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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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UT NURS 3120 - Urinary

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