Worksheet.mampanalba

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Gaa, Janine Beatriz C. Competency Appraisal

N4B July 9, 2013

Work Sheet

UTI, Cystitis, Glomerulonephritis

UTI

Clinical Manifestations: A strong, persistent urge to urinate A burning sensation when urinating Passing frequent, small amounts of urine Urine that appears cloudy Urine that appears red, bright pink or cola-coloreda sign of blood in the urine Strong-smelling urine Pelvic pain, in women Rectal pain, in men

Pathophysiology1. Infection spreads from renal pelvis to renal cortex2. Kidney grossly edematous; localized abscesses in cortex surface3. E. Coli responsible organism for 85% of acute pyelonephritis; also Proteus,

Klebisella

Causes: Urinary tract infections typically occur when bacteria enter the urinary tract

through the urethra and begin to multiply in the bladder. Although the urinary

system is designed to keep out such microscopic invaders, these defensessometimes fail. When that happens, bacteria may take hold and grow into a full-

blown infection in the urinary tract. Diagnostic Test/Exam and Preparations

Urine samplePreparations: Your doctor may ask for a urine sample for lab analysis to look for

white blood cells, red blood cells or bacteria. To avoid potential contamination of

the sample, you may be instructed to first wipe your genital area with anantiseptic pad and to collect the urine midstream.

Urine CulturePreparations: a test that uses your urine sample to grow bacteria in a lab. This

test tells your doctor what bacteria are causing your infection and whichmedications will be most effective.

Ultrasound or a computerized tomography (CT) scanPreparations: to create images of your urinary tract. In certain situations, your

doctor may also use a contrast dye to highlight structures in your urinary tract.

Intravenous pyelogram (IVP)Preparations: uses X-rays with contrast dye to create images. Historically,

doctors used this test for urinary tract imaging, but it's being replaced more oftenby ultrasound or CT scan.

Cystoscopy,


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Preparations: using a long, thin tube with a lens (cystoscope) to see inside your

urethra and bladder. The cystoscope is inserted in your urethra and passed through

to your bladder.

Urine test results

Color Normal: Pale to dark yellow

Abnormal: Many foods and medicines can affect the color of the urine. Urine

with no color may be caused by long-term kidney disease or

uncontrolleddiabetes.Dark yellow urine can be causedbydehydration.Red urine can be caused by blood in the urine.

Clarity Normal: Clear

Abnormal: Cloudy urine can be caused by pus (white blood cells), blood (red

blood cells), sperm, bacteria, yeast, crystals, mucus, oraparasite infection, such astrichomoniasis.

Odor Normal: Slightly "nutty" odor

Abnormal: Some foods (such as asparagus), vitamins, and antibiotics (suchaspenicillin)can cause urine to have a different odor. A sweet,

fruity odor may be caused by uncontrolled diabetes. Aurinary tract

infection (UTI) can cause a bad odor. Urine that smells like maplesyrup can mean maple syrup urine disease, when the body cannot

break down certainamino acids.

Specific

gravityNormal: 1.005-1.030

Abnormal: A very high specific gravity means very concentrated urine, which

may be caused by not drinking enough fluid, loss of too much fluid

(excessive vomiting, sweating, ordiarrhea), or substances (such assugar or protein) in the urine. Very low specific gravity means dilute

urine, which may be caused by drinking too much fluid, severe

kidney disease, or the use ofdiuretics.

pH Normal: 4.6-8.0

Abnormal: Some foods (such as citrus fruit and dairy products) and medicines

(such as antacids) can affect urinepH.A high (alkaline) pH can be

caused by severe vomiting, a kidney disease, some urinary tractinfections, andasthma.A low (acidic) pH may be caused by

severelung disease (emphysema), uncontrolled
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diabetes,aspirin overdose, severe diarrhea,dehydration,starvation,

drinking too much alcohol, or drinking antifreeze (ethylene glycol).

Protein Normal: None

Abnormal: Protein in the urine may mean kidney damage, an

infection,cancer,high blood pressure,diabetes,systemic lupus

erythematosus (SLE),orglomerulonephritis is present.

Protein in the urine may also mean thatheart failure,leukemia,

poison (lead or mercury poisoning), orpreeclampsia (if you arepregnant) is present.

Glucose Normal: None

Abnormal: Intravenous (IV) fluids can cause glucose to be in the urine. Toomuch glucose in the urine may be caused by uncontrolled diabetes,anadrenal glandproblem, liver damage,brain injury, certain types of

poisoning, and some types of kidney diseases. Healthy pregnant

women can have glucose in their urine, which is normal duringpregnancy.

Ketones Normal: None

Abnormal: Ketones in the urine can mean uncontrolled diabetes, a very low-

carbohydrate diet, starvation or eating disorders (such asanorexianervosa orbulimia),alcoholism,or poisoning from drinking rubbing

alcohol (isopropanol). Ketones are often found in the urine when a

person does not eat (fasts) for 18 hours or longer. This may occurwhen a person is sick and cannot eat or vomits for several days.

Low levels of ketones are sometimes found in the urine of healthy

pregnant women.

Microscopic

analysisNormal: Very few or no red or white blood cells or casts are seen. No

bacteria, yeast cells, parasites, or squamous cells are present. A few

crystals are normally seen.

Abnormal: Red blood cells in the urine may be caused by kidney or bladderinjury,kidney stones,a urinary tract infection (UTI), inflammation

of the kidneys (glomerulonephritis), a kidney or bladder tumor, or

systemiclupus erythematosus (SLE). White blood cells (pus) in theurine may be caused by a urinary tract infection, bladder tumor,

inflammation of the kidneys, systemic lupus erythematosus (SLE),
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or inflammation in thevagina or under the foreskin of the penis.

Medical Management UTIs are treated with antibiotics, agents which rid the body of bacteria. The

choice of antibiotic will depend on the organism causing the infection. The results

of the urine test will indicate to your health care provider which antibiotics areeffective.

A bladder anesthetic is often prescribed to relieve the acute discomfort of UTIs.The most common agent, phenazopyridine hydrochloride (Pyridium), provides

rapid relief of symptoms

Nursing Management Adequate fluid intake on a regular basis is important to good health in both men

and women and will help prevent UTIs.

After urinating or bowel movement, women should wipe from front to back. For women for whom UTIs are linked with sexual activity, it may help to urinate

both before and after intercourse. Commonsense levels of cleanliness usually are

adequate, but when UTIs are a problem, special care may be required of bothsexual partners.

CYSTITIS

Clinical Manifestations A strong, persistent urge to urinate A burning sensation when urinating Passing frequent, small amounts of urine Blood in the urine (hematuria) Passing cloudy or strong-smelling urine Discomfort in the pelvic area A feeling of pressure in the lower abdomen Low-grade fever

Pathophysiology
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Causes

Bacterial cystitisUTIs typically occur when bacteria outside the body enter the urinary tractthrough the urethra and begin to multiply. Most cases of cystitis are caused by a

type of Escherichia coli (E. coli) bacteria. Community-acquired bladder infections.These infections occur when people

who aren't in a medical care facility develop a bladder infection. Bladderinfections are more common in women than in men.

Hospital-acquired bladder infections.These infections, also called nosocomial(nos-o-KO-me-ul) infections, occur in people in a medical care facility, such as ahospital or nursing home. Most often they happen in those who have had a urinary

catheter placed through the urethra and into the bladder to collect urine, a

common practice before some surgical procedures, for some diagnostic tests, or as

a means of urinary drainage for older adults or people confined to bed.

Noninfectious cystitisAlthough bacterial infections are the most common cause of cystitis, a number ofnoninfectious factors also may cause the bladder to become inflamed. Someexamples:

Interstitial cystitis.The cause of this chronic bladder inflammation, alsocalled painful bladder syndrome, is unclear. Most cases are diagnosed in

women. The condition can be difficult to diagnose and treat. Drug-induced cystitis.Certain medications, particularly the

chemotherapy drugs cyclophosphamide and ifosfamide, can cause


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inflammation of your bladder as the broken-down components of the

drugs exit your body. Radiation cystitis.Radiation treatment of the pelvic area can cause

inflammatory changes in bladder tissue.

Foreign-body cystitis.Long-term use of a catheter can predispose you tobacterial infections and to tissue damage, both of which can causeinflammation.

Chemical cystitis.Some people may be hypersensitive to chemicalscontained in certain products, such as bubble bath, feminine hygiene

sprays or spermicidal jellies, and may develop an allergic-type reactionwithin the bladder, causing inflammation.

Cystitis associated with other conditions.Cystitis may sometimes occuras a complication of other disorders, such as gynecologic cancers, pelvic

inflammatory disorders, endometriosis, Crohn's disease, diverticulitis,lupus or tuberculosis.

Diagnostic Test/Exam

Urine analysis.Preparation: If it's suspected that you have a bladder infection, yourdoctor may ask for a urine sample to determine whether bacteria, blood or

pus is in your urine. Cystoscopy.

Preparation: Inspection of your bladder with a cystoscopea thin tube

with a light and camera attached that can be inserted through the urethra

into your bladdermay help with the diagnosis. Your doctor can alsouse the cystoscope to remove a small sample of tissue (biopsy) for analysis

in the lab. This test most likely won't be needed if this is the first time

you've had signs or symptoms of cystitis.

Imaging tests.Preparation: Imaging tests usually aren't necessary, but in some instances

especially when no evidence of infection is foundthey may be

helpful. For example, an X-ray or ultrasound may help rule out other

potential causes of bladder inflammation, such as a tumor or structuralabnormality.

Medical Management Antibiotic medication.A three- to five-day course is a common treatment

for most women. Symptoms usually improve within a day or so after

starting treatment. On average, taking antibiotics shortens the duration of

symptoms by around one day. One option is that your doctor may offer

you a delayed prescription for antibiotics. You then need only cash in theprescription if your symptoms worsen, or do not improve, over the

following few days. Not taking any treatmentmay be an option (if you are not pregnant or if

you have no other illnesses). Your immune system can often clear theinfection. Without antibiotics, cystitis (particularly mild cases), may go

away on its own in a few days. However, symptoms can sometimes last

for a week or so if you do not take antibiotics.
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Paracetamol oribuprofen.These ease pain or discomfort and can alsolower a high temperature (fever).

Nursing Management Have lots to drink is traditional advice to 'flush out the bladder cranberry juice or taking products that alkalise your urine (such as

potassium citrate or bicarbonate) improve the symptoms of cystitis. Thesesorts of products are sometimes sold as a treatment for cystitis. Inform client if you are pregnant or have certain other medical conditions,

you should alwaysbe treated with antibiotics to prevent possible

complications.

Glomerulonephritis

Causes The most common known causes are bacterial (most oftenstreptococcal)

and viral infections. Doctors have found that many children withglomerulonephritis had been diagnosed with a streptococcal infection,

such as strep throat, not long before developing signs of kidney damage.People with hepatitis or HIV/AIDS can also develop glomerulonephritis.

Pathophysiology1. Post-streptococcal infection(group-A, beta hemolytic)Release of material

from the organism, into the circulation (antigen)Formation of antibody

Immune complex reaction in the glomerular capillary Inflammatoryresponse Proliferation of epithelial cells lining glomerolus & cells between

endothelium & epithelium of capillary membrane Swelling capillary

membrane &infiltration with leukocytes Permeability of base membrane2. Glomerular filtration rateOcclusion of the capillaries of the glomeruli

vasospasm of afferent ventrioles Ability to form filtrate fromglomeruli

plasma flow Retention of H

3. O & Na; hypovolemia; circulatory congestion; Edema Hypertension,urinary output Urine dark in color Anorexia, Irritability lethargy

4. Leading to Glomerulonephritis Diagnostic Test/Exam

blood tests urine tests kidney or abdominal ultrasounds kidney or abdominal CT or CAT (computed tomography) scans an IVP (intravenous pyelogram) - an X-ray examination of the kidneys,

ureters, and bladder chest X-rays (if heart failure is suspected) a kidney biopsy

Preparation: The blood tests show any buildup of body wastes in the

bloodstream (such as urea), while urine tests reveal elements thatshouldn't be present, such as protein or red blood cells.

Ultrasounds and scans show kidney size (kidneys become enlarged
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in glomerulonephritis) and anything unusual, such as tumours or

blockages Finally, a kidney biopsy might be performed to confirm the

diagnosis. In a biopsy, they insert a fine needle into the kidney,

using an ultrasound as a guide; with the needle, they take a tiny

tissue sample, which they then check under a microscope fordamage or disease.

Normal A CBC is performed. A decrease in the hematocrit may

demonstrate a dilutional anemia. In the setting of aninfectious etiology, pleocytosis may be evident.

Electrolyte levels are measured (particularly the serumpotassium), along with BUN and creatinine (to allow

estimation of the glomerular filtration rate [GFR]). TheBUN and creatinine levels will exhibit a degree of renal

compromise.

The ESR is usually increased. Medical Management

Corticosteroids and medications to suppress the immune system may also be usedto treat glomerulonephritis.

Diuretics increase the body's urine output, causing you to urinate larger amountsmore frequently. These medications are often referred to as "water pills." It's

usually best to take diuretics in the morning or early afternoon to avoid having to

get up often during the night to urinate. Vitamin or mineral supplements may be recommended, depending on the results

of the blood tests, to help keep the levels of electrolytes (e.g., sodium, calcium,

and potassium) balanced. People with kidney problems might be advised to

change to a diet that cuts down on the waste buildup in the bloodstream. Thesediets aren't usually needed if the kidney damage is mild.

Nursing Management Provide best rest during the acute phase. Perform passive range of motion exercises for the patient on bed rest. Allow the patient to resume normal activities gradually as symptoms subside. Consult the dietician about a diet high in calories and low in protein, sodium,

potassium, and fluids. Protect the debilitated patient against secondary infection by providing good

nutrition and hygienic technique and preventing contact with infected people.

Check the patients vital signs and electrolyte values.

Monitor intake and output and daily weight. Explain to the patient taking diuretics that he may experience orthostatichypotension and dizziness when he changes positions quickly.


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