UTIs and Bladder Cancer Flashcards
Upper UTIs
pyelonephritis, renal abscess
Lower UTIs
Cystitis, Urethritis, Prostatitis
Classifications of UTIs
Uncomplicated vs Complicated, Community acquired vs Nosocomial
Contributing factors to UTI
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
Lower UTIs
primary cause is Ecoli, others include Klebisella, enterococcus, pseudomonas, proteus, staph, candida
UTI Clinical manifestations
Burning
* Frequency
* Urgency
* Nocturia
* Cloudy, foul-smelling urine
* Incontinence
* Enuresis
* Suprapubic/pelvic pain
* Hematuria
* Back/flank pain** more common w/ pyelo**
* Fever/chills*
Cystitis
inflammation of the bladder, organisms travel from urethra to bladder
Urethritis
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
Prostatitis
inflammation of the prostate, affects 12-15% of men, can be acute or chronic (Gram +/-, STDs)
Symptoms of Prostatitis
hesitancy, urgency, dysuria, difficulty initiating and terminating flow of urine, urethral discharge, tender and swollen prostate
Diagnostics for prostatitis
urinalysis, urine culture, PSA, US
Treatment for prostatitis
antibiotics for 4 weeks, 12 weeks if chronic
Lower UTIs in the Older adult
older women and men, same incidence
decreased estrogen, weakening of sphincters, decreased muscle tone, prostate enlargement
Most common symptom for older adult UTIs?
change in mental status
Diagnostic testing for lower UTIs
+ Hematuria, leukocytes, nitrites; Urine C+S, CT scan/ US
UTI meds
antibiotics (1-3 days uncomplicated, 7-10 complicated)
Urinary analgesic- Pyridium
Preventative measures for UTIs
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
Nursing interventions for UTIs
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
Pyelonephritis
Bacterial infection of kidney tissue
* usually, gram negative bacteria
* Can be acute or chronic
* Chronic pyelo»_space;> CKD or ESRD
* Causes kidney enlargement due to inflammation
* Pt. may develop urosepsis
* systemic infection»>septic shock & death
Symptoms of pyelonephritis
fever, chills, low back/ flank pain, CVA tenderness, nausea, vomiting, malaise, headache, painful urination
Diagnostics for pyelonephritis
Urinalysis
* WBC casts
* Increased bands (immature neutrophils)
* Hematuria may be present
* Urine Culture
* Blood Cultures may also be necessary
* Ultrasound
* CT Scan
* IV Pyelogram
Treatment for Pyelonephritis
fluoroquinolones, ceftriaxone, IV hydration
Nursing interventions for pyelonephritis
(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
Urinary retention
inability to empty bladder, caused by gen anesthesia, meds, obstruction, neurologic disorders
Neurogenic bladder
2 types- spastic (loss of motor control) and flaccid (loss of contractility)
Diagnostics of urinary retention
bladder scan, UA & culture, US/CT
Treatment of urinary retention
meds (dutasteride, finasteride, tadalafil, doxasozin, terazosin, tamsulosin), self cath, suprapubic cath
Nursing interventions for urinary retention
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)
CAUTI
catheter associated UTI, most commonly caught in hospitals, have to have a good rationale for why you are inserting the catheter
Preventing CAUTI
- 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
Renal calculi
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
Foods high in calcium oxalate
spinach, beans, rhubarb, beets, green peppers, eggplant, pecans, nuts, cocoa, chocolate, tea, blackberries, blueberries, raspberries, strawberries
Foods high in uric acid
shellfish, liver, chicken, bacon, turkey, veal, alcohol
symptoms of kidney stones
- Pain
- Severe»_space;> if lodged in ureter
- “renal colic“
- may radiate
- flank, groin, & upper outer quadrant of abdomen
- Men»_space;> testicular pain
- Nausea & vomiting
- CVA tenderness
- Hydronephrosis
- Stones ≤ ½ cm (5mm) usually pass through ureter- strain urine to obtain a passed stone
Diagnostics for kidney stones
urinalysis, stone analysis, US, KUB, IVP, CT
Interventional procedures for kidney stones
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
Nephrostomy tube care
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
Nephrostomy tube care
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
Bladder Cancer
- 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
Bladder cancer treatment
Trans-uretheral resection of bladder
* followed by intravesical administration of BCG (live mycobacterium)
* Complete cystectomy with urinary diversion
* Chemotherapy
* Intravenous
* Intravesical
* Radiation
Ileal conduit
- diverts urine to a new exit site
- s/p complete cystectomy
- ureter implanted in small section of
terminal ileum or sigmoid colon»_space;>
then exits via abdominal wall - creation of urinary stoma» ileostomy bag
Indiana pouch
s/p complete cystectomy
* Uses ileum or cecum to form “reservoir”
(pouch) for urine
* Urine collects in pouch, then
catheter inserted to remove urine
Cutaneous Ureterostomy
Ureters directed through abdominal wallm stoma created, more common for obstruction, 1 or 2 can be diverted
Urinary diversion nursing care
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»_space;> self-care
Kidney cancer
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
