Match:
1. Involuntary urination with increased pressure (sneezing)
2. Passage of urine containing gas
3. Inability to urinate even though bladder is full
a. retention
b. Pneumaturia
c. Stress incontinence
1. c
2. b
3. a
Match possible etiology and significance with abnormality:
1. Weakness of sphincter control; lack of estrogen, urinary retention
2. Fistula connection between bowel and bladder; gas-forming urinary tract infection
3. s/p pelvic surgery; childbirth; cath removal; urethral obstruction; neurogenic bladder
a. Retention
b. Pneumaturia
c. Stress incontinence
1. c
2. b
3. a
What are the three commonly used bowel prep to adequately visualize the urinary tract?
Which of the three are contraindicated in patients with kidney failure and why?
1. Enemas
2. Castor oil
3. Magnesium Citrate
Magnesium ccitrate and fleet enemas which contain magnesium are contraindicated because they cannot be excreted with kidney failure. You also want to avoid dehydration.
When sending a urine specimen for C&S, what three things found in the urine can indicate a UTI?
1. Nitrites
2. WBC
3. Leukocyte esterase (a screening test used to detect a substance that suggests there are white blood cells in the urine)
State definition of each:
1. Determine amount of urine left in bladder after urinating.
2. Inspects interior of bladder with a lighted scope, can be used to insert caths, remove calculi, obtain biopsy
3. radioactive isotopes are injected IV, assess size of kidney blood flow, cysts, tumors.
1. Residual urine
2. Cystoscopy
3. Renal Scan
State what labs these are and the normal levels:
1. can detect renal problems; elevated levels can also be d/t GI bleeding, dehydration, corticosteroid therapy
2. More reliable than #1 in determining renal fxn. It is a waste product of protein breakdown, primarily in muscle mass.
1. BUN 6-20 mg/dL
2. Creatnine 0.6-1.3 mg/dL
What is creatinine clearance and how is it done?
a 24-hour urine specimen: It is done by discarding first urination, and collecting up to right after the end of the 24-hour period.
Serum creatinine test is done here, and clearance of creatining by kidney approximates the glomerular filtration rate (GFR)
List normal levels:
Uric Acid
Na
K
Which is one of the first to become abnormal in renal dysfuncton?
What are normal calcium levels? How is calcium affected in kidney dz?
8.6-10.2 mg/dL
In kidney dz, there is a decreased reabsorption of calcium?
Fill in:
Normal phosphorous levels are __a__ mg/dL. In kidney disease, phosphorous levels are __b__ because the kidney is the primary excretory organ.
a. 2.4-4.4
b. elevated
T or F: Most renal faiure patients have metabolic alkalosis and high serum HCO3 levels
False: acidosis with low serum HCO3 levels
Fill in:
Voiding is controlled by stimulating and inhibiting impulses sent from the brain through the __a__ (T11-L2) and __b_ (S2-S4) areas of the spinal cord.
a. thoracolumbar
b. Sacral
If it is not appropriate to urinate at that moment, brain's inhibitor impulses are stimulated and then transmitted through the thoracolumbar and sacral nerves innervating the bladder.
This urinary diversion is an internal reservoir that a surgeon creates from a section of the bowel. Urine flows through the ureters into the reservoir and is drained by the patient. The patient has to be taught how to catheterize themselves.
a. Incontinent urinary diversion
b. Continent urinary diverson
b.
This urinary diversions often involve linking the ureters to a piece of intestine that is brought out of the belly. The urine then drains continuously into an ostomy bag you wear under your clothes. You'll still be able to take part in strenuous physical activity, as well as daily routines.
a. incontinent urinary diversion
b. continent urinary diversion
a.
Which of these are considered upper UTIs:
A. Pyelonephritis: inflammation caused by infection of the renal parenchyma, pelvis and ureters.
c. Cystitis: inflammation of the bladder caused by a UTI.
Fill in: Early tx of cystitis can prevent ascending infections like __a__.
Pyelonephritis
What is the ost frequent cause of chronic pyelonephritis, especially in children?
Reflux nephropathy: kidney damage (nephropathy) due to urine flowing backward (reflux) from the bladder toward the kidneys; the latter is called vesicoureteral reflux (VUR). Longstanding VUR can result in small and scarred kidneys during the first five years of life in affected children
Which two symptoms of lower tract urinary infections are often absent in older adults?
Urethritis: inflammation of the urethra
Cystitis: inflammation of the bladder
This term is chronic and painful inflammatory dz of the bladder and/or pelvis. It is associated with painful bladder syndrome.
Is it more common in men or women?
Interstitial Cystitis: more common in women
What is Urosepsis?
A life-threatening UTI that has spread systemically and requires emergent intervention
This dz is usually due to unprotected sex and is indicated by a purulent drainage. In some women, it may be more difficult to diagnose because they may not have a discharge
Gonorrhea Urethritis
T or F: Uncomplicated UTI usually involves ONLY the bladder
true
T or F: Pyelonephritis can be treated at home by drinking fluids and cranberry juice/tablets, or other medicines.
True
What defines a "complicated UTI?"
Infections with coexisting obstructions, stones, caths
Comorbidities: DM, neurologic dz, pregnancy-induced changes, recurrent UTI
List therapy for uncomplicated UTI (4)
1. abx
2. pain managemnt
3. teaching
4. adequate fluid intake (6 8oz glasses per day)
(teaching includes: adequate fluid intake, perineal care, take full course of abx, urinate regularly, cranberry juice)
Triethoprim / sulfamethoxazole (TMP/SMX) is the first drug of choice for this:
a. Uncomplicated UTI
b. complicated UTI
a. Uncomplicated UTI
Fluoroquinolones (Ciprofloxacin or Levofloxacin) are the drug of choice for:
a. Uncomplicated UTI
b. Complicated UTI
a. Complicated UTI
What is Phenazopyridine?
a urinary analgesic
This is the third leading cause of ESRD in the U.S.
Glomerulonephritis: inflammation of the glomeruli, affects both kidneys equally
(cause: Pg. 1073, table 46-8)
What is the most common type of Glomerulonephritis, especially in children and young adults?
How soon does it develop after an infection of the tonsils, pharynx, or skin?
Acute Poststreptococcal Glomerulonephritis (APSGN): 5-21 days after an infection
What are smoky or rust colored urine indicators of?
Indicative of upper UTI or inflammation Post streptococcal Glomerulo nephritis (GN)
This is a kidney disorder that causes the body to excrete too much protein.
What is it caused by?
Nephrotic Syndrome: usually caused by damage to the clusters of tiny blood vessels of the kidneys.
Dz that can cause this: DM, systemic lupus, HF, Amloidosis (protein)
What can these manifestations indicate:
- Massive proteinuria
- HTN, edema
- Hyerlipidemia
- Hypoalbuminemia
Nephrotic Syndrome
What is a serious complication of Nephrotic Syndrome?
Hypercoagulopathy can result from urine loss of anticoagulant proteins. This results in a thromboembolism, which occurs in 40% of nephrotic syndrome patients.
This term is defined as ureteral dilation and distention. It can be secondary to obstruction of the urinary tract (reflux or backflow of urine.
What can this be a risk for?
Hydroureter and vesicoureteral reflux (backflow of urine): This is a risk for pyelonephritis d/t urinary stasis and reflux.
Pyelonephritis is a sudden and severe kidney infection, which can be life-threatening.
What is another name for kidney stones?
What are the main causes in elderly patients?
Urinary tract Calculi Nephrolithiasis: dehydration and immobility
Keeping urine dilute and free flowing reduces risk of recurrent stone formation
What are the five major categories of calcium stones (Calculus)
1. calcium phosphate
2. calcium oxalate
3. Uric acid
4. cystine
5. struvite (magnesiu ammonium phosphate)
What are struvite stones?
Mineral found in urinary tract which are potentiated by bacterial infection. It hydrolyzes urea to ammonium and raises urine pH values
They may have to be surgically removed.
T or F: Bladder cancer affects women more than men by three times.
False
What is the #1 risk factor of bladder cancer?
List other risk factors
#1: smoking
exposure to dyes in rubber
patients who take pioglitazone (Actos)
Recurrent calculi or chronic lower UTIs
Long-time indwelling caths
This term is an internal urinary diversion in which a segment of the small intestine (usually ileum) is used to for a new (neo) reservoir or pouch for urine.
Who are ideal candidates for this?
What do patients of this need to be taught? (3)
Orthotopic Neobladder: ideal candidates are patients with >1-2 year life expectancy
1) patients should be taught urine will contain mucous because neobladder consists of intestinal segments.
2) They will also need ot be taught self care of tubes (suprapubic cath is placed through abdominal wall into new bladder)
3) they may also need to be taught clean intermittent catheterization technique
How long do the suprapubic catheters of neobladders stay on the patient for? What must be performed before it can be removed?
2-3 weeks after surgery: a cystogram (x-ray) is performed to ensure all sites of the new bladder are healed before tubes are removed.
Which type of urinary cath helps reduce spasms in men compared to the other types?
Coude tipped cath (curved tip)
What are indications for nephrostomy tube?
It is used on a temporary basis to preserve renal fxn when a ureter is completely obstructed.
