urinary system

Question 1

urinary tract infection (UTI)

Answer 1

• 2nd most common bacterial disease
• most common in women b/c shorter urethra = greater risk uti
• can cause death if sepsis (bodies response to infection causes injury to its own tissue)
• E. coli = most common pathogen
• bladder and contents should be bacteria free
• complicated = coexisting presence of an obstruction, diabetes, renal insufficiency, pregnancy changes, infection, immunosuppression

Question 2

UTI contributing factors

Answer 2

• drugs, chemicals, radiation
• -> feminine hygiene spray, bubble baths, jellies
• microbe-bacteria –> E. coli (90% uti), staph, candida
• urinary stasis –> neurogenic bladder (lacking control due to brain or nerve functions like Alzheimers, DM), Benign prostate hypertrophy, tumor
• foreign bodies –> catheters, stones
• obesity, fistula, cogenital defects
• multiple sex partners
• not peeing after sex

Question 3

UTI assessment

Answer 3

s/s:

• frequency
• urgency
• dysuria
• hesitancy
• low back pain
• incomplete bladder emptying
• incontinence
• retention
• nocturia - peeing a lot at night
• hematuria - blood

prgressed s/s — if progressed to pyelonephritis

• fever
• chills
• N/V
• flank pain

Question 4

UTI in older adults

Answer 4

• mental confusion
• unexplained falls
• sudden onset incontinence
• loss appetite, nocturia, dysuria
• fever, tachycardia, hypotension (urosepsis)

Question 5

normal urinalysis

Answer 5

• clear, amber yellow, odor = stronger in the am
• ph4.6-8
  Negative for: bilirubin, blood, glucose, ketones, protein, nitrates, leuocytes, casts
• specific gravity = 1.010-1.030 – higher number = more dehydrated

Question 6

UTI diagnostics

Answer 6

• positive nitrates (presence of bacteria)
• positive leukocyes
• RBC present
• need a clean catch to determine bacteria susceptibility to antibiotics
• cystoscopy for recurrent or complicated uti’s

Question 7

UTI tx

Answer 7

• antibiotics –> need sensitivity testing. uncomplicated = short term course 1-3 days. complicated - long term course 7-14 days
• • teach pt to take full prescription
• sulfonamides
• fluoroquinolones (tequin and noroxin) – not if preg
• ciprofloxacin
• penicillins

urinary analgesics:

• pyridium - used w/ antibiotics. provides soothing effect on urinary tract mucosa. used for pain and bladderspasm . urine is reddish orange (sometimes mistaken for blood)
• ditropan/oxybutynin chloride (overactive bladder) - used with antibiotics

Question 8

UTI nursing education

Answer 8

• drink 2-3 L water daily
• drink 50 mL concentrated daily juice
• empty bladder regularly & completely

women:

• clean perineal front to back
• wear loose fitting cotton underwear
• empty bladder before & after sex
• avoid douches & lube for sex
• topical estrogen - normalizes flora
• encourage good nutrition
• • avoid alc, citrus, chocolate, spiced foods
• medications - full course antibiotics even if symptoms gone
• report onset fever immediately

Question 9

Urinary Incontinence

Answer 9

• urine involuntarily leaves the bladder
• urge: overactive bladder
• stress: too much pressure
• overflow: incomplete emptying
• teach bladder training and scheduling
• decrease fluid in evenings
• kegel exercises
• weight control - obesity can influence incontinence
• never scold pt, respond call lights, change pads
• surgical managemt – bladder neck suspension
• drug therapy – anticholinergic: ditropan -for overactive bladder

Question 10

kidney stones

Answer 10

calcium in the kidneys - urinary calculi (stones)

• usually form in kidneys then migrate to lower urinary system
• causes: urinary stasis, concentrated urine, uric acid

risk factors:

• infection, failure to empty bladder completely, obesity, obstructed tract
• immobility, dehydration, hx stones, excessive calcium levels, high animal proteins in diet

Question 11

urinary calculi (Stones) assessment

Answer 11

• sharp severe sudden pain
• hematuria
• oliguria (small amounts urine output)
• anuria (no urine output)

goal:
- relieve obstruction
- increase fluids
- reduce pain
- prevent recurrence

FIRST PRIORITY = pain management

Question 12

urinary calculi tx

Answer 12

• pain management
• push fluids
• stents (open up to make it pass a little earlier)
• lithotripsy = sound wave therapy to break up stone
• surgical = last resort, monitor I & O, monitor drains
• do not limit activity bc sedentary lifestyle could make it worse

Question 13

urinary retention

Answer 13

• inability to empty the bladder

causes:

• neurological conditions
• enlarged prostate (BPH)
• medications
• general anesthesia
• detruser failure - muscle that pushed down for urinary elimination

manifestation:

• distended bladder, inability to empty bladder, small voids every hr, chronic UTI
• oliguria - diminished production
• anuria - no output
• IMPORTANT to determine if pt is not making urine or just not letting it out

Tx:

• bladder scan for post void residual
• straight cath

Question 14

bladder cancer

Answer 14

• most common cancer of the urinary tract
• strong correlation w/ nicotine/smoking and toxin exposure
• most common after age 60
• metastasizes

Question 15

bladder cancer assessment

Answer 15

• painless hematuria (gross or microscopic)
• dysuria
• routine urinalysis

Question 16

bladder cancer tx

Answer 16

surgical tx
medical tx - chemotherapy and radiation
immunotherapy - BCG (bacillus calmetter-guerin) - virus used to stimulate the immune response

Question 17

urinary division

Answer 17

• surgical removal of caner or bladder
• bladder reconstruction
• stoma
• promote self-care
• monitor drainage
• prevent odor: wash pouches with soap & water

Question 18

Benign Prostatic Hyperplasia (BPH)

Answer 18

• result in enlargement of prostate gland
• cause: unknown
• causes bladder outlet obstruction
• risk factors:
• obesity, DM, hormone, supplementation, lack of physical activity

Question 19

BPH assessment

Answer 19

• elimination patterns (retention, incomplete emptying), distended bladder
• psychosocial: irritability, depression, libido affected, anxiety

diagnostic:

• urinalysis and culture
• BUN
• prostate-specific antigen
• digital rectal exam
• transabdominal ultrasound

Question 20

BPH analysis & outcome

Answer 20

• urinary retention due to bladder obstruction
• decreased self-esteem due to overflow incontinence & sexual dysfunction
• alpha blockers: relax bladder neck muscles
• finasreride: shrink prostate
• cialis: treats erectile dysfunction

goal:
- improve urinary elimination

Question 21

prostate cancer

Answer 21

• slower growing with predictable metastasis
• advanced age = leading factor
• second most common cancer in men
• 100% cure if found early

Question 22

prostatectomy

Answer 22

• surgical removal of part or all of the prostate
• monitor transurethral resection syndrome which is a rare complication due to intraoperative surgical site irrigation
• intervention: assess for fluid overload, discontinue irrigation, administer diuretic agents
• urine will be blood-tinged
• check urine output every 2 hrs

Question 23

urinary reflux

Answer 23

• back flow of urine into the urinary tract – flows back into ureter & possibly into kidney
• can lead to hydronephrosis - structural abnormalities between kidney, ureter, and bladder

Question 24

urinary reflux causes, s/s, tx

Answer 24

causes:

• congenital (born with it)
• chronic bladder infection
• obstruction in bladder ( BPH, tumor, stones)

s/s:

• recurrent uti
• flank pain
• uti symptom
• dilation of ureter or kidney

tx:
- address cause

Question 25

pyelonephritis

Answer 25

- bacterial infection of upper urinary tract that usually develops in lower urinary tract infection - inflammation renal parenchyma and collecting system causes: - reflux: damage, anatomic anomalies, scarring, DM, kidney stones - e. coli urosepsis: can lead to septic shock and death acute: active infection, brief, recurs, relapses chronic: repeated infections, scarring, decrease in functioning nephrons = renal failure

Question 26

clinical manidestations pyelonephritis

Answer 26

- mild fatigue - chills - fever - vomiting - dysuria - frequency - urgency - cloudy urine - foul smell - increased WBC's - flank pain - CVA tenderness - usually found when client being evaluated for HTN

Question 27

pyelonephritis management

Answer 27

- eliminate organism - remove obstruction - treat N/V - provide hydration drug therapy - antibiotics - urinary analgesics - drink 2L water day - typically improve within 48-72 hrs after starting therapy

Question 28

Glomerulonephritis

Answer 28

- inflammatory cells damage glomeruli - leading cause of end stage renal disease - caused by immune reaction that changes glomerular structure - can lead to nephrotic syndrome - acute onset - HTN - hematuria - RBC in urine - proteinuria - fatigue - nephrotic syndrome may develop - fluid excess, excess proteinuria, hyperlipidemia

Question 29

diabetic nephropathy

Answer 29

- leading cause ESRD - relates to degree hyperglycemia - atherosclerosis - HTN - neuropathy of bladder tone - avoid dehydration - control blood glucose - decrease insulin need bc harsh on kidneys

Question 30

nephrotic syndrome

Answer 30

- proteinuria - hyperalbuminemia - edema - hyperlipidemia - lipiduria - manage infection - complications: fluid overload, HTN, dialysis