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52 Cards in this Set
- Front
- Back
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CYSTITIS
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-UTI from ascending bacteria or obstructive void patterns (causes decreased flow or urine stasis)
-8x's higher in women -untreated UTI's lead to pyleonephritis OR bacteremia -UTI's increase during hospital -Ecoli is most common bacteria from intestines -Ask women about gyno issues because STD's can be responsible for UTI symptoms -Urine culture most accurate diagnostic tool |
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HONEYMOON CYSTITIS
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not voiding after sex
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CYSTITIS SYMPTOMS
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-Pain
-Frequent/Urgent Voiding -Cloudy Urine -Dysuria (pain on urination) -Voiding small amounts -Incomplete emptying of bladder -Hematuria |
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ASYMPTOMATIC CYSTITIS
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-Only sign is usually altered mental status with or without fever and usually in older adults
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CYSTITIS MEDICAL TREATMENT
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-Broad spectrum antibiotics should begin before C&S
-Later more specific antibiotics like Bactrim, Cipro, Macrobid, Pyridium -EDUCATE to complete entire course of antibiotics -AVOID alcohol, caffeine, tomatoes, spicy foods, chocolate, and some berries because IRRITATES BLADDER -CRANBERRY JUICE and VIT C (ascorbic acid) ACIDIFIES URINE great with UTI's -- blocks bacteria from attaching to bladder -3-4L of fluids (water) per day it prevents urolithiasis |
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CYSTITIS COMPLICATIONS
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- antibiotics may destroy normal flora and cause diarrhea, bowel issues, vaginal candidiasis, and reduce the effectiveness of oral birth control and estrogen
-sulfa drugs increase sensitivity to sun -recurrent pyleonephritis can cause renal scarring and possibly chronic renal failure |
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CYSTITIS NURSING PLAN
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-clean catch urine specimen (wiping with towelette provided, urinating a little into toilet first, then catching specimen in cup, careful with touching inside of cup)
-keep urine ACIDIC .. 10oz cranberry juice daily -3-4L fluids (water) to flush system -NO CAFFEINE (causes urgency and frequency) -if catheter maintain closed drainage do meticulous perineal care with mild soap and water -fluid calculation = 0.5oz fluid/lb. -void Q2-4H or if preggo Q2-3H -void before and after sex -no tub baths, wear cotton undies, no pantyhose -VAGINAL ESTROGEN for older women to compensate for the atrophic mucosal layer |
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URETHRITIS
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-inflammed urethra
-STD's -mucosal lining is swollen, painful, red, irritated and produces PYRUIA (pus in urine) -Women usually have chemical irritant history -Men exhibit urethral discharge |
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URETHRITIS MEDICAL TREATMENT
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-C&S and exclude STD's as cause
-antibiotics -sitz baths -increase fluids -prevent by decreasing exposure to STD's -avoid sex until symptoms subside -use lubricant with sex to decrease irritation |
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UROSEPSIS
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-bacteremia originating in GI tract
-Ecoli most common but can be from bacteria, fungi, viruses, parasites -leads to septic shock and death |
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UROSEPSIS PATHO
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-bacteria release endotoxins which damage cells
-damaged cells release lysosomes which further damage tissues and instigate kinins and complement cascade -cell metabolism therefore becomes ANAEROBIC -finally lactic acidosis develops |
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UROSEPSIS SYMPTOMS
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-fever
-altered mental status -hyperventilation usually before fever begins (low carbon dioxide level and can result in resp alkalosis) |
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UROSEPSIS MEDICAL TREATMENT
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-IV aminoglycosides, beta-lactam antibiotics (Aztreonam), or 3rd generation cephalosporins until C&S results avail then antibiotic may change PRN
-continue IV until afebrile then continue with oral antibiotics |
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INTERSTITIAL CYSTITIS
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-painful bladder, aka Hunner's ulcer, pseudomembranous trigonitis
-mainly young women or those with inflammatory and irritable bowel diseases -urine is sterile |
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INTERSTITIAL CYSTITIS PATHO
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-fibrosis of submucosa of bladder wall leads to decreases elasticity of detrusor muscle (helps contract bladder to get rid of urine) which leads to decreased bladder capacity
-mast cell infiltrates usually present in bladder wall and these are associated with allergic reactions |
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INTERSTITIAL CYSTITIS SYMPTOMS
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-urgency and frequency up to 60 x's a day!
-painful bladder despite no bacteria in urine -if really severe = ulcerations and hemorrhage -during anterior palpation reveals tenderness around bladder trigone area, low abd and pelvic pain, nocturia, dyspareunia (painful sex) |
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INTERSTITIAL CYSTITIS DX CRITERIA
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-detailed hx with phys exam
-bladder diary -urine cytology -urodynamic eval -cystoscopy -bladder bx -DX features = during the cystoscopy you will see outpouches in bladder wall, Hunner's ulcers, and a severely decreased bladder capacity |
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INTERSTITIAL CYSTITIS MEDICAL TREATMENT
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-Elmiron (oral med of choice) - it increases bladder defenses or detoxifies irritants in urine
-antiinflammatory, antispasmodic, antidepressants to help cope, antihistamines, sometimes opioids or tranqs -instillation of agents into bladder to promote healing and pain reduction (Clorpactin, silver nitrate, dimethyl sulfoxide) -instillation of heparin into bladder -all of instillation meds aimed to decrease permeability of bladder mucosa so causing agent cant penetrate lining -BCG intravenously weekly has also been effective |
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INTERSTITIAL CYSTITIS NURSING PLAN
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-patient will be exhausted, depressed
-void by clock rather than urgency -pelvic floor exercises -transvag or transanal electric stim to help override spasms -traditional treatment is hydraulic distention of bladder with or w/o instillation DMSO to increase bladder capacity |
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BLADDER CANCER
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-50-60 years
-STOP SMOKING (CA results from exposure of bladder wall to carcinogen) -regular screenings for hematuria (usually painless and intermittent which can delay going to doc) -Vit C and E -greater intake fluidds can help reduce risk (milk, sodas, lemonade, coffee, tea, alcohol) -jewett marshall strong system and TNM classification stages bladder cancer (0ABCD 0 good D bad) and T0-T4N4M1 T0 good T4N4M1 bad) -cystoscopic exam for recurrence findings |
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BLADDER CANCER SYMPTOMS
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-painless hematuria usually intermittent and first sign
-as it progresses = frequent bladder irriation with dysuria, frequency, and urgency |
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BLADDER CANCER DIAGNOSTIC TESTS
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-IVP (dye-enhanced xray) can see bladder, ureters, and kidneys
-CT -MRI -US -CEA is a serum tumor marker which is present with adenocarcinomas of bladder (carcinoembryonic antigen) |
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BLADDER CANCER MEDICAL TREATMENT
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-intravesical BCG instilled into bladder
-retain fluid for 2 hours with side to side position changes or supine to prone Q15-30 minutes -pee to allow drainage -drink 2 glasses water to flush -steroids and CIPRO s/p to prevent recurrence -intravesical instillation of alkylating chemo agent for topic treatment (Gemzar,Valstar) -radiation rarely used except for palliative reasons |
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BLADDER CANCER CHEMO COMPLICATIONS
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-bladder irritation
-frequency/urgency -dysuria -these resolve in about 1-2 days -systemtic reaction = hematuria, fever, malaise, nausea, chills, arthralgia (joint pain), pruritis *REPORT THESE* |
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BLADDER CANCER RADIATION COMPLICATIONS
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-hemorrhagic cystitis (sudden onset hematuria with bladder pain)
-bladder irritation -instill formalin to help control bladder hemorrhaging resulting from cancer treatments -other symptoms = cystitis, proctitis (rectum inflamm), dysuria, freq/urgency, nocturia, diarrhea -6-12 mos s/p radiation can have delayed effects = ileitis, colitis, persistent cystitis, bladder ulceration, fistual formation |
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BLADDER CANCER NURSING PLAN
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-before BCG or chemo NO FLUIDS 4 hours prior it decreases the need to pee for 2 hours after tx
-chemo is toxic so for 6 hours s/p ALL URINE AND TOILET BOWL MUST BE CLEANED WITH BLEACH -if fever s/p instillation BCG give isoniazid or other meds that treat TB -radiation proctitis = low residue diet and drugs to decrease intestinal motility |
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BLADDER CANCER SURGICAL TREATMENTS
TRANSURETHRAL RESECTION (removes cancerous tissue) |
-resection of bladder tumor through cystoscope
-followed by instillation BCG or chemo to prevent recurrence -hematuria usually common issues s/p tx with 3 way indwelling cath and bladder irrigation -bright red or pink fades to clear in about 3 days |
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BLADDER CANCER SURGICAL TREATMENTS
PARTIAL CYSTECTOMY (removal of all or part of urinary bladder) |
-up to 1/2 of bladder can be removed
-for isolated tumor that cant be treated with resection -initial postop bladder capacity REDUCED big time may be able to handle no more than 60ml |
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BLADDER CANCER SURGICAL TREATMENTS
CYSTECTOMY (removal) and URINARY DIVERSION |
-tx of choice when resection or chemo isnt working
-women = removal of bladder, urethera, uterus, fallopian tubes, ovaries, anterior segment of vagina -men = removal of bladder, urethra, prostate, seminal vesicles -permanent urinary diversion is now required |
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BLADDER CANCER SURGICAL TREATMENTS
ILEAL CONDUIT s/p CYSTECTOMY |
-uses segment of intestine as conduit (channel for flow of urine) the surgeon constructs system for urine to empty through artificial stoma
-terminal ileum (end of small intestines) is used because of the less reabsorptive power -mucous shreds are present in urine -patients increased risk for pyleonephritis, hydronephrosis, and calculi formation |
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BLADDER CANCER SURGICAL TREATMENTS
INDIANA POUCH s/p CYSTECTOMY |
-aka Kock pouch
-resevoir created from ascending colon and terminal ileum (end of small intestines) -patient taught to self-cath at 3-4hour intervals -used for patients with life expect >2 years -creatinine level should be 2.5mg or less -pt needs to have fine gross and motor skills otherwise won't work -pt also can't have hx of bowel resection and malabsorption issues -electrolyte imbalances, malabsorption bile salts or vit b12 |
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BLADDER CANCER SURGICAL TREATMENTS
NEOBLADDER s/p CYSTECTOMY |
-aka ileal W-bladder
-urethra is spared -neobladder empties via pelvic outlet in urethra -empties neobladder by relaxing external sphincter and creating abd pressure - pt must learn self-cath to cope with void diff -educate "strain to void" or "valsalva voiding" -electrolyte imbalances, calculi, malabsorption bile salts, b12, fat, fat-soluble vit ADEK, increased risk steatorrhea and kidney stones |
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BLADDER CANCER PALLIATIVE PROCEDURES
PERCUTANEOUS NEPHROSTOMY OR PYELOSTOMY |
-to prevent obstruction
-cath into renal pelvis -local anesthia -important to stabilize tube to prevent dislodgement |
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BLADDER CANCER POSTOP NURSING PLAN
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-absent peristalsis cuz of manipulation and resection of bowel so NPO with IV lines and NG tubes until it return
-constantly monitor the stents in place for patency and drainage -major complications s/p are infection, wound dehiscence, skin irriation, ulceration, and stoma issues -if any obstruction occurs, irrigate gently using 30-60ml normal saline only if you have order |
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BLADDER CANCER POSTOP MONITORING s/p URINARY DIVERSIONS
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-measure urine output every hour for first 24 hours
-report anything less than 0.5ml/kg/hour or < 30ml/hr or no output for 15 minutes -check ostomy pouch -inspect stoma (DUSKY OR CYANOTIC BAD) -watch for symptoms of peritonitis = fever, abd pain, abd rigidity -observe for bleeding -teach resevoir cath = insert cath q2-3 hours to drain it, each week after increase interval by 1 hour until reaches every 4-6 hours day and every 6 hours night -teach resevoir irrig = after resevoir drained, leave cath in place to to use 50-60ml normal saline to irrigate and prevent excess mucous buildup; can repeat until free of mucous if it is too thick increase fluids and drink cranberry |
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URETERAL TUMORS
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-mainly men 50-60years
-gross hematuria -painless until obstruction happens (flank pain with or w/o hydronephrosis) -surgical excision and resection, poss radiation -nephrourectomy = removal of kidney, ureter, and attached seg of bladder -silicone rubber, teflon, or bovine graft to replace removed ureter -percut neph tube for palliative -poss urinary diversion or urinary stent to maintain patency -gibbson's stent or newer drouble J stent prevents migration up ureter or dislodgement from peristalsis waves |
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UROLITHIASIS/NEPHROLITHIASIS
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-from urinary stasis or supersaturation of urine with poorly soluble crystalloids
-increased solute concentrations from fluid depletion or increased solute load -abnormal ph levels can influence solubility -lack of inhibitor substances (Chelating agents) like citrate and magnesium can help increase stone develop -southeast part of US is "stone belt" lots of stones in people found here |
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UROLITHIASIS/NEPHROLITHIASIS TYPES OF STONES
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-CALCIUM (most common) - "calcium wasters" from high bone rate reabsorp, impaired renal tubule absort, gut absorpt; treat with vit b6, mag oxide, allopurinol
-OXALATE (second most common) - "diet" from resection/small bowel bypass, fat malabsorp, overdose ascorbic acid vit C, AVOID TEA, TOMATOES, COFFEE, COLA, BEER, RHUBARB, GREENBEANS, ASPARAGUS, SPINACH, CABBAGE, CELERY, CHOC, CITRUS, APPLEs, GRAPES, CrANBERR, PEANUTS -STRUVITE = staghorn calculus -URIC ACID = gout, diet high in purines, NO AGED CHEESE, WINE, BONY FISH, ORGAN MEATS, treat with allopurinol, nabicarb, or citrate |
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URINARY REFLUX
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-backwards flow urine
-increase pressure in blader -continuous pressure of residual urine leads to UTI's -can lead to renal damage and pyelonephritis; and overdistention of bladder decreases detrusor tone which increases the bladder's capacity |
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URINARY REFLUX
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-treatment is surgical
-reimplantation or other tx's of ureter -post op urine will progress from bright red to clear to yellow |
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URINARY RETENTION
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-bladder can't empty during voiding
-hazardous cuz resulting urine stasis contributes to UTI, stones, and structural damage of bladder, ureters, and kidneys and eventually loss bladder tone -prolonged obstruction leads to increased pressures in urinary tract and predisposes to diverticulum |
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URINARY RETENTION
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-primary sx is distended bladder or inability to empty
-25-50ml 1 or more times hour may indicate -DX test is cath post-void residual 100ml = retention |
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URINARY RETENTION
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-cholinergic meds can help stimulate bladder contractions (Urecholine,Prostigmin)
-if obstruction NO cholinergics -cholinergics combined with alpha-adrenergic blockers (hytrin, minipress, dibenzyline) -don't cath unless 300ml or more residual -prophylactic antibiotics sometimes given -bladder neck repair or suprapubic cystostomy -suprapubic postop = twisting/kinking, sediments/clots |
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URINARY INCONTINENCE
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-involunatry loss of urine
-dx tool is bladder diary -stress, detrusor, overflow -NOT A NORMAL PART OF AGING |
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STRESS INCONTINENCE
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-invol leakage on effort or exertion (sneeze, cough, laughing, exertion)
-qtip test (pt asked to strain >30 degree difference with horizontal plane indicates positive result and hypermobility) |
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DETRUSOR INCONTINENCe
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-unhibited detrusor activity assoc w/ motor disorders
-or decreased mobility from upper motor neuron spinal lesion |
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OVERFLOW INCONTINENCE
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-overdistention of bladder and eventually overflow of excessive urine
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URINARY INCONTINENCE MANAGEMENT
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-pelvic muscle exercises (kegel's)
-pelvic floor reeducation with biofeedback -electrical stimulation -bladder training -control fluids -avoid bladder irritants like alcohol, caffeine, chocolate -overactive bladder with anticholinergic (Ditropan,Detrol) -Tricyclic antidepressants (Tofranil, Elavil) -Vaginal Estrogen |
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URINARY INCONTINENC SURGICAL
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-bladder neck suspensions (restore normal urethrovesical junction or lengthen and support urethra) Burch colposuspension s/p suprapubic cath for 14 days
-sling procedure for intrinsic sphincter deficiency (severe stress incontinence) TVT aka transvaginal tape) -implantation of artificial urinary sphincter when all other measures have failed *control pump* |
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NEUROGENIC BLADDER
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-from spinal
-upper motor lesions (above sacral) produce spastic bladdres *HYPERREFLEXIA* -lower motor lesions (below sacral) produce lacking bladders (areflexic or atonic) -MAJOR SX = retention w/ or w/o incontinence; patient may or may not feel need to void or feel a sense of bladder distention |
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NEUROGENIC BLADDER
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-bladder train
-antispasmodics and anticholinergics (Ditropan, Detrol, Vesicare -alpha adrenergic blockers |
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KIDNEY STONES
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-thiazide diuretic (hydrocholorothiazide) prevents extra calcium loads in urine but give potassium citrate to replace K as needed
-for low urine citrate give K or NAcitrate |
