NURSING 6202 - Exam 1 Study Guide.

Nursing 6202 Exam 1 Notes


Renal and Urologic Problems

Urinary Tract Infection (UTI)

 Second most common bacterial disease
o Most common bacterial infection in women
o Commonly E. coli
o Urosepsis: can be fatal (bloodstream infection)
 Upper UTI
o Systemic symptoms
 Lower UTI
o Non-systemic symptoms
 S/Sx:
o Dysuria, frequency, urgency, supra-pubic discomfort/pressure, hematuria, or cloudy
urine
o Older adults will not exhibit the same symptoms as younger adults
 Non-localized abdominal pain or cognitive changes such as confusion
 Diagnostic Studies
o UA and culture with sensitivity
 Treatment
o Hydration, antibiotics, and teaching
o Patient tends to not want to drink since urination causes pain, however it is important
that they continue to hydrate
 Health Promotion
o Recognize risk
 Older adults, debilitated patients, immunocompromised patients, those on
corticosteroids or immunosuppressants
o Preventative measures:
 Regular bowel and bladder emptying
 Adequate hydration
 Perineal wiping from front to back
 Cranberry juice or tablets
 Voiding before and after intercourse
 Good urinary catheter care

Pyelonephritis

 Inflammation of the renal parenchyma (Upper UTI)
o Usually caused by a lower urinary infection that has ascended into the renal parenchyma
 Varied symptoms:
o Fatigue, chills, fever, vomiting, malaise, flank pain, lower UTI symptoms (above)
o Costovertebral angle tenderness
 Acute treatment: antibiotics and fluids

Cystitis

,Nursing 6202 Exam 1 Notes


 Inflammation of the bladder (Lower UTI)
 Risk factors:
o Being female
o Urinary catheterization
 S/Sx:
o Urgency, frequency, and cloudy or foul-smelling urine
 Treatment
o Urine acidifiers (cranberry juice)
o Urinary tract analgesic

Glomerulonephritis

 Inflammation of the glomeruli
 S/Sx:
o Hematuria, proteinuria, uremia, edema, hypertension
 Diagnostics
o UA, blood studies (WBC, BUN, Cr), CT or ultrasound of the abdomen or kidneys
 Treatment
o Manage symptoms (HTN, edema, and UTI)
o Low protein, low Na diet
o Fluid restriction, I&O, daily weights
 Teach
o Decrease dietary protein if ↑ BUN
o Daily weight

Urinary Calculi

 Calculus (Stone)
o Calcium oxalate (most common)
 Lithiasis (stone formation)
o Urolithiasis—urinary stone
o Nephrolithiasis—kidney stone
 Risk:
o Men > women, age 20-55
o White > AA
o Family history
o UTI, dehydration
 S/Sx:
o Obstruction of the urine flow
o Abdominal/flank pain
o Hematuria
o N/V, chills
o “kidney stone dance”—cannot get comfortable
o Severe pain
 Diagnostics

,Nursing 6202 Exam 1 Notes


o CT
o Ultrasound
o UA
o KUB x-ray
 Acute Attack Treatment
o Treat pain, infection, obstruction
o Hydration
o Medication
 Relax smooth muscle
 Tamsulosin or terazosin
o Strain all urine
o Treatment based on type **LOOK AT 45-11 TABLE**
 Teaching
o Adequate hydration
o Diet-based on cause
o Pain management
o Lithotripsy, surgical removal

Urinary Incontinence

 Uncontrolled leakage of urine
 Increased incidence with age; not “normal” aspect of aging
 Caused by: DRIP
 Types
o Stress
 Lifting, sneezing, laughing
o Overflow
 Constant dribbling (BPH, uterine prolapse)
o Urge
 Strong sudden urge
o Reflux
 Involuntary urination without warning (SCI, MS)
 Complications
o Infection (UTI)
o Skin breakdown
o Embarrassment
 Treatment/Teaching
o Hydration
 To prevent constipation
o Scheduled voiding or catheterization
o Pelvic floor exercises
o Double voiding
o Incontinence pads
o Medications

, Nursing 6202 Exam 1 Notes


 Alpha-adrenergic agonists (to ↑ sphincter tone)
 Anticholinergics (to relax the bladder muscle)

Urinary Retention

 Inability to empty the bladder with voiding thus causing an accumulation of urine
 Acute urinary retention: MEDICAL EMERGENCY
 Causes:
o Bladder outlet obstruction (enlarged prostate), ↓ detrusor contraction (may occur with
injury to the sacral nerves, anticholinergics, or diabetes)
 S/Sx:
o Frequent small urination, suprapubic distention or pain, elevated urine specific gravity
 Teaching
o Double/scheduled voiding
 Go to the bathroom and immediately attempt to restart the stream after it has
finished (DV)
o Catheter if indicated
o Diet
 Small frequent fluids, coffee or hot tea with caffeine induces urinary urgency
o Medications
 Alpha-adrenergic blocker (relax smooth muscle)
o Surgery for obstruction
 Complications:
o Ruptured bladder, infection, uremia

Urinary Diversion

 Urinary diversion to the skin, requires an appliance
 Indications: cancer,
neurogenic bladder, trauma
o Ileal conduit
 Ureters
implanted in
part of the
ileum, with
stoma (most
common)
o Cutaneous
ureterostomy
 Ureters
brought to
the abdominal wall, with stoma
o Nephrostomy
 Catheter inserted into renal pelvis of the kidney (temporary or permanent)
 Tube drains urine out into a pouch
 Urinary stomas should be symmetric with no skin breakdown, red, protrudes about 1.5 cm