urinary system Flashcards
1
Q
urinary tract infection (UTI)
A
- 2nd most common bacterial disease
- most common in women b/c shorter urethra = greater risk uti
- can cause death if sepsis (bodies response to infection causes injury to its own tissue)
- E. coli = most common pathogen
- bladder and contents should be bacteria free
- complicated = coexisting presence of an obstruction, diabetes, renal insufficiency, pregnancy changes, infection, immunosuppression
2
Q
UTI contributing factors
A
- drugs, chemicals, radiation
- -> feminine hygiene spray, bubble baths, jellies
- microbe-bacteria –> E. coli (90% uti), staph, candida
- urinary stasis –> neurogenic bladder (lacking control due to brain or nerve functions like Alzheimers, DM), Benign prostate hypertrophy, tumor
- foreign bodies –> catheters, stones
- obesity, fistula, cogenital defects
- multiple sex partners
- not peeing after sex
3
Q
UTI assessment
A
s/s:
- frequency
- urgency
- dysuria
- hesitancy
- low back pain
- incomplete bladder emptying
- incontinence
- retention
- nocturia - peeing a lot at night
- hematuria - blood
prgressed s/s — if progressed to pyelonephritis
- fever
- chills
- N/V
- flank pain
4
Q
UTI in older adults
A
- mental confusion
- unexplained falls
- sudden onset incontinence
- loss appetite, nocturia, dysuria
- fever, tachycardia, hypotension (urosepsis)
5
Q
normal urinalysis
A
- clear, amber yellow, odor = stronger in the am
- ph4.6-8
Negative for: bilirubin, blood, glucose, ketones, protein, nitrates, leuocytes, casts - specific gravity = 1.010-1.030 – higher number = more dehydrated
6
Q
UTI diagnostics
A
- positive nitrates (presence of bacteria)
- positive leukocyes
- RBC present
- need a clean catch to determine bacteria susceptibility to antibiotics
- cystoscopy for recurrent or complicated uti’s
7
Q
UTI tx
A
- antibiotics –> need sensitivity testing. uncomplicated = short term course 1-3 days. complicated - long term course 7-14 days
- teach pt to take full prescription
- sulfonamides
- fluoroquinolones (tequin and noroxin) – not if preg
- ciprofloxacin
- penicillins
urinary analgesics:
- pyridium - used w/ antibiotics. provides soothing effect on urinary tract mucosa. used for pain and bladderspasm . urine is reddish orange (sometimes mistaken for blood)
- ditropan/oxybutynin chloride (overactive bladder) - used with antibiotics
8
Q
UTI nursing education
A
- drink 2-3 L water daily
- drink 50 mL concentrated daily juice
- empty bladder regularly & completely
women:
- clean perineal front to back
- wear loose fitting cotton underwear
- empty bladder before & after sex
- avoid douches & lube for sex
- topical estrogen - normalizes flora
- encourage good nutrition
- avoid alc, citrus, chocolate, spiced foods
- medications - full course antibiotics even if symptoms gone
- report onset fever immediately
9
Q
Urinary Incontinence
A
- urine involuntarily leaves the bladder
- urge: overactive bladder
- stress: too much pressure
- overflow: incomplete emptying
- teach bladder training and scheduling
- decrease fluid in evenings
- kegel exercises
- weight control - obesity can influence incontinence
- never scold pt, respond call lights, change pads
- surgical managemt – bladder neck suspension
- drug therapy – anticholinergic: ditropan -for overactive bladder
10
Q
kidney stones
A
calcium in the kidneys - urinary calculi (stones)
- usually form in kidneys then migrate to lower urinary system
- causes: urinary stasis, concentrated urine, uric acid
risk factors:
- infection, failure to empty bladder completely, obesity, obstructed tract
- immobility, dehydration, hx stones, excessive calcium levels, high animal proteins in diet
11
Q
urinary calculi (Stones) assessment
A
- sharp severe sudden pain
- hematuria
- oliguria (small amounts urine output)
- anuria (no urine output)
goal:
- relieve obstruction
- increase fluids
- reduce pain
- prevent recurrence
FIRST PRIORITY = pain management
12
Q
urinary calculi tx
A
- pain management
- push fluids
- stents (open up to make it pass a little earlier)
- lithotripsy = sound wave therapy to break up stone
- surgical = last resort, monitor I & O, monitor drains
- do not limit activity bc sedentary lifestyle could make it worse
13
Q
urinary retention
A
- inability to empty the bladder
causes:
- neurological conditions
- enlarged prostate (BPH)
- medications
- general anesthesia
- detruser failure - muscle that pushed down for urinary elimination
manifestation:
- distended bladder, inability to empty bladder, small voids every hr, chronic UTI
- oliguria - diminished production
- anuria - no output
- IMPORTANT to determine if pt is not making urine or just not letting it out
Tx:
- bladder scan for post void residual
- straight cath
14
Q
bladder cancer
A
- most common cancer of the urinary tract
- strong correlation w/ nicotine/smoking and toxin exposure
- most common after age 60
- metastasizes
15
Q
bladder cancer assessment
A
- painless hematuria (gross or microscopic)
- dysuria
- routine urinalysis
16
Q
bladder cancer tx
A
surgical tx
medical tx - chemotherapy and radiation
immunotherapy - BCG (bacillus calmetter-guerin) - virus used to stimulate the immune response
17
Q
urinary division
A
- surgical removal of caner or bladder
- bladder reconstruction
- stoma
- promote self-care
- monitor drainage
- prevent odor: wash pouches with soap & water
18
Q
Benign Prostatic Hyperplasia (BPH)
A
- result in enlargement of prostate gland
- cause: unknown
- causes bladder outlet obstruction
- risk factors:
- obesity, DM, hormone, supplementation, lack of physical activity
19
Q
BPH assessment
A
- elimination patterns (retention, incomplete emptying), distended bladder
- psychosocial: irritability, depression, libido affected, anxiety
diagnostic:
- urinalysis and culture
- BUN
- prostate-specific antigen
- digital rectal exam
- transabdominal ultrasound
20
Q
BPH analysis & outcome
A
- urinary retention due to bladder obstruction
- decreased self-esteem due to overflow incontinence & sexual dysfunction
- alpha blockers: relax bladder neck muscles
- finasreride: shrink prostate
- cialis: treats erectile dysfunction
goal:
- improve urinary elimination
21
Q
prostate cancer
A
- slower growing with predictable metastasis
- advanced age = leading factor
- second most common cancer in men
- 100% cure if found early
22
Q
prostatectomy
A
- surgical removal of part or all of the prostate
- monitor transurethral resection syndrome which is a rare complication due to intraoperative surgical site irrigation
- intervention: assess for fluid overload, discontinue irrigation, administer diuretic agents
- urine will be blood-tinged
- check urine output every 2 hrs
23
Q
urinary reflux
A
- back flow of urine into the urinary tract – flows back into ureter & possibly into kidney
- can lead to hydronephrosis - structural abnormalities between kidney, ureter, and bladder
24
Q
urinary reflux causes, s/s, tx
A
causes:
- congenital (born with it)
- chronic bladder infection
- obstruction in bladder ( BPH, tumor, stones)
s/s:
- recurrent uti
- flank pain
- uti symptom
- dilation of ureter or kidney
tx:
- address cause
25
pyelonephritis
- bacterial infection of upper urinary tract that usually develops in lower urinary tract infection
- inflammation renal parenchyma and collecting system
causes:
- reflux: damage, anatomic anomalies, scarring, DM, kidney stones
- e. coli
urosepsis: can lead to septic shock and death
acute: active infection, brief, recurs, relapses
chronic: repeated infections, scarring, decrease in functioning nephrons = renal failure
26
clinical manidestations pyelonephritis
- mild fatigue
- chills
- fever
- vomiting
- dysuria
- frequency
- urgency
- cloudy urine
- foul smell
- increased WBC's
- flank pain
- CVA tenderness
- usually found when client being evaluated for HTN
27
pyelonephritis management
- eliminate organism
- remove obstruction
- treat N/V
- provide hydration
drug therapy
- antibiotics
- urinary analgesics
- drink 2L water day
- typically improve within 48-72 hrs after starting therapy
28
Glomerulonephritis
- inflammatory cells damage glomeruli
- leading cause of end stage renal disease
- caused by immune reaction that changes glomerular structure
- can lead to nephrotic syndrome
- acute onset
- HTN
- hematuria
- RBC in urine
- proteinuria
- fatigue
- nephrotic syndrome may develop - fluid excess, excess proteinuria, hyperlipidemia
29
diabetic nephropathy
- leading cause ESRD
- relates to degree hyperglycemia
- atherosclerosis
- HTN
- neuropathy of bladder tone
- avoid dehydration
- control blood glucose
- decrease insulin need bc harsh on kidneys
30
nephrotic syndrome
- proteinuria
- hyperalbuminemia
- edema
- hyperlipidemia
- lipiduria
- manage infection
- complications:
fluid overload, HTN, dialysis
