Disorders of the Urinary System and the Prostate (part 1) Student version.pptx

Disorders of the Urinary System and the Prostate (Part 1) WEEK 10 3512 S L I D E S A N D C O N T E N T S D E V E L O P E D B Y M E G H A N C O N R A D , B A R B G O O D W I N A N D C R Y S TA L V E L A S Q U E Z Class Overview UTI: cystitis + pyelonephritis Obstruction: urolithiasis, hydronephrosi...

Disorders of the Urinary System and the Prostate (Part 1) WEEK 10 3512 S L I D E S A N D C O N T E N T S D E V E L O P E D B Y M E G H A N C O N R A D , B A R B G O O D W I N A N D C R Y S TA L V E L A S Q U E Z Class Overview UTI: cystitis + pyelonephritis Obstruction: urolithiasis, hydronephrosis/hydroureter, BPH Cancer: Urothelial cancer (Bladder CA) + Renal cell carcinoma + Prostate CA Nephrotic syndrome AKI/CKD Urinary Tract Infections (UTI): Review Commonly (80%) resulting from e. coli bacteria Causes: ◦ Foley catheters in acute and long-term care settings (CAUTI) ◦ Urinary stasis Risk factors: ◦ Female sex (anatomical) ◦ Conditions that cause urinary stasis (ex. BPH) Urinary Tract Infections (UTI): Review Symptoms ◦ Cystitis: (inflammation of bladder, often caused by infection) ◦ Frequency, urgency, dysuria/burning ** ◦ Suprapubic/lower back pain ◦ Retention, feeling of incomplete bladder emptying ◦ Incontinence ◦ Nocturia ◦ Cloudy urine ◦ Pyelonephritis: (bacterial infection of kidney and renal pelvis) ◦ Cystitis symptoms plus: ◦ Fever, chills/rigors ◦ Nausea/vomiting/malaise ◦ Flank pain and costovertebral angle tenderness Urinary Tract Infections (UTI): Review Diagnostics (Cystitis & Pyelonephritis) ◦ Urinalysis ◦ Bacteriuria, pyuria, microscopic hematuria, nitrites, leukocytes ◦ Urine culture ◦ Identifies causative organism ◦ Tailored antibiotics ◦ Other ◦ Blood cultures, CBC, CRP, Lytes (BUN & creat.) ◦ Pyelonephritis specific: ◦ Xray kidneys, ureters, bladder (KUB) ◦ CT UTI: Interventions Interventions focus on: Pain relief and teaching about drug therapy, fluid intake, and preventative Preventing Drug therapy: measures Pain relief: 1. Acetaminophen (also fever management) 2. ___Diuretics___________ __ 3. Antispasmodics Antibiotics: Route and duration depends on severity of UTI • Ex. Trimethoprim/sulfamethoxazol e (septra), Nitrofurantoin, Cipro Pain Warm sitz bath 2-3 times per day for 20 minutes Fluid intake/Nutrition therapy • Drink enough fluid to maintain dilute urine • Cranberry containing products Surgery Treats conditions that increase risk of UTIs • Ex. Removing the obstruction Catheter replacement supportive care, for patients who still need catheter Teaching • _Take antibiotics in full** • Catheter care • Talk about techniques for preventing UTIs • See box p. _______ CKD: conserve existing kidney function Chronic UTI can cause CKD Nursing’s Role in preventing CAUTI (pg. 1338) Hand hygiene/aseptic technique Leave in place only as long as it is indicated Indications Assess need daily Maintain a closed system Obtain urine samples aseptically https://onlinelibrary-wiley-com.uml.idm.oclc.org/doi/full/10.111 Obstruction: Urolithiasis, BPH, hydronephrosis/hydroureter Urolithiasis: presence of calculi/stones in urinary tract ◦ Nephrolithiasis: stones in the kidney ◦ Ureterolithiasis: stones in the ureter BPH: Enlarged prostate gland that can cause bladder outlet obstruction (BOO) Hydronephrosis/hydroureter: enlargement of kidney or ureter resulting from an outflow obstruction Urolithiasis: Review Sometimes no symptoms until stones pass into the lower urinary tract  excruciating pain Stones = particles in the urine that occur in amounts too high to stay dissolved. When/if stone blocks/occludes the ureter and blocks the flow of urine, the ureter dilates. Enlargement of the ureter is called hydroureter. If this persists, we see enlargement of the kidney (hydronephrosis) ◦ Permanent kidney damage can result Pain is associated with ureter spasm and is excruciating Risk factors: ◦ ___Dehydration_____________** ◦ Diabetes, obesity, gout ◦ Diet (high sodium) Urolithiasis: Interprofessional Collaborative Care History ◦ Personal or family history of stones – was chemical analysis performed to determine stone type? ◦ Diet history (fluid intake patterns, supplement intake, etc.) Physical Assessment ◦ Severe pain (abdominal and flank) ◦ Renal colic (N/V, diaphoresis, pallor) ◦ Hematuria ◦ Frequency (stone in bladder) ◦ Oliguria/anuria (obstruction of bladder neck or urethra) ◦ Watch for bladder distension ◦ Monitor vital signs (watch for shock or infection) Urolithiasis: Interprofessional Collaborative Care Diagnostics Urinalysis (UA) ◦ pH can help with stone type ◦ Hematuria common ◦ WBC and bacteria may be present resulting from urinary stasis CT scan abdomen and pelvis KUB x-ray (If CT not possible) Ultrasound (U/S) for suspected pregnant woman with stones Urolithiasis: Taking Action Goals: Pain relief, preventing infection, and preventing obstruction Most stones are expelled by patient without invasive procedures Pain management (non-surgical) Drug therapy: ◦ _Narcotics_____ ◦ NSAIDS, ex Ketorolac ◦ Spasmolytic drugs (ex. Oxybutynin) ◦ Antibiotics (if infection) ◦ Thiazide diuretics & Allopurinol Lithotripsy (extracorporeal shock wave lithotripsy) ◦ Uses sound, laser, or dry shock waves to break the stone into small fragments Urolithiasis: Taking Action Pain management (surgical) ◦ Minimally invasive surgical procedure used if urinary obstruction occurs or if the stone is too large to be passed. ◦ Stenting, ureteroscopy, percutaneous ureterolithotomy, and percutaneous nephrolithotomy - Stenting: small tube placed in ureter by ureteroscopy - - - o Stent dilates the ureter and enlarges the passageway for the stone or stone fragments (Very painful). Ureteroscopy: Endoscopic procedure o Ureteroscope placed through urethra and bladder into ureter o Once stone seen, removed with grasping baskets, forceps, or loops o Lithotripsy can also be performed via ureteroscope Percutaneous ureterolithotomy, and percutaneous nephrolithotomy o Removal of a stone in the ureter or kidney through the skin o Often a nephrostomy tube is left in place o Monitor for complications post op. Open surgical procedure o If other stone removal attempts have failed or when risk or lasting injury to ureter or kidney is possible o There maybe be bleeding o Risk for DVT or blood clots Urolithiasis: Taking Action Preventing Infection Antibiotics to treat infection if present ◦ May be given prophylactically Nutrition and fluid intake maintenance ◦ Adequate caloric intake, balanced diet ◦ Enough fluid intake to dilute urine (about 2-3L/day) Preventing Obstruction High fluid intake, I+O Drugs(Antispasmodic) Stool softner, diet mod. and fluid intake Drug therapy and nutritional therapy dependent on type of stone ◦ Ex. Drugs to treat hypercalcemia ◦ See page 1349. Encourage walking often and strain urine Patient and Family Education: preparing for self management (see p. 1349) • Lifestyle modifications • Nutrition and fluid intake • Monitoring and follow-up as prescribed Benign Prostatic Hypertrophy (BPH): Review Enlarged prostate gland that can extend upward into the bladder and inward causing bladder outlet obstruction (BOO)  Very common male health problem, risk increases with age Assessment: History: AGE (Increases with age) Ask about elimination pattern, frequency, urgency, weak stream, incomplete emptying, straining, nocturia, intermittency Physical: See LUTS (lower urinary tract symptoms) – retention, leaking, or incontinence, eventually causing overflow urinary incontinence where urine leaks around enlarged prostate causing dribbling BPH: Analyze Cues Urinary retention d/t bladder outlet obstruction Decreased self esteem d/t overflow urinary incontinence and possible sexual dysfunction Improving urinary elimination: Behaviour modification Drug therapy ◦ Alpha-adrenergic antagonists ◦ 5-alpha-reducatase inhibitors (Help reduce prostrate size) Minimally invasive approaches 1476 (table 67.1) ◦ Prostate artery embolism ◦ TUNA (transurethral needle ablation) Cutting it ◦ TUMT (transurethral microwave therapy) Shrinking it BPH Surgical Management Some or all criteria would suggest need for surgery: - Acute urinary retention (AUR) d/t obstruction - Chronic urinary tract infections secondary to residual urine in the bladder - Hematuria - Hydronephrosis - Persistent pain with decrease in urine flow TURP (Transuretheral resection of the prostate) Enlarged portion removed through endoscope Pre-op: preparing for post op Post-op: - Catheter placed, may need continuous bladder irrigation - See box on p. 1477 for care of patient with TURP - Infection, mobilization, pain, environment safety, potential continuous bladder irrigation, bladder spasms, I+O documentation, monitor for obstruction (notify surgeon if can’t be resolved) BPH Improving self-esteem Keep peri care area clean Void when feel the urge Wear a small absorbent pad Provide objective and factual resources on risk for sexual dysfunction lasting post-surgery Care Coordination: BPH typically managed at home May be discharged with short term urinary catheter ◦ Don’t bath or swim when cath in place to decrease UTI risk Self-management of incontinence – often symptoms are temporary Hydronephrosis/Hydroureter: Review Enlargement of kidney or ureter resulting from an outflow obstruction Potential causes:  Kidney stones, tumors, trauma, etc Can see kidney damage and necrosis if treatment doesn’t occur in a timely manner. Hydronephrosis/Hydroureter: Assessment/Interventions History: changes in elimination patterns, urinary problems? Physical: flank or abdominal pain Imaging: bladder scan, CT, ultrasound Labs: U/A, blood chemistry Interventions: Treat cause of obstruction DONE