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chapter 37- nursing care of patients with disorders of the urinary system

front 1

Invasion of urinary tract by bacteria

back 1

  • starts at the meatus
  • ascending (they go up) can travel up to the kidneys
  • most common by bacterium E. coli

front 2

urinary tact is what type of infection?

back 2

hospital acquired infection

front 3

what do you look for in older adults with confusing?

back 3

infection and ask for a urine specimen

front 4

how much fluids should be given a day?

back 4

2-3 L a day unless contraindicated

front 5

cysitis

AKA- honeymoon cysitis

back 5

inflammation of the bladder wall

(bacteria enter the urethra after intercourse)

front 6

UTI risk factors

back 6

incomplete bladder emptying, previous UTI, aging changes and genital piercings

front 7

ute common signs

back 7

urgency, frequency, burning, cloudy, foul-smelling urine-hematuria, pelvic pain

front 8

pyleonephritis

back 8

kidney infection- higher risk for sepsis

front 9

urethitis

back 9

inflammation due to an infection, irritant, trauma, or urethraa

front 10

how can urethritis be caused?

back 10

by gonococcus and herpes.

s/s- burning, itching, frequency in voiding. meatus may be swollen and red

front 11

urosepsis caused by uti

back 11

common in older adults severe, potentially fatal form of sepsis caused by uti

-signs tachycardia and blood pressure (hypotension)

front 12

phenazopyridine (pyridium)

back 12

causes orange urine. (medication used to treat cystitis)

front 13

do you need an order for the use of heating sources?

back 13

yes, never use heating sources without an order

front 14

uti-nursing process teaching:

back 14

  • take all antimicrobial medication
  • fluids: increase
  • uti s/s recognize & report
  • prevention: interventions

front 15

urological obstructions

back 15

backward pressur damages kidney tissue and can lead to chronic kidney disease; distends kidney (hydronephrosis) fluid on the kidney

front 16

urethral strictures

back 16

causes: injury, STD'S, tissue trauma from catheters or surgical instruments, cancer, enlarged prostate.

occurs in men more than women

FREQUENT UTI'S

front 17

renal calculi (urolithiasis) or (nephrolithiosis)

back 17

hard small stones in urinary tract.

strain the urine, send the stone in for a urinalysis

front 18

ureterolithsis

back 18

ureter stones

front 19

If the left ureter is blocked, what do you think is happening?

back 19

an obstruction of the stone causing nephrolithiosis

front 20

etiology of renal calculi

back 20

hereditary, chronic dehydration, diet: high sodium, sugar, protein, obesity, repeated infections

high levels of calcium, oxalate, or uric acid

front 21

uric acid

back 21

causes include excess dietary intake of purine type foods (meats, gravies, red wine, sardines.

front 22

ureterolithiasis

back 22

pain radiation to the genitalia

front 23

what is going to happen with a blockage or obstruction of the left ureter, for example?

back 23

a ureteral stone causes urine backup, leading to hydroureter, hydronephrosis and potential renal damage if untreated

front 24

calcium oxalate stones

back 24

if low-oxalated diet is prescribed money foods may be restricted, including beets, chocolate, spinach, rhubarb, nuts, peanuts, and sweet potatoes

front 25

preventing kidney stones include

back 25

hydration, diet, exercise

front 26

diagnostic tests for renal calculi

back 26

calcium, uric acid, blood urea nitrogen (BUN), creatine

front 27

urinalysis for renal calculi

back 27

hematuria, crystals, urine PH

front 28

what procedure do you need to get a consent form for?

back 28

IV pyelogram

front 29

therapeutic interventions for renal calculi

back 29

hydration, analgesics, alpha-blocker (tamsulosin)

*analgesis- relieves serve renal colic pain

front 30

thiazide diuretics (HCTZ)

back 30

decrease urinary calcium excretion

front 31

Lithotripsy

back 31

sends shock waves to the stone itself to help crush it

front 32

what is a common post op side effect from lithotripsy ?

back 32

blood tinged urine (pink) for about 1 to 3 days and back pain

***remember*** BRIGHT RED BLOOD AND BLOOD CLOTS NEED TO BE REPORTED

front 33

Discharge instructions for lithotripsy

back 33

increase fluid intake to get rid of the stones and filter your urine to get the stones tested in lab to define which type of kidney stone it is.

front 34

Nephrostomy tube

back 34

inserted in an imaging lab, the tube will be inserted into the kidney.

watch for signs of infection

front 35

Hydroureter

back 35

abnormal dilation (stretching) of the ureter caused by urine backing up due to obstruction, most commonly kidney stones

front 36

hydronephrosis

back 36

obstruction causes urine backup

  • kidney enlarges as urine collects
  • kidney pressure increase

front 37

causes of hyrdonephrosis

back 37

block Foley catheter, BPH , tumors, kidney stones, scar tissue, birth defect pregnancies

front 38

S/S of hyrdroneohrosis

back 38

frequency, urgency, pysuria, flank and back pain

front 39

If hyrdonephrosis spreads to the muscle wall, its called what?

back 39

Invasive cancer

  • early signs- painless and hematuria
  • late signs- pelvic pain, dysuria, inability ton urinate

front 40

Diagnostic tests for hyrdonephrosis

back 40

cystoscopy and transurethral biopsy, urine tumor markers, bladder tumor associated antigen(BTA) and carcinoembryanic antigen (CEA)

front 41

Treatments for hyrdonephrosis

back 41

intravesical therapy (chemotherapy) medication instilled directly into the bladder. & immunotherapy(BCG)

front 42

immunotherapy (BCG)

(a therapy used for hyrdonephrosis)

back 42

live weekend bacteria used to stimulate the immune response. hold medication in bladder - 2 hours

  • must sit down to void to prevent splashing.
  • avoid pregnancy- use condoms during sex for 1 week

front 43

Photodynamic therapy

back 43

teach patient to avoid sunlight

front 44

Orthotopic neobladder

back 44

  • most common today
  • creates new bladder from intestine and implants ureters and urethra into the neobladder
  • allows voiding via urethra

front 45

risk factors for kidney cancer

back 45

smoking, obesity, hypertension, long-term kidney dialysis, exposure to radiation, absestos, or industrial pollution.

S/S- hematuria, dull pain in the flank area, and mass In the area

front 46

renal biopsy

back 46

a procedure where a small tissue sample of the kidney with a needle guided by ultra sound or ct scan to evaluate kidney disease

front 47

nursing care for renal biopsy

back 47

post procedure- monitor for bleeding (vitals and check urine), strict bed rest for 6-24 hours, patient positioning, hydration and activity restriction for discharge

front 48

chemotherapy

back 48

NEVER the first choice for kidney cancers because they are chemotherapy resistant.

front 49

Nursing care for chemotherapy

back 49

watching for pneumothorax signs- Shortness of breath- diminished breath sounds on affected side

front 50

Uric acid stone stones

back 50

renal calculi can be a complication of gout, which is a disorder of purine metabolism. limit high- purine foods such as organ meats, anchovies, herring, sardines, alcohol beverages, and gravy. increasing fruits and vegetables may reduce uric acid stone formation.