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84 Cards in this Set

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UTI
Invasion of the urinary tract by bacteria; most commonly caused by ascending infection
Hospital: nosocomial infections
Escherichia Coli: most common bacteria
UTI predisposing factors
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
S&S of UTI
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
urethritis etiology
Inflammation of the urethra
Causes: chemical irritant, bacterial infection, trauma or exposure to sexually transmitted disease
urethritis diagnosis
urinalysis and urine culture and sensitivity
urethritis treatment
Remove chemical irritant
Antibiotic based on urine culture results
Pyridium (Phenazopyridine): analgesic for dysuria, orange urine
cystitis etiology
Inflammation and infection of bladder wall
90% caused by Escherichia coli
Catheters in hospitals
cystitis diagnosis
urinalysis and urine culture and sensitivity: cloudy urine, WBCs, bacteria, RBCs, nitrates; determine appropriate antibiotic
cystitis treatment
Sulfa combination such as Sulfamethoxazole and Trimethoprim (Bactrim, Septra) or Ciprofloxacin (Cipro); Estrogen in women
pyelonephritis etiology
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
pyelonephritis etiology
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
pyelonephritis symptoms
Usual UTI, flank pain, costovertebral tenderness
pyelonephritis diagnosis
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
pyelonphritis treatment
Antibiotics based on culture & sensitivity results

Repeated infections can cause urosepsis, scarring and loss of function, renal failure
Trimethoprim-Sulamethoxazole (Bactrim and Septra) Sulfonamides:
UTI
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
Ciprofloxacin (Cipro) Fluoroquinolone:
UTI
Pseudomonas and other Enterobacteria
GI upset, dry mouth, oral and vaginal fungal infections
Avoid aluminum antacids, large
amounts of water, caution in pregnancy
Phenazopyridine (Pyridium):
UTI
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
urological obstructions
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
urethral strictures
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
n
renal calculi
“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
renal calculi causes
Family history, chronic dehydration, infection, dietary factors, immobility
renal calculi S&S
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
renal calculi diagnosis
Kidney-Ureter-Bladder (KUB) examination or intravenous pyelogram, renal ultrasound, urinalysis
renal calculi treatment
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
renal calculi interventions
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
prevention of renal calculi
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)
hydrophrosis etiology
Results from untreated obstruction of the urinary tract
Kidney enlarges and becomes a sac filled with urine instead of functioning
hydronephrosis causes
strictures, kidney stones, tumors, enlarged prostate
hydronephrosis treatment
Stents,
Nephrostomy Tube (avoid kinks in
tubing, do not clamp and assess urine
output)
Increased risk for UTIs
tumors of renal system
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
tumors of renal system S&S
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
tumors of renal system diagnosis
Diagnosis: Routine Urinalysis for presence of the enzyme telomerase, urine cytology; cystoscopy and biopsy; Intravenous Pyelogram
tumors of renal system interventions
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
tumors of renal system management
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
cancer of the kidney S&S
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
cancer of the kidney diagnosis
Renal Biopsy besides other tests such as CT scan, ultrasound, IVP, MRI, Cystoscopy and Pyelogram
cancer of the kidney interventions
Nephrectomy followed by radiation, chemotherapy
nursing management after nephrectomy
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
renal system trauma
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
polycystic kidney disease etiology
Formation of multiple cysts in the kidney, replace normal kidney structures; hereditary
polycystic kidney disease S&S
dull heaviness in flank or lumber region and hematuria, hypertenison, UTI
Renal failure; no treatment
diabetic nephropathy
most common cause of renal failure; damage to small blood vessels in the kidney
diabetic nephropathy risk factors
Hypertension
Genetic Disposition
Smoking
Chronic Hyperglycemia
diabetic nephropathy symptoms
Microalbuminuria advancing to proteinuria
Hypertension;
Decreased urine output, toxic wastes accumulate, renal failure
diabetic nephropathy diagnosis
Protein and albumin in urine, serum creatinine level, 24-hour creatinine clearance
More risk for cardiovascular disease
diabetic nephropathy treatment
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
nephrotic syndrome etiology
excretion of 3.5g or more of protein in the urine per day
nephrotic syndrome S&S
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
nephrotic syndrome care
ocus on prevention of infection and decrease edema; daily weights, abdominal girth measurements, intake and output, prevent injury to edematous tissue
nephrosclerosis etiology
Damage to the kidneys by hypertension causing sclerotic changes in arteries and arterioles and arteriosclerosis (thickening and hardening) in renal blood vessels
nephrosclerosis S&S
proteinuria, hyaline casts in urine and renal failure
nephrosclerosis treatment
Control hypertension, low sodium diet; dialysis
nephrosclerosis care
Impaired Health Maintenance: focus on education of renal failure symptoms and control hypertension
glomerulonephritis etiology
Inflammation of the glomerulus caused by immunological abnormalities, toxins, vascular disorders and systemic disease; allows protein, WBCs and RBCs to leak into urine
glomerulonephritis causes/types
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
glomerulonephritis S&S
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
glomerulonephritis care
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
renal failure etiology
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
acute renal failure etiology
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
acute renal failure causes
Hypotension
Vascular Obstruction
Glomerular Disease
Acute Tubular Necrosis (tubules damaged after administration of diagnostic contrast media)
Certain Nephrotoxic Medications
4 stages of acute renal failure
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
acute renal failure classifications
Classified as Prerenal, Intrarenal or Postrenal
Treated by relieving the cause. Prevention of permanent damage is the goal of treatment.
prerenal failure
“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
intrarenal failure
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
postrenal failure
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
Continuous Renal Replacement Therapy (CRRT):
Removes fluid and solutes in a controlled continuous manner in unstable patients with acute renal failure, cannot tolerate rapid fluid shifts
chronic renal failure etiology
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
chronic renal failure causes
diabetes mellitus resulting diabetic nephropathy, high blood pressure causing nephrosclerosis, glomerulonephritis and autoimmune disease
Without symptoms in early stages, 50% nephrons lost
renal insufficiency stage
at least 75% of neurons lost function
end stage renal disease
occurs when 90% of the nephrons are lost and require dialysis and/or kidney transplant to survive
symptoms of chronic renal failure
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
symptoms of renal failure
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
symptoms of renal failure
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
symptoms of renal failure
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
symptoms of renal failure
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
treatment of renal failure
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
treatment of renal failure meds
Diuretics
Control Hypertension
Phosphate Binders
Calcium and Vitamin D supplements
Must be closely monitored!
Diabetics need less insulin
treatment of renal failure dialysis
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
hemodialysis
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
hemodialyisis side effects
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
hemodialysis vascular access
Vascular Access Graft or Arteriovenous (AV) Fistula surgically placed in arm if possible; temporary access with central venous catheter
hemodialyisis venous access care
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
peritoneal dialysis
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
kidney transplant
Can reverse many of the physiological changes noted with renal failure
No longer dependent on dietary restrictions and dialysis