Nursing management of patients with renal and urinary disorders.
••> 1) Explain/define antidiuretic hormone.
=> Another name of antidiuretic hormone hormone is Arginine vasopressin {( Avp ) Arginine vasopressin). }
=> Antidiuretic hormone is secreted from the posterior pituitary gland and is responsible for the reabsorption of excess water by the kidneys.
=> Antidiuretic hormone plays an important role in maintaining water balance in the body.
••> 2) Explain/ define the diffusion.
=> Diffusion is a process in which solutes move from higher concentration to lower concentration.
••> 3)Explain/ Define glomerulus. (Define glomerulus)
=> Glomerulus is a part of nephron formed by tough capillaries which is responsible for filtration.
••>4)Explain / define GFR (Glomerular Filtration Rate).
=> How much plasma is filtered by glomeruli in kidney tubules is called glomerular filtration rate (GFR).
=> Normal glomerular filtration rate (GFR) is 120 ml/min.
••> 5) Micturition (micturition) means :=
urination / voiding.
••> 6) painful or difficulty in urination its called (pain full or difficulty in urination in urination called s) := dysuria
••>7) Awaking at night time to urinate is called:= Nocturia,
••> 8) Oligouria
How much urine is output in 24 hours in the condition of oligouria.
=> urine output is less than 100 ml in 24 hours.
••> 9) What is pus in urine called?.
=> pyuria (Pyuria) .
••>10) protein in urine is called as :=
=> Proteinuria (Proteinuria),
••>11) How much urine is output in 24 hours in the condition of Anuria?
=> less than 50 ml in 24 hours.
••>12) If bacteria are present in urine what is it called?:=
=> bacteria in urine is called as bacteriuria.
••> 13) Explain/ define creatinine. (Define Creatinine)
=> The waste product after metabolism of energy by muscles is called creatinine.
••> 14) Define/ Explain Aldosterone.
=> Aldosterone hormone is synthesized and released from the cortex of the adrenal gland which is responsible for sodium reabsorption in the kidneys.
••> 15) Inserting a tube into the urinary bladder and permitting drainage of urine is called what?
=> catheterization (catheterization),
••> 16) Blood in urine is called as:=
haematuria,
••> 17) Explain / Define peritonitis. (Define peritonitis)
=> Infection and inflammation in the peritoneal membrane on the abdominal cavity is called peritonitis.
••> 18)Explain/define osmosis. (Define Osmosis)
=> Osmosis is the process in which water moves through a semipermeable membrane from a lower solute concentration to a higher solute concentration.
••> 19) Number of particles dissolve in per kilogram urine it’s called as:=
=> Osmolality (Osmolality).
••> 20) Who is known as structural and functional unit of kidney.
=> Nephron (nephron),
••> 21) Circulation of the patient’s blood through a dialyzer and excess fluid and waste products are removed is known as which procedure.
=> haemodialysis,
••> 22) When the patient’s peritoneal membrane (membrane covers the abdominal cavity) is used as a semipermeable membrane and exchange of fluid and solutes is done, what is it called?
=> Peritoneal Dialysis,
••> 23) Explain “CAPD”
=> Full form of “CAPD” is Continuous Ambulatory Peritoneal Dialysis
~> (Continuous Ambulatory Peritoneal Dialysis)
=> This is a type of peritoneal dialysis method in which the patient undergoes four to five complete dialysis sessions throughout the day.
•> 24) Explain “CAVHD”
=> the full form of CAVHD is Continuous Arteriovenous Hemodialysis (Continuous
Arteriovenous Hemodialysis)
=> It is a type of continuous renal replacement therapy, in which fluid and waste products are removed.
=>Article blood in this procedure
After circulating through Hemofilter
A venous catheter
(venous catheter) is returned to the patient’s body.
••>25) Explain the “CAVH”
=> The full form of CAVH is Continuous Arteriovenous Hemofiltration (Continuous
arteriovenous hemofiltration)
=> This is a type of continuous renal replacement therapy in which fluid is mainly removed.
=> Arterial blood is circulated through the hemofilter and returned to the patient’s body through a venous catheter.
••> 26) Explain “CCPD”
=> the full form of “CCPD” Continuous Cyclic Peritoneal Dialysis (Continuous Cyclic Peritoneal Dialysis)
=> This is a type of peritoneal dialysis procedure in which the dialysis machine automatically performs the dialysis exchange even when the patient is in a sleep condition. ,
••>27) Explain the “CRRT”
=>The full form of “CRRT” is Continuous Renal Replacement therapy (Continuous Renal Replacement Therapy)
=> In continuous renal replacement therapy, different methods are used to normalize kidney function in which the patient’s blood is circulated through a hemofilter.
••> 28) Explain the “CVVHD”
=>The full form of “CVVHD” is Continuous venovenous Hemodialysis (Continuous Venovenous Hemodialysis).
=> This is a type of renal replacement therapy in which fluid and waste products are removed.
=> Which is mainly venous blood circulates through the hemofilter and is returned back to the patient’s body.
••> 29) Explain the “CVVH”
=> the full form of
“CVVH” Is Continuous Venovenous Hemofiltration
=> This is a type of renal replacement therapy in which fluid is mainly removed,
=> Venous blood is circulated through the hemofilter and returned to the patient’s body.
••> 30) What is the name of machine it’s called “Artificial kidney” :=
=>The other name of the artificial kidney is •>Dialyzer
(dialyzer) or •>Dialysis machine
(dialysis machine).
••> 31) The urine that remains in the bladder after voiding is called as a :=
=> Residual urine (residual urine),
••>32) Explain/define Stress incontinence. (Define stress incontinence)
=> When intra abdominal pressure increases, even if there is an intact urethra, involuntary urine loss is called stress incontinence.
••> 33) Involuntary and uncontrolled loss of urine is called as a:=
=> Urinary incontinence
••> 34) Black flow of urine from bladder into ureters is called what.
=> Vesico urethral reflux
(vesicourethral reflux)
••> 35) Explain the “VLPP”
=> Valsalva Leak – Point Pressure
=> This is the amount of abdominal pressure due to which the pressure increases in the bladder and urethra due to which urine is involuntarily leaked.
Explain the health history of the patient with the renal and urinary disorder.
★ subjective data:=
1) Important health information (Important health information)
Past History (Past Health History) :=
Ask the patient about any renal and other urinary organ related disorders in the past.
=> Asking whether the patient is taking any kind of medication in the past.
=> Asking whether the patient has been hospitalized in the past or not.
2) Assess the dietary habit of the patient. (Assessing the patient’s dietary habit)
=> Assessment about the patient’s dietary habit.
=> Taking information about the patient’s appetite.
=> Asking about the patient’s consumption of vitamin and mineral supplements or not.
=> Asking about the amount of fluids the patient is taking.
=> Asking about any changes in the patient’s weight.
=> Obtaining information about the type of food consumption the patient does daily.
3) Family history
=> To get information about whether any person in the patient’s family has a disorder of urinary system or not.
4)Lifestyle factors:=
=> To note whether the patient has any smoking habit or not.
=> Getting information about the amount of physical activity the patient does.
=> Obtaining occupational related information from the patient.
5) Activity Exercise patterns
=> Assessing the patient’s activity level.
=> Assessing whether there are any changes in the patient’s daily routine activities.
=> To obtain information about whether the patient develops any urinary tract related problem after stopping any activity.
=> Obtaining information about the amount of daily routine activity the patient does.
6) Assess about the Elimination pattern
=> To obtain information about whether the patient wakes up at night to urinate or not.
=> To find out whether the patient has blood present in urine or not.
=> To obtain information about whether the patient’s urine is filled with leakage or not.
=> Getting information about whether or not to use a special device to control urine.
=> To obtain information about patient’s pain during urination or not.
7) Assess the functional health patterns.
=> Obtaining information about the client’s general health.
=> Assess the energy amount of the patient.
=> Obtaining information about whether the patient has visual changes or not.
=> Obtain information about whether the patient smokes.
8) Assess the symptoms of the patient
=> To get information about any changes in the urine color of the patient or not.
=> Obtaining information about urinary frequency from the patient.
=> To obtain information about whether the patient experiences pain during urination or not.
objective data
=> Objective data is mainly obtained by physical examination
in which,
Inspection,
••> Palpation
(palpation),
••> Percussion
(Percussion), and Auscultation
includes the method of
1) Inspection
•> skin :=
~>any paleness in the skin,
~>yellow discoloration,
~>Any changes in skin colour,
~> skin turgor, etc
~> Getting information about any changes in skin texture.
•> Mouth (Mouth) :=
~> Assessment of any stomatitis condition in the mouth.
~> To assess whether ammonia breath is present in the patient’s mouth or not.
•>Face and Extremity
(Face and Extremity)
=> Assessing whether the patient is in generalized AD or not.
=> To assess whether the patient is present with kidney enlargement or not.
3) Abdomen
(abdomen)
~>Assessing whether any mass like structure is present in the abdominal area that would indicate urinary retention.
4) Weight
(weight)
~> Assessing whether the patient has any weight gain problems that indicate edema.
~> and to assess whether the patient’s weight is less than his normal weight or not.
2) Palpation
~> To assess whether the patient has any costo vertebral angle tenderness or not, any palpable mass or not and any palpable kidney or not.
3) Percussion
=> If costovertebral angle tenderness and pain is present then it indicates any infection in kidney or polycystic kidney disease.
4) Auscultation
=> Auscultation of Abdominal aorta and Renal Arteries is done to assess whether any bruit sound is present or not. Which indicates impaired blood flow in the kidney
Diagnostic funding of the patient with the urinary system (Write the diagnostic evaluation of the patient with the urinary system)
1) urin color
=> If the patient is taking diuretic medicine, alcohol consumption, glycosuria, renal disease then urine is dilute.
2) Bright yellow
=> If the patient is taking a multiple vitamins preparation then the color of his urine is bright yellow.
3) Yellow to milky white
=> Due to pyuria and infection.
4) orange to amber
=> Concentrated urine is bilirubin mainly due to dehydration, piles, bile, carbotens medication.
5) Blue, Blue green (Blue and Blue Green)
=> Dyes,
•>methylene blue,
•>Pseudomonas species organism,
And seen due to medicine.
6) pink to red color
=> Due to breakdown of HB (hemoglobin).
=>menses,
=> Bladder or prostate surgery,
=> Pink and red color is seen due to some medication like phenytoin.
7) brown to black (brown to black color)
=> Due to old red blood cells,
Due to urobilinogen, melanin, dehydration and medication.
2) Renal function test
=> Renal function test is mainly used to assess the severity of kidney diseases.
3) Kidney, ureters and bladder studies
=> This is mainly done to assess whether any normality is present in the structure of kidney, ureters and bladder.
=> Used to assess whether any tumor, cyst, stones are present or not.
4) Bladder sonography
=> Bladder sonography is mainly used to check whether any abnormality is present in the bladder or not.
=> Bladder sonography is mainly used to detect bladder size, bladder shape, Abnormality present in Bladder.
5) Cytography
Cytography is primarily used to evaluate any injury to the bladder or vesico-urethral reflux.
6) Renal angiography
=> Use in Renal angiography to detect Abnormality of Renal Artery
happens
7) Cytoscopy
=> Cytoscopy is used to directly visualize the urethra and bladder.
8) Kidney Biopsy
=> Kidney biopsy is mainly used to detect abnormality of kidney.
Like:=
Unexplained acute renal failure,
•> Hematuria,
•> Transplant rejection,
•>Glomerulopathies.
9) Assess the specific gravity of the urine
=> Concentration of urine is measured in specific gravity of urine. In which the amount of dissolved solutes is assessed.
=> the specific gravity of the urine is 1.005 to 1.030.
=> If specific gravity of urine is low then it is mainly seen due to diabetes insipidus, fluid intake in excessive amount.
=> Increase in specific gravity of urin is mainly seen due to dehydration, kidney problem.
10) Assess the leukocytes level. (leukocyte level)
=> To assess the leukocyte level of the patient.
=> If. If leukocytes are present in the urine, it indicates a urinary tract infection.
11) Nitrates Assess level
=> To assess the nitrate level of the patient’s urine.
=> If there are nitrates in urine, it indicates bacterial infection and indicates urinary track infection.
=> followed by protein in urine, ketone bodies, and pH of urine. to assess.
12) X Ray of kidney
=> X Ray investigation is done to assess whether there is any abnormality in the kidney or not.
1) Explain/Define Urinary retention. (Define urinary retention.)
=> Urinary retention is also called ischuriya.
=> Urinary retention is a condition in which the ability of the bladder to completely empty is impaired.
=> Due to which the bladder cannot be emptied completely and urine is retained in the bladder.
=> There are many factors that cause urinary retention. like ,
•> Due to any obstruction,
•> Due to nerve problem,
•>Due to muscle dysfunction,
There is difficulty in urination and the condition of urinary retention arises.
2) Explain the etiology/ cause of the urinary retention. (Give reasons for urinary retention)
(obstructive causes)
1)BPH (Benign Prostatic Hyperplasia)
=>Mostly in male, prostate gland enlarges due to aging and due to this obstruction in urethra due to which condition of urinary retention arises.
2) Urethral stricture
(urethral stricture)
=> Any inflammation and injury leads to the formation of scar tissues in the urethra and due to this narrowing of the urethra and the condition of urinary retention arises.
3) Bladder stone
=> Due to the formation of calculi in the bladder, the urethra becomes obstructed and the condition of urinary retention arises.
4) Tumor
=> If benign and malignant tumors arise in the bladder and prostate gland, they obstruct the urinary flow and due to this, the condition of urinary retention arises.
(Non Obstructive Cause)
1) Neurogenic dysfunction
=> The condition of urinary retention arises due to any injury and inflammation in the nerve that controls the bladder.
=> Due to injury in the spinal cord, due to multiple sclerosis, and also due to diabetes, nine is impacted and the condition of urinary retention arises.
2) certain medication
=> Certain types of drugs like anticholinergic, Opioids are also involved in the causes of urinary retention.
3) Pelvic organ prolapse
=> Urinary flow is also impaired due to bladder and uterus prolepse and due to this the condition of urinary retention arises
4) Infection (due to infection)
=> Urinary function is also impaired due to infection in some types of urinary track.
5)prostitis (prostitis),
3) Explain the clinical manifestation / sign and symptoms of the patient with the urinary retention. (State the symptoms and signs of a patient with urinary retention)
Difficulty in urination,
Sensation of incomplete voiding.
Urinary incontinence.
Nocturia (Awaking at night time to urinate).
Vic or intermittent stream.
incomplete emptying.
Increased condition of urinary frequency.
Urgency.
Abdominal discomfort and pain.
Hydronephrosis (Excess accumulation of fluid into the kidney).
Pyonephrosis (collection of pus into the kidney).
Kid’s failure and sepsis.
4) Explain the diagnostic evaluation of the patient with urinary retention. (Write diagnostic evaluation for urinary retention)
history taking and physical examination.
Bladder ultrasound.
assess the serum urea.
assess the serum creatinine level.
Renal function assessment.
Cytoscopy.
serum prostate specific antigen (PSA).
MRI of lumbar spine.
5) Explain the management of urinary retention. (Specify no management for urinary retention.)
Perform urinary catheterization if there is acute urinary retention.
Stent and suprapubic cytostomy to relieve urinary retention.
Prostectomy procedure.
If the cause of urinary retention is benign prostatic hypertrophy (benign prostatic hypertrophy), the patient should be given alpha blocker medicine due to which the urinary muscles relax and urinary flow can be done easily.
Perform Transurethral resection of the prostate on the patient.
If urinary retention is due to any infection then provide patient with biotic medicine.
If there is an inflammatory condition, provide the patient with a non-steroidal anti-inflammatory drug.
Providing cholinergic medicine to the patient.
Advise the patient to exercise.
Nursing management of patients with urinary retention. (State nursing management of patient with urinary retention)
Assessing the patient’s condition.
To provide education to the patient for sitting and standing position.
To properly assess the patient’s vital signs.
Provide proper catheter care to the patient.
Maintaining patient no intake output chart.
To provide education to the patient about the disease, its causes, its symptoms and signs and its treatment.
If the patient is in pain, provide analgesic medicine.
To provide comfort measures if the patient is uncomfortable.
Advise the patient to maintain personal hygiene.
Maintain aseptic technique to avoid any further complications to the patient.
Provide proper psychological support to the patient.
To clear all the doubts of the patient and his family members.
Advising the patient to take proper medication.
To provide a calm and comfortable environment to the patient.
1) Define/ explain urinary incontinence. (Define urinary incontinence)
=> Urinary incontinence is a condition in which there is involuntary and uncontrolled loss of urine from the bladder.
=> Urinary incontinence is a condition in which there is inability to control the passage of urine and urine is involuntarily lost.
=> Urinary incontinence is mainly seen in older people. And it is mainly seen more in women than in man.
2) Explain the types of urinary incontinence. (State the type of urinary incontinence)
=> There are total five types of urinary incontinence.
1) Stress incontinence
(Stress Incontinence),
2) Urge incontinence
(Urge Incontinence),
3) Overflow incontinence
(overflow incontinence),
4) Functional incontinence,
5) Gross total incontinence
(gross total incontinence).
••••>
1) Stress incontinence
(Stress Incontinence),
=> In stress incontinence, there is involuntary loss of urine when doing any action.
=> Like cuffing, sneezing, lifting causes abdominal pressure on the bladder due to which urinary incontinence occurs.
=> Stress incontinence is mainly seen when abdominal pressure increases on the bladder or when the sphincter muscles of the bladder are weakened.
=> The condition of incontinence is seen in women mainly due to physical changes like pregnancy, child birth and menopause.
=> This type of condition arises when the prostate gland is removed in men.
2) Urge incontinence
(Urge Incontinence),
=> Urge incontinence is mainly when strong,
When there is an uncontrollable, involuntary urge to urinate, uncontrolled urine voiding is called urge incontinence.
=> Urge incontinence is mainly any •>urinary track infection,
Bladder irritants,
Bowel problem,
Parkinson’s disease,
•>Alzheimer disease,
stroke,
•> Due to injury and damage in the nervous system, the condition of urge incontinence arises.
3) Overflow incontinence
(overflow incontinence),
=> Overflow incontinence is a condition in which there is constant dribbling of urine and small amounts of urine are frequently passed.
=> Overflow incontinence is mainly seen after urinary retention.
=> This type of incontinence condition is mainly seen when bladder is damaged, urethra is blocked and there is any abnormality in nervous system and diabetic condition.
=> Mainly seen in men when there is any problem of prostate gland.
4) Functional incontinence,
=> Functional incontinence is mainly seen when there is any physical and cognitive impairment.
5) Gross total incontinence
(gross total incontinence).
=> In gross total incontinence, continuous day and night urine leaking is seen.
=> This type of incontinence is mainly seen due to injury in any spinal code and urinary system.
3) Explain the etiology/cause of the patient with urinary incontinence. (Give reasons for urinary incontinence)
1) Stress incontinence
(Stress Incontinence)
Due to pelvic floor muscle weakness.
Due to pelvic organ prolapse.
2) Urge incontinence
(urge incontinence)
Due to over active bladder.
Due to the occurrence of neurological disorders.
3) Overflow incontinence
Due to obstruction.
Due to bladder muscle weakness.
4) Functional incontinence.
Mobility and cognitive impairment.
5) Mixed incontinence
=> Combination of factors.
6) other factors
Due to hormonal changes.
Because of the medication.
Due to chronic illness.
Due to taking bed rest.
Due to consumption of alcohol.
Due to infection and inflammation in the prostate gland.
Due to impaction of stool due to severe constipation.
Due to urinary tract infection.
Because of Alzheimer’s disease.
Due to multiple sclerosis.
Due to Parkinson’s disease.
Due to pregnancy.
Due to genito-urinary surgery.
Age related changes.
Due to certain types of medication.
4) Explain the clinical manifestation/sign and symptoms of the patient with urinary incontinence. (State the symptoms and signs of a patient with urinary incontinence.)
Dribbling of urine.
Poly urea.
Enlargement of the prostate gland.
Urinary incontinence.
Nocturnal enuresis.
Increased frequency of urine.
Urgency.
Incomplete emptying.
Pelvic discomfort and pain.
Functional limitation.
Skin irritation and infection.
Changes in life style.
Depression and anxiety.
5) Explain the diagnostic evaluation of the patient with urinary incontinence. (Write the diagnostic evaluation of a patient with urinary incontinence.)
history taking and physical examination.
urinalysis.
Urine culture.
residual urine measurement.
stress test.
Blood test.
Cytoscopy.
Ultra sound.
urodynamic test.
vaginal and anal examination.
serum electrolyte studies.
Assessment of calcium level.
Assess the BUN (Blood Urea Nitrogen) level.
Assess the creatinine level.
Spinal MRI.
Cytourethrography.
Intravenous pyelography (IVP).
Electromyography (EMG).
6) Explain the medical management of the patient with urinary incontinence. State the medical management of a patient with urinary incontinence.
1) Provide antispasmodic drugs
(provide anti spasmodic drug)
=> Antispasmodic drug relaxes the bladder.
EX :=
•> Flavoxate,
Dicyclomine,
2) Provide anticholinergic drug
(provided anticholinergic drug)
=> Anticholinergic drugs mainly reduce involuntary contractions of the bladder.
Ex:=
Oxybutynin
(Oxybutynin),
Darifenacin
(Darifenacin),
Solifenacin
(Solifenacin),
3) Provide Alpha and beta adrenergic drugs
(provide alpha and beta adrenergic drug)
=> This type of medicine is mainly used to reduce stress incontinence.
Ex:= phenpropanolamine.
4) Tricyclic antidepressant
=> This medicine mainly affects the bladder muscles.
EX:=
•> Noepinephrine,
•>Serotonin,
•>Doxepin,
•>Desipramine.
) Surgical management
fore female:=
Modified artificial sphincter is used.
For male:=
Transurethral Resection of prostate (TURP)
8) Explain the nursing management of patients with urinary incontinence. (State nursing management of patient with urinary incontinence)
1)Assessment:=
=> Complete assessment of the patient.
2)Education:=
=> To provide complete education to the patient about the causes of urinary incontinence, its symptoms and signs and treatment.
3) Bladder training
(bladder training)
=> Provide proper bladder training to the patient.
4) Pelvic floor exercise
(Pelvic Floor Exercise)
=> Advise the patient to do pelvic floor exercises.
5) Fluid management
=> Giving advice for proper fluid intake of the patient.
=> Advising patients to use assistive devices.
6) skin care
(skin care)
=> Providing proper skin care of the patient.
=> Advise the patient to do environmental modification.
7) Emotional support
(emotional support)
=> Provide proper emotional support to the patient.
8) Collaboration with the health care members (Collaboration with health care personnel)
=> Collaboration with health care personnel to take proper care of the patient.
9) Monitoring and documentation
=> Monitoring the patient continuously.
=> Proper documentation of the patient’s condition.
10) Follow up
=> Advising the patient to follow up regularly.
1) Define/Explain the Urinary track infection.
=> Urinary tract infection is mainly infection and inflammation in part of urinary system.
=> The urinary system mainly includes the kidneys, ureters, bladder, and urethra. If infection and inflammation occurs in this system, it is called urinary tract infection.
=> Urinary tract infection is mainly caused by pathogenic microorganisms.
=> If the urinary tract infection mainly affects the upper urinary tract
It is called pyelonephritis.
=> If the urinary tract infection mainly affects the lower urinary tract
It is called simple cystitis.
2) Explain the types of urinary track infection.
=> There are two main types of urinary tract infection.
1) Upper urinary track infection (Upper urinary track infection),
2) Lower urinary track infection (lower urinary track infection).
1) Upper urinary track infection (Upper urinary track infection),
=> Upper urinary tract infection is mainly called pyelonephritis.
=> Upper urinary track infection mainly includes kidneys and ureters.
=> Due to this mainly fever, chills, nausea, vomiting and other symptoms are seen.
2) Lower urinary track infection (lower urinary track infection).
=> Lower urinary tract infection
Simple cystitis
(simple cystitis) is called.
=> Lower urinary tract infection mainly includes bladder and urethra.
3) Explain Etiology/cause of the patient with the Urinary track infection.
Escheresia coli (Escheresia coli),
Klebsilla (Klebsilla),
Enterococcus (Enterococcus),
Enterobacter,
Pseudomonas,
Proteus
(Proteus),
Staphylococcus,
Mycoplasma (Mycoplasma),
Chlamydia
(Chlamydia),
4) Explain the risk factors of the patient with the Urinary track infection.
1) Female :=
•>short urethra,
•>Dimimosed urethral peristalsis,
•>use of Diaphragm.
2) Structural abnormality due to line.
•> Due to urethral stricture.
•> Due to urethral vesical function abnormality.
3) Obstruction (due to obstruction)
=> Because of tumor present.
=> Being calculai present.
=> Due to prostatic hypertrophy.
4) Impaired bladder innervation
=> Due to multiple sclerosis.
=> Due to urinary stasis.
=> Due to neurogenic bladder.
5) cronic disease (due to chronic diseases)
=> Immuno suppression,
=> Due to glomerulo nephritis,
=> Due to hyper tension.
=> Due to sickle cell anemia.
6) Age
=> Due to anemia.
=> Due to malnutrition.
5) Explain the clinical manifestation / sign and symptoms of the patient with the urinary tract infection. (State the symptoms and signs of a patient with urinary tract infection)
Dysuria (Dysuria:= pain and burning sensation during urination).
Increased frequency of urination.
urgency to urinate.
Hematuria (blood in urine).
Cloudy and foul smelling urination.
Pelvic pain.
Flank pain.
fever.
chills.
nausea
Vomiting.
Urinary incontinence.
Lower back pain.
Headache.
Pain during urination.
6) Explain the diagnostic evaluation of the patient with the urinary tract infection. (State the diagnostic evaluation of a patient with urinary tract infection)
history taking and physical examination.
Complete blood count.
Urine analysis.
Urinary microscopy.
Urine culture.
Ultrasound.
X ray.
MRI.
Cytoscopy.
7) Explain the medical management of the patient with the urinary track infection. Explain the medical management of the patient with the urinary track infection.
Monitor the patient’s intake output chart.
Assessing whether the patient has any adverse reaction or not.
Advise patient to increase fluid intake.
Provide antibiotic medicine to the patient.
Ex:=
ciorofloxacin,
•Nitrofurantoin/trimethoprime.
If the patient is in pain, provide analgesic medicine.
Ex:=
•> Acetaminophen,
Ibuprofen.
Advise the patient to avoid irritating food like alcohol, tea coffee, spicy food, hot food.
Advise the patient to maintain personal hygiene.
Provide psychological support to the patient.
Advising the patient to take medication properly.
8) Explain the nursing management of patients with the Urinary track infection.
Properly assess the patient.
Advise the patient for proper fluid intake.
If the patient is in pain, provide analgesic medicine.
Providing mind diversional therapy to the patient.
Assessing the effectiveness of the patient’s medication.
Provide properly prescribed antibiotic medicine to the patient.
Advise the patient to maintain proper personal hygiene.
Advise the patient to take adequate amount of rest
Assess whether the patient has any other complications.
Advise the patient to follow up regularly.
Proper documentation of patient information.
Providing proper psychological support to the patient.
To provide a calm and comfortable environment to the patient.
Advise the patient to take a properly nutritious diet.
Advise the patient to follow up regularly.
Provide psychological support to the patient.
To clear all the doubts of the patient.
To provide a calm and comfortable environment to the patient
1) Explain/Define the upper urinary tract infection. Define upper urinary tract infection.
=> Upper urinary tract infection is called pyelonephritis.
=> The upper urinary tract includes the kidneys and ureters.
=> Involvement of kidney, ureters, calyx and renal pelvis is seen in pyelonephritis.
=> Pyelonephritis is mainly caused by bacterial infection.
=> In pyelonephritis, the bacteria mainly travel from the lower urinary tract (bladder and urethra) to the upper urinary tract (kidney and ureters).
Creates infection and inflammation in the track.
2) Explain the types of pyelonephritis.
=> There are two types of pyelonephritis.
1) Acute pyelonephritis
(Acute Pyelonephritis),
2) cronic pyelonephritis (chronic pyelonephritis)
••••>
1) Acute pyelonephritis
(Acute Pyelonephritis),
=> Acute pyelonephritis develops rapidly and symptoms
There is a sudden onset.
=> Acute urinary tract infection mainly
Seen from 24 to 48 hours to a week.
give reason)
Due to bacterial infection.
E.coli bacteria (Escherichia coli).
Due to vesico urethral reflux (backward flow of urine from bladder to kidney).
Due to urin obstruction.
Due to impaired immune system.
Due to indwelling catheter.
klebsilla (Klebsilla).
Enterobacter species (due to Enterobacter species).
2) cronic pyelonephritis (chronic pyelonephritis)
=> Chronic pyelonephritis develops gradually. And mainly
Extended period
(Extended period) is seen till.
=> Chronic pyelonephritis is mainly due to repeated episodes of acute pyelonephritis infection resulting in chronic pyelonephritis.
=> In chronic pyelonephritis
Renal inflammation
And due to fibrosis of tubules and interstitial tissues, end stage renal disease is seen.
=> Chronic pyelonephritis is mainly seen from 6 months to 1 year.
=> Chronic pyelonephritis is seen due to recurrent or persistent renal infection, vesico-urethral reflux, and urinary tract obstruction.
Explain the etiology of chronic pyelonephritis. (State the cause of Chronic Pyelo Nephritis)
=> Due to bacterial infection.
=>Due to neurogenic bladder.
=> Due to hypertension.
=> Due to obstruction of urine flow.
=> Due to repeated infections.
=> Due to structural damage.
=>Kidney stone.
=> Due to urinary tract abnormality.
3) Explain the clinical manifestation / sign and symptoms of the chronic pyelonephritis. (State the symptoms and signs of chronic nephritis)
=> Fever.
=> Feeling cold.
=> Flank or back pain.
=> Urinary frequency increases.
=>Nausea and vomiting.
=> Painful urination.
=> Urinary frequency increases.
=> Costovertebral Angle tenderness.
=> Hematuria (blood in urine).
=> Fatigue (fatigue).
=> flank tenderness.
=> Malaise.
=> Having back pain.
=> Dysuria (Dysuria := difficulty and painful urination).
=> Confusion.
4) Explain the Diagnostic evaluation of the patient with the Urinary tract infection.
history taking and physical examination.
Urinalysis.
Urine culture.
Sensitivity test.
Complete blood count test.
Blood culture.
Intravenous pyelography (IVP).
Kidney ultrasound.
CT Scan.
voiding Cystourethrography to detect the structural and functional abnormality.
cytography to rule out the benign prostatic hypertrophy.
Renal biopsy.
MRI.
5) Explain the medical management of the patient with the pyelonephritis disorder. (State the medical management of a patient with pyelonephritis disorder)
Provide antibiotic medicine to the patient.
Ex:=
=>Tobramycin,
=>Gentamycine,
=>Vancomycin,
=>Ciprofloxacine,
=>Norfloxacine,
=> Trimethprim,
=> Sulfamethoxazole
Provide antipyretic medicine to the patient.
Ex:=Paracetamol.
Provide urinary antiinfective medicine to the patient.
Ex:=
Nitrofurantin,
Trimethoprime.
Providing urinary antiinfective medicine to the patient.
Ex:=
Tab Phenazopyridine.
6) Explain the surgical management of patients with pyelonephritis. (Write surgical management of patient with pyelonephritis)
1) ureteroplasty (Ureteroplasty)
=> In this procedure, the stricture in the ureters is surgically removed or repaired.
2)Ureteral reimplantatoin (ureteral reimplantation)
=> Urethral reimplantation is done to cure permanent vesicourethral reflux.
3)Ureteral stent
=>Urethral stent mainly increases urine flow.
4) percutaneous ultrasonic pyelolithotomy.
(Percutaneous Ultrasonic Paelolithotomy)
=>Percutaneous ultrasonic paeolithotomy is mainly used to remove crush and stones.
7) Explain the nursing management of patients with pyelonephritis.
Properly of the patient
Making an assessment.
To properly assess the patient’s vital signs.
Advise the patient for adequate fluid intake.
To provide intravenously to the patient.
To provide proper medicine to the patient.
To provide analgesic medicine to relieve the patient’s pain.
Advising the patient to take up meditation properly.
Maintain proper intake output chart of patient.
Advise patient to maintain aseptic techniques.
Advising the patient to follow up properly.
Advise the patient to take adequate rest
1) Explain the lower urinary tract infection. (Define lower urinary tract infection)
=> In lower urinary tract infection, infection and inflammation occurs in the bladder and uterus of the lower part of the urinary system.
=> Lower urinary tract infection occurs due to many reasons.
Like:=
1) Urethral vesic reflux.
2) Due to bacterial infection in urinary tract.
lower urinary tract infection :=
=> infection and inflammation of the lower urinary track ( bladder and urethra it’s called as a lower urinary track infection. ) }.
2) Explain the Etiology/cause of the patient with the lower urinary track infection.
Due to bacterial infection.
Ex:=
•>E.coli.
•>Klebsilla.
•>Enterococcus.
•>Staphylococcus •>saprophytucus.
Due to urinary tract abnormalities.
Due to a weakened immune system.
Urinary catheter.
Due to certain types of drugs.
due to radiation.
Due to unhygienic conditions.
Due to congenital deformity of urinary system.
unprotected sexual intercourse.
Due to any other infection.
3). Explain the clinical manifestation of the patient with the lower urinary track infection.
Burning sensation during urination.
Urinary frequency increases.
increase urgency of urination.
Passing urine in small and frequent amounts.
Nocturia
(urination during night time).
Urinary incontinence.
Fowl smelling in urine.
Hematuria (blood in urine).
Discomfort in the pelvic area.
Back pain.
Pelvic pain.
Getting a low grade fever.
Nausea.
Vomiting.
4) Explain the diagnostic evaluation of the patient with the lower urinary track infection.
History taking and physical examination.
Urine Analysis.
Cytoscopy.
Ultrasound.
x ray
intravenous urography.
colony count.
cellular findings.
5) Explain the medical management of the patient with the lower urinary track infection.
Providing antibiotic medication to the patient.
If the patient is in pain, give analgesic medicine.
Advising the patient to exercise properly.
Advise the patient to maintain personal hygiene.
Advise the patient to intake plenty of water.
6) Explain the nursing management of patients with the lower urinary tract infection.
Take a complete history of the patient.
Taking a proper history of what kind of signs and symptoms the patient has.
Advising the patient to take proper medication.
to the patient’s pain
Provide antispasmodic medication to relieve.
If the patient has a condition of inflammation, provide aspirin medicine.
Advising patient to hit application.
Advise the patient to have plenty of fluid intake.
Advising the patient to avoid irritating substances like tea, coffee, cold drinks and spicy food.
Advise the patient to maintain proper personal hygiene.
To measure patient’s vital signs properly.
Advise the patient to have plenty of fluid intake.
Providing psychological support to the patient.
To provide complete information to the patient about his disease condition, causes, symptoms and signs.