Chapter_37

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AlexisSheasMommy
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62679
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Chapter_37
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2011-01-28 21:55:27
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Eastern Suffolk Boces
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Urinary System Disorders
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  1. Urinary tract infections (UTI)
    Invasion of the urinary tract by Bacteria.
  2. The urinary tract is sterile above the __________.
    Urethra
  3. How many people are hospitalized with UTI's each year?
    >100,000 people.
  4. Lower urinary tract infections include?
    Urethritis, prostatis, and cystitis. (urethra, prostate and bladder)
  5. Upper urinary tract infections include?
    Pyelonephritis and ureteritis (kidney and ureter infections)
  6. Infections of the urinary tract can result in?
    chronic kidney disease sepsis or kidney damage.
  7. Where do most UTI's begin?
    At the external utinary meatus
  8. What bacteria causes most UTI's?
    Escherichia coli (E. Coli)
  9. Predisposing factors for UTI include?
    Stasis of urine in thr bladder, contamination from feces, having instruments or tubes inserted into thr urinary tract, faulty valves that cause urine reflux, previous UTI's, women, pregnant women (streptococci) and older adults.
  10. Signs and symptoms of UTI's
    Dysuria, urgency, frequency, incontinence, nocturia, hematuria, back pain, and cloudy foul smelling urine.
  11. The first sign of a UTI in a geriatric patient is?
    Altered Mental status and/or agitation.
  12. Urethritis
    Inflammation of the urethra that may result from a chemical irritant, bacterial infection, trauma, or exposure to an STD.
  13. A person with a history of UTI's should avoid?
    Bubble baths and bath salts.
  14. Urethritis can be caused by _________ _______.
    Spermicidal agents
  15. In men STD's ________ & _________ can cause urethritis in men.
    Gonorrhea; chlamydiosis.
  16. Sign and symptoms of urethritis include
    Urinary frequency, urgency and disuria. Males may have discharge.
  17. Treatment of urethritis is
    Remove the irritant, if bacteria treat with antibiotics
  18. Phenazopyridine (Pyridium)
    Urinary analgesic used to treat dysuria. Urine turns orange while on this drug.
  19. Cystitis
    Inflammation and infection ofthe bladder wall.
  20. Cystitis can be caused by
    Bacterias, viruses, fungi or parasites.
  21. Fungal infections of the bladder occur during ____ ____ ___________ ________.
    Long term antibiotic therapy.
  22. Signs and symptoms of cystitis
    Dysuria, frequency, urgency, and cloudy urine.
  23. Changes in the UA of a person with cystitis include
    Cloudy urine, WBC's, bacteria, and RBC's. Nitrates are usually positive and some labs test for leukocyte esterase which indicates infection.
  24. Treatment of uncomplicated cystitis includes
    Combination of sulfa meds such as bactrim and septra.
  25. Complicated cystitis drug of choice is?
    Cipro
  26. Estrogen used as an intravaginal cream may prevent?
    Recurrant UTI's in post menopausal women
  27. Pyelonephritis
    Infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys.
  28. Pyelonephritis usually begins as
    A lower UTI that travel upward.
  29. A preexisting condition such as ________, ________, ________, or _________ usually leads to pyelonephritis.
    Obstruction, stricture, stones or reflux.
  30. Risk factors for pyelonephritis
    Urological surgery, lymphatic infection, urinary stasis, and decreased immunity.
  31. Acute pyelonephritis begins in the _____ _______.
    Renal medulla
  32. Urosepsis
    Systemic infection arising from a source within the urinary system.
  33. Signs and symptoms of pyelonephritis
    Fatigue, urgency, frequency, dysuria, flank pain, fever, and chills. Urine is cloudy with increased WBC's bacteria casts and RBC's and positive nitrates.
  34. Tests to diagnose pyelonephritis
    Main sign is casts in UA. More than 100,000 bacteria per mm. Elevated WBC on CBC
  35. Treatment of pyelonephritis
    Antibiotics based on C&S, severe gram negative infections pt is hospitalized for IV ABT's.
  36. Complications of pyelonephritis
    Repeated kidney infections can result in scarring and loss of kidney function, leading to chronic kidney disease. Septecemia can occur
  37. Aztreonam (Azactam)
    • Effective against E. Coli, klebsiella, serratia.
    • Given IV.
    • S/E: headache diarrhea nausea and blurred vision.
    • Contraindicated in patients allergic to PCN and cephalosporins. Also if creat clearance is less than 30mL/min
  38. Fodfomycin (Monurol)
    • Effective against E. Coli and enterococcus faecalis
    • Given PO
    • S/E: headache diarrhea and nausea.
    • Disolve packet in 3-4oz of cold water.
  39. Nitrofurantoin (Macrobid)
    • Effective against E. Coli, enterococci, staph aureus, klebsiella and enterobacter
    • Given PO
    • S/E: headache anorexia diarrhea nausea
    • Give with food or milk and a full glass of water. Avoid antacids.
  40. Ciprofloxacin (Cipro)
    • Fleuroquinolone
    • Effective against E. Coli, klebsiella, pseudomonas and other.
    • Given PO
    • S/E: nausea headache diarrhea photosensitivity increased risk of tendonitis and tendon rupture.
    • Give with large amounts of water. Teach to avoid sunlight and report tendon aches promptly.
    • Absorption may be decreased when given within 2 hours of aluminum antacids.
  41. Levofloxacin (Levaqin)
    • Fleuroquinolone
    • Effective against E. Coli, klebsiella, pseudomonas and other.
    • Give. IV
    • S/E: neausea headache diarrhea photosensitiviy increased risk of tendonitis or tendon rupture.
    • Absorption may be decreased when given within 2 hours of aluminum antacids.
    • Give with large amounts of water. Teach to avoid sunlight and report tendon aches promptly.
  42. Trimethoprim sulfamethoxazole (Bactrim, Septra)
    • Sufonamides.
    • Effective against E. Coli and pseudomonas. Used for UNCOMPLICATED UTI's.
    • Given PO
    • S/E: photosensitivity GI upset hemolytic anemia rash hypersensitivity steven johnsons syndrome
    • Teach to avoid sunlight. Give with large amounts of water. Contraindicated in sever renal or liver disease.
  43. Cinoxacin (Cinobac)
    • Urinary antiseptic
    • Antibacterial action in the urine not systemic.
    • Effective against E. Coli, klebsiella and other gram negative organisms
    • Given PO
    • S/E: photosensitivity GI upset and rash.
    • Teach to avoid sunlight encourage fluids may discolor urine absorption may be decreased if given within 2 hours of aluminum or magnesium antacids.
  44. Methenamine (Mandelamine)
    • Urinary antispeptic, anti-infective
    • Effective against gram-negative and gram-positive organisms. E. Coli
    • Given PO
    • S/E: N/V rash
    • Do not use with sulfa drugs because it may cause crystalluria.
  45. Phenazopyridine (Pyridium)
    • Urinary analgesic
    • Topical analgesic. Relieves pain urgency and frequency associated with UTI.
    • Given PO
    • S/E: S/E: GI upset rash and blue/purple skin discoloration. Nephorotoxic and hepatotoxic.
    • Urine changes to red-orange. Avoid in renal insufficency. Changes urine glucose testing.
  46. How to prevent UTI's
    • Void frequently-every 3 hours while awake
    • Drink up to 3,000 mL of fluid a day unless there is a fluid restriction.
    • Drink one gkass if cranberry juice a day.
    • Take showers avoid baths.
    • Wipe from front to back.
    • Urinate after sex.
    • Avoid bubble bat, bath salts, perfuned feminine hygiene products, synthetic underwear, and constricting clothing.
    • Take meds such as ABT's until finished.
    • If UTI is associated with another infection make sure that infection is treated.
  47. An obstruction of urine flow causes
    Dilation and thinning of the renal tubules with eventual atrophy of renal tissues and renal blood flow is compromised and eventually destroyed. Obstructions may include strictures stones and tumors.
  48. Urethral stricture
    Narrowing of the lumen of the urethra caused by scar tissue. (can be r/t std's) usually acquired from injury or infection.
  49. People with urethral strictures are prone to develop _____ related to obstructed ______ ______.
    UTI's; urine flow
  50. Treatment of urethral strictures
    Mechanical dilation by a urologists or surgical repair: urethroplasty
  51. Renal Calculi
    Kidney stones. (one stone is a calculus). Masses of crystals and protein that form when urine becomes supersaturated with a salt capable of forming solid crystals. Symptoms occur when stones become impacted in the urinary tract.
  52. Nephrolithiasis
    Stones in the kidney
  53. Stones usually grow on the
    Papillae or in the renal tubules, calyces, or renal pelvis. Also may form in the ureter or bladder.
  54. Stones less than _____ are usually able to be passed in the urine.
    5mm
  55. Urinary salts that make up renal calculi
    • 1. Calcium oxylate
    • 2. Calcium phosphate
    • 3. Magbesium ammonia
    • 4. Uric acid
    • 5. Cystine.
  56. Causes of renal calculi
    Family history of stones. Chronic dehydration. Infection. Dietary factors. Immobility-stasis of urine. More common in men than women. Peaks between ages of 30-50.
  57. Signs and symptoms of renal calculi.
    • Flank pain
    • Renal colic
    • Pain radiating to genitalia
    • Hematuria
    • Dysuria
    • Frequency
    • Urgency
    • Enuresis
    • N/V/D
  58. Prevention of renal calculi
    • Encourage fluids
    • Encourage pt to walk to avoid stasis
  59. Complications of renal calculi
    • Increased risk for UTI.
    • Can lead ti retention of urine and kidney damage (hydronephrosis)
  60. Diagnostic testing for renal calculi
    • KUB- flat plate of the abd
    • IVP
    • Renal ultrasound
    • UA
  61. Therapeutic measures for renal stones
    • IV fluids are given to hydrate patient to flush the stones out of the body
    • Strain the urine to ensure stones have passed
    • If the patient cant pass on its own intervention is needed. Calcium stones may be treated with thiazide diuretics. Surgical removal may be needed.
  62. _______ _________ are a medical treatment option for calcium renal calculi
    Thiazide diuretics
  63. Lithotripsy
    Uses sound laser or dry shock energies to break the stone into small fragments. (ESWL)
  64. Hydronephrosis
    Distention of the renal pelvis and calices. This condition results from untreated obstuction of urine flow in the urinary tract. Occurs r/t obstuctuon of urine flow.
  65. The capacity of the renal pelvis is usually _-_mL's
    5-8
  66. Treatment of hydronephrosis
    Treat the obstruction
  67. Nephrostomy tube
    Inserted directly into the kidney to drain urine. NEVER CLAMP
  68. Bladder CA
    • Most common type of CA in the urinary tract.
    • Most common in men 50-70
    • 1 in 27 for men
    • 1 in 85 for women.
    • Rare in people younger than 40
  69. Bladder CA usually begin in the lining of the bladder called __________.
    Urothelium
  70. If CA affects only the inner lining of the bladder it is known as __________ CA
    Superficial
  71. If bladder CA has spread to the muscle it is called ________ CA
    Invasive
  72. Common sites for bladder CA Metz
    Liver bones and lungs
  73. Causes of bladder CA
    • Smoking
    • Aniline dye
    • Benzidine
    • Naohthylamine
    • Leather finishing
    • Metal michenery
    • Petrolium processing products
  74. Signs and symptoms of bladder CA
    • Painless hematuria (first)
    • Frank hematuria
    • Bladder irritability
    • Urine retention from clots
    • Fistula formation
    • Pelvic pain
    • Pain in the lower back
    • Painful urination
    • Changes is bladder habits
    • Inability to void
  75. Diagnostic tests for bladder CA
    • Urinalysis (telomerase)
    • Cytology
    • Urine culture
    • Cystoscopy
    • Transurethral biopsy
    • IVP
  76. Therapeutic measure for bladder CA
    • Chemo
    • BCG vax (prevent recurring tumors)
    • Photodynamic therapy
    • C&P with fuluration (destruction of tissue with electricak current)
    • Cystectomy with urinary diversion.
  77. Kidney CA risk factors
    • Smoking
    • Obesity
    • HTN
    • Dialysis
    • Exposure to:
    • Radiation
    • Asbestos
    • Industrial pollution.
  78. Kidney CA is more common in ___ than _____.
    Men; women
  79. Kidney CA signs and symptoms.
    • Hematuria
    • Dull pain in the flank area
    • Mass in the area
    • Symptoms may not present until the tumor invades surrounding tissues.
    • Less specific symptoms:
    • Fever
    • Wright loss
    • Night sweats
    • HTN
    • Anemia
    • Polycethemia
    • Swelling in the legs
    • Fatigue
    • Anorexia
    • Constipation
  80. Kidney CA diagnostic tests
    • IVP
    • C&P
    • Ultrasound of the kidneys
    • CT of the abd
    • MRI
    • Renal biopsy
  81. Nephrectomy
    Removal of thr entire kidney
  82. Polycystic kidney disease (PCKD)
    Heridetary disorder that can result in chronic kidney disease. Formation of multiple cysts in the kidney that may replace normal kidney structures.
  83. PCKD present as:
    Grapelike cysts that contain fluid blood or urine
  84. Signs and symptoms of PCKD
    Dull heaviness in the flank or lumbar region and hemituria. Others: HTN and UTI's
  85. Patients with PCKD may also experience
    Brain aneurysms and diverticulosis of the colon
  86. PCKD usually diagnosed with
    Ultrasound
  87. PCKD treatment
    None. Monitor and treat symptoms.
  88. Diabetic nephropathy
    Long term cause of DM r/t damage to the small vessels in the kidneys.
  89. Microalbuminuria
    May be deected within 5 years od type 1 diabetes and 10-15 years of onset of type 2. Renal damage appears about 15-20 years after onset
  90. Risk factors of diabetic nephropathy
    • HTN
    • Genetic predisposition
    • Smoking
    • Chronic hyperglycemia
  91. How diabetic nephropathy works
    • Increased osmotic pressure from hyperglycemia
    • Increased diuresis and compensatory cell growth and expansion
    • Increase GFR
    • Atherosclerotic changes in blood vessels
    • Thickening of glomerular capillaries
    • Protein leaks into the urine
    • Pyelonephritis
    • Renal scarring
    • Neurogenic bladder=incomplete bladder emptying= urinary retention= infection or obstruction causing further damage to the kidney
  92. Symptoms of diabetic nephropathy
    • Microalbumminuria advancing to proteinuria
    • Hypertension
    • Decreased urine output
  93. Complications of diabetic nephropathy
    Cardiovascular disease and increasing kidney damage
  94. Diagnosing diabetic nephropathy
    • Urine analysis for protein
    • 24 hour creatinine clearance test
  95. Nephrotic syndrome
    Excretion of 3.5 grams or more in the urine per day
  96. Nephrosclerosis
    Hardening of the renal blood vessels r/t HTN resulting in decreased blood flow
  97. Glomerulonephritis
    Inflammatory disease of the glomerulus.
  98. Causes of Glomerulonephritis
    • Immunilogical abnormalities
    • Toxins
    • Vascular disorders
    • Systemic diseases
  99. Etiology of Glomerulonephritis
    Usually following a streptococcal infection of the throat or skin
  100. Goodpastures syndrome
    Glomerulonephritis cause by an auntoimmune response
  101. Symptoms of chronic Glomerulonephritis
    • Fluid overload
    • Oliguria
    • HTN
    • Electrolyte imbalances
    • Periorbital edema
    • Ascities
    • Pleural effusion
    • Flank pain
    • Increase BUN and creatinine
    • UA: WBC's RBC's albumin and casts (can be dark and foamy)
  102. Diagnosis of Glomerulonephritis
    • UA
    • HTN
    • Ultrasound
    • X-ray
    • Biopsy
  103. Treatment of Glomerulonephritis
    Treatment of symptoms
  104. Azotemia
    Toxic wastes from protein metabolism in the blood
  105. Three phases of kidney disease
    • 1. Oliguric
    • 2. Diuretic
    • 3. Recovery
  106. Oliguric phase
    Less than 400 mL of urine in 24 hours lasting 1-7 days
  107. Diuretic phase
    • 1-3 L per urine per day.
    • Osmotic diuresis occurs from elevated waste products Dehydration and hypotension are a concern
  108. Recovery phase
    • GFR rises
    • BUN and creat decrease greatly but may take 1 year to return to normal.
  109. Kidney injury is broken into 3 categories
    • 1. Prerenal (before the kidney) usually resti ted blood flow
    • 2. Intrarenal injury (inside the kidney) damage to the nephrons
    • 3. Postrenal injury (prevents the urine from leaving the body)
  110. Common antibiotic nephrotoxins
    • Aminoglycosides
    • Amphotericin B
    • Cephalosporins
    • Sulfonamides
    • Tetracyclines
  111. Common analgesic nephrotoxins
    • Acetominophen
    • NSAID's
    • Salicylates
  112. Common nephrotoxins
    • ACE inhibitors
    • Amphetomines
    • Cisplatin
    • Dextran
    • Heroin
    • Interleukin-2
    • Mannatol
  113. Common nephrotoxic heavy metals
    • Arsenic
    • Copper
    • Gold
    • Lead
    • Lithium
    • Mercury
  114. Common organic solvent nephrotoxins
    • Gasoline
    • Glycols
    • Kerosene
    • Tetrachloroethylene
    • Turpentine
  115. Chronic kidney disease
    Irreversible renal damage in which the body is unable to maintain metabolic, fluid, and electrolyte balance.
  116. Continuous renal replacement therapy (CRRT)
    Used to remove fluid and solutes in a contolled continous manner in unstable patients with acute kidney disease.
  117. Polyuria
    Large amount of dilute urine
  118. Oral symptoms of CKD
    • Stomatitis
    • Bad taste in mouth
  119. Cardiovascluar symptoms of CKD
    • HTN
    • HF
    • Dysrhythmias
  120. GI symptoms of CKD
    • Anorexia
    • N/V
    • GI bleed
    • Ulcers
  121. Reproductive symptoms of CKD
    • Sexual dysfunction
    • Infertility
  122. Musculoskeletal symptoms of CKD
    Fractures
  123. Neurological symptoms of CKD
    • Fatigue
    • Depression
    • Headache
    • Confusion
    • Seizures
    • Coma
  124. Respiratory symptoms of CKD
    • Pulmonary edema
    • Pulmonary effusion
    • Dyspnea
  125. Renal symptoms of CKD
    • Anemia
    • Oliguria/anuria
  126. Skin symptoms of CKD
    • Pruritis
    • Ecchymosis
    • Uremic frost
    • Dry skin
    • Jaundice
    • Edema (anasarca)
  127. Care for an AV fistula
    • Monitor for bleeding
    • Monitor for s&s of infection
    • Listen for bruit
    • Palpate for a thrill
    • Patiet teaching
    • Notify physician of bleeding infection reduced circulation or swelling

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