Pathopharm exam 3

Function of the urinary system

Removes waste, regulates water/electrolyte balance, secretes erythropoietin, activates vitamin D, and maintains BP via the renin-angiotensin-aldosterone system.

What does urinalysis (UA) detect?

It evaluates urine color, pH, presence of blood, protein, glucose, bacteria, or casts — abnormalities indicate infection or renal pathology.

What do elevated BUN and creatinine indicate?

They signal impaired kidney function or renal failure, reflecting the kidneys' inability to excrete waste.

Define polyuria and oliguria.

Polyuria = increased urine output (e.g., diabetes); Oliguria = decreased output (e.g., renal failure).

What is anuria?

Absence of urine production — often associated with acute renal failure or complete urinary obstruction.

Cause of stress incontinence

Leakage with increased abdominal pressure (laughing, coughing); common in women post-childbirth due to weakened pelvic muscles.

Cause of overflow incontinence

Occurs when the bladder fails to empty completely, leading to constant dribbling; common in men with enlarged prostate.

Definition of urge incontinence

Sudden urge to urinate caused by overactive bladder or neurological issues; leakage occurs before reaching the toilet.

Functional incontinence meaning

Inability to reach the toilet due to physical or cognitive impairment (e.g., dementia, arthritis).

What is urinary retention?

Inability to empty bladder; can result from spinal injury, anesthesia, or obstruction such as tumors or prostate enlargement.

Most common cause of UTIs

E. coli (normal intestinal flora) ascending the urethra; more common in women due to shorter urethra.

Symptoms of cystitis

Dysuria, urgency, frequency, suprapubic pain, and cloudy urine; indicates inflammation of bladder wall.

Symptoms of pyelonephritis

Flank pain, fever, chills, dysuria, and fatigue; indicates kidney infection that can lead to renal failure if untreated.

Common antibiotics for pyelonephritis

Trimethoprim-sulfamethoxazole, nitrofurantoin, or cephalosporins; fluid intake should be increased.

What does cranberry juice do for UTIs?

May prevent bacterial adhesion to bladder mucosa, reducing recurrence; not a treatment for active infection.

Glomerulonephritis hallmark signs

'Smoky' or cola-colored urine, facial edema, high BP, and oliguria; follows streptococcal infection

Lab findings in glomerulonephritis

Proteinuria, hematuria, and RBC casts; elevated BUN and creatinine confirm renal involvement.

Treatment for acute glomerulonephritis

Sodium restriction, glucocorticoids, antihypertensives, and limited fluid intake to reduce kidney strain.

Define nephrotic syndrome

Excessive permeability of glomeruli causes massive protein loss → hypoalbuminemia, edema, and frothy urine.

Signs of nephrotic syndrome

Anasarca, weight gain, pleural effusion, and fatigue due to low plasma proteins and fluid shifts.

Treatment for nephrotic syndrome

Glucocorticoids, ACE inhibitors, increased dietary protein, and sodium restriction to reduce proteinuria and edema.

Define urolithiasis

Formation of kidney stones (calculi) due to calcium, uric acid, or infection; causes severe flank pain and hematuria.

Prevention of kidney stones

Increase fluid intake and adjust urine pH; analyze stone composition for targeted prevention.

Hydronephrosis cause and risk

Urine backflow from obstruction causes dilation of kidney; prolonged cases can lead to tissue necrosis and renal failure.

Define nephrosclerosis

Hardening of renal arterioles → ischemia → chronic renal failure; often secondary to hypertension or diabetes.

Polycystic kidney disease hallmark

Inherited disorder with multiple cysts causing progressive renal damage; often leads to dialysis by midlife.

Wilms tumor characteristics

Malignant kidney tumor in children under 5; presents as painless abdominal mass and sometimes hypertension.

Acute renal failure causes

Results from ischemia, toxins, or obstruction; marked by elevated BUN/creatinine, oliguria, and acidosis.

Chronic renal failure early vs late signs

Early: polyuria, anemia, fatigue; Late: oliguria, pruritic skin, edema, arrhythmias, and metabolic acidosis.

Treatment for chronic renal failure

Manage hypertension, anemia, electrolyte imbalance; restrict fluids and protein; dialysis or transplant may be needed.

Hemodialysis function

Blood filtered externally via machine to remove wastes and correct fluid/electrolyte imbalances; 3-4 hours, 3x weekly.

Complications of hemodialysis

Hypotension, infection, shunt failure, and risk for hepatitis B/C or HIV.

Peritoneal dialysis function

Uses peritoneal membrane for filtration; dialysate instilled into abdomen and drained by gravity.

Peritoneal dialysis complications

Peritonitis (cloudy drainage, fever, abdominal pain); requires immediate reporting and antibiotic treatment.

Difference between hemodialysis and peritoneal dialysis

HD is faster but invasive; PD is slower, home-based, and continuous but infection-prone.

Define azotemia

Presence of nitrogenous waste in blood; indicates impaired renal excretion capacity.

What causes elevated potassium in renal failure?

Kidneys can't excrete potassium → hyperkalemia → arrhythmias; managed with diet and dialysis.

Why is erythropoietin low in chronic renal failure?

Damaged kidneys can't produce enough hormone → anemia; treated with synthetic EPO injections.

How does renal failure affect bone health?

Reduced vitamin D activation → hypocalcemia → secondary hyperparathyroidism and renal osteodystrophy.

Nursing priority in acute renal failure

Identify and correct the underlying cause early (shock, obstruction, nephrotoxin exposure).

Dietary teaching for renal patients

Limit sodium, potassium, and phosphorus; moderate protein; maintain fluid restriction as ordered.

Key diagnostic test for kidney function

Creatinine clearance test — assesses glomerular filtration rate (GFR) accuracy.

Mechanism of action of tetracyclines

Inhibit bacterial protein synthesis, producing a bacteriostatic effect. Effective against gram+ and gram- bacteria, chlamydia, and rickettsiae.

Key safety concern with tetracyclines in children and pregnancy

Cause permanent discoloration of teeth and bone development issues; contraindicated in children under 8 and during pregnancy.

Important side effect of tetracyclines

Photosensitivity — patients should avoid excessive sunlight exposure.

How should tetracyclines be administered?

Usually orally; take with full glass of water, avoid antacids and dairy within 2 hours to improve absorption.

Aminoglycosides mechanism of action

Inhibit bacterial protein synthesis and are bactericidal; effective against gram-negative bacteria such as E. coli.

Common aminoglycoside examples

gentamicin, tobramycin, amikacin, streptomycin.

Main route of aminoglycoside administration

Given IV or IM due to poor GI absorption; some oral forms like neomycin used preoperatively to reduce bowel flora.

Aminoglycoside toxicity risks

Ototoxicity (hearing loss, balance issues) and nephrotoxicity (renal damage). Monitor serum levels and kidney function.

Drug interaction caution with aminoglycosides

Should be given several hours apart from penicillins, which can inactivate them when mixed in IV solutions.

Sulfonamides mechanism of action

Bacteriostatic by inhibiting bacterial folic acid synthesis; effective against E. coli and chlamydia.

Sulfonamide combinations and rationale

Often combined with trimethoprim (TMP-SMZ) to prevent resistance and achieve synergistic bactericidal effects.

Side effects of sulfonamides

Crystalluria, photosensitivity, GI upset, and hypersensitivity reactions; encourage hydration to prevent crystals.

TMP-SMZ pharmacodynamics

Acts synergistically (1:5 ratio) to inhibit bacterial metabolism; peaks in 4 hours and is effective against gram± organisms.

TMP-SMZ patient teaching

Take with full glass of water, complete full course, and monitor for rash or signs of allergic reaction.

Methenamine mechanism and condition for activity

Forms formaldehyde in acidic urine (pH <5.5) for bactericidal effect; used for UTI prophylaxis.

Methenamine interactions

Should not be taken with sulfonamides due to risk of crystalluria; antacids and bicarbonate decrease its effectiveness.

Patient teaching for methenamine

Acidify urine with cranberry juice or vitamin C; monitor for nausea, dysuria, or rash.

Nitrofurantoin mechanism of action

Bacteriostatic at low doses and bactericidal at high doses; concentrates in urine and is effective against E. coli.

Nitrofurantoin administration teaching

Take with food or milk to decrease GI upset; antacids reduce absorption; urine may turn brown (harmless).

Nitrofurantoin adverse reaction warning

Report cough, fever, or chest pain — may indicate pulmonary toxicity; discontinue and notify provider.

Fluoroquinolones mechanism of action

Inhibit bacterial DNA synthesis; bactericidal against many gram-negative and some gram-positive bacteria.

Fluoroquinolone examples

Ciprofloxacin, ofloxacin, levofloxacin — used for complicated UTIs when no safer options available.

Fluoroquinolone black box warnings

Can cause tendon rupture, peripheral neuropathy, CNS effects, and exacerbate myasthenia gravis.

Fluoroquinolone administration precautions

Avoid taking within 2 hours of calcium, magnesium, or iron supplements and dairy products; separate dosing.

Phenazopyridine (Pyridium) purpose

Urinary analgesic that relieves pain, burning, urgency, and frequency in cystitis; does not treat infection.

Phenazopyridine side effects

Turns urine reddish-orange (harmless); may cause hemolytic anemia or hepatotoxicity with prolonged use.

Phenazopyridine teaching

Use for 1-2 days only with antibiotics; warn about urine discoloration and possible false glucose test results.

Bethanechol chloride mechanism

Direct-acting parasympathomimetic (urinary stimulant) that increases bladder tone and detrusor muscle contraction.

Bethanechol contraindications

Avoid in patients with peptic ulcer, asthma, or urinary/GI obstruction due to risk of bronchospasm or perforation.

Antimuscarinics (anticholinergics) mechanism

Block parasympathetic impulses to reduce bladder spasms, urgency, and incontinence.

Common urinary antimuscarinic drugs

Oxybutynin and solifenacin; used for overactive bladder and urge incontinence.

Antimuscarinic side effects

Dry mouth, constipation, blurred vision, and tachycardia; advise patient to report severe dizziness or urinary retention.

Solifenacin patient teaching

Take once daily; avoid driving until effects known; report confusion, palpitations, or blurred vision.

Drug interaction alert for urinary antiinfectives

Antacids decrease nitrofurantoin absorption; sodium bicarbonate inhibits methenamine; methenamine + sulfonamides ↑ crystalluria risk.

Nitrofurantoin nursing considerations

Monitor urine output and specific gravity; discontinue if pulmonary symptoms occur; expect brown urine.

TMP-SMZ nursing considerations

Monitor CBC, BUN, creatinine; assess for rash and allergic reaction; encourage fluids to prevent crystalluria.

Fluoroquinolone nursing considerations

Monitor for tendon pain; avoid in athletes or elderly; teach to report neuropathy or confusion.

Phenazopyridine nursing considerations

Monitor renal function; warn of urine staining of clothing or contact lenses; limit use to short term.

Methenamine nursing considerations

Ensure urine acidity; teach to avoid antacids; monitor liver function if used long-term

Aminoglycoside nursing considerations

Check peak/trough levels; monitor for hearing loss and reduced urine output; avoid concurrent nephrotoxic drugs.

Primary nursing concept for urinary antiinfectives

Infection control — assess pain, burning, urgency; monitor urine characteristics and renal function.

patient teaching summary for all urinary antiinfectives

Take full course, increase fluids, avoid self-discontinuation, and report fever, rash, or worsening symptoms.

Intracellular vs extracellular

regulated by ADH, Aldosterone, ANP, BNP

ADH

Promotes water reabsorption from kidney tubules into blood.

Aldosterone

Increases sodium & water reabsorption from kidney tubules.

ANP & BNP

Promote sodium and water excretion to reduce blood volume.

Edema Causes

↑ Hydrostatic pressure, ↓ plasma proteins, lymph obstruction, ↑ permeability.

Edema Effects

swelling, pain, weight gain, impaired circulation.

Dehydration Causes

Vomiting, diarrhea, sweating, DKA, low intake.

Dehydration Signs

Dry mucosa, poor turgor, low BP, weak pulse, confusion.

Third Spacing

Fluid trapped in cavity/tissue, not circulating (e.g., burns).

Sodium

135-145 mEq/L; 'Swells the body' (BP, blood volume, pH).

Hyponatremia

Low Na; fatigue, confusion, seizures, hypotension

Hypernatremia

High Na; thirst, dry mucosa, agitation, edema.

Potassium

3.5-5 mEq/L; 'Pumps the heart & muscles'.

Hypokalemia

Low & slow; weakness, arrhythmias, constipation, postural hypotension, polyuria, serum pH elevated (alkalosis)

Hyperkalemia

Tight & contracted; cardiac arrest, diarrhea, paresthesias, oliguria, serum pH decreased (acidosis)

Calcium

9-10.5 mg/dL; 'Keeps 3 B's strong' (Bone, Blood, Beats)