URINARY SYSTEM DISEASES

URINARY TRACT INFECTIONS (UTI) A UTI is an infection of the urinary tract Normally the urinary system is sterile. Common causes of UTI’s are: Catheterization Urological exams Sexual intercourse Poor pericare Incomplete bladder emptying Poor fluid intake (UTIs) are the second most common bacterial disease. Nosocomial UTIs are responsible for 40% of all hospital acquired infections and the majority of these are related to catheterization.

URINARY TRACT INFECTIONS (UTI) Women are at higher risk d/t a shorter urethra, as well as the close proximity to the rectum and vagina (microbes can enter easily).

URINARY TRACT INFECTIONS (UTI) Prostate secretions help protect men from UTI’s, however, an enlarged prostate increases the risk for UTI’s in men. Infection in one area of the urinary tract can lead to infection of the entire urinary system

URINARY TRACT INFECTIONS (UTI) SIGNS/SYMPTOMS Urinary frequency Urinary urgency Dysuria Foul smelling urine Pyuria Oliguria DX Urine for C & S TX Antibiotics Analgesics (pain meds)

CYSTITIS CYSTITIS SIGNS/SYMPTOMS/DX/TX Cystitis is inflammation of the bladder. Infection is the most common cause. SIGNS/SYMPTOMS/DX/TX the same as UTI

PYELONEPHRITIS PYELONEPHRITIS Pyelonephritis is acute or chronic inflammation of the pelvis and kidney generally caused by infection. Pyelonephritis usually ascends from the lower urinary tract. DX Urine for C & S Renal u/s

PYELONEPHRITIS SIGNS/SYMPTOMS Tx Fever Chills Vomiting Malaise Flank pain Hematuria Tx Antibiotics Analgesics

RENAL FAILURE

RENAL FAILURE Renal failure is the severe impairment of total lack of kidney function. In renal failure there is an inability to excrete waste products and water from the blood and the body retains fluids. Renal failure is classified as acute or chronic.

RENAL FAILURE ACUTE RENAL FAILURE Acute renal failure is characterized by a rapid decline in renal (kidney) function with progressive azotemia (an accumulation of waste products in the blood). Azotemia then leads to uremia - the condition in which azotemia progresses to a symptomatic state. (you have signs/symptoms) Acute renal failure may progress through 3 phases, oliguria, diuresis and recovery. In some situations the pt. does not recover from acute renal failure and chronic renal failure results.

RENAL FAILURE OLIGURIC PHASE DIURETIC PHASE Acute renal failure is usually associated with a decrease in urinary output to < 400cc per day. Acute renal failure usually develops over hrs or days with elevations in bloodwork (BUN, Creatinine, K+) and may last from a few days to several weeks. The longer the oliguric phase the poorer the prognosis for recovery. DIURETIC PHASE Begins with a gradual increase in daily urine output of 1 to 3L but may reach 3-5L. Kidneys are still not fully functional and there are decreases in bloodwork (Na, K+). This phase may last 1-3 wks.

RENAL FAILURE RECOVERY PHASE Bloodwork starts to stabilize. This phase can last anywhere from 2 weeks to 12 months. The outcome of acute renal failure is influenced by the persons: overall health the severity of the renal failure the number and type of complications

RENAL FAILURE CAUSES Hypovolemia hemorrhage, burns, dehydration, prolonged vomiting Decreased cardiac output MI CHF Arrhythmias

RENAL FAILURE SIGNS/SYMPTOMS Oliguria CHF Constipation Hypotension (early ) Hypertension (after developments of fluid overload) N & V Anorexia Diarrhea Constipation Anemia (develops within 48hrs) Lethargy Convulsions Memory impairment Bloodwork abnormalities (increased BUN, creatinine, K+)

RENAL FAILURE DIAGNOSTIC TESTS Bloodwork BUN Creatinine Electrolytes Hx & physical exam Urinalysis Renal u/s

RENAL FAILURE Tx Treatment depends on the severity of the renal failure and may include: Diuretics Close monitoring of intake/output (fluid restrictions) Frequent bloodwork Therapies to reduce K+ levels (Insulin, Na Bicarb, Dialysis, dietary restrictions) Daily wt. (to assess fluid loss) Proper skin care Frequent oral care Measures to prevent infection

RENAL FAILURE CHRONIC RENAL FAILURE CAUSES Chronic renal failure involves progressive, irreversible destruction of the nephrons in both kidneys. The disease progresses until most nephrons are destroyed and replaced by non-functional scar tissue. There is no cure. CAUSES Hypertension Diabetes Infections Urinary tract obstructions Tumors

RENAL FAILURE SIGNS/SYMPTOMS Every body system is involved with chronic renal failure as waste products build up in the blood. Signs/symptoms appear when 80-90% of kidney function is lost and may include Anxiety Hypertension Anorexia Sexual dysfunction Gout Anemia Headache Dyspnea Dry skin Motor weakness

RENAL FAILURE Tx At the end stages of chronic renal failure, the pt. either needs a kidney transplant or dialysis is used to filter the blood. There are 2 types of dialysis. Hemodialysis Peritineal Dialysis

RENAL FAILURE PERITONEAL DIALYSIS HEMODIALYSIS

URINARY ASSESSMENT OBJECTIVE (signs) SUBJECTIVE (symptoms) Urine amount Urine colour Urine clarity Urine odour Particles Hematuria SUBJECTIVE (symptoms) Pain Incontinence Hx of urinary disease Diet

RENAL CALCULI To be done independently Pg 278 Definition Who is at greatest risk? Risk Factors Signs & symptoms Tx