NURS 611-Patho Exam 4
H H H H
NURS H611 HAdvanced
HPathophysiology H
Exam H#4 HStudy
HGuide
Week H15 HRenal Hand HUrologic H Systems: H Chapters H38 H& H39
Urinary HTract HObstruction: Hinterference Hwith Hthe Hflow Hof Hurine Hat Hany Hsite Halong Hthe Hurinary Htrac
* Impedes Hurine Hflow,
Hincreases
H hydrostatic
Hpressure, H and
H dilates Hstructures
Hproximal HtoH the
Hobstruction,
Hincreases Hrisk Hfor
Hinfection, Hand
Hcompromises H renal
Hfunction
Acute HUnilateral H Renal HObstruction H& HHypertension
* Passage Hof Hkidney Hstones Hcan Hbe Hextremely Hpainful H& Hmay Hproduce H“referred
Hpain” HtoH
umbilicus Harea H(due Hto Hthe Hsensory Hinnervation Hof Hthe
Hupper Hpart Hof
the Hureter Harising Hfrom Hthe H10th Hthoracic Hnerve Hroots)
Reduced Hperfusion H(kidneys Hrequirement His Hat Hleast H20-25% HCO-MAP) Hof
Hthe Haffected H kidney H activates H the H RAAS, H which H causes H constriction H of
H peripheralH
arterioles H(= HHTN)
Kidney H Stones: H masses H of H crystal, H protein, H or H other H substances H that H are H a
H commonH cause Hof Hurinary Htract Hobstruction
* Risk Hfactors Hare Hage, Hsex, Hrace, Hgeographic Hlocation, Hseasonal Hfactors, Hfluid Hintake,
Hdiet,H
occupation, Hgenetics, Hother Hconditions Hsuch Has HUTI, HHTN, Hatherosclerosis,
Hmetabolic Hsyndrome, Hobesity Hand HDM Htype HII
* Classified H according H to H primary H minerals Hthat make Hup
Hthe H stones--> H Calcium H Oxalate H most common
Pathophysiology
Complex H process; H involves H (1) H supersaturation H of H one or Hmore
salts Hin Hurine, H(2) Hprecipitation Hof Hsalts Hfrom Ha Hliquid Hto a
Hsolid H
state, H(3) Hgrowth Hthrough Hcrystallization Hor
, NURS 611-Patho Exam 4
H H H H
agglormeration, Hand H(4) Heffect Hof Hstone Hinhibitors
Clinical H Manifestations—Pain, HN/V, HGross Hor
microscopic Hhematuria
H
* Renal H colic H is Hmoderate Hto H severe Hpain
Posterior Hflank H& Hradiates Hto Hgroin Renal Hpelvis Hor Hproximal Hureter
Lateral Hflank Hor Hlower Habdomen Midureter
, NURS 611-Patho Exam 4
H H H H
Bothersome HUTI Hsymptoms H(urgency, Lower Hureter Hor Huterovesical Hjunction
Hfrequent
voiding, H urge H incontinence)
Urinary HTract HInfections H(UTI)
* Inflammation Hof Hthe Hurinary Hepithelium Husually
Hcaused H by H bacteria H from H gut H flora, H occurs
H anywhereHalong Hthe Hurinary Htract H(urethra,
Hbladder, Hureter, HorHkidney)
Who H His Hat H Hrisk? HPremature Hnewborns; Hprepubertal
Hchildren; Hsexually Hactive Hand H pregnant H women; Hwomen
Htreated Hwith Hantibiotics Hthat Hdisrupt Hvaginal Hflora;
Hspermicide H users; H estrogen-deficient H postmenopausal
Hwomen; Hindividuals H with H indwelling Hcatheters; Hpersons
H with H
DM, Hneurogenic Hbladder, Hor Hurinary Htract
Hobstruction
Clinical Hmanifestations Hof Ha HUTI Hin Han Holder Hadult Hare
Hconfusion Hand Hpoorly Hlocalized Habdominal Hdiscomfort,
HveryH
difficult Hdiagnose Hdue Hto Hvague Hsymptoms
Types
I. Cystitis
* Inflammation Hof Hthe Hbladder H& Hthe Hmost Hcommon Hsite Hof HUTI
HPathophysiology—most H common H infecting H microbe H is H E.coli H (80-85%), H second H is
HStaphylococcus H saprophyticus H (10%). H Bacterial H contamination H of H the H sterile H urine
H usuallyHoccurs Hby H retrograde Hmovement Hof Huropathic Hgram-negative Hbacilli H from
H the H gut H into H the Hurethra Hand Hbladder Hand Hthen Hto Hthe Hureter Hand Hkidney
Clinical H Manifestations: H related H to H the H host H inflammatory H response H & H usually
H includeH frequency, Hurgency, Hdysuria H(painful Hurination), H& Hsuprapubic Hand Hlow Hback Hpain
› Inflammatory Hedema Hin Hthe Hbladder Hwall Hstimulates Hdischarge Hof Hstretch Hreceptors,
Hinitiating H symptoms H of H bladder H fullness H with H small H volumes H of H urine H &
H producing H urgencyH
and Hfrequency
› Hematuria, Hflank Hpain, Hcloudy H& Hfoul-smelling Hurine
HareH
most Hserious Hsymptoms
Treatment--> Hurosepsis H& Hseptic Hshock Hare Hmedical
Hemergencies, H demand H parenteral, H broad-spectrum
H antibx Htx Hand Hmay Hrequire Hhospitalization
, NURS 611-Patho Exam 4
H H H H
II. Pyelonephritis
* Infection Hof Hone Hor Hboth Hupper Hurinary Htracts H(ureter, Hrenal
Hpelvis, H
kidney Hinterstitium)
Urinary Hobstruction H& Hreflux Hof Hurine Hfrom Hthe Hbladder
(vasicoureter Hreflux) Hare Hthe Hmost Hcommon Hunderlying Hrisk Hfactors
⟶ H Common H causes H are H kidney H stones, H vesicoureteral H reflux,
H pregnancy,H
neurogenic H bladder, H instrumentation, H and H female H sexual
H trauma
Pathophysiology— HMicrobes Hassociated Hinclude HE.coli, HProteus, H&
HPseudomonas. HLatter Htwo Hare Hassociated Hwith Hinfections Hafter
Hsurgery.
These Hspecific Hmicrobes Hsplit Hurea Hin
to Hammonia, Hmaking Halkaline Hurine Hthat Hincreases Hthe Hrisk Hof Hstone
Hformation. HIn Hsevere Hinfections, Hlocalized Habscesses Hmay Hform Hin Hthe
Hmedulla Hand Hextend Hto Hthe Hcortex.
Clinical HManifestations: Hacute, Hwith Hfever, Hchills, Hand Hflank Hor Hgroin Hpain. HOlder Hadults
HmayHexperience Hlow-grade Hfever Hand Hmalaise.
** HDifferentiating Hsymptoms Hof Hcystitis Hfrom Hthose Hof Hpyelonephritis Hby
H clinicalH
assessment Halone His Hdifficult.
The Hspecific Hdiagnosis His Hestablished Hby Hurine Hculture, HUA, Hand Hclinical Hsigns
H &H
symptoms.
WBC Hcasts Hindicate Hpylenephritis**
Painful HBladder HSyndrome/Interstitial HCystitis H(PBS/IC): Hunpleasant Hsensation H(pain,
Hpressure, Hdiscomfort) Hperceived Hto Hbe Hrelated Hto Hthe Hurinary Hbladder Hassociated Hwith
Hlower Hurinary HtractHsymptoms Hof Hmore Hthan H6 Hweeks’ Hduration Hin Hthe H Habsence H Hof H
Hinfection H Hor H Hother Hidentifiable H causes
H H H H
NURS H611 HAdvanced
HPathophysiology H
Exam H#4 HStudy
HGuide
Week H15 HRenal Hand HUrologic H Systems: H Chapters H38 H& H39
Urinary HTract HObstruction: Hinterference Hwith Hthe Hflow Hof Hurine Hat Hany Hsite Halong Hthe Hurinary Htrac
* Impedes Hurine Hflow,
Hincreases
H hydrostatic
Hpressure, H and
H dilates Hstructures
Hproximal HtoH the
Hobstruction,
Hincreases Hrisk Hfor
Hinfection, Hand
Hcompromises H renal
Hfunction
Acute HUnilateral H Renal HObstruction H& HHypertension
* Passage Hof Hkidney Hstones Hcan Hbe Hextremely Hpainful H& Hmay Hproduce H“referred
Hpain” HtoH
umbilicus Harea H(due Hto Hthe Hsensory Hinnervation Hof Hthe
Hupper Hpart Hof
the Hureter Harising Hfrom Hthe H10th Hthoracic Hnerve Hroots)
Reduced Hperfusion H(kidneys Hrequirement His Hat Hleast H20-25% HCO-MAP) Hof
Hthe Haffected H kidney H activates H the H RAAS, H which H causes H constriction H of
H peripheralH
arterioles H(= HHTN)
Kidney H Stones: H masses H of H crystal, H protein, H or H other H substances H that H are H a
H commonH cause Hof Hurinary Htract Hobstruction
* Risk Hfactors Hare Hage, Hsex, Hrace, Hgeographic Hlocation, Hseasonal Hfactors, Hfluid Hintake,
Hdiet,H
occupation, Hgenetics, Hother Hconditions Hsuch Has HUTI, HHTN, Hatherosclerosis,
Hmetabolic Hsyndrome, Hobesity Hand HDM Htype HII
* Classified H according H to H primary H minerals Hthat make Hup
Hthe H stones--> H Calcium H Oxalate H most common
Pathophysiology
Complex H process; H involves H (1) H supersaturation H of H one or Hmore
salts Hin Hurine, H(2) Hprecipitation Hof Hsalts Hfrom Ha Hliquid Hto a
Hsolid H
state, H(3) Hgrowth Hthrough Hcrystallization Hor
, NURS 611-Patho Exam 4
H H H H
agglormeration, Hand H(4) Heffect Hof Hstone Hinhibitors
Clinical H Manifestations—Pain, HN/V, HGross Hor
microscopic Hhematuria
H
* Renal H colic H is Hmoderate Hto H severe Hpain
Posterior Hflank H& Hradiates Hto Hgroin Renal Hpelvis Hor Hproximal Hureter
Lateral Hflank Hor Hlower Habdomen Midureter
, NURS 611-Patho Exam 4
H H H H
Bothersome HUTI Hsymptoms H(urgency, Lower Hureter Hor Huterovesical Hjunction
Hfrequent
voiding, H urge H incontinence)
Urinary HTract HInfections H(UTI)
* Inflammation Hof Hthe Hurinary Hepithelium Husually
Hcaused H by H bacteria H from H gut H flora, H occurs
H anywhereHalong Hthe Hurinary Htract H(urethra,
Hbladder, Hureter, HorHkidney)
Who H His Hat H Hrisk? HPremature Hnewborns; Hprepubertal
Hchildren; Hsexually Hactive Hand H pregnant H women; Hwomen
Htreated Hwith Hantibiotics Hthat Hdisrupt Hvaginal Hflora;
Hspermicide H users; H estrogen-deficient H postmenopausal
Hwomen; Hindividuals H with H indwelling Hcatheters; Hpersons
H with H
DM, Hneurogenic Hbladder, Hor Hurinary Htract
Hobstruction
Clinical Hmanifestations Hof Ha HUTI Hin Han Holder Hadult Hare
Hconfusion Hand Hpoorly Hlocalized Habdominal Hdiscomfort,
HveryH
difficult Hdiagnose Hdue Hto Hvague Hsymptoms
Types
I. Cystitis
* Inflammation Hof Hthe Hbladder H& Hthe Hmost Hcommon Hsite Hof HUTI
HPathophysiology—most H common H infecting H microbe H is H E.coli H (80-85%), H second H is
HStaphylococcus H saprophyticus H (10%). H Bacterial H contamination H of H the H sterile H urine
H usuallyHoccurs Hby H retrograde Hmovement Hof Huropathic Hgram-negative Hbacilli H from
H the H gut H into H the Hurethra Hand Hbladder Hand Hthen Hto Hthe Hureter Hand Hkidney
Clinical H Manifestations: H related H to H the H host H inflammatory H response H & H usually
H includeH frequency, Hurgency, Hdysuria H(painful Hurination), H& Hsuprapubic Hand Hlow Hback Hpain
› Inflammatory Hedema Hin Hthe Hbladder Hwall Hstimulates Hdischarge Hof Hstretch Hreceptors,
Hinitiating H symptoms H of H bladder H fullness H with H small H volumes H of H urine H &
H producing H urgencyH
and Hfrequency
› Hematuria, Hflank Hpain, Hcloudy H& Hfoul-smelling Hurine
HareH
most Hserious Hsymptoms
Treatment--> Hurosepsis H& Hseptic Hshock Hare Hmedical
Hemergencies, H demand H parenteral, H broad-spectrum
H antibx Htx Hand Hmay Hrequire Hhospitalization
, NURS 611-Patho Exam 4
H H H H
II. Pyelonephritis
* Infection Hof Hone Hor Hboth Hupper Hurinary Htracts H(ureter, Hrenal
Hpelvis, H
kidney Hinterstitium)
Urinary Hobstruction H& Hreflux Hof Hurine Hfrom Hthe Hbladder
(vasicoureter Hreflux) Hare Hthe Hmost Hcommon Hunderlying Hrisk Hfactors
⟶ H Common H causes H are H kidney H stones, H vesicoureteral H reflux,
H pregnancy,H
neurogenic H bladder, H instrumentation, H and H female H sexual
H trauma
Pathophysiology— HMicrobes Hassociated Hinclude HE.coli, HProteus, H&
HPseudomonas. HLatter Htwo Hare Hassociated Hwith Hinfections Hafter
Hsurgery.
These Hspecific Hmicrobes Hsplit Hurea Hin
to Hammonia, Hmaking Halkaline Hurine Hthat Hincreases Hthe Hrisk Hof Hstone
Hformation. HIn Hsevere Hinfections, Hlocalized Habscesses Hmay Hform Hin Hthe
Hmedulla Hand Hextend Hto Hthe Hcortex.
Clinical HManifestations: Hacute, Hwith Hfever, Hchills, Hand Hflank Hor Hgroin Hpain. HOlder Hadults
HmayHexperience Hlow-grade Hfever Hand Hmalaise.
** HDifferentiating Hsymptoms Hof Hcystitis Hfrom Hthose Hof Hpyelonephritis Hby
H clinicalH
assessment Halone His Hdifficult.
The Hspecific Hdiagnosis His Hestablished Hby Hurine Hculture, HUA, Hand Hclinical Hsigns
H &H
symptoms.
WBC Hcasts Hindicate Hpylenephritis**
Painful HBladder HSyndrome/Interstitial HCystitis H(PBS/IC): Hunpleasant Hsensation H(pain,
Hpressure, Hdiscomfort) Hperceived Hto Hbe Hrelated Hto Hthe Hurinary Hbladder Hassociated Hwith
Hlower Hurinary HtractHsymptoms Hof Hmore Hthan H6 Hweeks’ Hduration Hin Hthe H Habsence H Hof H
Hinfection H Hor H Hother Hidentifiable H causes
