urologic disorder

Question 1

Age-Related Changes in the Urinary System

Answer 1

Loss of nephrons, thickening of membranes in nephrons, and sclerosis of renal blood vessels
(results in less able to concentrate or dilute urine in response to osmolality of serum in the blood)
Creatinine clearance decreases with age
Nocturia: awaken from sleep to void
Bladder muscles weaken; connective tissue increases
Incontinence not normal consequence of age, but it is common
In men, urethral obstruction often a problem

Question 2

Health History

Answer 2

Chief complaint
Changes in urine quality or quantity, pain
History of present illness
Patient’s normal or usual pattern of urination
Pain or discomfort
Problem initiating or controlling urination
Document circumstances under which these problems occur
Past medical history
A history of streptococcal infections, recurrent urinary tract infections (UTIs), renal calculi (“stones”), gout, or hypercalcemia
Family history
Congenital kidney problems, such as polycystic kidneys or urinary tract malformations, diabetes mellitus, and hypertension
Review of systems
Changes in skin color, respiratory distress, edema, fatigue, nausea, vomiting, chills, and fever
Functional assessment
Daily fluid intake
Effects of the chief complaint on daily life

Question 3

Physical Examination

Answer 3

Skin color (ashen, yellow); crystals on skin (uremic frost)
Tissue turgor: to detect dehydration or edema
Periorbital edema: suggests fluid retention. Inspect the mouth
for moisture and P/A of odor of urine
Observe respiratory rate, pattern, and effort (increased rate could
indicate metabolic acidosis, infection, and fluid overload)
Auscultate the lungs for crackles or rhonchi
Inspect the abdomen for scars and contours, and palpate for
tenderness and bladder distention
Auscultate the kidney area over costovertebral angle to detect
renal bruits
Edema
Inspect the genitalia

Question 4

Inflammation of the urethra
By microorganisms, trauma, or hypersensitivity to chemicals in products such as vaginal deodorants, spermicidal jellies, or bubble baths

Answer 4

Urethritis

Question 5

Signs and symptoms Urethritis

Answer 5

Dysuria, frequency, urgency, and bladder spasms

Urethral discharge may be noted

Question 6

Medical diagnosis Urethritis

Answer 6

Based on patient signs and symptoms, urinalysis, and urethral smear

Question 7

Medical treatment Urethritis

Answer 7

Antimicrobials

Question 8

Assessment Urethritis

Answer 8

Comfort, possible causative factors, and understanding of treatment and prevention

Question 9

Interventions Urethritis

Answer 9

Sitz baths
Instruct female patients to wipe from front to back after toileting; void before and after sexual intercourse
Discourage bubble baths and vaginal deodorants
Instruct uncircumcised male patients to clean the penis under the foreskin regularly

Question 10

Inflammation of the urinary bladder

Answer 10

Cystitis

Question 11

Common cause Cystitis

Answer 11

is bacterial contamination

Other factors: prolonged immobility, renal calculi, urinary diversion, and indwelling catheters

Question 12

Signs and symptoms Cystitis

Answer 12

Urgency, frequency, dysuria, hematuria, nocturia, bladder spasms, incontinence, and low-grade fever
Urine may be dark, tea-colored, or cloudy
Fever, fatigue, and pelvic or abdominal discomfort

Question 13

Medical diagnosis Cystitis

Answer 13

Urinalysis, culture and sensitivity

White blood cells (WBCs)

Question 14

Medical treatment Cystitis

Answer 14

Antibiotics

Mild analgesic; hyoscyamine (Cystospaz) and flavoxate (Urispas

Question 15

Assessment Cystitis

Answer 15

Patient symptoms, causative factors, and understanding of treatment and prevention

Question 16

InterventionsCystitis

Answer 16

Patient teaching regarding medications, fluids, and prevention

Question 17

Pathophysiology and diagnosis
Inflammatory disease of the bladder, usually chronic
Cause is unknown
Bladder/pelvic pain; urinary frequency and urgency
Diagnosed by cystoscopy

Answer 17

Interstitial Cystitis

Question 18

Medical treatment Interstitial Cystitis

Answer 18

Symptom management; attempts to treat causes

Question 19

Nursing care Interstitial Cystitis

Answer 19

Primary role is teaching and support

Question 20

A result of inflammation of the renal pelvis

Answer 20

Pyelonephritis

Question 21

most often caused by ascending bacterial infection, but it may be bloodborne

Answer 21

Acute pyelonephritis

Question 22

often the result of reflux of urine during voiding; recurrent episodes of acute pyelonephritis with scarring and fibrosis of tissue (permanent)

Answer 22

Chronic pyelonephritis

Question 23

Signs and symptoms

Acute pyelonephritis

Answer 23

High fever, chills, nausea, vomiting, and dysuria; severe pain or constant dull ache occurs in the flank area ; malaise, dyuria with concurrent cystitis

Question 24

Signs and symptoms Chronic pyelonephritis

Answer 24

Bladder irritation, chronic fatigue, slight aching in one or both flank areas, low-grade fever, vague GI symptoms
May be asymptomatic

Question 25

Medical treatment

Pyelonephritis

Answer 25

R/O obstruction as cause
Pyuria: antibiotics 14 days with Acute; Chronic 4-6 weeks
Dysuria: analgesics (pyridium), antispasmodics (eg. flavoxate)
Drink at least eight 8-ounce glasses of fluids daily
Intravenous fluids may be ordered if nausea and vomiting
Dietary salt and protein restriction for patient with chronic disease

Question 26

Assessment Pyelonephritis

Answer 26

Related signs and symptoms, history of urinary tract disorders, and effects of the infection on daily activities

Question 27

Interventions for Pyelonephritis

Answer 27

Acute Pain
Activity Intolerance
Deficient Fluid Volume and Imbalanced Nutrition
Ineffective Management of Therapeutic Regimen

Question 28

Hereditary disorder
Two types: childhood and adult
In adults usually manifested by age 40 years
Grapelike cysts in place of normal kidney tissue
Cysts enlarge, compress functional renal tissue, and result in renal failure (sec. to RF = CHF and/or elv. B/P)

Answer 28

Polycystic Kidney Disease

Question 29

Signs and symptoms Polycystic Kidney Disease

Answer 29

Dull, aching abdominal & lower back or flank pain
or
Colicky pain that begins abruptly

Question 30

Medical treatment Polycystic Kidney Disease

Answer 30

Supportive treatment is recommended to preserve kidney function
Control hypertension
UTI : infections treated promptly with antibiotics
Dialysis, nephrectomy, and transplantation once end-stage renal disease develops

Question 31

Immunologic disease: inflammation of the capillary loops in the glomeruli (possible after strep infection)

Answer 31

Acute Glomerulonephritis

Question 32

Signs and symptoms

Answer 32

Urine becomes tea colored as output decreases 
Peripheral and periorbital edema
As glomerular filtration decreases:
     mild to severe hypertension occurs 
     and hypervolemia results

Question 33

Medical diagnosis

Answer 33

Patient assessment and laboratory tests
Urinalysis, BUN, creatinine, and albumin
Renal ultrasound, renal biopsy, or both

Question 34

Medical treatment

Answer 34

Diuretics, antihypertensive medications, and antibiotics
Bed rest; activity restriction
Fluids, sodium, potassium, and protein may be restricted
If renal failure develops, dialysis is necessary

Question 35

Nursing Assessment

Answer 35

Signs and symptoms, Hx recent infections, and changes in urine

Question 36

Nursing Interventions for

Answer 36

Excess Fluid Volume
Activity Intolerance
Self-Care Deficit
Anxiety