Disorder

Causative factor / Cause/ Contributing factor *Catheterization *Systemic disease

S/S

Medical TX

Surgical TX

Other TX

Nursing Consideration

Acute Cystitis/ UTI -inflammation of the urinary bladder - urethra ( most common route) - most common in women

-Frequency -Dysuria

-Antibiotics or sulfanamides - mild analgesics

N/A

N/A

- Encourage fluids /3-4 L if in atibiotic therapy ( prevent urinary stasis & crystals) - avoid tight fitting underwear - avoid irritants ( soaps, bubble baths - low sugar ( sugar promotes infection) - avoid sexual activity as much as possible ( risk for UTI) - Void immediately before & after sexual activity - warm packs alleviate pain - Vit C ( Acidify urine = prevent bacteria)

* changes in vaginal pH -Hematuria & other in women abnormal components of urine ( pus, WBC, + urine culture - heavy feeling in the abdomen or the perineumn

- phenazopyridine hydrochloride (pyridium)= orange red urine

Chronic Cystitis - recurrent UTI

- Frequency - Nocturia - incontinence LABS - High bacterial counts

Long term antibiotic therapy ( 3-6 mos)

N/A

Lubricant for vaginal irritation

- NC Acute UTI - Encourage shower ( avoid pushing bacteria up the urinary tract ) - monitor s/s yeast infections r/t antibiotic therapy - clean catch midstream spec. or intermittent straight catheterization

( accurate urine culture N/A Acute pyelonephritis -inflammation of the renal pelvis and the medulla - most common kidney disease - E.coli - ascending infection from Lower Urinary Tract or indwelling catheter - Rapid onset fever + chills - flank pain - pyuria -n/v - Headache frequency+ dysuria ( if infection reaches bladder) LABS: - Bacteuria - WBC - Casts Chronic Pyelonephritis - recurrent infections - urinary tract obstruction Interstitial cystitis - autoimmune, - inflammatory - infection Long term antimicrobial therapy N/A N/A NC Acute pyelonephritis - antimicrobial therapy ( 10 -14 days) - antibiotic - sulfanamides - urinary antiseptics - IV fluids ( dehydration r/t n/v) N/A - Med attention STAT for plank pain, fever & n/v -bed rest - encourage fluids - oral care - skin care - nourishment - pain management - reposition at least every 2 hrs

- lining of the bladder becomes leaky & allows irritants from the onset assoc. w/ UTI or urine to contact the instrumentation of the muscular wall causing Bladder irritability - common in women (20 -50 yrs old) - men w/ abacterial prostitis

- urge to void every 5 to Elmiron ( rebuilds 30 mins ( many days, protective layer of the no relief) bladder lining) - pelvic pain - dyspareunia - penile tip pain + perineal pain ( for men) LABS - Free of bacteria weekly for 6 wks - DMSO - Hydrocortisone - heparin - lidocaine

Hydrodistention ( ^ symptoms 1st few wks) PT - Stress reduction Techniques

- remove bladder irritants from diet - encourage fluids - little manipulation of the pelvic area as possible - stress management - social support, counselling

Glumerulonephritis - group of diseases in which kidneys are damaged and partly destroyed by the inflammation of the gallbladder

Acute infection ( poststreptococcal glumerulonephritis)

leads to Nephrotic syndrome aeb proteinuria + edema - 2 to 3 wks post URI - scarlet fever - streptococcus -Pale, puffy face - edema - nocturia family notices 1st -Antibiotics ( penicillin) - dietary management -bed rest - Daily I&O -Daily wt. - skin care -oral care - passive / active exercises - bed rest - law salt & fluid intake - low protein diet ( to reduce ammonia) -transfusion - pt in orthopneic position to facilitate breathing -

Acute Glumerulonephritis - common in children

Chronic Glumerulonephritis - may develop immediately after an acute episode - damages the kidney by destroying the nephrons and thereby disrupting the function - may lead to: ESRD Pulmonary edema ^ BP Cerebral hemorrhage CHF Renal Failure

Initial stage: - few symptoms other than: >mild general malaise > pale & dilute urine > slight anemia > hypertension > marked edema ( anasarca) Course of Disease - 10 -30 yrs > s/s renal insufficiency Advance stage > blurred vision >blindness Terminal Stage: > epistaxis > gastrointestinal bleeding

Antihypertensives ( for -Dialysis edema -kidney transplant

Restricted salt and water intake

Hydronephrosis

Obstruction blocking

Depending at the site of Removal of the cause

-is distension and dil the outflow of urine,

ation of the renal pelvis calyces

obstruction

of obstruction complete obstruction

- reversible if acute

pain,pressure, causing the waste products accumulate in s/s of UTI or kidney the kidney and back up stones if present in the blood leading to ESRD Primary : pain at the site colic - excruciating pain, in waves as the ureter to force the obstructing stone onward - gross hematuria( trauma in ureter) - asymptomatic or - mild hematuria - urgency - urge incontinence bladder stones s/s

medical emergency

Calculi Unknown - formed in the kidneys & descend to the maybe : infections urinary tract dehydration - lithiasis urinary stasis - common in men urine : uric acid calcium oxylate stones ^ uric acid = gouty arthritis risk for pt. W/: - MS - Diabetes - UTI

-Analgesics -antispasmodics -

- cystoscope Percutaneous Nephrolithotomy - stab wound @flank, catheter inserted, ultrasound waves crushes the stones ESWL ( extracorporeal shockwave lithotripsy) - stones in the kidney or upper ureters are blasted to smaller pieces Urethroscopic Calculi removal- stone removal without crushing - using stone basket. ( tong like instrumentation used to grab stone from ureter) - bleeding risk Lithotripsy use of soundwaves to crush stones obstructing the bladder, gallbladder or ureter

N/A

- Strain urine for calculi - Care pt. Stone removal (ESWL) PRE OP >Explain the procedure > in tx table, H2O cushion or tub > mild sedative + gen anesthesia POST OP > urine must be slightly bloody or rose > observe 1-2 days > fluids > strain urine >monitor s/s infections > report hematuria > warm packs (comfort)

* stent post UCR & lithotripsy Surgical Removal a) ureterolithotomysurgical removal of the cslculi in the ureter b) nephrolithotomy incision into the kidney and removal Stricture - narrowing of the urinary tract -common in men Fibrous bands - Frequency - dysuria - burning - stretching via sounds and bougies -Urethrotomy - incision of a urethral stricture Emotional Support Maybe genetics Asymptomatic or pain, decreased kidney function May not be necessary if no kidney disruption involved other wise , removal of the cysts Polycytric kidney disease -multiple cyst in the kidneys Cancer of the kidney/Nephroma/ hypernephroma - characterized by malignant kidney tumors - mostly men Malignant kidney tumor usually invades aorta & vena cava -Painless hematuria - fever -wt. Loss -malaise -palpable flank mass (painful later) chemotherapy Nephrectomy (early stage) curative radiation - bleeding risk - monitoring urine output ( risk UTI)

Benign Renal cyst * Monocystic kidney disease - single cyst in the kidneys

Bladder tumor -most common site of urinary cancer -mostly malignant -in bladder wall or small warts

-Chemicals -smoking -lung cancer - correlated to: caffeine artificial sweeteners

Painless hematuria

Chemotherapy (+tumor removal)

Transurethral resection of the bladder ( TUBRT) - Superficial tumor removal via: a) endoscopic resection (cutting out) b) fulguration ( destruction by electricity) - Resectoscope (tube, bladder to urethra) -Laser therapy -cystotomy -cutaneous cysthotomy -suprapubic cystocath -cystectomy ( stent bet. Ureter + ileum used post surg)

Radiation (+ tumor removal) complication: radiation cystitis -lead to loss of bladder compliance - appearance rough + red - tx for urge incontinence applicable