NUR 355B Urinary Path/Pharm: Exam 1

Oliguria

< 400 mL of urine output/day

Polyuria

> 3 L of urine output/day

Clean Catch Midstream

• Limits number of contaminants

• Not a sterile specimen

Dipstick

Grossly detect glucose, ketones, blood, bilirubin, protein, leukocyte esterase, and nitrates

UTI UA

• RBCs

• Positive leukocyte esterase, which indicates WBCs

• Nitrates, which indicate bacteria

Urosepsis

• Serious complication of UTI

• Bacteremia with bacterial endotoxins

• Acute, severe illness: fever, chills, confusion, disorientation, and hypotension

• Elderly, catheterized, and immunocompromised individuals are most at risk

Asymptomatic Bacteriuria (ASB)

• Two consecutive urine cultures with a colony count greater than 100,000 bacteria

• E.coli is most common organism

• Patient lacks UTI symptoms

• Treatment with antibiotics has not been found to improve outcomes

Kidney Stones (Urolithiasis)

• Nephrolithiasis (renal calculus)

• Ureterolithiasis (stones in ureter)

• Cystolithiasis (vesical calculi) in bladder

• Obstructive Uropathy = blockage

• Hydronephrosis = fluid buildup in kidneys

• Risks: genetic/family history, diet, metabolic abnormalities, frequent UTIs, urinary stasis, lack of adequate hydration

• Main types: calcium (most common), struvite, uric acid, cystine

Kidney Stones

• CVA tenderness (flank pain)

• Abdominal pain

• Severe and intermittent pain “renal colic” (pain comes in waves 20-60 minutes)

• N/V and fever

• Hematruia, pyruia

• Painful urination

• Treatment: hydration, pain meds, diuretic, lithotripsy, ureterorenoscopy

Stress Incontinence

• Most common

• Women more at risk

• Childbirth, abdominopelvic surgery

• Low estrogen

Overactive bladder

• Urge incontinence

• Detrusor muscle overactivity

Overflow

• Detrusor muscle loses strength and elasticity

• Overdistension and urine retention

Neurogenic Incontinence

Spinal cord disorders

Functional Incontinence

Cannot retain urine (stroke, delirium)

Benign Prostatic Hyperplasia (BPH)

• Non-cancerous enlargement of the prostate gland

• Common condition in which a client’s prostate is enlarged, compresses the urethra, and causes difficulties with passing urine

• If left untreated, the client may experience such manifestations as urinary frequency, incontinence, and urgency

• It can further lead to kidney failure, urinary tract infections, and stones in the bladder

Finasteride, Dutasteride

• 5-alpha reductase inhibitor

• Used for BPH

• Shrinks the prostate, improve urinary flow, and decrease urinary retention

• May cause sexual side effects, teratogenic

• Can take up to 6 months to work

• Adverse effect: prostate cancer

Tamsulosin, Terazosin, Doxazosin

• Alpha-adrenergic receptor antagonists

• Used for BPH

• Smooth muscle relaxation in urinary system , easier passage of urine

• Works in smooth muscle of prostate and bladder neck

• May cause hypotension, fatigue, dizziness, HA, and sexual side effects

• Avoid in clients with sulfa allergy

• Intraoperative risk of floppy iris syndrome, notify provider prior to eye surgeries

Oxybutynin

• Anticholinergic (antimuscarinic type)

• Used for urinary incontinence/overactive bladder

• Oral or transdermal

• Side effects: constipation, dry mouth, blurred vision, nausea, dizziness, drowsiness

Mirabegron

• Beta-3-adrenergic agonist

• Used for urinary incontinence/overactive bladder

• Increases bladder capacity and relax bladder smooth muscles

• Decreases spasms to allow for improvement in overactive bladder

• Decreases urge incontinence

• Not for patients with uncontrolled hypertension or on digoxin

• Take same time every day

Bethanechol

• Cholinergic agonist that mimics the neurotransmitter acetylcholine

• Used for urinary retention

• Increases tone and contraction of the bladder muscles

• Increases bladder pressure to promote urination

• Treatment of non-obstructive urinary retention (postoperative, postpartum, neurogenic bladder)

• GI effects, bradycardia/hypotension, bronchospasm

• Watch for muscle weakness, excessive salivation, sweating, tearing, very slow HR, severe low BP, abdominal cramps, diarrhea, difficulty breathing