NR 507 Week 4 Edapt Urinary System Pathologies, Exams of Nursing

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NR 507 Week 4 Edapt Urinary System

Pathologies

Advanced Pathophysiology)

NR507 Week 4 edapt: Urinary System Pathologies: Common

Diseases and Disorders Urinary Tract Infections/ Benign

Prostatic Hypertrophy/ Renal Calculi/ Urinary Incontinence/

Acute Kidney Injury/ Chronic Kidney Disease

Urinary Tract Infections

Upper UTIs occur in organs that are above the urinary bladder

and include ureter infections and pyelonephritis (kidney

infection).

Cystitis (bladder infection), urethritis (infection of the urethra),

and prostatitis (infection of the prostate) occur in the lower

urinary tract.

4. Lower Abdominal Discomfort : Pain or pressure in the lower abdomen can be caused by an infection anywhere in the urinary tract.

5. Pelvic Pain : Pain in the pelvic area is associated with a bladder infection, especially in women with a bladder infection.
6. Cloudy or Strong-Smelling Urine : Changes in the appearance or odor of urine can be caused by an infection anywhere in the urinary tract.
7. Blood in Urine (Hematuria) : The presence of blood, giving the urine a pink or reddish color can be caused by an infection anywhere in the urinary tract.
8. Fever : In some cases, a UTI can be accompanied by a systemic fever.
9. Back Pain : Pain in the lower back is associated with an infection in the kidneys. Assessment for pain or tenderness at the costovertebral angle (CVA) can increase both pain and inflammation and should be part of a routine assessment.
10. Fatigue : Feeling tired or generally unwell can be caused by an infection anywhere in the urinary tract.
11. Discomfort or Pain During Sex : Women with bladder or urethra infections may experience pain or discomfort during sexual activity.

Symptoms of infection, including fatigue, bacteria in the urine,

and an elevated temperature, may be present for any infection,

including lower UTI, upper UTI, and STI. Note: The presence of

bacteria in the urine from an STI may indicate contamination of

the urine sample.

Foul smelling urine and painful urination can be present with

both lower and upper UTI.

Pelvic pain is more likely to be present in a female with a

lower UTI or STI. An urgency to void is associated with

lower UTI.

An untreated lower UTI can progress to an upper UTI, leading

to permanent kidney damage or sepsis.

Uncomplicated Urinary Tract Infection Characteristics

• Urinary tract is normal
• Renal function is normal
• Lower risk for permanent renal damage or sepsis
• White blood cell (WBC) casts absent
• Requires no treatment if asymptomatic

• Requires a short course of antibiotics if symptomatic or pregnant Complicated Urinary Tract Infection Characteristics
• Urinary tract is altered
• Renal function is decreased
• Higher risk for permanent renal damage or sepsis
• White Blood Cell (WBC) casts present
• No response to IV antibiotics
• Presence of blood in the urine
• Recurrent UTIs (more than 3 in a year or 2 occurrences in 6 months.)

Uncomplicated UTIs

• Treatment can be deferred if the client has no symptoms.
• Treatment can be initiated based on symptoms without

waiting for laboratory reports.

• 3- to 5-day course of oral antibiotics is the standard treatment.
• If needed, a urine culture can be obtained prior to starting antibiotic

therapy.

• For a client with a history of recurrent UTI, symptoms may

resolve before the infection is resolved.

• Repeat urine culture 1 week after antibiotics were started

and at monthly intervals for 3 months.

Complicated UTIs

• Start with intravenous (IV) broad-spectrum antibiotic.
• Change to an organism-specific antibiotic after culture and

sensitivity results are known.

• After a course of IV antibiotics, oral antibiotics should be continued.
• Relieve any obstruction within the urinary tract.
• Treat other symptoms (e.g., antipyretic for fever, pain medication).

• Urinary Tract

Infection

Treatment

The client appears to have an uncomplicated lower UTI; therefore, blood cultures are not indicated at this time. Benign Prostatic Hypertrophy

Symptoms of BPH are classified as obstructive or irritative and are listed below.

• Obstructive symptoms relate to prostate enlargement and include the following: o difficulty starting the urine stream o post-void dribbling o straining o incomplete bladder emptying o decreased force of the urine stream
• Irritative symptoms relate to inflammation or infection and include the following: o nocturia o urinary frequency o urinary urgency o dysuria o bladder pressure o incontinence

Benign Prostatic

Hypertrophy

Clinical

Renal Calculi

Renal Calculi Diagnosis and Treatment Diagnosis

1. Urinalysis o Detects hematuria, infection, stone-forming crystals, and urine pH.
2. Imaging o KUB X-ray: Initial screening for most radiopaque stones. o Non-contrast CT scan: Provides detailed visualization. o Ultrasound: Preferred for detecting obstruction (e.g., hydronephrosis), especially in pregnancy. o IVP (Intravenous Pyelography): Uses contrast dye to visualize kidney and ureter anatomy.
3. Blood Tests o Identifies post-renal AKI (e.g., BUN, creatinine, GFR) and evaluates calcium and uric acid levels to assess stone formation causes. Treatment
4. Supportive Care o Ensure hydration and manage pain. o Treat infections with antibiotics if present. o Dissolution therapy (e.g., potassium citrate or sodium bicarbonate) for uric acid stones.
5. Stone Passage o Stones <5mm typically pass naturally (80-90%). o Use a urine strainer to collect stones for composition analysis.
6. Stone Removal o Ureteroscopy: Removes stones via the ureter, often with laser lithotripsy. o Percutaneous removal: Extracts stones through a small skin incision. o Open surgery: Reserved for very large stones. o ESWL (Shock Wave Lithotripsy): Breaks stones non-invasively with shock waves.

Dissolution therapy: Potassium citrate or sodium bicarbonate therapy is used to alkalinize the urine for suspected uric acid-based stones, as it can help dissolve them. Depending on stone etiology, different medications may be recommended.

• Calcium stones (most common):
  • Thiazide diuretics can be used in hypercalciuria.
• Uric acid stones:
  • Allopurinol can lower renal uric acid excretion, preventing the formation of uric acid stones.