Urology concerns.pptx

Lecture Overview

  • Lecture Title: Renal & Urologic Problems

  • Course: NURS 302: Pathopharmacology

  • Instructor: Hannah Ferguson, FNP-BC

Urinary Tract Calculi

  • Prevalence

    • 1 to 2 million individuals in the United States have nephrolithiasis.

    • More common in men; onset age averages between 20 to 55 years.

    • Increased incidence in:

      • White persons

      • Family history of stone formation

      • Previous history of stones

      • Summer months

Etiology and Pathophysiology

  • Stone Formation

    • No single theory exists for all cases.

    • Contributing factors include:

      • Metabolic factors

      • Genetic predisposition

      • Climatic influences

      • Lifestyle choices

      • Occupational exposures

  • Factors Affecting Stone Formation

    • Mucoprotein forms a matrix.

    • Influenced by:

      • Urinary pH (alkaline urine)

      • High solute load in urine

      • Lack of inhibitors in urine

    • Additional factors:

      • Urinary obstruction with stasis

      • Urinary Tract Infection (UTI)

      • Genetic factors

Types of Urinary Tract Calculi

  • Calcium Phosphate

  • Calcium Oxalate

  • Uric Acid

  • Cystine

  • Struvite (magnesium ammonium phosphate)

Clinical Manifestations of Urinary Calculi

  • Renal Colic

    • Sudden severe pain due to obstruction, often felt in:

      • Flank area

      • Back

      • Lower abdomen

  • Common sites of obstruction:

    • Ureteropelvic Junction (UPJ)

      • Causes dull pain in the costovertebral flank.

    • Ureterovesicular Junction (UVJ)

      • Causes groin pain.

  • Other Symptoms

    • "Kidney stone dance"

    • Mild shock with cool, moist skin.

    • Pain migrates to the lower quadrant as the stone nears UVJ.

    • Testicular or labial pain commonly experienced by both sexes.

    • UTI symptoms may also be present.

Interprofessional Care for Urinary Calculi

  • Acute Attack Management

    • Pain management using NSAIDs or opioids.

    • Infection treatment: monitor & treat appropriately.

    • Increase fluid intake between 1-3L per day.

  • Obstruction Relief

    • Medications such as α-adrenergic blockers relax smooth muscle in the ureter, aiding stone passage (e.g., Tamsulosin (Flomax), Terazosin (Hytrin)).

    • Assessment of underlying causes is crucial.

Urinary Tract Infection (UTI)

  • Most common bacterial infection in women, often due to various disorders, predominantly bacterial.

Common Pathogen in UTI

  • Escherichia coli (E. coli)

    • Counts of 105 CFU/mL or more signify a significant UTI.

    • Counts as low as 102 CFU/mL can indicate UTI if accompanied by clinical symptoms.

Classification of UTI

  • Upper vs. Lower Urinary Tract

    • Upper:

      • Pyelonephritis: involves renal parenchyma, pelvis, and ureters, typically presents with fever, chills, and flank pain.

    • Lower:

      • Cystitis: inflammation of the bladder, usually without systemic symptoms.

      • Urethritis: inflammation of the urethra.

  • Urosepsis:

    • A severe UTI spread systemically requiring immediate treatment.

Etiology and Pathophysiology of UTI

  • Organisms often introduced through the ascending route from the urethra, originating in the perineum.

  • Less common routes include bloodstream or lymphatic system.

  • Catheter-associated UTIs (CAUTI) are the most frequent healthcare-associated infections (HAI).

Clinical Manifestations of UTI

  • Uncomplicated Urethritis/Cystitis: Symptoms include:

    • Frequency, urgency, dysuria, hematuria, suprapubic pain, incontinence.

    • Severe cases can lead to systemic illness showing abdominal pain, fever, or reduced kidney function, particularly in pyelonephritis.

    • Additional symptoms may include fever and chills, along with CVA tenderness.

Special Considerations in Older Adults

  • Symptoms may be absent.

  • Non-specific abdominal discomfort may be reported instead of dysuria.

  • Cognitive impairment and reduced likelihood of fever may also occur.

Interprofessional Care for UTI: Drug Therapy

  • Antibiotics:

    • Empiric therapy or sensitivity testing informs choices.

    • Uncomplicated cystitis: short-term course (3 days);

    • Complicated UTIs: longer treatment (7-14 days or more).

  • Common antibiotics include:

    • Trimethoprim/sulfamethoxazole

    • Nitrofurantoin (Macrodantin, Macrobid)

    • Ampicillin, amoxicillin, cephalosporins

    • For complicated UTIs: Fluoroquinolones such as ciprofloxacin (Cipro).

    • Antifungals for fungal infections: Amphotericin or fluconazole.

Urinary Analgesics

  • Phenazopyridine:

    • Used alongside antibiotics for pain relief.

    • Causes urine to appear reddish-orange, which can be mistaken for blood. Should not be used beyond 2 days of UTI onset.

Prophylactic or Suppressive Antibiotics

  • May be prescribed for patients with recurrent UTIs either as low doses of antibiotics to prevent recurrence or single doses before potential triggers, such as sexual intercourse.

  • However, the risk of antibiotic resistance limits this strategy's use.