Genitourinary- Chapter 42

nitrofurontoin

Macrobid, Macrodantin

tamsulosin (Fosamax) terazosin alpha-adrenergic blockers

Medications for the management of renal calculi

amphotericin fluconazole ( Diflucan)

fungal UTI abx

urinary retention

inability to empty the bladder when a person voids or the accumulation of urine int he bladder because of inability ro urinate.

avoid sunlight notify HCP for fever, chills , cough, chest pain, dyspnea, rash, or numbness or tingling of fingers

indications for nitrofurontoin

azo dye excreted in urine may cause urine to turn ORANGE or RED -long-term use causes hemolytic anemia

indications for phenazopyridine

Pyelonephritis

inflammation of renal parenchyma and collecting system

cystitis

inflammation of the bladder

continent urinary diversions

intraabdominal urinary reservoir that can be cathterized or has an outlet controlled by the anal sphincter

urinary incontinence

involuntary leakage of urine

nephrolithiasis

kidney stone disease

intermiitent catheterization -inserting a urethral catheter into the bladder every 3 to 5 hrs; measure residual urine and to ensure an empty bladder.

main goal is to prevent urinary retention, stasis, and compromised blood supply to the bladder caused by prolonged pressure.

Urinary tract infections

most common bacterial infection in women

E.coli

most common pathogen causing UTI

urethral catheterization

most common route, involves the insertion of a catheter through the external meatus into the urethra, past the internal sphincterm and into the bladder.

-flank pain, back or abdomen -N&V -restlessness -dysuria -pink,red, or brown urine -fever and chills

Kidney stone symptoms

Fluoroquinolones

Abx for complicated UTI

ampicillin amoxicillin cephalosporins

Abx for uncomplicated UTI

Hx and PE DRE- Digital rectal exam Urinalysis with culture PSA-prostate specific antigen Serum creatinine Neurologic exam

BPH Assessment

TRUS scan Uroflometry Cystoscopy

BPH Diagonostic studies

-difficulty starting a urine stream -decreased flow of urine -urinary frequency

BPH symptoms

DRIP D-delerium, dehydration,depressiom R-restricted mobility, rectal impaction I-infection, inflammation, impaction P-polyuria, polypharmacy,

Causes of UI

pyelonephritis cystitis

Classifications of UTI

Nocturia urinary frequency urgency dysuria bladder pain incontinence

Irritative symptoms of BPH -associated with infection and inflammation

-decrease in the caliber and force of urinary stream -difficulty initiating a stream -intermittency ( stopping and starting stream while voiding) -dribbling at the end of urination

Obstructive symptoms of BPH

Aging Obesity Lack of physical activity Alcohol consumption erectile dysfunction smoking DM Family Hx

Risk factors for BPH

-immunocompromised -Diabetic -Kidney disease -patient that have undergone multiple courses of abx therapy -travelled or lived to certain developing countries

Risk factors for UTI

-large intake of dietary proteins that increases uric acid excretion -excessive amounts of tea or fruit juices that elevate urinary oxalate level -large intake of calcium and oxalate -low fluid intake the increase urinary concentration -immobility

Risk factors for renal calculi

nephrostomy tubes

Small tubes tunneled through the skin into the renal pelvis Placed to drain the renal pelvis when the ureter is obstructed

-may be asymptomatic -nonlocalized abdominal discomfort rather than dysuria -cognitive impairment -general physical decline is common -high risk for urosepsis

Symptoms of UTI in elderly

amitryptiline -tx for overactive bladder

TCA as tx for incontinence SE: dizziness, orthostatic hypotension

urosepsis

UTI that has spread systemically and is a life-threatening condition

Methenamine/phenyl salicylate (Urised)

Used in combination with antibiotics Used to relieve UTI symptoms Preparations with methylene blue tint urine blue or green

caffeinated beverages alcohol citrus juices chocolate highly spiced beverages or foods

What beverages should be avoided to decrease irritation of the bladder?

application of local heat to the suprapubic area or lower back

What can be applied to the suprapubic area to relieve discomfort associated with UTI?

Oxybutinin or belladona and opium (B&O)

What medication is used to decrease bladder spasms?

Duloxetine (Cymbalta)

Which medication used to treat urinary incontinence strengthens the urinary sphincters and has anticholinergic action? SNRI

enzymes found in cranberries inhibit attachment of urinary pathogens ( E.coli) to the bladder wall

Why does cranberry indicated for the management of UTI?

ciprofloxacin (Cipro) levofloxacin (Levaquin) ofloxacin gatifloxacin

examples of Fluoroquinolones

Finasteride (Proscar)

blocks the enzyme 5-alpha reductase necessary for the conversion of testosterone to DHT. Prostate size is directly related to DHT. Blocked DHT- decrease in prostate size

nephrostomy tubes

cathter is inserted into pelvis of kidney; done in advanced disease or palliative procedure

benign prostatic hyperplasia

condition in which the prostate gland increases in size, leading to disruption of the outflow of urine form the bladder to the urethra.

orthostopic bladder reconstruction orthtopic neobladder

construction of a new bladder in the bladder's normal anatomic position with discharge of the urine through the urethra

incontinent urinary diversions

diversion to the skin requiring an appliance; ileal conduit cutaneous ureterostomy

Bethanecol

muscarinic agonist -enhances bladder contractions

50 - 75 mL

normal PVR

ureteral catheters Inserted by: 1) threaded up the urethra and bladder to the ureters under cytoscopic observation 2) surgical insertion through the abdominal wall into the ureters

placed through the ureters into the renal pelvis.

5-alpha reductase inhibitors

reduce size of prostate gland

Alpha Adrenergic Blockers e.g doxazosin, Cardura

relax the smooth muscle in the ureter can be used to facilitate stone passage also used to relax the muscle tissue in the prostate in men with BPH

TURP (transurethral resection of the prostate)

removal of prostate tissue using a resectoscope inserted through the urethra to excise and cauterize obstructing prostatic tissue.

suprapubic catheter Insertion into the bladder: 1) through a small incision in the abdominal wall 2) by the use of a trocar

simplest and oldest method of urinary diversion

Dihydrotestosterone (DHT)

stimulates prostate cell growth -excess amounts cause overgrowth of prostate

-dysuria -urgency -hesitancy -incontinence -retention -cloudy or foul-smelling urine -fever, chills, flank-pain with upper tract (pyelonephritis)

symptoms of UTI

urinalysis

the examination of urine to determine the presence of abnormal elements. In UTI- presence of nitrites ( indicating bacteriuria ) , WBC, leukocyte esterase ( enzyme present in WBC, indicating pyuria)

Phenazopyridine (Pyridium)

topical analgesic of the urinary tract mucosa associated with UTI

SOUR FooT Stress incontinence Overflow incontinece Urge incontinence Reflex incontinence Functional incontinence Trauma ( from surgery)

types of urinary incontinence

cuteneous ureterostomy

ureters are excised from bladder and brought through abdominal wall , stoma is created

Ileal conduit (ileal loop)

urinary diversion in which the client must wear an external pouch over the stoma to collect the continuous flow of urine

Baclofen or Diazepam

used for Reflex incontinence -relaxes internal sphincter

anticholonergics

used for Urge incontinence -relaxes bladder tone and increases sphincter tone

< 4mm stone

will spontaneously pass