Week 6: UTIs, Kidney Issues

stress incontinence

weakness of urethral sphincter/pelvic floor muscles. leakage occurs with sneezing, coughing, for physical exertion. comorbidities copd/asthma

urge incontinence

detrusor muscle overactivity that causes bladder contraction, may also be caused by neurological problems or bladder irritation. sense of urgency that precedes or comes with leakage. comorbidities parkinson’s, MS, spinal cord injury, cns meds

overflow incontinence

leakage of an overdistended bladder, caused by a blockage or impaired contractility of the detrusor muscle. can be caused by pelvic organ prolapse, abdominal/pelvic masses, or BPH.

incontinence risk factors

spicy food, chocolate, caffeine. meds - anti-HTNs, diuretics, a-blockers, antidepressants, aceis, opioids, ca+ channel blockers.

incontinence interventions

no catheter, prioritize skin integrity. teaching to decrease - stop smoking, kegels, avoid lifting, lose weight, treat constipation promptly, limit caffeine and alcohol, drink plenty of water.

most common UTI causes

1. E. coli, 2. Candida albicans (common from foleys)

body’s defense mechanisms against UTIs

complete bladder emptying, high fluid intake, acidic pH (below 6.0), glycoproteins inhibit bacterial growth

lower UTI manifestations

emptying symptoms - hesitancy, intermittency, post void dribbling, retention, dysuria, hematuria/cloudy urine. storage symptoms - frequency, urgency, incontinence, nocturia, nocturnal enuresis

upper UTI manifestations

flank pain, chills, fever, fatigue, anorexia. older adults - nonlocalized abdominal discomfort, cognitive impairment/deterioration, afebrile.

UTI diagnostic studies

UA dipstick - nitrates (bacteria), WBCs, leukocyte esterase (pyruria - pus). urine culture/sensitivity, hx, US, CT.

UTi collab care

education - fluids, perineal hygiene. drug therapy - take each pill w/ a full glass of water.

UTI antibiotics

TMP/SMX, nitrofurantoin, phenazopyridine (AZO) - causes orange urine

pyelonephritis definition

inflammation of renal parenchyma and collecting system, typically bacterial (E. coli, proteus, klebisella, enterobacter). can lead to urosepsis

pyelonephritis manifestations

fever/chills, n + v, malaise, flank pain, lower UTI symptoms, CVA tenderness (where kidney is below the last rib)

pyelonephritis diagnostic studies

UA, culture + sensitivities, kidney function - GFR, CR, BUN, US, CT

pyelonephritis collab care

mild symptoms - fluids, NSAIDs, antibiotics oral → IV (sensitivity guided). severe - IV fluids until oral tolerated, combination parenteral antibiotics. relapse - 6 week course atbs. recurrent - prophylactic atbs

urosepsis definition

systemic infection that spreads from urinary system to bloodstream.

urosepsis manifestations

fever, tachycardia, hTN, mental status change, diarrhea, n+v, cold clammy skin

glomerulonephritis definition

glomerulus inflammation resulting from an immunologic process resulting in injury. fluid back up affects both kidneys equally. evaluate for immune disorders (it’s never lupus), can become chronic → renal failure.

glomerulonephritis manifestations

HTN, edema, hematuria, blood cells in urine, proteinuria, inc BUN + CR, inflammation - US

acute post-strep glomerulonephritis (APSGN) definition

occurs 1-6 weeks after group A strep as result of immune reaction, resulting in decreased waste filtering and increase in protein permeability.

glomerulonephritis collab care

Na+ and fluid restriction, rest until proteinuria, hematuria, and HTN subside. diuretics to reduce edema, reduce protein, anti-HTN, ATBs if strep

nephrolithiasis (kidney stone) risk factors

metabolic, climate, dietary (calcium, tea, juice, dehydration), genetics, lifestyle

5 types of kidney stones

calcium oxalate, calcium phosphate, cystine, struvite, uric acid

kidney stone manifestations

sudden severe pain (renal colic) in flank, back, lower abdomen, testicular or labial. ureter stretches, dilates, spasms. n + v, “kidney stone dance,” moist cool skin, UTI symptoms.

kidney stone diagnostic studies

CT noncontrast, US, UA - hematuria, crystalluria, 24 hr urine - Ca+, P+, Mg+. retrieve and analyze stones to determine cause.

kidney stone collab care

analgesics, nsaids, a-blockers (tamsulosin) to relax smooth muscle. 4 mm or less can pass, bigger need interventions (endourologic, lithotripsy, or open surgical removal.) strain urine and check for stones. tube care + surgical site care

kidney stone patient ed

adequate fluid intake (3 L/day) if no CV/renal compromise, produce 2.5 L urine/day, increase if active. low Na+, limit soda/caffeine/tea, limit high calcium and oxalate (spinach, cabbage, asparagus) and purine (muscles, liver, kidney, veal).

endourology

minimally invasive techniques used to inspect the urinary tract. cytoscopy - fills bladder with water to examine. lithotrite (stone crusher tool), lithotripsy (sonic waves break stones). complications - hemorrhage, retained fragments, infection, injury to adjacent structures

nephrostomy tube

catheter inserted into renal pelvis when ureter is completely obstructed.

nephrostomy tube nursing priorities

check patency if excessive pain, low urine output, or drainage around tube. assess abdomen + vitals. strict aseptic technique if irrigation ordered - no more than 5 mL sterile NSS. avoid kinking, compression, clamping. complications - infection, secondary stone formation

extracorporeal shock wave lithotripsy (ESWL)

laser lithotripsy. ureteral stent placed to facilitate passage of sand. post procedure - pain, mild bruising, hematuria, prophylactic antibiotics, encouraging fluids. rare complications - hemorrhage, infection, obstruction

kidney stone surgery types

nephrolithotomy (kidney), pyelolithotomy (renal pelvis), ureterolithotomy (ureter), cystotomy (bladder). complications - hemorrhage, sepsis

benign prostatic hyperplasia (BPH) definition

enlarged prostate gland creating pressure around urethra. related to endocrine changes, diet, sedentary lifestyle, aging.

BPH manifestations

frequency, nocturia, urgency, dysuria, pain, incontinence, hesitancy, dribbling, decreased stream. complications - retention, infections, renal failure

BPH diagnostic tests

digital rectal exam, prostate specific antigen to rule out prostate cancer, transrectal ultrasound to check for hydronephrosis, urine flow studies

BPH collab care

observation - see if it resolves. 5a reductase inhibitors, a-adrenergic blockers, microwaves, lasers, stents, TURP (transurethral resection), TUIP (transurethral incision), prostatectomy

a-adrenergic blockers

doxazosin, tamsulosin - vasodilator, relaxes smooth muscle in prostate to increase urinary flow. SE retrograde ejaculation.

5a reductase inhibitors

dutasteride, finasteride - reduces inflammation of prostate. SE - libido, erectile dysfunction, may take 6 mo. don’t touch! absorbs through skin, pregnant women esp.

post TURP nursing interventions

continuous bladder irrigation (CBI) - measure output against infusion. secure catheter, minimize pressure. blood clots should appear for first 36 hrs, then light pink. increase irrigation so that clots don’t block cath. manual irrigation (can cause bladder spasms)

post TURP patient ed

anti-spasmodics, analgesics, stool softeners, kegels. limit alcohol, caffeine, citrus → bladder irritation. report sexual and urinary changes to HCP. void q2-3h to avoid urinary stasis. adequate fluid intake. annual DRE >50 years.