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Urine color: Pale, colorless
Cause: dilute urine from diuretics, alcohol, diabetes, and fluid
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Urine color: Yellow-milky/white
Cause: pyuria, infection, vaginal cream
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Urine color: Bright yellow
Cause: Multivitamin
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Urine color: Pink or red
Cause: Blood in urine, beets, blackberries, dilantin, Rifampin, senna
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Urine color: Blue-green
dyes, methylene blue
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Urine color: Orange/amber
dehydration, fever, bile, billirubin
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Urine color: Brown/black
Old blood, urobilinogen, dehydration, flagyl, quinine, methydopa
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Hematuria
more than 3 RBCs per high power field (red blood cells in urine
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frequency: frequent voiding (more than once every 3 hrs)
cause: infection, prostatitis, obstruction, diuretics
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Urgency: strong desire to void
cause: infection, prostatitis, urethritis, diabetic neuropathy
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Dysuria: Painful or difficult voiding
cause: UTI, inflammation of bladder, prostatitis, stones
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Hesitancy: delayed; difficulty in initiating voiding
cause: decreased renal concentrating ability, heart failure, diabetes, nephrotic syndrome, ascites
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Enuresis: involuntary voiding during sleep
cause: children (CNS probs) obstructive disease of lower urinary tract, failure to concentrate urine, UTI, stress
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How many times does a person usually voids?
- 8x Q24 hrs
- 1-2 L in 24 hrs
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increased urgency and frequency with decreased volume means?
urine rentention
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Specific gravity
1.010-1.015
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Osmolality
- -most accurate measurement of the kidney's ability to dilute and concentrate urine
- -assesses body's fluid status
- -urine osmolality is 200-800
- -serum osmolality is 280-300
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Intravenous urography (IVP)
- -radioplaque adm by IV
- -shows KUB via x-ray as dye moves from upper to lower
- -used to estimate renal fn & initial assessment of urologic conditions
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Retrograde Pyelography
catheters advanced through ureters to renal pelvis via cystoscopy. contrast agent injected
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Cystography
- -Catheter inserted to bladder with contrast agent injected to outline bladder wall
- -used for evaluating vesicureteral reflux (backflow of urine)
- *NIC
- -Assess for bladder injury
- -expect blood tinged urine, burning, urninary retention
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Voiding cystourethography
- -visualizes lower urinary tract and assess urine storagte in the bladder
- -used to identify vesicoureteral reflux
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Renal clearance
ability of the kidneys to clear solutes from the plasma
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Patho of lower UTI
- 1. bacteria gains access to bladder
- 2. attaches and colonize epithelium of urinary tract
- 3. evade host defense mechanisms
- 4. initiate inflammation (infection)
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Most common cause of UTI
Fecal organisms (E. Coli)
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How bacteria enters urinary tract
- 1. transurethral (ascending infection) - most common (fecal)
- 2. bloodstream (hematogenous spread)
- 3. Fistula from the intestine (direct extension)
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S/S of uncomplicated UTI's
- - burning or urination
- - frequency
- - urgency
- - incontinence
- - suprapubic/pelvic pain
- - hematuria and back pain
- **half of pts have no symptoms
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S/S of uncomplicated UTI (elderly)
- *altered sensorium
- *lethargy
- anorexia
- new incontinence
- hyperventilation
- low-grade fever
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most common cause of acute bacterial sepsis in patients over 65
- no estrogen for women
- no prostatic secretions for men
- bot get more infections
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nrsg dx - UTI
- Acute pain r/t infection w/in the UT
- Deficient knowledge about factors predisposing the pt to infection
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rnsg interventions - UTI
- --for pain relief--
- antispasmodics
- antibiotics
- analgesics
- use of heat on perineum
- increase fluids
- no coffee, spices, cola, alcoho - all irritants
- empty bladder completely
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Prevention of UTIs
- shower - don't bathe
- clean perineum/urethral meatus front to back
- increase fluids to flush bacteria
- avoid coffee, tea, colas, alcohol, spicy foods
- void q2-3 hrs & completely empty bladder
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Pyelonephritis
- infection of
- renal pelvis
- tubules
- interstitial tissue of 1 or both kidneys
- Includes
- chronic pyelonephritis (inflammation of renal pelvis)
- interstitial nephritis (inflammation of the kidney)
- renal abscesses
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Causes of pyelonephritis
- upward spread of bacteria from the bladder
- spread from systemic sources reaching the kidney via bloodstream
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S/S of ACUTE pyelonephritis
*Actively ill with fever, chills, leukocytosis, bacteriuria, and pyuria
- may also experience--
- low back pain
- n/v
- headache
- malaise
- panful urination
- pain/tenderness
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manifestations of acute pyelonephritis
- enlarged kidneys with interstitial infiltrations of inflammatory cells
- abscess may be noted
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medical mngt of acute pyelonephritis
- treated as out-pt
- 2 wk course of abx
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complications of acute pyelonephritis
- chronic or reoccuring symptomeless infection for months/yrs
- --must follow up to make sure this is not happening
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Chronic pyelonephritis
- repeated bouts of acute may lead to chronic
- kidneys - scarred, contracted, non-fn
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S/S of chronic pyelonephritis
- fatigue
- headache
- poor appetite
- polyurua
- excessive thirst
- weight loss
- *asymptomatic unless an exacerbation occurs
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Complications of chronic pyelonephritis
- end-stage renal disease (bec. of loss of nephrons)
- htn
- kidney stones (from chronic infection)
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Medical mngt for chronic pyelonephritis
long term use of prophylactic abx therapy
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implications for chronic pyelonephritis
- I&O (3-4 L q day)
- temp q 4 hrs
- antipyuretic
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teaching for chronic pyelonephritis
- empty bladder fully
- hygiene
- prevention by increasing fluids
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Urinary incontinence
involuntary or uncontrolled loss of urine from bladder
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risk factors for urinary incontinence
- age, gender(women), # of vaginal deliveries
- menopause
- pelvic muscle weakness
- incompetent urethra
- immobility
- high-impact exercise
- diabetes
- stroke
- obesity
- cognitive disturbances (dementia, parkinson's)
- diuretic, sedatives, hypnotics, opioids
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types of incontinece
- stress: result of sneezing, coughing, or changing position
- urge: strong urge that can't be suppressed
- funtional: cognitive impairment make it difficult to identify voiding
- iatrogenic: extrinsic med factors (alpha-adrenergic)
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Mngt of urinary incontinence
- behavior therapy: 1st choice to decrease or eliminate incontinence
- kegel exrecises: represent behavioral therapy
- fld mngt: 1500-1600 ml in small amounts am-pm
- standard voiding: timed, prompted, habit, bladder
- vaginal cone retention:
- transvaginal or transrectal electrical stimulation:
- neuroamodulation
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Patho of uro and nephrolithiasis
- stones form in UT when:
- increased concentrations of substances (calcium), and uric acid
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S/S of stones in renal pelvis
- intense, deep ache in costovertebral region
- hematuria
- pyuria
- pain radiates downward toward bladder/testes
- n/v
- diarrhea
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S/S of stones in ureter (ureteral obstruction)
- acute, wavelike, colicky, pain
- radiates down to thigh and genitalia
- desire to void but little comes out with blood
- urinary retention
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Med mngt for stones. Goals:
- eradicate stones
- determine stone type
- prevent nephron destruction
- control infection
- relieve any obstruction present
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Priority for stones
- relieve the pain with opioids and NSAIDS first
- hot baths or moist heat to flank areas
- increase flds
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Nutritional therapy for stones
increase fld to 8-10 8oz glass (output of 2L q day is good)
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nutrition for calcium stones
- decrease calcium intake
- increase flds
- decrease protein and sodium
meds are ammonium chloride and thiazides
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nutrition therapy for uric acid stones
low-purine diet bec it reduces excretion of uric acid.
- foods high in purine:
- shellfish
- asparagus
- mushrooms
- organ meats
decrease protein
med is zyloprim bec it reduces uric acid levels and secretion
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Nutritional therapy for cystine stones
- low protein diet
- increase fluid intake
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nutritional therapy for oxalate stones
- strawberries
- spinach
- rhubarb
- chocolate
- tea
- peanuts
- wheat bran
*eliminate foods that increase urinary excretion of oxalate
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How to prevent kidney stones
- decrease protein - restrict to 60 grams/day
- reduce sodium - 3-4 grams/day
- avoid oxalate containing foods - strawberries, spinach, etc)
- increase fluid intake - water q 1-2 hrs
- 2 glasses h2O @bedtime & glass in AM to prevent concentration
- avoid excessive sweating & dehydration
- go to doc if UTI suspected
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