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NUR 425-ADULT HEALTH TEST 4 EXAM STUDY GUIDE, Exams of Nursing

NUR 425-ADULT HEALTH TEST 4 EXAM STUDY GUIDE

Typology: Exams

2023/2024

Available from 11/14/2023

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Renal and Urinary Tract Function

  • Terms to Know o Anuria- ▪ Total UOP <50 mL/24 hours o Clearance ▪ Volume of plasma that the kidneys can clear of creatinine (ml/min) o Creatinine ▪ Endogenous waste product of muscle energy metabolism o Glomerular Filtration Rate ▪ Volume of plasma filtered at the glomerulus into the kidney tubules each minute o Oliguria ▪ Total urine output <400 ml/24 hours o Osmolality ▪ Number of particles dissolved per kg of urine o Specific gravity ▪ Reflects the weight of particles dissolved in the urine o Urea nitrogen ▪ Nitrogenous end product of protein metabolism o Valsalve Leak-Point Pressure (VLPP) ▪ Amount of abdominal pressure against the bladder that causes the urethra to open and leak urine o Vesicoureteral Reflux ▪ Backflow of urine from bladder into the ureters
  • Renal Blood Flow o Renal Artery: delivers blood to each kidney o Afferent arterioles: deliver blood to the glomerulus o Efferent arterioles: deliver blood out of the glomerulus o Peritubular Arterioles: capillaries that surround the renal tubules o Renal Vein: returns filtered blood to the circulation by emptying into the inferior vena cava
  • Nephron o Nephron: ▪ basic functional unit of the kidneys; secrete and reabsorb ions, filter fluid/wastes/E+/acids/bases o Glomeruli: ▪ tuft of capillaries within each nephron; filter larger plasma proteins and blood cells o Bowman’s Capsule: ▪ surrounds glomeruli o Tubules: ▪ reabsorb water and electrolytes NA and CL from filtrate o Flow through Kidney ▪ Bowman’s capsule

▪ Glomerulus

  • GFR = 100-120ml/min ▪ Tubules
  • Proximal
  • Loop of Henle
  • Distal ▪ Collecting Ducts
  • Urine Flow o Minor Calyx – Major Calix – Renal Pelvis – Ureter – Urinary Bladder – Urethra
  • Function of Kidneys o Urine Formation o Excretion of Waste Products o Regulation of Electrolytes o Regulation of Acid-Base Balance o Control of Water Balance o Control of Blood Pressure o Renal Clearance o Regulation of RBC Production o Synthesis of Vitamin D to Active Form o Secretion of Prostaglandins
  • Urine Formation o Glomerulur Filtration: ▪ Blood flows from afferent arteriole to the glomerulus where filtration occurs ▪ the filtered fluid then enters the renal tubules (about 20% of blood passing through glomeruli is filtered into the nephron

o Tubular Reabsorption: ▪ Occurs in the renal tubules; substances move back into the peritubular capillaries o Tubular Secretion: ▪ Substances move from the peritubular capillaries into tubular filtrate ▪ 99% of the filtrate produced is reabsorbed back into the blood stream (leaving about 1000-1500ml of UA/day ▪ Most reabsorption occurs in the Proximal tubule (but occurs all along the tubule); filtrate becomes concentrated in the distal tubule and collecting ducts under the influence of ADH (antidiuretic Hormone) and becomes urine which then enters the renal pelvis.

  • Renin-Angiotensin System o This system can be stimulated by many factors: ▪ Decreased renal perfusion ▪ Decreased sodium delivery to kidney tubules o May be caused by many factors: ▪ Hemorrhage ▪ Heart failure ▪ Cirrhosis ▪ Loop diuretics ▪ Decreased sodium intake
  • Regulation of RBC Production o Kidney detects decreased oxygen tension in renal blood flow leading to release of erythropoietin o Erythropoietin stimulates bone marrow to produce red blood cells

o In kidney failure there is a loss of the ability to release erythropoietin leading to decreased RBC production

  • Vitamin C Synthesis o Kidneys convert inactive form of Vitamin D to active form o Vitamin D necessary to maintain Ca++ level in blood ▪ ++ 4.5-5.5 mEq/L or 9-11 mg/dL
  • Assessment o History ▪ Pattern of voiding ▪ Color or odor ▪ Pain ▪ GI symptoms ▪ Weight changes o Physical Exam ▪ Inspection - Skin color, Excoriation (pruritis), Uremic frost, edema ▪ Auscultation
  • Renal bruits, Peritoneal fld ▪ Percussion ▪ Palpation o GI Sx’s – Why assess: ▪ Uro and GI systems share autonomic and sensory innervation and renointestinal reflexes which may cause GI symptoms from Uro disorders. o Renal Bruits:

▪ may indicate renal artery stenosis or an aortic aneurysm o Skin color may be pale or yellow-gray ▪ Uremic Frost:

  • diffuse deposits of tiny white crystalline material on skin from “profound” azotemia
  • Kidney / Urinary System Changes Associated with Aging o Reduced blood flow to kidneys o Thickened glomerular and tubular basement membranes o Decreased tubule length o Decreased glomerular filtration rate o Nocturnal polyuria o Risk for dehydration
  • Diagnosis and Evaluation o Urinalysis and Urine Culture o Renal function tests o KUB, Ultrasound, CT, MRI, Nuclear Scan, IVP, Cystourethography, Angiography, Urodynamics and Endoscopy o Biopsy o UA: ▪ What would look for – color, clarity, odor, pH, SG, protein, glucose, ketones, RBC’s, WBCs, Casts, Crystals, Pus, Bacteria. o Review normal values: ▪ you should not see - RBCs (no more than 3), Protein (no more than 150mg/day – may see with heavy exercise, fever, prolonged standing)

o Renal Fx Tests: ▪ Review Table 43-4 on page 1264 of Brunner 10 th Ed; Table 43-5 on page 1507 of Brunner 11 th Ed o Know proper collection techniques for UA, Culture, 24hr UA o Review Nsg Management of a patient undergoing a biopsy o What is most serious complication you should monitor for??? ▪ Bleeding – kidney is very vascular! Genitourinary System

  • Assessment of the Renal / Urinary System o Anatomy and Physiology ▪ Kidneys ▪ Ureters ▪ Urinary bladder ▪ Urethra o Kidneys function to maintain body fluid volume, to filter waste from the body and allow the body to meet the human need for urinary elimination, while also regulating blood pressure, acid-base balance, produce erythropoietin needed for RBC synthesis and convert Vitamin D to its active form. o Larger than usual kidneys may indicate obstruction or polycystic disease. Smaller than normal kidneys may indicate chronic kidney disease (CKD). Variations in kidney number and size are of no significance as long as tests of kidney function are normal. o The renal system includes the kidneys, the ureters, the bladder and the urethra. o Structural or functional problems in the kidney or urinary tract may alter fluid, electrolyte, and acid-base balance.

o Kidneys are rich in blood. Receive about 20-25% of cadiac output. o Renal artery (branches off abdominal aorta) supplies blood to each kidney. o The renal artery divides into smaller arteries that supply all blood to areas of the kidney tissue (parenchyma) and the nephrons. The smallest arteries (afferent arterioles feed the nephrones directly to form urine. o Venous blood from kidneys start with capillaries surrounding each nephron. They drain into larger veins. Blood eventually returned through the renal vein to the inferior vena cava. o Outer surface is the renal capsule, which covers most of the kidney except the hilum where the renal artery and nerve plexus ender the renal vein and ureter exit. o Next are two layers of functional kidney tissue the cortex and the medulla. The renal cortex is the outer tissue layer, the medulla lays below the cortex in the shape of many fans or “pyramids” totalling 12-18 pyramids per kidney. The renal columns are cortical tissue that dips into the interior of the kidney and separates the pyramids. The end of each pyramid is the papilla which drain the urine into the collecting system or the calyx at the end of each papilla. The calices join together forming the renal pelvis which narrows into the ureter.

  • Nephron o Working unit of the kidney o It is here that urine is actually formed from blood o About 1 million nephrons per kidney

o 2 types: cortical nephrons and juxatmedullary nephrons (concentrate urine during times of low fluid intake)

  • Nephron Anatomy o Afferent arteriole = the smallest, most distal portion of the renal arterial system. From afferent blood flows into the glomerulus (series of specialized capillary loops). It is through these capillaries that water and small particles are filtered from the blood to make urine. The remaining blood leaves the glomerulus through the efferent arteriole( st vessel of venous system of kidney) o Bowman’s capsule (beginning of tube): a saclike structure that surrounds the glomerulus. Narrows into the proximal convuluted tubule (PCT). The PCT twists and turns into the descending limb of the loop of Henle. Coming up from the medulla it becomes the ascending loop of Henle. Then to the distal convoluted tubule (DCT) and ends in one of the many collecting ducts located in the kidney tissue. Urine in the collecting ducts passes through the papillae and empties into the renal pelvis. o Juxtaglomerular complex (specialized cells located in afferent arteriole, efferent arteriole, and DCT) that produce and store renin (hormone that helps regulate blood flow, glomerular filtration rate (GFR), and blood pressure) o Review renin-angiotensin-aldosterone pathway if needed.
  • Renin Angiotensin Aldosterone System o When sensing cells in the DCT sense changes in blood pressure, blood volume, or serum blood sodium levels are low, then renin is secreted. Renin then converts renin substrate (angiotensinogen) into angiotensin I. This leads to

a series of reactions that cause secretion of the hormone aldosterone. Aldosterone increases kidney reabsorption of sodium and water, restoring blood pressure, blood volume, and blood sodium levels. It also produces excretion of potassium.

  • Regulatory Functions of the Kidney o Maintenance of fluid, electrolyte, and acid base balance ▪ Glomerular filtration ▪ Tubular reabsorption ▪ Tubular secretion o Glomerular filtration is the first process in urine formation, blood passes through the afferent arteriole into the glomerulus, water, electrolytes, and other particles such as creatinine, urea nitrogen and glucose are filtered across the glomerular membrane into the Bowman’s capsule to form glomerular filtrate. As this filtrate enters the proximal convoluted tubule it is called tubular filtrate. o -Large particles like blood cells, albumin and proteins are too large to cross. (So these substances are not normally found in filtrate (or in the final urine). The rate of filtration is expressed in mL/min. Normal glomerular filtration rate (GFR) averages 125 mL/min. About 1-3L of filtrate (urine) excreted daily, the rest is reabsorbed into circulation. GFR controlled by blood pressure and blood flow. When afferent arteriole is constricted or efferent arteriole is dilated, pressure in glomerular capillaries falls and filtration decreases – increasing blood blood volume and b/p. o Tubular reabsorption is the second process that keeps normal urine output at 1-3 L/day and prevents dehydration.

As the filtrate passes through the nephron most of the water and electrolytes are reabsorbed. Reabsorption returns particles or solutes and water to the blood. This reabsorption occurs from the filtrate across the tubular lumen of the nephron. 99% of filtered water is returned to the body. The distal convoluted tubule can be permeable to water and some reabsorption can occur at this point. o The membrane here is made more permeable by the action of antidiurectic hormone (ADH) and aldosterone. ADH is also known as vasopressin and affects arteriole constriction, altering blood pressure. Aldosterone promotes the reabsorption of sodium in the DCT. Where sodium goes, water goes. o The third step in urine formation is tubular secretion which allows substances to move from the blood into the early urine. Substances move from the peritubular capillaries in reverse, across capillary membranes, and into cells that line the tubules from which substances are moved into the urine and are excreted from the body. Homeostasis of pH balance and electrolytes are also maintained by this method.

  • Renal Tubules o Tubular reabsorption : kidney reabsorbs some of the glucose filtered from the blood. However there is a limit to how much glucose it can reabsorb. The limit is called the renal threshold. The usual renal threshold for glucose is 220 mg/dL. Meaning if the blood glucose level is 220 mg/dL or less, there should be no glucose in the urine. However, if it is higher than 220 mg/dL then some glucose stays in the filtrate and is present in urine.
  • Hormone Functions of the Kidney o Renin o Angiotensin II o Prostaglandins o Bradykinin o Erythropoietin o Vitamin D activation o Renin release causes the production of Angiotension II which increases systemic blood pressure by powerful constricting effects and triggers the release of aldosterone from the adrenal glands. o Prostaglandins regulate intrarenal blood flow by vasodilation and vasoconstriction. o Bradykinin increases blood flow (vasodilation) and vascular permeability. o Erythropoietin is produced and released in response to decreased oxygen tension in kidney’s blood supply. It stimulates bone marrow to make red blood cells. o Vitamin D activation promotes absorption of calcium in the GI tract.
  • Gross Anatomy of the Ureter o The ureters tunnel through bladder tissue for a short distance before opening up. Contractions of the smooth muscle in the ureter move urine from the renal pelvis of the kidney into the bladder. The bladder is a muscular sac, in men it lies in front of the rectum, in women, it lies in front of the vagina. The bladder lies directly behind the pubic bone. Serves as a temporary storage site for urine. Provides

continence and enables voiding. The secretions of the lining resist bacterial growth. o Continence, the ability to voluntarily control bladder emptying. o The urethra is a narrow tube lined with mucous membranes and epithelial cells that eliminates urine from the bladder through the opening of the urethra or the urethral meatus. In men the urethra is about 6-8 inches or 15-20 cm long; in women it is about 1-1.5 inches or 2.5- 3.75 cm in length.

  • Renal / Urinary System Changes Associated with Aging o Reduced renal blood flow causing kidney loss of cortical tissue by 80 years of age (kidney gets smaller) o Thickened glomerular and tubular basement membranes, reducing filtrating ability o Decreased tubule length o Decreased glomerular filtration rate o Nocturnal polyuria and risk for dehydration o These changes often affect health. Reduced ability to filter blood and excrete waste products. o These changes lead to decreased glomerular filtration rate (GFR), Nocturia (can’t concentrate urine as well), decreased bladder capacity, tendency to retain urine, weakened urinary sphincter muscles. o Tubular changes decrease ability to concentrate urine, resulting in nocturnal polyuria; there is an increased risk for dehydration and hypernatremia. o Chart 65- 1
  • Assessment Methods

o Demographic information o Socioeconomic status o Nutrition history o Medication history o Family and genetic risk o Current health problems o Demographic information is a non modifiable risk factor o Socioeconomic status may influence health care practices. Low income may prevent pt. from seeking early intervention or prevent follow up. o Nutritional history usual diet and any recent changes noting excessive omission or intake of certain food groups. Assess fluid intake and what types of fluids the patient drinks. o Medication history including all prescription and non prescription medications and any recent changes and why. Drugs for DM and HTN are potential causes for kidney dysfunction. Explore OTC drugs. Long term use of NSAIDs or acetaminophen can seriously reduce kidney function. o Family and genetic risk as some kidney, and urological problems have genetic predispositions. (nephritis). o Current Health problems as the effects of renal failure result in changes in all body systems. Ask specifically about changes in urine patterns, urine stream, burning sensations, and loss of continence as well as any complaints of pain.

  • Physical Assessment o Inspection o Auscultation o Palpation o Percussion

o Assessment of the urethra o Assess general appearance, yellowish skin color and the presence of any rashes, bruising, or other discolorations. Edema especially pedal, pretibial (shin), sacral tissues, and around the eyes may be associated with kidney disease. o Auscultate for a bruit over renal arteries should hear a swooshing sound if present indicating a narrowed vessel as in renal stenosis. o Palpation can help locate masses and areas of tenderness and is usually performed by a MD or NP. Examine non tender areas first an if a tumor or aneurysm is suspected do not palpate as this may cause harm to the patient. With severe bladder distention the bladder will be seen as high as the umbilicus. Palpation of the kidney is easier in the thinner person, the right kidney more palpable than the left as the left is deeper. The kidney should be smooth, firm and non tender. o A distended bladder will sound dull when percussed. Costovertebral tenderness often occurs with kidney infection or inflammation. o Assessment of the urethra recording any blood, drainage, purulent drainage or mucus. Inspect surrounding skin for presence of lesions, rashes or other abnormalities of the penis, scrotum, labia or vaginal opening.

  • Blood Tests o Serum creatinine o Blood urea nitrogen o Blood urea nitrogen to serum creatinine ratio o Blood osmolarity

o No common pathologic condition other than renal disease will increase the serum creatinine level. Therefore it is a good indicator of kidney function. o BUN measures renal excretion of urea nitrogen and can determine the extent of renal clearance of this nitrogen waste product. Elevation is not always a result of renal damage. Injury (blood in tissues and not in vessels) infection, chemo and steroids may also cause a rise in the BUN. o The BUN to serum creatinine ratio will help determine if nonrenal factors such as dehydration or poor perfusion are causing an elevation in the BUN rather than kidney damage. The ratio will be increased in dehydration or hypotension. If they rise at the same rate the ratio will stay the same or remain normal suggesting that the increase in BUN and creatinine are related to kidney function rather than dehydration or poor perfusion. o Blood osmolarity is the measure of the overall concentration of the blood, normally the excretion or reabsorbtion of water keeps blood osmolarity in the range of 285- should be slightly higher in older adults ranging from 285-

  1. When decreased the release of antidiuretic hormone is inhibited and without ADH the distal tubule and the collecting ducts are not permeable to water; therefore water is excreted and not absorbed and blood osmolarity increases. With this increase the permeability returns and water is reabsorbed and the blood osmolarity decreases.
  • Urinalysis o Color, odor, and turbidity

o Specific gravity o pH o Glucose o Ketone bodies o Protein o Leukoesterase, nitrites o Cells, casts, crystals, and bacteria o A urinalysis evaluates waste products from the kidney and detects urologic disorders. Should collect in AM, more concentrated sample. o Should be clear and not cloudy. o Urine should smell faintly of ammonia and is clear without turbidity or cloudiness or haziness. o Specific gravity is the density of the urine compared with water which has a density of 1.000. Normal specific gravity of urine ranges from 1.005-1.030. In kidney disease, changes do not reflect systemic fluid volume. An increase in specific gravity occurs with dehydration, decreased kidney blood flow or the presence of ADH. o A decrease in specific gravity occurs with fluid intake, diuretic drugs, and DI. o pH is a measurement of urine acidity or alkalinity. Diet high in certain vegetables and fruits will cause a more alkalinic urine where a high protein diet results in acidic urine. E.coli presence results in acidic urine. Urine samples become more alkaline when left standing unrefrigerated for 1 hour or more, when bacteria is present or left uncovered. o Glucose may be present in urine when blood glucose is greater than 220mg/dl.

o Ketone bodies are formed from the incomplete metabolism of fatty acids. Normally there should be no ketones in the urine. o Protein is not normally present in the urine. When glomerular membranes are not intact, protein molecules pass through. Increased membrane permeability occur with infection, inflammation, or immunologic problems. o Nitrites are not normally found in urine, but when present indicate infection. o Casts are structures formed around other particles and are described as granular and waxy. Crystals come from salts as a result of diet, drugs or disease. o Bacteria in a urine sample multiplies quickly and must be evaluated promptly. Normally urine is sterile but can easily become contaminated with perineal bacteria during collection. o Chart 68-4 on pg 1478 for urinalysis info.

  • Other Urine Tests o Urine for culture and sensitivity o Composite urine collections o Creatinine clearance—best indication of overall kidney function o Urine electrolytes o Urine osmolarity o C&S analyzes for number and types of organisms present and to which antibiotics they are sensitive or resistant to treatment with. o A composite urine is a 24 hour urine that allows for a more precise analysis of one or more substances.

o Creatnine clearance is calculated measurement of glomerular filtration rate. It is the best indication of overall kidney function. o Electrolytes such as sodium which amount excreted should equal amount consumed. o Urine osmolarity measures the concentration of particles in a solution, particles contributing: glucose, electrolytes, urea and creatinine.

  • Other Studies o Bedside sonography/bladder scanners o Imaging assessment o Retrograde procedures o Urodynamic studies o Renal biopsy o Cystography o Cystourethrography o Voiding cystourethrogram o Bladder scanners measure post void residual. o KUB xray plain film shows gross abnormalities. Shows stones and obvious obstructions. o Retrograde means against the normal flow, radioactive dye is injected into the bladder and ureters via a catheter and xrays are taken to outline these structures. o Urodynamic studies examine processes of voiding and include bladder capacity, pressure and tone; urethral pressure and urine flow; perineal voluntary muscle function. Evaluates problems with urine flow. Pt asked to void normally. Then catheter placed to measure the residual volume. Then fluid is instilled in the bladder via the catheter.

Pt reports first feelings of feeling like he/she needs to void and is recorded. o Renal biopsy can help determine unexplained renal problems and can direct or change therapy. Percutaneous CT guided needle biopsies are most common and the pt. must be NPO for 6-8 hours prior to procedure. Risk of bleeding post procedure; preliminary platelet counts, coagulation studies and bleeding times are needed prior to procedure. Blood transfusions may be required to correct anemia before biopsy. Pt. is sedated but can follow commands, prone, and must hold his/her breath during advancement of needle. o Post: Monitor for bleeding, blood pressure, flank pain and hematuria. Pt must lie supine, complete bedrest for 2- hrs. Care of Patients with Urinary Problems – Chapter 66 o More than 20 million ppl in the US are treated annually for UTI, cystitis, kidney and ureter stones, or urinary incontinence. o Upper UTI- pyelonephritis. o Lower urinary tract disorders include: urethritis, cystitis, and prostatitis. o UTI typically categorized as uncomplicated or complicated. o Uncomplicated: o Cystitis o Pyelonephritis o Premenopausal, non-pregnant, healthy women o Complicated:

  • Cystitis o Associated w/ conditions that increase your risk for tx failure or serious outcomes such as: ▪ Obstruction ▪ Pregnancy ▪ DM ▪ Urogenic bladder ▪ Renal insufficiency ▪ Immunosuppression o Inflammation of the bladder ▪ Interstitial cystitis- presence of bacteria in the urinary tract, which causes chronic inflammation of the bladder, urethra, and pelvic muscles but not related to an active infection. o Most commonly caused by bacteria that move up the urinary tract from the external urethra to the bladder ▪ Mostly E. coli ▪ More common in women b/c of short urethra. o Catheters are the most common factor placing patients at risk for UTIs in the hospital setting ▪ Catheters shouldn’t be placed b/c of nursing convenience due to increased risk of infection, should only be left in for a short amount of time, and should have a doctor order o Commonly from infection, but can be without infection. o Not life threatening but can lead to life threatening complications (pyelonephritis or sepsis) if untreated. o Severe kidney damage is rare unless it is complicated.
  • Cystitis Manifestations

o Frequent urge to urinate o Dysuria o Urgency o Low back pain o Hematuria o Nocturia o Retention o Feeling of incomplete emptying o Urinalysis needed when testing for leukocyte esterase and nitrates o Type of organism confirmed by urine culture ▪ Culture will be indicated when UTI becomes complicated or fails therapy. ▪ Fungal infections, viruses, STIs can cause cystitis. ▪ Can have noninfectious cystitis from chemical exposure to certain drugs. o Other diagnostic assessments ▪ Look at WBC to determine infection. ▪ If it is coming from obstruction then use CT scan to look for renal calculi. ▪ Cystoscopy will be used for those who have recurrent infections (>3-4 per year).

  • Scope is inserted into the urethra to view the lining of the urethra.
  • Can see calculi, renal strictures, and trabeculation (abnormal thickening of the bladder wall, which comes from urinary retention and obstruction) o Will use this to accurately diagnose interstitial cystitis.
  • Drug Therapy- table 66.4 o Urinary antiseptics ▪ Macrodantin (nitrofurantoin) o Antibiotics ▪ Sulfonamides, quinolones, PCN, cephalosporins. ▪ Sulfamethoxazole/trimethoprim and nitrofurantoin are most commonly used to treat chronic bladder infections. o Analgesics ▪ Pyridium (phenazopyridine) o Antispasmodics ▪ Hyoscyamine o Antifungal agents- namely fluconazole o Long-term antibiotic therapy for chronic, recurring infections
  • Non-Surgical Management o Urinary elimination o Diet therapy includes all food groups, calorie increase because of increase in metabolism caused by the infection, fluids, possible intake of cranberry juice preventively ▪ Daily consumption of 50 mL of cranberry juices decreases the ability of bacteria to adhere to the urinary tract lining. ▪ If it is interstitial cystitis then cranberry juice should be avoided. o Other pain-relief measures, such as warm sitz baths o Daily recommendation of 1.5L of urine output or 7 to 12 voidings per day! ▪ Make sure to drink enough to dilute the urine unless it is contraindicated.
  • Prevention o Drink 2-3 L of fluid per day unless contraindicated. o Adequate rest, sleep, and nutrition daily o Perineal cleansing from front to back o Avoid bubble baths, nylon underwear, scented toilet tissue, tight or constricting clothing o Empty bladder as soon as you get the urge and every 4 hours o Take all prescribed antibiotics to prevent recurrent infections and schedule follow-up 10-14 days for re-check o Teach to void before and after sex.
  • Urethritis o Inflammation of the urethra that causes symptoms similar to urinary tract infection o Most common cause is STD. o Common in post menopausal women b/c of tissue changes related to low estrogen levels. o Rule out cystitis first. o Treat with ABX therapy or a vaginal estrogen cream in postmenopausal women to alleviate symptoms. o Patient-centered collaborative care
  • Urethral Strictures o Narrowed areas of the urethra o Complication of STDs, trauma during childbirth, or urinary procedures. o 1/3 cause is unknown. o More common in men than women. o Most common symptom: obstruction of urine flow ▪ Rarely cause pain.

o More at risk for development of UTI w/ stricture or they may have overflow due to over distention of the bladder. o Surgical treatment by urethroplasty: best chance of long- term cure ▪ Removal of stricture. ▪ May have to have grafting to create a larger opening. ▪ Recurrence rate is still high after sx. o Dilation of the urethra: a temporary measure, not curative

  • Urinary Incontinence- HAVE TO KNOW THE DIFF IN THESE AND HOW TO INTERVENE.
  • Incontinence is involuntary loss of urine severe enough to cause social or hygienic problems.
  • Not considered a normal consequence of aging or childbirth.
  • For normal voiding to occur, urethra must relax and bladder must contract w/ enough pressure to empty completely. Should occur voluntarily under conscious control. o Five types of incontinence are: ▪ Stress incontinence - Loss of small amounts of urine during coughing, sneezing, jogging. - Pt can’t tighten urethra enough to overcome increased bladder pressure. ▪ Urge incontinence - Loss of urine associated w/ a strong desire to urinate. - Perception of urgent need to urinate as a result of bladder contraction regardless of the volume- - This is also called overactive bladder. ▪ Mixed incontinence