Chapter_37

Invasion of the urinary tract by Bacteria.

Urethra

>100,000 people.

Urethritis, prostatis, and cystitis. (urethra, prostate and bladder)

Pyelonephritis and ureteritis (kidney and ureter infections)

chronic kidney disease sepsis or kidney damage.

At the external utinary meatus

Escherichia coli (E. Coli)

Stasis of urine in thr bladder, contamination from feces, having instruments or tubes inserted into thr urinary tract, faulty valves that cause urine reflux, previous UTI's, women, pregnant women (streptococci) and older adults.

Dysuria, urgency, frequency, incontinence, nocturia, hematuria, back pain, and cloudy foul smelling urine.

Altered Mental status and/or agitation.

Inflammation of the urethra that may result from a chemical irritant, bacterial infection, trauma, or exposure to an STD.

Bubble baths and bath salts.

Spermicidal agents

Gonorrhea; chlamydiosis.

Urinary frequency, urgency and disuria. Males may have discharge.

Remove the irritant, if bacteria treat with antibiotics

Urinary analgesic used to treat dysuria. Urine turns orange while on this drug.

Inflammation and infection ofthe bladder wall.

Bacterias, viruses, fungi or parasites.

Long term antibiotic therapy.

Dysuria, frequency, urgency, and cloudy urine.

Cloudy urine, WBC's, bacteria, and RBC's. Nitrates are usually positive and some labs test for leukocyte esterase which indicates infection.

Combination of sulfa meds such as bactrim and septra.

Cipro

Recurrant UTI's in post menopausal women

Infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys.

A lower UTI that travel upward.

Obstruction, stricture, stones or reflux.

Urological surgery, lymphatic infection, urinary stasis, and decreased immunity.

Renal medulla

Systemic infection arising from a source within the urinary system.

Fatigue, urgency, frequency, dysuria, flank pain, fever, and chills. Urine is cloudy with increased WBC's bacteria casts and RBC's and positive nitrates.

Main sign is casts in UA. More than 100,000 bacteria per mm. Elevated WBC on CBC

Antibiotics based on C&S, severe gram negative infections pt is hospitalized for IV ABT's.

Repeated kidney infections can result in scarring and loss of kidney function, leading to chronic kidney disease. Septecemia can occur

• Effective against E. Coli, klebsiella, serratia.
• Given IV.
• S/E: headache diarrhea nausea and blurred vision.
• Contraindicated in patients allergic to PCN and cephalosporins. Also if creat clearance is less than 30mL/min

• Effective against E. Coli and enterococcus faecalis
• Given PO
• S/E: headache diarrhea and nausea.
• Disolve packet in 3-4oz of cold water.

• Effective against E. Coli, enterococci, staph aureus, klebsiella and enterobacter
• Given PO
• S/E: headache anorexia diarrhea nausea
• Give with food or milk and a full glass of water. Avoid antacids.

• Fleuroquinolone
• Effective against E. Coli, klebsiella, pseudomonas and other.
• Given PO
• S/E: nausea headache diarrhea photosensitivity increased risk of tendonitis and tendon rupture.
• Give with large amounts of water. Teach to avoid sunlight and report tendon aches promptly.
• Absorption may be decreased when given within 2 hours of aluminum antacids.

• Fleuroquinolone
• Effective against E. Coli, klebsiella, pseudomonas and other.
• Give. IV
• S/E: neausea headache diarrhea photosensitiviy increased risk of tendonitis or tendon rupture.
• Absorption may be decreased when given within 2 hours of aluminum antacids.
• Give with large amounts of water. Teach to avoid sunlight and report tendon aches promptly.

• Sufonamides.
• Effective against E. Coli and pseudomonas. Used for UNCOMPLICATED UTI's.
• Given PO
• S/E: photosensitivity GI upset hemolytic anemia rash hypersensitivity steven johnsons syndrome
• Teach to avoid sunlight. Give with large amounts of water. Contraindicated in sever renal or liver disease.

• Urinary antiseptic
• Antibacterial action in the urine not systemic.
• Effective against E. Coli, klebsiella and other gram negative organisms
• Given PO
• S/E: photosensitivity GI upset and rash.
• Teach to avoid sunlight encourage fluids may discolor urine absorption may be decreased if given within 2 hours of aluminum or magnesium antacids.

• Urinary antispeptic, anti-infective
• Effective against gram-negative and gram-positive organisms. E. Coli
• Given PO
• S/E: N/V rash
• Do not use with sulfa drugs because it may cause crystalluria.

• Urinary analgesic
• Topical analgesic. Relieves pain urgency and frequency associated with UTI.
• Given PO
• S/E: S/E: GI upset rash and blue/purple skin discoloration. Nephorotoxic and hepatotoxic.
• Urine changes to red-orange. Avoid in renal insufficency. Changes urine glucose testing.

• Void frequently-every 3 hours while awake
• Drink up to 3,000 mL of fluid a day unless there is a fluid restriction.
• Drink one gkass if cranberry juice a day.
• Take showers avoid baths.
• Wipe from front to back.
• Urinate after sex.
• Avoid bubble bat, bath salts, perfuned feminine hygiene products, synthetic underwear, and constricting clothing.
• Take meds such as ABT's until finished.
• If UTI is associated with another infection make sure that infection is treated.

Dilation and thinning of the renal tubules with eventual atrophy of renal tissues and renal blood flow is compromised and eventually destroyed. Obstructions may include strictures stones and tumors.

Narrowing of the lumen of the urethra caused by scar tissue. (can be r/t std's) usually acquired from injury or infection.

UTI's; urine flow

Mechanical dilation by a urologists or surgical repair: urethroplasty

Kidney stones. (one stone is a calculus). Masses of crystals and protein that form when urine becomes supersaturated with a salt capable of forming solid crystals. Symptoms occur when stones become impacted in the urinary tract.

Stones in the kidney

Papillae or in the renal tubules, calyces, or renal pelvis. Also may form in the ureter or bladder.

5mm

• 1. Calcium oxylate
• 2. Calcium phosphate
• 3. Magbesium ammonia
• 4. Uric acid
• 5. Cystine.

Family history of stones. Chronic dehydration. Infection. Dietary factors. Immobility-stasis of urine. More common in men than women. Peaks between ages of 30-50.

• Flank pain
• Renal colic
• Pain radiating to genitalia
• Hematuria
• Dysuria
• Frequency
• Urgency
• Enuresis
• N/V/D

• Encourage fluids
• Encourage pt to walk to avoid stasis

• Increased risk for UTI.
• Can lead ti retention of urine and kidney damage (hydronephrosis)

• KUB- flat plate of the abd
• IVP
• Renal ultrasound
• UA

• IV fluids are given to hydrate patient to flush the stones out of the body
• Strain the urine to ensure stones have passed
• If the patient cant pass on its own intervention is needed. Calcium stones may be treated with thiazide diuretics. Surgical removal may be needed.

Thiazide diuretics

Uses sound laser or dry shock energies to break the stone into small fragments. (ESWL)

Distention of the renal pelvis and calices. This condition results from untreated obstuction of urine flow in the urinary tract. Occurs r/t obstuctuon of urine flow.

5-8

Treat the obstruction

Inserted directly into the kidney to drain urine. NEVER CLAMP

• Most common type of CA in the urinary tract.
• Most common in men 50-70
• 1 in 27 for men
• 1 in 85 for women.
• Rare in people younger than 40

Urothelium

Superficial

Invasive

Liver bones and lungs

• Smoking
• Aniline dye
• Benzidine
• Naohthylamine
• Leather finishing
• Metal michenery
• Petrolium processing products

• Painless hematuria (first)
• Frank hematuria
• Bladder irritability
• Urine retention from clots
• Fistula formation
• Pelvic pain
• Pain in the lower back
• Painful urination
• Changes is bladder habits
• Inability to void

• Urinalysis (telomerase)
• Cytology
• Urine culture
• Cystoscopy
• Transurethral biopsy
• IVP

• Chemo
• BCG vax (prevent recurring tumors)
• Photodynamic therapy
• C&P with fuluration (destruction of tissue with electricak current)
• Cystectomy with urinary diversion.

• Smoking
• Obesity
• HTN
• Dialysis
• Exposure to:
• Radiation
• Asbestos
• Industrial pollution.

Men; women

• Hematuria
• Dull pain in the flank area
• Mass in the area
• Symptoms may not present until the tumor invades surrounding tissues.
• Less specific symptoms:
• Fever
• Wright loss
• Night sweats
• HTN
• Anemia
• Polycethemia
• Swelling in the legs
• Fatigue
• Anorexia
• Constipation

• IVP
• C&P
• Ultrasound of the kidneys
• CT of the abd
• MRI
• Renal biopsy

Removal of thr entire kidney

Heridetary disorder that can result in chronic kidney disease. Formation of multiple cysts in the kidney that may replace normal kidney structures.

Grapelike cysts that contain fluid blood or urine

Dull heaviness in the flank or lumbar region and hemituria. Others: HTN and UTI's

Brain aneurysms and diverticulosis of the colon

Ultrasound

None. Monitor and treat symptoms.

Long term cause of DM r/t damage to the small vessels in the kidneys.

May be deected within 5 years od type 1 diabetes and 10-15 years of onset of type 2. Renal damage appears about 15-20 years after onset

• HTN
• Genetic predisposition
• Smoking
• Chronic hyperglycemia

• Increased osmotic pressure from hyperglycemia
• Increased diuresis and compensatory cell growth and expansion
• Increase GFR
• Atherosclerotic changes in blood vessels
• Thickening of glomerular capillaries
• Protein leaks into the urine
• Pyelonephritis
• Renal scarring
• Neurogenic bladder=incomplete bladder emptying= urinary retention= infection or obstruction causing further damage to the kidney

• Microalbumminuria advancing to proteinuria
• Hypertension
• Decreased urine output

Cardiovascular disease and increasing kidney damage

• Urine analysis for protein
• 24 hour creatinine clearance test

Excretion of 3.5 grams or more in the urine per day

Hardening of the renal blood vessels r/t HTN resulting in decreased blood flow

Inflammatory disease of the glomerulus.

• Immunilogical abnormalities
• Toxins
• Vascular disorders
• Systemic diseases

Usually following a streptococcal infection of the throat or skin

Glomerulonephritis cause by an auntoimmune response

• Fluid overload
• Oliguria
• HTN
• Electrolyte imbalances
• Periorbital edema
• Ascities
• Pleural effusion
• Flank pain
• Increase BUN and creatinine
• UA: WBC's RBC's albumin and casts (can be dark and foamy)

• UA
• HTN
• Ultrasound
• X-ray
• Biopsy

Treatment of symptoms

Toxic wastes from protein metabolism in the blood

• 1. Oliguric
• 2. Diuretic
• 3. Recovery

Less than 400 mL of urine in 24 hours lasting 1-7 days

• 1-3 L per urine per day.
• Osmotic diuresis occurs from elevated waste products Dehydration and hypotension are a concern

• GFR rises
• BUN and creat decrease greatly but may take 1 year to return to normal.

• 1. Prerenal (before the kidney) usually resti ted blood flow
• 2. Intrarenal injury (inside the kidney) damage to the nephrons
• 3. Postrenal injury (prevents the urine from leaving the body)

• Aminoglycosides
• Amphotericin B
• Cephalosporins
• Sulfonamides
• Tetracyclines

• Acetominophen
• NSAID's
• Salicylates

• ACE inhibitors
• Amphetomines
• Cisplatin
• Dextran
• Heroin
• Interleukin-2
• Mannatol

• Arsenic
• Copper
• Gold
• Lead
• Lithium
• Mercury

• Gasoline
• Glycols
• Kerosene
• Tetrachloroethylene
• Turpentine

Irreversible renal damage in which the body is unable to maintain metabolic, fluid, and electrolyte balance.

Used to remove fluid and solutes in a contolled continous manner in unstable patients with acute kidney disease.

Large amount of dilute urine

• Stomatitis
• Bad taste in mouth

• HTN
• HF
• Dysrhythmias

• Anorexia
• N/V
• GI bleed
• Ulcers

• Sexual dysfunction
• Infertility

Fractures

• Fatigue
• Depression
• Headache
• Confusion
• Seizures
• Coma

• Pulmonary edema
• Pulmonary effusion
• Dyspnea

• Anemia
• Oliguria/anuria

• Pruritis
• Ecchymosis
• Uremic frost
• Dry skin
• Jaundice
• Edema (anasarca)

• Monitor for bleeding
• Monitor for s&s of infection
• Listen for bruit
• Palpate for a thrill
• Patiet teaching
• Notify physician of bleeding infection reduced circulation or swelling