Professional Documents
Culture Documents
Urinary Disorders 2
Urinary Disorders 2
Urinary Disorders 2
o A patient is scheduled for cystometrography. Which instructions will the nurse provide to the
patient about this procedure?
a) The patient will urinate into a specialized toilet to measure the voiding pressure.
b) Water will be instilled into the bladder through a catheter to assess bladder tone.
Rationale: Cystometrography is an evaluation of bladder tone, sensations of filing,
and bladder stability. Water or saline is instilled into the bladder through a urinary
catheter.
c) The patient will urinate into a container to measure the time and volume of urine
excretion.
d) The bladder will be filled with contrast media, and fluoroscopic images will be taken
during voiding.
o The nurse is caring for a patient who has just undergone cystoscopy. Which assessment finding
necessitates an immediate intervention by the nurse?
a) Back pain
b) Bright red urine
Rationale: Bright red urine is not expected after a cystoscopy. Burning on
urination, pink-tinged urine, and urinary frequency are expected effects.
c) Urinary frequency
d) Burning on urination
Diagnostic Studies
o History and physical examination
o Dipstick urinalysis
Identify presence of nitrites, WBCs,
and leukocyte esterase
o Urine for culture and sensitivity (if indicated)
Clean-catch sample preferred
Specimen by catheterization or suprapubic needle aspiration more accurate
Determine bacteria susceptibility to antibiotics
o Imaging studies
CT urography or ultrasonography when obstruction suspected
Collaborative Care - Drug Therapy
o Antibiotics
Selected on empiric therapy or results of sensitivity testing
Uncomplicated cystitis
Short-term course (1 to 3 days)
Complicated UTIs
Long-term treatment (7 to 14 days)
Trimethoprim/sulfamethoxazole (TMP/SMX)
Used to treat uncomplicated or initial UTI
Inexpensive
Taken twice a day
E. coli resistance to TMP-SMX
Nitrofurantoin (Macrodantin)
Given three or four times a day
Long-acting preparation (Macrobid) is taken twice daily
Ampicillin, amoxicillin, cephalosporins
Treat uncomplicated UTI
Fluoroquinolones
Treat complicated UTIs
Example: ciprofloxacin (Cipro)
o Antifungals
Amphotericin or fluconazole
UTIs secondary to fungi
o Urinary analgesic
Phenazopyridine (Pyridium)
Used in combination with antibiotics
Provides soothing effect on urinary tract mucosa
Stains urine reddish orange
o Can be mistaken for blood and may stain underclothing
o Prophylactic or suppressive antibiotics sometimes administered to patients with repeated UTIs
Nursing Management
o Nursing Assessment
Health history
Previous UTIs, calculi, stasis, retention, pregnancy, STIs, bladder cancer
Antibiotics, anticholinergics, antispasmodics
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Urologic instrumentation
Urinary hygiene
Nausea, vomiting, anorexia, chills, nocturia, frequency, urgency
Suprapubic/lower back pain, bladder spasms, dysuria, burning sensation on
urination
Objective data
Fever
Hematuria, foul-smelling urine, tender, enlarged kidney
Leukocytosis, positive findings for bacteria, WBCs, RBCs, pyuria, ultrasound, CT
scan, IVP
Nursing Diagnoses
Impaired urinary elimination
Readiness for enhanced self-health management
Planning
Patient will have
Relief from lower urinary tract symptoms
Prevention of upper urinary tract involvement
Prevention of recurrence
Nursing Implementation
Health promotion
Recognize individuals at risk
o Debilitated persons
o Older adults
o Underlying diseases (HIV, diabetes)
o Taking immunosuppressive drug or corticosteroids
Emptying bladder regularly and completely
Evacuating bowel regularly
Wiping perineal area front to back
Drinking adequate fluids
Avoid unnecessary catheterization and early removal of indwelling catheters
Aseptic technique must be followed during instrumentation procedures
Wash hands before and after contact
Wear gloves for care of urinary system
Routine and thorough perineal care for all hospitalized patients
Avoid incontinent episodes by answering call light and offering bedpan at
frequent intervals
Acute intervention
Adequate fluid intake
o Dilutes urine, making bladder less irritable
o Flushes out bacteria before they can colonize
o Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods
Potential bladder irritants
Evaluation
The patient with a UTI will
Experience normal urinary elimination patterns
Report relief of bothersome urinary tract symptoms
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o Acute kidney injury (AKI), previously known as acute kidney failure, is the term used to
encompass the entire range of the syndrome, including a very slight deterioration in kidney
function to severe impairment.
o AKI is characterized by a rapid loss of kidney function. This loss is accompanied by a rise in
serum creatinine level and/or a reduction in urine output. The severity of dysfunction can range
from a small increase in serum creatinine or reduction in urine output to the development of
azotemia (an accumulation of nitrogenous waste products [urea nitrogen, creatinine] in the
blood).
o AKI can develop over hours or days with progressive elevations of blood urea nitrogen (BUN),
creatinine, and potassium, with or without a reduction in urine output.
Etiology and Pathophysiology
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o
Phases of ARF
o Oliguria Phase
o Diuretic Phase
o Recovery Phase
o ** If a patient does not recover from AKI it can progress to CKD
o
Clinical Manifestations
o Oliguric phase
Urinary changes
Urinary output less than 400 mL/day
Occurs within 1 to 7 days after injury
Lasts 10 to 14 days
Urinalysis may show casts, RBCs, WBCs
Waste product accumulation
Elevated BUN and serum creatinine levels
Neurologic disorders
Fatigue and difficulty concentrating
Seizures, stupor, coma
Fluid volume
With decreased urine output, fluid retention occurs
o Neck veins distended
o Bounding pulse
o Edema
o Hypertension
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Fluid overload can lead to heart failure, pulmonary edema, and pericardial and
pleural effusions
Metabolic acidosis
Serum bicarbonate level decreases
Severe acidosis develops
o Kussmaul respirations
Sodium balance
o Increased excretion of sodium
o Hyponatremia can lead to cerebral edema
Potassium excess
o Usually asymptomatic
o ECG changes
o Diuretic phase
Daily urine output is 1 to 3 L
May reach 5 L or more
Monitor for hyponatremia, hypokalemia, and dehydration
o Recovery phase
May take up to 12 months for kidney function to stabilize
Q&A: Which assessment would indicate to the nurse that a patient has oliguria related to an intrarenal
acute kidney injury?
a) Urinary sodium levels are low.
b) The serum creatinine level is normal.
c) Oliguria is relieved after fluid replacement.
d) Urine testing reveals a specific gravity of 1.010.
Rationale: The urine specific gravity in oliguria of intrarenal acute kidney injury will be
fixed at 1.010. This value reflects tubular damage with loss of concentrating ability by the
kidneys. The serum creatinine level is above normal in oliguria of intrarenal acute kidney
injury. Urinary secretion of sodium increases with oliguria of intrarenal acute kidney
injury. Prerenal oliguria related to hypovolemia will usually respond to fluid replacement.
Diagnostic studies
o Thorough history
o Serum creatinine
o Urinalysis
o Kidney ultrasonography
o Renal scan
o Computed tomography (CT) scan
o Renal biopsy
o Contraindicated
Magnetic resonance imaging (MRI)
Magnetic resonance angiography (MRA) with gadolinium contrast medium
Nephrogenic systemic fibrosis
Contrast-induced nephropathy (CIN)
Collaborative care
o Primary goals
Eliminate the cause
Manage signs and symptoms
o Prevent complications
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Dialysis
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o
Peritoneal Dialysis
o Peritoneal access is obtained by inserting a catheter through the anterior abdominal wall
o Technique for catheter placement varies
o Usually done via surgery
o Tenckhoff Catheter
o
o
o
o
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o Dialyzers
Long plastic cartridges that contain thousands of parallel hollow tubes or fibers
Fibers are semipermeable membranes
o Hemodialysis Procedure
Two needles placed in fistula or graft
One needle is placed to pull blood from the circulation to the HD machine
The other needle is used to return the dialyzed blood to the patient
o Components of Hemodialysis
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Kidney Transplantation
Very successful
One-year graft survival rate
o Cadaver transplants: 90%
o Live donor transplants: 95%
Advantages of kidney transplantation over dialysis
o Reverses many of the pathophysiologic changes associated with renal failure
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o
Immunosuppressive Therapy
o Goals
Adequately suppress the immune response
Maintain sufficient immunity to prevent overwhelming infection
Complications
o Rejection
Acute rejection
Occurs days to months after transplantation
Chronic rejection
Process that occurs over months or years and is irreversible
Infection
CV Disease
Malignancies
Recurrance of Renal Disease
Steriod-Related Complications
Q&A: Six days after kidney transplantation from a deceased donor, a patient develops a temperature of
101.2 F (38.5 C), tenderness at the transplant site, and oliguria. The nurse recognizes that these
findings indicate
a) Acute rejection, which is not uncommon and is usually reversible.
b) Hyperacute rejection, which will necessitate removal of the transplanted kidney.
c) An infection of the kidney, which can be treated with IV antibiotics.
d) The onset of chronic rejection of the kidney with eventual failure of the kidney.
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