Urinary tract infections, obstructions 3 b Flashcards
Pyelonephritis
causes
Inflammation of the renal pelvis, tubules and interstitial tissue
} Causes:
◦ Usually begins with infection of lower urinary tract via ascending
urethral route
◦ Bacterial Infection
◦ Secondary to vesico-ureteric reflux or urinary tract obstruction
} Can be acute or chronic
Acute pyelonephritis
Clinical Manifestations:
medical and nursing management
Clinical Manifestations: • Fever and chills • Leucocytosis • Bacteriuria and pyuria • Flank pain and costovertebral tenderness • Nausea and vomiting • Lower urinary tract symptoms (dysuria and frequency) Medical & Nursing management: • Outpatient or inpatient care • Antibiotic therapy (oral and/or IV) • Hydration (oral or IV) • Non steroidal anti-inflammatory or antipyretic drugs, assessment of temperature 4th hourly • Urinary analgesics
Acute pyelonephritis – Nursing Management
Nursing diagnosis: Risk for infection, related to bacteria in the urinary tract
Nursing interventions: • Monitor urine character, malodour. • Encourage oral fluids. • Instruct to void when urge is felt. • Encourage perineal hygiene. • Health promotion measures – early treatment of cystitis to prevent ascending infections. • Continue prescribed medications. • Follow up urine culture. • Recognise symptoms of relapse
Chronic pyelonephritis (interstitial nephritis) Definition:
Definition: Kidney that has lost function due to scarring and fibrosis Causes: Recurrent infections
Chronic pyelonephritis (interstitial nephritis) Clinical manifestations: Nursing Managment
• Fatigue, headache, anorexia, polyuria, excessive thirst, weight loss • Late stages: renal failure symptoms Medical and Nursing Management: • Antimicrobial agents • Monitoring of renal function • May require hospitalisation • Teaching prevention of UTI’s
Urinary Obstruction
“Urinary obstruction refers to any anatomical or
functional condition that blocks or impedes the
flow of urine”
Can adversely alter urinary tract function and
structure
Urinary Obstruction
Associated condition
Associated conditions:
• Reflux – backflow of urine
• Hydronephrosis
Hydronephrosis
Dilation of the renal pelvis and calyces of one or
both kidneys leading to distension and atrophy
caused by uretero-vesical reflux.
• Caused by obstructions in the urinary tract.
• Onset may be acute or gradual, unilateral or
bilateral.
• May develop chronic pyelonephritis and renal
atrophy
Urinary Tract Calculi
types
Calculi (stones) in the urinary tract or kidney
• Vary in size or location
Urolithiasis
• Nephrolithiasis -
– calculi (stones) in the urinary system kidney stones (renal calculi)
Pathophysiology Urinary Tract Calculi
Multiple causes such as: • Supersaturation of substances in the urine • High urinary concentrations of calcium oxalate, calcium phosphate and uric acid in urine • Absence of substances that prevent formation such as citrate and magnesium • Dehydration
Conditions that favour calculi formation
- Infection
- Urinary Stasis
- Immobility
- Hypercalcaemia
Clinical Manifestations
Clinical Manifestations
• Depends upon location and presence of obstruction or infection.
• Where stone is in urinary tract.
• Pain and haematuria.
Renal Pelvis
o Dull aching flank pain to acute pain
o Manifestation of UTI
o Microscopic haematuria
o Abdominal discomfort, nausea and vomiting
Ureters
o Excruciating colicky, wavelike pain (renal colic) radiating down the thigh and
genitalia, urge to void
o Nausea, vomiting, pallor, cool and clammy skin
Bladder
o May be asymptomatic or have dull suprapubic pain
o Irritation associated with UTI and haematuria
o Urinary retention can occur if the stone obstructs the bladder neck
Complications
Assessment and Diagnostic Findings
- Obstruction
- Hydronephrosis
- Infection
• X-ray (KUB) • Ultrasound • IVP (Intravenous Pyelogram) • Blood chemistries and stone analysis (may be asked to strain all urine and save any stones that pass)
Medical Management
Goals:
• Manage
- Manage acute attack
- Identify cause of stone formation
- Eliminate stone
- Control any infection
- Prevent nephron destruction
- Relieve any obstruction • Relieve pain
Stones greater than 4mm
m are unlikely to pass
through ureter
prevent obstruction
• A ureteral stent may need to be inserted
Procedures include:
Medical Management
Procedures include:
•Ureteroscopy
•Percutaneous Nephrostomy or Percutaneous Nephrolithotomy (PCNL)
•Lithotripsy to fragment stones
o Cystoscopic laser lithotripsy
o Percutaneous ultrasonic lithotripsy
o Extracorporeal shock wave lithotripsy (ESWL)
•Open surgery for removal of stones
o Nephrolithotomy- incision into kidney
o Pyelolithotomy – incision into renal pelvis
o Ureterolithotomy – incision into ureter
o Cystotomy – incision into bladder
•Chemolysis
o Use of infusions of chemical solutions such as alkylating agents to dissolve the stone
•Nephrectomy
o Removal of kidney only if non-functional secondary to infection or hydronephrosis
Patient education on preventing kidney
stones
Education regarding recurrence, understanding causes of renal calculi and following a regime
to avoid further stone formation.
Patient education includes:
• Drink enough fluid
• Increase mobility.
• Follow their prescribed diet- change diet to reduce intake of primary substance that forms calculi.
• Reduce salt intake.
• Ensure adequate rehydration when involved in activities that cause too much sweating and
dehydration.
• Contact doctor if developing symptoms of a UTI
Nutrition & Fluids
Fluid intake is preferably 3000ml – 4000ml/day. Drink water every 1-2 hours, two glasses before bedtime and a glass each time when waking at night.
Aim for urine output exceeding 2L per day.
Diet:
Modify diet to decrease foods high in causative factors (i.e. calcium stones – decrease dairy, chocolate, dried fruits and nuts)
