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NURSING 6202 - Exam 1 Study Guide.
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Nursing 6202 Exam 1 NotesRenal 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
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