Urinary-Tract-Disorders-1.pdf

Urinary Tract Infections   Most infections involve the lower urinary tract A urinary  Women are at greater risk of tract developing a UTI than men are. infection  Urinary tract infections don't always...

Urinary Tract Infections   Most infections involve the lower urinary tract A urinary  Women are at greater risk of tract developing a UTI than men are. infection  Urinary tract infections don't always cause signs and symptoms, but when (UTI) is an they do they may include: ❑ A strong, persistent urge to urinate infection in ❑ A burning sensation when urinating any part of ❑ Passing frequent, small amounts of the urinary ❑ urine Urine that appears cloudy system — ❑ Urine that appears red, bright pink kidneys, or cola-colored — a sign of blood in the urine ureters, ❑ Strong-smelling urine bladder and ❑ Pelvic pain, in women — especially in the center of the pelvis and urethra. around the area of the pubic bone  Risk Factors for UTI a. Inability or failure to empty the bladder completely b. Obstructed urinary flow c. Immunosuppression may weak immune system d. Instrumentation of the urinary tract mga may catheter etc e. Inflammation of the urethral mucosa f. Contributing conditions - Congenital anomalies Diabetes Mellitus - urethral strictures Pregnancy - Contracture of the bladder Neurologic Disorders neck Gout - Bladder tumor - Calculi in the ureter or kidney  Lower UTI’s Urethra Urethritis Urinary Bladder Cystitis Prostate Gland Prostatitis Uncomplicated UTI’s are community acquired Complicated UTI’s usually occur in people with urologic abnormalities or recent catheterization and are often hospital acquired Several mechanism maintain the sterility of the bladder: The physical barrier of the urethra Urine flow/ efflux of urine Ureterovesical junction competence Antiadherent effects by the mucosal cells Glycosaminoglycan ( GAG) – hydrophilic protein, normally exerts non adherent protective effect against various bacteria. GAG molecules attracts water molecules, forming a water barrier that serves as a defensive layer between the bladder and the urine. UROTHELIUM – transitional cell epithelium that prevents re-absorption of urine  Normal bacterial flora of the vagina and urethral area also interfere with adherence of Escherichia coli. Urinary Immunoglobin A (IgA) in the urethra may also provide barrier to bacteria Urinary Tract Infection Classification of UTIs Lower UTI’s Upper UTI’s Complicated Complicated Uncomplicated Uncomplicated Lower UTI’s :  usually caused by Escherichia coli (E. coli),  Sexual intercourse may lead to cystitis  All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.  Urethritis  This type of UTI can occur when bacteria spread from the anus to the urethra.  because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea can cause urethritis. Complications of UTI  Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.  Increased risk in pregnant women of delivering low birth weight or premature infants.  Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.  Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys. REFLUX An obstruction to the free flowing urine is known as URETHROVESICAL REFLUX Backward flow of urine from the urethra into the bladder Increase bladder pressure caused by sneezing, coughing or straining Forces urine from bladder to urethra When pressure returns to normal urine flow back into the bladder bringing bacteria  VESICOURETERAL REFLUX Backward flow of urine from the bladder to the ureters Bacteriuria – defined as more than 105 colonies of bacteria per ml of urine Bacteria enters the body in three ways: * transurethral route (ascending infection) * bloodstream ( hematogenous spread) * fistula from the intestine ( direct extension) Urosepsis – sepsis from infected urine Gerontologic Conditions Bacteriuria increases with age and disability Women> men UTI is the most common cause of acute bacterial sepsis in patients >65 years old Antibacterial activity of prostatic secretions decreases  Upper UTI’s ▪ Pyelonephritis – Is a bacterial infection of the renal pelvis, tubules an interstitial tissue of one or both kidneys ❑ Causes : upward movement of bacteria or systemic spread (incompetent ureterovesical valve) ❑ Obstruction : bladder tumors, benign prostatic hyperplasia, urinary stones urine stasis urine retention; bladder cannot entirely empty  Pyelonephritis ❑ Acute: kidneys are enlarge with interstitial infiltrations of inflammatory cells; abscess on renal capsule; atrophy and destruction of tubules and glomeruli may result ❑ Chronic: kidneys becomes scarred, contracted and non functioning Nephron LOSS  ACUTE PYELONEPHRITIS CHRONIC PYELONEPHRITIS Clinical Manifestation : Usually has no symptoms a. Chills unless acute exacerbation occurs b. Fever Clinical Manifestation : c. Leukocytosis a. Fatigue b. Headache d. Bacteriuria c. Poor appetite e. Pyuria d. Polyuria f. Low back pain e. Excessive thirst g. Flank pain f. Weight loss h. Nausea and vomiting Medical management : i. Headache a. Long term use of prophylactic antibiotics j. Malaise b. Renal replacement k. Painful urination  Diagnostic Findings a. Urinalysis :microscopic analysis of the urine shows signs of infection. Excess of white blood cells and bacteria. b. Urine culture :Within days, bacteria in urine may grow on a culture dish, allowing the best antibiotic to be chosen. c. Blood cultures. d. Computed tomography (CT scan) e. Kidney ultrasound. help identify abscesses, stones, and blockages.  Medical Management  Antibiotic therapy  Relieve obstruction  Analgesics  Nephrostomy - a tube inserted through the skin on the back into the kidney abscess to drain  Renal function test monitoring Nursing Management ❑ Fluid monitoring (I & O) ❑ 3-4 L /day unless contraindicated ❑ Monitor v/s ❑ Health Teaching o Prevent recurrence of infection ❖ Adequate fluids ❖ Regular bladder emptying o Perineal hygiene o Drug compliance Adult Voiding Dysfunction o Urinary Incontinence o Urinary Retention o Neurogenic Bladder  Definition : involuntary loss of urine in the bladder Types : Stress Urge Functional Iatrogenic Mixed Urinary Incontinenc Incontinence Incontinence Incontinenence Incontinence e Stress Incontinence o Involuntary loss of urine through an intact urethra as a result of sneezing, coughing or changing position o Predominantly affects women who have had vaginal deliveries, decreasing pelvic ligaments and pelvic floor support of the urethra and decreasing estrogen levels in the urethral walls and bladder base o In men, after radical prostatectomy, bladder wall irritability Urge Incontinence o Is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed o Patient is aware of the need to void that cannot be suppressed and unable to reach the toilet in time Functional Incontinence o refers to those instances in which lower UT function is intact but other severe cognitive impairment makes it difficult for the patient to identify the need to void o Physical impairment make it difficult or impossible for the patient to reach the toilet in time for voiding.  Iatrogenic Incontinence o refers to the involuntary loss of urine due to extrinsic factors, predominantly medications Mixed Urinary Incontinence o encompasses several types of urinary incontinence o Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing  Medical Management 1. Behavioral Therapy 2. Pharmacologic Therapy 3. Surgical Management  Behavioral Therapy a. Fluid management – 1500 to 1600ml in increments b. Standardized Voiding Frequency 1. Timed Voiding- void by the clock 2. Prompted Voiding- timed voiding carried out by family when patient has cognitive impairments 3. Habit Retraining- timed voiding with interval that is more frequent than the individual would normally choose (restores urge sensation)  4. Bladder Retraining – “bladder drill”; incorporates time voiding schedule and urinary urge inhibition exercise to inhibit voiding or urine leakage in an attempt to remain dry for a set of time 5. Pelvic Muscle Exercise (PME)- also known as Kegel’s Exercise (10-30 repetitions) 6. Vaginal Cone Retention Exercise – 15 minutes BID by contracting the pelvic muscles  7. Transvaginal or Transrectal Electrical Stimulation -electrical stimulation is known to elicit a passive contraction of the pelvic floor musculature at high frequency – stress incontinence at moderate frequency – mixed incontinence at low frequency – urinary urgency, frequency and urge incontinence 8. Neuromodulation- trans V or trans Rectal nerve stimulation of the pelvic floor inhibits detrusor over activity and hypersensory bladder signals and strengthen weak spinchter Pharmacologic Therapy a. Anticholinergic – inhibits bladder contraction and are considered first line medications for urge incontinence b. Tricyclic anti depressants – decrease bladder contraction and increase bladder neck resistance c. Pseudoephedrine Sulfate- acts on alpha adrenergic receptors causing urinary retention d. Hormone therapy- estrogen  Surgical Management Most procedures involve lifting and stabilizing the bladder a. Anterior vaginal repair – stress incontinence b. Retropubic suspension c. Needle suspension to reposition the urethra Procedures to Compress the urethra and increase resistance to urine flow a. Sling procedures b. Placement of periurethral bulking agents – artificial collagen  periurethral bulking agents – semi permanent procedure in which small amounts of artificial collagen are placed within the walls of the urethra to enhance the closing pressure of the urethra  ARTIFICIAL URINARY SPHINCTERS - to close the urethra and promote continence  Periurethral cuff  Cuff Inflation pump THANK YOU!! YEYYY!!