chapter 37- nursing care of patients with disorders of the urinary system
Invasion of urinary tract by bacteria
urinary tact is what type of infection?
hospital acquired infection
what do you look for in older adults with confusing?
infection and ask for a urine specimen
how much fluids should be given a day?
2-3 L a day unless contraindicated
cysitis
AKA- honeymoon cysitis
inflammation of the bladder wall
(bacteria enter the urethra after intercourse)
UTI risk factors
incomplete bladder emptying, previous UTI, aging changes and genital piercings
ute common signs
urgency, frequency, burning, cloudy, foul-smelling urine-hematuria, pelvic pain
pyleonephritis
kidney infection- higher risk for sepsis
urethitis
inflammation due to an infection, irritant, trauma, or urethraa
how can urethritis be caused?
by gonococcus and herpes.
s/s- burning, itching, frequency in voiding. meatus may be swollen and red
urosepsis caused by uti
common in older adults severe, potentially fatal form of sepsis caused by uti
-signs tachycardia and blood pressure (hypotension)
phenazopyridine (pyridium)
causes orange urine. (medication used to treat cystitis)
do you need an order for the use of heating sources?
yes, never use heating sources without an order
uti-nursing process teaching:
urological obstructions
backward pressur damages kidney tissue and can lead to chronic kidney disease; distends kidney (hydronephrosis) fluid on the kidney
urethral strictures
causes: injury, STD'S, tissue trauma from catheters or surgical instruments, cancer, enlarged prostate.
occurs in men more than women
FREQUENT UTI'S
renal calculi (urolithiasis) or (nephrolithiosis)
hard small stones in urinary tract.
strain the urine, send the stone in for a urinalysis
ureterolithsis
ureter stones
If the left ureter is blocked, what do you think is happening?
an obstruction of the stone causing nephrolithiosis
etiology of renal calculi
hereditary, chronic dehydration, diet: high sodium, sugar, protein, obesity, repeated infections
high levels of calcium, oxalate, or uric acid
uric acid
causes include excess dietary intake of purine type foods (meats, gravies, red wine, sardines.
ureterolithiasis
pain radiation to the genitalia
what is going to happen with a blockage or obstruction of the left ureter, for example?
a ureteral stone causes urine backup, leading to hydroureter, hydronephrosis and potential renal damage if untreated
calcium oxalate stones
if low-oxalated diet is prescribed money foods may be restricted, including beets, chocolate, spinach, rhubarb, nuts, peanuts, and sweet potatoes
preventing kidney stones include
hydration, diet, exercise
diagnostic tests for renal calculi
calcium, uric acid, blood urea nitrogen (BUN), creatine
urinalysis for renal calculi
hematuria, crystals, urine PH
what procedure do you need to get a consent form for?
IV pyelogram
therapeutic interventions for renal calculi
hydration, analgesics, alpha-blocker (tamsulosin)
*analgesis- relieves serve renal colic pain
thiazide diuretics (HCTZ)
decrease urinary calcium excretion
Lithotripsy
sends shock waves to the stone itself to help crush it
what is a common post op side effect from lithotripsy ?
blood tinged urine (pink) for about 1 to 3 days and back pain
***remember*** BRIGHT RED BLOOD AND BLOOD CLOTS NEED TO BE REPORTED
Discharge instructions for lithotripsy
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.
Nephrostomy tube
inserted in an imaging lab, the tube will be inserted into the kidney.
watch for signs of infection
Hydroureter
abnormal dilation (stretching) of the ureter caused by urine backing up due to obstruction, most commonly kidney stones
hydronephrosis
obstruction causes urine backup
causes of hyrdonephrosis
block Foley catheter, BPH , tumors, kidney stones, scar tissue, birth defect pregnancies
S/S of hyrdroneohrosis
frequency, urgency, pysuria, flank and back pain
If hyrdonephrosis spreads to the muscle wall, its called what?
Invasive cancer
Diagnostic tests for hyrdonephrosis
cystoscopy and transurethral biopsy, urine tumor markers, bladder tumor associated antigen(BTA) and carcinoembryanic antigen (CEA)
Treatments for hyrdonephrosis
intravesical therapy (chemotherapy) medication instilled directly into the bladder. & immunotherapy(BCG)
immunotherapy (BCG)
(a therapy used for hyrdonephrosis)
live weekend bacteria used to stimulate the immune response. hold medication in bladder - 2 hours
Photodynamic therapy
teach patient to avoid sunlight
Orthotopic neobladder
risk factors for kidney cancer
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
renal biopsy
a procedure where a small tissue sample of the kidney with a needle guided by ultra sound or ct scan to evaluate kidney disease
nursing care for renal biopsy
post procedure- monitor for bleeding (vitals and check urine), strict bed rest for 6-24 hours, patient positioning, hydration and activity restriction for discharge
chemotherapy
NEVER the first choice for kidney cancers because they are chemotherapy resistant.
Nursing care for chemotherapy
watching for pneumothorax signs- Shortness of breath- diminished breath sounds on affected side
Uric acid stone stones
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.