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Med-Surg Ch 27

Urinary Disorders

QuestionAnswer
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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