Adult health urinary

Urinary Disorders - Overview

• Urinary disorders encompass a wide range of conditions affecting the urinary system.

Urine Composition and Characteristics

• Normal daily urine output is 1000-2000 ml.
• Urine is 95% water with remaining nitrogenous wastes and salts.
• Urine pH ranges from 4.6 to 8.0.
• The bladder holds 750-1000 ml of urine.
• A person typically feels the urge to urinate with 200-400 ml of urine in the bladder.

Urine Abnormalities

• Albumin: Presence indicates possible kidney disease, increased blood pressure, or kidney cell toxicity.
• Glucose: Presence indicates high blood glucose levels.
• Erythrocytes: Presence indicates potential infection, tumors, kidney disease, or kidney stones.

Ketone Bodies and Leukocytes

• Ketone bodies: Excessive quantities indicate fatty acid oxidation, often seen in diabetes mellitus, starvation, and metabolic conditions.
• Leukocytes: Presence indicates a urinary tract infection.

Laboratory and Diagnostic Examinations

• Urinalysis (clean catch): Evaluates urine composition and characteristics.
• Specific Gravity: Measures the concentration of dissolved substances in urine.
• Blood Urea Nitrogen (BUN): Measures urea nitrogen in the blood.
• Serum Creatinine: Measures creatinine in the blood.
• 24-hour urine for Creatinine Clearance: Evaluates kidney function.
• Prostate-Specific Antigen (PSA): Used in prostate health assessments.
• Osmolality: Measures concentration of solutes in urine.

Additional Laboratory and Diagnostic Examinations

• Kidney-Ureter-Bladder Radiography: X-ray imaging of the kidneys, ureters, and bladder.
• Intravenous Pyelogram (IVP)/Intravenous Urography: Provides detailed images of the urinary tract using contrast dye.
• Retrograde Pyelography: Images the urinary tract using contrast injected into the ureters.
• Voiding Cystourethrography: Visualizes the urinary bladder and urethra during urination.
• Cystoscopy: Examination of the bladder and urethra using a cystoscope.
• Renal Angiography: Examines blood vessels supplying the kidneys.
• Renal Venogram: Examines the veins of the kidneys.

Diagnostic Tests

• Computed Tomography (CT): Detailed cross-sectional images.
• Magnetic Resonance Imaging (MRI): Creates detailed images of internal structures in the body.
• Renal Scan: Evaluates kidney function or blood flow.
• Ultrasonography: Uses sound waves for anatomical imaging.
• Transrectal Ultrasound:
• Renal Biopsy: Examines kidney tissue.
• Urodynamic Studies: Assess bladder and urinary tract function.

Catheter Types

• Urinary drainage catheter: Designed with a balloon to hold the catheter in the bladder.
• Coude' catheter: Tapered tip for ease of insertion into a male patient with an enlarged prostate.
• Malecot and Pezzer catheter: Drains urine from the kidney pelvis.
• Robinson catheter: Has multiple openings for intermittent drainage.
• Ureteral catheter: Long and slender to reach ureters; often has a wider opening for more easily passing blood clots.
• Whistle tip catheter: Has an angled, larger opening for use when blood is present.
• Suprapubic catheter: Inserted into the bladder through an abdominal incision.
• Condom catheter: Non-invasive, used for male external urine drainage.
• External female catheter: Used for incontinence in female patients.

Self-Catheterization

• Used by patients with spinal cord injuries or neurological issues.
• Promotes independent and self-care.

Bladder Training

• Exercises to improve voluntary bladder control.
• Routine of clamping and unclamping bladder may be ordered to improve bladder tone.
• Kegel exercises are commonly used.

Habit Training

• Monitoring and adjusting the voiding schedule as needed.

Urinary Retention

• Inability to void despite the urge.
• May be acute or chronic.
• Common causes include physical/mental impairment preventing patient from reaching a restroom, medication side effects such as muscle spasms, and complications from previous surgery.
• Results in risk of urinary tract infections (UTIs), or discomfort/restlessness.

Treatment

• Urinary catheters or surgical procedures to relieve obstructions.
• Analgesics and antispasmodics may be used to relieve discomfort and relax the patient.
• Have the patient void and measure the residual urine.
• Goal is to keep residual urine below 50 ml.

Urinary Incontinence

• Involuntary loss of urine.
• Stress incontinence results from loss of sphincter control.
• Urge incontinence occurs with sudden urges to urinate.
• Overflow incontinence results from the inability to fully empty the bladder.
• Functional incontinence arises from physical or mental impairment preventing access to a bathroom.

Diagnostic Tests, Types, and Complications

• Surgical repair: May be needed.
• Botox: For overactive bladder.
• Temporary/permanent urinary diversion: Used in various situations.
• Pessary: Used for clients ineligible or resistant to other treatments or first line treatment.
• Avoid fluids decrease: Avoid causing bladder irritation in patients.
• Bladder Retraining Program: A program to help clients manage incontinence.
• Kegel exercises: Strengthen perineal muscles.
• Transvaginal sling: Used in certain cases of incontinence.
• Oxybutynin: Medication to treat incontinence issues.
• Avoid caffeine and alcohol:

Neurogenic Bladder

• Voiding control issues caused by neurological system lesions.
• May result in urinary retention or incontinence.
• Spastic neurogenic bladder has loss of sensation/control over bladder resulting in urinary reflux.
• Flaccid neurogenic bladder has loss of bladder sensation in the absence of voluntary muscle control leading to bladder distention.

Clinical Manifestations

• Infection: Back pain, abdominal discomfort, perineal pain, confusion, urosepsis (septic poisoning), retention in tissues.
• Retention: Backup of urine can lead to structures of the urinary tract distension.
• Incontinence: Urine loss (stress or urge).

Treatment

• Antibiotics for infection.
• Antispasmodics to ease the patient.
• Use of catheters to alleviate or manage.

Urinary Tract Infection (UTI)

• Infection in the urinary tract.
• Factors causing UTI include immobility, sensory impairment, multiple organ impairments, and sexual encounters.
• Common causes include catheters, bladder obstruction, insufficient bladder emptying, and decreased bactericidal secretions of the prostate gland and other urinary structures.
• Symptoms often include frequency, burning on urination, microscopic hematuria, nocturia, and asthenia (tiredness).

Nursing Interventions

• Hydration of client with 2000ml per day, unless contraindicated.
• Administration of antibiotics as required.
• Monitoring for allergies.
• Monitoring for ongoing or lingering infections.

Prevention of Urinary Infections

• Change sanitary products frequently.
• Avoid irritating feminine products.
• Wipe front to back.
• Urinate before and after sexual encounters.
• Adequate fluid intake.
• Appropriate Vitamin C intake.
• Drink 3-4 glasses of water daily.
• Proper catheter care and handwashing.

Urethritis

• Inflammation of the urethra (either with or without gonorrhoea).
• Gonorrheal urethritis is acute infection of the urethra's mucous membrane; results in purulent exudate from the meatus, burning sensations or pain during urination.

Gonococcal Urethritis

• Purulent discharge from the urinary meatus.

Non-Gonococcal Urethritis

• Mucoid (mucus-like) discharge from the urethral meatus.

Cystitis

• Inflammation of the urinary bladder wall.
• Common in women, often due to contamination from fecal matter or catheter insertion.
• Symptoms include dysuria (pain/burning during urination), urinary frequency, nocturia (nighttime urination), pyuria (pus in urine), and lower abdominal discomfort.

Teaching

• Proper fluid intake (2000ml daily).
• Good perineal hygiene.
• Early detection and follow up after intercourse.
• Avoid tea, chocolate, coffee, alcohol for potential kidney irritant properties.
• Use of appropriate substitutes for urinary irritants such as juice, herbal tea, or other substitutes.

Prostatitis

• Inflammation or infection of the prostate gland.
• May be bacterial, arising from pathogens traveling up the urethra, or nonbacterial, arising from a variety of factors (occlusion or obstruction inside the urethra, or urethral narrowing that results in inflammation).
• Causes include symptoms such as perineal/suprapubic pain or burning sensation.

Clinical Manifestations (Prostatitis)

• Burning sensation.
• Perineum discomfort.
• Lower back/abdominal pain.
• Urgency and frequency issues.
• Edema (potential).

Treatment/Teaching

• Broad-spectrum anti-infective therapy (2-16 weeks).
• IV antibiotics may be necessary.
• Sexual activity/arousal should be avoided during acute stages.
• Monitoring and management of complications and pain is indicated.

Pyelonephritis

• Kidney inflammation affecting the renal pelvis, renal tubules, and interstitial tissue.
• Often due to bacterial infections (E. coli).
• May be related to pregnancy, chronic health issues, catheterization, infections, obstruction, or trauma.
• Symptoms include cloudy urine containing pus and blood, unilateral/bilateral pain, fever, chills, and prostration.

Diagnosis

• Urinalysis (presence of bacteria, pus, blood cells).
• Culture/sensitivity testing (identifies bacteria type).
• Ultrasound (detects abnormalities such as obstruction or hydronephrosis).
• IVP (detects obstruction/degenerative changes).
• Blood tests (BUN, Creatinine).

Medical Management

• Mild symptoms: Outpatient antibiotics (14-21 days).
• Severe symptoms: Inpatient IV antibiotics (14-21 days).
• Specific antibiotic therapy based on culture and sensitivity testing.
• Adequate hydration may be recommended.
• Urinary analgesics (pain relief).

Urinary Obstruction

• Obstruction of the urinary tract from various causes (tumors, strictures, kinks, cysts, calculi, prostatic hypertrophy).
• Results in potential blood chemistry alterations (infection), ischemia (due to compression), or atrophy of kidney tissue (from damage and/or obstruction of blood flow).

Renal Colic

• Pain resulting from kidney stones in minor or major kidney calyces or ureters.

Clinical Manifestations and Diagnosis

• Complaint of repeated/unrelenting need to void.
• Dull or incapacitating pain.
• Nausea.
• Distended bladder.
• KUB (Kidney, Ureter, Bladder) radiograph to observe stones.
• Renal ultrasonography or IVP or endoscopy (for visualizing).
• Blood chemistry tests (assessing electrolytes).

Medical Management

• Insertion of indwelling catheter.
• Analgesics for pain.
• Anticholinergic agents to reduce smooth muscle motility (helpful for reducing spasms and/or pain related to smooth muscle constriction).
• Use of a suprapubic catheter.
• Stents, temporary or permanent.

Hydronephrosis

• Dilation of the renal pelvis and calyces of the kidneys, often caused by urinary tract obstruction.
• Can be congenital or acquired.
• Prolonged obstruction results in fibrosis and loss of function in affected nephrons.

Clinical Manifestations (Hydronephrosis)

• Pain
• Nausea and vomiting
• Difficult urination
• Dribbling
• Nocturia (nighttime urination)
• Burning sensation during urination
• Possible palpable abdominal mass.
• Bladder distention and tenderness over kidneys.

Treatment

• Surgical intervention to relieve obstruction.
• Nephrostomy: Incision to drain the kidney pelvis, helpful with obstruction.
• Management of infections.
• Pain relief.

Urolithiasis

• Formation of urinary calculi (stones) in any part of the urinary tract (kidneys, ureters, or bladder).
• Nephrolithiasis (kidney stones).
• Ureterolithiasis (ureter stones).
• Cystolithiasis (bladder stones).

Clinical Manifestations (Urolithiasis)

• Intractable pain (difficult to manage).
• Nausea and vomiting (N/V).
• Hematuria (blood in urine).
• Urgency to urinate.

Diagnosis and Treatment (Urolithiasis)

• KUB and IVP (for visualizing).
• Urinalysis.
• Procedures to flush urinary system (IV fluids).
• Surgical procedures to manage obstruction such as lithotripsy.
• Monitoring for urinary retention.

Nutritional Therapy (Kidney Stones)

• Increase water intake.
• Avoid high oxalate foods (chocolate, whole grains, spinach).
• Limit salt intake.

Renal Cysts

• Presence of cysts in the kidneys (often fluid-filled).
• Often a genetic disorder (polycystic kidney disease).
• Complication may be caused by pressure on kidney structures, infections, and scarring leading to abnormal function.

Clinical Manifestations (Renal Cysts)

• Abdominal and flank pain.
• Headaches.
• Gastrointestinal issues.
• Urinary disturbances.
• History of recurrent UTIs.
• Hematuria.

Benign Prostatic Hypertrophy (BPH)

• Enlargement of the prostate gland in men over 50.
• Common cause of urinary obstruction/retention.
• Symptoms include urinary urgency and frequency, straining, incomplete bladder emptying, and nocturia (nighttime urination).
• Risk factors include age.

Diagnosis and Treatment (BPH)

• Rectal examination to assess prostate size.
• Cystology or IVP to evaluate bladder and kidney function.

Prostatectomy

• Surgical procedure to remove all or part of the prostate.

Surgical Procedures (Prostatectomy)

• Suprapubic and Perineal Prostatectomy

Techniques of Prostatectomy - TURP

• Transurethral Resection of the Prostate(TURP).
• Less invasive compared to open procedures.
• Outer layer of prostate gland is left intact; done with a flexible fiberoptic endoscope/resectoscope introduced into the urethra.
• Watch for post-operative urine character and maintaining proper Foley catheter placement.

Post-Operative Care (Prostatectomy)

• Assess for and manage complications.
• Urine monitoring and management.
• Pain management.

Cancer of the Prostate

• Common in men over 50.
• Painless hematuria is common symptom.
• Elevated age risk.
• Urinary issues.
• Metastasis is common involving lymph nodes and bone.

Post-Operative Care

• Continence monitoring and management.
• Wound care and/or hematoma prevention.

Nephrotic Syndrome

• Common result of unusual allergic reactions or previous URIs.
• Signs include generalized edema, proteinuria, hypoalbuminemia (low albumin in blood), hyperlipidemia (high fat levels in blood), anorexia, fatigue, foamy urine, oliguria (low urine output).

Nephritis - Acute and Chronic

• Primarily inflammation of the glomeruli, tubules, or interstitial kidney tissue.
• Acute glomerulonephritis can be preceded by infection, systemic diseases (multisystem), or lupus.
• Acute phase is commonly triggered by an infectious process that triggers an immune response; this response causes glomerular filtration rate inflammation resulting in blood/protein excretion in the urine.

Clinical Manifestations (Nephritis)

• Swelling of the face and periorbital.
• Anorexia, nocturia, malaise, SOB.
• Changes in lung and heart sounds.
• Hematuria, decreasing urine output or dysuria.
• Frequently have albuminuria (having albumin/protein in urine).

Nephritis Treatment

• Treating primary symptoms.
• Preventing complications.
• Dietary adjustments of Na and K.
• Bed rest.
• Fluid intake adjustments (based on output).
• Antibiotics (abx) helpful to manage the underlying infection and minimize risk of sepsis.

Chronic Glomerulonephritis

• Morning headaches, dyspnea, vision/digestive disturbances, edema, weight loss/fatigue are present.
• Signs also include anemia, proteinuria, anasarca, cardiac/cerebral manifestation, issues related to mental functioning, and irritability.

Clinical Manifestations (Chronic Glomerulonephritis)

• Slurred speech, ataxia (lack of muscle coordination), tremors.
• Edema, ecchymoses, rash, dry skin that scratches.
• Abnormal urine color and amounts.

Chronic Renal Failure / End Stage Renal Disease (ESRD)

• Kidney's inability to restore normal function.
• Possible causes of this condition include pyelonephritis, glomerulonephritis, glomerulosclerosis, chronic urinary obstruction, high blood pressure, gout, and polycystic kidney disease.

Clinical Manifestations (Chronic Renal Failure)

• Headaches, lethargy, anorexia, pruritus, elimination changes, muscle cramps/twitching, other notable urinary/neuro/GI disturbances.
• Pain, potential edema (fluid build-up).

Diagnosis and Treatment

• BUN and serum Cr are used to determine if chronic renal failure is present.
• Treatment options focus on preserving existing renal function for as long as possible- including dialysis and kidney transplantation.
• Medications may include anticonvulsants, antianemics, vitamin and electrolyte supplements, antiemetics, antipruritics, and stimulating erythrocyte production (epogen)
• Some types of dietary modifications may be necessary.

Nutritional Therapy for Chronic Renal Failure

• Decrease protein breakdown.
• Avoid edema, dehydration.
• Correct acidosis and electrolyte imbalances.
• Control vomiting and diarrhea.

Nutritional Therapy (Chronic Renal Failure)

• Modified mineral and protein intake (dependent on output rates in the kidneys- output adjusted for potassium).
• Fluid balance (output + 300-600ml).

Nutrition and Dialysis

• Post-dialysis, dietary restrictions usually less stringent.
• As treatment nears, restrictions get stricter.

Dialysis

• Method that mimics kidney function when kidney function is interrupted or has failed.
• Certain elements or compounds may be removed from the body through an external membrane/method, adjusting imbalances.

Hemodialysis

• Blood is routed through an artificial kidney to remove wastes, fluids, and electrolytes; the blood is returned to the patient's body.
• Access is generally accomplished by an arteriovenous fistula and a thrill or a bruit is present (used to monitor).

Peritoneal Dialysis

• The peritoneal membrane/cavity is used as a semipermeable membrane to remove wastes, fluids, and electrolytes from the body through diffusion.
• Catheter is used for dialysing/removing waste.

Nursing Interventions

• Patient comfort, wound care, and proper management of fluids and electrolytes.

Nephrostomy

• Incision to drain the kidney pelvis by a catheter (necessary to prevent obstruction).
• Drainage amounts are recorded, and the patient is monitored for any complications.
• The patient is checked/positioned for proper drainage and ventilation.

Kidney Transplantation

• The non-functioning kidney remains in place.
• The donor kidney is positioned in the iliac fossa.
• Patients may need immunosuppressant medications.
• Relatives, such as siblings, are commonly appropriate donors in this procedure.

Postoperatively (Kidney Transplantation)

• Assess for signs, symptoms, or issues that indicate rejection, infection, and any needed post-operative care.
• Manage pain.
• Monitor urinary output and vital signs.

Teaching Post-Surgery

• Proper fluid management/intake.
• Strict monitoring of I&O.
• Preventing infection and harmful activities that cause trauma to the urinary tract

Nutrition and Kidney Transplants

• Dietary restrictions are usually unnecessary and often high caloric diet is needed right after the procedure.
• Simple CHO may be restricted due to steroid usage (steroids can help reduce rejection, but some may increase blood glucose).

Urinary Diversion

• Usually used for certain types of bladder or cervix cancers and for issues related to neurogenic bladder or congenital anomalies.
• Cystectomy (surgical removal of the bladder) may be a required treatment step.
• An ileal conduit (ureters are implanted into the ileum that is brought to the surface) is another common treatment procedure for diversion.

Post-Operative Care (Urinary Diversion)

• Daily urine measurement and monitoring.
• Stoma observation- ensuring it is pink and moist in appearance.
• Appropriate fluid intake.
• Teaching regarding care at home.

Test your knowledge on urinary output, characteristics that indicate kidney disease, and catheter types used in urology. This quiz will cover essential nursing considerations and diagnostic tests related to urinary health. It's designed for students and professionals in the medical field.