Podcast
Questions and Answers
A nurse is caring for a patient with glomerulonephritis. Which assessment finding would warrant immediate intervention?
A nurse is caring for a patient with glomerulonephritis. Which assessment finding would warrant immediate intervention?
- Complaints of fatigue and generalized weakness.
- Urine output of 20 mL/hr for the past 2 hours. (correct)
- A recent weight gain of 2 pounds in one day.
- Mild periorbital edema present upon waking.
A client with a recent history of kidney stones is prescribed allopurinol. What specific instruction should the nurse include in the teaching plan regarding this medication?
A client with a recent history of kidney stones is prescribed allopurinol. What specific instruction should the nurse include in the teaching plan regarding this medication?
- Restrict fluid intake to prevent drug-induced edema.
- Increase intake of vitamin C-rich foods to enhance drug absorption.
- Increase fluid intake to at least 2-3 liters per day. (correct)
- Avoid grapefruit juice which can increase drug toxicity.
A nurse is reviewing the urinalysis results of a client with a suspected urinary tract infection (UTI). Which of the following findings would be most indicative of a UTI?
A nurse is reviewing the urinalysis results of a client with a suspected urinary tract infection (UTI). Which of the following findings would be most indicative of a UTI?
- Elevated protein level
- Presence of leukocyte esterase and nitrites (correct)
- Presence of ketones
- Slightly elevated specific gravity
The nurse is caring for a patient post-renal biopsy. Which of the following complications should the nurse prioritize monitoring for in the first 24 hours?
The nurse is caring for a patient post-renal biopsy. Which of the following complications should the nurse prioritize monitoring for in the first 24 hours?
The nurse is assessing a patient with acute pyelonephritis. What assessment finding is most indicative of this condition?
The nurse is assessing a patient with acute pyelonephritis. What assessment finding is most indicative of this condition?
A nurse is teaching a client about the importance of pelvic floor exercises (Kegel exercises) for managing stress incontinence. Which instruction is the most crucial for the nurse to emphasize?
A nurse is teaching a client about the importance of pelvic floor exercises (Kegel exercises) for managing stress incontinence. Which instruction is the most crucial for the nurse to emphasize?
An older adult client reports urinary frequency, nocturia, and urgency, but denies dysuria. The nurse should initially assess for which of the following?
An older adult client reports urinary frequency, nocturia, and urgency, but denies dysuria. The nurse should initially assess for which of the following?
A nurse is providing discharge teaching to a client who has been diagnosed with urolithiasis(renal calculi). What dietary modification should the nurse include for a client with oxalate stones?
A nurse is providing discharge teaching to a client who has been diagnosed with urolithiasis(renal calculi). What dietary modification should the nurse include for a client with oxalate stones?
A patient presents with genitourinary trauma following a motor vehicle accident. Which finding suggests a possible urethral injury?
A patient presents with genitourinary trauma following a motor vehicle accident. Which finding suggests a possible urethral injury?
A nurse is caring for a patient who had a cystectomy with an ileal conduit. What is the priority nursing intervention in the immediate postoperative period?
A nurse is caring for a patient who had a cystectomy with an ileal conduit. What is the priority nursing intervention in the immediate postoperative period?
A male client with a family history of testicular cancer asks the nurse about screening recommendations. Which of the following is the most appropriate response?
A male client with a family history of testicular cancer asks the nurse about screening recommendations. Which of the following is the most appropriate response?
A nurse is providing care for an older adult client with urinary incontinence. Which intervention should the nurse prioritize to prevent skin breakdown?
A nurse is providing care for an older adult client with urinary incontinence. Which intervention should the nurse prioritize to prevent skin breakdown?
The nurse is reviewing lab results for a client with suspected acute kidney injury (AKI). Which lab value is the most sensitive indicator of AKI?
The nurse is reviewing lab results for a client with suspected acute kidney injury (AKI). Which lab value is the most sensitive indicator of AKI?
A patient with a ureteral calculus is prescribed intravenous fluids at 150 mL/hr. What is the rationale for this intervention?
A patient with a ureteral calculus is prescribed intravenous fluids at 150 mL/hr. What is the rationale for this intervention?
The nurse is providing discharge instructions to a client who underwent percutaneous nephrolithotomy. Which of the following instructions is most important to emphasize?
The nurse is providing discharge instructions to a client who underwent percutaneous nephrolithotomy. Which of the following instructions is most important to emphasize?
Which of the following factors places older adults at higher risk for developing urinary tract infections (UTIs)?
Which of the following factors places older adults at higher risk for developing urinary tract infections (UTIs)?
The nurse is educating a client with urinary incontinence on strategies to manage their condition. Which statement indicates a need for further education?
The nurse is educating a client with urinary incontinence on strategies to manage their condition. Which statement indicates a need for further education?
A nurse is reviewing the medication history of a patient with renal calculi who is prescribed a thiazide diuretic. Which concurrent medication warrants immediate concern?
A nurse is reviewing the medication history of a patient with renal calculi who is prescribed a thiazide diuretic. Which concurrent medication warrants immediate concern?
A nurse assesses a patient with a newly created ileal conduit. Which findings indicate a possible stomal complication?
A nurse assesses a patient with a newly created ileal conduit. Which findings indicate a possible stomal complication?
A client presenting with a history of renal stones asks the nurse about the best measures to prevent future occurrences. In addition to maintaining adequate hydration, which of the following recommendations is most appropriate?
A client presenting with a history of renal stones asks the nurse about the best measures to prevent future occurrences. In addition to maintaining adequate hydration, which of the following recommendations is most appropriate?
A nurse is caring for a client who has undergone a transurethral resection of the prostate (TURP). What finding requires immediate intervention?
A nurse is caring for a client who has undergone a transurethral resection of the prostate (TURP). What finding requires immediate intervention?
The nursing assistant is assisting a female patient to collect a midstream urine specimen. Which action by the nursing assistant requires intervention by the nurse?
The nursing assistant is assisting a female patient to collect a midstream urine specimen. Which action by the nursing assistant requires intervention by the nurse?
A home health nurse is providing instruction to a patient with chronic kidney disease regarding prevention of uremia. Which dietary instruction is most appropriate for this patient?
A home health nurse is providing instruction to a patient with chronic kidney disease regarding prevention of uremia. Which dietary instruction is most appropriate for this patient?
A client with a history of calcium oxalate renal calculi is prescribed hydrochlorothiazide to reduce the recurrence of stones. Which electrolyte imbalance requires careful monitoring while taking this medication?
A client with a history of calcium oxalate renal calculi is prescribed hydrochlorothiazide to reduce the recurrence of stones. Which electrolyte imbalance requires careful monitoring while taking this medication?
The nurse is educating a client about the use of phenazopyridine (Pyridium) for the management of urinary tract infection symptoms. Which statement by the client indicates a need for further teaching?
The nurse is educating a client about the use of phenazopyridine (Pyridium) for the management of urinary tract infection symptoms. Which statement by the client indicates a need for further teaching?
A nurse is caring for a patient with a neurogenic bladder. The nurse understands that the classification of the neurogenic bladder as spastic or flaccid depends on which factor?
A nurse is caring for a patient with a neurogenic bladder. The nurse understands that the classification of the neurogenic bladder as spastic or flaccid depends on which factor?
A nurse is providing education about testicular self-exams. The nurse should include which of the following instructions?
A nurse is providing education about testicular self-exams. The nurse should include which of the following instructions?
The emergency department nurse is assessing a male patient who has sustained blunt trauma to the lower abdomen after a fall. Which finding requires immediate surgical intervention?
The emergency department nurse is assessing a male patient who has sustained blunt trauma to the lower abdomen after a fall. Which finding requires immediate surgical intervention?
A nurse is managing a patient diagnosed with urge incontinence. Which medication, if prescribed, would the nurse anticipate administering?
A nurse is managing a patient diagnosed with urge incontinence. Which medication, if prescribed, would the nurse anticipate administering?
A patient taking Nifedipine develops renal stones. What action of Nifedipine is the most likely cause?
A patient taking Nifedipine develops renal stones. What action of Nifedipine is the most likely cause?
Following extracorporeal shock wave lithotripsy (ESWL) for renal calculi, a patient reports flank pain and notices bruising on the treated side. Which nursing intervention is most appropriate?
Following extracorporeal shock wave lithotripsy (ESWL) for renal calculi, a patient reports flank pain and notices bruising on the treated side. Which nursing intervention is most appropriate?
A nurse caring for an older adult patient in a long-term care facility notes the patient has had several episodes of urinary incontinence. The patient denies any burning or pain upon urination, and is afebrile. What is the priority intervention by the nurse?
A nurse caring for an older adult patient in a long-term care facility notes the patient has had several episodes of urinary incontinence. The patient denies any burning or pain upon urination, and is afebrile. What is the priority intervention by the nurse?
A kidney biopsy is performed on a client. Post procedure, the nurse monitors the client for signs and symptoms of complications. Which signs and symptoms is indicative of a potential complication?
A kidney biopsy is performed on a client. Post procedure, the nurse monitors the client for signs and symptoms of complications. Which signs and symptoms is indicative of a potential complication?
A patient has a history of kidney stones. What is the main goal of the nurse intervention in this case?
A patient has a history of kidney stones. What is the main goal of the nurse intervention in this case?
A nurse is caring for a male client scheduled for an open retroperitoneal lymph node dissection for testicular cancer. The nurse explains to the client that he is at risk for what post-operative complication?
A nurse is caring for a male client scheduled for an open retroperitoneal lymph node dissection for testicular cancer. The nurse explains to the client that he is at risk for what post-operative complication?
A client is diagnosed with cutaneous ureterostomy. Which of the following indications is most important for the nurse to include during education about this diversion?
A client is diagnosed with cutaneous ureterostomy. Which of the following indications is most important for the nurse to include during education about this diversion?
What should the nurse teach a client about the correct technique for performing testicular self-examination?
What should the nurse teach a client about the correct technique for performing testicular self-examination?
A patient is receiving furosemide. The nurse should prioritize the evaluation of which lab result?
A patient is receiving furosemide. The nurse should prioritize the evaluation of which lab result?
What is the primary rationale for administering opioid analgesics to a patient experiencing ureteral colic due to urolithiasis?
What is the primary rationale for administering opioid analgesics to a patient experiencing ureteral colic due to urolithiasis?
A nurse is caring for a patient with urge incontinence who is prescribed oxybutynin. Which assessment finding would warrant the most immediate communication with the healthcare provider?
A nurse is caring for a patient with urge incontinence who is prescribed oxybutynin. Which assessment finding would warrant the most immediate communication with the healthcare provider?
A patient with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which pre-procedure assessment is most critical for the nurse to communicate to the physician before the procedure?
A patient with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which pre-procedure assessment is most critical for the nurse to communicate to the physician before the procedure?
An older adult patient is admitted with a urinary tract infection (UTI). The patient is confused, agitated, and has a low-grade fever. Which intervention should the nurse prioritize?
An older adult patient is admitted with a urinary tract infection (UTI). The patient is confused, agitated, and has a low-grade fever. Which intervention should the nurse prioritize?
A patient is diagnosed with a neurogenic bladder. Which statement most accurately reflects the long-term management goals for this condition?
A patient is diagnosed with a neurogenic bladder. Which statement most accurately reflects the long-term management goals for this condition?
Which is the priority nursing diagnosis for a client who has undergone surgical creation of an ileal conduit?
Which is the priority nursing diagnosis for a client who has undergone surgical creation of an ileal conduit?
What is the most important instruction for a nurse to give to a client with oxalate renal calculi?
What is the most important instruction for a nurse to give to a client with oxalate renal calculi?
When caring for a client with urinary incontinence, what is the most important intervention?
When caring for a client with urinary incontinence, what is the most important intervention?
When providing care to a client who has had a Transurethral Resection of the Prostate (TURP), what would be the priority finding to immediately act on?
When providing care to a client who has had a Transurethral Resection of the Prostate (TURP), what would be the priority finding to immediately act on?
A nurse is providing dietary instructions to a client at risk for uremia. What dietary instruction is the most important?
A nurse is providing dietary instructions to a client at risk for uremia. What dietary instruction is the most important?
What is the cause of the condition called Urethrovesical reflux?
What is the cause of the condition called Urethrovesical reflux?
Following a kidney biopsy, what signs and symptoms would be indicative of a potential complication?
Following a kidney biopsy, what signs and symptoms would be indicative of a potential complication?
A client develops renal stones while taking Nifedipine. What action of Nifedipine is the most likely cause?
A client develops renal stones while taking Nifedipine. What action of Nifedipine is the most likely cause?
The patient is currently scheduled for an open retroperitoneal lymph node dissection for testicular cancer. What post-operative complication is the client at risk for?
The patient is currently scheduled for an open retroperitoneal lymph node dissection for testicular cancer. What post-operative complication is the client at risk for?
When a client is diagnosed with cutaneous ureterostomy, what is the most important education point for the nurse to tell the client?
When a client is diagnosed with cutaneous ureterostomy, what is the most important education point for the nurse to tell the client?
Why are older adults at a higher risk for developing a urinary tract infection?
Why are older adults at a higher risk for developing a urinary tract infection?
The nurse should include what instructions when educating a client on the correct technique to perform self-examination?
The nurse should include what instructions when educating a client on the correct technique to perform self-examination?
The nurses is at a long-term care facility and is trying to decrease the number of urinary tract infections that the clients on the unit are getting. What should the nurse include to tell the nursing assistants?
The nurses is at a long-term care facility and is trying to decrease the number of urinary tract infections that the clients on the unit are getting. What should the nurse include to tell the nursing assistants?
When educating a client about performing the testicular self examination, what is the best time for the client to perform one?
When educating a client about performing the testicular self examination, what is the best time for the client to perform one?
A patient sustained blunt trauma to the lower abdomen after a fall. What physical findings would make you suspect the patient had urethral damage?
A patient sustained blunt trauma to the lower abdomen after a fall. What physical findings would make you suspect the patient had urethral damage?
What behavioral therapies are available to decrease or eliminate urinary incontinence?
What behavioral therapies are available to decrease or eliminate urinary incontinence?
What are the advantages of a suprapubic catheter in comparison to a urethral catheter?
What are the advantages of a suprapubic catheter in comparison to a urethral catheter?
A patient has a urinary tract infection. Which nursing interventions are important? Select all that apply.
A patient has a urinary tract infection. Which nursing interventions are important? Select all that apply.
The nurse is providing education to a client about bladder cancer who is undergoing treatment. What teaching points is important to the client?
The nurse is providing education to a client about bladder cancer who is undergoing treatment. What teaching points is important to the client?
The nurse is educating a patient about potential bladder cancer risks. What would you want to include?
The nurse is educating a patient about potential bladder cancer risks. What would you want to include?
Which of the following statements correctly describes the different types of genitourinary trauma in the body?
Which of the following statements correctly describes the different types of genitourinary trauma in the body?
When talking about kidney disease, the nurse knows that the main goal is to help?
When talking about kidney disease, the nurse knows that the main goal is to help?
Loop diuretics, such as furosemide (Lasix), can result in what electrolyte abnormality?
Loop diuretics, such as furosemide (Lasix), can result in what electrolyte abnormality?
When taking Sulfonamides, what are some contraindications? Select all the apply.
When taking Sulfonamides, what are some contraindications? Select all the apply.
What are some cause of Urinary retention? Select all that apply.
What are some cause of Urinary retention? Select all that apply.
What are some teaching instructions that needs to be told to the client following a ESWL Extracorporeal shock wave lithotripsy?
What are some teaching instructions that needs to be told to the client following a ESWL Extracorporeal shock wave lithotripsy?
When administering a glucocorticoid medication such as prednisone, what are the most important things to know about it?
When administering a glucocorticoid medication such as prednisone, what are the most important things to know about it?
What are some of the nursing diagnosis that is important following a surgery?
What are some of the nursing diagnosis that is important following a surgery?
What are causes of urinary incontinence?
What are causes of urinary incontinence?
The doctor says that you are at risk for neurogenic bladder. What measures do you need to put in place?
The doctor says that you are at risk for neurogenic bladder. What measures do you need to put in place?
What risk factors cause CAUTI, what is one of THE MOST important thing that is contributing to it?
What risk factors cause CAUTI, what is one of THE MOST important thing that is contributing to it?
How does someone come up with urolithiasis and nephrolithiasis?
How does someone come up with urolithiasis and nephrolithiasis?
What is the best prevention you can give to a patient that potentially has kidney stones?
What is the best prevention you can give to a patient that potentially has kidney stones?
A patient has bladder cancer, what statements should the nurse include?
A patient has bladder cancer, what statements should the nurse include?
What are some test to know for a client with upper UTI? Select all that apply.
What are some test to know for a client with upper UTI? Select all that apply.
Flashcards
Urinary Retention
Urinary Retention
Inability to empty the bladder completely.
Complications of Neurogenic Bladder
Complications of Neurogenic Bladder
Urinary stasis, catheterization, renal calculi, impaired skin integrity, and urinary incontinence or retention.
Types of Neurogenic Bladder
Types of Neurogenic Bladder
Spastic (or reflex) bladder and flaccid bladder.
Neurogenic Bladder
Neurogenic Bladder
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Urinary Incontinence
Urinary Incontinence
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Factors Contributing to UTI
Factors Contributing to UTI
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Urethritis
Urethritis
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Prostatitis
Prostatitis
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Cystitis
Cystitis
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Upper Urinary Tract
Upper Urinary Tract
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Lower Urinary Tract
Lower Urinary Tract
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Urinary Tract Infection (UTI)
Urinary Tract Infection (UTI)
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Urethrovesical reflux
Urethrovesical reflux
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Urolithiasis and Nephrolithiasis
Urolithiasis and Nephrolithiasis
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Kidney Functions
Kidney Functions
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Sulfonamides Action
Sulfonamides Action
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Urinary Antiseptics Action.
Urinary Antiseptics Action.
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Types of Urinary Incontinence
Types of Urinary Incontinence
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Urge Incontinence
Urge Incontinence
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Stress Incontinence
Stress Incontinence
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Ureteral Colic
Ureteral Colic
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Genitourinary Trauma Causes
Genitourinary Trauma Causes
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Clinical manifestations of Renal Calculi
Clinical manifestations of Renal Calculi
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Management of large kidney stones
Management of large kidney stones
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Calcium Channel Block Action
Calcium Channel Block Action
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Conventional ileal conduit.
Conventional ileal conduit.
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Vesicostomy
Vesicostomy
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in the male patients
in the male patients
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Testicular Cancer occurs
Testicular Cancer occurs
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Study Notes
Required Readings for the Unit
- Hinkle chapters 47, 49, and 53 provide foundational knowledge
- Karch chapters 9, 15, 41, and 52 offer additional insights
- Kaplan Focused Review, specifically the RENAL-UROLOGIC SYSTEM A section, is also a key resource
Learning Objectives
- Understand key terms related to genitourinary function
- Apply knowledge of pathophysiology for disorders such as:
- Hypospadias/epispadias
- Cryptorchidism
- Nephrotic syndrome
- Glomerulonephritis
- Urolithiasis
- Wilms tumor
- Enuresis
- Male reproductive disorders
- Prostate disease
- Bladder and testicular cancer
- Renal calculi
- Urinary diversions
- Utilize the nursing process for adult patients with altered GU function or genitourinary disorders
- Relate diagnostic tests to patients with altered genitourinary function
- Apply pharmacotherapeutics to treat selected genitourinary diseases
- Determine developmental changes and aging effects on genitourinary health
- Articulate nursing responsibilities for nutritional needs in patients with altered genitourinary function
- Develop health promotion and maintenance practices
- Identify unique teaching/learning needs for patients
- Demonstrate dignified nursing care, considering cultural needs
- Use effective communication techniques
- Discuss safety principles and efficient resource use
Physical Assessment of the Bladder
- An empty bladder is typically not palpable
- Dullness upon percussion indicates residual urine
- A midline mass suggests a full bladder
Physical Assessment of the Renal System
- Palpate at the costovertebral angle (12th rib and spine); refer to Figures 47-5 & 47-7
- Peripheral edema might indicate reduced kidney function
- Refer to Table 47-2 to ID characteristics of genitourinary pain
Diagnostic Studies for Genitourinary Issues
- Urinalysis and urine culture help diagnose infections and kidney disorders
- Renal function tests are crucial, as detailed in Table 53-5
- Ultrasonography (KUB) provides imaging of the kidneys, ureters, and bladder
- CT and MRI scans offer detailed anatomical views
- Nuclear scans can identify functional abnormalities
- Endoscopic procedures allow direct visualization
- Common procedures include biopsies, IV urography, retrograde pyelography, cystography, and renal angiography
- Refer to Chart 53-4 for additional information
Urine Cultures
- Urine cultures help identify the specific organism in UTIs
- A colony count over 100,000 CFU/mL in a clean-catch or catheterized specimen signals infection
- Multiple-test dipsticks often check for WBCs (leukocyte esterase) and nitrites
Tests for STIs and Imaging
- Sexually transmitted infections (STIs) should be tested for when acute urethritis symptoms are present
- X-rays, CT scans, and ultrasounds can detect pyelonephritis, abscesses, obstructions, tumors, and cysts
24-Hour Urine Testing
- Renal clearance and creatinine clearance indicates renal function
- Results may reflect progression of renal disease
Serum Creatinine and Blood Urea Nitrogen
- Normal serum creatinine levels are 0.6-1.2 mg/dL
- Normal blood urea nitrogen (BUN) levels are 7-18 mg/dL
Cystoscopy Overview
- Cystoscopy is an operative procedure
- Prep includes NPO status, premedication, and anesthesia; consent is required
- Post-procedure, monitor output, blood-tinged urine and also for burning
Kidney Functions
- Kidneys control blood pressure and water balance
- They excrete waste products and regulate electrolytes and acid-base balance
- Erythropoietin is produced, stimulating the bone marrow to produce RBCs
- Kidneys perform renal clearance, secrete prostaglandins, produce vitamin D, produce urine and more
Factors Contributing to UTIs
- Bacterial invasion, urethrovesical reflux, and uropathogenic bacteria increases the risk
- A shorter female urethra increases UTI risk
- Instrumentation, preexisting conditions (diabetes, pregnancy), immobility all increase the risk as well
- Incomplete bladder emptying, obstructions, and immunosuppression are risk factors
Urinary Tract Infections (UTIs)
- UTIs are caused by pathogenic microorganisms
- They are classified as lower if involving the bladder and structures below, and upper if involving the kidneys and ureters
- UTIs are the second most common infection
- Catheter-associated UTIs (CAUTI) account for 50% of hospital-acquired infections
Upper Urinary Tract Infection: Pyelonephritis
- Acute symptoms include chills, fever, and UTI symptoms
- Low back/flank pain and costovertebral tenderness are common
- Generalized malaise is also a symptom
Upper and Lower UTIs
- Upper UTIs include pyelonephritis, which can be acute or chronic
- Symptoms include chills, fever, leukocytosis, bacteriuria, and pyuria
- Physical exams reveal pain and tenderness in the costovertebral angle
- Lower UTIs include cystitis, urethritis, and prostatitis (in men)
Urethrovesical and Ureterovesical Reflux
- Urethrovesical reflux is the backward flow of urine from the urethra into the bladder, bringing bacteria
- Vesicoureteral reflux is the backward flow of urine from the bladder into one or both ureters, potentially damaging the kidneys
Gerontologic Considerations for UTIs
- Older adults are more susceptible to kidney injury due to structural and functional changes
- Sclerosis of glomerulus and renal vasculature, decreased blood flow, decreased GFR, and altered tubal and acid-base balance
- Incomplete bladder emptying and decreased nerve innervations contribute
- Cognitive impairment, frequent antimicrobial use, and multiple chronic conditions are factors
- Immune compromise, low fluid intake, and obstructed urine flow also contribute
Gerontologic Considerations
- Escherichia coli (E. coli) is a common cause of UTIs in older adults
- Early UTI symptoms in older adults include malaise, nocturia, incontinence, or foul-smelling urine
- Treatment regimens are generally the same as for younger adults
- Age-related changes may necessitate alterations in antimicrobial regimens, with close monitoring of kidney function
Diagnosing UTIs
- Dipstick tests are used for leukocyte esterase and nitrates
- Urine analysis and culture should be performed
- At risk populations: the elderly
- Symptomatic relief and teaching & prevention are the keys
Nursing Goals for Managing UTIs
- Encourage showers over baths
- Encourage good perineal cleansing habits ("front to back")
- Void after intercourse
- Prescribe Anti-Microbial Therapy
- Avoid scented toilet paper and perineal perfumes
- Empty the bladder regularly
- Encourage an increased fluid intake, increase water and cranberry juice
Nursing Process: Assessment of UTIs
- Take note of Signs and Symptoms
- Complete a patient presentation
- Note any associations and how it correlates with age
- Check vital signs for infection
- Complete diagnostic tests
Potential Complications of UTIs
- Sepsis (urosepsis)
- Acute kidney injury
- Chronic kidney disease
Nursing Interventions for UTIs
- Medications (antibiotics, analgesics, antispasmodics)
- Apply heat to the perineum
- Increase fluid intake to flush bacteria
- Avoid urinary tract irritants like coffee, tea, citrus and alcohol
- Void frequently
- Avoid Caffeinated products that encourage infections
Nursing Interventions: Further Details
- Establish a scheduled voiding pattern
- Consider bladder retraining and pelvic muscle exercises (Kegel exercises) two to three times
Sulfonamides Characteristics
- These inhibit folic acid synthesis
- Absorption occurs in the GI tract, reaching peak levels in 3-6 hours
- Adverse effects include GI issues and nephrotoxicity
- Contraindications include allergy, pregnancy/breastfeeding, and caution in renal disease
Urinary Antiseptics
- Nitrofurantoin, phenazopyridine, and trimethoprim sulfamethazole are examples
- Actions: they act specifically within the urinary tract
- Contraindications: allergy, renal dysfunction, pregnancy, or lactation
Educational Priorities for Preventing UTIs
- Focus on hand hygiene, frequent toileting assistance, careful perineal care
- Avoid briefs
Adult Voiding Dysfunction Overview
- Incontinence: unplanned or involuntary urine loss
- Retention: inability to fully empty the bladder when voiding
- Trauma: causes hematuria
- Disorders: Urolithiasis; Urolithiasis and nephrolithiasis is the presence of stones or calculi in the urinary tract
Urinary Incontinence: Key Facts
- Affects over 25 million adults in the U.S.
- It is underdiagnosed and underreported
- It affects both women and men
- It is a symptom of many possible disorders
Types of Urinary Incontinence
- Stress incontinence: results from exertion (sneezing or exertion)
- Urge incontinence: involuntary loss associated with a strong urge
- Overflow incontinence: The continual leakage from a distended bladder
Types of Urinary Incontinence Continued
- Functional incontinence: due to physical or cognitive challenges
- Transient incontinence: is associated with delirium, infection, Atrophic Urethritis, pharmaceuticals, psychologic episodes, and excess urine output
Managing Urinary Incontinence
- Incontinence is treatable
- Management takes encouragement and support
- Education is pivotal
- Behavioral Interventions are key such as kegel exercises
Suprapubic Catheter : Advantages
- Can be kept in for extended periods
- Allows for more mobility
- Allows measurement of residual urine without urethral instrumentation
Urolithiasis and Nephrolithiasis Overview
- Urolithiasis and Nephrolithiasis are calculi stones that are located in the urinary tract or kidneys
- The cause is urinary stasis
Urinary Calculi : Types
- Calcium Stones
- Uric acid stone
- Cystine Stones
- Oxalate Stones
Manifestations and Management of Stones
- Manifestations depend on the location and size of the stones.
- Ureteral colic : causes deep pain
- The objective is to relieve pain. Prescribe NSAIDS
- If the stone is longer than 1 cm it must be removed
Renal Calculi Risk Factors and Diagnostics
- Infection, urinary stasis & retention, immobility, dehydration increase risk
- Increases in Uric Acid and Urinary Oxalate
- Diagnoses can be made by checking urine PH, Ultrasound, Cystoscopy and more
Interventional Procedures for Renal Calculi
- Cystoscopy with capture and removal
- extracorporeal shock wave lithotripsy (ESWL)
- Percutaneous Nephrolithotomy
Medical Management for Renal Stones
- Opioids, analgesics, and NSAIDS are often prescribed
- encourage fluids
Calcium Channel Blockers
- Nifedipine (Procardia) can be helpful
Loop Diuretics and Glucocorticoid
- Loop Diuretics like Furosemide can be used since it decreases water reabsorption, lowers blood pressure
- A Glucocorticoid like Prednisone can reduce inflammtion
Teaching With Stones
- Reinforce signs and symptoms to report
- Importance of PH monitoring, fluid intake, and regular follow up
- Reinforce measures to prevent recurrent stones and medication education
Genitourinary Trauma: Causes
- Ureteral: motor vehicle accidents, sport injuries, falls
- Bladder: pelvic fracture, multiple trauma, blow to lower abdomen
- Urethral: blunt trauma to lower abdomen and pelvis
Genitourinary Trauma Management
- Medical management involves controlling hemorrhage, pain, and infection
- Surgical management is needed for urethral trauma
- Nursing involves education and promoting fluid intake
Bladder Cancer
- Medical Management Involves chemotherapy and radiation
- Surgical Management: cystectomy and urinary diversion
- Educate patient on the importance of taking medication
Urinary Diversion
- Immediate PostOp monitor urine volume to maintain organ function
- provide stoma and test urine
Types of Urinary Diversions
- Reasons Cutaneous urinary diversion Continent urinary diversion
Cutaneous Urinary Diversion Complications
- Peritonitis , Stoma Ischemia
Preoperative / Postoperative Nursing Diagnosis
- PreOP: Anxiety, Imbalanced nutrition
- PostOp: Risk of impared skin, acute pain, deficient knowledge etc
Testicular Cancer
- Early detection is most important
- Teach patients what they can do to follow up for any abnormalities
Testicular Cancer : Risk Factors
- Risk factors; undescended testicles, positive family history, cancer of one testicle, Caucasian American race
- Manifestations; painless lump or mass in the testes
Nursing Management
- Provide emotional support while educating and encouraging positive attitudes
Testicular Self Exam
- Should be completed monthly and should be done after a warm bath in shower
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