Urinary1. Anuria: urine output less than 100 ml/24 hrs2. Oliguria: less than 30 - 50 ml per hour or 100 - 400 ml/24 hrs3. Polyuria: unusually large amounts of urine output4. Frequency: voiding more often than Q2H5. Urgency: strong sudden urge to void6. Dysuria: burning (pain) on urination7. Nocturia: frequent need to urinate at night8. Hesitancy: difficulty starting a stream of urine (BPH)9. Residual: urine left in the bladder after voiding10. Retention: the amount of urine left in the bladderUTI- 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 burning pain- Diet modification- avoid caffeine, chocolate, alcohol, spicy, INCREASE fluids to 3-4L/dayUroseposis a gram-negative bacteremia originating in the genitourinary tract…can lead to septisis and deathwithout aggressive, immediate treatment Most common is E-coli Hypo, mental status changes, feverBladder 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 MDUrinary 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- TYPESo Calciumo Oxalateo Struviteo Uric acido Cystineo Xanthene- Symptoms/ Diagnosiso Sharp sudden onset of pain- severeo Infection- UTI, fevero Nausea/Vomiting from pain and obstructiono KUB (kidney, ureter, bladder)- x-ray for location of stoneo IVP (Intravenous Pylogram)- use dye to highlight (need bowel prep) o Cysto- visualize/remove stone- Managemento Increase fluid to 3-4 liters/day Help flush out stoneo Reduce pain Antispasmotics (Ditropan)o Prevent calculi formation Identify stone make-up and change dieto Dietary changes Less Calcium, more water!Urinary retention is a manifestation of another pathologic condition-post void residual >100mlCauses Sensory input to/from bladder Muscle tension, anxiety Neurologic conditionsBenign 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 signso Manage Continuous Bladder Irrigation (CBI) Regulate flow based on urine coloro Document urine coloro Accurate I&Oo Pain Management CONTINUOUS BLADDER IRRIGATION (CBI)o Insertion of a Three Way Cathetero Continuous infusion of 0.9% solution (isotonic)o Presence of Clots: increase the irrigation rateo Total output minus the amount of irrigation solution used = urine outputo Catheter Patency is critical- If urine is very bloody, speed up the irrigation flow, so that clots do not formIncontinence1. Stress urinary incontinence2. Detrusor over-activity – “urge incontinence”3. Overflow urinary incontinence4. 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 lbGlomerulonephritis 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 syndromeNephrotic 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 nephrologistAcute Renal Failure Abrupt loss of Kidney function -days to weeks Glomerular filtration rate decreases - serum creatinine increases - blood urea nitrogen increase (BUN) Urine output decreasesClassification 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, tumorsChronic Kidney Failure- Kidney damage for 3 months. CAUSES- DM & HYPERTENSIONHemodialysis 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, dizziness 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 through the filterPeritoneal 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
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