Urology Diseases Flashcards
UTI is most commonly caused by
E coli bc grows in feces
- POSSIBLE fungal or parasitic
UTI
Bacteria enters the sterile bladder causing inflammation
Cystitis vs pyelonephritis vs urosepsis
Cystitis
inflammation of bladder
Pyelonephritis
inflamed kidneys parenchyma and collecting system
Urosepsis
sepsis caused by UTI
-emergent
- painful urination to abdominal pain and fever
What is the most common hospital-acquired infection and preventable?
CAUTI
most underrecognized and undertreated
Who gets a UTI more in gender?
females
Lower UTI included
Urethritis
Cystitis
Upper UTI included
Pyelonephritis
UTI Risk Factors
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
Are there usually manifestations in Lower UTI?
no
If toxins are occluding the urethra, the kidneys do what to the BP and erthythopoetin?
BP high
Fever
Erythro low along with RBCs
K high
S/S of Urethritis
Pain/burning/difficult urination (Dysuria)
Frequency
Urgency
Males: clear mucous-like discharge (STI)
Females: lower abdominal discomfort
Nocturia
Frequency is
voiding more than 2 hours
more than 8 times in 24 hours
S/S of Cystitis
Urethritis symptoms) PLUS +
Bladder irritability
Hesitancy
Suprapubic pain
Incontinence (elderly)
nocturnal enuresis (while sleeping)
Hesitancy
difficulty starting a urine stream; delay between initiation of urination and beginning of flow of urine
Dx Studies for Lower UTIs
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)
What shows up as positive in a UA for lower UTIs?
+ Nitrites (bacteria)
+ White Blood Cells (WBCs)
+ Leukocyte esterase
- not filtered
Uncomplicated UTIs
short term 3 days antibiotic
Urine Culture needs to be taken
mid-stream in a clean catch washing the penis with alcohol in between
finish in the cup
Medications/Preventions for UTIs
antibiotic
NSAIDs and pain analgesics
Cranberry juice with low sugar
Increase fluids
Vitamin C
help with bladder spasms (Pyridium)
Complicated UTIs
longer tx 7-14 days
UA and culture need to be done before
antibiotics are given
Systemic effects usually take place in what UTI
pyelonephritis
BP temp
Upper Tract includes
Renal parenchyma, pelvis, and ureters
Typically causes fever, chills, flank pain
Pyelonephritis: inflammation of renal parenchyma and collecting system
Parenchyma
outermost part of the kidney and renal medulla
Renal pelvis
center of kidneys
Pyelonephritis can lead to
kidney injury
The UTIs work
backward up the tubes from the lower to the upper
A preexisting factor can be present such as
vesicoureteral reflux:
Obstruction from Benign Prostatic Hyperplasia
Stricture
Urinary stone
CAUTI
Recurring acute episodes of Upper UTIs can lead to
scarred, poorly functioning kidney and chronic pyelonephritis
ACUTE pyelonephritis often starts in the
renal medulla and spreads through cortex
pregnancy
S/S of Pyelonephritis
Fever/Chills
Nausea/Vomiting
Fatigue/Malaise
Flank pain/Pain at costovertebral angle
S/S Lower (pain when urine, urgency and frequency)
Pyelonephritis classic sign in elderly
confusion
Dx/ Assess of Pyelonephritis
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)
Pyelonephritis can lead to what quickly
urosepsis
Pyelonephritis Nursing Care
Antibiotics
possible hospitalization
fluid intake increase
monitor urosepsis (VS)
promote prevention techniques like good hygiene
Urosepsis has both
bacteriuria
bacteremia
Frequent Causes of Urosepsis
Escherichia coli
Proteus
Klebsiella
Enterobacteria
S/S of Urosepsis
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)
What color does Pyridium turn your urine?
reddish orange
Teach the pt on UTIs
Disease Process
Prevention of UTI
Medication use
Pain management
Follow-up appointments
Rest
Dietary Education and Fluid intake
What urine should look like
To Prevent Cytstitis
high water
front to back
avoid douches, bubble baths or sprays
urinate after intercourse
Prevention of CAUTI
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
Antibiotics for UTIs
Nitrofurantoin, ampicillin, amoxicillin, cephalosporins, Fluoroquinolones
Analgesic for UTIs
Phenazopyridine
Antifungals for UTIs
Amphotericin or fluconazole
Antibiotic Therapy is dependent on
urine culture
Pyridium is used for
bladder spasms
and pain associated
Nitrofurantoin (Macrodantin)
Treat and prevent UTIs
Given three or four times a day
Long-acting preparation (Macrobid) is taken twice daily
Ampicillin, amoxicillin, cephalosporins
Treat uncomplicated (only bladder) UTI
broad range and low toxicity to kidneys
cheap
Fluoroquinolones
Treat complicated UTIs
Example: ciprofloxacin (Cipro)
Complicated UTIs are associated with
fevers, stones, sepsis, obstruction, catheters, AKI, CKD, renal transplant, diabetes, neurologic diseases
The structural or functional problem in the urinary tract exists
Ciprofloxacin caution with
severe renal impairment
with food and glass of water
Complicated UTIs lead to
renal injury
Amphotericin or fluconazole
Flu = 1st line choice
Amphotericin not given with
ns due to imcompatibility
Glomerulonephritis Patho
Caused by strep (infection)/ Lupus (autoimmune) and inflammation of the glomeruli bilaterally
Acute Glomerulonephritis
come suddenly and may be reversible
Chronic Glomerulonephritis
slowly progressive and can lead to irreversible renal failure
Risk Factors of GN
STREP
Kidney infections (HIV, HEP B AND C)
Nephrotoxic drugs
Immunocompromised system - SLE
Systemic disease HTN
S/S of GN
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
Gn can ultimately lead to
heart failure
HTN
renal issues
respiratory distress
fluid accumulation
Assess daily wt by
same time, day, clothes, and scale
I&O
abdominal girth or edema size
Medications for GN
Antihypertensives
Diuretics
Corticosteroids
- PREDNISONE effective immunosuppression for some nephrotic syndrome
Dietary for GN
LOW-Sodium/LOW to MODERATE-Protein/Fluid restriction
* if urine loss is high then more protein is recommended*
Antibiotics should ONLY be given if
strep infection is present
full course of antibiotics
Teaching of GN
Disease process
Medication
Follow-up appointment
Avoid infections
Rest
Severity
Another way to remember GN S/S with mnemonic HAD STREP
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
Urolithiasis means
Kidney stones
Risk Factors of Kidney Stones
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)
Patho of Kidney Stones
Calcifications in the urinary system
Commonly referred to as kidney stones
Microscopic crystals in the urinary tract aggregate together causing a stone to occur
S/S of kidney stones
PAIN sharp sudden and severe*
N/V
Urinalysis
+ RBC (shards)
blood in urine
UTI like symptoms
High Uric Acid can cause
kidney stones
Dx of Kidney stones
Ultrasound
CT
IVP
RENAL STONE ANALYSIS
RETROGRADE PYELOGRAM
CYSTOSCOPY
pH
Medications of Kidney Stones
Narcotics and NSAIDS
Antiemetic
Alpha-adrenergic blockers help pass
Labd of kidney stones
high BUN and Creatinine
UA
CBC
Nurse MGMT of Kidney Stones
Vital signs – bp and p
Fluid management
I&O
Teaching
Strain urine to pass
Symptoms of infection/obstruction
Prevention
What happens when you can not pass a stone?
ultrasound waves break up and easier to pass
-fluids
- avoid uric acid
Uric Acid Foods to Avoid in Stone pt
mushrooms, shellfish, beets, oxylate, teas, chocolate preventions
Goal of Renal Calculi care
Maintain free flow of urine with minimal hematuria
Report satisfactory pain relief
Verbalize understanding of disease process and measures to prevent recurrence
What is the most common cause of Bladder CA
smoking
S/S of Bladder CA
Painless hematuria
Urine cytology
Lab looking for tumor markers
Cystoscopy (ABnormal cells)
-if hematuria is present
Imaging
Nursing Mgmt of Bladder CA
Vital signs
Medication
Chemo
Immunotherapy
Continuous bladder irrigation** (Murphy drip)**
I&O
Murphy Drip is used for
Bladder CA
3 way
irrigation and drainage
Superficial or low-grade bladder cancers
tx
Consist of excision or removal through fulguration or laser ablation
Invasive bladder cancer
Radical cystectomy
Combined with neoadjuvant or adjuvant chemotherapy (before and after)
Fulguration
procedure using heat to destroy abnormal cells
Renal CA most likely will affect
males 50-70
Renal CA PATHO
Usually found in the cortex or pelvis of the kidney
S/S of Renal CA
Initially asymptomatic
Classic triad
Flank mass, flank pain, and hematuria
Weight loss
Hypertension
Fever
Anemia
feel with palpation
Renal CA classic triad
Flank mass, flank pain, and hematuria
Dx Renal CA
IVP? Depends on function
Ultrasound
CT/MRI
Urine cytology
Tx of Renal CA
Biological immunotherapy or cytokinesis
Radical nephrectomy
Nursing Mgmt Post-Op nephrectomy
Pain management
IV hydration
JP Drain
Post-op
Bleeding*****
Incision
Patency of tubes/catheters
I&O
If a pt has low BP, they could have
internal bleeding
Incontience
Involuntary or uncontrolled loss of urine in any amount
Stress incontience
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
Urge incontinence:
Often referred to as overactive bladder
Occurs randomly when involuntary urination is preceded by urinary urgency
Overflow:
Occurs when pressure of urine in overfull bladder overcomes sphincter control = post-op or tumor
Functional:
Loss of urine resulting from cognitive, functional, or environmental factors- inability to get up (arthritis, dementia)
Tx goal of incontinence
prevent or stop urinary leakage*
Medications for Incontinence
Anticholinergic (reduce overactive)
Alpha-adrenergic blockers (increase resistance)
Tricyclic Antidepressants (sensory urgency low)
Hormone Therapy (lower irritation and increase host against UTIs)
Lifestyle Modifications of Incontience
reduce caffeine intake, artificial sweeteners
Good bowel regimen
Weight reduction
Smoking cessation
Fluid modification
Skin CARE
SUPPORT
Bladder Kegels and scheduled bathroom
Anticholinergic (OXYBUTIN)
Reduces overactive bladder contractions; improves storage capacity of bladder
Alpha (Doxazosin and Tamulosin)
Reduce urethral sphincter resistance to urinary outflow
Tricyclic antidepressant (Amitriptyline)
Reduce sensory urgency and burning pain
Renal Trauma
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
Renal Trauma occurs in males less than
30
