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Module 4 (MedSurg 2) > Urology Diseases > Flashcards

Urology Diseases Flashcards

1
Q

UTI is most commonly caused by

A

E coli bc grows in feces
- POSSIBLE fungal or parasitic

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2
Q

UTI

A

Bacteria enters the sterile bladder causing inflammation
Cystitis vs pyelonephritis vs urosepsis

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3
Q

Cystitis

A

inflammation of bladder

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4
Q

Pyelonephritis

A

inflamed kidneys parenchyma and collecting system

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5
Q

Urosepsis

A

sepsis caused by UTI
-emergent
- painful urination to abdominal pain and fever

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6
Q

What is the most common hospital-acquired infection and preventable?

A

CAUTI
most underrecognized and undertreated

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7
Q

Who gets a UTI more in gender?

A

females

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8
Q

Lower UTI included

A

Urethritis
Cystitis

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9
Q

Upper UTI included

A

Pyelonephritis

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10
Q

UTI Risk Factors

A

Immunosuppressed/Immunocompromised (steroids)
Diabetes (sugar)
History of kidney problems
Have undergone multiple antibiotic courses (good and bad)
Have traveled to developing countries
Catheterization
Cystoscopic examination (anything foreign inside)
Occupation/Habitual delay (nurses/day workers)
STI
multiple sex partners
poor hygiene
bubble baths
sprays
pregnancy
cystoscopy

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11
Q

Are there usually manifestations in Lower UTI?

A

no

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12
Q

If toxins are occluding the urethra, the kidneys do what to the BP and erthythopoetin?

A

BP high
Fever
Erythro low along with RBCs
K high

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13
Q

S/S of Urethritis

A

Pain/burning/difficult urination (Dysuria)
Frequency
Urgency
Males: clear mucous-like discharge (STI)
Females: lower abdominal discomfort
Nocturia

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14
Q

Frequency is

A

voiding more than 2 hours
more than 8 times in 24 hours

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15
Q

S/S of Cystitis

A

Urethritis symptoms) PLUS +
Bladder irritability
Hesitancy
Suprapubic pain
Incontinence (elderly)
nocturnal enuresis (while sleeping)

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16
Q

Hesitancy

A

difficulty starting a urine stream; delay between initiation of urination and beginning of flow of urine

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17
Q

Dx Studies for Lower UTIs

A

H&P (kidney problems, risk factors)
UA (things not filtered)
+ Nitrites
+ White Blood Cells (WBCs)
+ Leukocyte esterase
Urine culture and sensitivity (recurrent)
Determine bacteria’s susceptibility to antibiotic drugs
Imaging Studies (if indicated)

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18
Q

What shows up as positive in a UA for lower UTIs?

A

+ Nitrites (bacteria)
+ White Blood Cells (WBCs)
+ Leukocyte esterase
- not filtered

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19
Q

Uncomplicated UTIs

A

short term 3 days antibiotic

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20
Q

Urine Culture needs to be taken

A

mid-stream in a clean catch washing the penis with alcohol in between
finish in the cup

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21
Q

Medications/Preventions for UTIs

A

antibiotic
NSAIDs and pain analgesics
Cranberry juice with low sugar
Increase fluids
Vitamin C
help with bladder spasms (Pyridium)

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22
Q

Complicated UTIs

A

longer tx 7-14 days

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23
Q

UA and culture need to be done before

A

antibiotics are given

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24
Q

Systemic effects usually take place in what UTI

A

pyelonephritis
BP temp

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25
Q

Upper Tract includes

A

Renal parenchyma, pelvis, and ureters
Typically causes fever, chills, flank pain
Pyelonephritis: inflammation of renal parenchyma and collecting system

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26
Q

Parenchyma

A

outermost part of the kidney and renal medulla

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27
Q

Renal pelvis

A

center of kidneys

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28
Q

Pyelonephritis can lead to

A

kidney injury

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29
Q

The UTIs work

A

backward up the tubes from the lower to the upper

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30
Q

A preexisting factor can be present such as

A

vesicoureteral reflux:
Obstruction from Benign Prostatic Hyperplasia
Stricture
Urinary stone
CAUTI

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31
Q

Recurring acute episodes of Upper UTIs can lead to

A

scarred, poorly functioning kidney and chronic pyelonephritis

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32
Q

ACUTE pyelonephritis often starts in the

A

renal medulla and spreads through cortex
pregnancy

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33
Q

S/S of Pyelonephritis

A

Fever/Chills
Nausea/Vomiting
Fatigue/Malaise
Flank pain/Pain at costovertebral angle
S/S Lower (pain when urine, urgency and frequency)

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34
Q

Pyelonephritis classic sign in elderly

A

confusion

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35
Q

Dx/ Assess of Pyelonephritis

A

H&P
UA
Urine culture and sensitivity
Imaging studies (US, CT scan, cystoscopy)
CBC
Blood culture (if bacteriemia is suspected)
Percussion for flank pain (CVA)

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36
Q

Pyelonephritis can lead to what quickly

A

urosepsis

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37
Q

Pyelonephritis Nursing Care

A

Antibiotics
possible hospitalization
fluid intake increase
monitor urosepsis (VS)
promote prevention techniques like good hygiene

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38
Q

Urosepsis has both

A

bacteriuria
bacteremia

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39
Q

Frequent Causes of Urosepsis

A

Escherichia coli
Proteus
Klebsiella
Enterobacteria

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40
Q

S/S of Urosepsis

A

Malaise/fatigue
Chills/fever
Nausea/vomiting
Characteristic of cystitis
Dysuria, urgency, frequency
Costovertebral tenderness on the affected side
Elderly present with delirium
VS changes (fever, HR increase, BP decrease)

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41
Q

What color does Pyridium turn your urine?

A

reddish orange

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42
Q

Teach the pt on UTIs

A

Disease Process
Prevention of UTI
Medication use
Pain management
Follow-up appointments
Rest
Dietary Education and Fluid intake
What urine should look like

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43
Q

To Prevent Cytstitis

A

high water
front to back
avoid douches, bubble baths or sprays
urinate after intercourse

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44
Q

Prevention of CAUTI

A

Avoidance of unnecessary catheterization
Early removal of indwelling catheters
Follow aseptic technique for procedures
Handwashing before and after patient contact
Wear gloves for care of urinary catheters

45
Q

Antibiotics for UTIs

A

Nitrofurantoin, ampicillin, amoxicillin, cephalosporins, Fluoroquinolones

46
Q

Analgesic for UTIs

A

Phenazopyridine

47
Q

Antifungals for UTIs

A

Amphotericin or fluconazole

48
Q

Antibiotic Therapy is dependent on

A

urine culture

49
Q

Pyridium is used for

A

bladder spasms
and pain associated

50
Q

Nitrofurantoin (Macrodantin)

A

Treat and prevent UTIs
Given three or four times a day
Long-acting preparation (Macrobid) is taken twice daily

51
Q

Ampicillin, amoxicillin, cephalosporins

A

Treat uncomplicated (only bladder) UTI
broad range and low toxicity to kidneys
cheap

52
Q

Fluoroquinolones

A

Treat complicated UTIs
Example: ciprofloxacin (Cipro)

53
Q

Complicated UTIs are associated with

A

fevers, stones, sepsis, obstruction, catheters, AKI, CKD, renal transplant, diabetes, neurologic diseases
The structural or functional problem in the urinary tract exists

54
Q

Ciprofloxacin caution with

A

severe renal impairment
with food and glass of water

55
Q

Complicated UTIs lead to

A

renal injury

56
Q

Amphotericin or fluconazole

A

Flu = 1st line choice

57
Q

Amphotericin not given with

A

ns due to imcompatibility

58
Q

Glomerulonephritis Patho

A

Caused by strep (infection)/ Lupus (autoimmune) and inflammation of the glomeruli bilaterally

59
Q

Acute Glomerulonephritis

A

come suddenly and may be reversible

60
Q

Chronic Glomerulonephritis

A

slowly progressive and can lead to irreversible renal failure

61
Q

Risk Factors of GN

A

STREP
Kidney infections (HIV, HEP B AND C)
Nephrotoxic drugs
Immunocompromised system - SLE
Systemic disease HTN

62
Q

S/S of GN

A

General body edema (facial and neck 1st)
Decreased urine output (Retain)
Oliguria/hematuria/proteinuria
Hypertension
HIGH BUN/creatinine
History of group A strep* (sore throat)
- renal bx to confirm
Evidence of immune-mediated response

63
Q

Gn can ultimately lead to

A

heart failure
HTN
renal issues
respiratory distress
fluid accumulation

64
Q

Assess daily wt by

A

same time, day, clothes, and scale
I&O
abdominal girth or edema size

65
Q

Medications for GN

A

Antihypertensives
Diuretics
Corticosteroids
- PREDNISONE effective immunosuppression for some nephrotic syndrome

66
Q

Dietary for GN

A

LOW-Sodium/LOW to MODERATE-Protein/Fluid restriction
* if urine loss is high then more protein is recommended*

67
Q

Antibiotics should ONLY be given if

A

strep infection is present
full course of antibiotics

68
Q

Teaching of GN

A

Disease process
Medication
Follow-up appointment
Avoid infections
Rest
Severity

69
Q

Another way to remember GN S/S with mnemonic HAD STREP

A

Hypertension
ASO titer (+) –this is a test for STREP
Decreased GFR
Swelling in face/eyes
Tea-colored urine
Recent strep infection
Elevated BUN and Creatinine
Proteinuria

70
Q

Urolithiasis means

A

Kidney stones

71
Q

Risk Factors of Kidney Stones

A

More common in men
Average age at onset: 20–55 years
White
Family history of stone formation
Previous history (personal)
- infection, stasis, retention, immobility
Summer months (DEHYDRATION)

72
Q

Patho of Kidney Stones

A

Calcifications in the urinary system
Commonly referred to as kidney stones
Microscopic crystals in the urinary tract aggregate together causing a stone to occur

73
Q

S/S of kidney stones

A

PAIN sharp sudden and severe*
N/V
Urinalysis
+ RBC (shards)
blood in urine
UTI like symptoms

74
Q

High Uric Acid can cause

A

kidney stones

75
Q

Dx of Kidney stones

A

Ultrasound
CT
IVP
RENAL STONE ANALYSIS
RETROGRADE PYELOGRAM
CYSTOSCOPY
pH

76
Q

Medications of Kidney Stones

A

Narcotics and NSAIDS
Antiemetic
Alpha-adrenergic blockers help pass

77
Q

Labd of kidney stones

A

high BUN and Creatinine
UA
CBC

78
Q

Nurse MGMT of Kidney Stones

A

Vital signs – bp and p
Fluid management
I&O
Teaching
Strain urine to pass
Symptoms of infection/obstruction
Prevention

79
Q

What happens when you can not pass a stone?

A

ultrasound waves break up and easier to pass
-fluids
- avoid uric acid

80
Q

Uric Acid Foods to Avoid in Stone pt

A

mushrooms, shellfish, beets, oxylate, teas, chocolate preventions

81
Q

Goal of Renal Calculi care

A

Maintain free flow of urine with minimal hematuria
Report satisfactory pain relief
Verbalize understanding of disease process and measures to prevent recurrence

82
Q

What is the most common cause of Bladder CA

A

smoking

83
Q

S/S of Bladder CA

A

Painless hematuria
Urine cytology
Lab looking for tumor markers
Cystoscopy (ABnormal cells)
-if hematuria is present
Imaging

84
Q

Nursing Mgmt of Bladder CA

A

Vital signs
Medication
Chemo
Immunotherapy
Continuous bladder irrigation** (Murphy drip)**
I&O

85
Q

Murphy Drip is used for

A

Bladder CA
3 way
irrigation and drainage

86
Q

Superficial or low-grade bladder cancers
tx

A

Consist of excision or removal through fulguration or laser ablation

87
Q

Invasive bladder cancer

A

Radical cystectomy
Combined with neoadjuvant or adjuvant chemotherapy (before and after)

88
Q

Fulguration

A

procedure using heat to destroy abnormal cells

89
Q

Renal CA most likely will affect

A

males 50-70

90
Q

Renal CA PATHO

A

Usually found in the cortex or pelvis of the kidney

91
Q

S/S of Renal CA

A

Initially asymptomatic
Classic triad
Flank mass, flank pain, and hematuria
Weight loss
Hypertension
Fever
Anemia
feel with palpation

92
Q

Renal CA classic triad

A

Flank mass, flank pain, and hematuria

93
Q

Dx Renal CA

A

IVP? Depends on function
Ultrasound
CT/MRI
Urine cytology

94
Q

Tx of Renal CA

A

Biological immunotherapy or cytokinesis
Radical nephrectomy

95
Q

Nursing Mgmt Post-Op nephrectomy

A

Pain management
IV hydration
JP Drain
Post-op
Bleeding*****
Incision
Patency of tubes/catheters
I&O

96
Q

If a pt has low BP, they could have

A

internal bleeding

97
Q

Incontience

A

Involuntary or uncontrolled loss of urine in any amount

98
Q

Stress incontience

A

Sudden increase in intraabdominal pressure causes involuntary passage of urine =
Can occur during coughing, laughing, sneezing, or physical activities, such as heavy lifting, exercising
Leakage usually is in small amounts and may not be daily

99
Q

Urge incontinence:

A

Often referred to as overactive bladder
Occurs randomly when involuntary urination is preceded by urinary urgency

100
Q

Overflow:

A

Occurs when pressure of urine in overfull bladder overcomes sphincter control = post-op or tumor

101
Q

Functional:

A

Loss of urine resulting from cognitive, functional, or environmental factors- inability to get up (arthritis, dementia)

102
Q

Tx goal of incontinence

A

prevent or stop urinary leakage*

103
Q

Medications for Incontinence

A

Anticholinergic (reduce overactive)
Alpha-adrenergic blockers (increase resistance)
Tricyclic Antidepressants (sensory urgency low)
Hormone Therapy (lower irritation and increase host against UTIs)

104
Q

Lifestyle Modifications of Incontience

A

reduce caffeine intake, artificial sweeteners
Good bowel regimen
Weight reduction
Smoking cessation
Fluid modification
Skin CARE
SUPPORT
Bladder Kegels and scheduled bathroom

105
Q

Anticholinergic (OXYBUTIN)

A

Reduces overactive bladder contractions; improves storage capacity of bladder

106
Q

Alpha (Doxazosin and Tamulosin)

A

Reduce urethral sphincter resistance to urinary outflow

107
Q

Tricyclic antidepressant (Amitriptyline)

A

Reduce sensory urgency and burning pain

108
Q

Renal Trauma

A

Penetrating injury
-Stabbing
-Gunshot wound
-Objects piercing the abdominal wall
Blunt force trauma
-Compression of the abdominal wall and bladder
-Injuries to the renal system can range from -contusion or hematoma to a shattered kidney

109
Q

Renal Trauma occurs in males less than

A

30

Module 4 (MedSurg 2) (36 decks)

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