theory test 3

And, you know, the the uh, you know, when you look at some of them, okay, um, you know, like a a 12 is fairly small, okay?

You look at at 18, that's a frigging garden hole, and some people have those.

Not the first time they have them put it in, because that would be mean to be all.

But sometimes people long term have to have a bigger one to prevent leaking around it, because things kind of stretch up, right?

Okay, so when we're talking about the reoral vessicle unit function, um, it's what we call the bladder, uh, do you refur in the pelvet floor muscles , because they all play a role in avoiding being voluntary.

You might save yourself, what?

You know, you can see why, you know, the bladder fills you, feel the pressure, right?

And then, you know, uh you think your, you think of, you know, your rethr meatis vinctures and things that keep that um from being voluntaries.

But what about pel muscles?

How do they come into play, okay?

Well, you know, if you have several children sitting on your pelic floor muscles. Stretching them out, okay?

That's how it, you know, those muscles can get, you know, your your blood isn't being suspended as well anymore, right?

And if your bladder is not suspended as well anymore, , you know, sometimes you peep when you laugh, okay, that's or cough, or okay?

So that's how that has to do with it.

And that's why we always tell people, well teaching peopleles, so people exercises . Okay.

And it's not just for pregnancy, okay?.

Okay, um muscles have to be exercised to maintain their phone, okay?

And sometimes, you know, you're uh when it gets really bad, people will have to have their bladder suspended.

Okay, uh each related considerations effects of the aging on the urinary system , uh, a decrease in size and weights of the kidneys, um, happens between 30 and 90 years of age.?

So the gradual process, obviously, you get decreased blood flow and then that an amount of decrease in blood flow really can depend, okay?

Um when you think about that blood flow, it really can depend on, you know, a person's generalized health, right?

So, if you have changes to any artries, you have arterial scosis, a lot of changes, can that happen your mean all arteries as well?

Yeah, absolutely, right?

So, you know, it depends, okay?

Some people, you know, very, you know, healthy, uh, healthy lifestyles, or whatever, some sometimes people are just genetic the smallest to it seems like hyperithhenia. Um, so it can be. Physiology changes to the kidney, the bladder and the rethreat, dec decrease the lossity, um little, you know, when your ageing loss to be all over, um, you know, decreases. Be beginning, um decrease a lot of capacity and for men, uh prosthetic mars which is common. Would you agree or standard en large prostates?

Yeah. Very.

Okay.

So, uh assessment on that you your system, I wanna look at past, uh, health history, medications, any surgeries, um, nutritional and elimination assessment, activity assessments, pain assessments, self concept and sexuality , come into play and cooling assessments.

Okay?

Um, physical exam, just like health assessment, you know, uh inspection, uh calpation, protestant profession, and oitation.

Well, the oscultation comes in when you're listening to vascular sounds, um, but, you know, it's the inspection can be related to kidney as like somebody had a hy oforosis, they can end up with, you know, very standard abdomen. , if they have uh, like an um a large kidney, a hydro neosis, with um fluish, it's large blue fluid, not explained that word a little bit later.

But usually when we're doing the palpation, um, you know, we just tenderness, uh from the kidney that caro langu, we might be checking that.

But usually when you're talking about theation in the an, um you're talking about culpating for a standing ladder, okay you do that on a pretty great number.?

Now, if you look on the table on 1131 in your textbook, Oh yeah, okay?

This is a good table, okay?

When you're thinking about all the things that the ne these three chapters that we're gonna be doing for the urinary system, because it just lists a whole bunch of dis symptoms that are pretty common, okay, when there is a disorder of the ordinary system . So for, you know, a you know, a lower UTI, a common syitis, a a lateral infection, right?

You might not have all of those symptoms, right?

Um, but you could have some of those.

So it's just kind of puts them all together. Of things that can happen.

You know, you're not gonna get a demon with uh, you know, labor infection, but you you know, you you can get that. Um when, you know, you have renal filter, okay?

So, related to the, but it kind of puts it together.

Um, there's also a the table that does the same kind of thing, uhessmentapormalities on 11 33., okay?

Okay, Pat the hurry in, um, juneal. itch palped a kidney there in that diagram in case you' forgotten.

Okay. Um Okay. Um so, diagnostic studies?

Um, that is a huge table of all the diagnostic studies.

Now, I'm gonna mention them while we talk about different disorders as well. But it again, good table, is very huge, okay?

I don't expect you to study um three full pages I diagnostic studies related to um uoga system, okay?

Um, the main ones that we're looking at um, I'm just gonna tell you, okay?

So, um, analysis of un, okay?

So a UA is just a urinary analysis.

That's pretty common. Everybody that comes in pretty much, you know, gets a CBC in the the uh routine and microspot here and does, okay?

Um, clean Catch or mystry urine, um, uh what's the time we're doing when we're suspecting infection?

That's why we're looking at current culture sensitivity. We can also do death sticks, right, and tell us somebody has protein area, they have hematuria, quick, easy test, and then we can do a u for specific rap.

Okay, to find out how concentrated or how dilute urine is, that's what specific gravity is.

Now, uh, radiological procedures, um and radioal uh radioucleotide imaging.

So it's put those together. You know, uh a CT MRI is been in like you visualize the kidneys.

Okay, one to get better than the other one, okay?

You gonna be able to visualize things.

But specific to yourary system oftentimes we do what's called a KUB, which is kidneys uor bladder x ray. Okay?

Um, and IDP is an intravenous pilot brand, so that's the injection of dying, and then following it through theriary system., to see how the urinary system is functioning. If there's any obstructions there.

Oftentimes people that have kidney stones and they' you know, the physician may order an IDP to be done. Um to see, um, you know, if there is there is stones obstructing.

Okay, because with the diet that's gonna so for herstructive oftentimes. , ultrasounds are also done, um, if it's a, you know, a question of blood flow to the kidneys, you can do a renal, uh arteriorogram to check the blood flow, okay?

Just like you would, you know, it's a arteriorogram.

It's just like you would do, you know, check for the cornard arteries. Um, it's a cro arteries, you you can do those kinds of tests, to check the flow, okay?

Now, you're a dnamics testing, there's a lot of them describing that table, but um you know, something that's very common. For say somebody that has overactive blood sex,?

They're gonna do a cistro uh metro uh graphy, uh, so, you know, you do that with this thisoscope and you fill the bladber band. And then, um study the uh studied the blabber pressure basically, like when once you fill it, uh the bladder, um, you know, how much of the bladder could be filled before, um uh the pressure increase this kind of thing. And so for, you know, overactive bladder is, you know, you can't fill it very much, it gives us use about food why. Okay?

So I know that was very quickly done for 47, but just a review.

So, now we will go to chopter 48.

I'm talking to investigating.

This is okay, I was starting to slow down there?

I just to exit this out and did you see that where I tried to use theouse for this computer on this laptop like moron?

Okay, so chapter 48 um Renal and urological conditions that we're gonna talk about today.

Um, so infectious and inflammatory disorders of the neuros system. We can have we we're gonna talk about urinary tract infections.

If you pylon ofritus chronic pylotiferritis, your eritis, your will dieverticuli, interstit cyitis and renal tuberculosis.

Because contig spare ne Yes, it can.

We usually think of TV is something that of our lungs, right?

And that's usually, but TV is a bacteria and it can look other replaces, right.

Okay, so a urinary tract infection, okay?

It is is it very common y urinary attract infections?

Yeah.

What sex do you believe it's more common?

And why is it more common in women are you?

Yeah, sure you okay. And you know, men have penises. And so they come on through your rethrust because there youthomated, we us is sitting at the end of her their penis, right?

So they're opening into their bladders, okay, you know, varies per penis lines, I suppose.

But um it is pretty far away from the rectil area, right?

Okay.

And when you think about the female larity getting is the distance from that area as far away?

No, it's not as far as away, right?

So oftentimes when we think UTIs, it's we think of it being more prevalent and females, and especially in little girls.

Why?

White people, they don't white correct feet, and they forget, okay?

And they may be wiping friends back within, you know, they wipe front to back and then go back in the other direction.

Okay?

So, oftimes, and I told you guys this, oftentimes when it's a, you know, a blad infection, lower urinary tract. Um we think of eola, okay?

Um, but as the second most of common bacterial disease and the most common, um overall, and then the most common in it, okay?

So we can class it a couple of ways, uh upper versus is lower. Okay?

And when you're talking about an upper, you're talking about uh like key infections that we're gonna talk about today.

And sometimes they, you know, they are a result of an untreated lower , okay?

Um, so upper we're talking about the renal um Pina chim. Um the pelvis and uh the uh your urin um like pry. Okay?

And oftentimes we have the upper, we have systemic manifestations about it, so the thing, you know, yeah, my fever of chills, flank pain, okay?

Um, you see that that was lower?

Um, there's usually no systemic manifestations.

Okay?

Um, you know, unless that infection has uh spread, um, we usually don't see this stemic amountest stations, okay?

People usually don't have fever with a simple bladder infection, okay, a lower, okay?

So, um bladder you are lower, um, you know, stinus is is what's up, uh bladder infection.

Um, so there are usually no usemic mount his stations.

And then you can also classify as um complicated or uncomplicated. Okay?

So if you're going to have a, you know, you're you're attract infection, you want it to be lower and you wanted to be uncomplicated.

If you have a choice, okay?

So when we're talking about uncomplicated, that's something that occurs in somebody that um you know, otherwise has a normal urine or attract, um, and that usually only involves the blackder.

When we're talking about complicated, then you can have a obstruction going on, you can have stones involved, um, anytime somebody has its cavernertits, okay?

And it's a catheter like induced infection, right?

The reasonable we do really good ascepsis, or're doing catorizations, and we do really good capital care on people is because not can make but not, but as, that can make a complic of if a person has passed, you know, um existing diabetes, okay, or they have um um neurological diseases that can make it complicated, um, uh pregnancy, uh changes in compensute pregnancy can make it complicated.

And then when somebody has reur infections.

Are reincurrent , you know, every once in a while somebody gets a UT, right?

It's not as common for that. Not and it's a very, it's most common in women, right?

Most common in acterial infection they get, but should it be in investigated if somebody's having reurrent infections, it should be then you start to think of, okay, why is this happening??

Is a bl emptying problems is there a structural problem, what's going on?

Well.

A and how many I'm singing in you?

Well, I would say if you have more than two year, I'd be I'd be asking , but it being hurts, okay?

Um, and, you know, oftentimes it's kind of practice to make sure that a while after anyiotics, the person is, um the person has a repeat, uh theme caption inry urine done to make sure that everything's good.

And sometimes what happens is with antibiotic therapy, then you end up with something else moving in that it's nons susceptible. And that would make it ated that well.?

Um, so that's kind of a good practice.

Um, not all physicians are gonna order it to be young or repeat, um with your test, you know, a while after me any object through but.

It's it's a pretty good practice, okay?

Um, so you your char infections.

So when we look at the ideiology and the topic physiology of this one slide is gonna be very long, okay?

Want to say on this one slide, because, you know, it's not fill down and there's a lot here, okay?

So the ideology and p half of physiology, um so normalization of the bladder prevents um you know,oleriaryracts infections, right?

Think about that.

Normal empty in the blood. Okay?

Yeah,itter battle bladders are full.

Should we peep?

Yes, we should pee when our bladders are full.

When you have figure too, little boy, okay?

Um you know, um and we should do that to prevent your consum their two laws, okay?

Um, normally, that's a you know, urine hysteal.s, in a sterile environment, right?

But if things and and just the movement of urine keeps things going in one direction, right?

So if you, you know, you are hydrating well, you're enting your bladder on a regular basis , you know, if there's anything sitting in that you, shouldn't you be flushing that out?

You should be flushing it out, right?

Okay?

So usually that keeps are, you know, uh infections out of our ordinary tract. You know?

So that the blood is con in its contents are free from bacteria in most healthy people, okay?

There's no bacteria in there.

Um, now, some people have colonizing bacteria in their bladder, and it's just it's called asymptomatic, uh uh bacteriria.

And once they're diagnosed with the fast, okay, it doesn't justify treatment. Because those people, okay, that don't have symptoms from it, they just colonize bacteria. And it, you know, it doesn't reach levels that kind of need treatment.

If you treat that, what's gonna happen is they're going to end up with a different bacteria.

You kill up one yet, and it's just a vicious circle.

Does that make sense to everybody?

OK. So, I game, second most common bacterial disease, most common bacterial, infection in women. In some cases, patients develop negative, bacterial infections. Can die from them.

Okay, so, you know, we don't think of it usually as being um very serious, but they can't uh eat coli, though, is the most common confagen funal and parasitic infections, can cause UTI as well, um but they are certainly not common like bacterial infections are, um but and for people to have, you know, um uh, especially for fungal infections, you know, uh they would be, you know, at people that are increased risk for, you know suppression, have diabetes, um, you know, multiple courses of the antibiotics, um, and, you know, for those curs ones is usually travel to different countries. You know?

Okay, here eight, if you swim in certain places and tropical areas, you can actually get a penis fish.

Have you ever heard of that? . I didn't think it was I didn't think it was actually a thing that was.

Okay.

So, um now, will we look at some clinical manifestations, okay?

Do you look at the symptoms?

I'm gonna describe the symptoms related to bladder storage or bladder empty. Okay?

So, for um and I please there's a text table in your textbook as well, if you don't want to take all these notes with us.

But for letter storage, okay?

Um, you get urinary frequency, okay?

And normally frequent, okay, so like less than every two hours have to eat, okay?

That's not normal, okay?

Um you know, unless you're in a bar, you can a lot of beer, right?

Yes, is that just those, yeah. Um, urgency, okay, and when we're looking at urgency, that's the you know, send strong desire to avoid immediately.

I have to go in and have to go right now.

Usually, did we have some warning?

We have to be.

We have a warning, right?

In continents, okay, um related toad the platter storage, of course, the loss of or leakage of urine, uh, docteria, we in you know, uh greater or equal to, you know, two times, uh night toid , um, not consider normal, that can be a problem with storage, right?

Of urine.

Um, you know, and that's with the absence of, you know, if somebody had a lot of fluids at that time, that could cause that, but, you know, normally, that doesn't happen , right?

Um, no, nocturnal your an ais, okay?

Um, so that's, you know, lots of urine during sleep, inway, right?

Is what we call it urances.

Now, can that be normal and little people? , okay?

And just when I say little people, you know, sometimes nine year old, ten year olds, than a piece is.

It happens, okay?

Um, when it's an isolated thing, it's usual that it related to being very tired. If you think about it, if you look at a kid that he's the bad, it's usually because they're very tired, um they country too much to drink and they just not in the bathroom at time.

You know, sometimes kids need to be reminded to keep people look at, okay?

And oftentimes, you know, when people will pee toand their kids will pee the bad, you know, they'll be dreaming about going to the out.

They think they're in the bouncer, right?

Okay.

Now, clinical manifestations are related withatter empty, okay? , so a weak stream, okay?

Um hesidency, difficulty sturging New Year stream. Uh intermittency.

So, you know, normally when you start to keep the flow should be, you know, it just starts until it stops.

You don't have breaks in between.

So, intrumittency is, you know, the interruption, um of that currentstream while you void. Okay?

Um post vo journals, um, you know, you're in lock after completion of weight, okay?

So it bladder hasn't been fully empty.

You thought it was, it's okay.

Um, you're very retention.

Um, inability to empty your from the ladder.

Um, and, you know, if you have somebody with your earention where they can't be the water can only hold so much, and , uhna excruciating and painful that yeah.

And can the person's bladder rupture?

Yeah, doesn't happen very often that that can actually happen, okay?

So you have somebody with duringary nutrition. , you know, we used to have to to be able to see, you know, you do in a filmlessness and you got to standard louderder.

So, you suspect somebody, you know, you know, actually, somebody is retaining your.

It's not such you're produced not producing the urine.

It's there.

They just can't pee it out, okay?

So what, you know, when you you and's assessment and you've got a distended ladder, then you're gonna put a capt through, okay?

Um, now, for are some people's hard to do a nomal assessments for theens?

Yeah, because in the size of their actctions, so it's very hard to alate a fullatter on those people, right?

Um, and, you know, people that are on pain medications, they might go and have a lot of either.

You know, so those things can be hard.

So we'll be used to have to do is say, you know, the first thing has a white in thatem of hours.

You're not sure, because you can't we helping the bladder.

If it's yourary um retention or the lap of producing you, right?

So, what we would always have to do is do a in and out calorization to see, okay?

So you're you know, just a straight one, it's not one that we're deeping in there, okay?

You see how much you' was in the the letter, but now, you have to do that to see how much earn water, what can you do?

You do a bladder scan, right?

Okay.

I was very excited when we got the bladder scanner, okay?

And the when we had first got the platter scanner, it was always because we had a urologists coming, it was the OR piece of equipment, right?

So, we used to have to sneak down to the ORs and steal the bladder scanners, so yes, do you want to be putting a customer?

Some people you don't have to?

You don't want to be doing none, right?

The more times somebody can be calorized, the more you can risk, actually need well is more at risk an in and out.

But anyway, you get the idea, okay?

So you can see if that's hereary preension.

So that, of course, is a bladder emptying issue.

Um, can be related to drugs the things as well, and the bladder case of emptying because of that.

Um, this?

Um is a a difficulty of avoiding um, so, you know, that can cause trouble emptying that platter, and then um, you know, you can have pain on urination as well, okay?

Something has lot of pain on urination, can they be has been too train hold it?

Yeah, yeah.

Okay, um, so, um, when we talk about um clinical manifestations of, you know, a upper, um, VTI oftentimes we' looking at client pain, gain, everybody understands what I mean by a flight, okay?

It's kind of like, just put your handwrit area.

That's your flank.

Um, so chills, uh and fever. Um is the indication of ain that upperap, like Kylenagus.

In older adults, um symptoms are often absent.

There are variety of reasons. We talked about the speech more older people, they may be on medications, they just don't present as textbook, right?

And that's a problem, okay, whether they have a cyitis or , they have a upper, um, that's problematic, okay?

Um, they experience non localized and normal discomfort, rabbing industria, um, they cannot cogn into impairment as well, so they can't communicate , and they are less likely to have a fever in an upper, okay?

So the other thing is, older adults with a catig are most at risk for UTI.

At most at risks.

So you've got an older adult and you've got a caty in, okay?

Um, should concutors ever urinary caliors ever be used for the treatment of incontents?

No, okay?

If somebody' MT or plot, but they are in contents.

That's okay. Directing their plot, it's not a problem, okay?

Um, they're much likely less likely to get a UTI, um that, you know, you don't see syoms in and end up with a your census, right?

Um, if they have a transfer.

So catheters should not be used for patients that are in continent, okay?

The only time that you sometimes see that is if you have like a big ultra on the cox six figure or, you know, bigger trying to keep dry.

Sometimes, um, you know, that's not healing, because it's all of the moisture and so sometimes we'll put a cat here in then , but you really have to, you know, it's, you know, risk versus meth in that case, okay?

Um cut your care twice a day, minimum, um, you know, because we do it pure in as well, so if some of these incontinent of stool, you're going to clean them up regularly, right?

Um, because that canap as a yes, right?

Now you have an enlarged pathway into that urine system, and that can act like a wick.

So here, Perry along with you know, seeing of that off, you know, was a mild soap um, you know, can prevent the incident of eachI's the.

So not a really important thing, okay?

Um, diagnostic studies, so it mean we have that frequ table, diagnostic studies, but the most common has the clean were gone over, you know, getlo history, um and uh physical examination first and then about to lead you to your diagnostic studies, dipsticks, you know, you're gonna be able to tell them there's one year and not indicated infection. That indicates kidney stones?

Yeah.

So, you know, an infection sometimes, you get blood mir put it put it indicate a cancer of your blood mirror?

It's usually visible by indicate that as well.

Okay, um, but, you know, when somebody has an infection and you dip it, they can have WEC there as well. Okay?

Um uh, you know, leucocytes um you can identify nitrates in the urine, um you know, if there's a protein in the urine, you can see that so um urine for culture and sensitivity. Um, a clean cl touch uh is uh per first, um we to get it, okay, so that's like yours normal minstream urine, clean, PSX. Stop. That's midstream, okay?

That is preferred, okay?

Is it always, are you always able to get one of those?

From P?

Have do you ever tried to get um a uh thingat from a person that is um incontinent and cognitively impaired?

Sometimes you can't get it, okay?

Um, now for children, you have little bags that we put on. Okay?

Um, for males, yeah, it's pretty easy you put on a quondum calidter, right?

So, you know, you clean it clean the area off, you put it on a cl condom calheter and you canle that your, okay?

It's a, you know, you put a new catter bag and you can can collect that. , but just for um females, it can be tricky, um and but for babies, we have little eggs that we can put on them. Okay?

So they're just little, you know, there sterile things, canal same they' you, they here, okay?

Um, it is with modern, you can collect it that way. Okay?

Um, so, um, please task is preferred, it's referred not to how to use the houses. Um yes, that u for culture sensitivity, but sometimes we have to. And certainly if somebody has a cat in, okay. Um, well, then it's very easy to guess, okay?

Well, would you collect products over the bags?

Would you collect the out of the bag with somebody with the counter?

No. How often are those bag exchang?

Not very often..

Yeah.

So there is a, right?

Sports in the, you . And that's the preferred message.

It' seeing the port extract you and put it into the sterile container, and when patients are doing them on their own this well, you have to instruct them not to touch the task. Okay?

Or the edge, okay?

Um, because you don't want to detaminate that specimen, okay?

That's a that's a wasted lot costs of that.

See you gonna teach how to do this, okay?

Um, so, um imaging studies as well.

Okay, you talked about some and usually, I mean, imaging studies are done if you have reoccurring lower UTIs because, okay, nonus image of imaging now to see if there is some kind of structural problems here.

Or if, you know, it is complicated, or upper or stones, IP I mentioned Donal uh CTs or ultrasounds, uh, Renal loc sounds, uh, to be done for reoccurrent ones as well.

Okay?

So, okay, um next is collaborative care and therapy, okay?

Um, well, um, antibiotist wearyact infections. Are uh selected on empirical therapy, um, or the results of uh sensitivity testing.

So, most of the time is on verical therapy. That we do, and about certain lab infection.

Do you get told to uh when you give thaturnample?

Okay, we're gonna wait for the results in the multion antibiotic. , okay?

Can he be treated now for a urinary traction infection by a pharmacist, a simple and complicated uti?ad infections, can you be treated by a pharmacist, for example?

It's on the list of things you can't guys.

Yeah, you don't have to go to a sit merge for your sort of labection. Guy?

Because they are most common bacterial infection in women, they that's something that preises can commun in, okay?

So, um you know, you just, what is, you know, we have certain antibiotics that treat some that are broad spectrum that treat the most common bacteria. Equali in others, so they are broad spectrum, okay?

Now, that you know, sometimes people wait for the not very often, for the results of the culture and the sensitivities, but there should always be followed up, okay?

So, you know, before the antibiotic is started, the culture and sensitivity is done.

You don't start antibiotic towards it done, because that can skew the results, right?

So then the you' us away, and you have the person is on the wrong antibiotic, it can be on the wrong antibiotic for three days until we have the culture sensitivities back, though you do get a preliminary oftentimes really culture 24 hours, 24 to 40 is a sensitivity to 72.

So that's the time when, you know, the prescriber maybe get the results called in the say you on the money about it.

That really doesn't help that. Compared to therapy where well, okay?

Um, so for your own complicated cyitis, uh, you know, oftentimes it's uhce that people are put on uh short term uh, course can be just one to three days.

We used to put people on it. Um sometimes you would be hurt, put it them on long term therapy. Um for, you know, 14 to 30 days. Um complicated ones can require that long term therapy. Um so you think of uh likeypophloxin as a very common one that's used now.

There are a bunch of others um that you'll learn on the terermatology, but Cypos are really common one. Um and you know, for complicated UIs, they often they do quite a longer terms of treatment.

So you're looking at like seven to 14 days, not sure of term treatment.

Okay?

Prophylactic or uh suppressive andiotics sometimes administered to patients with repeated UTIs, uh, so might feel separate, like I said, um, for a longer term, or they can be on natural term. ? Now, other drug therapy related to your drug system, um, is um um I only talked to you in the break, but um it was just looking Yeah. What time did we start cost today?

22?

Okay.

So this is probably the right time for a breaks, right?

Because we started ten minutes, yeah.

Okay, so, um I'll talk more about drugs, okay?

Um we' we come back.

I'll go over those quick because then we'll move on.

Okay, so, take your grip. Um, you really only sometimes give and pay is not gonnaibiotics it's year or animal Jesus.

What we need to know about the pyridium is it stains, um uh urine, like her rich orange, you want you to help you around that when you some ingredient?

Um, because it could kind of be a orange, and then, um, as anotherug called um, your set, another you yourinary anal. Um, sometimes stains urine word mudits, okay?

Now that was the alarming, eh?

I watched for people too, because I just wanted to see them blue green of the u, but never saw it, okay?

Pyridium on see a lot, though.

Okay. Um.

So, yeah, um, assessments, we've gone over history.

Oh, yeah, for assessments of people. Now on, um the table there below, um, of uh management, uh, or this like below, and there's a good table rather, um of nursing assessment on stage, although 43 if you don't want to take some , but basically you want to look at the person's history and like how they had UTIs.

You want to ask about STIs as well, right?

Pregnancy, uh issues with retention, are they on men, how they didn't comphorized, um, he wanted look at things like hygiene. Um, you know, do they have fever?

Um and, you know, is there problems with other systems as well?

Um Paying the location of the pain, um is a u foulel smelling, um, you know, is there blood and it?

Did you find that out with a a dipstick?

So, you know, those kinds of things around , um, uh the assessment of it, okay?

Urome diagnosis is oftentimes in outiturnary elimination. Um, uh, you know, for various of the duringary retact infections, that can be a problem.

Um implementations, okay?

You want to use the teaching about decreasing the risks, like white crown to back, increase your fluid intakes, unless somebody's on a flu restriction, you don't tend to drinking off water. Avoid caffeine, alcohol, uh system and spicy.

They are all consideredatter irritants, and they will make syms worse.

So when somebody has a UTI, you know, when you have the space and you bet they irritation going on, do you want to irritate a lot more?

No, you don't, right?

So, do you know, caffeine alcohol, citrus, and a spicy tinny, are considered blood or irritants, um you want also instruct people to void after intercourse. And cranberry juice.

Why do the instruct like with real cranberry juice?

Yeah, okay?

So, uh, cranberry juice can be helpful, okay?

Um, but you've got you have to with any juices when you're you know, when um and kids shouldn't be drinking juices, and when they do your juices, they always be diluted because the sugar content is far too high, and you don't want them to getting calories from sugar, right?

Just sugar, not a lot of nutritional value?

But then they do drinkes, they all should be diluted. Right?

And you should never have them drinking it before bed because that can sit withoutushing your teeth, it can sit on your teeth, and it problems ental problems.

So, you know, but when you do look at any kind of a juice, okay?

It should say juice on it.

You don't want something that says, cranberryries cocktail or cranberry drink.

You want to see that it's 100% like a her juice, okay?

Some of those things have absolutely they are flavored like a fruit, but they have absolutely nothing to do with the fruit.

Makes sense, okay?

So you're not getting you know, fruits are are are good for us, right?

So, fr fruit usices can be good, you know, but um, you know, not good if they're just a drink. So, you know, I read my juice boxes dice. Because I still drink juice box.

A lot of juice box.

Yeah, yeah, I love.

Okay. Um planning has to be around um uh things like, uh pain control, um, you know, or discomfort from the infection.

And you want that person to have no complications, okay?

Uh health promotion, I've kind of already gone over that for teaching those risk factors. Also, you know, early treatment.

You don't want something to that blad infection to go and not have it seen to, and then they end up with a upper, okay?

Things get more serious, uh, uncomplicated can become complicated.

Okay?

Okay, so now, um I a lot ofphritis.

Okay, uh so acute pylenophritis.

Okay. Um, so ideiology andath of physiology. Um, if, you know, um if bactrinia is the possibility, uh, you want uh close observation and monitoring. Um and vital signs are essential to nuts. Um uh proper recognition and treatment of subject shock as well. You know, um nate prevent the uh irversible damage or death. Um hostilization for patients with severe infections and complications, um like nausea, vomiting, with dehydration . Science and symptoms with theupolinphthritis, uh, typically start to improve, uh, 48 hours to 72 hours after this year approved.

She has started, which, of course, includes um any thought, incense, uh, for fever and for pain, urinearyanalics, and really important for follow up, um, as well with uhering cultures, okay?

Um So I you know, this piloner Frank usually begins with a colonization, an infection of that lower garirinary tracks, so it gains, right?

You know, if you don't treat it in only, the luinary trap, it can move and become a complicated upper, something that we don't want.

And, you know, then you get, you know, the inflammation of your ringo, parima and the collecting system, um andaining it's mostly caused by bacteria.

It can't be, you know, fungi protozo viruses , infecting kidneys, uh, can be the clause, but it can be extremely, extremely serious, if not treated promptly, okay?

Um, and like I said, it can even be fatal, okay?

Now, for it, for a key pile in aritus, there is usually a preexist doing factor, present for it, um, you know, you can have what's called a um uh Nesso uh girle refflux that happens, soaffward movement of urine from the lower to the upward tract.

Um, you can have dysfunction of the lower urinary tract so you can get obstruction from vph. , structures or urinary stones, okay?

So, when somebody has a kidney stone, cannot cause in a obstructive pilotritis, yeah, um, so, you know, uh and you know, sometimes people get upcastic case, so may not recognize, um that, you know, they may think that they may put the pain off to oh well, you know, I still have who have the pain after you pass the stock, okay?

Kind of dullig enough.

So they could put the pain off to, well, maybe there's another stone there, maybe I'm just knots, okay?

But if you've been obstructed for a while with a kidney stone and you get that fat full ofherent , you sceptible to it.

Okay. Um so, focus from somebody that had kidney stone that ended up with a pyl ofritis and, you know, a py didn't realize it for a bit. Um, you know, uh not great.

Yeah, when we talked about this being something that, you know, can't even lead to death, there is a potential for euros substance, okay?

And yourpsis ends up being as systemic infection from the from a neurological uh source.

And then for the urpsis is that's something that you see elderly people when they see them with dementia.

Yeah, absolutely, okay?

Um and they can end up the seicock.

So, you know, zero ses, yes, and she'sond theritus europsis, septic shock, without cont diagnosis and treatment account, it can result in death, right?

Pretty serious.

Okay.

Oh, okay.

So, um, nursing assessment is pretty much the data for UTI. Um, you know, nursing diagnosis can be around pain, um planning around decreasing the pain, fever, no further complications that I just mentioned, and no kidney compromise, so no renal compromise, okay?

Health promotion is, like I said, it's a very much of o early treatment for lower uh UTI, um acute intventions in home care well, drug compliance and treatments, um and need for fa follow up. Uh and prevention of reourrence, okay?

So some investigations, you know, because of preexisting factor is often present port . Investigations for those preexisting, okay?

Um, you know, what's going on that that's causing this.

Okay?

So for chronic pilot deergus, it's a term used to describe kitty that has become shrunken and lost function owing to spar orphibrosis.

Um, it usually occurs at the upcome of reoccurring infections involving gaperact.

Okay?

So that's all as prom is, so, you know, you don't want an acute to become a chronic, so find out the investigations need to be done.

Why is it happening as there something to do about it?

Okay. Um you reach your tennis is pretty simple, that it'm information of the read.

It's right in the name of it, right?

Uh, causes of common um commonly bacterials can be viral, uh tomolus and uh modial infection, especially in women's.

It can be caused by chlamydia, it can be caused by nonorhea, especially in men.

So similar symptoms to ETI difficult diagnose in women, uh, may be mistaken for that UTI um and treatment is not effective, of course, if that's a funal source. This?

So, you know, somebody goes on an endiotic and their syptoms aren't further investigation might find out that, you know, in fact, it's a punal and it's your research..

So, you know, P after sex and use your cons sense, so you don't get any of those the need and not aheas that're gonna talk about next week.

I 12 pictures of the slides first S. I just wasn't in the mood.

And that they all in the textbook, I just was I was reviewing slides and I was just going, do need to sleep sleep every gross picture.

Did you get it's what I. I I have a very good friend that whenever her son and all his friends were leaving the house, she would yells up, use your content sense.

It wased..

Okay, yeah. Didn't go over so well, but she said it might was all my teenage daughters time. They all mushed and boys laughed, girls blushhed. Um your research results have a priicully. So, the the result of obstruction and subsequent rupture of the period re repliance into the retral movement withelization, so regrowth of tissue is all that means, or the opening of the resulting period cavity, uh, more common in women than in men, because life's not there. Um they care mostly in the area of the carry Eance. Similar science systems really are similar to UTI along with urine area and continents, which is common , um and um hematrya can be present as well, because of it.

Now, interstitial cystagus is chronop painful and climatory disease over the bladder.

It's thought to be autom immune or an allergic response, okay?

Um, like many things we always don't know the exactiology at. Characterized by symptoms of urgency, frequency and pain, um again often misdiagnosed as a lower urine attracted infection. Okay, it is ongoing, okay?

It doesn't go away.

So a person can be treated initially, for a UTI and then it just doesn't get better. Bladder pain syndrome or painful bodger syndrome can occur. Um, but, you know, it's a diagnosis pretty much of a solutions, okay?

Um so look, you could see is, you know, you do the urineus it' negative.

The person has all the symptoms of UTI, you use the CNS, and the culture saysivity, and urine's not culturing any bacteria.

So management of it assessment uh focuses on characteracterization of the pain associated with it, um and with it, one of the telltale things is the pain is relieved by boy.

Okay?

So, if somebody says, you know, I'm a pain, I'm repeat,ang goes away. You know, that's a pretty pretty good clue.

Um, so the data collection uh involves uh includes a bladder log or a white diary to keep over a period of at least three dates due to determine uhural void frequency.

Uh, so that's during the day, head off, nearly going during the day, and patterns of no, so are they going in?

Nice.

Okay, the questions, anybody?

Try out to go too fast?

Oh, do we have of the luxid is in history.

Okay, we are.

Yes.

Okay, um so we know tuberculosis, it's rarely a primary lesion.

It's usually setory to TB of the lungs that has spread. Um now, are we gonna see it as often as a place like North America where we have readily available treatment for TVD or redetection, probably don't.

Okay. But I mean TD is higher than like colon people, so could it not but it could, right?

Um, but you see if more in the countries where they don't have easily easy access to healthcare and any. In a small percentage of patients with pulmonary TV, the tuber the sil reached kidneys through, of course, the bloodstream, you want say it occurs five to eight years after the primary infection and depend on colation processes of treatment, for those and structures to occur.

The longer they go, the worse that's gonna gap, right?

okay? , you, we're gonna talk about you logical disorder so the kid itself. So modular neritis, a huge post destructed coffee, uh longulinarphritis, with pastures, um rapidly progressive, uh colonarphagus chronic, uh, the colomulularagus , and a phronic syndrome.

OK?

Um so when you look at the word long we learn Ephritis, kind of heard say, it's an immune related inflammation of the one realist.

Okay?

Um, so political manifestations of it can be hematuria, uh, protein area, um you can also have uh RBCs, WBCCs and what's called castur, and when we talk about Casire, they're just basically particles, and those particles can be uh, you know, uh parts of, you know, what blood cells, red blood cells, kidney cells, protein, or fat, okay, um, patients, uh with it will have an increased bund and serumriatin , um, a decreased urin aput. Um, they can have a dema related to that decrease formular of filtration rate, because theomular fluattration rate, which is, you know, the big thing that we measure kid function. Um, you know, if kidneys aren't functioning well at TA results, okay?

Um so um that's, uh diagnostic studies, um it can develop five to 21 days after a strip of copal infection, okay?

So things strep throat is most on the line can be related to him but table as well, but it strep throats you more lot more likely you have a systemic. Um so it's another example of why struct throat needs to be treated. Diagnnostgen treated early, right?

Have we sym a lot of things down where you you got to treat struct throat. The importance of treating structural.

Okay.

Yeah, the damaging Perville, kidneys, yeah.

Okay, um so nursing and introf professional management.

I um I for a cute post struct couple, while theyis, uh management focuses on symptomatic relief, rest is recommended until the signs of the formula incation. That protein area, that humanria and the paper tension and can result subside, aem is treated by restricting sodium and intate and in ministering directs as needed, severe hpertension is, of course, reading with number 10 mess otein intake maybe restricted. You still in protein in your you want restrict your dietria?

Good postures is another auto immune disease characterized by st circulating anyodies against uh glumular and aviol basement membrane . Um, the primary target organ is the kidney, but the lungs are also involved. Disease that is mostly seen in young male sulbert. Okay?

And when we talk about the management of it until recently the prognosis was work with development of themudosuppressive airan advanced uh in transplation tech case, uh outlook hasn' scooge. Management consists of purpids, uh ammosuressive medications, like uh cycophosphalite, uh zaproprine, um, also plasmaphrsis and diis.

Okay?

Um, but it's rapidly progressing, uh, quantular interphritis, the glomar diseases associated with a rapid progressive loss of pinumction over days to weeks.

So that's pretty serious.

Renofill your name or within weeks to months, in contrast to chronic, in which it develops insidiously and progresses over many years.

So for chronic, it is a a syndrome that reflects the end stage of vomular impanatory disease.

Most types of the glomular phritis in productic syndrome. Can eventually lead to cross, okay?

Um so neontic system, uh the causes of ne product sy system here is a whole table of pauses on page 1154 4810 it is.

But basically with neronic symptom, what we are just what is being described is a kind of course that can be associated with a number of disease conditions, most often times, though, it's diabetes or lumists.

Okay?

Um, you get an increase in globular uh membrane permability, and it causes a massive excretion of protein in the urine.

So, with that um you get your, you know, a massive excretion of protein in the urine, it decreases serum alumin.

And when you don't have enough serum alumin, you just get aema. Okay?

We need help serumalum to you just get a lot of it, okay?

Um, so you know, what what do you do about it?

Well, you know, dietary restrictions low sodium, uh low protein, um a inhibitors, diuretics through adema, and then if it's very severe ne productox syndrome, a stereids are used, okay?

Um the major intervention for a patient with robot robotic sy is related to not aema. Um it's really important to assess Eema by leading um the patients daily, and when you lay a patient daily, do you want to always do that at the same time?

Yeah, same time of the day, and normally by time is not. First thing in the morning, same time of the day, okay?

And you compare, you know, 24 hours to 24 hours.

There you have weight gained in 24 hours for food, okay?

Um, so, you know, um, you have to accurately report the intake output as well, weight being like a phenomenal um indicator of urinary uh.

So with retention, retention. Solid retention?

Um, but so is intake an output, okay?

So that we know if people are a positive or negative ysis, okay?

Um, so, uh abdominal birthus wealth, um, or extremity size, okay?

And I' told you all how you measure a down longer and extremities um to see if those are getting bigger, okay?

Um, because it give me really generalized toene as the person has. Um, those patients are going to be, of course, susceptible to infection, so measures should be taken to avoid exposure to persons with unknown. , with known infections, not un.

Any infections.

Okay, so now we're gonna move to urinary tract calculi, okay?

Um yeah, oh, we're gonna focus on um we're gonna focus on Kitty Jones, there is such a thing as blad films, but it's an whole different thing and it's not problematic like, so you don't calcul they are. Um so, um there is no single cause for the ordinary type popul. Um uh put lots of uh causes of crystals precipitating to pharmacy, okay?

Um, it can be, you know, due to metabolism under, it can oftentimes be due to that.

I told you guys before with that, they actually do testing to see if people are gonna end up with kidney stuff, because there' genetic element to it.

It's a no.

It's about their legacyhood. Of ending up on it. Ending out but not. Climate can evenplay a role, of course, lifestyle diets, occupations.

Those are things that can all influence, you did a lot of theAyles.

Okay?

There is a good table with risk factor up for them on page 11 56. Um table uh 41. Okay?

I could not figure out why I had kidney stones, because um nobody in my family had kidney stones, right?

Um, and I thought, well, this is kind of odd.

And then all four of my daughters ended up having episodes of kidney stones throughout the years . So this seemed odd to me until my dad had a cat scan of his abdomen.

There's something else.

And I'm, you know, I'm reading his CAT scan results and he's got like he's full of kidney stones.

It's just full of kidney stones, right?

And my dad had never been treated without those of the kidney stones.

But everyone so long they has that with glo.

You say, oh, yeah, I gotta so back. Right?

He'd say, no, I must have done something. And he' walk funny and, you know, yeah, I'm not, so.

And, you know, you'd find dad laying after the dining room table.

It feeds sticking out, because he it sometimes help for him to lie on the floor fly.

I don't know what, but, you know, oh, your backset again ten, never lasted that long.

Christ.

Yes, I guess you never paid attention to see if any stones were but yeah, he never got and I thought, oh, okay.

So you from him.

That' got in front.

Yeah, you always just like nothing, never guys else with the kidneys songs.

And the amounts of stones that he had in his kidneys yeah. He passed the lot of him every time . Every time he's back widow, that's what was going on..

Yeah, so, uh types, okay?

Most oftimes, um can you tell you were casting, okay?

Um, but it's very common to send those away to see you know, we strain here for kidneys don't, okay, and we took them in a jar, we send them away for analysis to see what you're made. Because you should know what kind of kidney somebody is passing.

Um, yeah, you know, um I wouldn't bother anymore.

I know might or calcium, so, you know, I'm taking this again.

The first three word, I bet you the restaurant it's a calcium thing, right?

Okay, and those are the most common.

So, calcium uh oater calcium phospate are the most common, you can also have and there's a table here as well with the types on page 11:57 table 482. You don't have to write this all down. But they can be strew type, they can be your casset, they can be cystine, okay?

It's just about what your compositions, but but when you look at a nutritional therapy, there's a table for that as well in your textbook that, you know, for different types of stones different nutritional therapy. Clinical manifestations of urinaryact calculate, at they just st state what, you're really not problematic. Okay?

It's when they start moving, and they extruct.

So if the clinical manishations are due to the obstruction of urinary flow and the actual movement of that stone, okay?

Um from that kidney, um to that blood, okay?

Um, so, you know, um and, you know, in the ends, like people are still keen because the other kid, like, chances of you having sell to vote years and both kidneys and both yourors at the same time.

Well, you know, um that would be quite different sense, right?

So the person is still able to pee, but they're obstructing from the white kid , okay?

So that's why, if that obstruction goes on too long, you can end up with a hyd neosis, pylenophritis happy, okay?

Now, um, people will say they sometimes have aominal pain oftentimes like pain, or I've heard people say, um, and this is a good description.

I've got pain in mylly right into my back, okay?

Um, you know, it's hard to pointenance that location, okay?

Because it seems like it's in a big location, like a bigger location.

You can't just say it's in this one tiny area.

It's kind of, you know. Um but that pain is often very severe, uh Renalulk is not fun. Patients will have also have as clinical manifestations, heematuria, um the pain can be so severe that it can cause nausea.

So the nausea bombing is coming from the pain being so f and unlike people will break up and like be very pale looking suddenly because of the few pain and they'll break up in like a they'll be planning, okay?

They'll just like preote to kind of, you know, you say home sweat, but that's, you know, people sweating and get planted.

I cannostic studies. Um you check, you know, you just check your for blood, is one of the first you to do, okay?

You're for culture and sensitivities are very common because of complication compete. Um a infection from them, or just to rule out, um an IDP, um, which I've already explained an intervenous pogram.

It shows that obstruction, it's a diet, okay?

So it'serted intravenously and then as it goes through your system, it's going to show you um uh any obstruction in the kidneys, as it leads your body, right?

The guy is gonna leave your body. Uh so um retrograde uh pyogram can be done as well. Ultrasound CT uh soscopy.

Okay.

Now, thisoscopy is invas up, right?

Okay, so usually you go with the other tests before you go with thisoscop..

Okay. Oh, um, now, um until um neurological procedures, um, so it can be a umyosopy if it is called we call it a cystoscopy, if it's the latter. Um uh you know, bladder to the your, okay?

Um when it's a cyoscopy with a stone crusher, okay?

We call that a cysto little uh tripssy, okay?

When we when it's a cyoscopy with um a ultrasound waves as well, um, we let's a cyo legatracy.icitris is, you know, you can do it with an effr scope, through a small incision in the flank, but that'sination up, right?

Okay?

I can be problematic.

So, more often it's than not, it's done, it's called extra corpus inside the bite. Um it's none of it's the most common, and it just used shockave sound waves, you know, and or , um to break up those stones.

Okay?

So, you know, you've got a kidney, that's got stones in them. Those stones are too large to cost.

You make them smaller so that they're possible, and they don't cause future obstructions.

So, and IP will tell you that. Okay?

Uh, CT will tell you that as well, but uh an IVP, you know, person passes in stone and they have more to come, let's break them up. So that they're easier to pass, and they don't cause that destruction, okay?

You know, like if you have you know, the pencil eraser. A racar at the end of the pencil, if you cut that that can have down the middle and said that was, you know, the size of your kidney stone, that would be a huge kidney stock. Okay?

It like it just speaks to the diameter, okay?

You know, sometimes people will look at them and, well, well, that's, you, when you're stringing to your ear, well, that's if you're being, well, yeah, it was.

It you know, it's it's for the area how to travel through, that's pretty big, okay? , you know, surgical period we doesn't happen very often and last, uh, you know, the uh Tripssy fails or and that usually needs people that are obese, okay?

Um, nutritional therapy again, there is a table of that, um uh for the different types of stones, what, for helps teaching are people, but basically when people are obstructed, um, you, you know, uh fluids to two prevent dehydration, but you do not push fluids, okay?

You don't want to overdeal with the fluids. Um, because that can lead to a hydrogenoposis. You know, for calcium, this school is thought used to be dec decrease the calcium in the diets. Um and really, um calcium is still needed, right?

So, like it first verse benefit, right?

So I get kidneys stones, but I' wanna fracture my head.

Right?

Okay?

So, you know, , yeah, I'll pass some kidneys to around doing the fracture way yeah.

Right?

So, you know, the thing is, I'm not gonna decrease my calcium take because I have calcium stones, I'm gonna drink more water, to try and flush the pot to prevent them California, right?

Um, so, uh that's the helps teaching.

We do a real now, okay?

Um when you have, you know, other, you know, when people have your passid crystals, you you know, one of the things is no more you meat. . Um I don't eat living anyway, so I wish mine were not trust.

I wish mine were thousand.

I'm not eating anything as hard.

I ever else. So nursing management, we have a good table as well. Table 48 14. Um but um nursing assessment includes paint assessments, a general gentry urinary assessment, checking and gain for blood New urine.

Ning diagnosis or can be around she's paint and that is the priorities.versing diagnosis because it's so painful. Bigger the stones that more painful it is, but it doesn't take a big stone to be very painful.

You want to you know, the planning has to be around pain relief and, you know, not have to complications occurring and implementation used stre and measure all your.

Okay?

You want to know the patients's output, um and you want to know that you caught that stone.

So did you guys see it yours stranger?

It's it's just a like you're disposable round, but there's just a little plastic strainer.

So what you do is you put you know, the plastic hat for collecting your, you always put one in the toilet to patients, and then you know how this you have the little place where you can pour it out of the hat, you pour that through the string and there, okay?

Sometimes, you know, you can put the you and you take the stringer fit in the hat, but you might not touch the, so you strain all the urine, okay?

And it's like the stringer is not like you're collar for spaghetti.

It's trying to get granules.

So it's like his oh, it's like a fine screening on.

Okay?

Like event yeah, like have fine sh it's a hard m match, but it's yeah, it's like really tiny little that just allows liquid and not you'll allow any brandized.

Because sometimes you you're gonna get like little like almost looks like sand, okay?

Um a little bit bigger than sand, but you're, you know, from the, so you wanna be able to s to see that, okay?

And you monitor that so you know if the patient is passing after. Patients can still have some pain out because, you know, you've just done some, you know, you've you've had some irritation about your you're need some stretching and some trying kind of you like, so you can have some pain after a while.

Okay, so to keep on track it is great time now I'm going to have And the grudge.

Yes.. .

Um, so, uh management of it, um treatment can include searchable therapy, readingition and chemotherapy and intraical therapy, which is chemotherapy thatits andilled directly into the water using a u cat. When you're doing that, that is done in the twoartment um, and there are spec of process are that, okay?

So, you know, patient was in the chemotherapy,irm it's 19 had started in in this type of chemotherapy because you become the ability when it's a bladder cancer that took put it right in the pl writings?

It's almost like it's it's more direct.

Like it's localized to So, for certain types of ladder that are limited in the bladder, that can be done.

So it's instilled that's left into a certain amount of time and then the bladder isained. But then, there are precautions like double flushing that it, okay?

That those patients, okay?

And because you're putting, you know, there's cautions for the person that putting those drugs into the out there just like there is for I um, but, you know, when you think about ID medications or all like a closed system, right?

There's there's opportunities for search in the platter 1, so you have to be very careful, okay?

Um sometimes um people uh for surgical therapy can have a um suspectomy surgery uh, as well. Um you know, uh and a personalial, uh susceptive part letter removed, so, um, you know, an important postoff care that's given to people what's not, um, is that you want to promote, um muscle relaxation to induce weight, cause void can be problematic after.

So, you know, yeah, 15 minutesit mass a few times a day can really help with that, okay?

Um, I even put people in the top and they haven't been able to noise and, you know, um to promote voice.

Um, uh, what's next?

Okay, we did that, we did not.

Okay, uary, uh, inantin uh, retention, two opposite things, right?

Um, so in Constance it is an uncontrolled lawuit hurt.

It uh caused may be transient, or the wires.

Uh acquired disorders include stress, so stress and continents, okay, so you cough, you sneeze, you laugh.

That's considered stress, okay?

Um urge, um overflow, reflex or functional continents, um and it continents after tremor or surgery.

Um, retention is the ability to empty the bladder and there are different types of urinary uh retention. Uh, for urinary continents, um, interventions can be lifestyle modifications . So, you know, um you don't wanna tell somebody to decrease their fluid intake if the restaurant fluid restriction, uh, but avoiding iritance can be helpful by hurting mention those things. Not it being be one alcohol, right?

Um, scheduling, voiding regimes, um in the healthful as well, and you do that in bladder, retain fil..

Um, the public floor, muscle, rehabilitation, that's just a fancy word for Beatles. Okay?

Um, anti uh condense devices. Okay?

Will they make things?

Um can't really caught on though they werearked against, and I think they're even at the um the sanitary product voice. Voice, yeah. , I'm not sure quite how they work.

Um, and then containment devices, okay?

So, some things you contain you, well, you know, let's that is. Continue, right?

You're not so like did, but then I have a less.

I's him.

Okay?

Um, so, uh, your retention, acute during of your retention is the medical emergency in required to condition. Andadder.?

So the nurse should insert a catheter as prescribed, unless otherwiserupted.

Well, normally we need a order for urinary cathorization, okay?

Um, but you want to get that order and get that, you as soon as possible.

So, the next slides up, that slide in it just shows different types of uary counter.

The first three are your considered a one way counters or your for straight train, okay?

You know, they's just, you know, um two big competitters, um, you can instill things as well.

Okay, so you have a two a copy, okay?

Um, you know, there's a place to instill things, there's a place to look up the bank, um, you'll notice the ends of them or different, okay?

Um, if you look at the one fourE, that's often one to use. Um, for nails to get around their prostate, so they test.

I forget what it's called, there's a certain import, but, yes. Um, so yeah, those are um you know, just examples of captures.

Two ways, one ways is two base and then three ways so that you can put up. Um, aad irrigation to that.

So you can instill something as well as means something.

Um, the used to use um for people with copiters used to use a neosore lab irations all the time.

And I studies came up that it wasn't that effective.

The ideal was to keep um for people with long term calors was to keep that uh and from getting all these attractive vections, it was found not to be that infected, so we don't you don't see that.

Okay, that's when you used to see the yellow back. Used to have to nix up those bags and run out, um blady irrigation.

Now, most of the time, so when you're seeing bladder irrigation, it's your relationship to churps, okay?

And that's a whole difference thing, okay?

Um, so, yeah. Uh,adder scanners, we've already talked about um so that's the different types of uh instrumumentation.

Um, as well, um, and we have some uh we have some in both labs. Um Sometimes people, for example, people that are paraplegics, and you not, uh, you know, they do not want to have an indwelling cast here, one that stays in there, they can be doing instrument and caterization. To, um uh train their bladders.

There are people with issues been emptying their bladders, and they will do selfaporization.

Have you ever heard of anybody doing that selfathzation?

Okay. Um so for um for females sit are doing selfathzation, it like male um like empty the bladder on a regular basis, um it is just a very because the research so short, it's just a very short little capter and it's very stiff, okay?

And it's kind of sand.

And it's the person just, you know, goes into the bathroom things himself off and corizes himself to empty their blood, and that's how they do it..

And um there is and you think, well, infection, all those corizations. And yes, the more you talk varies, the more chaps to introduce infection, if you learn a good technique, it's actually safer in an ineller cat . Okay?

Um, so people will do that, because they don't want a calor bay. For many reasons, you know, for a leg of urine, right?

Okay, uh, Reno and neal surgery, um preopative management depends on the surgery, like is the person having their frosted domain changes put in, um, are they having this skin put in?

So, you know, pre management is evoked, uh, what type of anesthetics they're having as well. Um, you know, with his people who are generally. You know, not right out. Um poster operative management, it's doesn't matter what kind of uh, you or your history, it's a big focus focus on um, urinary outputs, do you can expect to have?ometer? Do you remember who yourometer is?

So it's that little hard, plastic thing that's outside the past day. Outputs, uh respiratory status and course, depending on the tech medicineitic that they've had and checking for aomalension, okay?

Laotted in the direct to is laproscop ically. Um removing a kidney, um like don't know much about that that's fairly new.

Um, and then youary diversions, okay?

So sometimes when you have two bypops in the area, just like think about Bructions and losing valel, okay?

There's something that's costing an obstruction and now we have to have a temporary ostice. Um, because of that, okay?

Um, or a permit one.

So, uh you near diversions, um sometimes have to be done.

So there is an incontinent incontent urinary diversion. There is a content, uh urinary uh diversion that's done, which is like it sounds. Um it's like, um you would uh much like, you know, intermittentathorization.

Um, and and uh there is an orthotopic uhadder substitution. Um, that is can be done as well.

And in your textbook, and there is, oh yeah, there's a bunch of different kinds of urinary diversions.

So it shows to your frosty tubes that I talked about. Okay?

Um, and that person in that picture in that last picture of your Mariivers has bilateral across to me too.

And you see um, you know, you don't wanna be like sn much behind a short in a collection and you lean back where you sat down, you could be sitting on it.

So, you you, those are they're showing them on the vaccine link, but more often than not, they're around the sides of the lakes. So that people are not sitting on those clut bags, okay?

So it just shows that at the back, but really they're off to the sides , okay?

But they you know, they have enough to be nuts, say a person wanted to lay on their side, you can slide that over, okay?

just , when you're sitting or l on your back, but if you want to lay on your side, you can, you know, get in the above of the way. You just have to be weird has in those shoes, that you don't want them live with.

Or on the chewing, right?

You don't want them, you know, um grab them downut, so they, you know, you take off to the side, um that tube is fairly hard to collapse, that you't have to have put weight on the closes, but that shows the different types of them, okay?

Okay.

Now, um, we'll do a little bit, we'll get started with a key um a hugeitty disease. And uh chic kid.

I don't suspect that we're gonna get that far with it, before we run out the time. Um but I they don't gonna get scared by it, because I want to have enough time to speed to finish first we have more hours in the stadi.

Okay, so a cute kidding entry versus a chronic kidney disease.

Okay. Um so you can have an acute kidney injury that leads to front kidney disease, okay?

Um, and how we talk about them is we talk about them, um for Qini injuries?

Are they be something that's happened before the kidney so that's preranal?

Is it something happening in the kidney?

So that's intrannal?

It' is it something after the kidney?

Okay?

Poststal, okay?

So when you think about things that are after the kidney, you think about, you know, obviously the the murers of the lot, things like that, okay?

That can't cost.

Um, so in your textbook as well, for a huge kidney injury. Um you, you know, you look at that, um, and, you know, it's on that pyramid, and the things that are looked at, um, at the top are, you know, values forongular uh filtration rate and urinary output criteria that puts a person at risk , and then the values that are actually put the mass injury and then the values where we declare it to be a kidney sal.

Okay, makes sense to everybody?

Okay?

So for um political manifestations, um during that, the uh initiation phase, um, you can have some clinical manifestations, but mostly you see them during that maintenance phase of it so you get changes in, um yourary changes, uh, you can get flu volume access, so with, you know, feeling kidneys, do people get a damatis that ? Yeah, okay?

Um, then about the castogosis, sodium uh balances affected, potassium excesses can occur.

When we think about people in renal failure, we always, always are careful about their diets or potassium, okay?

Becauseassium is one of those things why, if it's too low, it's too high, you can have cardext ris yes, and if it gets high enough, you can have a cardiac arrest, right?

Okay?

Those just rhythias can lead to it's used tociium for these all injection, right?

So potassium excess still really important to monitor catassium, and then to have a dietitian segose patients.

Now, for, you know, we're usually managing that it constinate Q kidney injury. That doesn't progress, but for people with realal failure, uh, chronic kidney disease, renal failure, it is really important that a dietitian sees them. And those referrals go up, um, because sometimes people think, oh, perassium bananas, right?

But tables are super high pas here, okay?

So you have got to know what foods that you have have to avoid, okay?

Um heatological disorders, calcium deficit and phosphate access, uh waste product, of course, in humiliulation because of the kidneys role in getting rid of place, um and then uh neuralological disorders. ? Um, the clinical manifestation basically, when you look at the recovery ph page is that everything should be improving. Um, if the patient is actually recovering, if not, it can if you know, um if there is enough damage sustained, um, then it can end up that there are chronic uh they have chronic kidney disease.

Okay?

Um, so, um I think that's where're all we off today, just explain the differences between the two and what pick it up next week.

Because there's no place where I'm trying to end off here, okay?

So next week, so I'll let you go now. Because my audience is looking very tired, and this is not testing, everybody looks very tired. .. Yes.

Okay, so I will post that uh quiz at some point today on the above. Weekend, everybody?

Abortion

 Loss or termination of pregnancy before viability

 Spontaneous abortion

➢ Natural loss before 20 weeks’ gestation

 Induced abortion

➢ Intentional or elective termination of pregnancy

➢ Techniques (depend on gestational age, patient’s

condition and preference)

• Menstrual evacuation, suction curettage, dilation and

evacuation (D & E), medication therapy

56-2Chapter 57

Nursing Management:

Male Reproductive ConditionsConditions of the Prostate Gland

 Benign prostatic hyperplasia

 Prostate cancer

 Prostatitis

57-4Benign Prostatic Hyperplasia (BPH)

 Enlargement of prostate gland resulting from an

increase in number of epithelial cells and

stromal tissue

 Most common urological condition in males

57-5Benign Prostatic Hyperplasia (Cont.)

 About 50% of all men in their lifetime will

develop BPH.

 BPH with lower urinary tract symptoms does not

lead to an increased risk of prostate cancer.

57-6Benign Prostatic Hyperplasia (Cont.)

 Etiology and pathophysiology

➢ Not completely understood

➢ Thought to result from endocrine changes from aging

process

➢ Possible causes

• Excessive accumulation of dihydroxytestosterone

• Stimulation by estrogen

➢ Typically develops in inner part of prostate, called the

transition zone

57-7Benign Prostatic Hyperplasia (Cont.)

57-8Benign Prostatic Hyperplasia (Cont.)

 Clinical manifestations

➢ Symptoms usually gradual in onset

➢ Early symptoms usually minimal because bladder can

compensate

➢ Worsen as obstruction increases

➢ Symptoms categorized into two groups

1. Obstructive symptoms

2. Irritative symptoms

57-9Benign Prostatic Hyperplasia (Cont.)

 Clinical manifestations (cont.)

➢ Obstructive symptoms

• Symptoms due to urinary retention; include decrease in the

calibre and force of the urinary stream, difficulty in initiating

voiding, intermittency (stopping and starting stream several

times while voiding), and dribbling at end of urination

➢ Irritative symptoms

• Symptoms associated with inflammation or infection; include

urinary frequency, urgency, dysuria, bladder pain, nocturia,

and incontinence

57-10Benign Prostatic Hyperplasia (Cont.)

 Complications

➢ Related to urinary obstruction

➢ Acute urinary retention: Common complication and

may be indication for surgical intervention

➢ Urinary tract infection (UTI), and sepsis

➢ Incomplete bladder emptying with residual urine

provides medium for bacterial growth

57-11Benign Prostatic Hyperplasia (Cont.)

 Complications (Cont.)

➢ Calculi may develop in the bladder because of

alkalinization of residual urine.

➢ Renal failure: Caused by hydronephrosis

➢ Pyelonephritis

➢ Bladder damage

57-12Benign Prostatic Hyperplasia (Cont.)

 Diagnostic studies

➢ History and physical examination

➢ Digital rectal examination (DRE)

➢ Urinalysis with culture

➢ Prostate-specific antigen (PSA) level

➢ Serum creatinine

57-13Benign Prostatic Hyperplasia (Cont.)

 Diagnostic studies (Cont.)

➢ Transrectal ultrasonography (TRUS) scan

➢ Uroflowmetry

➢ Cystoscopy

57-14Benign Prostatic Hyperplasia (Cont.)

 Interprofessional care

➢ Goals

• Restore bladder drainage

• Relieve symptoms

• Prevent and treat complications

➢ Active surveillance—“Watchful waiting”

➢ Dietary changes

➢ Timed voiding schedule

57-15Benign Prostatic Hyperplasia (Cont.)

 Interprofessional care (Cont.)

➢ Medication therapy: Offers symptomatic relief of BPH

• 5α-reductase inhibitors

• α-adrenergic receptor blockers

• Erectogenic medications

• Herbal therapy

 Saw palmetto, African plum bark, and stinging nettle appeal to

some patients; however, there is no research to support their

use.

57-16Benign Prostatic Hyperplasia (Cont.)

 Interprofessional care (Cont.)

➢ Minimally invasive therapy

• Transurethral microwave thermotherapy (TUMT)

• Transurethral needle ablation (TUNA)

• Laser prostatectomy

• Intraprostatic urethral stents

➢ Invasive therapy

• Transurethral resection of the prostate (TURP)

• Transurethral incision of the prostate (TUIP)

• Prostatectomy

57-17Benign Prostatic Hyperplasia (Cont.)

57-18Nursing Management:

Benign Prostatic Hyperplasia

Nursing assessment

 Subjective data

➢ Important health information

➢ Medications

➢ Symptoms

 Objective data

➢ Older male

➢ Distended bladder on palpation; firm, elastic

enlargement of prostate

➢ Possible findings

57-19Nursing Management:

Benign Prostatic Hyperplasia (Cont.)

Nursing diagnoses

 Acute pain; potential for infection

Planning

 Overall goals

➢ Restoration of urinary drainage; treatment of UTI;

patient understanding of procedures

 Postoperative goals

➢ No complications; restoration of urinary control;

complete bladder emptying; satisfying sexual

expression

57-20Nursing Management:

Benign Prostatic Hyperplasia (Cont.)

Nursing implementation

 Health promotion

➢ Cause attributed to the aging process

➢ Focus on early detection and treatment

 Acute intervention

➢ Preoperative and postoperative care

 Ambulatory and home care

➢ Discharge teaching

57-21Nursing Management:

Benign Prostatic Hyperplasia (Cont.)

 Evaluation

➢ No complaints of pain

➢ Patient describes follow-up care and activity

restrictions

➢ Patient reports decreased urine leakage between

voidings

57-22Prostate Cancer

 Malignant tumour of prostate

 In 2017 it was estimated that 21 300 new cases of

prostate cancer were diagnosed in Canada that year,

and that 4 100 men would die of it.

 On average, 59 Canadians are diagnosed with prostate

cancer each day and 11 men will die from this disease.

 It is the most common male cancer, excluding skin

cancer.

 >75% of cases occur in men over age 65.

57-23Prostate Cancer (Cont.)

 Etiology and pathophysiology

➢ Androgen-dependent adenocarcinoma

➢ Majority of tumours occur in outer aspect of the gland

➢ Usually slow growing

57-24Prostate Cancer (Cont.)

 Etiology and pathophysiology (Cont.)

➢ Spreads by three routes

• Direct extension

• Through lymph system

• Through bloodstream

57-25Prostate Cancer (Cont.)

 Etiology and pathophysiology (Cont.)

➢ Direct extension involves seminal vesicles, urethral

mucosa, bladder wall, and external sphincter.

➢ Cancer later spreads through the lymphatic system to

the regional lymph nodes.

➢ Veins from the prostate seem to be a mode of spread.

➢ Age, ethnicity, and family history are nonmodifiable

risk factors.

57-26Prostate Cancer (Cont.)

 Clinical manifestations and complications

➢ Usually asymptomatic in early stages

➢ Eventually patient may experience symptoms similar

to BPH

• Dysuria

• Hesitancy

• Dribbling

• Frequency

• Urgency

57-27Prostate Cancer (Cont.)

 Clinical manifestations (Cont.)

➢ Symptoms similar to BPH

• Hematuria

• Nocturia

• Retention

• Interruption of urinary stream

• Inability to urinate

57-28Prostate Cancer (Cont.)

 Clinical manifestations and complications

➢ Pain in lumbosacral area that radiates to hips or legs,

when coupled with urinary symptoms, could indicate

metastasis.

➢ Once the cancer has spread to distant sites, pain

management becomes the major issue.

57-29Prostate Cancer (Cont.)

 Diagnostic studies

➢ Primary screening tool

• DRE (digital rectal examination)

 Abnormal prostate findings: hard, nodular, and asymmetrical

➢ PSA (prostate-specific antigen) blood test no longer

recommended for screening

 Risks outweigh benefits

 Used to monitor success of treatment

➢ Prostate cancer antigen 3 (PCA3)

57-30Prostate Cancer (Cont.)

Diagnostic studies (Cont.)

➢ Elevated levels of prostatic acid phosphatase (PAP)

also indicate prostate cancer.

➢ DRE is not a definitive diagnostic test.

➢ Biopsy of prostate tissue is necessary to confirm the

diagnosis.

• Done using TRUS to allow health care provider to visualize

and pinpoint abnormalities

57-31Prostate Cancer (Cont.)

 Interprofessional care

➢ Whitmore-Jewett and tumour–node–metastasis

(TNM) classification systems used to stage prostate

cancer

• Based on size (volume) and spread

➢ Grading of tumour is done using Gleason scale

57-32Prostate Cancer (Cont.)

 Refer to Table 57.5, Whitmore-Jewett Staging

Classification of Prostate Cancer, in the textbook

57-33Prostate Cancer (Cont.)

 Interprofessional care (Cont.)

➢ Conservative therapy

• Active surveillance when:

 Life expectancy is less than 10 years.

 Presence of significant comorbid disease

 Presence of low-grade, low-stage tumour

➢ Surgical therapy

• Radical prostatectomy

• Nerve-sparing surgical procedure

• Cryosurgery

57-34Prostate Cancer (Cont.)

 Interprofessional care (Cont.)

➢ Radiation therapy

• External beam irradiation

 Most widely used method of radiation for prostate cancer

• Brachytherapy

57-35Prostate Cancer (Cont.)

 Interprofessional care (Cont.)

➢ Medication therapy

• Androgen deprivation therapy

 Androgen synthesis inhibitors

– CYP17 enzyme inhibitor

 Androgen receptor blockers

➢ Orchiectomy

➢ Chemotherapy

➢ Radiotherapy

57-36Nursing Management:

Prostate Cancer

Nursing assessment

 Subjective data

➢ Health history, medications, family history, surgery

➢ Symptoms: Urinary hesitancy; urgency or frequency;

retention with dribbling; low back pain; anorexia;

fatigue; anxiety

 Objective data

➢ Distended bladder; enlarged, fixed prostate;

pathological fractures

➢ Possible findings

57-37Nursing Management:

Prostate Cancer (Cont.)

Nursing diagnoses

 Decisional conflict

 Acute pain

 Inadequate urinary elimination

 Sexual dysfunction

 Anxiety

57-38Nursing Management:

Prostate Cancer (Cont.)

Planning

 Overall goals for patient

➢ Will be active participant in treatment plan

➢ Will have satisfactory pain control

➢ Will follow therapeutic plan

➢ Understand effect of plan on sexual dysfunction

➢ Will find a satisfactory way to manage impact on

bladder or bowel function

57-39Nursing Management:

Prostate Cancer (Cont.)

Nursing implementation

 Health promotion

➢ Encourage having annual check-up and DRE

screenings

 Acute intervention

➢ Preoperative and postoperative care of radical

prostatectomy

➢ Sensitive, caring support for patient and family

➢ Encourage joining a support group, seeking

information

57-40Nursing Management:

Prostate Cancer (Cont.)

Nursing implementation (Cont.)

 Ambulatory and home care

➢ Catheter care for in-dwelling catheters

➢ Incontinence

➢ Palliative and end-of-life care for stage D patients

• Pain management

57-41Nursing Management:

Prostate Cancer (Cont.)

Evaluation

 Actively participate in treatment plan

 Have satisfactory pain control

 Follow therapeutic plan

 Understand the effect of treatment on sexual

function

 Find satisfactory way to manage impact on

bladder or bowel function

57-42Prostatitis

 Broad term that describes a group of acute or

chronic inflammatory conditions affecting the

prostate gland

 Etiology and pathophysiology

➢ Usually results from infection

➢ Four categories

1. Acute bacterial prostatitis

2. Chronic bacterial prostatitis

3. Chronic prostatitis–chronic pelvic pain syndrome

4. Asymptomatic inflammatory prostatitis

57-43Prostatitis (Cont.)

 Clinical manifestations and complications

➢ Acute bacterial prostatitis

• Fever; chills; back pain; perineal pain; acute urinary

symptoms

➢ Chronic bacterial prostatitis and chronic prostatitis–

pelvic pain syndrome

• Similar symptoms but milder

• Obstruction symptoms are uncommon

➢ Clinical features may mimic UTI

57-44Prostatitis (Cont.)

 Diagnostic studies

➢ Urinalysis and urine culture are indicated.

➢ White blood cell count and blood cultures in presence

of fever

➢ PSA test may be done to rule out prostate cancer;

levels may be elevated with prostatic inflammation.

➢ Microscopic evaluation and culture of expressed

prostate secretion

57-45Nursing and Interprofessional

Management: Prostatitis

 Antibiotics

 Pain management

 Treat acute urinary retention

 Prostatic massage

 High fluid intake

Sexually Transmitted

Infections (STIs)

 Infectious diseases most commonly transmitted

through sexual contact

 Can also be transmitted by

➢ Blood

➢ Blood products

➢ Perinatal transmission

➢ Autoinoculation

55-2Sexually Transmitted

Infections (Cont.)

 Can be bacterial, viral, or caused by parasites

 Mucousal membranes are particularly vulnerable

to agents that cause STIs and are usually the

initial site of infection.

55-3Sexually Transmitted

Infections (Cont.)

 Remain a significant public health concern

 Largely preventable and treatable

55-4Sexually Transmitted

Infections (Cont.)

 In Canada, all cases of gonorrhea, syphilis, and

chlamydia must be reported to the

Communicable Disease Division in each

province or territory.

55-5Sexually Transmitted

Infections (Cont.)

 Contributing factors to STI rates

➢ Earlier reproductive maturity

➢ Longer sexual lifespan

➢ Greater sexual freedom

➢ Media emphasis

➢ Inconsistent or incorrect use of barrier methods

during sexual activity

➢ Growth of online dating industry

➢ Increased international travel

➢ Lack of knowledge

55-6Sexually Transmitted

Infections (Cont.)

 Changes in methods of contraception

➢ The condom is the best protection against STIs, but it

is still is not used frequently in the general population.

➢ Often not used by the younger and older age cohorts

55-7Gonorrhea

 Second most frequently occurring STI

 Infection rate continues to increase

➢ 65.4 cases per 100 000 in 2019

➢ Greater relative rate increase was observed in

females

55-8Gonorrhea:

Etiology and Pathophysiology

 Caused by Neisseria gonorrhoeae

➢ Gram-negative diplococcus bacterium

➢ Direct physical contact with infected host

➢ Mucosa with columnar epithelium is susceptible.

• Present in urethra, cervix, rectum, and oropharynx

55-9Gonorrhea: Etiology and

Pathophysiology (Cont.)

 Easily killed by drying, heating, or washing with

antiseptic

 Incubation period: 3–8 days

 Provides no immunity to subsequent reinfection

55-10Gonorrhea: Etiology and

Pathophysiology (Cont.)

 Elicits inflammatory process that can lead to

fibrous tissue and adhesions

➢ Increases risk of ectopic pregnancy

55-11Gonorrhea:

Clinical Manifestations

 Cis-gender men and nonoperative trans women

➢ Initial site of infection is urethra

➢ Symptoms

• Develop 2–5 days after infection

 Dysuria

 Profuse, purulent urethral discharge

➢ Unusual to be asymptomatic

55-12Gonorrhea: Clinical

Manifestations (Cont.)

 Cis-gender women and nonoperative trans men

➢ Mostly asymptomatic or have minor symptoms

• Vaginal discharge

• Dysuria

• Frequency of urination

55-13Gonorrhea: Clinical

Manifestations (Cont.)

 Cis-gender women and nonoperative trans men

(Cont.)

➢ After incubation

• Redness and swelling occur at the site of contact.

• Greenish, yellow purulent exudate often develops.

 May develop abscess

➢ Disease may remain local or may spread by tissue

extension to uterus, fallopian tubes, and ovaries.

55-14Gonorrhea: Clinical

Manifestations (Cont.)

 Anorectal gonorrhea

➢ Usually from anal intercourse

➢ Few symptoms

• Include rectal pain, itching, and mucopurulent discharge of

anus

55-15Gonorrhea: Clinical

Manifestations (Cont.)

 Orogenital

➢ Few symptoms

➢ Gonococcal pharyngitis can develop.

➢ Painful, burning sensation in the throat or difficulty

swallowing

55-16Gonorrhea:

Complications

 Cis-gender men and nonoperative trans women

➢ Include prostatitis, urethral strictures, and sterility

➢ With no symptoms, seldom seek treatment early, so

more likely to develop complications

➢ Include pelvic inflammatory disease (PID), Bartholin’s

abscess, ectopic pregnancy, chronic pelvic pain and

infertility

➢ A small percentage develop disseminated gonococcal

infection (DGI).

• Skin lesions, fever, arthralgia, arthritis, or endocarditis

55-17Gonorrhea:

Complications (Cont.)

 Eye infections in newborns

➢ Instillations of prophylactic erythromycin or

tetracycline

➢ Untreated infants develop permanent blindness.

55-18Gonorrhea:

Diagnostic Studies

 History and physical examination

 Laboratory tests

➢ Gram-stained smear to identify organism

➢ Culture of discharge

➢ Nucleic acid amplification test

➢ Testing for other STIs

55-19Gonorrhea:

Diagnostic Studies (Cont.)

 Cis-gender women and nonoperative trans men

➢ Smears and discharge do not establish diagnosis.

• The genitourinary (GU) tract harbours organisms resembling

N. gonorrhoeae.

➢ Must have culture to confirm diagnosis

55-20Gonorrhea:

Interprofessional Care

 Medication therapy

➢ Treatment generally instituted without culture results

➢ Treatment in the early stage is curative.

➢ Reinfection, rather than treatment failure, is the main

cause for infections identified after treatment has

ended.

➢ See Table 55.3 for medication therapy for

uncomplicated gonorrheal infections.

➢ Also treated for chlamydial infection, unless a

Chlamydia test result is available and negative

55-21Gonorrhea:

Interprofessional Care (Cont.)

 All sexual contacts of patients must be evaluated

and treated.

 Patient should be counselled to abstain from

sexual intercourse and alcohol during treatment.

 Re-examine if symptoms persist after treatment.

55-22Syphilis

 Rates increased in Canada by 178% between

2007 and 2016.

 Rates increased among males by 192% and

among females by 75%.

55-23Syphilis: Etiology and

Pathophysiology

 Caused by Treponema pallidum

➢ Spirochete bacterium

➢ Enters the body through breaks in skin or mucous

membranes

• Facilitated by abrasions that occur during sexual intercourse

55-24Syphilis: Etiology and

Pathophysiology (Cont.)

 Complex disease in which many organs and

tissues can become infected

 Causes production of antibodies that react with

normal tissues

 Not all exposures cause disease.

55-25Syphilis: Etiology and

Pathophysiology (Cont.)

 Destroyed by drying, heating, or washing

 May also be spread through

➢ Contact with infectious lesions

➢ Sharing of needles among persons who use or

misuse IV drugs

55-26Syphilis: Etiology and

Pathophysiology (Cont.)

 Incubation 10–90 days (average is 21 days)

 Spread in utero during pregnancy

➢ The infected mother has a greater risk of miscarriage,

of stillbirth, or of having a baby who dies shortly after

birth.

55-27Syphilis: Etiology and

Pathophysiology (Cont.)

 High risk of also acquiring HIV infection

 Syphilitic lesions on the genitals enhance HIV

transmission.

 Evaluation of all patients with syphilis includes

testing for HIV, with the patient’s consent.

55-28Syphilis: Clinical Manifestations

 A variety of signs and symptoms can mimic

another disease.

 Primary stage

➢ Chancres appear.

• Painless indurated lesions

• Occurs 3–90 days after inoculation

• Lasting 3–8 weeks

55-29Syphilis: Complications

 Occur most often in late syphilis

 Gummas can produce irreparable damage to

bone, liver, or skin.

 Aneurysm may press on structures such as

intercostal nerves, causing pain

55-30Syphilis:

Complications (Cont.)

 Neurosyphilis causes degeneration of the brain

with mental deterioration.

➢ Neurological deficits are possible.

 Tabes dorsalis causes nerve involvement.

 Sudden attacks of pain

 Loss of vision and sense of position in the feet

and legs

55-31Syphilis:

Diagnostic Studies

 History, including sexual history

 Physical examination (trauma-informed

approach)

➢ Examine lesions.

➢ Note signs and symptoms.

 Dark-field microscopy and direct fluorescent

antibody (DFA)

 Serological testing

 Testing for other STIs

55-32Syphilis:

Interprofessional Care

 Medication therapy

➢ Benzathine penicillin G (Bicillin)

➢ Recurring or persistent symptoms after medication

therapy are retreated.

55-33Syphilis:

Interprofessional Care (Cont.)

 Monitor neurosyphilis with periodic serological

testing, clinical evaluation, and repeat

cerebrospinal fluid (CSF) exams for at least 3

years.

 Sexual contacts require treatment.

 Treatment during pregnancy

55-34Chlamydial Infections

 Most prevalent bacterial STI in Canada

 60% of patients are cis-gender women or

nonoperative trans men

 Three-quarters of total cases occur in the 15- to

29-year age groups

55-35Chlamydial Infections (Cont.)

 Major contributor to

➢ PID

➢ Ectopic pregnancy

➢ Infertility

➢ Epididymouorchitis

55-36Chlamydial Infections:

Etiology and Pathophysiology

 Caused by Chlamydia trachomatis

➢ Gram-negative bacteria

 Largely underreported because infected persons

are asymptomatic

 Transmitted during penetrative vaginal, anal, or

oral sex

55-37Chlamydial Infections:

Clinical Manifestations

 “Silent disease”

➢ Symptoms may be absent or minor.

 Infection often is not diagnosed until

complications appear.

55-38Chlamydial Infections:

Clinical Manifestations (Cont.)

 Cis-gender men and nonoperative trans women

➢ Urethritis

• Dysuria

• Urethral discharge

➢ Proctitis

• Rectal discharge

• Pain during defecation

➢ Epididymitis

• Unilateral scrotal pain

• Swelling

• Tenderness

• Fever

55-39Chlamydial Infections:

Clinical Manifestations (Cont.)

 Cis-gender women and nonoperative trans men

➢ Cervicitis

• Mucopurulent discharge

• Hypertrophic ectopy

➢ Urethritis

• Dysuria

• Frequent urination

• Pyuria

➢ Bartholinitis - purulent exudate

➢ Dyspareunia - pain with intercourse

➢ Menstrual abnormalities

55-40Chlamydial Infections:

Diagnostic Studies

 Laboratory tests

➢ Nucleic acid amplification test (NAAT)

➢ Direct fluorescent antibody (DFA)

➢ Culture for chlamydia

 Cervical or urethral discharge is less purulent,

watery, and painful in chlamydia than in

gonorrhea.

55-41Chlamydial Infections:

Interprofessional Care

 Medication therapy

➢ Doxycycline (Vibramycin)

• 100 mg bid for 7 days

➢ Azithromycin (Zithromax)

• 1 g in single dose

55-42Chlamydial Infections:

Interprofessional Care (Cont.)

 Follow-up care for persistent symptoms

 Treatment of sexual partners

 Encouraging use of condoms

55-43Genital Herpes

 Not a reportable disease in most provinces and

territories

 True incidence is difficult to determine

 Worldwide, about 500 million people are

estimated to have herpes simplex virus (HSV)

55-44Genital Herpes:

Etiology and Pathophysiology

 Caused by herpes simplex virus (HSV)

 Enters through mucous membranes or breaks in

the skin during contact with infected persons

 HSV reproduces inside the cell and spreads to

surrounding cells.

 Virus enters peripheral or autonomic nerve

endings.

 Ascends to sensory or autonomic nerve

ganglion, where it is dormant

55-45Genital Herpes: Etiology and

Pathophysiology (Cont.)

 Recurrence when virus descends to initial site of

infection

 Persists for life

 Virus sheds even in the absence of a lesion.

55-46Genital Herpes: Etiology and

Pathophysiology (Cont.)

 Two different strains

➢ HSV-1

• Causes infection above the waist

➢ HSV-2

• Frequently infects genital tract and perineum

 Either strain can cause disease on the mouth or

genitals.

55-47Genital Herpes:

Clinical Manifestations

 Primary (initial) episode

➢ Burning or tingling at site

➢ Small vesicular lesion appears on penis, scrotum,

vulva, perineum, perianal areas, vagina, or cervix.

➢ Vesicles contain large quantities of infectious virus

particles.

➢ Lesions rupture and form ulcerations.

➢ Crusting and epithelialization occur.

➢ Tend to be associated with local inflammation and

pain with systemic manifestations

• Including fever, headache, malaise, myalgia, and regional

lymphadenopathy

55-48Genital Herpes:

Clinical Manifestations (Cont.)

 Primary (initial) episode (Cont.)

➢ Urination may be painful from urine touching the

lesion.

➢ Purulent vaginal discharge may develop.

➢ Primary lesions present for 17–20 days.

➢ New lesions sometimes continue to develop for 6

weeks.

➢ Lesions heal spontaneously.

55-49Genital Herpes:

Clinical Manifestations (Cont.)

 Recurrent genital herpes

➢ Occurs in 50 to 80% in following year

➢ Triggers

• Stress

• Fatigue

• Sunburn

• General illness

• Immunosuppression

• Menses

55-50Genital Herpes: Complications

 Aseptic meningitis

 Lower neuron damage

➢ Atonic bladder

➢ Erectile dysfunction

➢ Constipation

55-51Genital Herpes:

Complications (Cont.)

 Autoinoculation to extragenital sites

➢ Lips, breasts, and fingers

 High risk of transmission in pregnancy with

episode near delivery

➢ An active lesion is an indication for Caesarean birth.

55-52Genital Herpes:

Diagnostic Studies

 History and physical examination

 Viral isolation by tissue culture

 Antibody assay for specific HSV viral type

 Direct immunofluorescence

 Enzyme immunoassay (EIA)

 DNA amplification

55-53Genital Herpes:

Interprofessional Care

 Use of condoms

 Abstinence with active lesions

 Medication therapy

➢ Inhibits viral replication

➢ Suppresses frequent recurrences

• Acyclovir (Zovirax)

• Valacyclovir (Valtrex)

• Famciclovir (Famvir)

➢ Not a cure, but shortens duration and healing time

and reduces outbreaks

55-54Genital Herpes:

Interprofessional Care (Cont.)

 Symptomatic care

➢ Genital hygiene

➢ Loose-fitting cotton underwear

➢ Lesions clean and dry

➢ Sitz baths

➢ Barrier methods during sexual activity

55-55Human Papillomavirus Infection:

Clinical Manifestations (Cont.)

 Rapid growth with pregnancy

 Transmitted to newborn but risk is low

 Caesarean delivery only if birth canal blocked by

massive warts

55-56Genital Human

Papillomavirus (HPV) Infection

 Highly contagious

 Of adult population in Canada, at least 70%

have at least one genital HPV infection over

lifetime

55-57Human Papillomavirus Infection:

Etiology and Pathophysiology (Cont.)

 Caused by human papillomavirus (HPV)

➢ Common low-risk genotypes types 6 and 11

➢ High-risk genotypes types 16 and 18

 Highly contagious

 Frequently seen in young, sexually active adults

 Minor trauma causes abrasions for HPV to enter

and proliferate into warts.

 Incubation period: 3–4 months

55-58Human Papillomavirus Infection:

Clinical Manifestations

 Discrete single or multiple growths

 White to grey and pink-fleshed coloured

 May form large cauliflower-like masses

 Itching may occur with anogenital warts.

 Bleeding on defecation may occur with anal

warts.

55-59Human Papillomavirus Infection:

Diagnostic Studies

 Diagnosis is on basis of appearance of lesions

➢ May be confused with other diseases

55-60Human Papillomavirus Infection:

Diagnostic Studies (Cont.)

 Primary goal: removal of symptomatic warts

➢ Removal may or may not decrease infectivity.

➢ Difficult to treat

➢ Often require multiple office visits and variety of

treatment modalities

55-61Human Papillomavirus Infection:

Interprofessional Care

 Treatments

➢ Chemical

• Trichloroacetic acid (TCA)

• Bichloroacetic acid (BCA)

➢ Patient-managed topical treatments

• Podofilox

• Podophyllin

• Sinecatechins

• Imiquimod

 Immune response modifier

55-62Human Papillomavirus Infection:

Interprofessional Care (Cont.)

 Recurrences and reinfection possible

 Careful long-term follow-up advised

 Vaccine to prevent cervical cancer,

precancerous genital lesion, and genital warts

due to HPV

55-63Nursing Management:

Nursing Assessment

 Subjective data

➢ Past medical history, including sexual history

➢ Medication use

➢ IV drug use

➢ Nausea/vomiting

➢ Dysuria

➢ Urethral discharge

➢ Burning lesions

➢ Vaginal discharge

➢ Presence of genital or perianal lesions

55-64Nursing Management:

Nursing Assessment (Cont.)

 Objective data

➢ Fever

➢ Visual assessment of lesions, warts, rash

➢ Purulent rectal discharge

➢ Proctitis

➢ Urethral and cervical discharge

➢ Laboratory findings

55-65Nursing Management:

Nursing Diagnoses

 Potential for infection

 Anxiety

 Reduced health maintenance

55-66Nursing Management:

Planning

 Patient with STI will

➢ Demonstrate understanding of mode of transmission

and risks imposed

➢ Complete treatment and follow-up

➢ Notify or assist in notification of sexual contacts

➢ Abstain until infection is resolved

➢ Demonstrate knowledge of safer-sex practices

55-67Nursing Management:

Nursing Implementation

 Discuss practices with all patients.

 Screen for cervical cancer.

 Teach to inspect partner’s genitals.

 Some protection if void immediately after

intercourse; wash genitalia and adjacent areas

with soap and water

55-68Nursing Management:

Nursing Implementation (Cont.)

 Proper use of condoms

 Avoiding sexual contact with HIV-infected

persons

 Establishing risk of contracting STI

 Compassion and respect

 Screening programs

 Locating and examining all contacts of person

with STI for testing and treatment

55-69Nursing Management:

Nursing Implementation (Cont.)

 Education programs

 Counselling to verbalize feelings

 Explaining adverse effects, need for treatment

adherence, and follow-ups

 Emphasize hygiene (hand hygiene, bathing).

 Avoid douching.

 Avoid wearing undergarments made of synthetic

materials.

55-70Nursing Management:

Nursing Implementation (Cont.)

 Abstinence during treatment period, condoms

afterward

 Avoid oral-genital contact.

 Vaginal microbicides, topical gels, creams

55-71Nursing Management:

Evaluation

 Patient with STI will

➢ Describe modes of transmission

➢ Use appropriate hygienic measures

➢ Experience no reinfection

➢ Demonstrate adherence to follow-up protocol

55-72Audience Response Question

The nurse is caring for a patient with a sexually transmitted

infection. What information should the nurse include in the

plan of care?

1. Advise all sexual partners of the need for treatment.

2. Use a condom for sexual intercourse during treatment.

3. Engage in monogamous relationships to prevent reinfection.

4. Wash the genitalia before sexual intercourse to prevent

disease transmission.

55-73Audience Response Question

The nurse teaches the patient with genital herpes

about the use of:

1. Acyclovir ointment

2. Oral acyclovir (Zovirax)

3. Human papillomavirus vaccine

4. Podofilox (Condylox) topical gel

55-74Case StudyCase Study

 An 18-year-old cis-gender woman and a 20-

year-old cis-gender man enter a university

student clinic for an STI screening.

 They would like to begin to have unprotected

sex but are concerned they might have an STI.

55-76Case Study (Cont.)

 The cis-gender man has some pain upon

urination that began 2 days ago.

 The cis-gender woman has no symptoms.

 A blood test is performed on both, and a culture

is taken from the penis.

55-77Case Study (Cont.)

 He is diagnosed with gonorrhea.

 She is diagnosed with chlamydia.

55-78Case Study (Cont.)

 He is given a single intramuscular injection dose

of ceftriaxone (Rocephin).

 The woman is given a prescription for

azithromycin (Zithromax).

55-79Discussion Questions

1. 2. They would like to know how long to wait

before they can have protected or unprotected

sex. What can the nurse tell them?

What patient teaching should the nurse do with

them?

Acute Kidney Injury

 Etiology and pathophysiology

➢ Prerenal

➢ Intrarenal

➢ Postrenal

49A-2Acute Kidney Injury (Cont.)

49A-3Acute Kidney Injury (Cont.)

 Clinical manifestations

➢ Initiation phase

➢ Maintenance phase

• Urinary changes

• Fluid volume excess

• Metabolic acidosis

• Sodium balance

• Potassium excess

• Hematological disorders

• Calcium deficit and phosphate excess

• Waste product accumulation

• Neurological disorders

49A-4Acute Kidney Injury (Cont.)

 Clinical manifestations (Cont.)

➢ Recovery phase

 Diagnostic studies

 Interprofessional care

➢ Nutritional therapy

49A-5Nursing Management:

Acute Kidney Injury

 Nursing assessment

 Nursing diagnoses

 Planning

 Nursing implementation

➢ Health promotion

➢ Acute intervention

➢ Ambulatory and home care

 Evaluation

49A-6Age-Related Considerations:

Acute Kidney Injury

 Older persons are more susceptible than

younger adults to acute kidney injury because

the number of functioning nephrons decreases

with age.

 Impaired function of other organ systems (e.g.,

cardiovascular disease, impaired pancreas

function) can increase the risk of developing

acute kidney injury.

49A-7Age-Related Considerations:

Acute Kidney Injury (Cont.)

 The aging kidney is less able to compensate for

changes in fluid volume, solute load, and cardiac

output.

 Common causes of acute kidney injury in the

older person include dehydration, hypotension,

diuretic therapy, aminoglycoside therapy,

obstructive disorders (e.g., prostatic

hyperplasia), surgery, infection, and

radiocontrast agents.

49A-8Chronic Kidney Disease

 Involves progressive, irreversible loss of kidney

function

 Clinical manifestations

49A-9Chronic Kidney Disease (Cont.)

49A-10Chronic Kidney Disease (Cont.)

 Clinical manifestations

➢ Urinary system

➢ Metabolic disturbances

• Waste product accumulation

• Altered carbohydrate metabolism

• Elevated triglycerides

49A-11Chronic Kidney Disease (Cont.)

 Clinical manifestations (Cont.)

➢ Electrolyte and acid–base imbalances

• Potassium

• Sodium

• Calcium and phosphate

• Magnesium

• Metabolic acidosis

49A-12Chronic Kidney Disease (Cont.)

 Clinical manifestations (Cont.)

➢ Hematological system

• Anemia

• Bleeding tendencies

• Infection

➢ Cardiovascular system

➢ Respiratory system

➢ Gastrointestinal system

➢ Neurological system

49A-13Chronic Kidney Disease (Cont.)

 Clinical manifestations (Cont.)

➢ Musculoskeletal system

➢ Integumentary system

➢ Reproductive system

➢ Psychological changes

 Diagnostic studies

49A-14Chronic Kidney Disease:

Pathophysiology

49A-15Chronic Kidney Disease (Cont.)

 Interprofessional management of chronic kidney

disease

➢ Medication therapy

• Hyperkalemia

• Hypertension

• Chronic kidney disease—mineral and bone disorder

• Anemia

• Dyslipidemia

• Complications of medication therapy

49A-16Chronic Kidney Disease (Cont.)

 Interprofessional management of chronic kidney

disease (Cont.)

➢ Nutritional therapy

• Protein restriction

• Sodium and fluid restriction

• Potassium restriction

• Phosphate restriction

49A-17Nursing Management:

Chronic Kidney Disease

 Nursing assessment

 Nursing diagnoses

 Planning

 Nursing implementation

➢ Health promotion

➢ Care considerations for chronic kidney disease in

stages 4 to 5

➢ Ambulatory and home care

 Evaluation

49A-18Dialysis

 General principles of dialysis

➢ Diffusion

➢ Osmosis

➢ Ultrafiltration

49A-19Dialysis (Cont.)

49A-20Peritoneal Dialysis

 Catheter placement

➢ Nonsurgical approach

➢ Surgical approach

49A-21Peritoneal Dialysis (Cont.)

49A-22Peritoneal Dialysis (Cont.)

49A-23Peritoneal Dialysis (Cont.)

 Dialysis solutions and cycles

 Peritoneal dialysis systems

➢ Automated peritoneal dialysis

➢ Continuous ambulatory peritoneal dialysis

49A-24Peritoneal Dialysis (Cont.)

49A-25Peritoneal Dialysis (Cont.)

 Complications of peritoneal dialysis

➢ Exit-site infection

➢ Peritonitis

➢ Abdominal pain

➢ Outflow problems

➢ Hernias

➢ Lower back problems

➢ Bleeding

➢ Pulmonary complications

➢ Protein loss

➢ Carbohydrate and lipid abnormalities

49A-26Peritoneal Dialysis (Cont.)

 Effectiveness of and adaptation to chronic

peritoneal dialysis

49A-27Hemodialysis

 Vascular access sites for hemodialysis

➢ Arteriovenous fistulas and grafts

➢ Central venous catheters

➢ Temporary vascular access

49A-28Hemodialysis (Cont.)

49A-29Hemodialysis (Cont.)

49A-30Hemodialysis (Cont.)

 Dialyzers

 Procedure for hemodialysis

 Settings for hemodialysis

49A-31Hemodialysis (Cont.)

49A-32Hemodialysis (Cont.)

49A-33Hemodialysis (Cont.)

 Complications of hemodialysis

➢ Hypotension

➢ Muscle cramps

➢ Loss of blood

➢ Hepatitis

➢ Sepsis

➢ Disequilibrium syndrome

 Effectiveness of and adaptation to hemodialysis

49A-34Continuous Renal

Replacement Therapy

49A-35Kidney Transplantation

 Ethical issues

 Recipient selection

 Histocompatibility studies

 Donor sources

➢ Living donors

➢ Deceased donors

 Surgical procedure

➢ Live donor

➢ Kidney transplant recipient

49A-36Kidney Transplantation (Cont.)

49A-37Nursing Management:

Kidney Transplant Recipient

 Preoperative care

 Postoperative care

➢ Living donor

➢ Kidney transplant recipient

 Immunosuppressive therapy

49A-38Nursing Management:

Kidney Transplant Recipient (Cont.)

 Complications of transplantation

➢ Rejection

➢ Infection

➢ Cardiovascular disease

➢ Malignancies

➢ Recurrence of original renal disease

➢ Corticosteroid-related complications

49A-39Age-Related Considerations:

Chronic Kidney Disease

 The incidence of stage 5 chronic kidney disease

in Canada is increasing most rapidly in older

patients.

 The most common diseases leading to renal

failure in older persons are diabetes and

hypertension.

49A-40Age-Related Considerations:

Chronic Kidney Disease (Cont.)

 Physiological changes of clinical importance in

the older person with chronic kidney disease

include diminished cardiopulmonary function,

bone loss, immunodeficiency, altered protein

synthesis, impaired cognition, and altered drug

metabolism.

 Malnutrition is common in the older patient with

chronic kidney disease.

Acute Kidney Injury

 Etiology and pathophysiology

➢ Prerenal

➢ Intrarenal

➢ Postrenal

49A-2Acute Kidney Injury (Cont.)

49A-3Acute Kidney Injury (Cont.)

 Clinical manifestations

➢ Initiation phase

➢ Maintenance phase

• Urinary changes

• Fluid volume excess

• Metabolic acidosis

• Sodium balance

• Potassium excess

• Hematological disorders

• Calcium deficit and phosphate excess

• Waste product accumulation

• Neurological disorders

49A-4Acute Kidney Injury (Cont.)

 Clinical manifestations (Cont.)

➢ Recovery phase

 Diagnostic studies

 Interprofessional care

➢ Nutritional therapy

49A-5Nursing Management:

Acute Kidney Injury

 Nursing assessment

 Nursing diagnoses

 Planning

 Nursing implementation

➢ Health promotion

➢ Acute intervention

➢ Ambulatory and home care

 Evaluation

49A-6Age-Related Considerations:

Acute Kidney Injury

 Older persons are more susceptible than

younger adults to acute kidney injury because

the number of functioning nephrons decreases

with age.

 Impaired function of other organ systems (e.g.,

cardiovascular disease, impaired pancreas

function) can increase the risk of developing

acute kidney injury.

49A-7Age-Related Considerations:

Acute Kidney Injury (Cont.)

 The aging kidney is less able to compensate for

changes in fluid volume, solute load, and cardiac

output.

 Common causes of acute kidney injury in the

older person include dehydration, hypotension,

diuretic therapy, aminoglycoside therapy,

obstructive disorders (e.g., prostatic

hyperplasia), surgery, infection, and

radiocontrast agents.

49A-8Chronic Kidney Disease

 Involves progressive, irreversible loss of kidney

function

 Clinical manifestations

49A-9Chronic Kidney Disease (Cont.)

49A-10Chronic Kidney Disease (Cont.)

 Clinical manifestations

➢ Urinary system

➢ Metabolic disturbances

• Waste product accumulation

• Altered carbohydrate metabolism

• Elevated triglycerides

49A-11Chronic Kidney Disease (Cont.)

 Clinical manifestations (Cont.)

➢ Electrolyte and acid–base imbalances

• Potassium

• Sodium

• Calcium and phosphate

• Magnesium

• Metabolic acidosis

49A-12Chronic Kidney Disease (Cont.)

 Clinical manifestations (Cont.)

➢ Hematological system

• Anemia

• Bleeding tendencies

• Infection

➢ Cardiovascular system

➢ Respiratory system

➢ Gastrointestinal system

➢ Neurological system

49A-13Chronic Kidney Disease (Cont.)

 Clinical manifestations (Cont.)

➢ Musculoskeletal system

➢ Integumentary system

➢ Reproductive system

➢ Psychological changes

 Diagnostic studies

49A-14Chronic Kidney Disease:

Pathophysiology

49A-15Chronic Kidney Disease (Cont.)

 Interprofessional management of chronic kidney

disease

➢ Medication therapy

• Hyperkalemia

• Hypertension

• Chronic kidney disease—mineral and bone disorder

• Anemia

• Dyslipidemia

• Complications of medication therapy

49A-16Chronic Kidney Disease (Cont.)

 Interprofessional management of chronic kidney

disease (Cont.)

➢ Nutritional therapy

• Protein restriction

• Sodium and fluid restriction

• Potassium restriction

• Phosphate restriction

49A-17Nursing Management:

Chronic Kidney Disease

 Nursing assessment

 Nursing diagnoses

 Planning

 Nursing implementation

➢ Health promotion

➢ Care considerations for chronic kidney disease in

stages 4 to 5

➢ Ambulatory and home care

 Evaluation

49A-18Dialysis

 General principles of dialysis

➢ Diffusion

➢ Osmosis

➢ Ultrafiltration

49A-19Dialysis (Cont.)

49A-20Peritoneal Dialysis

 Catheter placement

➢ Nonsurgical approach

➢ Surgical approach

49A-21Peritoneal Dialysis (Cont.)

49A-22Peritoneal Dialysis (Cont.)

49A-23Peritoneal Dialysis (Cont.)

 Dialysis solutions and cycles

 Peritoneal dialysis systems

➢ Automated peritoneal dialysis

➢ Continuous ambulatory peritoneal dialysis

49A-24Peritoneal Dialysis (Cont.)

49A-25Peritoneal Dialysis (Cont.)

 Complications of peritoneal dialysis

➢ Exit-site infection

➢ Peritonitis

➢ Abdominal pain

➢ Outflow problems

➢ Hernias

➢ Lower back problems

➢ Bleeding

➢ Pulmonary complications

➢ Protein loss

➢ Carbohydrate and lipid abnormalities

49A-26Peritoneal Dialysis (Cont.)

 Effectiveness of and adaptation to chronic

peritoneal dialysis

49A-27Hemodialysis

 Vascular access sites for hemodialysis

➢ Arteriovenous fistulas and grafts

➢ Central venous catheters

➢ Temporary vascular access

49A-28Hemodialysis (Cont.)

49A-29Hemodialysis (Cont.)

49A-30Hemodialysis (Cont.)

 Dialyzers

 Procedure for hemodialysis

 Settings for hemodialysis

49A-31Hemodialysis (Cont.)

49A-32Hemodialysis (Cont.)

49A-33Hemodialysis (Cont.)

 Complications of hemodialysis

➢ Hypotension

➢ Muscle cramps

➢ Loss of blood

➢ Hepatitis

➢ Sepsis

➢ Disequilibrium syndrome

 Effectiveness of and adaptation to hemodialysis

49A-34Continuous Renal

Replacement Therapy

49A-35Kidney Transplantation

 Ethical issues

 Recipient selection

 Histocompatibility studies

 Donor sources

➢ Living donors

➢ Deceased donors

 Surgical procedure

➢ Live donor

➢ Kidney transplant recipient

49A-36Kidney Transplantation (Cont.)

49A-37Nursing Management:

Kidney Transplant Recipient

 Preoperative care

 Postoperative care

➢ Living donor

➢ Kidney transplant recipient

 Immunosuppressive therapy

49A-38Nursing Management:

Kidney Transplant Recipient (Cont.)

 Complications of transplantation

➢ Rejection

➢ Infection

➢ Cardiovascular disease

➢ Malignancies

➢ Recurrence of original renal disease

➢ Corticosteroid-related complications

49A-39Age-Related Considerations:

Chronic Kidney Disease

 The incidence of stage 5 chronic kidney disease

in Canada is increasing most rapidly in older

patients.

 The most common diseases leading to renal

failure in older persons are diabetes and

hypertension.

49A-40Age-Related Considerations:

Chronic Kidney Disease (Cont.)

 Physiological changes of clinical importance in

the older person with chronic kidney disease

include diminished cardiopulmonary function,

bone loss, immunodeficiency, altered protein

synthesis, impaired cognition, and altered drug

metabolism.

 Malnutrition is common in the older patient with

chronic kidney disease.

Structures and Functions

of the Urinary System

 Primary functions of the kidneys

➢ Filter waste

➢ Maintain fluid and electrolyte and acid–base balance

in the body

➢ Excrete metabolic waste products

47-2Structures and Functions

of the Urinary System (Cont.)

 Secondary functions of the kidneys: to regulate

➢ Blood pressure

➢ Bone density

➢ Erythropoiesis

47-3Structures and Functions

of the Urinary System (Cont.)

 Kidneys

➢ Macrostructure

➢ Microstructure

➢ Blood supply

➢ Physiology of urine formation

• Glomerular function

• Tubular function

47-4Structures and Functions

of the Urinary System (Cont.)

 Kidneys (Cont.)

➢ Other functions of the kidneys

• Production of erythropoietin

• Activation of vitamin D

• Production and secretion of renin

47-5Structures and Functions

of the Urinary System (Cont.)

47-6Structures and Functions

of the Urinary System (Cont.)

47-7Structures and Functions

of the Urinary System (Cont.)

The animation referenced below can be viewed in the PowerPoint Animations asset.

Overview of the Urinary System

47-8Structures and Functions

of the Urinary System (Cont.)

47-9Structures and Functions

of the Urinary System (Cont.)

47-10Structures and Functions

of the Urinary System (Cont.)

 Ureters

 Bladder

 Urethra

 Urethrovesical unit function

47-11Structures and Functions

of the Urinary System (Cont.)

47-12Age-Related Considerations: Effects of

Aging on the Urinary System

 Decrease in size and weight of kidney from 30 to

90 years of age

 Decreased blood flow

 Physiological changes to kidney, bladder, and

urethra

➢ Decreased elasticity, weakening

➢ Decreased bladder capacity

➢ Prostatic enlargement

47-13Assessment of the Urinary System

Subjective data

 Important health information

➢ Past health history, medications, surgery

➢ Nutritional and elimination assessment

➢ Activity assessment

➢ Pain assessment

➢ Self-concept and sexuality assessment

➢ Coping assessment

47-14Assessment of the Urinary System (Cont.)

Objective data

 Physical examination

➢ Inspection

➢ Palpation

➢ Percussion

➢ Auscultation

47-15Assessment of the Urinary System (Cont.)

 Refer to Table 47.5, Clinical Manifestations of

Disorders of the Urinary System, in the textbook

47-16Assessment of the Urinary System (Cont.)

 Refer to Table 47.7, Assessment Abnormalities --

Urinary System, in the textbook

47-17Assessment of the Urinary System (Cont.)

47-18Diagnostic Studies

 Analysis of urine

 Blood tests

 Radiological procedures

 Renal radionuclide imaging

 Surgical study (renal biopsy)

 Endoscopy

 Urodynamics testing

47-19Diagnostic Studies (Cont.)

47-20Diagnostic Studies (Cont.)

47-21