Urinary system Flashcards
at what volume will the sensation to void present?
In adults 150 ml
What are the ureters for?
To allows urine to pass down from kidney to bladder
What is considered urinary retention?
Great than 300ml < x2 episodes
Greater than 100ml< after voiding
What is normal urinary retention?
30-50ml usually remains in bladder and is considered normal
What type of muscle is in both ureters and internal urethral sphincter?
Smooth muscle
Involuntary
What muscle is in the external urethral sphincter and why?
Skeletal muscle
The external sphincter has to be relaxed in order for urine to pass through and be excreted, normally it is contracted
Skeletal muscle is voluntary control
What is a UTI? What are the different sub groups
An infection involving any part of the urinary system
Lower urinary tract infection
Upper urinary tract infection
Complicated vs uncomplicated UTI
Which infections are of the lower urinary tract?
Cystitis- inflammation of the urinary bladder
Bacterial prostatitis- Inflammation of the prostate gland
Bacterial urethritis- Inflammation of the Urethra
Which conditions are associated with upper urinary tract infections?
Acute pyelonephritis- inflammation of renal pelvis
Chronic Pyelonephritis- inflammation of renal pelvis
Renal abscess
Perineal abscess
Interstitial nephritis- Inflammation of the kidney
If a UTI is acquired in the hospital what is it dx as?
Most common cause?
Complicated UTI Catheterization Also- occur in Pts with urological abnormalities pregnancy Immunocompromised Obstructions
Frequent recurrence!
Define uncomplicated UTI
Community acquired, common among young women, not usually recurrent
s/s of UTI
Increased frequency of urination with urgency Delay, hesitancy Dysuria- pain w/ urination Nocturia Hematuria Cloudy foul smelling urine Incontinence Bladder spasms/bladder pressure
s/s of pyelonephritis
Fever, chills N/V Flank pain CVA tenderness over affected kidney Dysuria
What are some considerations regarding UTI and geriatric
Patients on many medications, tx of chronic medical conditions Frequent use of antimicrobial agents May be immunocompromised Cognitive impairment Immobility Incomplete emptying of bladder Use of bedpan rather than commode
Atypical presentation of UTI with older clients
Anorexia fatigue change in cognitive function New incontinence Hyperventilation Low grade fever
What test is preformed for UTI
Urinalysis
Urine Culture and sensitivity (urine C&S)
Describe the steps of a urinalysis
Collect 10ml of urine in sterile cup using clean void or Cath
Deliver to laboratory immediately or must be refrigerated/ put on ice
What will be present if UTI
Leukoesterase Nitrates WBC Cloudy/foul smelling Bacteria over 100,000
What is the difference between urinalysis and Urine culture and sensitivity
Urinalysis shows that abnormal material is in urine
If urinalysis is c/w infection such as WBC, nitrates, leukoesterase, bacteria greater than 100,000
How long do urine culture results take?
48 hours
Which medication is primarily given with community acquired UTI
Trimethoprim/sulfamethoxazole BACTRIM DS 3-7 days
Monitor for adverse rxn- rash common s/e
Which medication can be used in low doses prophylactivley?
Bactrim DS
Used for clients that have chronic reoccurring UTI
What other medications are given for UTI
Cephalexin- Keflex- NO with PCN allergy
Ciprofloxacin- cipro
Ceftriaxone
Which medication is given if UTI is Fungal?
Fluconazole (diflucan)
for IV/oral use only
Many medication interactions
no PO w/ pregnancy/ breast feeding
If patient is still presenting with fever 24-48 hours after starting medication what is the concern?
If client still has fever after this time frame considering abx not working
A patient with UTI no longer has fever but complains of pain and dysuria, what medications can be given?
Phenazopyridine (Pyridium)
- Analgesic effects
- May turn urine red-orange
Hyoscyamine (anaspaz) -antispasmoic effects on detrusor -c/o constipation urinary retention (remember contraction of detrusor is needed to urinate) Drowsiness Dry mouth
What are some key points for patient teaching regarding care for UTI
Meds need to be finished!
Try to void Q2-3 hours
Drink 2-3 L of fluid daily
Teaching for prevention of UTI
Avoid bubble baths, nylon underwear, scented toilet tissues
Wear loose fitting cotton underwear
Void before and after sex
Avoid douching
Avoid vigorous cleaning or perineum with harsh soaps
How do you assess for kidney tenderness?
CVA test- make a fist and tap on CVA area, + if tender, swelling, bruising or redness
occurs w/ kidney infection
Located- b/l sides below portion of 12th rib and spinal column
Where would you auscultate and what would you hear?
Bruits b/l midclavicular side
Can palpate for thrill
What does a bruit indicate?
Usually renal artery stenosis
What can cause a UTI?
Bacterial- feces
Fungal- candida
Parasite (trichomonas)
Viruses- rare
Risk factors for UTI
Female sex
Renal calculi
DM
Sexual activity
What are the different types of incontinence
Stress incontinence Urge incontinence Overflow/ reflex incontinence Functional incontinence Iatrogenic incontinence
