Exam III

Cause: dilute urine from diuretics, alcohol, diabetes, and fluid

Cause: pyuria, infection, vaginal cream

Cause: Multivitamin

Cause: Blood in urine, beets, blackberries, dilantin, Rifampin, senna

dyes, methylene blue

dehydration, fever, bile, billirubin

Old blood, urobilinogen, dehydration, flagyl, quinine, methydopa

more than 3 RBCs per high power field (red blood cells in urine

cause: infection, prostatitis, obstruction, diuretics

cause: infection, prostatitis, urethritis, diabetic neuropathy

cause: UTI, inflammation of bladder, prostatitis, stones

cause: decreased renal concentrating ability, heart failure, diabetes, nephrotic syndrome, ascites

cause: children (CNS probs) obstructive disease of lower urinary tract, failure to concentrate urine, UTI, stress

• 8x Q24 hrs
• 1-2 L in 24 hrs

urine rentention

8-23

0.7-1.5

2.7-7.7

• men: 14-18
• women: 12-16

4.5-8

1.010-1.015

• -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

• -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

catheters advanced through ureters to renal pelvis via cystoscopy. contrast agent injected

• -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

• -visualizes lower urinary tract and assess urine storagte in the bladder
• -used to identify vesicoureteral reflux

ability of the kidneys to clear solutes from the plasma

• 1. bacteria gains access to bladder
• 2. attaches and colonize epithelium of urinary tract
• 3. evade host defense mechanisms
• 4. initiate inflammation (infection)

Fecal organisms (E. Coli)

• 1. transurethral (ascending infection) - most common (fecal)
• 2. bloodstream (hematogenous spread)
• 3. Fistula from the intestine (direct extension)

• - burning or urination
• - frequency
• - urgency
• - incontinence
• - suprapubic/pelvic pain
• - hematuria and back pain
• **half of pts have no symptoms

• *altered sensorium
• *lethargy
• anorexia
• new incontinence
• hyperventilation
• low-grade fever

• no estrogen for women
• no prostatic secretions for men
• bot get more infections

• Acute pain r/t infection w/in the UT
• Deficient knowledge about factors predisposing the pt to infection

• --for pain relief--
• antispasmodics
• antibiotics
• analgesics
• use of heat on perineum
• increase fluids
• no coffee, spices, cola, alcoho - all irritants
• empty bladder completely

• 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

• 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

• upward spread of bacteria from the bladder
• spread from systemic sources reaching the kidney via bloodstream

*Actively ill with fever, chills, leukocytosis, bacteriuria, and pyuria

• may also experience--
• low back pain
• n/v
• headache
• malaise
• panful urination
• pain/tenderness

• enlarged kidneys with interstitial infiltrations of inflammatory cells
• abscess may be noted

• treated as out-pt
• 2 wk course of abx

• chronic or reoccuring symptomeless infection for months/yrs
• --must follow up to make sure this is not happening

• repeated bouts of acute may lead to chronic
• kidneys - scarred, contracted, non-fn

• fatigue
• headache
• poor appetite
• polyurua
• excessive thirst
• weight loss
• *asymptomatic unless an exacerbation occurs

• end-stage renal disease (bec. of loss of nephrons)
• htn
• kidney stones (from chronic infection)

long term use of prophylactic abx therapy

• I&O (3-4 L q day)
• temp q 4 hrs
• antipyuretic

• empty bladder fully
• hygiene
• prevention by increasing fluids

involuntary or uncontrolled loss of urine from bladder

• 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

• 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)

• 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

• stones form in UT when:
• increased concentrations of substances (calcium), and uric acid

• intense, deep ache in costovertebral region
• hematuria
• pyuria
• pain radiates downward toward bladder/testes
• n/v
• diarrhea

• acute, wavelike, colicky, pain
• radiates down to thigh and genitalia
• desire to void but little comes out with blood
• urinary retention

• eradicate stones
• determine stone type
• prevent nephron destruction
• control infection
• relieve any obstruction present

• relieve the pain with opioids and NSAIDS first
• hot baths or moist heat to flank areas
• increase flds

increase fld to 8-10 8oz glass (output of 2L q day is good)

• decrease calcium intake
• increase flds
• decrease protein and sodium

meds are ammonium chloride and thiazides

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

• low protein diet
• increase fluid intake

• strawberries
• spinach
• rhubarb
• chocolate
• tea
• peanuts
• wheat bran

*eliminate foods that increase urinary excretion of oxalate

• 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