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Urinary Incontinence

• It refers to the involuntary loss of urine, serious enough to cause social or hygienic problems
• It is not a normal consequence of aging or childbirth
• It is a stigmatizing and underreported health problem

Types of Urinary Incontinence

• Stress: Inability to retain urine when laughing, coughing, sneezing, jogging, or lifting
• Urge: Loss of urine for no apparent reason after suddenly feeling the urge to urinate
• Overflow: Detrusormuscle fails to contract, bladder becomes overdistended, and urine leaks out
• Functional: Occurs due to factors other than abnormal bladder or urethra function, such as cognitive decline in dementia patients

Signs/Symptoms

• Distended abdomen
• Prolapse (females)
• A comprehensive examination from a healthcare provider.
• DRE (males)
• Leakage

Risk Factors from Drugs

• Central nervous system (CNS) depressants decrease consciousness and the urge to void and contribute to constipation of opioid analgesics
• Diuretics cause frequent voiding, often in large amounts
• Multiple drugs can change mental status or mobility and irritate the bladder
• Anticholinergic drugs affect both cognition and the ability to void

Risks Factors from Diseases

• Stroke, Parkinson's, dementia, and other neurologic disorders affect mobility, sensation, or cognition
• Arthritis decreases mobility and causes pain

Depression, Resources, Labs and Diagnostics

• Patients with depression have decreased energy to maintain continence
• Decreased self-esteem reduces the importance of maintaining continence
• A lack of assistive devices or costly products may affect continence
• A lack of assistance to the bathroom may lead to incontinence
• Labs and diagnostics include urinalysis, imaging assessement, bladder scan, CT of kidneys and ureters, VCUG, urodynamic testing, EMG of pelvic muscles

Potential Complications and Treatment/Medications

• Impaired comfort, activity disruption, shame/embarrassment, and loss of tissue integrity
• Nutrition therapy with weight reduction helps obese patients
• Drug therapy with hormones enhances nerve conduction, improves blood flow, and reduces tissue deterioration
• Anticholinergics suppress involuntary bladder contraction and increase bladder capacity
• Pessary devices help hold internal organs in place for prolapsed bladders or uteruses
• Electrical stimulation, magnetic resonance therapy, pelvic muscle therapy (Kegel exercises), vaginal cone therapy, and behavioral interventions (habit training) are other treatments
• Surgical sling procedures create a sling around the bladder neck and urethra

Nursing and Patient Interventions

• Nurse led patient teaching
• Educate about maintaining a normal body weight
• Avoid limiting fluid intake and ensure adequate fluid intake for kidney function and health

Cystitis

• It is an inflammatory condition of the bladder, commonly from infection, but can be caused without one

Signs/Symptoms and Ricks Factors

• Frequency/urgency, dysuria, fever, chills, and/or nausea.
• Risk factors include infection, drugs, chemicals, local radiation therapy, irritants, long-term catheter use, gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus, or tuberculosis

Labs/Diagnostics and Potential/Treatment

• Use UA, culture & sensitivity, pelvic ultrasound, CT, cystoscopy, WBCs and assess for distended bladder
• Potential for UTI with untreated urosepsis
• For treatment, increase fluid intake, use drug therapy for infections, and consider surgery if recurrent

Nursing and Patient interventions for CAUTI and Cystitis

• Nursing Interventions should include Patient teaching and sterile techniques to prevent CAUTI
• For patient education, when using catheters at home, use a single one with clean technique, but sterile technique is for hospitals
• Patient Education: depending on what caused the irritation

Urethritis

• Inflammation of the urethra resulting from infectious and noninfectious conditions

Pathophysiology/Etiology Risk factors and Symptoms of Urethritis

• STI is the most common cause and the highest incidence is adults aged 20-24
• Risk factors include irritants, long-term catheter use, and lower estrogen in postmenopausal women
• Signs and symptoms include mucopurulent or purulent discharge, dysuria, and discomfort

Labs Diagnostic Potential Complications and Treatment/Medications

• Testing for STIs, N. gonorrhoeae, and C. trachoma with smears, pregnancy tests for women, pelvic exams for tissue changes, urethroscopy for inflammation, UA for pyuria (WBC in urine)
• Untreated STIs lead to infertility, secondary infections, and even death
• It usually spontaneously resolves with antibiotics is being taken for an STI
• Postmenopausal women improve urethral symptoms with the use of estrogen vaginal cream

Nursing and Patient Interventions

• Nurse led patient teaching

Urolithiasis

• Presence of calculi (stones) in the urinary tract
• Dehydration is the major associated condition

Signs/Symptoms, Risk Factors and Labs/Diagnosis

• Stones cause excruciating pain when passing into the lower urinary tract
• Risk factors include metabolic risk factors (e.g., dehydration), family history, obesity, diabetes, gout, diet (e.g., increased sodium), past treatment (if a history of stone formation)
• Labs and Diagnostics include urinalysis, urine specific gravity and osmolarity, urine pH, and a 24-hour urine analysis

Potential Complications, Treatments, and Interventions

• Untreated urinary tract obstruction which needs emergency treatment Nephrolithiasis (kidney), ureterolithiasis (ureter), and urosepsis possible
• Treatments include pain relief, antibiotics, strain of urine, lithotripsy, ureteroscopy
• Nursing interventions focus on relieving pain and preventing infection and urinary obstruction
• The main patient education topic is prevention and hydration
• The current standard for confirming urinary stones is an unenhanced helical CT scan of the abdomen and pelvis

Urothelial Cancer

• Malignant tumors of urothelium that lines transitional cells in kidney, renal pelvis, ureters, urinary bladder, and urethra known as bladder cancer
• Ask about the patient's perception of their health, exposure to cigarette smoke and environmental agents, occupation, and habits to aid diagnoses

Symptoms, Diagnosis, Complications and Treatment

• Blood in urine is usually a painless and intermittent, and is first indication of bladder cancer
• Dysuria, frequency, and urgency occur when infection or obstruction is present
• Diagnoses Exposure to toxins and tobacco use
• Diagnosis includes routine urinalysis is gross or microscopic hematuria, bladder-wash, biopsies, cystoscopy, cystoureterography, CT scans, and MRI
• The main potential complication is Metastasis
• Treatment includes Prophylactic immunotherapy with BCG, multi-agent chemotherapy, radiation therapy, and surgical interventions

Nursing and Patient interventions

• Nurse should provide patient education and monitor treatment
• Teach about smoking cessation, PPE use for chemicals, and showering/bathing after contact with chemicals

Pyelonephritis

• Active bacterial infection (often E. coli) that moves from the bladder up to infect the kidneys

Pathophysiology of Acute and Chronic

• It stems from repeated or continued upper urinary tract infections that occur with anatomic abnormalities
• Acute leads to fever, chills, tachycardia, tachypnea, flank pain, CVA tenderness, abdominal discomfort, nausea and vomiting, fatigue, burning, urination frequency/urgency/nocturia, and recent UTI
• Chronic leads to hypertension, inability to conserve urine, decreased urine, tendency to develop hyperkalemia and acidosis, and potential for confusion

Risk Factors and Lab Diagnostics of Pyelonephritis

• Most Common in younger sexually active women and also catheter placement with disease that reduces immunity (e.g. Diabetes M.)
• Chronic: conditions that lead to relapsing inflammatory damage of the kidney, structural abnormality, neurogenic bladder dysfunction, and primary vesicoureteral reflux
• Urinalysis positive for Bacteria and WBC , urine culture, blood cultures, complete blood count, c-reactive protein and erythrocyte sedimentation rate (ESR), BUN with creatinine, and GFR to trend kidney function

Potential Complications, Treatment and Interventions

• Urosepsis, kidney abscesses, and fibrosis scar tissue
• Treatment includes acetaminophen for pain, antibiotics to treat infection, catheter replacement for patients requiring a catheter for more than 2 weeks, nutrition therapy that maintains a adequate diet, fluid intake should be 2liters a day to dilute urine, and/or corrective surgery if needed
• Teaching the patient depending on treatment is main Nursing intervention

Patient Interventions for Pyelonephritis

• If no surgery is performed, the patient may need help with self-care, nutrition, and drug management at home
• If surgery is performed, he or she may need help with incision care, self-care, and transportation for follow-up appointments

Glomerulonephritis

• It is a immune response within the kidney tissues.
• Stems from untreated Group A beta-hemolytic Streptococcus
• Symptoms are fluid overload, skin lesions, edema (face eyelids & hands), crackles in lungs, blood in urine, dysuria/ oliguria, mild hypertension, fatigue, anorexia, and nausea/vomiting

Risks, Diagnostics, potential Complications, and Interventions

• Risks factors include infection, hypertension, inflammation from immunity excess, or poor kidney blood flow
• Risk factors include a Secondary disease that reduces immunity
• For diagnostics: Urinalysis, 24 hour urine, creatinine & BUN, and kidney biopsy is utilized
• Complications stem from acute Kidney Failure, Disrupted fluid and electrolytes
• Treatment focus on fixing cause as well as modifying diet/lifestyle

Nursing and Patient Interventions to support Chronic patients

• Managing infection as a cause of acute Glomerulonephritis begins with appropriate antibiotic therapy.
• Prevent complications with fluid and electrolyte disruption needs antibiotics
• Managing fluid overload, hypertension, and edema with diuretics and restrictions
• Stess personal hygiene and basic infection control to prevent spread

Chronic

• Develops over years to decades.
• It stems from infection, hypertension, inflammation from immunity excess, or poor kidney blood flow.

Pathophysiology and Assessment of Chronic Glomerulonephritis

• mild proteinuria and hematuria, hypertension, fatigue, and occasional edema.
• Nursing Interventions: check for circulatory overload, uremic symptoms(slurred speech, ataxia, tremors), urine output, Protein, sodium and retention
• Check GFR (low), urinalysis, Electrolytes, Hyperkalemia, hyperphosphatemia, and X-ray- small kidneys, biopsy

Patient Education

• Teach the importance of completing the entire course of the prescribed antibiotic.
• Patients receiving immunosuppressants need to take precautions to avoid exposure to new infections
• Pt Education: diet changes, fluid intake, drug therapy

Nephrotic Syndrome

• An immunologic kidney disorder in which glomerular permeability increases and larger molecules are excreted

Common Causes Risks Symptoms and Diagnostics

• Common causes an altered immunity with inflammation. Assess hydration status
• Symptoms increased protein elimination with severe proteinuria, low albumin in the blood, high serum lipid levels, fats in the urine, edema, and hypertension
• Risks factors include systemic Diseases, genetics, bacterial/viral infections, NSAIDs
• Diagnostics Use UA- Excessive proteinuria, identified by kidney biopsy, CMP- check for hypoalbuminemia

Potential Complications

• reduced kidney function Interventions focus on deceasing protein in blood such as ACE inhibitors, cholesterol lowering drugs, reduce defects/increase function with Heparin, diet is more important for treatment
• Patients should follow these guidelines that limit sodium and fat as well as monitor protein intake

Nephrosclerosis

• A degenerative arterial disorder resulting from changes in kidney blood vessels that is result of changes in kidney blood vessels. Nephron blood vessels thicken, resulting in narrowed lumens and decreased kidney blood flow
• It is chronically hypoxic, with ischemia and fibrosis developing over time.
• Symptoms and risks factors are Hypertension with all types of Hypertension, atherosclerosis, and diabetes mellitus (DM)

Interventions and Diagnostics of Kidney disease

• Diagnostics: UA, CMP and Kidney biopsy
• Potential Complications: The changes caused by hypertension may occur within a time span ranging from months or years
• Treatment/Medications: the use Antihypertensive drugs and Diuretics with pt education
• NSG Interventions: Patient education and focus on diet chnages

Polycystic Kidney Disease (PKD)

• Genetic disorder in which fluid-filled cysts develop in the nephrons
• Relentless development and growth of cysts leads to kidney enlargement
• Ultrasound is the most commonly used diagnostic
• Autosomal dominant PKD is the most common inherited kidney disease, occurring in 1:400 births
• Symptoms and indicators often show by way flank Pain, frequent urination, and increased waist size.

Signs, Symptoms, Labs, Diagnostics, and Interventions for PKD.

• Signs and Symptoms nocturia, UTIs, increased abdominal girth, constipation, hematuria, sodium wasting, inability to concentrate urine, kidney failure issues, frequent infections
• Labs and Diagnostic: ultrasound (primary method), genetic tests, MRI
• Treatment Medication: low sodium diet, increased hydration with potential diuretics, pain management, antibiotics for infections, and eventually dialysis/kidney transplant

Potential Complications

• decline in kidney function and impaired elimination
• In relation to Nursing, you want to manage blood pressure(ACE In) and pain, prevent infections, constipation, and slow progression of CKD

Patient Eduction for Polycystic Kidney Disease

• Weigh yourself every day at the same time of day and with the same amount of clothing
• Limit your intake of salt
• Notify primary health care provider blood in urine

Hydronephrosis and Hydroureter

• Hydronephrosis the kidney enlarges as urine collects in the renal pelvis and kidney tissue, causing obstruction
• Enlargement of the ureters causing obstruction/blockage
• It is an Urologic or Radiologic Intervention

Signs Symptoms risks Factors tests

Symptoms such as

• Pain and fever with high WBC count in urine
• High creatinine, low GFR and electrolyte imbalance If it is a calculus or stone it would require:
• Cystoscopy, uretogram
• stent, if a stricture it calls for a Radiologic Interventions

Treatment Potential Complications and Interventions

Treatment: urologic interventions

• Main Intervention is a nephrostomy.
• Failure to treat the cause of obstruction and infection which could lead to kidney injury.
• You can notify surgeon immediately if Drainage is absent, discolored, pain

Renovascular Disease (RVD)

• RVD consists of any disease in relations to renal arteries may severely narrow the lumen and greatly reduce blood flow to the kidney tissues. RVD may cause renal vein thrombosis or renal artery stenosis (RAS), atherosclerosis, or thrombosis

Signs, Symptoms, and Diagnostics of RVD

• It is difficult to control blood pressure
• Elevated serum creatinine
• Decreased GFR with poorly controlled diabetes (Conventional Contrast Angiography)
• Treatment medication consist of identifying condition/procedure to ensure blood supply to kidney. Use of drugs to lower blood pressure as Stent placement with or without balloon angioplasty to lower blood pressure
• Severe impairment of urinary elimination
• fluid and electrolyte balance to control conditions with proper diet and lifestyle.
• Renal artery bypass surgery to prevent stroke

Renal Cell Carcinoma (RCC)

• Renal cell carcinoma or adenocarcinoma of the kidney or more commonly known as kidney cancer
• RCC consist of result of impaired cellular regulation and occurs in Adults who use tobacco or exposed to heavy metals, asbestos or trichlorethylene
• Diagnosis consist of an MRI which also increase RBC and hemoglobin

Acute Kidney Injury

• kidney failure to maintain waste elimination, fluid and electrolyte balance, and acid-base balance, dehydration, fluid loss and cardiac arrest increase risks for kidney injuries
• In the event of Oliguria, hypotension and fluid overload

Treatment for Acute Kidney Injury

• Treatment: use of loop diuretics
• monitor the patient for edema and lab work
• Assess fluids with characteristics and monitor

Chronic Kidney Disease (CKD)

• Unlike acute kidney injury CKD is a progressive, irreversible disorder lasting longer than 3 months
• CKD is a result of numerous hypertension, diabetes due to the metallic toxic build up and nerve damage. This can lead to uremia and the patient needs to be checked for confusion, tremor and edema
• Treatments used are drug therapy, nutrition(Potassium binders for hypo), dialysis

Chronic kidney disease hemodialysis Complications and Interventions

• Complications: hypotension, dialysis disequilibrium, cardia events and reactions
• Nursing interventions: Protein, sodium potassium with phosphorus restriction .
• Patient teaching consist of managing fluid, blood pressure, electrolytes and following the treatment/ medication plan
• Hemodialysis(Hospital/Home/center) and most common method of the End Stage
• Kidney Transplant is the most common method to decrease any risk factors, and also maintain a balanced life to prevent future Kidney failure.