Caring for pt's with problems of urinary elimination part 2

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Caring for pt's with problems of urinary elimination part 2
2010-11-14 21:10:08
nursing test

issues with urinary elimination part 2 for test 3 of nursing 110
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  1. Urinary Tract Infections
    • pathogenic microorganisms
    • 2nd most common infection
    • occurs most in women
    • most common site of nosocomial infections (hospital and cath)
    • ecoli #1
  2. Lower Urinary Tract Infections (UTI)
    Risk Factors
    • inability/failure empty bladder = urinary stasis
    • obstructed flow = kidney stones- enlarged prostate
    • decrease defense
    • inflammation
    • instruments in urinary tract
    • contributing conditions
    • increased risk of kidney stones with diabetes and pregnancy
  3. Lower UTI- Patho
    • bacteria enter bladder, attach to epithelium, initiate inflammation
    • water barrier between bladder/urine- defense layer
    • normal flora vagina/urethra area- defense against E Coli.
    • uropathogenic (disorder involving the urinary tract) bacteria- bacterial count more than 100,000 colonies/ml- women

    sugar substances- sacrine and aspertane eat away the defense layer
  4. Routes of Infection
    • ascending infection- from urethra (most common)- improper hygiene
    • bloodstream- distant infection
    • direct extension- fistula from intestine- opening between intestine and urinary tract
  5. Clinical Manifestations of Lower UTI (S&S)
    • half have bacteriuria with no symptoms, many patients with cath associated UTI
    • burning on urination, freq, urgency, nocturia, incontinence, pain, hematuria
    • symptoms less common with elderly- pts in nursing homes with chronic bacteriuria; urinary stasis, post menopausal women (estrogen protects against bacteria)
  6. Lower UTI- Nursing Process Assess/Diagnose
    • assess voiding pattern/urine note any s&s's
    • assess knowledge
    • urine cultures- clean catch (midstream) or cath specimen

    • pyuria- pus in urine
    • WBC's in urine- all with UTI
    • hematuria- present with 1/2 pts with UTI

    diagnosis- acute pain r/t .... manifested by .... deficient knowledge
  7. Medical Management for Lower UTI's
    • involves meds and pt education:
    • 1. acute pharmacologic therapy- antibacterial agent that kills urinary tract bacteria with minimal effects- most cured with 3 day treatment
    • 2. long term pharmacologic therapy- keflax and ?

    • 25% get yeast infection
    • 90% reinfected with new bacteria
  8. Lower UTI Nursing Interventions
    • administer antimicrobial (relieves pain), may need antispasmodic agents, may need Analgesic
    • heat to perineum
    • hygiene- basic, front to back, shower over bath
    • fluids and what to avoid- cranberry and blueberry juice are good! avoid- alcohol, coffee, soda and tea
    • frequent urination- q 2-3hrs

    vitamin C for recurrent UTI's because it acidifies urine
  9. Outcomes for Lower UTI's
    • relief of pain
    • knowledge of UTI's/treatment
    • no complications
  10. Upper UTI- Acute Pyelonephritis
    Patho and Clinical Manifestations (S&S)
    • bacterial infection of renal pelvis, tubules, and interstitial tissue of 1 or both kidneys
    • *Acutely ill- chills, fever, pyuria, bacteriuria, pain, n/v, headache, malaise, dysuria, tenderness costovertebral angle
  11. Upper UTI Assess/Diagnose
    • assess s&s
    • assess diagnostic findings- urine c/s, ultrasound/ct scan, IVP, urine c&s
  12. Upper UTI Medical Management
    • treated as outpt without symptoms dehydrations, n/v, sepsis symptoms
    • 2 week course antibiotics (cipro)
    • may need up to 6 wks if recurrent symptomless infection- followed by urine c&s 2 wks after med done to make sure it worked
  13. Chronic Pyelonephritis- Clinical manifestations (S&S)
    • repeat acute pyelonephritis may lead to chronic
    • usually no symptoms
    • symptoms with acute exacerbation- may include fatigue, headache, poor appetite, polyuria, thirst, weight loss
    • may produce scarring of kidney- renal failure result
  14. Upper UTI Assess/Diagnose/Manage
    • assess extent of disease- IVP, creatinine clearance, BUN, creatinine levels
    • complications- renal disease, hypertension, kidney stones
    • medical management- long term prophylactic antimicrobial, assess renal function r/t meds
    • nursing management- monitor i&o, increase fluids if able, assess temp q4hrs, teaching r/t prevention infections
    • possible antipyretics for temp
  15. Adult voiding dysfunction- urinary incontinence
    • involuntary loss of urine
    • underdiagnosed and underreported
    • risk factors- # vaginal deliveries, menopause, high impact exercise, etc
  16. types of incontinence
    • stress- pt with intact urethra, results of sneezing, coughing, changing position - after prostate cancer surgery for men
    • urge- strong urge to void cannot be suppressed- just can't get to bathroom fast enough
    • functional- urinary tract ok but cognitive or physical issue
    • iatrogenic- related to meds
    • mixed- several types together