Quiz/EXAM 2

2.0

What is cystitis?

Inflammation of the urinary bladder and can be interchangable with using lower UTI

What is prostatitis?

Inflammation of the prostate gland

What is urethritis?

inflammation of the urethra

What usually causes a uti?

bacteria

What are the routes a lower UTI can be made through?

Transurethral and blood stream

How can a UTI happen transurethrally?

1. A foley catheter- we only do these when absolutely necessary bc their high risk of causing infections like UTI

2. Wiping back to front- introduces bacteria to the vagina

How can a UTI happen through the bloodstream?

It is less common to happen through the bloodstream bc that means an infection already occurred and then the UTI was secondary to that when usually a UTI is what causes an infection

Note lower UTIs can also be bc of fistulas-tunneling of and organ

What is the most common infection in older adults?

UTI’s bc they usually start to become incontinent and unable to take care of themselves

Are upper or lower UTIs more dangerous?

Upper UTIs are more dangerous bc they can lead to sepsis or kidney damage

What part of the kidney and bladder system is sterile?

Above the ureter is sterile so technically urine is sterile

Do UTIs affect men or women more?

Women bc the shorter urethra

Sexual intercourse and UTIS?

Sexual intercourse can push bacteria from the urethra to the bladder. Lower UTI’s

Note- UTIs are not always due to poor hygiene, an example is if a women cleans her vagina with a douche that can also cause a UTI

When should a catheter be placed in a pt?

When ABSOLUTELY NECESSARY bc of the risks of UTI and an intermittent catheter is better than an indwelling catheter.

How should foley bags be handled?

1. Bag should never touch the ground if needing to be as low to the ground bc bed is at lowest position then we would get a chuck or basin and put the catheter bag on that. Foley bags should always be lower then the patient

What can cause fistulas?

• Prolonged vaginal labor

• Inflammation

• Abdominal or pelvic surgery

• Pelvic cancer

Note-all fistulas need to be fixed surgically and sometimes vaginal fistulas can cause poop to come from the vagina and if that happens we need to call provider immediately to get them into surgery

What are the S/S of a lower uncomplicated UTI?

1. Burning while peeing-dysuria

2. frequency/urgency

3. Nocturia-peeing at night

4. Hematuria

5. Incontinence

6. suprapubic/pelvic pain

7. Malodorous urine

What are the S/S of UTIs in older adults?

1. confusion/delirium

2. burning while peeing-dysuria

3. incontinence

4. urgency

5. fever

What are the S/S of a lower complicated UTI?

1. Asymptomatic s/s to sepsis and shock s/s

2. Increased HR and RR

3. Low BP

4. Fever or hypothermia

What is the diagnostic tool that confirms the diagnosis of a UTI etc?

A urine culture, which shows what the urine is positive for and what antibiotics can work against the infection and which the microorganism is resistant towards

How are urine cultures obtained?

A clean catch midstream of from a catheter

What is a microscopic hematuria test?

A test that detects blood in the urine and around 50% of pts with UTI’s will test positive

What is a pyuria test?

A test that sees if there are any WBC’s in the urine all pts with a UTI are positive for pyuria.

Why is a pyuria test not diagnostic for UTIs?

because people with kidney stones are also positive for WBC’s in their urine

What is a nitrite test?

A test that checks for nitrites in the urine. If positive we could suspect that the pt has a UTI, bc we normally have nitrates in our urine but when bacteria get into the urine they turn nitrates into nitrites.

When writing an order for a urinary analysis and Culture sensitivity what needs to be written?

We need to specify that we want both a urinary analysis as well as a cultural sensitivity (UA & CS) if not specified (UA) then it would be expected to the lab to just do a urinary analysis bc culture sensitivities are expensive so it needs to be specified 

What is a leukocyte esterase test?

A test to see if leukocyte esterase is in the urine. If positive a UTI would be suspected because we would have WBC’s fighting in the urine.

What would we test along with a urinalysis or culture?

STI’s

What is included in a urinalysis?

1. pyuria

2. hematuria

3. leuko esterase

4. nitrites

What is Dysuria?

painful/burning/uncomfortable urination

What is urosepsis?

a severe, life-threatening condition that occurs when a urinary tract infection (UTI) spreads to the bloodstream, causing a systemic inflammatory response

What would a nurse expect if a client, especially an older adult, kept using their call bell saying they have to pee and when dumping their urine a CNA reports that their urine is foul smelling?

We would suspect that the patient has a UTI and do a urine culture and a urinalysis

How is urine taken from a catheter?

We wipe the port with an alcohol swab and take a 10cc syringe and get the urine.

What do we have a pt clean their genitals with when we want a clean urine catch?

We want them to clean with NS or soap and water or both

What is Nitrofurantoin?

A urinary tract bactericidal antibiotic 

How does Nitrofurantoin work?

It goes into the blood and then into the urine and kills all the bacteria and is the drug of choice for UTI

What is a side effect that we should tell our pt about Nitrofurantoin?

It turns urine brown but is normal 

What is a cephalosporin that is an example for this test that can be used to treat a UTI?

Cefadroxil

Which dipstick finding has highest specificity for detecting UTI?
A. Leukocyte esterase
B. Nitrites
C. Microscopic hematuria
D. Protein

B, more than 90 percent of UTI pts test positive

What is a Fluoroquinolone that is an example for this test that can be used to treat a UTI?

Ciprofloxacin-tendon rupture common side effect so watch for a pt stating “my calf hurts”

What is a penicillin that is an example for this test that can be used to treat a UTI?

Amoxicillin- since its a penecillin watch pts reaction

What is a Trimethrompin that is an example for this test that can be used to treat a UTI?

Sulfamethoxazole/co-trimoxazole- if a pt is allergic to sulfas they can't take this medicine for their UTI

What is pyridium?

A urinary analgesic for burning especially think Pyro and TAKE WITH FOOD

Note- does not treat the infection

How long is the acute pharm therapy for UTI’s?

A 3 day treatment/7 day treatment/ single dose administration

How long is the long pharm therapy for lower UTI’s?

Long therapy happens when you do the short term therapy and it did not kill the infection all the way so you have to do another short term therapy plus a bedtime dose of an antibiotic and meds will be taken every other night for 6-7 months

Note- this is may change between a doctor and pt

T/F-cranberry juice can prevent and control symptoms of a UTI?

True cranberries fresh or frozen/ cranberry juice can prevent and control symptoms of a UTI but the juice has to be real not from concentrate

Note-not the ocean spray brand that is not true cranberry juice

Why do citrus fruits alkaline the acid?

They start off as acidic but once in the body/metabolized turn alkaline

Patient education for UTI’s?

1. Tell patient to drink at least 3L of water a day

2. Tell pt no bubble baths

3. Tell pt to pee every 3-4 hrs instead of waiting until bladder is full

4. Tell pt that to help with pelvic pain they can take a warm sitz bath- which is a bath that looks like a bucket or chair and you can sit in it and it is filled with warm water

5. Avoid an indwelling catheter in a pt unless absolutely necessary

6. Avoid wearing panty hose

7. Avoid sitting in wet clothes like bathing suits

8. Wipe front to back

What is an upper UTI?

An infection called pyelonephritis- an infection that affects the kidneys and ureters

What are the s/s of acute pyelonephritis?

• Chills

• Fever

• Leukocytosis

• Pyuria

• Low back pain

• Flank pain-characteristic

• N/V

• Malaise

• Painful urination

• Costovertebral tenderness-characteristic

How is uncomplicated acute pyelonephritis managed?

Can be outpatient or inpatient for 2 week treatment of antibiotics and then we would do a urine culture 2 weeks after we have completed the therapy to see if we need to go longer with the antibiotics. If pt needs to go longer the treatment can be up to 6 weeks

What antibiotic treatment is longer, upper or lower UTI’s?

Upper at 2 weeks

Lower at 3-7days

What causes chronic pyelonephritis?

Repeated bouts of acute pyelonephritis

What are the S/S of chronic pyelonephritis?

Asymptomatic until an exacerbation

What can chronic pyelonephritis lead to?

Scarring of the kidneys and chronic kidney failure

Is it good for chronic UTI patients to have an exacerbation where they feel pain?

Yes bc they are asymptomatic when not in exacerbations so we want them to feel the pain so we can intervene and help.

What is the urine PH?

4.5 to 8 with average at 6

How is urolithiasis and nephrolithiasis formed?

What are the sizes of stones that can form in the body?

As small as a grain of sand ( can be passed) to as big as a golf ball (can’t be passed)

What are the risk factors of stone formation?

• Urinary stasis- when we hold our pee

• Frequent infections

• Periods of immobility- the muscle break down and calcium enters into the blood

• dehydration

How many kidney stones are calcium ones

Around 80% caused from calcium build up

What patients are more likely to get uric acid stones?

Pts with gout or a history of gout and pts with myeloproliferative disorders

What do we give to lower uric acid levels?

allopurinol

What are the different types of stones in the urinary tract?

• Calcium 

• Uric acid

• Struvite 

• Cysteine

• oxalate

What causes a Struvite stone?

A problem with someone's Nervous system like seen down below

neurogenic bladder (urgency, incontinence, or retention)

What type of urine are struvite stones usually formed in?

Alkaline ammonia rich urine

What are the S/S of urolithiasis and nephrolithiasis?

The symptoms depend on if there is an obstruction or infection or edema

What happens when there is an obstruction of the Urinary tract?

There will be a blockage of the flow of urine and the renal pelvis will distend as well as the proximal end of the obstruction and hydronephrosis will occur

T/F some stone are asymptomatic while destroying nephrons

true

What are the S/S of stones in the renal pelvis?

1. Costovertebral intense deep ache

2. Hematuria

3. Pyuria

4. Renal colic- pain that out of nowhere becomes acute with tenderness over the Costovertebral area with N/V

5. Pain that radiates anteriorly ( front of body) and down to the bladder and to the testes if applicable

What are S/S for a stone in the ureter?

• Excruciating colicky wave like pain that can radiate to the genitals (ureteral colic)

• Hematuria

What is the urines normal PH?

4-5.8

Urine on average is a 6 more alkaline

If someone is prone to UTI they would want their urine to be more acidic so they would want cranberries and vitamin C

How are urolithiasis and nephrolithiasis diagnosed?

• CT scan-confirms the diagnosis of a kidney stone

• KUB (Kidney ureter and bladder) X-ray this is used less bc now the CT scan is more preferred with the xray our kidneys have to work to help excrete the dye

• Ultrasound used for pregnant pts bc no radiation

• Blood chemistry (sodium and magnesium, urine acid, calcium) and 24 hour urine collection- when 24 hour urine collections are done then it starts the day after it is ordered and the first pee has to be discarded

• Patient history- ex family diet, medical history like if someone is taking allopurinol we can guess that they have had gout or were at risk for gout so we would think that they are at risk for uric acid stones

How are kidney stones managed?

1. Opioids

2. NSAIDs

3. Moist heat to the flank area

4. We want to give them a lot of fluids so we need to provide them more than 1 urinal and we want to strain the urine so that we can test the stones

5. Alpha adrenergic blockers- relaxes the ureter so stones can pass and are drugs that end in -sin like terazosin

6. Spasmolytic drugs like oxybutynin chloride- relieves pain from spasm

What do alpha adrenergic blocker drugs end in?

-sin like terazosin- kidney stone management they relax the smooth muscles so the stones can pass

What are the Side effects of alpha adrenergic blockers?

Hypotension and lightheadedness are common

What should we monitor for pts on oxybutynin?

-monitor for urinary retention

-Constipation

Dry mouth-give gum etc

What nutrition therapy is given to people with or at risk for calcium stones?

• Calcium restricted diet (controversial)

• Increased fluid intake

• Drug given is ammonium chloride

What nutrition therapy is given to people with/ at risk for uric acid stones?

1. Low purine/protein diet NO shellfish, anchovies, asparagus, mushrooms, and organ meat like “sweet bread”

2. Drug given is allopurinol

What nutrition therapy is given to people with/ at risk for cystine stones?

• Low protein diet

• We want to alkalize the urine so we would eat citrus fruit

• Increase fluid intake

What nutrition therapy is given to people with/ at risk for oxalate stones?

• Limit high oxalate foods like strawberry, spinach, rhubarb, chocolate, tea, peanuts, and beats

What is our main priority with kidney stones/urolithiasis?

Pain management-NSAIDs, opioids, combination

What is acid ash?

the byproduct of the metabolism of food it is not the actual food itself only the byproduct example would be cranberries, plum, prunes (dried plum), fish, and eggs, meat, cereals, Ascorbic acid and cranberry

Note-ascorbic acid and cranberries are the best for making urine acidic

What is alkaline ash?

The byproduct of food, not the food itself only the byproduct

citrus fruits, citrus legumes and mainly fruits and vegetables

What are surgical interventions for kidney stones?

• Ureteroscopy

• ESWL (extra corporeal shockwave lithotripsy)

What is a ureteroscopy?

When the stone is reached through the scope and a laser is set on the stone to break it up and remove it and a stent is placed for 48 hrs the ureter is kept patent

What is an ESWL (extra corporeal shockwave lithotripsy)?

When a high energy shock wave (sound wave) breaks down a stone so that it is excreted by urine the procedure lasts at least 30 minutes and pt might need more than several treatments

After when the pt pees the urine will be strained so that we can get the stones

Bruising at shock wave site is normal and mild hematuria is normal but if not mild then it needs attention

What is different with people with renal colic pain?

Instead of trying to be as still as possible they will pace around bc they cant find a position that is comfortable for them

What should the minimal urine output be?

30-50ml/hr

What are the risk factors of stress incontinence?

• Female and post menopause

• childbirth

• Smoking

• obesity

What are the risk factors of urge incontinence?

Bladder irritants like caffeine, nicotine, artificial sweeteners etc

What are the risk factors of functional incontinence?

Pts that cant get to the toilet or pts that can't communicate that they have to go pee

What are the risk factors of reflex incontinence?

NS disorders like multiple sclerosis, brain tumors, and stroke

What is a nephron?

the basic unit of the kidneys

What is a glomerulus?

A tuft (cluster) of capillaries where blood is filtered at the Bowman's capsule

What substances does the Bowman's capsule let filter out of the blood?

Sodium, bicarb, acids, and urea, but it does not let albumin filter through

After substances filter out of the blood by the glomerulus where do they go?

The substances are filtered out of the blood at the bowman's capsule and go to the proximal tubule, where large amounts of water, potassium, and sodium are reabsorbed into the bloodstream then any remaining substances go to the loop of henle, where sodium is reabsorbed again. Then the remaining substances of that filtration go to the distal tubule, where aldosterone will increase water and sodium reabsorption and excrete potassium. Then whatever is remaining goes to the collecting duct where Antidiuretic hormone will work to retain more water if needed making less urine for us to pee out

What is GFR?

The amount of renal blood flow filtered per unit of time (directly related to kidney perfusion)

What are the functions of the kidneys?

1. Makes and excretes urine to get rid of excess substances

2. Regulates water and electrolytes by excreting or retention as well as acid base

3. Makes vitamin D

4. Makes RBCs

What supplements do pts get if they have a kidney issue?

Calcium and Calcitriol (active form of vit D)/vitamin D bc if someone has a kidney issue then they don't have enough vit D since the kidneys activate vitamin D so if there is an issue then…