Nur 200 - Chapter 28 Nursing MgMt: Pts with Urinary Disorders
what are the goals and interventions for patients with urinary calculi?
pain relief, prevention of recurrence and absence of complications (monitoring urine character and output volume)
what does the assessment reveal in a patient with urinary calculi?
pain, nausea, vomiting, diarrhea, and abdominal distention
what is the most common symptom of cancer of the bladder?
painless gross hematuria
UTIs are the ______ most common reason patients seek health care.
second
what are some things we can teach our patients to prevent recurrent UTIs?
shower rather than bathe wipe from front to back drink liberal amounts of fluid avoid coffee, tea, alcohol, etc. as they are urinary irritants void every 2-3 hours during the day and completely empty the bladder take meds as prescribed
what are some treatment regimens for uncomplicated UTIs in women?
single-dose administration, short course (3-4 days) regimens, or 7-10 day regiments. Short course is preferred for uncomplicated UTIs because most cases are cured after 3 days of treatment
What is nephrolithiasis?
stones in the kidney
What is urolithiasis?
stones in the urinary tract
what is the ideal medication for treatment of a UTI?
antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on GI and vaginal flora, minimizing the incidence of vaginal yeast infections
what are considered first-line medications for urge incontinence?
anticholinergic agents like oxybutynin (Ditropan) because they inhibit bladder contraction
what technique is used when teaching the patient how to perform self-catheterization?
aseptic
what is the treatment for uric acid stones?
avoid foods high in purine allopurinol may be prescrived to reduce serum uric acid elvels and urinary acid excretion
For patients with spinal cord injury or other neurologic disorders, what is the treatment of choice when the ability to empty the bladder is impaired?
self-catheterization
What is urosepsis?
severe illness that occurs when an infection starts in the urinary tract and spreads into the bloodstream aka septicemia caused by a UTI
If a teen inserts a foreign object into his penis, once the object has been removed, what has to happen?
the tract must be evaluated which can typically be done with a cystoscopy
A client has been diagnosed with a small kidney stone. He has been told to increase his fluid intake and is asking why. Which of the following is the nurse's best response? A. this will decrease pain B. this will increase urine production and help move the stone from the system C. this will help pain medications to work more quickly D. this will help prevent any nausea he is having
B.
The nurse advises a pt with renal stones to avoid eating shellfish, and organ meats. She states that these foods should be avoided because she knows that his renal stones are composed of which of the following substances? A. Calcium B. Uric acid C. Struvite D. cystine
B.
Which of the following is a cause of a calcium renal stone? A. foreign bodies B. Excessive intake of vitamin D C. Neurogenic bladder D. Gout
B.
what is patient with genitourinary trauma hard to manage?
Because it can take hours before urine output develops
Most UTIs occur in men. T/F
False - women due to the close proximity of the anus
when is cancer of the bladder usually found?
In the late stages due to not being able to see the blood (elderly), menstruation, cognitive issues, or colorblind
what are the 3 types of continent urinary diversions?
Indiana pouch Continent ileal (kock pouch) male and female Ureterosigmoidostomy
How does the Kock pouch differ in males?
It can be modified by attaching one end of the pouch to the urethra allowing more normal voiding. The female urethra is too short for this modification. There are 2 sources of urine output.
What type of UTI is most common?
Lower UTIs which include bacterial cystitis (inflammation of the bladder), bacterial prostatitis (inflammation of the prostate) and bacterial urethritis (inflammation of the urethra).
who do stones more commonly affect and what season?
Men and in the spring and summer due to dehydration
what are ways to control pain from kidney stones?
NSAIDS, opiods, position of comfort, and a heating pad
what antibiotic for UTIs should not be used in patients with renal insufficiency?
Nitrofurantoin
Is calcium restriction always the treatment for kidney stones?
No because not all kidney stones are calculi.
what is the most common cause of acute bacterial sepsis in patients older than 65?
UTIs
what is the difference between a complicated UTI and an uncomplicated UTI?
Uncomplicated - mostly community acquired Complicated - occurs in people with urologic abnormalities, comorbidities such as diabetes, or recent catheterization
what type of infections are included with upper UTIs?
acute or chronic pyelonephritis (inflammation of the kidney and renal pelvis), interstitial nephritis (inflammation of the spaces between the kidney tubules) and renal abscesses (pus-filled cavity of the kidney).
What is hydronephrosis?
When a stone has blocked a portion of the urinary tract causing the urine to back up into the kidneys causing distention of the kidney
what is endourologic stone removal?
a nephroscope is introduced through a percutaneous route into the renal parenchyma. Depending on stone size, it may be extracted with forceps or by a stone retrieval basket.
what is endourologic stone removal?
a nephroscope of introduced through a percutaneous route into the renal parenchyma. Depending on stone size, it may be extracted with forceps or by a stone retrieval basket.
what is an extracorporeal shock wave lithotripsy?
a noninvasive procedure where a high energy amplitude of pressure or shock wave, is generated by the abrupt release of energy and transmitted through water and soft tissues to break up stoens in the calyx. If the procedure is successful, the fragments are spontaneously voided.
what are the different types of kidney stones?
calcium, uric acid (gout/myeloproliferative disorders), struvite, and cystine
what is the treatment of choice for a complicated UTI?
cephalosporin or an ampicillin/aminoglycoside combination; ideally, the choice is based on culture results.
what are the two types of urinary diversions?
cutaneous and continent
what is the reason for cystine stones?
occurs exclusively in patients with a rare inherited defect in renal absorption of cystine (an amino acid)
what is often created for bladder cancer?
urinary diversion
what is a cutaneous urinary diversion?
urine drains through an opening created in the abdominal wall and skin
what is the main complaint with kidney stones?
pain
what do the treatments include for bladder cancer?
chemo, radiation or surgery
A 42 year old male patient complains of nausea, vomiting, and right flank pain. What is the most likely cause of these symptoms? A. interstitial cystitis B. renal colic C. ureterocele D. nephritic syndrome
B.
what are some risk factors for UTIs?
inability or failure to empty the bladder completely obstructed urinary flow immunosuppression instrumentation of the urinary tract (cath or cystoscopic procedures)
Barring no contraindications, what size catheter would be used for acute urinary retention?
14-18 French foley
what percentage of kidney stones are calculi?
75%
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute glomerulonephritis b) Acute renal failure c) Nephrotic syndrome d) Chronic renal failure
A.
A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. Which of the following postop procedures should the nurse perform? A. maintain skin and stomal integrity B. Show photographs and drawings of the placement of the stoma C. suggest a visit to a local ostomy group D. determine the patient's ability to manage stoma care
A.
An elderly man is seeing his urologist for an annual check up. The provider is concerned with s/s he detects for bladder cancer. Which of the following s/s is diagnostic for bladder cancer? A. painless gross hematuria B. deep flank and abdominal pain C. muscle spasm and abdominal rigidity over the flank D. decreasing kidney function associated with fever and hematuria
A.
Patients with urolithiasis need to be encouraged to: A. increase their fluid intake B. participate in strenuous exercise C. supplement their diet with calcium D. limit their voiding to every 6-8 hours
A.
The kidney received approximately what percentage of cardiac output every minute? A. 25% B. 35% C. 55% D. 45%
A.
when caring for a patient with an uncomplicated, mild UTI, the nurse knows that recent studies have shown which of the following drugs to be a good choice for a short course therapy? A. levofloxacin B. Bactrim C. Ciprofloxacin D. Nitrofurantoin
A.
which of the following is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia? A. change in cognitive functioning B. back pain C. Hematuria D. Incontinence
A.
Following a post void bladder scan, straight catheterization is performed if the bladder has how many mL left in it? A. 100 B. 25 C. 50 D. 75
A. 100
Which of the following medications may be ordered to relieve discomfort associated with a UTI? A. Phenazopyridine B. Levofloxacin C, Ciprofloxacin D. Nitrofurantoin
A. This is an analgesic. The rest are antibiotics.
which of the following is a potential cause of transient incontinence? select all that apply A. delirium B. restricted activity C. Stool impaction D. Atrophic vaginitis E. UTI
All
A patient is being treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidneys function. Which of the following measures can the nurse take to help achieve the objective? A. Palpate for a thrill over the vascular access B. Monitor the patient's intake and output C. Note the nail beds and mobility of the fingers D. Inspect the skin over the fistula or graft for signs of infection
B
A pt is prescribed a diet moderately reduced in calcium to prevent renal stones. The nurse instructs the pt to avoid: A. citrus fruits B. milk C. pasta D. whole grain breads
B
which of the following is a strategy to promote urinary continence? A. take diuretics after 4pm B. void regularly, 5-8 times a day C. Implement a low fiber diet D. use caffeine in moderation
B
which of the following is classified as a upper UTI? select all that apply A. prostatitis B. acute pyelonephritis C. urethritis D. renal abscess E. Cystitis
B and D
when teaching the patient how to perform self-catheterization, which of the following is important? A. the nurse uses nonsterile technique in the hospital setting B. The catheterization should occur every 4-6 hours and before bedtime C. Peroxide is recommended for cleaning the urinary cath D. The cath is rinsed with sterile normal saline after soaking in a cleaning solution
B.
why are patients with genitourinary trauma hard to manage?
Because it can take hours before urine output develops
What is neurogenic bladder?
Bladder dysfunction caused by an interruption of normal bladder nerve innervation typically caused by spinal cord injury, spinal tumor, herniated disk, MS, congenital disorders, infection, or diabetes mellitus
A women comes to her provider's office with s/s of kidney stones. Which of the following should be the primary medical management goal? A. determine the stone type B. relieve any obstruction C. relieve the pain D. prevent nephron destruction
C.
Rejection of a transplanted kidney within 24 hours after transplant is termed which of the following? A. acute rejection B. simple rejection C. hyperacute rejection D. chronic rejection
C.
Sympathomimetics have which of the following effects on the body? A. constriction of the bronchioles B. constriction of the pupils C. relaxation of the bladder wall D. Decrease of heart rate
C.
The nurse who provides teaching to the female patient regarding prevention of recurrent urinary tract infections includes which of the following statements? A. Take tub baths instead of showers B. Void every 5 hours during the day C. Void immediately after sexual intercourse D. Increase intake of coffee, tea, and colas.
C.
What type of incontinency refers to the involuntary loss of urine due to medications? A. Urge B. Reflex C. Iatrogenic D. Overflow
C.
When being instructed on methods for managing the mucous in their urinary diversion, pts should be reminded to do which of the following? A. increase fiber intake B. consume high levels of citrus fruits and juices C. increase consumption of cranberry juice D. avoid caffeine consumption
C.
Which of the following is a factor contributing to UTIs in older adults? A. Sporadic use of antimicrobial agents B. Active lifestyle C. Immunocompromise D. Low incidence of chronic illness
C.
which of the following accounts for the majority of ureteral injuries? A. unintentional injuries B. sports injuries C. gunshot wounds D. knife wounds
C.
which of the following is the most common site of a nosocomial infection? A. Skin B. GI tract C. Urinary tract D. Respiratory tract
C.
which of the following would be included in a teaching plan for a patient diagnoses with a UTI? A. void every 4-6 hours B. use tub baths as opposed to showers C. Drink liberal amounts of fluids D. Drink coffee and tea to increase diuresis
C.
If an indwelling cath is necessary, nursing intervention that should be implemented to prevent infection include which of the following? A. using clean technique B. using sterile technique to disconnect the cath from tubing to obtain urine specimens C. placing the cath bag on the patient's abdomen when moving the patient D. performing meticulous perineal care daily with soap and water
D.
The nurse needs to assess the fluid volume status of a patient with chronic glomerulonephritis. Which of the following methods should the nurse use to accurately assess the patient's fluid volume status? A. Weigh the patient daily, at the same time, using a different scale every time, with similar clothing B. Weigh the patient daily, once in the morning, on the same scale, with similar clothing C. Weigh the patient daily, at the same time, on the same scale, with only minimal clothing D. Weight the patient daily, at the same time, on the same scale, with similar clothing
D.
The treatment of choice for a spinal cord-injured patient with impaired bladder emptying would include which of the following? A. condom cath B. indwelling cath C. no cath D. intermittent self-cath
D.
Which of the following is the most common symptom of bladder cancer? A. altered voiding B. back pain C. pelvic pain D. painless gross hematuria
D.
Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease? A. Incomplete bladder emptying B. Urgency C. Urinary retention D. Incontinence
D.
which drugs, originally developed for HTN, relax smooth muscle tissue found in the prostate? A. ACE inhibitors B. Beta blockers C. Digitalis prep D. Alpha blockers
D.
which metabolic defects are associated with stone formation? A. hyperthyroidism B. Hypoparathyroidism C. Hypouricemia D. Hyperparathyroidism
D.
which of the following is the most effective intravesical agent for recurrent bladder cancer? A.Methotrexate B. Cisplatin C. Vinblastine D. Bacillus Calmette-Guerin
D.
which of the following terms is used to refer to inflammation of the renal pelvis? A. cystitis B. urethritis C. interstitial nephritis D. pyelonephritis
D.
which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing? A. Reflex B. Urge C. Overflow D. Stress
D.
what are the causes of transient incontinence?
Delirium Infection of the urinary tract Atrophic vaginitis, urethritis Pharmacologic agents (anticholinergics, sedatives, alcohol, analgesics, diuretics, etc.) Psychological factors (depression, regression) Excessive urine production Restricted activity Stool impaction DIAPPERS
what is a continent urinary diversion?
a portion of the intestine is used to creat a new reservoir for urine
what is a continent urinary diversion?
a portion of the intestine is used to created a new reservoir for urine
what is a ureteroscopy?
a procedure that inserts a ureteroscope into the ureter and then, depending on the size of stonem either basketing or inserting a laser, electrohydraulic lithotriptor, or ultrasound device through the ureteroscope to fragment and remove the stones. A stent may be inserted and left in place for 48 hours or more after the procedure to keep the ureter patent.
If a patient has past history of prostatic disease, what type of cath would be used for acute urinary retention?
coude cath
what are the risk factors for bladder cancer?
cigarette smoking exposure to environmental carcinogens: dyes, rubber, leather, ink or paint chronic UTIs bladder stones high urinary pH high cholesterol pelvic radiation prostate, colon and rectum cancer
what are some signs and symptoms of a calculi stone?
depends on the presence of obstruction, infection, and edema, but pain is common
what are three things that can be done to decrease the incidence of UTIs in patients in long term care facilities?
diligent hand hygiene careful perineal care frequent toileting
what should the nurse inform the patient about regarding self-catheterization?
emphasize the important of frequent catheterization and emptying of the bladder at the prescribed time average daytime clean intermittent cath schedule is every 4-6 hours and just before bedtime If patient awakes at night with an urge to void, catheterization may be performed but after an attempt to void normally is made
what is the treatment for struvite stones?
fluid intake is increased
what are some of the reasons for calculi stones?
hypercalcemia (high serum calcium) hypercalciuria (high urine calcium) hyperparathyroidism cancers excessive intake of vitamin D insufficient fluid intake excessive intake of milk
what are some signs and symptoms of urosepsis?
hypothermia or hyperthermia tachycardia tachypnea leukopenia
what is the treatment for calcium stones?
if it's due to hypercalciuria, restric calcium intake. encourage fluid intake dietary restriction of protein and sodium meds such as ammonium chloride thiazide diuretics
what does a dusky stoma indicate?
impaired perfusion and the surgeon should be alerted
what does self-catheterization promote?
independence, results in few complications, and enhances self esteem and quality of life
what decreases the risk of infection and may be indicated in patients with recurrent infections?
long-term use of antimicrobial agents
what is the treatment for cystine stones?
low protein diet fluid intake increases
what are some reasons for uric acid stones?
low purine diet foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided
what type of technique can a patient use at home for self-catheterization?
nonsterile (clean) technique
what do the medical interventions include for kidney stones?
pain management nutritional therapy
What are some reasons for struvite stones?
persistent alkaline, ammonia-rich urine caused by the presence of urease-splitting bacteria such as proteus, pseudomonas, klebsielle, staph or mycoplasma) people with a neurogenic bladder (lack bladder control due to a brain, spinal cord or nerve problem), foreign bodies, and recurrent UTIs
what is an example of a urinary analgesic that can be given to relieve the discomfort associated with the infection?
phenazopyridine
what is a nephrostomy urinary diversion?
surgeon inserts a catheter into the renal pelvis via an incision in the flank or by percutaneous catheter placement in to the kidney. There are two sources of urine output. There will be a nephrostomy bag that will hold up to a liter of urine. Bag must be dependent for draining.
what is an Indiana pouch continent urinary diversion?
surgeon introduces the ureters into a segment of ileum and cecum. Urine is drained periodically by inserting a catheter into the stoma. There is only once source of urine output.
what is a ureterosigmoidostomy continent urinary diversion?
surgeon introduces the ureters into the sigmoid colon, thereby allowing urine to flow through the colon and out of the rectum. There is only one source of urine output and it's important to remind the physician of the possibility of a mixed culture for a urinalysis.
What is a vesicostomy urinary diversion?
surgeon sutures the bladder to the abdominal wall and creates an opening (stoma) through the abdominal and bladder walls for urinary drainage. There is only one source of urine output
what is a conventional ileal conduit cutaneous urinary diversion?
surgeon transplants the ureters to an isolated section of the terminal ileum (ileal conduit), bringing one end to the abdominal wall. These patients will not urinated out of the urethra so there is only one output area.
What is a continent ileal urinary diversion aka kock pouch?
surgeon transplants the ureters to an isolated segment of the small bowelm ascending colon, or ileocolonic segment and develops an effective continence mechanism or valve. Urine is crained by inserting a catheter into the stoma. There is only one source of urine output.
what is the most common cutaneous urinary diversion used and why?
the ileal conduit because of the low number of complications and surgeons' familiarity with the procedure.
what is a cutaneous ureterostomy urinary diversion?
the surgeon brings the detached ureter through the abdominal wall and attaches it to an opening in the skin. There are 2 sources of urine output so must remember to document which kidney was used for the output.
what are the three surgical treatment options for renal stones?
ureteroscopy extracorporeal shock wave lithotripsy endourologic (percutaneous) stone removal
what are the three types of genitourinary trauma?
urethral trauma - wife cuts off husband's penis or teens inserting things into the penis like paper clips, pencils, etc. ureteral trauma - kidney stones or blunt trauma bladder trauma - gunshot, stabbing, or pelvic fracture
why are calculi stones formed?
urinary concentrations of calcium oxalate, calcium phosphate, and uric acid increases