NCM 112 – Lecture o Congenital abnormalities

Urinary Disorders (UTI & URINARY STONE FORMATION) o Urethral strictures

o Contracture of the bladder neck
CLASSIFYING URINARY TRACT INFECTIONS o Bladder tumors
 Urinary tract infections (UTIs) are classified by o Calculi (stones) in the ureters or kidneys
location: o Compression of the ureter
 The lower urinary tract (which includes the
bladder and structures below the bladder) or the ASSESSMENT AND DIAGNOSTIC FINDINGS
upper urinary tract (which includes the kidneys  Urinalysis
and ureters).  Urine Cultures
 They can also be classified as uncomplicated or  X-ray images, computed tomography (CT) scan,
complicated ultrasonography, and kidney scans
 UTIs.
MEDICAL MANAGEMENT
LOWER UTI’S  Management of UTIs typically involves
 Cystitis pharmacologic therapy and patient education.
 Prostatitis  Various prescribed medication regimens are used
 Urethritis to treat UTI.
 Acute Pharmacologic Therapy
 Long-Term Pharmacologic Therapy
UPPER UTIS  Although brief pharmacologic treatment of UTIs
 Acute Pyelonephritis for 3 days is usually adequate in women, infection
 Chronic Pyelonephritis recurs in about 20% of women treated for
 Renal Abscess uncomplicated UTIs. Infections that recur within 2
 Interstitial Nephritis weeks of therapy do so because organisms of the
 Perirenal Abscess original offending strain remain.

UNCOMPLICATED LOWER OR UPPER UTIS NURSING CARE OF THE PATIENT WITH A LOWER UTI
 Community-acquired infection; common in young FOCUSES ON TREATING THE UNDERLYING INFECTION
women and not usually recurrent AND PREVENTING ITS RECURRENCE
Assessment:
COMPLICATED LOWER OR UPPER UTIS  A history of pertinent signs and symptoms is
 Often acquired in the hospital and related to obtained from the patient with a suspected UTI.
catheterization; occur in patients with urologic  The presence of pain, frequency, urgency,
abnormalities, pregnancy, immunosuppression, hesitancy, and changes in urine are assessed,
diabetes, and obstructions and are often documented, and reported
recurrent
NURSING DIAGNOSIS
CONTRIBUTING CONDITIONS SUCH AS:  Acute pain related to infection within the urinary
 Female gender tract
 Diabetes  Deficient knowledge about factors predisposing
 Pregnancy the patient to infection and recurrence, detection
 Neurologic disorders and prevention of recurrence, and pharmacologic
therapy
 Gout
 Acute kidney injury and/or chronic kidney disease
 Altered states caused by incomplete emptying of
may occur as the long-term result of either an
the bladder and urinary stasis
extensive infective or inflammatory process
 Decreased natural host defenses or
immunosuppression
PLANNING AND GOALS
 Inability or failure to empty the bladder
 Major goals for the patient may include relief of
completely
pain and discomfort, increased knowledge of
 Inflammation or abrasion of the urethral mucosa
preventive measures and treatment modalities,
 Instrumentation of the urinary tract (e.g.,
and absence of complications.
catheterization, cystoscopic procedures)
 Obstructed urinary flow caused by:
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NURSING INTERVENTIONS CAUSES OF HYPERCALCEMIA (HIGH SERUM CALCIUM) AND
 Relieving pain HYPERCALCIURIA (HIGH URINE CALCIUM) MAY INCLUDE THE
 Monitoring and managing potential complications FOLLOWING:
 Hyperparathyroidism
EVALUATION  Renal tubular acidosis
1. Experiences relief of pain  Cancers (e.g., leukemia, multiple myeloma)
a. Reports absence of pain, urgency, frequency,  Dehydration
nocturia, or hesitancy on voiding  Granulomatous diseases (e.g., sarcoidosis,
b. Takes analgesic, antispasmodic, and antibiotic tuberculosis), which may cause increased vitamin D
agents as prescribed production by the granulomatous tissue
2. Explains UTIs and their treatment  Excessive intake of vitamin D
a. Demonstrates knowledge of preventive  Excessive intake of milk and alkali
measures and prescribed  Myeloproliferative diseases such as polycythemia
vera, which produce an unusual proliferation of
b. Treatments
blood cells from the bone marrow.
c. Drinks 8 to 10 glasses of fluids daily
d. Voids every 2 to 3 hours
CLINICAL MANIFESTATIONS
e. Produces urine that is clear and odorless (Signs and symptoms of stones in the urinary system depend
3. Experiences no complications on the presence of obstruction, infection, and edema)
a. Reports no symptoms of infection (fever,  Chills
frequency)  Fever
b. Has normal kidney function, negative urine  Frequency
and blood cultures  Pain
c. Exhibits normal vital signs and temperature;  Discomfort
no signs or symptoms of sepsis (urosepsis)  Hematuria
d. Maintains adequate urine output more than  Pyuria
0.5 mL/kg/h.  Nausea and Vomiting occur

HEALTH EDUCATION ASSESSMENT AND DIAGNOSTIC FINDINGS

The nurse instructs the patient on the following basic  Noncontrast CT scan
information:  Blood chemistries
1. Hygiene  24-hour urine test for measurement of calcium, uric
2. Fluid Intake acid, creatinine, sodium, pH, and total volume
3. Voiding Habits  Stone analysis
4. Take medication exactly as prescribed
5. For recurrent infection, consider acidification of the MEDICAL MANAGEMENT
urine through ascorbic acid (vitamin C), 1000 mg
 Opioid analgesic agents
daily, or daily consumption of cranberry juice.
 Nonsteroidal anti inflammatory drugs (NSAIDs)
6. Notify the primary provider if fever occurs or if signs
 Thiazide diuretics
and symptoms persist.
 Allopurinol (Zyloprim) – uric
URINARY STONE FORMATION
NUTRITIONAL THERAPY
PATHOPHYSIOLOGY  Fluid intake is the mainstay of most medical therapy
 Stones are formed in the urinary tract when urinary for kidney stones.
concentrations of substances such as calcium  Calcium-based kidney stones were recommended to
oxalate, calcium phosphate, and uric acidincrease. restrict calcium in their diet
 Referred to as supersaturation, this depends on the
amount of the substance, ionic strength, and pH of
the urine.
 Stones may be found anywhere from the kidney to
the bladder and may vary in size from minute
granular deposits, called sand or gravel, to bladder
stones as large as an orange.

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PATIENT EDUCATION EVALUATION
 Avoid protein intake to decrease urinary excretion of 1. Reports relief of pain
calcium and uric acid. 2. States increased knowledge of health-seeking
 Limit sodium intake to 3–4 g/day. Table salt and behaviors to prevent recurrence
high-sodium foods should be reduced, because a. Consumes increased fluid intake (at least
sodium competes with calcium for reabsorption in eight 8-oz glasses of fluid per day)
the kidneys. b. Participates in appropriate activity
 Be aware that low-calcium diets are not generally c. Consumes diet prescribed to reduce dietary
recommended, except for true absorptive
factors predisposing to stone formation
hypercalciuria. Evidence shows that limiting calcium,
d. Recognizes symptoms (fever, chills, flank
especially in women, can lead to osteoporosis and
pain, hematuria) to be reported to primary
does not prevent stones.
 Avoid intake of oxalate-containing foods (e.g.,
provider.
spinach, strawberries, rhubarb, tea, peanuts, wheat
bran).
 Drink fluids (ideally water and one glass of
cranberry juice per day) every 1–2 hours during the
day.
 Drink two glasses of water at bedtime and an
additional glass at each nighttime awakening to
prevent urine from becoming too concentrated
during the night.
 Avoid activities leading to sudden increases in
environmental temperatures that may cause
excessive sweating and dehydration.
 Contact the primary provider at the first sign of a
urinary tract infection

SURGICAL MANAGEMENT
 Nephrolithotomy
 Pyelolithotomy
 Ureterolithotomy
 Cystotomy
 Cystolitholapaxy

NURSING DIAGNOSIS
 Acute pain related to inflammation, obstruction, and
abrasion of the urinary tract
 Deficient knowledge regarding prevention of
recurrence of kidney Stones
 Infection and urosepsis (from UTI and
pyelonephritis)
 Obstruction of the urinary tract by a stone or edema
with subsequent acute kidney injury.

PLANNING AND GOALS

 The major goals for the patient may include relief of
pain and discomfort, prevention of recurrence of
kidney stones, and absence of complications

NURSING INTERVENTIONS
 Relieving pain
 Monitoring and managing potential complications
 Educating patients about self-care.
 Need to be reported to the primary provider if
complication arises.