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Med Surg > UTIs and Bladder Cancer > Flashcards

UTIs and Bladder Cancer Flashcards

1
Q

Upper UTIs

A

pyelonephritis, renal abscess

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2
Q

Lower UTIs

A

Cystitis, Urethritis, Prostatitis

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3
Q

Classifications of UTIs

A

Uncomplicated vs Complicated, Community acquired vs Nosocomial

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4
Q

Contributing factors to UTI

A

Female gender
Menopause
low estrogen + low
lactobacillus
Pregnancy
Intercourse
Diabetes
Neurologic disorders
associated w/ incomplete
emptying of bladder
Obstructions of urinary tract
Immunosuppression
Catheter insertion &
procedures

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5
Q

Lower UTIs

A

primary cause is Ecoli, others include Klebisella, enterococcus, pseudomonas, proteus, staph, candida

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6
Q

UTI Clinical manifestations

A

Burning
* Frequency
* Urgency
* Nocturia
* Cloudy, foul-smelling urine
* Incontinence
* Enuresis
* Suprapubic/pelvic pain
* Hematuria
* Back/flank pain** more common w/ pyelo**
* Fever/chills*

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7
Q

Cystitis

A

inflammation of the bladder, organisms travel from urethra to bladder

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8
Q

Urethritis

A

inflammation of the urethra, std is the most common cause, common in postmenopausal women (low estrogen levels), also candida

Treat the STD, treat the UTI

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9
Q

Prostatitis

A

inflammation of the prostate, affects 12-15% of men, can be acute or chronic (Gram +/-, STDs)

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10
Q

Symptoms of Prostatitis

A

hesitancy, urgency, dysuria, difficulty initiating and terminating flow of urine, urethral discharge, tender and swollen prostate

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11
Q

Diagnostics for prostatitis

A

urinalysis, urine culture, PSA, US

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12
Q

Treatment for prostatitis

A

antibiotics for 4 weeks, 12 weeks if chronic

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13
Q

Lower UTIs in the Older adult

A

older women and men, same incidence
decreased estrogen, weakening of sphincters, decreased muscle tone, prostate enlargement

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14
Q

Most common symptom for older adult UTIs?

A

change in mental status

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15
Q

Diagnostic testing for lower UTIs

A

+ Hematuria, leukocytes, nitrites; Urine C+S, CT scan/ US

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16
Q

UTI meds

A

antibiotics (1-3 days uncomplicated, 7-10 complicated)
Urinary analgesic- Pyridium

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17
Q

Preventative measures for UTIs

A

Regular bladder emptying
* Evacuate bowel regularly
* Cleanse perineum FRONT to BACK
* Shower vs. baths
* Drink adequate fluids
* Cranberry juice MAY reduce frequency of UTI’s
* inhibits attachment of organisms
* Avoid bladder irritants
* caffeine, alcohol, citrus juices, chocolate, spicy foods

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18
Q

Nursing interventions for UTIs

A

Handwashing !!!
* Avoid unnecessary catheter insertion
* Early removal of indwelling catheters…..BE PROACTIVE
* Aseptic technique w/ procedures
* Assist w/ patient hygiene
* Encourage preventive measures
* Answer call lights promptly
* Offer bathroom assistance & bedpan frequently
…..HOURLY ROUNDS

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19
Q

Pyelonephritis

A

Bacterial infection of kidney tissue
* usually, gram negative bacteria
* Can be acute or chronic
* Chronic pyelo&raquo_space;> CKD or ESRD
* Causes kidney enlargement due to inflammation
* Pt. may develop urosepsis
* systemic infection»>septic shock & death

20
Q

Symptoms of pyelonephritis

A

fever, chills, low back/ flank pain, CVA tenderness, nausea, vomiting, malaise, headache, painful urination

21
Q

Diagnostics for pyelonephritis

A

Urinalysis
* WBC casts
* Increased bands (immature neutrophils)
* Hematuria may be present
* Urine Culture
* Blood Cultures may also be necessary
* Ultrasound
* CT Scan
* IV Pyelogram

22
Q

Treatment for Pyelonephritis

A

fluoroquinolones, ceftriaxone, IV hydration

23
Q

Nursing interventions for pyelonephritis

A

(1) Administration of:
* Antibiotics
* Antipyretics
* Pain medications
* assess pain hourly
* IV fluids
(2) Encourage:
* increased oral fluids
* preventive measures
* follow-up urine testing
(3) Teach patient to watch for recurrent infection

24
Q

Urinary retention

A

inability to empty bladder, caused by gen anesthesia, meds, obstruction, neurologic disorders

25
Q

Neurogenic bladder

A

2 types- spastic (loss of motor control) and flaccid (loss of contractility)

26
Q

Diagnostics of urinary retention

A

bladder scan, UA & culture, US/CT

27
Q

Treatment of urinary retention

A

meds (dutasteride, finasteride, tadalafil, doxasozin, terazosin, tamsulosin), self cath, suprapubic cath

28
Q

Nursing interventions for urinary retention

A

Identify medications that may cause retention
* Promote urinary elimination
* comfortable & accessible voiding
* Encourage scheduled voiding
* Warm compress to relax sphincters
* Trigger techniques
* running water
* hands in warm water
* drink hot beverages (caffeine free)

29
Q

CAUTI

A

catheter associated UTI, most commonly caught in hospitals, have to have a good rationale for why you are inserting the catheter

30
Q

Preventing CAUTI

A
  • Use of closed system
  • Anchor the catheter
  • Always clamp tubing if bag raised above level bladder
  • Avoid routine irrigation of catheter
  • Soap & water cleansing of perineal area BID
  • Or use 2% chlorhexidine wipes
  • Adequate fluid intake
  • Removal of catheter ASAP
  • Empty collection bag every 8 hours
31
Q

Renal calculi

A

stones in urinary tract & kidneys, 30-50, 2x more than women

caused by infection, dehydration, urinary stasis, immobility, increased blood calcium, vit d intox, excessive milk intake

32
Q

Foods high in calcium oxalate

A

spinach, beans, rhubarb, beets, green peppers, eggplant, pecans, nuts, cocoa, chocolate, tea, blackberries, blueberries, raspberries, strawberries

33
Q

Foods high in uric acid

A

shellfish, liver, chicken, bacon, turkey, veal, alcohol

34
Q

symptoms of kidney stones

A
  • Pain
  • Severe&raquo_space;> if lodged in ureter
  • “renal colic“
  • may radiate
  • flank, groin, & upper outer quadrant of abdomen
  • Men&raquo_space;> testicular pain
  • Nausea & vomiting
  • CVA tenderness
  • Hydronephrosis
  • Stones ≤ ½ cm (5mm) usually pass through ureter- strain urine to obtain a passed stone
35
Q

Diagnostics for kidney stones

A

urinalysis, stone analysis, US, KUB, IVP, CT

36
Q

Interventional procedures for kidney stones

A

Ureteroscopy
* Laser device to fragment stone lodged in ureter
* Temporary stent may be placed 48-72 hours
* Lithotripsy
* extracorpeal shock wave lithotripsy (ESWL)
* for stone lodged in calyx of kidney
* Percutaneous stone removal
* nephrolithotomy to remove stone
* nephrostomy tube may be left in place
* to relieve hydronephrosis & drain urine

37
Q

Nephrostomy tube care

A

Usually place under fluoroscopy
Local anesthesia for insertion
Irrigate (as per order) 5ml NSS
Do not aspirate
Allow to drain by gravity
Hematuria expected for 6 hours (in small amounts)
Assess for:
bleeding, infection, pain, tube placement, urine output

37
Q

Nephrostomy tube care

A

Usually place under fluoroscopy
Local anesthesia for insertion
Irrigate (as per order) 5ml NSS
Do not aspirate
Allow to drain by gravity
Hematuria expected for 6 hours (in small amounts)
Assess for:
bleeding, infection, pain, tube placement, urine output

38
Q

Bladder Cancer

A
  • common > 55 yr
  • 3x more common in men
  • associated w/ smoking
  • especially in men
  • can metastasize
  • Most common symptom:
  • painless hematuria
  • pain is more indicative of mets
39
Q

Bladder cancer treatment

A

Trans-uretheral resection of bladder
* followed by intravesical administration of BCG (live mycobacterium)
* Complete cystectomy with urinary diversion
* Chemotherapy
* Intravenous
* Intravesical
* Radiation

40
Q

Ileal conduit

A
  • diverts urine to a new exit site
  • s/p complete cystectomy
  • ureter implanted in small section of
    terminal ileum or sigmoid colon&raquo_space;>
    then exits via abdominal wall
  • creation of urinary stoma» ileostomy bag
41
Q

Indiana pouch

A

s/p complete cystectomy
* Uses ileum or cecum to form “reservoir”
(pouch) for urine
* Urine collects in pouch, then
catheter inserted to remove urine

42
Q

Cutaneous Ureterostomy

A

Ureters directed through abdominal wallm stoma created, more common for obstruction, 1 or 2 can be diverted

43
Q

Urinary diversion nursing care

A

measure of UOP, assess for hematuria and infection

Stoma care- assessment of stoma
* assessment of surrounding skin
* proper fit of appliance
* change every 3-7 days
* proper drainage
* encourage adequate
* oral fluids
* patient teaching&raquo_space;> self-care

44
Q

Kidney cancer

A

Usually diagnosed early
* prior to metastasis
Symptoms:
* hematuria
* one-sided back pain
* weight loss
Treatment:
* Partial nephrectomy
* tumor < 3 inches
* Total nephrectomy
* Chemo
* Immunotherapy
* Interleukin-2

Med Surg (15 decks)

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