1
Q
urinary tract infection (UTI)
A
- involves any portion of the lower urinary tract (ureters, bladder, urethra, prostate)
- due to high virulence bacteria overcoming normal host bacteria
- may also be due to immunocompromised host
2
Q
types of UTIs
A
- cystitis (most common)
- urethritis
- prostatitis
3
Q
upper UTI
A
•inflammation of kidney pelvis
Ex: pyelonephritis
4
Q
cystitis
A
- inflammation of the bladder
- most often caused by E. coli
- bacteria growing in perineal area and moving into the bladder following irritation, trauma, catheterization
5
Q
urosepsis
A
- systemic infection that can lead to overwhelming organ failure, shock, and death
- most common cause of sepsis in hospitalized pts
- more common in OAs
6
Q
risk factors for UTI
A
- female
- catheter
- stool incontinence
- bladder distention
- disease states
- OA
7
Q
subjective data UTI
A
- lower back/abd pain
- nausea
- urinary frequency/urgency
- dysuria (discomfort)
- perineal itching
- hematuria
- pyuria
8
Q
urinary frequency vs. urgency
A
- frequency is the urge to urinate often in small amnts
* urgency is feeling urination will occur now
9
Q
pyuria
A
- cloudy urine
* > 4 WBC in urine sample
10
Q
objective data UTI
A
- fever
- vomit
- voiding in small amnts
- nocturia
- discharge
- foul smell
11
Q
s/s UTI in OA
A
- confusion
- incontinence
- loss of appetite
- nocturia/dysuria
- hypotension, tachycardia, tachypnea (sepsis)
- fever
12
Q
urinalysis
A
- evaluates waste products from kidney and detects urologic disorders
- analyzed for color, clarity, concentration, acidity/alkalinity, specific gravity, drugs, glucose, ketones, and protein
- early AM sample best
- need at least 10 mL
13
Q
urinalysis of UTI
A
- confirmed bacteria, sediment, and WBCs
* takes 48 hrs to confirm type of pathogen and # colonies (for abx tx)
14
Q
presence of glucose, ketones, proteins, nitrates, and leukocyte esterase in urinalysis indicates…
A
- diabetes
- fat metabolism (DKA)
- infection
- cancer
15
Q
urinalysis WBC count > 10,000 indicates
A
- increased # of immature neutrophils in response to infection
- increases r/o STI
16
Q
cystoscopy
A
- detects urethral/bladder injury
- contrast dye instilled thru catheter to provide image of bladder/ureters
- performed for complicated/recurrent UTI
- monitor pt for 72 hrs for infection
17
Q
nursing intervention UTI
A
- 3 L fld/day
- cranberry juice to decrease risk of UTI
- admin abx (sulfonamides- bactrim); fluoroquinolones- cipro/levaquin)
- encourage frequent urination
- warm sitz bath (shower better)
- proper wiping
- avoid catheterization
18
Q
cranberry juice and UTIs
A
•compound in cranberries bay stop certain bacteria from adhering to mucosa of urinary tract
19
Q
cranberry juice contraindicated
A
•if pt has chronic cystitis it will worsen
*irritant, rather than preventative
20
Q
complications of UTI
A
- urethral obstruction
- pyelonephritis
- severe kidney damage
- urosepsis
21
Q
pyelonephritis
A
- infection/inflammation of kidney pelvis, calyces, and medulla
- begins in lower urinary tract w/ organism ascent into pelvis
- most often caused by e/ coli
22
Q
pyelonephritis consequences
A
•filtration, reabsorption, and secretion impaired
*decreased renal fxn
23
Q
actue pyelonephritis
A
•active bacterial infection that can cause…
- inflammation
- tubular necrosis
- abscess formation
- temporarily altered kidney fxn
24
Q
chronic pyelonephritis
A
- repeated infections that cause progressive inflammation and scarring of kidney pelvis
- changes blood flow to kidney, glomerulus, and tubular structure
25
risk factors for pyelonephritis
* OA (esp. w/ BPH)
* stones
* spinal cord injury (reflux)
* pregnancy
* malformations
* bladder tumor
* illness
* incomplete bladder emptying
26
s/s pyelonephritis
* fever/chills
* abd pain
* nausea
* malaise
* dysuria
* CVA tenderness
* bacteremia
27
pyelonephritis labs
```
•urine analysis
•WBC > 10,000
•blood cultures positive for bacteria
•increased BUN and Cr levels
•C-reactive protein elevated (inflammation)
*same as UTI labs
```
28
blood urea nitrogen (BUN)
* breakdown of protein in liver creates by-product that is excreted by kidneys
* affected by dehydration, infection, chemo, steroids, and liver damage
* not indicative of UTI, but helpful if chronic
29
normal BUN levels
•7-22 mg/dl
| *elevated suggests kidney dz
30
serum creatinine (Cr)
* produced due to muscle breakdown
* kidney dz is ONLY cause of elevated levels
* specific to KIDNEY
31
normal Cr levels
•0.5-1.2
| *elevated suggest kidney dz
32
diagnostic procedures pyelonephritis
* KUB x-ray
* gallium scan
* IVP
33
KUB x-ray
* kidneys, ureters, bladder
* used to detect calculi (stone), structural abnormalities, stricture, Ca2+ deposits, obstruction
* pt in supine position
34
gallium scan
•nuclear med test that uses dye to see organs having infection/inflammation
35
IVP
* intravenous pyelogram
| * used to detect calculi or structural abnormalities
36
complications of pyelonephritis
* septic shock
* chronic kidney dz (r/t fibrosis of kidney)
* HTN (dec. filtration causes fld retention)
37
pyelonephritis tx
* goal to promote comfort and urinary elimination
* analgesics for pain
* antispasmodics for bladder spasms
* abx for bacterial UTIs
38
urologic calculi
* urologic stones caused by many disorders
* exact mechanism uknwn
* most contain Ca2+, phosphate, oxalate
* most expelled w/o invasive procedures
39
urolithiasis
* presence of calculi in urinary tract
| * usually asymptomatic until passing thru tract
40
nephrolithiasis
•formation of calculi in kidney
41
ureterolithiasis
•formation of calculi in ureters
42
formation of stones
* supersaturation of urine w/ Ca2+ that becomes crystallized and becomes a stone
* slows urine flow
* damages urinary tract lining
43
predisposing factors for renal calculi
* decreased amnts of inhibitor substances that would normally prevent supersaturation and crystal aggregation
* high urine acidity/alkalinity
* drugs that contribute to stone formation
44
risk factors for renal calculi
* male
* damaged urinary tract
* decreased urinary flow
* urinary stasis, retention
* dehydration
45
s/s renal calculi
* renal colic
* urinary frequency/dysuria
* fever
* diaphoresis
* pallor
* N/V
* tachycardia/pnea
* BP fluctuations w/ pain
* oliguria/anuria/hematuria
46
renal colic
•sudden, intense pain that is located in the flank and is unrelieved by position changes as stone moves out of kidney pelvis and thru ureter
47
oliguria/anuria w/ calculi
* due to stones obstructing urine flow
| * medical emergency tx to preserve kidney fxn
48
flank pain suggests...
•stone in kidney or ureter
49
radiating flank pain suggests...
* pain radiating to abd, scrotum, testes, vulva
| * stones in ureter or bladder
50
urinalysis calculi
* if infection malodorous w/ turbidity (cloudy)
* elevated RBC, WBC, bacteria
* crystals on microscope
* abnormal Ca, Ph, uric acid
51
diagnostic tests calculi
* KUB
* IVP (unless suspect obstruction)
* CT or MRI (if x-ray insuff.)
* ultrasound
* cystoscopy
52
nursing interventions calculi
* meds
* stone passage (save for lab)
* 3L+ fld intake
* IV flds
* ambulation
53
medications for calculi
* opioids- pain
* NSAIDs- inflammation
* smasmolytic drugs
* abx b/c at risk for UTI
54
smasmolytic drugs
* Ditropan
* tx for renal calculi
* anti-spasmotic drugs
* AE of inc. intraocular press use (not good for glaucoma)
* monitor for dizzy, tachy, retention
55
extracorporeal shock wave lithotripsy (ESWL)
* uses shock wave energies to break stones into fragments
* moderate sedation
* ECG monitoring
* analgesics
* may elicit hematuria
* strain urine following procedure to monitor stone fragments
56
stenting for renal calculi
•small tube placed in ureter to dilate and allow stone passage
57
retrograde ureteroscopy for renal calculi
•use basket forceps to grasp/remove stone
58
percutaneous ureterolithotomy for renal calculi
•use laser to grasp/extract stone
59
open surgery for renal calculi
* surgical incision to remove large, impacted stones
| * may access ureter, kidney pelvis, or kidney
60
complications of renal calculi
•obstruction
•hydronephrosis
*controlling infections crucial to prevent sepsis
61
hydronephrosis
* stone blocks portion of urinary tracts, causing urine reflux into kidney
* results in kidney distention
62
renal calculi preventative nutrition
* avoid excess intake of protein, Na+, Ca, oxalates, caffeine, etoh
* encourage foods high in purines
* adequate hydration
63
oxalate food sources
```
•rhubarb
•spinach
•beets
•nuts
•chocolate
•tea
•wheat bran
•strawberries
•vit C
*AVOID to prevent renal calculi
```
64
foods high in purines
* lean meats
* organ meats
* whole grains
* legumes
65
indwelling catheter procedure
* don't delegate to AP
* assess client for allergies, bladder distention, LOC, ability to cooperate, mobility
* perineal care
* STERILE technique
66
shift to left
* increased # immature WBCs (neutrophils)
| * > 10,000
67
what intervention for urolithiasis
•strain all urine
68
pt has hydronephrosis secondary to calculi. stone removed and post obstructive diuresis is occurring. What intervention should be taken?
* assess for urine output every shift
| * monitor electrolytes
69
stone sent to lab to be analyzed for what...
•composition of calculi
70
DC teaching for pt w/ uric acid calculi the RN should instruct to avoid which type of diet?
•high-purine
71
pt w/ urolithiasis has chronic UTIs, so likely has which type of urinary stone
•calcium oxalate
72
flank pain indicates...
•inflammation of the kidney
73
cystitis pain involves...
* suprapubic area, not kidneys
| * NOT flank pain
74
increased BUN indicates...
•dehydration
75
increased Cr indicates
•kidney impairment
76
priority after urography
•hydration b/c dye can cause dehydration
77
Which nursing activity illustrates proper aseptic technique during catheter care
* placing collection bag below level of bladder
| * prevents reflux
78
interventions to decrease the risk for cystitis
•drink 2.5 liters of fld daily
79
Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients
•Re-evaluating periodically the need for indwelling catheters
80
A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begin
* I take over-the-counter naproxen (Aleve) twice a day for joint pain
* Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure
