Disorders Of The Urinary System

Front 1

UTI

Back 1

Invasion of the urinary tract by bacteria; most commonly caused by ascending infection
Hospital: nosocomial infections
Escherichia Coli: most common bacteria

Front 2

UTI predisposing factors

Back 2

Predisposing factors:
Stasis of urine
Contamination in the perineal and urethral areas
Instrumentation
Reflux of urine
Previous UTI
Women more susceptible then men
Elderly more susceptible

Front 3

S&S of UTI

Back 3

Dysuria
Urgency
Frequency
Incontinence
Nocturia
Hematuria
Back or Flank Pain
Costovertebral tenderness
Cloudy Urine
Foul-Smelling Urine
>100,000 bacteria
↑ sedimentation rate
Bacteria, casts and WBCs in urine
Fever
Confusion
Generalized Fatigue (elderly)
Decline in Mental Status
Decline in Cognitive Functioning
Complications: chronic

Front 4

urethritis etiology

Back 4

Inflammation of the urethra
Causes: chemical irritant, bacterial infection, trauma or exposure to sexually transmitted disease

Front 5

urethritis diagnosis

Back 5

urinalysis and urine culture and sensitivity

Front 6

urethritis treatment

Back 6

Remove chemical irritant
Antibiotic based on urine culture results
Pyridium (Phenazopyridine): analgesic for dysuria, orange urine

Front 7

cystitis etiology

Back 7

Inflammation and infection of bladder wall
90% caused by Escherichia coli
Catheters in hospitals

Front 8

cystitis diagnosis

Back 8

urinalysis and urine culture and sensitivity: cloudy urine, WBCs, bacteria, RBCs, nitrates; determine appropriate antibiotic

Front 9

cystitis treatment

Back 9

Sulfa combination such as Sulfamethoxazole and Trimethoprim (Bactrim, Septra) or Ciprofloxacin (Cipro); Estrogen in women

Front 10

pyelonephritis etiology

Back 10

Infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys
Small abscesses and enlargement of the kidney
Causes: infection spread by ascending urethral route

Front 11

pyelonephritis etiology

Back 11

Infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys
Small abscesses and enlargement of the kidney
Causes: infection spread by ascending urethral route
Urosepsis: systemic infection arising from a source within the urinary system

Front 12

pyelonephritis symptoms

Back 12

Usual UTI, flank pain, costovertebral tenderness

Front 13

pyelonephritis diagnosis

Back 13

Urinalysis will show cloudy urine, WBCs, RBCs, pus, casts (differentiates from cystitis), >100,000 colonies of bacteria per milliliter, nitrates; CBC will show elevated WBC with increase sedimentation rate

Front 14

pyelonphritis treatment

Back 14

Antibiotics based on culture & sensitivity results

Repeated infections can cause urosepsis, scarring and loss of function, renal failure

Front 15

Trimethoprim-Sulamethoxazole (Bactrim and Septra) Sulfonamides:
UTI

Back 15

E. Coli and Pseudomonas
GI upset, homolytic anemia and rash, severe hypersensitivity (Stephens-Johnson Syndrome)
Give with large amounts of water
Caution with severe renal and liver disease

Front 16

Ciprofloxacin (Cipro) Fluoroquinolone:
UTI

Back 16

Pseudomonas and other Enterobacteria
GI upset, dry mouth, oral and vaginal fungal infections
Avoid aluminum antacids, large
amounts of water, caution in pregnancy

Front 17

Phenazopyridine (Pyridium):
UTI

Back 17

Topical analgesic, relieve pain, urgency and frequency
GI upset, rash and blue to purple skin discoloration, nephrotoxic and hepatotoxic
Urine color changes to read orange, changes urine glucose testing

Front 18

urological obstructions

Back 18

Topical analgesic, relieve pain, urgency and frequency
GI upset, rash and blue to purple skin discoloration, nephrotoxic and hepatotoxic
Urine color changes to read orange, changes urine glucose testing

Front 19

urethral strictures

Back 19

Narrowing of the lumen of the urethra cause by scar tissue
Most acquired from injury or infection
Some from trauma from insertion of catheter or other instruments
Diminished urinary stream and prone to UTIs
Treatment: mechanical dilatation by urologist and/or urethroplasty followed by insertion of urinary catheter for healing to occur
Need to teach patient on UTI prevention
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Front 20

renal calculi

Back 20

“Kidney Stones”: one stone is called a calculus
Nephrolithiasis: found in the kidney
Formed when urinary salts are concentrated in which a nucleus collects salts made out of calcium oxalate, calcium phosphate, magnesium ammonia, uric acid and cystine
Locations: kidneys,
ureters, bladder,
urethra
Symptoms occur when
impacted in system

Front 21

renal calculi causes

Back 21

Family history, chronic dehydration, infection, dietary factors, immobility

Front 22

renal calculi S&S

Back 22

Flank pain, renal colic (occurs suddenly, progresses rapidly and peaks over a 30 minute period), pain radiating down to the genitalia (ureter), hematuria, dysuria, frequency, urgency and enuresis, costovertebral tenderness, oliguria (decreased urine output) or anuria (absence of urine output); nausea, vomiting an diarrhea

Front 23

renal calculi diagnosis

Back 23

Kidney-Ureter-Bladder (KUB) examination or intravenous pyelogram, renal ultrasound, urinalysis

Front 24

renal calculi treatment

Back 24

Intravenous fluids and encourage fluids
Vital Signs
May pass stones on their own, ambulate
Strain urine with special strainer and saved for laboratory analysis, urine output
Pain medication such as morphine
Thiazide Diuretics and Allopurinol (calcium)
Increased risk of developing UTIs and hydronephrosis
Monitor patency of drains and catheters pre and post operatively , such as a nephrostomy tube or catheter

Front 25

renal calculi interventions

Back 25

Surgical Removal needed for large stones, obstructions, or intractable pain. Type depends on locations
Lithotripsy
Cystoscopy, percutaneous nephrolithotomy, nephrostomy tube placement

Teach patient to report signs/symptoms of UTI, prevention measures, strain urine, medications

Front 26

prevention of renal calculi

Back 26

Avoid foods that increase calculus development
Encourage fluids, prevent dehydration, 3000ml fluid/day
Walk and keep active
Low-oxalate diet to avoid calcium oxylate stones: avoid beets, rhubarb, spinach, cocoa and instant coffee (approx. 80% composed of calcium oxylate)

Front 27

hydrophrosis etiology

Back 27

Results from untreated obstruction of the urinary tract
Kidney enlarges and becomes a sac filled with urine instead of functioning

Front 28

hydronephrosis causes

Back 28

strictures, kidney stones, tumors, enlarged prostate

Front 29

hydronephrosis treatment

Back 29

Stents,
Nephrostomy Tube (avoid kinks in
tubing, do not clamp and assess urine
output)
Increased risk for UTIs

Front 30

tumors of renal system

Back 30

Cancer of Bladder: most common type of urinary tract cancer
Strong correlation with cigarette smoking
Benign growth on wall
Superficial vs Invasive
Metastasis: liver, bones and lungs

Front 31

tumors of renal system S&S

Back 31

Painless hematuria (most common): intermittent then frank hematuria, urine retention
Pelvic pain, pain in lower back, painful urination, changes in bladder habits and inability to void

Front 32

tumors of renal system diagnosis

Back 32

Diagnosis: Routine Urinalysis for presence of the enzyme telomerase, urine cytology; cystoscopy and biopsy; Intravenous Pyelogram

Front 33

tumors of renal system interventions

Back 33

Chemotherapy instilled in bladder or systemic, photodynamic therapy, surgical treatment
Incontinent Urinary Diversion: Urine leaves the body in a different manner, bladder removed; such as an ileal conduit in which a patient uses a ostomy bag and urine contains mucus and is cloudy; ostomy appliance to collect urine

Front 34

tumors of renal system management

Back 34

Similar to other surgical patients; Assess for adequate urine output and detect and report any obstruction of urine drainage early to prevent complications
Patient/family will need instruction on caring for the urinary diversion after surgery
Skin care around stoma

Front 35

cancer of the kidney S&S

Back 35

3 Classic Symptoms: hematuria, dull pain in the flank area, and mass in the area
Other symptoms: fever, weight loss, night sweats, hypertension, anemia, polycythemia, swelling of legs, fatigue, anorexia and constipation
Often metastasized before diagnosed: bones, lungs and liver leading to cough, bone fractures, liver abnormalities

Front 36

cancer of the kidney diagnosis

Back 36

Renal Biopsy besides other tests such as CT scan, ultrasound, IVP, MRI, Cystoscopy and Pyelogram

Front 37

cancer of the kidney interventions

Back 37

Nephrectomy followed by radiation, chemotherapy

Front 38

nursing management after nephrectomy

Back 38

Assess for signs of bleeding and hypovolemic shock
Assess urine output, change in color, bleeding, amount and signs of infection
Assess for shortness of breath: spontaneous pneumothorax

Front 39

renal system trauma

Back 39

Renal Trauma is the most common injury to the urinary system
Young Males at greatest risk
Assess patient: history, inspection of abdomen and flank area for bruising or swelling, hematuria
Usual diagnostic tests
Bladder Trauma
Nursing Care: Intake and Output, Vital Signs, IV fluids and pain control

Front 40

polycystic kidney disease etiology

Back 40

Formation of multiple cysts in the kidney, replace normal kidney structures; hereditary

Front 41

polycystic kidney disease S&S

Back 41

dull heaviness in flank or lumber region and hematuria, hypertenison, UTI
Renal failure; no treatment

Front 42

diabetic nephropathy

Back 42

most common cause of renal failure; damage to small blood vessels in the kidney

Front 43

diabetic nephropathy risk factors

Back 43

Hypertension
Genetic Disposition
Smoking
Chronic Hyperglycemia

Front 44

diabetic nephropathy symptoms

Back 44

Microalbuminuria advancing to proteinuria
Hypertension;
Decreased urine output, toxic wastes accumulate, renal failure

Front 45

diabetic nephropathy diagnosis

Back 45

Protein and albumin in urine, serum creatinine level, 24-hour creatinine clearance
More risk for cardiovascular disease

Front 46

diabetic nephropathy treatment

Back 46

Strict control of blood glucose levels and blood pressure
Restricted protein diet
Dialysis
Kidney or Kidney-Pancrease transplant is treatment of choice
Most likely use smaller insulin doseages

Front 47

nephrotic syndrome etiology

Back 47

excretion of 3.5g or more of protein in the urine per day

Front 48

nephrotic syndrome S&S

Back 48

Increased glomerular membrane permeability
Decrease in serum albumin and total serum protein
Edema, Ascites and Anasarca (wide spread edema)
Elevated serum cholesterol, low-density lipoproteins and triglycerides
Foamy urine, elevated BP, increased infection risk

Front 49

nephrotic syndrome care

Back 49

ocus on prevention of infection and decrease edema; daily weights, abdominal girth measurements, intake and output, prevent injury to edematous tissue

Front 50

nephrosclerosis etiology

Back 50

Damage to the kidneys by hypertension causing sclerotic changes in arteries and arterioles and arteriosclerosis (thickening and hardening) in renal blood vessels

Front 51

nephrosclerosis S&S

Back 51

proteinuria, hyaline casts in urine and renal failure

Front 52

nephrosclerosis treatment

Back 52

Control hypertension, low sodium diet; dialysis

Front 53

nephrosclerosis care

Back 53

Impaired Health Maintenance: focus on education of renal failure symptoms and control hypertension

Front 54

glomerulonephritis etiology

Back 54

Inflammation of the glomerulus caused by immunological abnormalities, toxins, vascular disorders and systemic disease; allows protein, WBCs and RBCs to leak into urine

Front 55

glomerulonephritis causes/types

Back 55

Acute Poststreptococcal Glomerulonephritis: group A beta-hemolytic streptococcal infection; follow throat or skin infection
Goodpasture’s Syndrome: autoimmune response
Chronic Glomerulonephritis: inflammatory disease; lupus and insulin-dependent diabetes

Front 56

glomerulonephritis S&S

Back 56

Caused by Fluid Volume Overload
Oliguria
Hypertension
Electrolyte Imbalance, BUN and Creatinine Elevated
Edema to Extremities, Periorbital Edema, (abdomen) Ascites, (lungs) Pleural Effusion
Flank Pain
Urinalysis: RBCs,WBCs, protein and casts
Foamy urine, urine dark and cola colored

Front 57

glomerulonephritis care

Back 57

Nursing Diagnosis:
Fluid volume excess related to compromised renal regulation
Decreased tissue prefusion related to anemia, impaired cardiac output and edema
Symptom Relief
Vital Signs
Fluid and sodium restriction to control edema
Encourage rest
Limit protein intake
Prognosis for acute is good although if progresses can result in renal failure, chronic occurs over time leading to renal failure

Front 58

renal failure etiology

Back 58

Kidneys are no longer functioning adequately to maintain normal body processes.
Dysfunction of all other parts of the body
Imbalances in fluid, electrolytes and calcium levels
Impaired RBC and elimination of wastes
Acute: sudden onset
Chronic: gradually over time

Front 59

acute renal failure etiology

Back 59

Sudden loss of body’s ability to clear waste products and regulate fluid and electrolyte balance
Azotemia: toxic wastes from protein metabolism, BUN and Creatinine are elevated
Most reversible, but can lead to chronic
Urine output less than 30ml/hr or 400ml/day

Front 60

acute renal failure causes

Back 60

Hypotension
Vascular Obstruction
Glomerular Disease
Acute Tubular Necrosis (tubules damaged after administration of diagnostic contrast media)
Certain Nephrotoxic Medications

Front 61

4 stages of acute renal failure

Back 61

Initial Phase
Oliguric Phase
<400ml of urine/24 hours
24 hours to 7 days after the initial phase
Prognosis decreased the longer it lasts
Retained fluid, fluid overload, Increased Serum Potassium, Decreased Serum Sodium
Diuretic Phase
Starts to excrete waste products, 1 to 3 weeks
Urine 1 to 3 liters/day
Dehydration and hypotension
BUN and creatinine high
Recovery Phase
Glomerular filtraton rate increases, up to a year

Front 62

acute renal failure classifications

Back 62

Classified as Prerenal, Intrarenal or Postrenal
Treated by relieving the cause. Prevention of permanent damage is the goal of treatment.

Front 63

prerenal failure

Back 63

“Before the Kidney”, decreased or interruption of blood supply
Decrease BP from dehydration, blood loss, shock, trauma, arterial blockage
Use of nonsteroidal anti-inflammatory drugs and cyclooxygenase-c inhibitors
Treatment:
IV fluid challenge if dehydration
Arteriogram, Angioplasty
Serum creatinine increases and creatinine clearance decreases

Front 64

intrarenal failure

Back 64

Inside the Kidney”, damage to nephrons
Caused by ischemia, reduced blood flow and toxins
Also caused by infectious processes leading to glomerulonephritis, tauma to kidney, exposure to nephrotoxins (Table 37.4 in book), medications, allergic reaction to radiology dyes, severe muscle injury
Caution with radiology contrast media (IVP and CT scan) when patient is dehydrated or has renal impairment; patient must be adequately hydrated!
Check BUN and Creatinine
Encourage fluids before, during and after to flush out the contrast dye

Front 65

postrenal failure

Back 65

After the Kidney”, obstruction blocks the flow of urine out of the body
Common Causes: kidney stones, tumors of the ureters or bladder and enlarged prostate

Front 66

Continuous Renal Replacement Therapy (CRRT):

Back 66

Removes fluid and solutes in a controlled continuous manner in unstable patients with acute renal failure, cannot tolerate rapid fluid shifts

Front 67

chronic renal failure etiology

Back 67

Irreversible deterioration in renal function, body is unable to maintain metabolic, fluid and electrolyte imbalance, gradual decrease in kidney function over time that affects all body systems

Front 68

chronic renal failure causes

Back 68

diabetes mellitus resulting diabetic nephropathy, high blood pressure causing nephrosclerosis, glomerulonephritis and autoimmune disease
Without symptoms in early stages, 50% nephrons lost

Front 69

renal insufficiency stage

Back 69

at least 75% of neurons lost function

Front 70

end stage renal disease

Back 70

occurs when 90% of the nephrons are lost and require dialysis and/or kidney transplant to survive

Front 71

symptoms of chronic renal failure

Back 71

Uremia- Urea in blood
Figure 37.6 Symptoms of Chronic Renal Failure, effects every system of the body!
Disturbance in Water Balance (fluid overload)
Edema of the extremities, sacral area and abdomen, periorbital edema
Shortness of breath
Crackles and wheezes to lungs
Blood vessels extended in neck
Hypertension
Polyuria: large amounts of dilute urine
Oliguria: small amounts of urine
Anuria: no urine

Front 72

symptoms of renal failure

Back 72

Disturbance in Electrolyte Balance
Hypernatremia: (excessive sodium) leads to water retention, edema and hypertension
Hyponatremia: (too little sodium) show signs of confusion
Hyperkalemia: (high levels of potassium) can lead to dysrhythmias and cardiac arrest, muscle weakness, abdominal pain and diarrhea, >5mEq/L
Educate on restricting potassium intake: foods high in potassium such as citrus fruits and juices, bananas, salt substitutes, potatoes, excessive dairy products, excessive meat and chocolate
Intravenous insulin, glucose or calcium gluconate, Kayexylate, hemodialysis used to decrease levels; dialysis
Disturbances in Electrolyte Balance (cont.):
Calcium: decreases, < 8.5mg/dL, leads to hyperphosphatemia (high phosphorus level)
>5mg/dL
Prone to fractures, itching, muscle cramps
Medications that bind phosphate: calcium carbonate (Tums, Caltrate), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum (Fosrenol) with meals; prevents damage to bones from high phosphorous levels

Front 73

symptoms of renal failure

Back 73

Disturbance of Removal of Waste Products
Due to Azotemia…Dialysis is the treatment
Weakness and fatigue
Confusion
Seizures
Twitching Movements of Extremities (Asterixis)
Nausea
Vomiting
Lack of Appetite
Metallic or Bad Taste in Mouth
Smell of Urine on Breath
Yellowish and pale skin, itching

Front 74

symptoms of renal failure

Back 74

Disturbance in Maintaining Acid- Base Balance:
Affects hydrogen ion excretion leading to metabolic acidosis
Headache
Fatigue
Weakness
Nausea
Vomiting
Lack of appetite
As acidosis progresses leads to coma, lethargy and stupor, kussmaul’s respirations

Front 75

symptoms of renal failure

Back 75

Disturbances in Hematological Function:
Unable to produce adequate erythropoietin (hormone that stimulates RBCs)
Nutritional deficiencies and blood loss
Impaired WBCs and Immune Response
Impaired platelet function: bleeding, bruising
Treatment: Epoetin (Epogen/Procrit) injections

Front 76

treatment of renal failure

Back 76

Renal insufficiency and early renal failure: based on symptoms, diet and fluid restriction, medications and monitoring
Dialysis used for later stages
Kidney transplant
Dietary Requirements (Box 37.11)
Individualized
High Calories, Fluid Restriction and Limits
Restrict Protein, Sodium, Potassium, Phosphorous, Saturated Fat and Cholesterol
Increased Calcium
Receive supplements of Iron, Folic Acid, Vitamins and Minerals to supplement diet

Front 77

treatment of renal failure meds

Back 77

Diuretics
Control Hypertension
Phosphate Binders
Calcium and Vitamin D supplements
Must be closely monitored!
Diabetics need less insulin

Front 78

treatment of renal failure dialysis

Back 78

Dialysis:
Started when symptoms become severe and are life threatening
Hemodialysis or Peritoneal Dialysis: movement and diffusion of particles from an area of high concentration to an area of low concentration through a semipermeable membrane

Front 79

hemodialysis

Back 79

Hemodialysis
Use of an “artificial kidney” to remove waste products and excess water from the patient’s blood
Takes 3-4 hours to complete, 3-4 times/week

Front 80

hemodialyisis side effects

Back 80

weakness, fatigue, hypotension, vertigo, nauseated, cardiac dysrhythmias and angina, muscle cramps, lethargy, bleeding from puncture sites (heparin), gastrointestinal system or other sites of injury
Weighed before and after, should loose weight

Front 81

hemodialysis vascular access

Back 81

Vascular Access Graft or Arteriovenous (AV) Fistula surgically placed in arm if possible; temporary access with central venous catheter

Front 82

hemodialyisis venous access care

Back 82

Check for patency by palpating for a thrill (a tremor) and ascultating for a bruit (swishing sound)
Report to the physician a decrease or absence in the thrill or bruit which may indicate occlusion
Do not take blood pressure, use a tourniquet or draw blood, give injection, or start intravenous line in the affected arm
Instruct to not wear constrictive clothing, not lift heavy objects or purse, avoid prolonged bending or sleeping on access arm, no jewelry over site
Notify physician if signs of bleeding, infection, coldness, numbness, tingling, weakness, redness, fever, drainage or swelling to area or extremity

Front 83

peritoneal dialysis

Back 83

Done at home continuously
Peritoneal catheter in patient’s peritoneal space between the two layers of the peritoneum below the waistline
Exchange process: filling, dwell time and draining
Continuous Ambulatory Peritoneal Dialysis (CAPD) is done 3 times a day and at bedtime
Education very important
Sterile technique!
Peritonitis is major complication due to poor technique, abdominal pain first sign

Front 84

kidney transplant

Back 84

Can reverse many of the physiological changes noted with renal failure
No longer dependent on dietary restrictions and dialysis