chp. 37 nursing care of pt’s with disorders of the urinary system – Flashcards
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Urinary tract Infection (UTI)
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Invasion of urinary tract by bacteria -woman > men -aging = older men due to enlarged prostate; women due to declining estrogen
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predisposing factors: UTI
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-stasis of urine -contamination in perineal/ urethral area -instrumentations -reflux of urine -previous UTI's
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UTI: signs & symptoms
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-dysuria -urgency -frequency -incontinence -nocturia -hematuria -back pain -cloudy, foul-smelling urine
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Uti symptoms in Elderly
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-generalized fatigue is the most common - atypical symptoms: change in cognitive functioning
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UTI:Urethritis
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Inflammation of urethra -R/T chemical irritant, bacterial infection, trauma, exposure to STD -SX: urinary frequency, urgency & dysuria -TX: remove cause, antibiotic
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UTI: Cystitis
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Inflammation & infection of bladder wall -R/T bacteria, viruses, fungi, or parasites -90% UTI's caused by Escherichia coli -SX: dysuria, frequency, urgency & cloudy urine -TX: sulfa med. combo (Bactrim/Septra) complicated case ciprofloxacin (Cipro)
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UTI: Pyelonephritis
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Infection of the kidneys -R/T bacteria, ascending -SX: fatigue, urgency, frequency, dysuria, flank pain, fever, chills, cloudy urine -Usually much more ill -TX: antibiotics (IV for severe cases)
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UTI: diagnosis
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-urinalysis -C&S -CBC
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UTI: nursing data collections
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SX: dysuria, flank pain, fever, chills, malaise -urine examined for cloudiness, blood, foul odor -predisposing factors -urinalysis & culture results
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UTI: nursing diagnosis
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-acute pain -impaired urinary elimination -risk for injury -knowledge deficit
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UTI: nursing care
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-monitor symptoms -monitor intake & output -pain control ( non-narcotics) -reinforce RN instructions: medications- take all antibiotics, prevention
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Urological Obstruction
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Urinary tract obstruction is an interference with the flow of urine at any location along the urinary system -obstruction of urine flow is always significant -backup of urine destroys kidney -Causes: strictures, stones, & tumors
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urethral strictures
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-urethra lumen narrowing due to scar tissue TX: mechanical dilation -surgery-urethroplasty
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renal calculi
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-hard, generally small stones -kidney stones ( nephrolithiasis)
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renal calculi : pathophysiology
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-urinary salts settle out -calcium oxalate most common
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causes of renal calculi
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-family H/O -chronic dehydration -infection -immobility -dietary factors -men > women
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S&S renal calculi
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-FLANK pain -hematuria -renal colic -frequency -dysuria -urgency -costovertebral tenderness -enuresis -GI upset
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diagnosis: renal calculi
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-kidney-ureter-bladder (kub) xray -intravenous pyelogram (IVP) -renal ultrasound -urinalysis
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therapeutic interventions: renal calculi
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-small stones passed (5mm or smaller) -IV fluids -pain control (morphine) -thiazide diuretics (increase reabsorbtion of calcium) -Allopurinal (reduces uric acid production) -lithrotripsy (breaks into small fragments)
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renal calculi surgery
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-cystoscopy -cystolitholapaxy ( crushed & washed out) -cystotomy -ureterolithotomy -nephrolithotomy ( kidney stones) ; nephrostomy
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prevention : renal calculi
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foods hydration exercise
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complications: renal calculi
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uti's hydronephrosis
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nursing diagnosis: renal calculi
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-ACUTE PAIN -risk for infections -deficient knowledge
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renal calculi Nursing care
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-monitor symptoms -strain all urine -intake and output -monitor for pain -hydration -VS
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Hydronephrosis
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Abnormal dilation of kidneys caused by obstruction of urine flow -obstruction in urinary tract -kidney enlarges as urine collects Treat cause -kidney stones -tumor -enlarged prostate
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S&S : hydronephrosis
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-asymtomatic initially -frequency -urgency -dysuria -flank & back pain -renal failure
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therapeutic interventions: hydronephrosis
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-treat cause -urinary catheter -stents Nephrostomy Tube ( inserted directly into kidney to drain urine) -intake & output -no clamping
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Cancer of the bladder
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Most common urinary tract cancer -more in men; ages 50-70 Main causes is smoking, also industrial pollution
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painless hematuria
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what's the early sign of bladder cancer?
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Late Sign & symptoms : bladder cancer
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-frank hematuria -bladder irritability -urine retention -pelvic pain -lower back pain -dysuria -changes in bladder habits -inability to void
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Diagnosis: bladder cancer
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-urinalysis- Telomerase -urine for cytology, culture -cystoscopy & transurethral biopsy -IVP
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Therapeutic interventions: bladder cancer
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-chemotherapy -BCG ( Bacille Calmette-Guerin Vaccine) -photodynamic therapy
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Therapeutic interventions; bladder cancer
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Surgery -cystoscopy & pyelogram with fulguration -laser -robotic laparoscopic radical cystectomy -urinary diversion
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Incontinent Urinary diversion
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Ileal conduit -must wear ostomy at all times -6-8 inch section of ileum or colon removed
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Continent urinary diversion
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-Knock pouch -Indiana pouch -mainz pouch -Florida pouch
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interventions
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orthotopic bladder substitution -studer pouch -hemi-kock pouch -Ileal W-neobladder *to make a neobladder (new bladder)
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Nursing care: bladder cancer
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wound,ostomy, continence (WOC) nurse -monitor urine output -instruct how to care for urinary diversion -preop & postop care
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Cancer of the Kidney
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-rare Risk Factors: -smoking -obesity -hypertension -long term kidney dialysis -radiation exposure -asbestos -industrial pollution
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kidney cancer S&S
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early S&S are rare Later s&s -hematuria -dull pain in flank area -mass -weight loss -fever -weakness
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therapeutic interventions: kidney interventions
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-radical nephrectomy ( entire kidney removed) -nephron-sparing surgery (only tumor) -radiation therapy -immunotherapy -chemotherapy
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nursing post-op care: kidney cancer
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-monitor urine output -changes in amount or color -bleeding -signs of infection -check for SOB & diminished breath sounds on affected side -pneumothorax
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Renal Trauma
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-R/T MVA, sports injuries, falls, gunshot wounds, stabbing -SX: flank pain, hematuria -DX: IVP, UA, US, CT, MRI -TX: treat injury, bedrest to surgery
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nursing care for renal trauma
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-measure I & O -monitor VS -Add IV fluids -monitor for pain
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Polycystic kidney disease
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Multiple cysts in the kidney -progressive -No treatment to stop the progression -kidney transplant -hereditary disease -results in CKD
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S&S polycystic kidney disease
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-dull heaviness in flank/back -hematuria -hypertension -UTI
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Diabetic Nephropathy
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Disease of the kidneys, inflammatory, degenerative & sclerotic lesions
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diabetic nephropathy:
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-long term complication of diabetes -Most common cause of CKD -atherosclerotic changes decrease blood to kidney -smaller doses of insulin as progresses -chronic renal failure develops
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interventions: diabetic nephropathy
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Early -control blood glucose & blood pressure -restricted-protein diet Later -dialysis -kidney or kidney pancreas transplant
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Nephrotic Syndrome
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The end result of a variety of diseases that damage capillaries of the glomerulus -large amounts of protein lost in urine -increased glomerular membrane permeability
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Nephrosclerosis
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Hardening or sclerosis of renal blood vessels -HTN damages kidneys by sclerotic changes Therapeutic Interventions: antihypertensives, low Na diet Nursing diagnosis: ineffective health maintenance
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Glomerulonephritis
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Inflammatory disease of the glomerulus of the kidney -glomerulus more porous -results in proteins, WBCs, RBC, leak into urine (slow process)
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Causes: glomerulonephritis
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-acute post-streptococcal (strep throat) -goodpasture's syndrome -chronic glomerulonephritis
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S&S of Glomerulonephritis
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-oliguria (diminished urine, less than 400mL) -hypertension -electrolyte imbalance -edema -flank pain -Cola color from old RBC & foamy due to protein
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Diagnosis: Glomerulonephritis
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urinalysis ultrasound xray biopsy
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Nursing care: glomerulonephritis
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-vital signs -symptom support -rest -fluid, sodium, protein restrictions -CKD care -reinforce instructions given by RN about prevention of recurrence
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Acute Kidney Injury
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-sudden loss of kidney function -Azotemia= when waste products accumulate (tested by BUN & Cr) -Oliguric -May recover
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Causes: acute kidney injury
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-Prerenal failure -intrarenal failure -postrenal failure
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Prerenal failure
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-decreased blood supply to kidneys -causes of this: dehydration, blood loss, shock, trauma, blockage in artery (before the kidney) (55-60% of cases)
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Intrarenal failure
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-damage to nephrons -caused by ischemia, reduced blood flow, toxins (inside the kidney)
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Postrenal failure
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-obstruction -caused by stone, tumor, enlarged prostate
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nephrotoxins
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Nephrotoxins -diagnotic contrast media (dyes) -medications -chemicals
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Prevention: acute kidney injury
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-check serum BUN & creatinine prior to dyes or meds -hydrate before and after contrast media monitor peak/trough levels of nephrotoxic drugs per institutional policy
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Phases of acute kidney injury
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-Oliguric = less than 400mL urine in 24 hrs -Diuretic = 1-3 L urine day -Recovery = GFR rises, BUN & Cr decrease
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Continuous renal replacement therapy (CRRT)
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-removes fluid continuously -remove fluid/solutes in controlled, continuous manner in unstable patients -blood flows through hemofilter, excess fluids/ solutes move into collection bag -less dramatic fluid shifting; alternative of hemodialysis
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Chronic Kidney Disease (CKD)
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A progressive, irreversible, deterioration in renal function -gradual decrease in k idney function -Irreversible -Progressive -Large proportions of nephrons damaged
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Etiology: CKD
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-diabetic nephropathy -nephrosclerosis -glomerulonephritis -autoimmune diseaes HTN & DM 70% of cases
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Stages of CKD
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-early or silent stage: usually no SX. up to 50% of nephrons left -renal insufficiency stage: 75% of nephrons lost -End stage renal disease (ESRD) 90% of nephrons lost
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CKD: Uremia
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Urea in blood -affects all body systems
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Symptoms of kidney disease
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-fluid accumulations -electrolytes -waste products retained -acid-base imbalances -anemia -urine output
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Kidney disease Therapeutic interventions
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Diet: -high calorie (maintain weight & energy) -low protein (unless on dialysis) -low sodium, potassium, phosphorus -increased calcium -vitamins Fluid restriction to prevent overload
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Therapeutic interventions: kidney disease
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Medications -diuretics -antihypertensives -phosphate binders -calcium/vitamin D supplements -Kayexalate prn
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Nursing interventions: kidney disease
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-Monitor weight qd same time -report wt gain > 2 lbs -measure I&O -maintain fluid restriction
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Dialysis
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These are some reasons of why a person might need what?? -symptoms of fluid overload -high potassium -neurological signs -uremia
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Hemodialysis
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Artificial kidney removes waste products & excess water from blood -lasts 3-4 hours, done 3-4 times a week
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Vascular access
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-LifeSite hemodialysis access system -A-V Graft = tube of synthetic material attach to artery & vein -A-V Fistula = sewing a vein & artery together under skin
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Vascular access Care
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-Thrill (tremor) , bruit (swishing sound)- RN -protect -Postop -Neurovascular checks, pain -elevate extremity
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Peritoneal dialysis
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-continuous dialysis done by patient -peritoneal membrane is semipermeable membrane, across which excess wastes/fluids move from blood -peritoneal catheter -MAJOR COMPLICATION - Peritonitis
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kidney transplant
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-living related donor or cadaver donor -anti-rejection drugs
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CKD nursing diagnoses
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-excess fluid volume -impaired skin integrity -activity intolerance -risk for injury -risk for infection -imbalanced nutrition: less than body requirements
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CKD: nursing care
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excess fluid volume -monitor weight same time qd -report wt gain > 2lbs -intake & output -fluid restriction -monitor for fluid retention
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CKD: Nursing care
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electrolyte imbalance -monitor levels -dietary restrictions -monitor dysrhythmias
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CKD: nursing care
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Waste products -oral care,skin care -lotion -protect from injury Impaired hematological function -protect form injury/infection
