urologic disorder Flashcards
Age-Related Changes in the Urinary System
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
Health History
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
Physical Examination
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
Inflammation of the urethra
By microorganisms, trauma, or hypersensitivity to chemicals in products such as vaginal deodorants, spermicidal jellies, or bubble baths
Urethritis
Signs and symptoms Urethritis
Dysuria, frequency, urgency, and bladder spasms
Urethral discharge may be noted
Medical diagnosis Urethritis
Based on patient signs and symptoms, urinalysis, and urethral smear
Medical treatment Urethritis
Antimicrobials
Assessment Urethritis
Comfort, possible causative factors, and understanding of treatment and prevention
Interventions Urethritis
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
Inflammation of the urinary bladder
Cystitis
Common cause Cystitis
is bacterial contamination
Other factors: prolonged immobility, renal calculi, urinary diversion, and indwelling catheters
Signs and symptoms Cystitis
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
Medical diagnosis Cystitis
Urinalysis, culture and sensitivity
White blood cells (WBCs)
Medical treatment Cystitis
Antibiotics
Mild analgesic; hyoscyamine (Cystospaz) and flavoxate (Urispas
Assessment Cystitis
Patient symptoms, causative factors, and understanding of treatment and prevention
InterventionsCystitis
Patient teaching regarding medications, fluids, and prevention
Pathophysiology and diagnosis
Inflammatory disease of the bladder, usually chronic
Cause is unknown
Bladder/pelvic pain; urinary frequency and urgency
Diagnosed by cystoscopy
Interstitial Cystitis
Medical treatment Interstitial Cystitis
Symptom management; attempts to treat causes
Nursing care Interstitial Cystitis
Primary role is teaching and support
A result of inflammation of the renal pelvis
Pyelonephritis
most often caused by ascending bacterial infection, but it may be bloodborne
Acute pyelonephritis
often the result of reflux of urine during voiding; recurrent episodes of acute pyelonephritis with scarring and fibrosis of tissue (permanent)
Chronic pyelonephritis
Signs and symptoms
Acute pyelonephritis
High fever, chills, nausea, vomiting, and dysuria; severe pain or constant dull ache occurs in the flank area ; malaise, dyuria with concurrent cystitis
Signs and symptoms Chronic pyelonephritis
Bladder irritation, chronic fatigue, slight aching in one or both flank areas, low-grade fever, vague GI symptoms
May be asymptomatic
Medical treatment
Pyelonephritis
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
Assessment Pyelonephritis
Related signs and symptoms, history of urinary tract disorders, and effects of the infection on daily activities
Interventions for Pyelonephritis
Acute Pain
Activity Intolerance
Deficient Fluid Volume and Imbalanced Nutrition
Ineffective Management of Therapeutic Regimen
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)
Polycystic Kidney Disease
Signs and symptoms Polycystic Kidney Disease
Dull, aching abdominal & lower back or flank pain
or
Colicky pain that begins abruptly
Medical treatment Polycystic Kidney Disease
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
Immunologic disease: inflammation of the capillary loops in the glomeruli (possible after strep infection)
Acute Glomerulonephritis
Signs and symptoms
Urine becomes tea colored as output decreases
Peripheral and periorbital edema
As glomerular filtration decreases:
mild to severe hypertension occurs
and hypervolemia resultsMedical diagnosis
Patient assessment and laboratory tests
Urinalysis, BUN, creatinine, and albumin
Renal ultrasound, renal biopsy, or both
Medical treatment
Diuretics, antihypertensive medications, and antibiotics
Bed rest; activity restriction
Fluids, sodium, potassium, and protein may be restricted
If renal failure develops, dialysis is necessary
Nursing Assessment
Signs and symptoms, Hx recent infections, and changes in urine
Nursing Interventions for
Excess Fluid Volume
Activity Intolerance
Self-Care Deficit
Anxiety
