Urinary 1 Anuria urine output less than 100 ml 24 hrs 2 Oliguria less than 30 50 ml per hour or 100 400 ml 24 hrs 3 Polyuria unusually large amounts of urine output 4 Frequency voiding more often than Q2H 5 Urgency strong sudden urge to void 6 Dysuria burning pain on urination 7 Nocturia frequent need to urinate at night 8 Hesitancy difficulty starting a stream of urine BPH 9 Residual urine left in the bladder after voiding 10 Retention the amount of urine left in the bladder UTI burning pain Uroseposis Cystis most common type Cause E coli STD Klecsiella enterobacter Symptoms burning frequency urgeny cloudy urine malaise tired mental status changes Meds Ciprofloxacin Sulfamethoxazole Bactrim Nitrofurantoin Macrobid Pyridium for Diet modification avoid caffeine chocolate alcohol spicy INCREASE fluids to 3 4L day a gram negative bacteremia originating in the genitourinary tract can lead to septisis and death without aggressive immediate treatment Most common is E coli Hypo mental status changes fever Bladder Cancer Most frequent neoplasm of the urinary tract Strong correlation with smoking Industrial exposure asbestos dyes Chronic cystitis bladder always inflamed cells begin to change to cancer cells over time Pelvic radiation can lead to bladder cancer Painless hematuria 85 of all cases Initially intermittent bleeding So do not seek medical attention and cancer grows Obstruction can t urinate takes you to MD Urinary Calculi Commonly called stones Causes o Urinary stasis crystals form more easily o Supersaturation of urine Extremely concentrated Immobility Dehydration Metabolic disturbances DM History of stones High mineral content in water UTI s TYPES o Calcium o Oxalate o Struvite o Uric acid o Cystine o Xanthene Symptoms Diagnosis o Sharp sudden onset of pain severe o Infection UTI fever o Nausea Vomiting from pain and obstruction o KUB kidney ureter bladder x ray for location of stone o IVP Intravenous Pylogram use dye to highlight need bowel prep o Cysto visualize remove stone Management o Increase fluid to 3 4 liters day Help flush out stone o Reduce pain Antispasmotics Ditropan o Prevent calculi formation Identify stone make up and change diet o Dietary changes Less Calcium more water Urinary retention is a manifestation of another pathologic condition post void residual 100ml Causes Sensory input to from bladder Muscle tension anxiety Neurologic conditions Benign Prostate Hypertrophy Avoid alpha adrenergic agonists Catapres Tenex Aldomet Avoid diphenhydramine Benadryl Care with antidepressants antipsychotics calcium channel blockers TRANS URETHRAL RESECTION OF PROSTATE TUR P o Monitor vital signs o Manage Continuous Bladder Irrigation CBI Regulate flow based on urine color o Document urine color o Accurate I O o Pain Management CONTINUOUS BLADDER IRRIGATION CBI o Insertion of a Three Way Catheter o Continuous infusion of 0 9 solution isotonic o Presence of Clots increase the irrigation rate o Total output minus the amount of irrigation solution used urine output o Catheter Patency is critical If urine is very bloody speed up the irrigation flow so that clots do not form Incontinence 1 Stress urinary incontinence 2 Detrusor over activity urge incontinence 3 Overflow urinary incontinence 4 Functional incontinence may be due to physical psychosocial of pharmacologic causes unrelated to the urinary system Kegal exercises bladder training q2 3h 0 5oz of fluid for every lb Glomerulonephritis is caused by immunologic reaction that produces inflammation in the glomerular structure Large immune complexes that damage the kidney Acute or chronic Manifested by Nephrotic syndrome Nephritic syndrome Nephrotic Syndrome Protein wasting loss in urine Secondary to diffuse glomerular damage Leads to edema Causes Glomerulonephritis Systemic disorders Allergic reactions Complications Extracellular fluid accumulation Renal failure Treatment Heal the leaking glomerular membrane and stop the protein from leaking into the urine Maintain fluid and electrolytes Reduce inflammation Prevent thrombosis Minimize protein loss Emotional support Manifestations Hematuria Oliguria Urine output 400 ml in 24 hours Hypertension Elevated BUN Decreased GFR glomerular filtration rate Kidney Cleans blood removes waste Filters out waste products Maintains body chemical balance Controls blood pressure Helps to make Red Blood Cells RBC s PROTECTION Keep BP under control Reduce proteinuria Hemoglobin HgA1C 7 Medication adjustments for GFR 50 Avoid Nephrotoxic drugs Education diet fluids Early referral to nephrologist Acute Renal Failure Abrupt loss of Kidney function days to weeks Glomerular filtration rate decreases serum creatinine increases blood urea nitrogen increase BUN Urine output decreases Classification of Renal Failure Pre renal decrease blood flow to kidney Blood loss burns diuretics Tachy hypo dry flat veins coma Intra renal paranchymal changes kidney tissues Acute tubular necrosis strep B e coli Hypovolemia vomit cool lethargy confusion Post renal obstruction in urinary tract BPH stones tumors Chronic Kidney Failure Kidney damage for 3 months CAUSES DM HYPERTENSION Blood is filtered of toxins and extra fluid removed Hooked to a machine for 4 hours 3 times per week Can be significant physiologic changes in that 4 hours so watch for B P changes confusion Some medications are dialyzed out so hold meds as instructed Anti hypertensives are generally not given since they want the B P high enough to push blood Hemodialysis dizziness through the filter Peritoneal Dialysis Hypertonic fluid instilled through special catheter into the abdomen strict sterile technique Fluid remains for 6 8 hours Fluid drained out by gravity measured carefully should have more fluid than what went in Can easily be managed at home