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Renal and Urological
Chapter 48: Nursing Management: Renal and Urological Conditions
| Term | Definition |
|---|---|
| UTIs are more common in __________ | Women; UTIs are the most common bacterial infections in women |
| Cystitis | an inflammatory condition of the urinary bladder, characterized by pain, urgency and frequency of urination, and hematuria |
| Urethritis | inflammation of the urethra; most commonly from a sexually transmitted bacterial or viral infection. |
| Pyelonephritis | inflammation—usually caused by infection—of the renal parenchyma and the collecting system |
| -itis | inflamed |
| Predisposing factors to UTIs | urinary stasis, foreign bodies, anatomical factors, factors compromising immune response, and functional disorders |
| Sexual intercourse promotes __________ | milking of the bacteria from the vagina and the perineum; may cause minor urethral trauma that predisposes women to UTIs |
| Common pathogen (bacteria) leading to a UTI | E. coli |
| UTI symptoms | dysuria, frequent urination (more than every 2 hours), urgency, and suprapubic discomfort or pressure. |
| Symptoms of Upper UTI | Flank pain, chills, and the presence of a fever |
| UTI diagnostic tests | Dipstick urinalysis: nitrites (indicating bacteriuria), WBCs, and leukocyte esterase (an enzyme present in WBCs indicating pyuria) A voided midstream technique yielding a clean-catch urine sample is preferred. |
| UTI drug treatments | Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin is often used to empirically treat uncomplicated or initial UTIs. Additional drugs may be used to relieve discomfort |
| UTI health promotion | (1) emptying the bladder regularly and completely (2) evacuating the bowel regularly, (3) wiping the perineal area from front to back after urination and defecation (4) drinking an adequate amount of liquid each day |
| Acute Pyelonephritis | The most common cause is bacterial infection that begins in the lower urinary tract |
| Chronic pyelonephritis | a kidney that has become shrunken and has lost function owing to scarring or fibrosis; recurring infection involving upper urinary tract; often progresses to end-stage renal disease when both kidneys are involved |
| Acute Pyelonephritis Clinical Manifestations | vary from mild fatigue to the sudden onset of chills, fever, vomiting, malaise, flank pain, and the bothersome lower urinary tract symptoms (LUTS) characteristic of cystitis |
| Antibiotics course for Acute Pyelonephritis lasts _______ | 14-21 days |
| Acute Pyelonephritis Interventions | teaching about the disease process with emphasis on (1) the need to continue drugs as prescribed, (2) the need for a follow-up urine culture to ensure proper management, and (3) identification of risk for recurrence or relapse |
| Chronic pyelonephritis diagnostic tests | radiological imaging and histological testing. Imaging studies: small, contracted kidney with a thinned parenchyma. Pathological analysis: loss of functioning nephrons, infiltration of the parenchyma with inflammatory cells, and fibrosis. |
| Urethritis Manifestations and Treatment | discharge, particularly in men, with dysuria, urgency, and frequency; Treatment is based on the underlying cause and providing symptomatic relief |
| Glomerulonephritis | immune-related inflammation of the glomeruli characterized by proteinuria, hematuria, decreased urine production, and edema |
| Goodpasture’s syndrome | rare autoimmune disease characterized by the presence of circulating antibodies against glomerular and alveolar basement membranes |
| Acute post-streptococcal glomerulonephritis (APSGN | develops 5 to 21 days after strep infection |
| Chronic glomerulonephritis | end stage of glomerular inflammatory disease |
| Rapidly progressive glomerulonephritis (RPGN) | glomerular disease associated with rapid, progressive loss of renal function over days to weeks |
| Immunological disorders of the kidneys interprofessional Care | Adjustment of dietary protein intake to level of proteinuria and uremia |
| Obstructive Uropathies | any anatomical or functional condition that blocks or impedes the flow of urine; congenital or acquired; Damage from urinary tract obstruction affects the system above the level of obstruction |
| Partial obstruction can occur | If pressure remains low/moderate, kidney may continue to dilate with no noticeable loss of function |
| Urinary Tract Calculi | Crystals, when in a supersaturated concentration, can precipitate and unite to form a stone • Keeping urine dilute and free flowing reduces the risk for recurrent stone formation |
| Calculus | abnormal stone formed in body tissues by an accumulation of mineral salts |
| Nephrolithiasis | formation of stones in the urinary tract |
| 5 major categories of stones | 1. Calcium phosphate 2. Calcium oxalate 3. Uric acid 4. Cystine 5. Struvite (magnesium-ammonium phosphate) |
| Urinary Tract Calculi Clinical Manifestations | • Symptoms occur when stone obstructs urinary flow • Abdominal or flank pain (usually severe) • Hematuria • Renal colic • Nausea and vomiting (from pain) |
| Urinary Tract Calculi Diagnostic Studies | • Urinalysis • Urine culture • Ultrasound • Cystoscopy • Intravenous pyelogram and retrograde pyelogram to locate the degree and site of obstruction • CT scan • BUN, GFR, serum CR 12 |
| Urinary Tract Calculi Interprofessional Care | Manage the acute attack and Evaluate the cause of the stone formation and prevent future development: |
| 3 types of surgical intervention for urinary tract calculi | Endourological Procedure, Lithotripsy, Surgical Therapy |
| Endourological Procedure | cystoscopy; large stones broken up with lithotrite (stone crusher) then irrigated; ureteroscopes inserted and use laser to break stone |
| Lithotripsy | Use of sound waves to break renal stones; hematuria common after procedure; stent placed to promote passage of stone and prevent obstruction, removed 1-2 weeks later |
| Surgical Therapy | Nephrolithotomy: incision into the kidney to remove a stone Pyelolithotomy is an incision into the renal pelvis to remove a stone Ureterolithotomy: performed if stone is located in ureter Cystotomy: for bladder calculi Hemorrhage: common complication |
| Stricture | abnormal temporary or permanent narrowing of the lumen of a hallow organ |
| Ureteral stricture | Usually, an unintended result of surgical intervention oDepending on severity, obstruction can threaten the function of the kidney oStent placed under endoscopic control or diverting urinary flow via nephrostomy tube |
| Urethral stricture | result of fibrosis or inflammation of the urethral lumen oCompliance of urethra is compromised |
| Renal Vascular Conditions: Nephrosclerosis | a vascular disease of the kidney characterized by sclerosis of the small arteries and arterioles of the kidney, resulting in renal tissue destruction. It may be benign or malignant. |
| Renal Vascular Complications | Renal artery stenosis and Renal vein thrombosis |
| Renal Involvement in Metabolic & Connective Tissue Diseases: Gout | Syndrome of acute attacks of arthritis • Caused by hyperuricemia • Monosodium urate crystal deposits in joints |
| Urinary incontinence | uncontrolled loss of urine 1. Stress 2. Urge 3. Overflow 4. Reflex 5. Functional |
| Urinary retention | inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of the inability to urinate |
| Surgery of the Urinary Tract | Open nephrectomy and Laparoscopic nephrectomy |
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selenay15
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