Week 3 Bladder and Kidney Disorders Flashcards
4 Layers of Tissue of Bladder
Adeventia- Outer Layer
Detrusor Muscle- Smooth Muscle
Submucosal CT- Interface of inner most layer
Transitional Cell Epithelium- Impermeable to water- Innermost layer
Polysaccharides help to maintain biological function to maintain collagen and elastin fibers to retain moisture
Glycosaminoglycan
Involuntarily smooth muscle associated with internal sphincter
Bladder neck
Lower UTIs include
Cystitis
Prostatitis
Urethritis
Upper UTIs include
Pyelonephritis- acute and chronic
Interstitial Nephritis
Renal abscess and Perirenal abscess
Uncomplicated UTI
Community Acquired
Complicated UTi
Hospital Acquired
Renal Abcess
Caused by UTI of bladder and spreads to bladder
Perineal Abcess
Abscess around one or both kidneys secondary to UTI complications
Cystitis
Inflammation of urinary bladder
Factors Contributing UTI
GAG function
Ureterovesical Reflux
Ureterovesical Reflux
Uropathogenic bacteria
Shorter Urethra in woman
RF- sex, moisture, genetics, hygiene, procedures, pregnancy, decreased prostatic fluid
E. Coli, Klebsialla Pneumoniae
Uropathogenic bacteria that are gram -
Efflux/ Anteograde
Downward movement of urine
Reflux or Retrograde
Upward movement of urine
Most common cause of sepsis
UTI
Indicator of UTI for older adults is
Acute Confusion
Early symptoms include burning, urgency, and fever
Some may develop incontinence and delirium
Myogenic
Over distention of bladder
Neurogenic
Decreased bladder tone
Most common cause of UTIs for men?
Chronic Bacterial Prostatitis
Also males have decrease prostatic fluids
HOUDINI
Hematuria
Obstruction
Urology surgery
Decubitus Ulcer
I Input and output
N DNR
I immobility
UTI Assessment
Pain, burning, urination
Half Asymptomatic
Association with sexual practices
Assess urine and cultures and other tests
Nursing Diagnosis UTI
Acute Pain
Deficient Knowledge
Impaired Urinary Elimination
Urinary Retention
Risk for impaired skin integrity
Ineffective renal perfusion
Nursing Planning UTI
Relief of pain
Increase knowledge
Urine culture
Pt meet CAUTI criteria
Nursing Process UTI Implementing
Treat with antibiotics
Anti fungal
Pyridium- analgesic- orange urine
Routine toileting
I and Os
Catheter Care
Interventions UTI
Wipe front to back
Medications
Application of heat
Avoidance of UTI irritants
Frequent voiding
Pt Education
Complications of UTI
Nocturia
Urinary Frequency
Sepsis
Renal Failure
Nosocomial Infection
Rx to medication Tx
Sepsis screening completed when?
Blood work is resulted
What qualifies Sepsis?
Positive SIRS Have one or more signs of infection
If positive SIRS and infections Pt is septic
Severe Sepsis
One or more signs of organ dysfunction
Organ Dysfunction Vitals
BP lower than 90
HR increase
RR above 22
T above 38 C
SPo2 less than 90
When is Septic Shock determined?
Pt experiences refractory hypotension after fluid resuscitations interventions
SBP drops below 90 after 30ml fluid Bolus
Watch for overload of fluids
SIRS
temp
HR
WBC
RR
qSOFA
RR
Systolic
GCS
Urinary Incontinence
Not a normal consequence of aging
Underdiagnosed or underreported problem that can have significant impact on life and decrease independence and may lead to compromise of upper urinary system
Stress Incontinence
Physical activity that increases intraabdominal pressure, stresses bladder
Reflex Incontinence
Urine leaks upon bladder contraction without warning
Urge Incontinence
Loss of voluntary control. Sudden urges to urinate
Overflow Incont.
Involuntarily release of urine from a distended overfull bladder
Functional Incont.
Aware of need to urinate but physically unable or mentally unable to get to the bathroom
Disabling medical condition prevents ability to get to the bathroom (arthritis)
Iatrogenic Incontinence
Drug induced
Usually due to muscle relaxants and drugs that affect the nervous system
ex: Sedatives, hypnotics, ACE inhibitors, Loops, NSAIDs, Ca channel blockers
Nursing Dx for Incontinence Issues
Urinary Incontinence by
Functional
Overflow
Reflex
Stress
Urge
Toileting
Situational Low Self Esteem
Pt Education of Urinary Incontinence
Not inevitable and is treatable
Management takes time
Develop and use voiding log or diary
Behavioral Interventions
Medication education
Strategies for promoting continence
Common Drug for Urinary Incontinence is
Oxybutynin
What do anticholinergics do?
Decreases activity in muscles, decrease bodily fluid production, and stabilizes mood.
Acts as anti spasmodic. Focus on detrusor muscle.
Muscarinic Antagonist
Blocks activity of the muscarinic acetylcholine receptors
Ex
Derifenacin
Flavoxate
Solifenacin
Tolterodine
Trospium
Anticholinergic Toxicity
Overdose produces exaggerated effects.
Increases sympathetic effects
Symptoms
Hyperthermia
Mydriasis
Delirium
Seizures, coma, and respiratory arrrest
Anticholinergic Overdose Tx
Activated Charcoal
Use physostigmine salicylate (parasympathetic alkaloid)
Via IV slowly
Diazepam used to tx and prevent seizures
Ice bags, cooling blankets, tepid sponges
Reduces fever
What is the most common cause of urinary retention?
Lack of nerve innervation
Also called neurogenic bladder
Other causes diabetes, enlarged prostate, pregnancy, neurological disorders such multiple sclerosis or Parkinson’s
Pt may describe a sensation of bladder fullness or incomplete bladder emptying and may experience leakage
What medications causes urinary retention?
Amitriptyline, Nortriptyline, or trimipramine
Amrytripline inhibits reuptake of
Noreepinephrine and serotonin
Nortriptyline inhibits reuptake of
Noreepinephrine
Trimipramine inhibits reuptake of
norepinephrine and serotonin with anticholinergic properties
Acute Care for Urinary Retention
Straight Cath or In N Out Cath
Drains bladder completely
Give bladder massage while draining
Done with sterile technique
Foley Catheterization
Send home with leg
Educated proper use, draining, and positioning
Follow up with urology
Tx of Urinary Retention
Cholinergic Agonist
Bethanechol
Sympathomimetic agent that acts cholinergic receptors in the urinary and GI tracts to increase muscle tone . Increased tone in detrusor muscle in bladder and allows emptying
Muscarinic Agonist
Cholinergic
Absorbs GI tract
Does not cross BBB
Crosses placenta and breast milk
Bethanecol
Gradual increase the medication
10-50 mg PO 3-4 times per day
Take 1 hour before meals or 2 hours after meals
Pt should avoid 1hr after administration
Asses BP, EKG, sweating and flushing, ABD pain, nausea or vomiting
Antidote is atropine . Blocks the action of acetylcholine thus blocks parasympathetic actions
Chlonergic Agonist does what?
Increases Acetylcholine
Pt over doses shows extreme parasympathetic actions
Emergency Tx of Bethanechol
Atropine is antidote to organophosphate poisoning and this includes insecticides
What causes the inactivation of of actylcholinerase?
Sarin gas and insecticides
Causes overload and causes excessive stimulation of muscarinic and nicotine receptors
Excessive secretions
What works on nicotinic synapses?
Pralidoxime
Medications to treat Urinary Retention include?
Alpha 1 blockers . Promote relaxation of smooth muscle
Most end in -osin
-OSINS
Assists with dilating urethra and ureters to assist with urination.
Phosphodiesterase -5 Enzyme
Contraindicated with nitroglycerin and if given may drop the BP with too much vasodilation
Initially treated for HTN
What is pyelonephritis?
Inflammation of the renal pelvis
Classic symptoms include
Chills and fever
Leukocytosis- Elevated WBC in serum
Bacteruria
Pyuria
Flank Tenderness
Diagnostic Studies for Pyelonephritis
CBC and Chem Panel
Urinalysis- Protein, RBCs
Urine Culture
Urine Dipstick
Nitrates and Leukocytes
Ultrasound- Fluid(Hydronephrosis), Kidney stone
CT- Fluid, kidney stone, abscess, tumor
Swelling of kidney due to a build up of urine. Happens when urine can’t drain out from the kidney to the bladder from blockage or obstruction
Hydronephrosis
Stages of Hydronephrosis
Grade 1- Grade V
Higher the grade, more urine reflux.
Tx of Pyelonephritis
Same as UTIs
Take NSAIDs
Toradol, Ibuprofen for kidney related pain
Encourage Fluid intake
Assess Pt for improvement and watch for urosepsis
Recurrent Pyelonephritis may be due to CKD
Stone formation in kidney
Nephrolithiasis
Stone formation in bladder or urinary tract
Urolithiasis
Kidney Stones
Hard deposits of minerals and acid salts that accumulate in concentrated urine
Formation depends on: substances in urine, fluid amount, presence of infection, mobility
Instruct Pt to void into strainer
Tx of Renal Calculi
Encourage fluid intake
Pain under control
Tamsulosin- Alpha 1 Blocker, also used for BPH
Change Diet
Strain Urine
May need to give antiemetic
Renal Calculi Types
Calcium
Uric Acid
Struvite
Cystine
Oxalates
Potato chips, peanuts, beets, and spinach
Purines
Animal Proteins
Struvite
More common in women with UTI
Lead to obstruction and can be large
Cystine
Rare, due to genetics and leads to cytinuria
Risk Factors for Renal Calculi include :
Obesity, dehydration, gastric bypass, diest high in protein, glucose, and salt, IBS, and taking direutics
3 common sites for Renal Stones
Ureteropelvic Junction
Ureteral Segment
Ureterovesical Junction
Physical Removal of stones in ureter near the bladder
Ureteroscopy
Extrocorpeal Shockwave Therapy
Lithotripsy
Use of electromagnetic waves to break up stone
Percutaneous Nephrolithotomy
Device used to penetrate multiple layers of tissue to reach kidney and remove stone
Ureteroscope
Used to obtain kidney stone all depends on the Pt and size of the stone
Pt Education
S/S to report
Follow Up care
Urine Ph formation
Measures to prevent
Importance of fluid intake
Medication education as needed
Dietary Education
Restrict foods that breakdown into salts that formed the salts
Calcium Oxlate
Proteins, spinach, beets, and chocolate
Calcium Phosphate Stones
Dairy, broccoli, sardines, and salmon
Struvite Stones
Bacteria, Ammonia, alkaline environment
Uric Acid
Seafood, bacon, turkey, veal, and liver
Cystine Stones
Genetics
Pork, poultry, dairy, garlic, onions, Brussel sprouts
