Med Surg Chapter 45 Urinary Disorders

Front 1

What are common lower UTI's?

Back 1

bacterial cystitis, bacterial prostatitis, bacterial urethritis
-can be bacterial or nonbacterial

Front 2

What is the difference between complicated and uncomplicated?

Back 2

complicated-occur from urologic abnormalities or recent catheterization
uncomplicated-community acquired

Front 3

What are the risk factor for UTI?

Back 3

failure to empty bladder completely, obstruction of urinary flow, immunosuppression, instrumentation into UT, imflammatino of urethral mucosa, other contributing factors (DM, preg, neuro, gout, altered LOC)

Front 4

What is urthrovesical reflux?

Back 4

reflux of urine from urethra into bladder

Front 5

What is ureterovesical reflux?

Back 5

backward flow of urine from bladder into one or bother ureters

Front 6

Define bacteriuria

Back 6

>100000 colonies/mL of clean catch urine

Front 7

What are the routes of in UTI?

Back 7

transurethral, bloodstream, fistula in intestine, sexual intercourse, massage of urethra

Front 8

What are the s/s of UTI?

Back 8

dysuria, burning, frequency, nocturia, incontinence, suprapubic or pelvic pain, hematuria, back pain

Front 9

What are elderly patient s/s of UTI?

Back 9

altered sensorium, lethargy, anorexia, new incontinence, hyperventilation, low-grade fever

Front 10

What factors contribute to UTI's in older adults?

Back 10

chronic illness, use of antimicrobial agents, infected pressure ulcers, immunocompromised, cognitive impairment, immobility, bedpan use

Front 11

What else could hematuria indicate?

Back 11

urinary cancer
early stream blood- urethral
late stream blood- bladder lesion

Front 12

What studies will be done to diagnosis?

Back 12

urine, std, WBC, CT, ultrasonography,

Front 13

What are complications of UTI's?

Back 13

renal failure, sepsis, strictures, obstructions

Front 14

How are UTI's treated?

Back 14

antibiodic, liberal fluid intake, frequent voiding, hygenic measures

Front 15

What are some contributing factors to UTI?

Back 15

disfx of glycosaminoglycan, urethrovesical reflux, ureterovesical relux, uropathogenic bacteria, shortened urethra

Front 16

What are common upper UTI's?

Back 16

acute or chronic pyelonephritis, interstitual nephritis, renal abscesses

Front 17

What causes upper UTI's?

Back 17

upward spread of bacterial from the bladder or bloodstream to the kidney
bladder tumors, strictures, BPH, stones, systemic infection

Front 18

S/S of acute pyelonephritis?

Back 18

(imflammation of renal pelvis)
ill with chills, fever, leukocytosis, bacteriuria, pyuria, low back pain, N/V, headache, malaise, dysuria, frequency

Front 19

Diagnosis and treatment of pyelonephritis?

Back 19

ultrasound, CT to see obstruction, WBC, urine culture and sensitivity tests
antibiodics, hydration, voiding

Front 20

What are the s/s of chronic pyelonephritis?

Back 20

fatigue, headache, poor appetite, polyuria, excressive thrist, weight loss

Front 21

What are the complications of chronic pyelonephritis?

Back 21

ESRD, from scarring, hypertension, kidney stones

Front 22

What diagnosis tests are used for chronic pyelonephritis?

Back 22

IV urogram, creatinine clearance, BUN, creatinine levels, bacteria in urine

Front 23

What could be causes of voiding disyfuction?

Back 23

incomplete bladder emptying from poor detrusor pressure from recurrent bladder infections
incomplete bladder emptying due to bladder outlet obstruction

Front 24

Define stress incontinence?

Back 24

intact urethra, invol loss of urine by sneezing, coughing, changing position
(causes-dec ligament support of urethra, absent estrogen levels, readical prostatectomy)

Front 25

Define urge incontinence?

Back 25

strong urge to void that cannot be suppressed

Front 26

Define reflex incontinence?

Back 26

absence of normal sensation usually assoc with voiding (SCI)

Front 27

Define functional incontinence?

Back 27

cognitive impairment

Front 28

Define Iatrogenic incontinence?

Back 28

invol loss of urine due to medical factors, usually meds

Front 29

What are the risk factors for urinary incontinence?

Back 29

preg, menopause, GU surgery, pelvic muscle weakness, imcomplete urethra due to trauma, immobility, high impact exercise, DM, stroke, age-related changes in UT, morbid obesity, cognitive disturbances, meds, toilet unavailable

Front 30

What are causes of transient incontinence?

Back 30

delirium, UTI, vaginitis, urethritis, meds, psychological factors, excessive urine production, stool impaction

Front 31

What are treatments for incontinence?

Back 31

pelvic floor muscle exercises, voiding diary, anticholingergic agents, antispasmodics, fluid management, vaginal cone

Front 32

Define urinary retention?

Back 32

inability to empty the bladder completely

Front 33

What is a normal residual urine volume?

Back 33

<100 mL

Front 34

What causes urinary retention?

Back 34

DM, BPH, urethral pathology, preg, neuro disorder, anticholinergic, antispasmodic, tricyclic antidep, alph-adrenegric agents, beta adrenergic lcokers, estrogens

Front 35

What are complications of urinary retention?

Back 35

chronic infection, renal calculi, pyelonephritis, sepsis, hydronephrosis, urine leakage causing skin breakdown

Front 36

What nursing management strategies can be used for urinary retention?

Back 36

warm/cold compresses, get up to commode, open faucet, privacy, catherization, bladder retraining

Front 37

What is neurogenic bladder?

Back 37

dysfunction that results from a lesion of the NS

Front 38

What are the 2 types of neurogenic bladder?

Back 38

spastic
flaccid

Front 39

What are urolithiasis and nephrolithiasis?

Back 39

renal calculi

Front 40

When do renal calculi occur?

Back 40

with an increase in calcium oxalate, calcium phosphate, uric acid

Front 41

What increases the risk for renal calculi?

Back 41

periods of immobility, urinary stasis, infection, IBS, ileostomy, bowel resection, antacids, acetazolamide, Vit D, laxative, high doses of asprin

Front 42

What is hypercalcemia and hypercalciuria?

Back 42

hypercalcemia- high serum calcium levels
hypercalciuria- high urine calcium

Front 43

What causes hypercalcemia and hypercalciuria?

Back 43

hyperparathyroidism (Ca+ gets pulled out of the bones), renal tubular acidosis, cancer, granulomatous disease (inc in Vit D production), excess Vit D intake, excessive intake of milk and alkali, myeloproliferative disease

Front 44

What causes uric acid stones?

Back 44

gout or myeloproliferative disorders

Front 45

What causes struvite stones?

Back 45

urease-splitting bacteria, neurogenic bladder, foreign bodies, recurrent UTI

Front 46

What causes cystine stones?

Back 46

rare inherited defect in renal absorption of cystine

Front 47

What are s/s of renal calculi?

Back 47

infection, deep ache in costovert region, hematuria, pyuria, N/V/D, renal colicky pain radiating down thigh into genitalia, urinary retention

Front 48

What mediates the colic pain?

Back 48

prostagladin E, increases ureteral contractility and renal blood flow and that leads to increased intraureteral pressure and pain

Front 49

Diagnostic tools for renal calculi?

Back 49

x-rays of KUB (kidney, ureters, bladder), ultrasound, IV urography, retrograde pyelography, blood chem, 24 hr urine collection (calcium, uric acid, creatinine, sodium, pH, vol), family hx, diet, meds

Front 50

What is the medical management of renal calculi?

Back 50

1. relieve the pain, NSAIDS work well- also inhibit prostagladin E
2. inc hydrostatic pressure with inc fluids
3. low protein and sodium diet

Front 51

What interventional procedures might be done for renal calculi?

Back 51

ureteroscopy (lasar), extracorporeal shock wave lithotripsy (electrical charge), endourologic stone removal (forceps removal), nephrolithotomy (stone removal), cystotomy, pyelolithotomy

Front 52

What type of diet is specified for the following types of stones
calcium, uric acid, cystine, oxalate?

Back 52

calcium-low protein and sodium
uric acid- low purine (organ meats, shellfish, mushrooms, asparagus
cystine- low protein
oxalate- low oxalate (spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran)

Front 53

What are potential complications of renal calculi?

Back 53

infection, urosepsis (UTI), obstruction, edema

Front 54

What are nursing management techniques for renal calculi?

Back 54

inc fluid intake, ambulation, all urine should be strained, VS, temp, hematuria is expected for a few days following treatment, treat UTI asap, s/s of complications

Front 55

What are common causes of GU trauma?

Back 55

gunshot wounds, blow to lower abdomen

Front 56

What is the medical and nursing management for GU trauma injuries?

Back 56

control hemorrhaging, infection and maintain urinary drainage, look for signs of oliguria, hemorrhagic shock, acute peritonitis, hypertension

Front 57

What are the risk factors for bladder cancer?

Back 57

smoking, environmental exposures, recurring UTIs, bladder stones, high urine pH, high chol intake, pelvic radiation therapy, cancers from prostrate, colon, rectum

Front 58

What are s/s of bladder cancer?

Back 58

painless hematuria, pelvic or back pain, UTI- frequency, urgency, dysuria

Front 59

What diagnosistic techniques are used for bladder cancer?

Back 59

CT, ultrasonography, bimanual exam, urography, cystoscopy, antigen, growth factor

Front 60

What are the treatments for bladder cancer?

Back 60

transurethral resection or fulguration (cauterization), BCG, radial cystectomy, chemo, radiation, photodynamic techniques

Front 61

What is a radical cystectomy?

Back 61

removal of bladder, prostate, seminal vesicles, lower urether, uterus, fallopian tubes, ovaries, anterior vagina, urethra, and may be pelvic lymph nodes

Front 62

What is a cutaneous urinary diversion?

Back 62

when urine is drained through an opening created in the abdominal wall and skin

Front 63

Describe an ileal conduit

Back 63

ureters are connected to a ileal segment that has one end brought to the abdominal wall, urine drains into ileostomy bag

Front 64

What are possible complications of ileal conduits?

Back 64

wound infection, leakage, ureteral obstruction, hyperchloremic acidosis, small bowel obstruction, ileus, gangrene, stenosis, pyelonephritis, renal calcuil, renal deterioration

Front 65

What are some nursing considerations for ileal conduit?

Back 65

drain bag when 1/3 full, inspect skin often, keep urine pH <6.5, avoid foods that cause urine to smell, take ascorbic acid by mouth to suppress urine odor

Front 66

What is a cutaneous ureterostomy?

Back 66

one ureter is brought to skin, usually caused by ureteral obstruction

Front 67

What is a continent ileal urinary reservoir?

Back 67

bladder is removed and replaced by using the ileum and cecum along with a cecostomy tube to bring to abdominal wall. Urine is then drained by regular catheterization into cecostomy tube

Front 68

What is a ureterosigmoidostomy?

Back 68

implantation of ureters into sigmoid colon. Voiding occurs from the rectum.

Front 69

What are complications of ureterosigmoidostomy?

Back 69

infection, electrolyte imbalance/acidosis (bowel reabsorption of electrolytes), diarrhea, gas can cause urinary incontinence, pyelonephritis