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Med-Surg Ch 27
Urinary Disorders
| Question | Answer |
|---|---|
| UTI Types | Urethra, Cystitis, Prostatitis, Pyelonephritis. |
| Risk Factors of UTI | Vesicoureteral reflux, Obstruction, Calculi, Chronic diseases (DM), Urine characteristics, Gender, Age, Sexual activity, Use of antibiotics, Instrumentation, Genetics, Pregnancy, Hygiene. |
| Cystitis | Inflammation of bladder, Infectious vs. non-infectious, Bacteriuria, Colonization, Seen with elderly, Bacteria /s symptoms. |
| Cystitis Etiology | Pathogen and host, Escherichia coli, Staphylococcus saprophyticus, Klebisiella pneumonia, Proteus and Enterobacter species, Fungal (Candida), Viral and parasitic (trigamonis), Non-infectious (Radiation, Immunologic responses). |
| Cystitis Manifestations | Frequency, Urgency, Hesitancy, Dysuria (pain), Pyuria (foul color/odor), Hematuria (blood), Nocturia, Elderly (Symptoms may be vague, Increased mental confusion, Sudden onset of incontinence, Fever, tachycardia, hypotension, Loss of appetite, nocturia). |
| Pyelonephritis Causes | Defect, Obstruction, Reflux, Pregnancy Spinal cord injuries, Placement of urinary catheter |
| Pyelonephritis Organisms | 85% of cases is E.coli, Proteus, or Klebsiella |
| Pyelonephritis Complications | Tissue inflammation=scar tissue (fibrosis), Tubular cell necrosis, Abscess |
| Pyelonephritis Manifestations | Fever, Chills, Flank pain (Tender costal vertebral angle), N/V, diarrhea, Malaise, fatigue, symptoms of cystitis |
| Pyelonephritis Labs | Urinalysis, Midstream urine sample, Culture, Sensitivity, WBC with differential, After treatment follow-up UA 7-14 d |
| Pyelonephritis Other Diagnostics | IVP, Voiding cystourethrogram, Cystoscopy, Manual pelvic or prostate examination |
| Teach Prevention of Pyelonephritis | Drink 2-3 L water/day, avoid sugar-filled drinks, Cleanse perineal area daily, Wipe front to back, Avoid bubble baths, nylon underwear, sprays, douche, Wear loose fitting clothing, Empty bladder regularly |
| Pyelonephritis Antimicrobial Drug Therapy | Sulfonamides: Bactrim, photosensitivity, take ALL. Quinolones: Cipro, Levaquin, must be 18+ effects growth, monitor for dysrhythmias, no milk or antacids. Penicillins: Amoxil or Augmentin, watery diarrhea. Cephalosporins: Duricef, severe diarrhea |
| Pyelonephritis Antiseptic Drug Therapy | Nitrofurantion (Macrodantin), 6-8 glass of water/day, brown urine |
| Pyelonephritis Bladder Analgesic Drug Therapy | Phenazopyridine (Pyridium), orange-red urine |
| Pyelonephritis Antispasmodic Drug Therapy | Hyoscyamine (Anaspaz), Vision changes, dizziness, difficulty passing urine, fast HR |
| Other Therapies for Pyelonephritis | Cranberry juice, avoid caffeine, carbonated beverages, tomato products, increase fluid intake (if possible), Sitz bath, heating pads, I/O, Strict aseptic technique, Maintain closed urinary drainage system, Perineal care |
| Surgical Therapy for Pyelonephritis | Cystoscopy with uretheral stent placement (Monitor I/O, Don’t pull the string!). Ureteroplasty (Repair of ureter, Structure abnormalities, Strictures) |
| Urolithiasis | stones in urinary tract, more common in WHITE MEN, young to middle adulthood |
| Urolithiasis Risk Factors | Personal/family hx, Metabolic disorders, Stasis/Retention, Immobility, Dehydration |
| Urolithiasis Manifestations | Excruciating pain-renal colic, Flank pain, Sudden and unbearable, Nausea, vomiting, Pallor & Diaphoresis, Frequency and dysuria, Oliguria or anuia |
| Urolithiasis Obstruction | Requires prompt recognition and treatment, permanent damage can occur in <48h-weeks; > pressure = < GFR = renal failure |
| Urolithiasis Obstruction Can Lead to | Hydronephrosis (Distention of renal pelvis) or Hydroureter (Distention of ureter, Unrelieved=damage, function, Infection) |
| Urolithiasis Diagnostic Test | UA, (Hemautria, WBC, bacteria, Increase turbidity, Crystals, pH), KUB, CT scan, Renal ultrasonography, Cystoscopy |
| Urolithiasis Interventions | Promote stone passage & hydration, labs, avoid over/under hydration, look at diet, strain all urine |
| Urolithiasis Drug therapy | Morphine, Tordal or Indomethacin (NSAIDs), tamsulosin (Flomax) |
| Urolithiasis Lithotripsy | Extracorporeal shock wave lithotripsy, Moderate sedation, Monitor cardiac rhythm, Monitor for bruising, Hemorrhage, UO, may have Foley catheter, Strain urine |
| Urolithiasis Removal of Stones | Ureteroscopy (Laser beams used, No soft tissue damage), Percutaneous nephrolithotomy (Small incision, stone fragmented by laser/transducer, Nephrostomy tube, Monitor bleeding , pneumothorax, and infection) |
| Urolithiasis Open Surgical Procedures | Ureterlithotomy, Pyelolithotomy, Nephrolitotomy (into kidney) |
| Nephrolitotomy | Large flank and abdominal incision, May place tubes and drains (Penrose, Foley cath), Monitor effects of anesthesia, bleeding, Maintain hydration, prevention of infection, Strain all urine, Teach prevent of future stones |
| Urothelial Cancer | Malignant tumors of urinary tract, 90% occur in bladder, Most common after age of 60, Men more than women, White men more than Black men, Multifocal, Highly invasive, Untreated leads to liver, lung, bone |
| Urothelial Cancer Risk Factors | tobacco use, Occupational (Hair dressing chemicals, Rubber, Paint, Electrical cable, Work in textile industries), Schistosoma heamatobium (Egypt/Sundan) rresh water snail than can invade |
| Urothelial Cancer Manifestations | painless hematuria, Symptoms of UTI, Obstruction |
| Urothelial Cancer Diagnostics | UA-hematuria, Cystoscopy with bladder washings or biopsy, CT scan, MRI |
| Urothelial Cancer Interventions | Removal of tumor for dx and staging; Bacille Calmette-Guerin (BCG), in bladder, Inflammatory reaction to reduce/eliminate tumor; Chemotherapy, in bladder, systemic for metastases; Radiation, Pallitative treatment, Implanted seeds in bladder |
| Urothelial Cancer Surgical Management | Partial or Complete Cystectomy, Invasive tumors; Urinary Diversion will result, Ileal conduit, Cutaneous urostomy, Continent pouch/reservoir (Kock pouch) |
| Bladder Trauma | Penetrating or blunt injury, Stabbing, Gunshot, Fx of pelvis, Sexual assault, Seat belt injur, Requires surgical intervention |
| Urinary Retention | Incomplete emptying of the bladder, Mechanical obstruction or Functional problem, BPH (benign prostetic hyprofetophy) |
| Benign Prostetic Hyprohetophy | Acute inflammation, Scarring /strictures, Bladder calculi, Surgery, Meds: anticholinergics, those with anticholinergic side effects, and antihistamines, Voluntary urinary retention, Constipation |
| Urinary Retention Manifestations | unable to completely empty bladder, Overflow voiding (25-30 ml urine eliminated at frequent intervals), Incontinence, Untreated, can progress to hydronephrosis and acute renal failure |
| Nursing Interventions for Impaired Urinary Elimination | Promote voiding and normal position, Provide privacy, Bathroom rounds, May catheterize to relieve, If male with BPH, use coude, Drain urine in 500ml increments and clamp catheter for 5 minutes to prevent vasovagal response (drop BP, syncopy, pass out) |
| Neurogenic Bladder | Disruption of the nervous system of the bladder that controls bladder filing, perception of fullness, need to void, and emptying, Spastic bladder dysfunction, Flaccid bladder dysfunction |
| Neurogenic Bladder Medications: Cholinergic Drugs | Bethanechol chloride (Urocholine): Stimulates detrusor muscle contraction promoting emptying in flaccid neurogenic bladder, Use in combination with bladder training, Post-op and Postpartum urinary retention, Atropine is antidote, Slow position changes |
| Neurogenic Bladder Medications Anticholingerics/Antispasmodics | Oxybutynin (Ditropan) and Tolterodine (Detrol): Causes bladder muscle relaxation/suppress urge to void, Caution use with glaucoma, SE: Dry mouth, Constipation, Urinary retention, dysrhymias |
| Neurogenic Bladder Treatment | Nutrition; Bladder Training, Measures to stimulate reflex voiding, trigger points, Crede’s method (applying pressure to the suprapubic region with the fingers of one or both hands), Clean intermittent self-catheterization every 3-4 hours |
| Urinary Incontinence | Involuntary loss of urine, NOT a normal of aging |
| Forms of Urinary Incontinence | Stress, Urge, Overflow, Functional, Mixed |
| Stress Incontinence | Increased abdominal pressure; <leakage by Diary, Kegal exercises, Nutritional (avoid things irritating bladder), Vaginal cone therapy(weights), Surgical |
| Stress Incontinence Medications | Duloxetine (Cymbalta), inhibits uptake of norephinephrine and serotonin, Drug of choice for treating Stress UI not relieved by kegals. Side effects: Nausea, Headache, Insomnia, Constipation |
| Urge Incontinence | Behavioral modifications, Surgery is not recommended, Use of collection devices, pads, undergarments |
| Urge Incontinence Drugs | Anticholinergics: Estrogen (Cenestin), Improving vaginal and urethral blood flow, Increased risk of endometrial cancer, Report vaginal bleeding, Increased risk for thrombophlebitis, Avoid smoking |
| Overflow incontinence | Interventions aimed at removal of obstruction: Prostate removal, Repair of genital prolapsed, Intermittent cath, Behavioral, Bethanechol chloride (Urocholine) used after surgery |
| Functional Incontinence | Treat reversible cause. For non reversible: Urinary habit training, Catherization, Pessaries and penile clamps, Containment, Major concern: SKIN BREAKDOWN |
| Total or Mixed Incontinence | Combo of 2 or more types of involuntary urine loss, Use interventions for each type identified |
| Surgical Treatment for Total Incontinence | Look at treating structural causes, Prostatectomy, Cystocele, Urethocele, Artifical sphincter, Augmentation of bladder |
Created by:
nimeggs
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