Urinary Tract Infections (UTIs) Overview

<p>pyelonephritis-infection of one or both kidneys..............ureteritis</p> Signup and view all the answers

<p>Costovertebral tenderness – High fever – Chills – Nausea/vomiting</p> Signup and view all the answers

<p>Sepsis that occurs from an untreated UTI – Drop in BP, Increase in HR, Temp and RR – Changes in mental status – Organ failure – Blood cultures x 2 8</p> Signup and view all the answers

<p>Phenazopyridine (Pyridium) • Antibiotics Medications • Foods to prevent UTI (polyphenols) • Encourage increased fluid consumption • Void Q3-4 Hours while awake • Hygiene • Avoid tight clothing • Void after sex Nonpharmacological 9</p> Signup and view all the answers

<p>From point of obstruction Urine backs up • (distention of kidney) Hydronephros is occurs------ then Builds up pressure---then Kidney damage ---then Impaired function then ------CKD</p> Signup and view all the answers

<p>Narrowing of the lumen of the urethra (scar tissue) • Causes – Diminished urinary stream – Frequency – Urgency – Dysuria – Frequent UTI’s 11</p> Signup and view all the answers

<p>Catheterization • Mechanical dilation • Endoscopic urethrotomy • Urethroplasty • Implantation of stent 12</p> Signup and view all the answers

<p>Pathophysiology • Minerals and salts • High uric acid • Substances that inhibit stone formation are low Types • Calcium • Uric acid • Struvite • Cystine 13</p> Signup and view all the answers

<p>RENAL CALCULI (UROLITHIASIS) 14 • DM, gout, HTN, intestinal disorders, obesity, Genetics Medical conditions Chronic high pH Chronic UTI • ASA, indinavir, topiramate, triamterene, vitamin C supplements, vitamin D, calcium supplements, Dehydration Excessive sweating DIET• low in calcium, phytate, and potassium • high in fructose, oxalate, animal protein, vitamin C, sodium, and sucrose Medication</p> Signup and view all the answers

<p>nephrolithiasis • Flank Pain • Hematuria ...............Ureterolithiasis • Severe colicky pain • Flank, side, or lower abdominal pain • Intense urge to void • Frequency • Dysuria • Hematuria • N/V.............. Bladder Stones• Hematuria • Oliguria 15</p> Signup and view all the answers

<p>Blood Tests • BUN/creatinin e • Calcium • Uric acid ----------Urinalysis • Hematuria • Crystals • WBC • Bacteria------------ 24-hour urine collection • Calcium • Sodium • Uric acid • Oxalate • Citrate • Creatinine -----------------Imaging test • Noncontrost CT • Renal ultrasound • IV pyelography</p> Signup and view all the answers

<p>Hydration – 2-3 quarts daily • Avoid sweetened beverages and grapefruit juice • DASH diet and Mediterranean diet recommended • Ambulate • Urocit-K (potassium citrate)</p> Signup and view all the answers

<p>L E S S T H A N 1 0 M M I N S I Z E Hydrate • 2-3 quarts of fluid Pain control • NSAIDs • Opioids • Heat Strain all urine • Stone analysis Alpha-blocker • Tamsulosin (Flomax</p> Signup and view all the answers

<p>Cystoscopy(goes in head of penis and tap away the calculi) Ureteroscopy Lithotripsy • Shock-wave • Laser Percutaneous Nephrolithotomy 18</p> Signup and view all the answers

<p>Caused by years of damage from elevated glucose levels to small blood vessels in kidneys Reduce risk in DM patients • Control BGL • Control HTN • Control weight • Smoking cessation • Caution with NSAIDs Strict control of BGL – AIC &lt;7 • Strict control of HTN – ACE inhibitors – ARBs • Cholesterol control – statins 23</p> Signup and view all the answers

<p>Massive loss of protein through urine Can be caused by many different conditions Increased glomerular permeability which leads to protein (albumin) being filtered into urine instead of staying in blood</p> Signup and view all the answers

<p>Anasarca(widespread edema) Ascites.... Low serum total protein and albumin Elevated serum cholesterol .....Foamy urine ..........Elevated BP</p> Signup and view all the answers

<p>Average blood glucose concentration over the past 2-3 months</p> Signup and view all the answers

<p>Decrease pressure • ACE inhibitors/ARBs Interventions for edema • Loop diuretics • Sodium restriction • Daily weights • Strict I&amp;Os • Abdominal girth measurements • Skin breakdown prevention Prevention of infection Dietary consult • Protein consumption</p> Signup and view all the answers

<p>Inflammation of the glomerulus • Altered filtration allows proteins, WBCs, RBCs, and electrolytes to be excreted in urine</p> Signup and view all the answers

<p>Post- streptococcal infection-Usually, strep throat or skin infection.......................Goodpasture Syndrome-autoimmune...........................Chronic Glomerulonephritis-Progressive inflammation of glomerulus</p> Signup and view all the answers

<p>Oliguria • Fluid overload – HTN – Edema – electrolyte imbalance • Flank pain • Dark “cola-colored” urine – Sometimes foamy urine • Urinalysis – Hematuria – Proteinuria • Serum BUN/Creatinine – May be elevated • Ultrasound • X-Ray • Biopsy</p> Signup and view all the answers

<p>Acute disease usually resolves with symptomatic Tx within a week • Goal is prevention of progression to CKD – Rest – Edema treatment • Fluid restrictions • Na restrictions – Protein restriction • if increased BUN/creatinine – Education focused on prevention</p> Signup and view all the answers

<p>Rapid onset of decreased kidney function Combination of hypoperfusion, tissue injury/damage, and inflammation Causes waste products to accumulate in the bloodstream (azotemia) Kidneys are unable to filter waste products and may leak other products into urine Usually, reversible</p> Signup and view all the answers

<p>Prerenal • Decreased perfusion to kidneys Intrarenal • Damage to nephrons Postrenal • Obstruction</p> Signup and view all the answers

<p>Nephrotoxins – Diagnostic Contrast Media (Dyes) – Medications – Heavy Metals – Organic Solvents</p> Signup and view all the answers

<p>Antibiotics: – Aminoglycosides – gentamycin, neomycin, tobramycin – Amphotericin B – Cephalosporins – Cefazolin, Cefdinir, Cefepime – Sulfonamides - Bactrim – Tetracyclines – doxycycline, Vibramycin • Analgesics – Acetaminophen – NSAIDs – Salicylates – ASA • Contrast media • Other meds: – ACE inhibitors – Amphetamines – Cisplatin – Dextran – Heroin – Interleukin-2 – Mannitol 34</p> Signup and view all the answers

<p>Initiating • Time of renal injury – occurrence of symptoms -------------------------OLIGURIC&lt;400mL of urine in 24 h • Fluid retained • Electrolytes imbalances • Waste products not excreted (azotemia) • Metabolic acidosis - ----------------DIURETIC• Kidneys begin to excrete 1 – 3L/day • Dehydration/hypotension are a concern • Monitor for hypovolemia, hyponatremia, hypokalemia, hypotension - ----------------Recovery• GFR rises • BUN and creatinine decrease</p> Signup and view all the answers

<p>Correcting the cause – prevent permanent damage • Treat s/sx – Restore fluid/electrolyte balance – DC nephrotoxic drugs – Bypass – Obstructions – Short-term CRRT</p> Signup and view all the answers

<p>Alternative to dialysis • Removes fluid and solutes in a controlled continuous manner • Uses temporary vascular access • Blood flows through the hemofilter: excess fluids and solutes flow into bag – Remaining blood returns to the patient via venous access – May give electrolytes through access • Nursing considerations – Hourly vitals – Monitor vascular access – Strict I&amp;O – Electrolytes – Daily weights</p> Signup and view all the answers

<p>Check creatinine/GFR before contrast dye or medication administration • Monitor levels routinely as indicated • Follow hydration protocols for contrast dye • Prevention of kidney stones</p> Signup and view all the answers

<p>Gradual progressive, irreversible deterioration in renal function. – Unable to maintain metabolic, fluid and electrolyte balance – Nitrogenous waste accumulates – Uremia occurs • Diagnosed when 75% of nephron function is lost – Renal insufficiency s/sx occur • ESRD occurs when 90% function is lost – BUN and creatinine are always elevated 39</p> Signup and view all the answers

<p>ABG – Metabolic Acidosis decreased RBCs – elevated BUN - elevated Creatinine - elevated Magnesium - elevated Potassium - elevated Sodium – elevated........ Calcium – decreased----------------------------stage 1 slight decrease 90 or greater.....stage 3 moderate decrease 45-59.......stage 5 dialysis/transplant &lt;15</p> Signup and view all the answers

<p>Disturbance in Water Balance – Edema – SOB – Crackles/wheezes – HTN – Polyuria, oliguria, or anuria • Disturbance in Electrolyte Balance – Hypernatremia – water retention, edema, HTN – Hyponatremia due to vomiting or diarrhea – confusion – Hyperkalemia – muscle weakness, abdominal cramping, diarrhea, confusion – Hypocalcemia – increased risk for fractures – Hyperphosphatemia – severe itching 41</p> Signup and view all the answers

<p>Disturbance of Removal of Waste Products – Azotemia – Weakness/fatigue – Confusion, seizures, – Asterixis – N/V – lack of appetite – Metallic taste – Yellowish skin – Itching – Uremic Frost • Disturbance in Maintaining Acid-Base Balance – hydrogen excretion affected – Metabolic acidosis • Disturbance in Hematologic Function – anemia 42</p> Signup and view all the answers

<p>Depends on pt’s condition High calorie, low fat Protein restriction unless on dialysis Na+/K+/phosphorus restriction Supplements Fluid restriction as needed Can be anorexic and have N/V</p> Signup and view all the answers

<p>Tx for hyperkalemia • Kayexalate, insulin (+D50), Lasix, albuterol • Place on cardiac monitor – Vitamin/electrolyte supplements • Ex: Calcium gluconate – Sodium Bicarbonate – Diuretics for fluid overload – Sevelamer hydrochloride (Renagel) – Control HTN – Control DMII</p> Signup and view all the answers

<p>Definitive tx of CKD/ESRD/uncontrolled hyperkalemia • Intermittent artificial blood filtration –Vascular Access • Temporary- central line • Permanent- AV fistula or graft</p> Signup and view all the answers

<p>PERITONEAL DIALYSIS • Continuous Dialysis Done by Patient – Peritoneal membrane used to filter out waste via peritoneal vessels – Peritoneal catheter inserted between layers of the peritoneum • Exchange Process 1. Fill 2. Dwell 3. Drain</p> Signup and view all the answers

<p>Thrill- palpable tremor Bruit- swishing sound when auscultating PROTECT Postoperative • Neurovascular Checks – What do you do if there are concerns? • Elevate, ROM, control pain</p> Signup and view all the answers