Renal and Urinary System • • • Kidney function Urological Assessment Nursing History ▫ ▫ ▫ ▫ ▫ ▫ ▫ Reason for seeking care Current
illness Previous illness Family History Social History Sexual history Urological Assessment
Key Signs and Symptoms of Urological Problems EDEMA • associated with fluid retention Renal dysfunctions usually produce ANASARCA
Key Signs and Symptoms of Urological Problems PAIN Suprapubic pain= bladder Colicky pain on the flank= kidney Urological Assessment
Key Signs and Symptoms of Urological Problems HEMATURIA Painless hematuria may indicate URINARY CANCER! Early-stream hematuria= urethral lesion Late-stream hematuria= bladder lesion
Key Signs and Symptoms of Urological Problems DYSURIA • Pain with urination= lower UTI
Key Signs and Symptoms of Urological Problems POLYURIA OLIGURIA ANURIA • Less than 50 mL per day Less than 400 mL per day More than 2 Liters urine per day
Key Signs and Symptoms of Urological Problems Urinary Urgency - is a sudden, compelling urge to urinate Urinary retention - also known as ischuria is a lack of ability to urinate Urinary frequency - Urinating too often, at too frequent intervals, not due to an unusually large volume of urine, but rather to a decrease in the capacity of the bladder to hold urine. • Urological Assessment
PHYSICAL EXAMINATION Inspection Auscultation Percussion Palpation • Urological Assessment
Urinalysis 2. Serum electrolytes 4. limit fluid as directed Weigh client daily to detect fluid retention Implementation Steps for selected problems
Ensure Adequate urinary elimination • • Encourage to void at least every 2-3 hours Promote measures to relieve urinary retention: ▫ ▫ Alternating warm and cold compress Bedpan
.1. BUN and Creatinine levels of the serum 3. Urological Assessment Laboratory examination Radiographic ▫ ▫ ▫ ▫ ▫ • IVP KUB x-ray KUB ultrasound CT and MRI Cystography
Implementation Steps for selected problems
Provide PAIN relief • • • Assess the level of pain Administer medications usually narcotic ANALGESICS Implementation Steps for selected problems
Maintain Fluid and Electrolyte Balance • • • • Encourage to consume at least 2 liters of fluid per day In cases of ARF.
and specific gravity of the urine Palpation of the abdomen for suprapubic tenderness Percussion of the flanks for costovertebral angle tenderness Prostate examination Subjective assessment for symptoms. such as blood dyscrasias.
. frequency. Bright red bloody urine indicates lower urinary tract bleeding. anticholinergics.
Thorough assessment of the urinary tract includes: • • • • • • • Hourly intake and output measurement Assessment of color. such as urgency. aminoglycoside antibiotics. such as nonsteroidal anti-inflammatory drugs.blood in the urine. clarity. Color of bloody urine depends on several factors including the amount of blood present and the anatomical source of the bleeding. rusty urine indicates bleeding from the upper urinary tract. hematuria. diabetes. and hypertension. Painless hematuria may indicate neoplasm in the urinary tract. hesitancy. nocturia. ▫ ▫ Considered a serious sign and requires evaluation. and those with prostate and other diseases of the urinary tract. and incontinence Be alert to drugs that may impair urinary and renal function. anticoagulant therapy.
Hematuria may be due to a systemic cause. ▫ ▫ Dark. dribbling. sympathomimetics. hypotensive patients.▫ ▫ ▫
Open faucet Provide privacy Catheterization if indicated
STANDARDS OF CARE GUIDELINES • Patients at risk for renal impairment include those with cardiovascular disease. decreased force of stream. Changes in Micturition (Voiding)
Changes in Amount or Color of Urine • Hematuria . or extreme exercise. postoperative patients.
pain or difficult urination.
Oliguria . such as infection and diseases of urinary tract. • Due to inflammatory conditions of the bladder.large volume of urine voided in given time.voiding occurs more commonly than usual when compared with the patient's usual pattern or with a generally accepted norm of once every 3 to 6 hours. or urethra.small volume of urine.
Hematuria is common in patients with urinary tract stone disease and may also be seen in renal tuberculosis.
Frequency . May result from acute renal failure. hypertension. chronic renal disease. neurogenic voiding dysfunctions.strong desire to urinate that is difficult to postpone. • • Volume is out of proportion to usual voiding pattern and fluid intake. and trauma to the kidneys or urinary tract.
. • • • Output less than 50 mL/24 hours.excessive urination at night. Indicates serious renal dysfunction requiring immediate medical intervention. Symptoms Related to Irritation of the Lower Urinary Tract
Dysuria .absence of urine output. polycystic disease of kidneys. • Increasing frequency can result from a variety of conditions. use of diuretics. which interrupts sleep. chronic prostatitis or bladder outlet obstruction in men. and urogenital atrophy in postmenopausal women. shock. fluid and electrolyte imbalance
Anuria . diabetes insipidus. • Burning sensation seen in wide variety of inflammatory and infectious urinary tract conditions. acute or chronic bacterial infections. dehydration. acute pyelonephritis.
Polyuria . prostate. metabolic disease. Demonstrated in diabetes mellitus. • • Output between 100 and 500 mL/24 hours. medications (diuretics). thrombosis and embolism involving renal artery or vein.
may be due to pathologic. Seen in severe cystitis and interstitial cystitis. but is generally seen in the more acute conditions of the urinary tract. Metabolic causes include decreased renal concentrating ability or heart failure.prolonged dribbling or urine from the meatus after urination is complete. Incomplete emptying . severity related to how quickly it develops. neurogenic bladder.
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. May be physiologic during early childhood. leads to infection. May be caused by bladder outlet obstruction. colicky pain felt in the flank area that radiates to the groin or testicle.decreased force of stream when compared to usual stream of urine when voiding. Due to distention of the renal capsule.undue delay and difficulty in initiating voiding. or overactive bladder.
May indicate compression of urethra.feeling that the bladder is still full even after urination. outlet obstruction. or physiologic factors affecting the urinary tract Enuresis . Involuntary Voiding Urinary incontinence .
Strangury . anatomical. • • • • • Blood staining may be noted.involuntary voiding during sleep. and the increased urine production at rest that occurs with aging.may be felt as a dull ache in costovertebral angle. Indicates either urinary retention or a condition that prevents the bladder from emptying well. Symptoms Related to Obstruction of the Lower Urinary Tract Weak stream . only small amounts of urine voided.slow and painful urination. Urinary Tract Pain Genitourinary (GU) pain is not always present in renal disease. may be functional or symptomatic of obstructive or neurogenic disease (usually of lower urinary tract) or dysfunctional voiding. • • Terminal dribbling .• •
Causes include urologic conditions affecting bladder function.involuntary loss of urine. poor bladder emptying. Hesitancy . diabetes mellitus. thereafter. or may be a sharp. Kidney pain . bladder outlet obstruction.
to the suprapubic area. or from urethritis due to infection or trauma.due to inflammatory swelling of epididymis or testicle. Back and leg pain . tar.•
Ureteral pain . or torsion of the testicle. orchitis. contact with chemicals. penile shaft pain is from urethral problems. What is the past medical and surgical history. torsion of spermatic cord.
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History • What are the patient's present and past occupations? Look for occupational hazards related to the urinary tract. Pain in glans penis is usually from prostatitis. Testicular pain . prostatic abscess. Bladder pain (lower abdominal pain or pain over suprapubic area) . and urethra if the lower ureter is the source. Pain in scrotal area . pain increases when voiding.felt in the back and radiates to the groin or scrotum if the upper ureter is the source. penis. from foreign body in canal. Perineal or rectal discomfort .may be due to bladder infection or overdistended bladder.due to cancer of prostate with metastases to bone. also truck or school bus drivers. plastics.due to injury. especially in relation to urinary problems? Is there any family history of renal disease?
What childhood diseases did the patient have? • • • • Is there a history of urinary tract infections (UTIs)? Did any occur before age 12? Did enuresis continue beyond the age when most children gain control? Any history of genital lesions or sexually transmitted diseases (STDs)? For the female patient: Number of children? Vaginal or cesarean delivery? Any forceps deliveries? When? Any signs of vaginal discharge? Vaginal/vulvar itch or irritation? Family history of pelvic organ prolapse (dropped bladder or uterus) or urinary incontinence?
DIAGNOSTIC TESTS/LABORATORY STUDIES
.from irritation of bladder neck. rubber.due to acute prostatitis. Urethral pain . mumps.
Most sensitive indication of early renal disease. There is no single test of renal function. Most sensitive test of renal function. best results are obtained by combining a number of clinical tests. to evaluate the severity of kidney disease. Renal function is variable from time to time. Measures volume of blood cleared of creatinine in 1 minute. and to follow the patient's progress. Useful to follow progress of the patient's renal status. this test detects early defects in renal function
Creatinine clearance • • • • Provides a reasonable approximation of rate of glomerular filtration.
Nursing and Patient Care Considerations • Renal function may be within normal limits until about 50% of renal function has been lost. hence.
Serum creatinine • • A test of renal function reflecting the balance between production and filtration by renal glomerulus.
Renal concentration test • • Specific gravity Osmolality of urine
Purpose/Rationale • • Tests the ability to concentrate solutes in the urine.Tests of Renal Function • Renal function tests are used to determine effectiveness of the kidneys' excretory functioning.
Serum urea nitrogen (Blood urea nitrogen [BUN]) • Serves as index of renal excretory capacity. Concentration ability is lost early in kidney disease.
Patients who have undergone treatment for prostate cancer are monitored periodically with PSA levels for recurrence. Level rises continuously with the growth of prostate cancer.
Prostate-Specific Antigen • • • • PSA is an amino acid glycoprotein that is measured in the serum by a simple blood test. PSA
Nursing and Patient Care Considerations • • No patient preparation is necessary. An elevated PSA indicates the presence of prostate disease. white cell casts in pyelonephritis). Proteinuria >150 mg/24 hours may indicate renal disease.
Urine casts • Mucoproteins and other substances present in renal inflammation. (Urea is the nitrogenous end-product of protein metabolism. although this association has not been proved. help to identify type of renal disease (eg. but is not exclusive to prostate cancer.
Protein • Random specimen may be affected by dietary protein intake. red cell casts present in glomerulonephritis. Normal serum PSA level is less than 4 mg/mL.• •
Serum urea nitrogen depends on the body's urea production and on urine flow. fatty casts in nephrotic syndrome.
Microalbumin/Creatinine ratio • Sensitive test for the subsequent development of proteinuria. to prevent artificial elevation of PSA level.) Affected by protein intake. tissue breakdown. Some clinicians prefer not to perform digital rectal examinations of the prostate at the same time that a PSA is drawn.
. >30 mcg/mg creatinine predicts early nephropathy. Levels less than 10 mg/mL may be indicative of benign prostatic hyperplasia (BPH) and not necessarily prostate cancer.
and osmolality as well as microscopic evaluation for the presence of normal and abnormal cells. colloidal particles. fat.normal urine is clear. Abnormally cloudy urine due to pus (pyuria). porphyria. Offensive odor may be due to bacterial action in presence of pus.
. Cloudy urine (phosphaturia) is not always pathologic. blood. may normally vary from 4. Appearance . Dark brown or black due to malignant melanoma. Characteristic odors produced by ingestion of asparagus. pH of urine reflects the ability of kidney to maintain normal hydrogen ion concentration in plasma and extracellular fluid. specific gravity. or lymph fluid (chyluria).6 to 7.
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Color shows degree of concentration and depends on amount voided. pH should be measured in fresh urine because the breakdown of urine to ammonia causes urine to become alkaline. spermatozoa. Concentrated urine is highly colored. phosphate. indicates acidity or alkalinity of urine. epithelial cells. pH.normal urine has a faint aromatic odor. prostatic fluid. a sign of insufficient fluid intake. Dilute urine is straw-colored. Red or red-brown due to blood pigments. bleeding lesions in urogenital tract. chyle. fat droplets.urea-splitting bacteria such as Proteus. some drugs and food (beets). Normal pH is around 6 (acid).•
Involves examination of the urine for overall characteristics. Normal urine may also develop cloudiness on refrigeration or from standing at room temperature. thymol. Odor . related only to the precipitation of phosphates in alkaline urine. bacteria. including appearance. • • • • • • • • Normal urine is clear yellow or amber because of the pigment urochrome. Cloudy or smoky colored may be from hematuria. leukemia.5. Cloudy urine with ammonia odor . transfusion reaction. Yellow-brown or green-brown may reveal obstructive lesion of bile duct system or obstructive jaundice. causing UTIs.
and Bladder • • • Consists of plain film of the abdomen Delineates size. Usually done before other testing. such as calcifications (stones). Average value is 300 to 1. cysts. Ureters. Specific gravity reflects the kidney's ability to concentrate or dilute urine.090 mOsm/kg for males. Urine culture and sensitivity tests are typically performed using the same specimen obtained for urinalysis.025. but is considered a more precise test.
X-ray of Kidneys. Obtain sample of about 30 mL. it is also easy. tumors. or kidney displacement
Nursing and Patient Care Considerations • • • No preparation is needed. hydronephrosis. use clean-catch or catheterization techniques. therefore.•
Urine acidity or alkalinity has relatively little clinical significance unless the patient is on a special diet or therapeutic program or is being treated for renal calculous disease. Osmolality is an indication of the amount of osmotically active particles in urine (number of particles per unit volume of water). inability to concentrate or dilute urine indicates disease. 390 to 1.
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Nursing and Patient Care Considerations • • • Freshly voided urine provides the best results for routine urinalysis. shape. It is similar to specific gravity. Patient will be asked to wear a gown and remove all metal from the X-ray field. Normal specific gravity ranges from 1.005 to 1. only 1 to 2 mL of urine are required. may reflect degree of hydration or dehydration.090 mOsm/ kg for females. and position of kidneys Reveals deviations. some tests may require first morning specimen. In a person eating a normal diet.
allergic reactions to contrast material are rare in this examination. clear liquids only in the morning). in patients receiving drug therapy for chronic bronchitis. or with suspected perforation of the ureter or bladder. Nothing by mouth (NPO) after midnight the day of the examination (if scheduled for afternoon. uncontrolled diabetes. emphysema.V. Patients with known iodine/contrast material allergy must have steroid/antihistamine preparation. or asthma and in patients taking metformin (Glucophage). The contrast medium is cleared from the bloodstream by renal excretion. in some cases.
. introduction of a radiopaque contrast medium that concentrates in the urine and thus facilitates visualization of the kidneys. May be done when intravenous pyelography (IVP) is contraindicated or if IVP provides inadequate visualization of the collecting system. ureter. Bowel preparation is necessary: ▫ ▫ ▫ Clear liquids only the day before the examination.(Intravenous Urogram) • • • • I.
Retrograde Pyelography • Injection of opaque material through ureteral catheters. RETROGRADE PYELOGRAPHY
Nursing and Patient Care Considerations • Contraindicated in patients with UTI. and bladder. IVP IVP
Nursing and Patient Care Considerations • Contraindicated in patients with renal failure. The opaque solution is introduced by gravity or syringe injection. an anesthesiologist must be available. Cathartics/laxatives are given the evening before the examination. or multiple myeloma. which have been passed up ureters into renal pelvis by means of cystoscopic manipulation.
May not be done on the same day as other studies requiring barium or contrast material. or structural abnormalities of the urethra or bladder. of only the urethra is a urethrogram. Additional X-rays may be taken after catheter is removed and patient voids (voiding cystourethrogram). catheter is threaded through the femoral and iliac arteries into the aorta or renal artery. Provide reassurance to allay patient's embarrassment.
Renal Angiography • • • • I.V. Contrast material is injected to visualize the renal arterial supply. adequate hydration is essential.
. tumors. Continue oral medications (special orders needed for diabetic patients). demonstrates abnormal vasculature. with the leg kept straight on the side used for groin access. required. and differentiates renal cysts from renal tumors. VOIDING CYSTOURETHROGRAM
Nursing and Patient Care Considerations • • • • Carries risk of infection due to instrumentation. Maintain bed rest for 8 hours after the examination. I. Used to identify injuries.V. An examination of only the bladder is a cystogram. RENAL ANGIOGRAPHY
Nursing and Patient Care Considerations • • • • • Clear liquids only after midnight before the examination.• • •
Visualization of urethra and bladder by X-ray after retrograde instillation of contrast material through a catheter. Allergy to contrast material is not a contraindication. or to evaluate emptying problems or incontinence (voiding cystourethrogram). Evaluates blood flow dynamics.
Evaluates renal size. or sitting position.
Cystoscopy • Cystoscopy is a method of direct visualization of the urethra and bladder by means of a cystoscope that is inserted through the urethra into the bladder. To allow insertion of ureteral catheters for radiographic studies. Uses include: ▫ To inspect bladder wall directly for tumor.
Nursing and Patient Care Considerations • • The patient should be well hydrated. stone. Keep sandbag at bedside for use if bleeding occurs. can be identified. illuminated view of the bladder. It has a self-contained optical lens system that provides a magnified. or obstructions.
Renal Scans • • • Radiopharmaceuticals (also called radiotracers or isotopes) are injected I.•
Observe frequently for hematoma or bleeding at access site. or before abdominal or GU surgery. Organs in the urinary system create characteristic ultrasonic images that are electronically processed and displayed as an image. position.
. A noninvasive technique.
Ultrasound • Uses high-frequency sound waves passed into the body and reflected back in varying frequencies based on the composition of soft tissues. prone. Abnormalities.V. and function or blood flow to the kidneys. shape. fluids as ordered before scan. or ulcer and to inspect urethra for abnormalities or to assess degree of prostatic obstruction. Furosemide (Lasix) or captopril (Capoten) may be administered in conjunction with the scan to determine their effects.V. Give several glasses of water or I. Studies are obtained with a scintillation camera placed posterior to the kidney with the patient in a supine. useful in differentiating between solid and fluid-filled masses. malformations. such as masses.
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To see configuration and position of ureteral orifices. Most urodynamic equipment uses computer technology with results visible in real time on a monitor. the patient may feel an urge to urinate during the examination. urinary tract hemorrhage. To remove calculi from urethra. urethra. Expect the patient to have some burning on voiding.
Nursing interventions after cystoscopic examination: • • • • • Monitor for complications: urinary retention. The patient's genitalia are cleaned with an antiseptic solution just before the examination. Increase hydration. sedation or general anesthesia may be used. where I. Because fluid flows continuously through the cystoscope.
Urodynamics • Urodynamics is a term that refers to any of the following tests that provide physiologic and functional information about the lower urinary tract. To diagnose and treat lesions of bladder. Provide routine catheter care if urine retention persists and an indwelling catheter is ordered. such as ibuprofen or acetaminophen. A local topical anesthetic (Xylocaine gel) is instilled into the urethra before insertion of cystoscope.
. bladder. and prostate. More complicated cystoscopy involving resections or ureteral catheter insertions are done in the operating room cystoscopy suite. Contraindicated in patients with known UTI. blood-tinged urine. They measure the ability of the bladder to store and empty urine. Administer or teach self-administration of antibiotics prophylactically as ordered to prevent UTI. infection within prostate or bladder.V. Advise warm sitz baths or analgesics. and ureter. to relieve discomfort after cystoscopy. and urinary frequency from trauma to mucous membrane of the urethra.
Nursing and Patient Care Considerations • Simple cystoscopy is usually performed in an office setting.
along with the simultaneous measurement of intra-abdominal pressure by way of a small tube with a fluid-filled balloon that is placed in the rectum. and the entire study is performed under fluoroscopy. encourage fluids.1. Cystometrogram .recording of the pressures exerted during filling and emptying of the urinary bladder to assess its function. Nursing and Patient Care Considerations • • • • Contraindicated in patients with UTI. EMG activity may be measured using surface (patch) electrodes placed around the anus or with percutaneous wire or needle electrodes.a record of the volume of urine passing through the urethra per unit of time (mL/s). providing radiographic pictures in combination with the recording of bladder and intra-abdominal pressures. Sphincter electromyelography (EMG) measures the activity of the pelvic floor muscles during bladder filling and emptying. Video urodynamics are reserved for patients with complicated voiding dysfunction. Frequently performed by nurses. Pressure-flow studies involve all of the above components. Uroflowmetry (flow rate) . Data about the ability of the bladder to store urine at low pressure and the ability of the bladder to contract appropriately to empty urine are obtained. The fluid used to fill the bladder is contrast material. 4. treatment. Video urodynamics use all of the above components. 3. It is shown on graph paper and gives information about the rate and flow pattern of urination. and prognosis of renal disease Nursing and Patient Care Considerations Prebiopsy nursing management
. useful in securing specimens for electron and immunofluorescent microscopy to determine diagnosis. Short-term antibiotics are commonly given to prevent infection
Needle Biopsy of Kidney • Performed by percutaneous needle biopsy through renal tissue with ultrasound guidance or by open biopsy through a small flank incision. This permits better interpretation of actual bladder pressures without the influence of intra-abdominal pressure. Patients will have burning on urination afterward (due to instrumentation). 2. essential to provide information and support throughout the test to ensure clinically significant results. 5.
and urine culture are done. urinalysis. passing from the side of higher concentration to that of lower concentration. Establish an I. including holding breath (to prevent movement of the thorax) during insertion of the biopsy needle. line. Report for follow-up 1 to 2 months after biopsy. The purpose of dialysis is to maintain the life and well-being of the patient.▫
Ensure that coagulation studies are carried out to identify the patient at risk for postbiopsy bleeding and that serum creatinine. as ordered. Notify health care provider if any of the following occur: flank pain.
DIALYSIS • Dialysis refers to the diffusion of solute molecules through a semipermeable membrane. or to determine accurate measurement of urinary drainage in critically ill patients. will be checked for hypertension. to drain urine preoperatively and postoperatively.
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Instruct the patient on the following after biopsy: • • Avoid strenuous activity. or any other signs and symptoms of bleeding. as ordered. strenuous sports. hematuria. to determine the amount of residual urine after voiding. It is a substitute for some kidney excretory functions but does not replace the kidneys' endocrine and metabolic functions. and heavy lifting for at least 2 weeks. Describe the procedure to the patient. Ensure that patient fasts for several hours before the procedure.V.
CATHETERIZATION • Catheterization may be done to relieve acute or chronic urinary retention.
Methods of dialysis include: • Peritoneal dialysis. and the biopsy area is auscultated for a bruit. ▫ ▫ Intermittent peritoneal dialysis (acute or chronic) Continuous ambulatory peritoneal dialysis. rapid pulse. lightheadedness and fainting.
It is used for patients with end-stage renal failure or for acutely ill patients who require short-term dialysis.arteriovenous connection consisting of a tube graft made from autologous saphenous vein or from polytetrafluoroethylene.
Hemodialysis • Hemodialysis is a process of cleansing the blood of accumulated waste products. or femoral). potassium. or fluid intake.direct cannulation of veins (subclavian. sodium. Central vein catheters .creation of a vascular communication by suturing a vein directly to an artery AV fistula Arteriovenous graft . Ongoing health care monitoring includes careful adjustment of medications that are normally excreted by the kidney or are dialyzable. Central venous catheter
Complications of Vascular Access • • • • • • Infection Catheter clotting Central vein thrombosis or stricture Stenosis or thrombosis Ischemia of the hand (steal syndrome) Aneurysm or pseudoaneurysm
Lifestyle Management for Chronic Hemodialysis • • • Dietary management involves restriction or adjustment of protein. Surveillance for complications.▫
Continuous cycling peritoneal dialysis uses automated peritoneal dialysis machine overnight with prolonged dwell time during day. Ready to use in 2 to 3 weeks.
Methods of Circulatory Access • • • Arteriovenous fistula (AVF) . internal jugular. may be used as temporary or permanent dialysis access.
nausea. exit-site and tunnel infections. coronary heart disease. stroke Anemia and fatigue Gastric ulcers and other problems Bone problems (renal osteodystrophy. Bleeding at catheter site. hernia formation. disturbance of lipid metabolism (hypertriglyceridemia).. Peritoneal pleural communication. Obstruction may occur if omentum becomes wrapped around the catheter or the catheter becomes caught in a loop of bowel. obstruction. distention. Hypervolemia. sexual dysfunction
Continuous Ambulatory Peritoneal Dialysis • Continuous ambulatory peritoneal dialysis (CAPD) is a form of intracorporeal dialysis that uses the peritoneum for the semipermeable membrane
Advantages Over Hemodialysis • • • • Physical and psychological freedom and independence More liberal diet and fluid intake Relatively simple and easy to use Satisfactory biochemical control of uremia
Complications • • • • • • • Infectious peritonitis. hypovolemia. Noninfectious catheter malfunction.
LOWER URINARY TRACT INFECTIONS • A UTI is caused by the presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms. GI bloating.
. aseptic necrosis of hip) from disturbed calcium metabolism Hypertension Psychosocial problems: depression. suicide.▫ ▫ ▫ ▫ ▫ ▫
Arteriosclerotic cardiovascular disease. dialysis-sate leak. Lower UTIs may predominate at the bladder (cystitis) or urethra (urethritis). heart failure.
Irritation from bubble baths 3. increasing the risk of recurrent infection. Instrumentation 5. urinary stasis • Urinary Tract Infection (UTI)
PATHOPHYSIOLOGY • The invading organism ascends the urinary tract.• • •
Urinary Tract Infection (UTI) Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli Urinary Tract Infection (UTI)
Predisposing factors include 1.
In men. and the mechanical effect of coitus. periurethral glands. Residual urine. prostatic hyperplasia) are the most frequent cause. • Urinary Tract Infection (UTI)
. irritating the mucosa and causing characteristic symptoms ▫ ▫ ▫ ▫ ▫ Ureter= ureteritis Bladder= cystitis Urethra=Urethritis Pelvis= Pyelonephritis Women are more susceptible to developing acute cystitis because of shorter length of urethra.
Poor voiding habits may result in incomplete bladder emptying. and rectum (fecal contamination). anatomical proximity to vagina. Urinary reflux 4. obstructive abnormalities (strictures. Acute infection in women most commonly arises from organisms of the patient's own intestinal flora (Escherichia coli). Poor hygiene 2.
acid-ash diet).Assessment findings • Urinary Tract Infection (UTI)
Assessment findings • • • • • • • Low-grade fever Abdominal pain Enuresis Pain/burning on urination Urinary frequency Hematuria Urinary Tract Infection (UTI)
Assessment findings: Upper UTI • • • • Fever and CHIILS Flank pain Costovertebral angle tenderness Urinary Tract Infection (UTI)
Laboratory Examination 1. Urinalysis 2. Urine Culture • Urinary Tract Infection (UTI)
Nursing interventions • • • • • • Administer antibiotics as ordered Provide warm baths and allow client to void in water to alleviate painful voiding. Force fluids. Nurses may give 3 liters of fluid per day Encourage measures to acidify urine (cranberry juice. Urinary Tract Infection (UTI) Provide client teaching and discharge planning concerning
Recurrent UTIs may indicate the following: • • Relapse . organisms are found in urine. • Urinary Tract Infection (UTI)
Pharmacology 1. Increase in foods/fluids that acidify urine. Sulfa drugs ▫ ▫ Highly concentrated in the urine Effective against E. Avoidance of tub baths b. In asymptomatic bacteriuria. Quinolones • • Bacteriuria refers to the presence of bacteria in the urine (105 bacteria/mL of urine or greater generally indicates infection). Avoidance of bubble baths that might irritate urethra c.recurrent infection with an organism distinct from previous infecting organism
Complications • • Pyelonephritis Hematogenous spread resulting in sepsis
Nursing Diagnoses • • Acute Pain related to inflammation of the bladder mucosa Deficient Knowledge related to prevention of recurrent UTI
. but the patient has no symptoms. Importance for girls to wipe perineum from front to back d.a. coli!
2.recurrent infection with an organism that has been isolated during a prior infection Reinfection .