NRS 317 GU slides

What organism most commonly causes cystitis?

E coli.

What anatomical structure is inflamed in cystitis, and what are its common findings?

The bladder lining (lower UTI); common findings include dysuria, urgency, frequency, suprapubic discomfort, and cloudy or malodorous urine.

Which assessment findings signal that a urinary tract infection involves the kidney rather than just the bladder?

Fever, chills, flank pain, vomiting, or systemic decline.

What specific structures are infected in pyelonephritis?

The kidney tissue and the renal pelvis (upper UTI).

What parameters must the nurse trend and monitor when caring for a patient with pyelonephritis?

Trend temperature, HR, BP, respiratory status, and mental status; monitor I&O and BUN/creatinine; review urine culture and administer prescribed antibiotics.

Which clinical findings in a patient with pyelonephritis require immediate escalation?

Suspected sepsis, hemodynamic instability, persistent fever, vomiting with inability to keep fluids down, or new confusion.

What patient education is key for a patient recovering from pyelonephritis?

Complete the prescribed antibiotics, report persistent fever, worsening pain, vomiting, or inability to keep fluids down, keep follow-up appointments, and address contributing risks such as recurrent UTI or obstruction.

In Case 1, a 68-year-old with vomiting and diarrhea presents with UOP of $20\,\text{mL/hr}$, dry mouth, and rising BUN and creatinine. Which type of AKI is most likely?

Prerenal AKI, caused by fluid loss and reduced perfusion to the kidneys.

What are the two most concerning clinical findings indicating hypovolemia and a prerenal AKI pattern in Case 1?

A 68yo pt was admitted after several days of vomiting and diarrhea. The nurse notes UOP has ave 20 mL/hr over the last 3 hrs. The pt reports feeling weak and has a dry mouth. Blood urea nitrogen (BUN) and creatinine are rising.

Low UOP (about $20\,\text{mL/hr}$) and rising BUN/creatinine.

In Case 2, an AKI patient has $K^+$ $6.2\,\text{mEq/L}$, muscle weakness, and tall peaked T waves. What is the greatest immediate risk?

A patient with acute kidney injury has a potassium level of 6.2 mEq/L. The patient reports muscle weakness. The ECG shows tall, peaked T waves.

Life-threatening cardiac dysrhythmia.

What are the immediate priority nursing actions for a patient with severe hyperkalemia and tall peaked T waves?

Continuous cardiac monitoring, notifying the healthcare provider, and administering ordered treatment.

In Case 2, how does the nurse confirm that a patient treated for hyperkalemia is improving?

A patient with acute kidney injury has a potassium level of 6.2 mEq/L. The patient reports muscle weakness. The ECG shows tall, peaked T waves.

Repeat $K^+$ trends down, ECG normalizes, muscle strength improves, and cardiac rhythm is stable.

What is the correct clinical sequence for how obstruction harms the kidneys?

Obstruction

urine backup

hydronephrosis

postrenal AKI.

What is hydronephrosis in the context of urinary tract obstruction?

Distention of the renal pelvis caused by backed-up urine, which raises internal pressure and reduces kidney function.

What are the classic symptoms of benign prostatic hyperplasia (BPH)?

Decreased force of stream, hesitancy, nocturia, and incomplete bladder emptying.

Which over-the-counter medications can worsen urinary flow or trigger acute urinary retention in a patient with BPH?

Antihistamines and decongestants (OTC cold and allergy products).

How can benign prostatic hyperplasia (BPH) lead to acute kidney injury (Case 4)?

A 76yo patient reports difficulty starting urination, a weak stream, and frequent nighttime urination. The patient develops lower abdominal discomfort. The nurse finds bladder distention and notes that very little urine has been passed. A bladder scan shows a large postvoid residual. Laboratory results show rising creatinine.

Progressive urethral compression obstructs urine flow, which backs up and raises pressure in the kidneys (postrenal AKI).

Which clinical findings best support a diagnosis of urinary retention in Case 4?

A 76yo patient reports difficulty starting urination, a weak stream, and frequent nighttime urination. The patient develops lower abdominal discomfort. The nurse finds bladder distention and notes that very little urine has been passed. A bladder scan shows a large postvoid residual. Laboratory results show rising creatinine.

Bladder distention with very little urine passed and a large postvoid residual (PVR) on bladder scan.

What are the first clinical decisions a nurse must make when evaluating a patient with urinary retention?

Decide whether the patient cannot void or is incompletely emptying, and consider the cause (such as outlet obstruction, medication effect, or a neurologic condition).

What nursing actions are required after urinary retention is relieved with a catheter?

Confirm the catheter drains without obstruction, measure and trend UOP, evaluate patient comfort and bladder decompression, and watch for excessive ongoing losses.

What discharge instruction should be given if a patient with urinary retention goes home with an indwelling catheter?

Teach catheter and drainage-bag care.

What is post-obstructive diuresis, and why is it dangerous?

High UOP occurring after a blockage is relieved, which can cause volume depletion, falling blood pressure, and electrolyte problems.

In Case 5, after a catheter drains $1500\,\text{mL}$, a patient produces $400\,\text{mL}$ in the next hour, feels dizzy sitting up, and BP drops from $132/78$ to $96/60$. What should the nurse suspect?

Post-obstructive diuresis with volume depletion.

What priority assessments and nursing actions follow suspected post-obstructive diuresis with hypotension and dizziness (Case 5)?

A patient with urinary retention has a urinary catheter inserted. The catheter drains 1,500 mL immediately. During the next hour, the patient produces 400 mL of urine. The patient becomes dizzy when sitting up, and blood pressure decreases from 132/78 to 96/60 mm Hg.

Reassess BP and orthostatics, trend UOP, check electrolytes and weight, apply fall precautions for dizziness, notify the provider, and anticipate fluid replacement.

What three questions help evaluate recovery after the relief of urinary obstruction?

Is UOP stabilizing without dehydration, are BP, electrolytes, and kidney labs improving, and is the cause addressed with follow-up arranged?