Urinary Problems

Question 1

Factors Contributing to UTIs

Answer 1

• Obstruction
• Stones (calculi)
• Vesicoureteral Reflux
  > bacteria laden urine if forced backward from bladder up into ureters & kidneys
• Diabetes Mellitus
  > excess glucose in urine provides a rich medium for bacterial growth
• Characteristics of Urine
  > alkaline urine & concetrated urine promotes bacterial growth
• Gender
  > incrd incidence in female
• Age
  > incrd incidence in older adutls
• Sexual activity
• Recent use of antibiotics
  > antibiotics change normal protective flora

Question 1

Urolithiasis Etiology

Answer 1

• Unknown
• 90% have a metabolic risk factor
  > calcium & vit D supplementation
  > high-dose ascorbic acid (vit C)

Question 2

Urolithiasis - Risk Factors

Answer 2

• Family hx
• Overweight
• Diet (animal proteins, dcr fluid intake)
• Hx of urinary tract infections
• stones usually don’t cause symps until they pass into lower urinary tract

Question 3

Urolithiasis - Assessment

Answer 3

• Hx
• CMs
  > severe pain (renal colic)
  > hematuria
  > N/V, pallor, diaphoresis
  > frequency & dysuria occur when a stone reaches bladder
  > flank pain suggests tht stone is in kidney or upper ureter
  > flank pain tht extends toward abdomen or to scrotum & testes or vulva suggestions tht stones are in ureters or bladder
  > pain is most intense when stone is moving or when ureter is obstructed
  > oliguria (scant urine output) & anuria (absence of urine output) suggests obstruction; Obstructions is an emergency & must be treated immediately to preserve kidney func - hydronephrosis which is enlargemetn of kidney may occur

Question 4

Urolithiasis - Lab & Diagnostic

Answer 4

• Lab
  > urinalysis (hematuria is common)
  > WBCs & bacteria may be present as a result of urinary stasis
  > elevated serum WBC w/ infection
• Diagnostic: KUB x-ray, CT, US