & anastomosed to the native urethra
What would you do preoperatively a cystectomy?
address anxiety and fear
address teaching needs for post op care
include wound ostomy and continence nurse WOCN)
What would you do postoperatively after cystectomy
- 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
What should the Stoma look like
Moist and Beefy red
