Kidney part 4

Urinary tract infection

Type: uncomplicated(acute cystitis, acute pyelonephritis), asymptomatic bacteriuria, healthcare-associated UTI

Patho: E.Coli

Risk: female, catheter, poor hygiene, sexual activity, DM, immunocompromised, high rate(16-35, post menopausal)

S/s: frequency, urgency, dysuria, hematuria, subrapubic pain

-urethra: discharge, burning urination

-Bladder: blood, lower ABD pain, pelvic pressure, frequent, dysuria

-kidney: flank/back pain, costovertebral angle tenderness, vomiting, chills, fever

Lab: UA(WBC, RBC, nitrates), CS

Education: ABX, 2-3L water, female(back→front, sex, shower, empty, no holding)

UTI in elderly patients

S/s: new onset confusion, incontinence, lack of appetite, lethargy

Complication: pyelonephritis, urosepsis

Pyelonephritis

Acute infection/obstruction→chronic

S/s: fever>102F, chills, pain/side/back/groin, dysuria, cloudy/bloody, N/V, fatigue, confusion-older adult

Treatment: ABX(levofloxacin, ciprofloxacin, ampicillin), IV fluids, antipyretics, pain(phenazopyridine)

Nursing: hydration, medication, UTI prevention

Complications: sepsis, shock, acute renal failure

Renal Calculi

Kidney stone, nephrolithiasis, urolithiasis→mineral accumulation→80-90% passes spontaneously

Risk: diet, genetic, lack of hydration, hyperparathyroidism

S/s: acute flank pain, N/V

Complication: obstruction, pyelonephritis, acute renal failure

Medication: tamsulosin(Flo max), shockwave lithotripsy, ureteral stenting, IV fluids

Incontience

Involuntary loss control of urine

Patho: urge incontinence, overflow, pelvic organ prolapse, pelvic mass, BPH, diuretics, neurological bladder

Stress incontinence common in female, urge incontinence common in male

Age related: decrease muscle tone/bladder capacity, hormonal changes post menopause

Lab/Dx: test(coughing with full bladder-stress) , UA, bladder scan

Nursing care: assess skin, hygiene, barrier cream, frequent toilet, external catheter

Urinary retention

Causes:

-Obstruction: pelvic floor prolapse, BPH, renal stones

-infection: prostatitis, urethritis, UTI

-other: complications from childbirth, neurological disorders/neurogenic bladder

male>female

S/s: Lower ABD pain/discomfort, difficulty/inability to start urine stream

Lab/Dx: culture, bladder scan, cystoscopy

Nursing care: monitor renal function, toileting regularly, post void residual, straight catch>indwelling catheter

Benign prostatic hyperplasia(BPH)

Patho: non-cancerous growth of prostate issue, compresses urethra→retention/blockage urine flow

Risk: male>50yrs, family Hx, obesity

S/s: difficulty starting urine stream, dysuria, nocturia, frequency, urgency, weak urine stream, inability to drain bladder

Lab/dx: prostate specific antigen(prostate cancer), digital rectal exam(prostate size)

Treatment: Alpha-adrenergic blockers(doxazosin, tamsulosin-flomax), 5-alpha reductive inhibitors(fin asteroids), anticholingeric(oxybutynin)

Surgical: transurethral resection of prostate(TURP), transurethal incision of prostate, open prostatectomy, laser surgery

Transurethral resection of prostate(TURP)

Surgical option

Catheter 3-5 days to drain bladder

Nursing management: risk bleeding/infection

Continuous bladder irrigation

Purpose: flush clots→bladder→after surgery→or when gross hematuria occurs

Nursing care: titrate to desire output(pink/no clots), UO=subtract irritant from catheter output.