Urinary Nursing

  1. List possible etiology of each
    1. Anuria
    2. Dysuria
    3. Nocturia
    4. Pneumaturia
    • 1. Acute kidney injury, ESKD, bilateral ureteral obstruction
    • 2. UTI, interstitial cystitis
    • 3. Kidney dz with impaired ability; bladder obstruction
    • 4. (Pneumaturia: passage of urine containing gas) Fistula connection between bowel and bladder; gas-forming urinary tract infection

    *to much motrin can cause sludge in kidneys*
  2. 1. How is a Urinalysis performed?
    2. Urine culture and sensitivity?
    3. What are positive signs for a UTI?
    4. Why is it contraindicated to administer a Fleet enema to a patient with kidney dz?
    • 1. Urinalysis: first urinated morning specimen, sent to lab within 1 hour. Use clean catch. 
    • 2. Urine C&S: if suspected UTI, ID causing organism. Use sterile container, do not contaminate container, cleanse meatus using at least 3 cleansing sponges, void mid stream.
    • 3. Positive if there are presence of nitrites, WBC and leukocyte esterase. 
    • 4. It is contraindicated because magnesium cannot be excreted by the kidney with pts who have kidney failure. avoid dehydration with bowel prep.
  3. BUN, Cr, Cr clearance
    • BUN: 6-20 mg/dL: can detect renal problems, but BUN can be up d/t GI bleed, dehydration, corticosteroids
    • Cr: 0.6-1.3 mg/dL; more reliable than BUN for renal fxn. It is a waste product of protein breakdown
    • Creatinine Clearance: 24-hour urine specimen; discard first urination. Clearance of creatinine of kidney approximates the glomerular filtration rate (GFR)
  4. Calcium, Phosphorous, Bicarb
    • Calcium: 8.6-10.2 mg/dL in kidney dz, decreased reabsorption of calcium
    • Phosphorous: 2.4-4.4 phosphorous balance is inversely related to calcium balance. In kidney dz, it is elevated because it is excreted in kidneys
    • Bicarb: most renal failure pts have metabolic acidosis and low serum HCO3 levels
  5. What is Pyelonephritis? Is it an upper or lower TI? What s/s can it cause?
    • An upper tract infection. It is inflammation causesd by infection of the renal parenchyma, pelvis and ureters. 
    • s/s: fever, chills, and flank pain.
  6. List conditions that can affect the fxn of the cns/pns that can cause incontinence
    • DM, multiple sclerosis, para/quadriplegia
    • Meds can also cause it
    • Older women are more prone to incontinence and bladder infection d/t loss of elasticity and muscle support
  7. What is done with each type of urinary diversion?
    1. Incontinent urinary diversion
    2. Continent urinary diversion
    • 1. Ureterocutaneostomy: detaches one or both ureters from the bladder, and brings them to the surface of the abdomen with the formation of an opening (stoma) to divert the flow of urine away from the bladder when the bladder is not functioning or has been removed.
    • 2. Uretero (ileo-) sigmoidostomy / rectal bladder (artificial anus). 
    •  - Internal pouch where urine is stored (Kock or Indiana Pouch).
    •    > need to be taught to self cath and that they will see mucus thread
  8. Lower tract symptoms are usually related to what organ?
    What is Urethritis?
     - causes? s/s?
    • Lower tract symptoms: bladder storage or bladder emptying
    • Urethritis: Inflammation of the urethra
    •  - causes include bacteria or viral infection (Trichomonas and monilial infection, chlamydial, gonorrhea)
    •  - Gonorrhea urethritis may have a purulent drainage in men, but no discharge in women, just pain.
  9. What is Cystitis (Interstitial)?
    What is it associated with? 
    • It is chronic and painful inflammatory dz of the bladder and/or pelvis. 
    • It is associated with painful bladder syndrome - suprapubic pain r/t bladder filling.
    • s/s: pain in pelvis and between  - vagina/penis and anus,
    •  - persistent, urgent need to urinate
    •  - frequent/small urination,
    •  - pain when bladder fills, relief afterwards
    •  - pain during sex
  10. Uncomplicated vs. complicated UTI
    What can struvite kidney stones be caused by?
    • Uncomplicated: UTI involves only the bladder usually
    • Complicated: infections with coexisting obstructions, stones, or caths; DM, pregnancy, etc.
    •  - Recurrent UTI: can cause struvite kidney stones. Teach women to hydrate.
  11. List patient and caregiver teaching for UTI
    • 1. Cranberry juice can prevent UTI
    • 2. Adequate fluid intake
    • 3. Perineal care
    • 4. Take FULL course of abx
    • 5. Urinate regularly, don't hold
    • 6. Don't wear tight clothing, nylon
  12. List meds for uncomplicated and complicated UTI
    Which drug do you avoid with sunlight?
    Which can you use as a prophylactic for recurrent UTI, such as prior to sex?
    What is the drug used as a urinary analgesic? How will it affect urine?
    • Uncomplicated UTI: first drug of choice is Trimethoprim / sulfamethoxazole (TMP/SMX) (can be used as prophylactic for recurrent UTI)
    •  - another is Nitrofurantoin (avoid sunlight)
    • Complicated UTI: Fluoroquinolones which include Cipro and levofloxacin
    • Urinary Analgesic: Phenazopyridine - change urine to red/orange
  13. What is APSGN? How many days does it take to manifest after an infection?
    What are clinical manifestations?
    What will you see in the urinalysis? 
    What is the most important way to prevent it?
    • Acute Poststreptococcal Glomerulonephritis: common type of acute glomerulonephritis.
    •  - Seen mostly in children and young adults
    •  - develops 5-21 days after an infection of tonsils, pharynx or skin
    • Clinical manifestations: smoky or rust colored urine
    •  - generalized body edema, HTN, oliguria
    •  - hematuria and proteinuria
    • Urinalysis: erythrocyte casts and protein 
    • Early dx and tx of sore throat and lesions. 95% usually recover if managed early.
  14. What is Nephrotic Syndrome and characteristics?
    List two systemic dz that can cause it
    What is a serious clotting complication from urine loss?
    List Nursing interventions
    • results when the glomerulus is excessively permeable to plasma protein, causing proteinuria -> low plasma albumin and edema
    • Characteristics: peripheral edema, massive proteinuria
    •  - HTN
    •  - Hyperlipidemia
    •  - Hypoalbuminemia
    •  - Ascites and anasarca (edema begins in face)
    • 2 causes: DM or systemic lupus
    • Complication: Hypercoagulopathy can result from urine loss of anticoagulant proteins.
    •  - this results in thromboembolism as a serious complication. 
    •  - If this occurs, ask pt for these s/s: CP, pedal edema/pain/clots
    • Interventions: daily weight
    •  - strict I/O
    •  - abdominal girth measuring
    •  - cleaning of edematous skin
    •  - correction of malnutritioni
    •  - support for altered body image
  15. Define these obstructive uropathies:
    1. hydroureter
    2. Hydronephrosis
    3. Vescoureteral reflux
    • 1. Hydroreter: ureteral dilation and distention
    • 2. dilation or enlargement of upper urinary tract system
    • 3. backflow or backward movement of urine from lower to upper tract system
  16. What is the #1 priority of urinary tract calculi?
    What are usual causes of it in elderly patients?
    What can you see in the urinalysis?
    How can they form into struvite stones?
    When will a lithotripsy be needed?
    • #1 priority: pain management
    • Elder causes: dehydration and immobility 
    • Urinalysis: blood in the urine, crystalluria, and urinary pH (acidic if uric acid or alkaline if struvite)
    • *if there is blood but patient reports no pain, could indicate cancer
    • Struvite: UTI with urea-splitting bacteria cause urine to become alkaline and contribute to struvite.
    • Tx: if struvite, requires control of infection as well. 
    •  - Adequate hydration 3L/day
    •  - alpha-adrenergic blockers, tamsulosin to relax smooth muscles (plus norco usually) 
    • Lithotripsy: surgery for stone removal if too large >7mm or if stones are causing impaired kidney fxn.
  17. T or F: bladder cancer affect women 3x more than men
    What are the other demographics affected?
    What is the most common clinical manifestation?
    • False: it is also higher incidence among white men than black men 
    • 60-70 y/o are most common
    • Most common manifestation: microscopic or gross, painless hematuria
Card Set
Urinary Nursing
ADN-C MSE2 Urinary Nursing