UTI pyeloneph stones aki

pyelonephritis

inflammation of kidneys

cystitis

inflammation of bladder UTI

urethritis

inflammation of urethra

cystitis rf

female

18-30 yo

older male

sexual activity spermicide and lube

poor or too much hygeine

conditions like diabetes menopause pregnancy bc anything altering estrogen bladder probs bph infections foley cath

cystitis patho

Bacteria in urethra and moves up to bladder and causes inflammation main one is cleaning after going to bathroom CLEAN FRONT TO BACK

cystitis dx

UA leukocytes leukoesterase nitrates rbc bacteria

cystitis tx

abx bactrim cipro 3 days for uncomplicated complicated treats up to 7 

vag health

cranberry juice with NO SUGAR

cystitis complications

pyelonephritis cysts in kidneys and stones

cystitis surgery

stone removal abscess removal

pyelonephritis rf

young women

multiple preexisting UTIs

vesicouretal reflux

obstructions

long term indqwelling cath

pregnancy

sexual activity

patho pyelonephritis

The vesicoureteric junction enters at an angle into the bladder wall. The ureters enter the bladder, they travel through the wall of the bladder for a distance in such a way that they create a tunnel This configuration closes off the ureteral orifice as the bladder expands. If there is alteration of the angle, this may lead to vesicoureteral reflux (VUR).

pyelonephritis dx

CVA tenderness, UA, CBC, looking at WBC

WBC shift to the left more neutro bands and segmented neutrophils in blood

infection overwhelming body so much that the immune system is sending immature wbc to fight infection

pyelonephritis tx

fluids and IV abx broad spectrums stay hydrated

pyelonephritis complications

urosepsis

renal scarring

CKD or permanent kidney damage

surgery

urolithiasis

kidney stoneski

kidney stones rf

males

caucasians

southeastern USA

summer months

high protein

high crystal forming substances

hx of kidney stones

kidney stone patho

dehydration

urine super sat —> nucleation —> crystal growth —> crystal aggregation —> crystal formation

kidney stone dx

ct without contrast

KUB

kidney stone tx

< 5 mm (1/2 cm): pass stone on own

5-9 mm: s/s pain watch those and manage symptoms give pain meds and antiemetics tamsulosin to relax ureters and allows stone to pass

10 mm or greater ureteroscopy

bigger than 20 mm percutaneous nephrolithotomy

less than or = 20 mm extracorporeal shock wave lithotripsy

kidney stone complications

pyelonephritis

urosepsis

irreversible renal damage

AKI rf

cvd

dm

sepsis

administration of contrast media

exposure to nephrotoxins

decline in the number of nephrons with aging

distinctive characteristics of AKI

acute rapid loss of renal function

azotemia

increase in potassium

decrease in calcium

uremia

patho of aki

1. blood loss (hypovolemia), low perfusion, dehydration

2. ischeia, drugs, toxins, infection

   1. BPH, prostate CA, calculi, trauma, tumors

phases of aki

initiating to oliguric to diuretic to reoveryo

oliguric phase urine

less than 400 mL in 12 hours

oliguric phase s/s

edema increased volume in body but not out

SUPER HIGH BP

hyperkalemia

hyponatremia

hypocalcemia

hyperphosphatemia

oliguric ABG

metabolic acidosis and kussmaul breathingso

tx for oliguric phase

remove whatever is hurting the kidneys

diuretic phase

all fluid in body is gonna go out of body

diuretic urine output

3-6 liters in 24 hours

diuretic phase s/s

hypotension

diuretic recovery

levels back to normal

A 30-year-old female patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply:

A. Water intoxication

B. Hypotension

C. Low urine specific gravity 

D. Hypokalemia

E. Normal GFR

specific gravity

concentration

AKI major goals

eliminate the cause prevent complications and assist pt to recovery

aki meds

diuretics

avoid nephrotoxic agents

short term dialysis

aki nutrition

adequate calories from carbs fats

low protein

low sodium

complications for aki

kidney failure

CKD

hyperkalemia EKG

peaked t waves

long PR interval

wide QRS

tall T wave

absent P wave sinusoidal wave

vtach and cardiac arrest

management of hyperkalemia

iv calcium gluconate or calcium chloride

iv glucose followed by iv reg insulin

albuterol

bicarb

PO sodium polystyrene sulfonate (kayexalate)

iv lasix

kayexalate teaching

pt goes to bathroom all day long

cystitis cm

frequency urgency dysuria burning during urination hesitancy hematuria cloudy urine smelly bladder spasms suprapubic pain/tenderness

fever chills

AMS delirium in the elderly

foley in place and the pt reports urgency

UTI labs

UA and CS

hematuria leukocytes nitrates cloudy urine abx

UTI meds

abx, bladder analgesics like pyridium (3 days)

pyelonephritis cm

mostly same as uti

LOW BACK PAIN

n/v nocturia urinary incontinence anorexia

pyelonephritis labs

UA and CS pyuria

WBC
complete WBC count leukocytosis and immature cells

blood cultures

UO

urolithiasis cm

severe pain 

colicky pain

location of stone influences pain location

unable to find comfy position

n/v

gross hematuria 

microhematuria

urolithiasis labs

acidic urine

gross hematuria

thick urine

blood clots

pos urine cultures high WBC

UO

kidney stone prevention

low sodium diet

increase dietary intake of citrate (lemon lime oranges grapefruits vit c)

decrease dietary intake of oxalate (rhubarb chocoalte tea coffee nuts leafy greens soy almonds)

AKI cm

oliguria (less than 400 mL in 24 hrs)

volume overload like edema SOB HF JVD pericardial and pulmonary effusion htn

dysthymias azotemia electorlyte imbalance (high K P low Ca NA)

high BUN crea and ratio

metabolic acidosis anemia anorexia nausea constipation diarrhea confused and lethargia seizures coma