NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Urinary Tract Infections Urethritis Etiology/Pathophysiology (Possible Causative and Risk Factors) Short urethra predisposes women -Close proximity of urethra to rectum Decreased estrogen in aging women leads to urethral atrophy -sexual intercourse, hygiene sprays, pregnancy, urinary catheters can lead to introduction of bacteria to the urinary tract causing infection Infection induced inflammation of the urethra Infectious or due to post trauma Typically caused by STD Clinical Manifestations Diagnostic Tests -Lower back or abdominal discomfort over bladder -Urinary frequency and urgency -Dysuria, bladder cramping and spasms -feeling of incomplete bladder emptying -Hematuria -Pyuria, fever -vomiting -cloudy urine - Elders→ confusion Frequently asymptotic -Urinalysis and urine culture and sensitivity -Client must clean catch urine -Bacteria, sediment and WBC would be expected findings -WBC count -STI testing Yellow, brown, green or bloodtinged discharge Dysuria, itching, orchialgia (heaviness in genitals-male) Nursing Interventions and Collaborative Management -Teaching proper technique for collection of clean -catch specimen -Promote fluid intake 3L -Administer antibiotics as prescribed -Encourage urination every 3-4 hours instead of waiting until bladder is completely full -Encourage showers daily -Avoid indwelling U-Cath -Educate on medications/ antibiotics Possible Complications and Treatments/Interventions for Complications -Complications: obstruction, pyelonephritis, chronic kidney disease, septic shock -Consult with urology -Urethral culture urethral smear -Purulent urethral discharge shows evidence of urethritis - STD testing -Treat with antibiotic therapy if contracted due to STD - Spontaneously resolves over time -Have patient avoid intercourse with multiple partners as well as unprotected sex Complications are uncommon but they do exist: -cystitis -orchitis -prostatitis -epididymitis -urethral stricture -Consider urology consult if recurring 1 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications -Follow up care for those who appeared symptomatic Acute Pyelonephritis -Bacterial invasions of the renal parenchyma -Bacteria typically reaches the kidneys by ascending the lower urinary tract -Fever -Costovertebral angle pain -Nausea/vomiting -Hematuria (typically women) -Elderly -mental status change, generalized deterioration -Urinalysis through -Dipstick leukocyte esterase test (ET) pyuria -Nitrate production test (NPT) bacteriuria -CT scan MRI Antibiotic therapy (outpatient) Complicated pyelonephritis should be managed as inpatient and treated with parenteral antibiotics Monitor urine and blood culture results Maintain adequate hydration Sepsis Renal vein thrombosis Papillary necrosis Acute renal failure Emphysematous pyelonephritis Surgery if drainage is necessary due to abscess Immediate urologic referral for pediatric patients Obstetricians consult for pregnant patients 2 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Chronic Pyelonephritis Renal inflammation and fibrosis induced by persistent renal infection or urinary tract obstruction Can be caused due to neurogenic bladder dysfunction, risky sexual activity, pregnancy, genetic factors, and bacterial virulence factors Most common in children with major anatomical anomalies (VUR) Cause of interstitial cystitis unknown but may be due to a defect in the epithelium of the bladder May be associated with chronic pain disorders such as fibromyalgia or IB Fever lethargy nausea/vomiting flank pain dysuria Cystitis/Interstitial Cystitis/Painful Bladder Syndrome Pelvic pain Pain between anus and vagina/scrotum Persistent/urgent need to urinate Frequent small urination amounts Pain during intercourse Diagnostic Tests Ultrasound CT scan Pelvic exam Urine test Cystoscopy Bladder biopsy Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Antibiotic therapy for kids until they hit puberty if urine reflux is occurring Renal injury can be reduced with protein restriction Monitor renal function Stress importance of adhering to antibiotic therapy Surgery is suggested for those with persisting reflux after puberty Treatment based around alleviating symptoms NSAIDS Antihistamines may relieve urinary frequency and urgency Tricyclic antidepressants can help relax the bladder and block pain Acute Renal failure Hematuria Chronic or recurrent UTI Candidemia Sepsis Bladder rupture Dietitian to help understand a low protein diet Observe for progressive renal scarring as it may lead to end stage renal disease Consult a social worker or therapist to help patient deal with emotional stress and depression from chronic pain Physical therapy may help alleviate 3 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications pelvic pain TENS and sacral nerve stimulation Kidney Cancer Bladder Cancer Mutations in the DNA of kidney cells causing the abnormal cells to rapidly reproduce forming a tumor. Factors include smoking, obesity, hypertension, dialysis patients, family history, and old age One of the most common cancers affecting men more than women. Frequently develops in the urothelial cells that line the bladder. Mutated cells form a tumor and can be caused by smoking, parasitic infections, radiation exposure, and chronic irritation in the lining of the bladder Hematuria Back pain Anorexia Unexplained weight loss Fatigue Fever CT scan MRI Kidney tissue biopsy Blood/urine test Cryoablationfreezes cancer cells Radiofrequency ablationused to heat and burn cancer cells Radiation therapy Immunotherapy drugs Hematuria Pelvic pain Painful urination Back pain Frequent urination Cystoscopy Bladder biopsy Urine cytology CT scan, MRI, and bone scans can determine the extent of the nodes Surgery is the main treatment to remove the tumor or affected area of the kidney Treat and alleviate symptoms Help patient understand their diagnosis and provide comfort and an opportunity to listen to the patient’s feelings Support groups help patients and their families to cope with this diagnosis Provide coping and support for the patient Provide information for support groups Alleviate symptoms of cancer treatment regimen and for symptomatic pain Hypertension Hypercalcemia High red cell blood count Liver and spleen problems Spread of the cancer Death Anemia Swelling of ureters Urethral stricture Collaborative: Chemotherapy Radiation therapy Immunotherapy Surgical removal of tumor Bladder reconstruction for 4 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications new release of urine Mental health counseling Urinary Incontinence Urinary Retention Urethral Diverticula The loss of bladder control. Can be categorized as stress, urge, or functional incontinence. Can be caused by underlying physical or medical conditions, pregnancy, obstruction, prostate cancer, neuro disorders, or temporary based on certain foods/drinks stimulating the bladder Bladder retention due to infection, neurogenic bladder, prostate enlargement, post-op etc. outpouching forms next to urethra Stress- urine leakage when pressure exerted on the bladder by coughing, sneezing, laughing UrgeIntense sudden urge to urinate followed by involuntary urine loss Functionalphysical or mental impairment that keeps you from making it to the toilet Unable to fully empty bladder. May not be able to void at all or only small amounts. -dysuria -frequency -urgency -pain with sex -dribbling after voiding Urinalysis Bladder diary Post-void residual measurement Cough stress test Treatment is based on type of incontinence Bladder training Scheduled toileting Double voiding Explain importance of selfcare hygiene to reduce the possibility of skin breakdown and infection Anticholinergics can help to calm an overactive bladder Skin problems: rash, skin infections, sores Bladder scan -insert straight Cath -insert foley Cath -strict I&Os Extended bladder = urine leaking UTI Kidney damage -urologist -surgeon -Primary care provider -Voiding -foley care cystourethrography -suprapubic catheter care -ultrasound -administer meds as -MRI ordered Urethrovaginal fistula -surgeon 5 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests -recurrent UTIs Renal Tuberculosis Glomerulonephritis / APSGN Nephrotic Syndrome human tubercle bacillus, M. tuberculosis, bovine tubercle bacillus, M. bovis Immune mediated kidney disorder due to genetic factors or other health disorders like Lupus or diabetic nephropathy -acute usually occurs after an infection Chronic is insidious (2030y) Caused by damage to the clusters of small blood vessels in the kidneys causing them to excrete too much protein in the urine Vague, rarely show regular TB symptoms Repeated UTI, increased urinary frequency -Dysuria, flank pain Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications -urologist PPD CBC Erythrocyte sedimentation rate Serum chemistry CPR Anorexia, Nausea Dysuria, Oliguria Fatigue Hypertension, difficulty breathing Crackles, S3 heart sounds -weight gain, cola colored urine Urinalysis GFR- will be decreased Blood, skin, throat cultures serum blood urea Antistreptolysin-O Electrolytes Edema around eyes, ankles, and feet Foamy urine Weight gain due to fluid retention Fatigue Anorexia Urinalysis Kidney tissue biopsy Serum creatinine and blood urea Blood protein albumin levels - Strict I & O, fluid therapy, goal is to preserve renal function -Management of comorbid disorders Complication: infertility, superinfection, renal hypertension Nephrologist -Radiology -Surgeon Coordinate care to conserve client energy Administer antibiotics as ordered Monitor respiration status Monitor fluid and electrolytes Treat underlying medical condition Diuretics, ACE inhibitors, and statins to decrease symptoms Calcium deposits in the kidney Deterioration of kidney function Hypertension Development of cellular changes called keratinizing squamous metaplasia Acute kidney failure High blood pressure Nephrotic syndrome Blood clots Acute kidney injury Infections Chronic kidney injure Dietitian to assist patient in choosing lean protein, 6 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Urinary Tract Calculi Stricture Ureteral Urethral Nephrosclerosis Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Calculi/stones can develop in the urinary tract when the bladder does not empty completely and urine crystals form. Obstruction, infections, and conditions affecting the bladder's ability to hold urine can be a cause of stone formation Lower abdominal pain, Hematuria Burning during urination Cloudy or abnormally dark urine Physical exam Urinalysis CT, ultrasound, XRAY scarring that narrows the tube that carries urine out of your body that then restricts the flow of urine from the bladder urinary retention hesitancy urgency -endoscopic examination -radiology imaging - ultrasound Progressive kidney damage as a result of uncontrolled hypertension -Loss of appetite - Nausea -Vomiting - Itching -Confusion Renal biopsy Blood test Nursing Interventions and Collaborative Management reducing fat and cholesterol in diet, and low sodium diet UTI’s and chronic bladder dysfunction can develop if calculi aren’t expelled. Encourage patient to drink plenty of fluids Surgical removal of stones is needed if they cannot pass on their own Cystolitholapaxy can be used as a laser is inserted with a cystoscope and breaks calculi into smaller pieces to pass - catheterization -monitor I&Os surgeon urology Monitor fluid and electrolytes Monitor I&O Administer ace inhibitors Possible Complications and Treatments/Interventions for Complications Urinary fistula Extravasation Urosepsis Ureteral scarring and stenosis Voiding and storage issues Acute urinary retention Urethral carcinoma Renal failure Fournier’s gangrene Bladder acontractility Renal failure Heart failure Myocardial infection Cardiologist 7 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Dialysis Dietitian Polycystic Kidney Disease Acute Kidney Injury inherited disorder in which clusters of cysts develop primarily within the kidneys -Sudden cessation of renal function that occurs when blood flow to the kidneys is significantly compromised High blood pressure ● Back or side pain ● Headache ● feeling of fullness in abdomen ● Increased size of your abdomen due to enlarged kidneys ● Blood in your urine ● Kidney stones ● Kidney failure ● Urinary tract or kidney infections Ultrasound CT MRI -FVO, edema Crackles, decreased 02, shortness of breath -Change in urine output -Serum creatinine -BUN -Urine specific gravity -Serum electrolytes -Hematocrit Monitor I&O Monitor for signs of infection Monitor pain level Monitor kidney levels Cardiologist Dialysis Dietitian -Identify, correct underlying cause -Monitor I & O strictly -Review labs, report abnormal, changes -Assess for edema Growth of cysts in the liver Pregnancy complications Colon problems Heart valve abnormalities Development of an aneurysm in the brain High levels of potassium in the blood Fluid in the lungs Metabolic acidosis 8 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Chronic Kidney Disease Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations -occurs abruptly -Prerenal: occurs as result of prolonged volume depletion -Intrarenal: occurs as a result of direct kidney damage - lack of oxygen Postrenal: result of bilateral obstruction Progressive, irreversible kidney disease Can be secondary to another disease process -lethargy, muscle twitching, seizures -Dry skin, Diagnostic Tests -Urinalysis -ABG Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications -restrict fluid intake -assess for flank pain, nausea, vomiting -EKG -Adhere and educate on dietary recommendations Dietician/ nutritionist Nephrologist -fatigue -high blood pressure -edema -F&E imbalance -changes in urinary pattern Bun Creatine GRF Proteinuria Monitor I&Os BP Assess for edema F&E status Administer medications as ordered (diuretics, BP, another meds) Gout Metabolic acidosis Bone disease Heart disease Hyperkalemia Fluid build up -dialysis References: Gersch, Carolyn J., et al. Medical-Surgical Nursing Made Incredibly Easy! Wolters Kluwer, 2017. 9 NR 325 Renal and Genitourinary (Urologic) Disorders – Worksheet Student Name: Date: 09/12/2021 Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Textbooks Online Resources http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241064/figure/i1524-5012-11-4-325-f01/ 10
