This document provides an overview of the urinary system and urinary tract infections for nursing students. It begins with the objectives and anatomy of the urinary system. It then discusses urinary problems like incontinence, retention, infections, and kidney stones. It covers types of urinary tract infections like cystitis and pyelonephritis. Nursing management is focused on prevention, treatment, patient teaching, and promoting normal urinary function. The goal is for students to understand urinary system disorders and provide appropriate nursing care.

1. 1
Jigjiga University, College of Medicine
and Health Science
Department of Nursing
Medical Surgical Nursing for Nursing
students
By:
Tadele K. (MSc N , BSc N)

2. Outlines
 Anatomy and physiologic review of UT system
 Assessment of pt with UT problem
 Infections of the urinary tracts: UUTI, LUTI
 interventions for clients with UT system
problems
 Nursing process for a pt with UTS problems
2

3. Objectives:
3
 At the end of this chapter you are expected to:
1. Define UTS disorders
2. Identify causes of some UTI
3. Differentiate the diagnostic methods used
4. Clearly differentiate the clinical features of the
UTIs
5. Perform appropriate nursing care for a pt
6. Over all implement nursing process.

4. Anatomy and physiologic overview
4
 Components of system
 Kidneys
 Ureters
 Bladder
 Urethra

5. Anatomy and physiologic overview
Kidneys
 filter waste from the blood, Urine Formation
 produce substances that form red blood cells
 erythropoietin
 fluid and electrolyte balance, acid base balance,
fluid/water balance
 blood pressure control
 renin-angiotensin-aldosterone system
 Activation of Vitamin D
5

6. Anatomy and physiologic overview
6
 Ureter
 transport urine from the kidneys to the bladder
 Bladder
 reservoir for urine until the urge to urinate
develops
 Urethra
 urine travels from the bladder and exits
through the urethral meatus

7. Anatomy and physiologic overview
7

8. Physiology of urination
 Brain structures that influence bladder
emptying:
 cerebral cortex, thalamus, hypothalamus, brain
stem
 normal voiding involves contraction of the bladder
muscles and relaxation of the urethral sphincter
 amount of urine in bladder
 adult normally holds 600ml/ urination
 child 150 – 200ml/ urination
 increasing urine volume stimulates the
micturation center in the spinal cord
 normally voiding is a voluntary process
8

9. Factors that influence urination
 Diabetes: nerve and perfusion changes
 Multiple sclerosis: nerve changes
 BPH: retention
 cognitive disorders
 Alzheimer's disease – sensation, cognitive
 ESRD: waste buildup, fluid & electrolyte
imbalance
9

10. Factors that influence urination
 Socio cultural factors
 privacy
 psychological factors
 Anxiety
 surgical procedures
 medications
 diagnostic examination
10

11. Urination problems
 Urinary incontinence
involuntary urination
 Causes:
aging
50% of all long term care residents suffer
from incontinence
 complications
skin breakdown
11

12. Types of incontinence
12
A. Stress incontinence: is the involuntary
loss of urine
through an intact urethra as a result of a
sudden increase
in intra-abdominal pressure (sneezing,
coughing, or
changing position).
It predominately affects women who have had
vaginal
deliveries and is thought to be the result of
decreasing
ligament and pelvic floor support of the urethra.

13. 13
-In men, stress incontinence is often experienced
after a
radical prostatectomy for prostate cancer because
of
the loss of urethral compression that the prostate
had
supplied before the surgery, and possibly bladder
wall irritability.

14. B. Urge incontinence
14
 is the involuntary loss of urine associated with a
strong
urge to void that cannot be suppressed.
 the patient is aware of the need to void but is
unable to
reach a toilet in time.
 an uninhibited detrusor contraction is the
precipitating
factor.
 this can occur in a patient with neurologic
dysfunction
that impairs inhibition of bladder contraction or in a

15. C. Reflex incontinence
15
 is the involuntary loss of urine due to hyper
reflexia in the absence of normal sensations
usually associated with voiding.
 This commonly occurs in patients with spinal
cord injury because they have neither
neurologically mediated motor control of the
detrusor nor sensory awareness of the need to
void.

16. D. Overflow incontinence
16
-is the involuntary loss of urine associated with
over
distention of the bladder.
-Such over distention results from the bladder’s
inability
to empty normally, despite frequent urine loss.
Both
neurologic abnormalities (eg, spinal cord lesions)
and
factors that obstruct the outflow of urine (eg,
tumors,

17. Mgt of incontinence
17
 behavioral therapy: are always the first choice to
decrease or eliminate urinary incontinence. In
using these techniques, clinicians help patients
avoid potential adverse effects of pharmacologic
or surgical interventions.
 pharmacologic therapy:
Pharmacologic therapy works best when used
as an adjunct to behavioral interventions. For
instance Anticholinergic agents (oxybutynin) can
be used.

18. Mgt of incontinence
18
 Ditropan], dicyclomine [Antispas]) inhibit
bladder contraction and are considered
first-line medications for urge
incontinence.
 Several tricyclic antidepressant
medications (imipramine, doxepin,
desipramine, and nortriptyline) also
decrease bladder contractions as well as
increase bladder neck resistance.

19. 19
 Estrogen (taken orally, transdermally, or
topically) has been shown to be beneficial for all
types of urinary incontinence. Estrogen
decreases obstruction to urine flow by restoring
the mucosal, vascular, and muscular integrity of
the urethra.
 Surgical correction

20. Nursing Mgt
20
 Nursing management is based on the premise
that incontinence is not inevitable with illness or
aging and that it is often reversible and
treatable.
 For behavioral therapy to be effective, the
nurse must provide support and encouragement
to because it is easy for the patient to become
discouraged if therapy does not quickly improve
the level of continence.

21. Nursing Mgt
21
 Patient teaching regarding the bladder program
is important and should be provided verbally
and in writing.
 The patient is assisted to develop and use a log
or diary to record timing of Kegel exercises,
changes in bladder function with treatment, and
episodes of incontinence.

22. Urination problems...con’t
 Urinary diversion
 divert ureters to abdominal stoma
 causes
 cancer of the bladder
 trauma
 radiation
 chronic cystitis
 nephrostomy
Management: surgery, antibiotics,
Nursing mgt: continuous palliative
22

23. Urination problems...con’t
23
 Urinary retention: is the inability to empty the
bladder completely during attempts to void.
Chronic urine retention often leads to overflow
incontinence (from the pressure of the retained
urine in the bladder).
 In a healthy adult younger than age 60,
complete bladder emptying should occur with
each voiding. In adults older than age 60, 50 to
100 ml of residual urine may remain after each
void because of the decreased contractility of
the detrusor muscle.

24. Urinary retention…
24
 Urinary retention can occur postoperatively in
any patient, particularly if the surgery affected
the perineal or anal regions and resulted in
reflex spasm of the sphincters.
 General anesthesia reduces bladder muscle
innervations and suppresses the urge to void,
impeding bladder emptying

25. Pathophysiology
25
Urinary retention may result from diabetes,
prostatic enlargement, urethral pathology
(infection, tumor, calculus), trauma (pelvic
injuries),
pregnancy, or neurologic disorders such as
cerebrovascular accident, spinal cord injury,
multiple sclerosis, or Parkinson’s disease.

26. Pathophysiology
26
 Medications that cause retention by inhibiting
bladder contractility include anticholinergic
agents (atropine sulfate, dicyclomine
hydrochloride [Antispas, Bentyl]), antispasmodic
agents (oxybutynin chloride [Ditropan],
belladonna, and opioid suppositories), and
tricyclic antidepressant medications (imipramine
[Tofranil], doxepin [Sinequan]).

27. 27
 Medications that cause urine retention by
increasing bladder outlet resistance
include alpha-adrenergic agents
(ephedrine sulfate, pseudoephedrine),
beta adrenergic blockers (propranolol),
and estrogens.

28. Dx: ask the following questions:
28
 What was the time of the last voiding, and
how much urine was excreted?
 Is the patient voiding small amounts of
urine frequently?
 Is the patient dribbling urine?
 Does the patient complain of pain or
discomfort in the lower abdomen?

29. 29
 Does percussion of the suprapubic region
elicit dullness (possibly indicating urine
retention and a distended bladder)?
 Are other indicators of urinary retention
present, such as restlessness and
agitation?
 Does a postvoid bladder ultrasound test
reveal residual urine?

30. Complications
30
 chronic infection
 calculi
 pyelonephritis
 sepsis
 perineal skin breakdown

31. Nursing mgt
31
 management strategies are instituted to prevent
over distention of the bladder and to trea
infection or correct obstruction.
 the nurse should explain why normal voiding is
not occurring and should monitor urine output
closely.
 the nurse should also provide reassurance
about the temporary nature of retention and
successful management strategies.
 promoting normal urinary elimination
 promoting home and community-based care

32. Urinary tract infections (UTIs)
 most common health care associated
infections
 main causes:
catheterization
surgical manipulation
75% – 95% caused by E.coli
any condition resulting in urinary retention
NB: Women develop UTI more than men
because:
shorter urethras/anatomical structure.
32

33. Classifications of UTIs
1. Upper UTI: less common, can be
un/complicated
a. Acute pyelonephritis
b. chronic pyelonephritis
c. renal abscess
d. interstitial nephritis
2. lower UTI: more common, can be
un/complicated
a. Prostitis
b. Cystitis
c. Urethritis
33

34. General clinical features
1. Upper UTIs:
 Chills, fever
 Malaise
 Pain below the ribs
 Nausea, Vomiting
34

35. General clinical features
2. Lower UTIs:
 Back pain
 Blood in the urine (hematuria)
 Cloudy urine
 Inability to urinate despite the urge
 Fever
 Frequent need to urinate
 General discomfort (malaise)
 Painful urination (dysuria)
35

36. UTIs con’t…
 Diagnostic tests:
1. Urine analysis
2. Urine culture
3. WBCs
4. biopsy
5. ultrasound
Management: mostly involves pharmacological
(antibiotics).
36

37. UTIs…Prevention:
1. Avoid products that may irritate the urethra
(e.g.,
bubble bath).
2. Cleanse the genital area before sexual
intercourse.
3. Change soiled diapers in infants and toddlers
promptly.
4. Drink plenty of water to remove bacteria from
the
urinary tract.
5. Do not routinely resist the urge to urinate
37

38. UTIs…preventions
6. Take showers instead of baths.
7. Urinate after sexual intercourse/ if possible.
8. Women and girls should wipe from front to
back
after voiding to prevent contaminating the urethra
with
bacteria from the anal area.
38

39. Cystitis
39
 An inflammation of the urinary bladder.
 More common in females.
 Common causes are coitus(E.coli),
prostatitis, and diabetes mellitus.
 S/S:
 Dysuria, urgency, frequency, hematuria,
pyuria
 burning, incontinence, supra pubic pain,
fever, cloudy urine

40. Cystitis
40
 Diagnosis: urinalysis
 Medical mgt: antibiotics, analgesics
 Nursing mgt:
 Sitz baths
 ^ fluid
 Teach
avoid tight clothing, showers appropriately
 no caffeine, wipe front to back
 cranberry juice

41. Urethritis
41
 Inflammation of the urethra
 In men
 Cause : gonococcal or nongonococcal
 Usually burning, or difficulty with urination, purulent discharge
 In women
 Burning, pain and difficulty voiding
 Irritation from vaginal deodorants and bubble bath
 Treatment
 Treat STIs, Treat with antibiotics if bacteria present
 Sitz baths, Wipe front to back, Void before and after sexual
activity
 Decrease bubble baths and vaginal deodorants

42. Pyelonephritis
42
 A bacterial infection of the renal pelvis, tubules, and interstitial
tissue of one or both kidneys.
 One or both kidneys
 Patients with pyelonephritis usually have enlarged kidneys
with interstitial infiltrations of inflammatory cells
 May lead to renal failure
 Etiology:
 Ascending infection from a lower GU tract infection
 Staph or Strep infection in the blood
 S/S
 Nausea, chills, dysuria, CVA tenderness, High fever,
severe back and flank pain, fatigue
- Dx: ultrasound, CT scan

43. Pyelonephritis
43
 Treatment/medical:
 Antibiotics: cotrimoxazole, ciprofloxacillin,
gentamicin
 Analgesics
 Nursing Care:
 Give pain RX
 Assist with:
 ADL’s
 Ensure adequate diet
 Provide IV fluids and oral fluids up to 2-3
liters/day

44. Urolithiasis
Urolithiasis: The process of forming stones in the
kidney, bladder, and/or urethra (urinary tract).
 Most common age of presentation of urinary
calculi is
20-50 years.
 90% of urinary calculi are Radio-opaque.
Etiology:
 Immobility
 Hypercalcemia/metabolic
 UTIs
 Urine stasis/ obstruction
 Fractures
44

45. Urolithiasis
45

46. Types of urolithiasis
Calcium oxalate
stone
* The principal risk factors are:
Higher urine calcium, Higher urine
oxalate, Lower urine citrate, Lower
urine volume, Dietary factors,
including a low intake of fluid,
calcium, potassium and phytate, and
a high intake of oxalate, sodium,
sucrose, fructose, and , animal
protein
* Medical conditions, including primary
hyperparathyroidism, obesity, gout,
diabetes,
* The degree to which the above risk
factors contribute to stone, disease
varies in different populations.
* -75% of all urinary calculi.
46

47. Types of urolithiasis
Tr i p l e p h o s p h a t e
-composed of magnesium ammonium
phosphate (struvite) ± calcium
carbonate-apatite
- Triple phosphate ( struvite )
- 10% of all calculi !
- Grows in infected alkaline urine (
chronic UTI)
-upper urinary tract infection with a
urease
producing organism, such as Proteus or
Klebsiella
-F> M (3:1)
-Tends to be very large (stag horn)- it
enlarges
in the pelvis ,it grows with in major and
minor calyces
- Dirty white to yellow color , radio
opaque
47

48. C/m
 Nausea and vomiting accompanying
 severe pain (located in CVA 75%)
 Fever and chills
 Hematuria
 Rarely, oliguria or anuria
 Bladder distension (urine retention)
 Pyuria, if complicated
 Stone in the ureter (manifests with severe
pain radiating from loin to groin )
48

49. C/m
49

50. Dx:
 KUB radiograph reveals visible calculi
 IVP (Intravenous Pyelogram) determines size
and location of calculi/ x-ray of kidney
 Ultrasonography:
๗ Locates Stone In The Kidney
๗ Detects Hydronephrosis
Urinalysis:
๗ Presence of RBC,
๗ Pus cells,
๗ calcium oxalate
50

51. Mgt
51
Small ureteric stones and non-obstructive kidney stones
can be managed conservatively
 Analgesics - for pain
 Antibiotics - for underlying infection
 fluid intake - expecting the stone to be washed out by
the urine (Small stones (<0.5cm)
 Follow up x-ray – check for removal
 Open surgery : nephrolithotomy

52. Nursing Mgt
 Monitor intake of fluid amount and urinary
output.
 Medicate for pain as prescribed.
 Continue antibiotic therapy as prescribed.
 Correct diet to include reduced protein and
calcium content.
 Encourage plenty clear fluid intake.
52

53. Acute Renal Failure/ARF
-is a sudden, usually reversible deterioration in
normal renal function Or Inability of kidney to
maintain homeostasis leading to a buildup of
nitrogenous wastes OR by laboratory:
 Increase in baseline creatinine of more than 50%
 Decrease in creatinine clearance of more than
50%
-can occurs over hours/days.
 Anuria – no urine output or less than 50mls/24
hrs
 Oliguria - <400mls UOP/24 hours or <20mls/hr
 Polyuria - >2.5L/24 hours
53

54. ARF.......................... (cont’d)
 It can be classified according to underlying cause as:
1. Prerenal (functional):
a. Hypovolemia: GI loss, renal loss/diuresis,
Hemorrhage
b. Impaired cardiac efficiency
c. Vasodilatation
2. Post renal obstruction (obstruction):
a. Urinary tract obstruction b. Tumors
3. Intrarenal (structural):
a. Acute nephritis b. Antibiotics c. NSAIDs
54

55. ARF: Persons at Risks
55
 Major surgery
 Major trauma
 Receiving nephrotoxic medications
 Elderly
 ARF occurs in:
1% of hospitalized patient
20% of patients in ICU
4% to 15% of patients after cardiovascular surgery

56. ARF: Stages
56
 Onset/initiation : 1-3 days with ^ BUN and creatinine
and possible decreased UOP
 Oliguric : UOP < 400/d, ^BUN,Creatinine, Phos, K,
may last up to 14 days
 Diuretic : UOP ^ to as much as 4000 mL/d but no
waste products, at end of this stage may begin to see
improvement
 Recovery: things go back to normal or may remain
insufficient and become chronic

57. ARF: Stages
57
Stage Increase in Serum
Creatinine
Urine Output
1 1.5-2 times baseline
OR
0.3 mg/dl increase from
baseline
<0.5 ml/kg/h for >6 h
2 2-3 times baseline <0.5 ml/kg/h for >12 h
3 3 times baseline
OR
0.5 mg/dl increase if
baseline>4mg/dl
OR
Any RRT given
<0.3 ml/kg/h for >24 h
OR
Anuria for >12 h

58. ARF…………………..con’t
 Objective symptoms
 Oliguric phase –
 vomiting
 disorientation,
 edema,
 ^K+
 decrease Na
 ^ BUN and creatinine
 Acidosis
 uremic breath
 CHF and pulmonary
edema
 hypertension caused
by hypovolemia,
anorexia
 sudden drop in UOP
 convulsions, coma
 changes in bowels
58

59. ARF…………………….con’t
Objective symptoms
 Diuretic phase
 Increased UOP
 Gradual decline in
BUN and creatinine
 Hypokalemia
 Hyponaturmia
 Tachycardia
 Improved LOC
59

60. ARF: C/M
1. Nausea and vomiting
2. Diarrhea
3. Decreased tissue turgor
4. Dry mucous membranes
5. Lethargy
6. Difficulty in voiding; changes in urine flow
7. Steady rise in serum creatinine
8. Fever
9. Edema
60

61. ARF: Dx
1. Serum creatinine level: the most reliable measure of the
GFR, found to be rising
2. Radionuclide studies to evaluate GFR and renal blood
flow and distribution
3. Urinalysis: reveals proteinuria, hematuria, casts
4. Ultrasonography: to determine anatomic abnormalities
5. History &Physical examination
6.KUB, CT/MRI
7. Detailed review of the chart, drugs administered,
procedures done
8. Renal biopsy
61

62. 5 Key Steps in evaluating ARF
62
1) Obtain a thorough history and physical
examination; review the chart in detail
2) Do everything you can to accurately assess
volume status/urine
3) Always order a renal ultrasound
4) Look at the urine/hematuria
5) Review urinary indices

63. ARF: mgt
1. Correction of any reversible cause of acute
renal
failure (ie, surgical relief of obstruction)
2. Correction and control of fluid and electrolyte
imbalances
3. Restoration and maintenance of stable vital
signs
4. Maintenance of nutrition with low-sodium,
low-
potassium, low-phosphate, moderate-protein
diet
5. Hemodialysis: Subclavian approach and
Femoral approach
6. Peritoneal dialysis and Continous renal
63

64. ARF: Nursing mgt
 Nursing interventions
 Monitor I/O, including all
body fluids
 Monitor lab results
 Watch hyperkalemia
symptoms: malaise,
anorexia, parenthesia, or
muscle weakness, EKG
changes
 watch for hyperglycemia or
hypoglycemia if receiving
insulin infusions
 Maintain nutrition
 Safety measures
 Mouth care
 Daily weights
 Assess for signs of heart
failure
 GCS and Denny Brown
 Skin integrity problems
 NB: The first sign of
recovery in oliguric or
anuric patients is an
increased urine
production.
64

65. Chronic Renal Failure/ ESRD
is irreversible destruction of nephrons so that
they are no longer capable of maintaining
normal fluid and electrolyte balance or kidney
damage for >3months or GFR < 60ml/min.
 Causes:
1. Recurrent UTIs, recurrent ARF, causes of
ARF
2. Toxic agents
3. Diabetic nephropathy
4. Uncontrolled hypertension
65

66. Stages of CRF
66
Stage 1 Kidney damage with
normal or ↑ GFR
GFR ≥ 90 ml/min/1.73
m2
Stage 2 Kidney damage with
mild ↓ GFR
GFR 60-89
Stage 3 Moderate ↓ GFR
renal insufficiency
GFR 30-59
Stage 4 Severe ↓ GFR renal
failure
GFR 15-29
Stage 5 Kidney failure/ESRD GFR <15 (or dialysis)

67. CRF: C/M
Symptoms occur when 75% of function is lost
but considered chronic if 90-95% loss of
function
 Decreased appetite and energy level
 Increased urinary output and fluid intake
 Bone or joint pain
 Delayed or absent sexual maturation
 Growth retardation
 Dryness and itching of skin
 Anemia
 Markedly elevated BUN and creatinine
67

68. CRF: Dx
1. Serum studies
a. Decreased hematocrit, hemoglobin, Na+,
Ca++;
increased K+, phosphorous
b. As renal function declines, BUN, uric acid,
and
creatinine values continue to increase.
68

69. CRF: Dx...con’t
2. Urine studies:
a. Specific gravity: increased or decreased
b. 24-hour urine for creatinine clearance is
decreased
(increased creatinine in urine) reflecting
decreased
GFR.
c. Changes in total output/ decrease
3. Many other tests may be ordered to evaluate
other systems and extent of disease (ie, chest x-
ray, electrocardiogram)
69

70. CRF: mgt
1. Correction of calcium phosphorous
imbalance: Administer activated vitamin D to
increase calcium absorption and calcium
phosphate binders with meals to bind
phosphate in the gastrointestinal tract.
2. Correction of acidosis with buffers such as
Bicitra
3. Diets should meet caloric needs of the child
containing adequate protein for development
(1.0–1.5 g/kg per day).
70

71. CRF: mgt
4. Correction of anemia through the use of
erythropoietin (Epogen) administered
subcutaneously at home
5. Growth retardation should be evaluated for
possible use of growth hormone.
6. Treatment options for end-stage renal
disease are hemodialysis, peritoneal dialysis,
or transplantation.
7. Institute dialysis therapy while transplant
work-up is in progress.
71

72. CRF: Nursing Mgt
A. Ensuring Safety
1. Protect the patient from the effects of
decreased
level of consciousness and involuntary
movements
by maintaining crib or bed side rails up and
padded,
as necessary.
2. Monitor for any seizure activity and have
airway or
tongue blade and suction equipment on hand.
72

73. CRF: Nursing Mgt
B. Educating About Chronic Renal Failure
1. Because numerous issues may interfere with
the
patient's psychological and social development
and
education, help the patient and family to cope
with:
a. Uncertainty regarding the course of the disease
and
ultimate prognosis.
b. Abnormal lifestyle necessitated by dialysis.
c. Burden of dialysis and continuous
administration of
medications.
d. Fear of death, present in most children,
73

74. Treatment modalities
74
 Decrease fluid 1000ml/day
 Decrease protein (.5-1kg body weight)
 Decrease sodium (1-4gm variable)
 Decrease potassium
 Decrease phosphorous (<1000mg/day)
 Dialysis (periotoneal, hemodialysis)
 RBC, Vitamin D (calcitrol replacement) etc.

75. CRF: Complications
75
1.Azotemia/uremia: nitrogen waste products
accumulating in blood. Toxic levels manifest
themselves in many ways such as coma,
headache, gastrointestinal disturbances,
neuromuscular disturbances.
2.Metabolic acidosis: as a result of decreasing GFR
3.Electrolyte imbalance
4.Severe anemia: kidneys unable to stimulate
erythropoietin; uremic toxins deplete erythrocytes;
nutritional deficiencies.
5.Hypertension:renal ischemia stimulates renin–
angiotensin system.
6.Congestive heart failure

76. Nephritic Syndrome
76
 is a primary glomerular disease characterized by:
• Marked increase in protein in the urine (proteinuria)
• Decrease in albumin in the blood (hypoalbuminemia)
• Edema
• High serum cholesterol and low-density lipoproteins
(hyperlipidemia)
Causes
 staphylococcus and pneumococcus
 viral infections such as chickenpox, and parasitic infections
 chronic glomerulonephritis, diabetes mellitus renal vein
thrombosis.

77. C/m
77
 About half of the people with acute nephritic
syndrome have no symptoms.
 If symptoms do occur,
 fluid retention and tissue swelling (edema) - may
first appear as puffiness of the face and eyelids/
periorbital but later is prominent in the legs and may
be ascites.
 low urine volume
 dark urine that contains blood
 high blood pressure and swelling of the brain may
produce headaches, visual disturbances, and more
serious disturbances of brain function.

78. Dx:
78
 Proteinuria (predominately albumin) exceeding
3 to 3.5 g/day is sufficient for the diagnosis of
nephrotic syndrome.
 U/A for WBCs, epithelial casts
 Kidney biopsy
Complication: infection (due to a deficient
immune
response), thromboembolism (especially of the
renal
vein), ARF (due to hypovolemia), and accelerated
atherosclerosis (due to hyperlipidemia).

79. Medical mgt
79
 No specific treatment is available in most cases
of acute nephritic syndrome.
 low protein and low sodium
 Diuretics plus ACE may be prescribed to help
the kidneys excrete excess sodium and water
but precaution is needed.
 Corticosteroids

80. Nursing mgt
80
 Similar with acute glomerulonephritis in ealry
phases and similar with that of chronic renal
failure in later phase. (revisit)

81. Nursing process for pt with UTI
Assessment:
 subjective information
 difficulty urinating
 painful urination
 incontinence
 frequency
 urgency
 leaking
 usual patterns, changes, fluid intake
81

82. Nursing process for pt with UTI
Assessment:
 objective data
 assess urine
 color
 odor
 amount
 review laboratory findings
 physical assessment
 abdominal distention
 retention [bladder scan] after voiding
82

83. Nursing Process: Diagnosis
 Some nursing dx includes:
 Altered/ Impaired Urinary elimination r/t urethral
obstruction/indwelling urinary catheter/ altered
sensation…..
 Risk for infection R/T indwelling urinary catheter
 Fluid/Electrolyte imbalance R/T decreased renal
function
 Impaired skin/tissue integrity R/t irritation &
moisture [urine on skin] 2° to incontinence
83

84. Nursing Process: Diagnosis
 Disturbed Body Image r/t urinary diversion
[suprapubic catheter] OR urine leakage
 Risk for Injury [fall] r/t wet floor 2° to
incontinence, confusion
 Knowledge deficit r/t catheterization
techniques/ fluid intake need/toilet retraining
NB: focus on client issues not medical diagnosis
84

85. Nursing Process: Goals
Long term goal: Normal Urinary elimination
 Pt will achieve:
 Normal Voiding with complete bladder emptying [per
bladder scan] within 14 days
 Urine output > 30ml/hr, 300ml/void
 Continence of urine tonight
 Increased fluid intake of 1500ml/ day
 Pain-free urination 6X/day
85

86. Nursing Process: Goals
Goals focus on pt/ client:
 Intake [fluids, acidification]
 Output [urine]
 Comfort
 Safety
 Infection/risk
 Demonstration of Knowledge/ techniques
 Skin Integrity [especially for incontinent pts]
86

87. Nursing process: interventions
 intake and output
 intake: all liquid taken in
 PO fluids
 IV fluids
 output
 measure all fluids eliminated from body
 urine
 wound drainage
 NG drainage
 diarrhea
87

88. Nursing process: interventions
 Perineal Care/ Hygiene
 Catheter Care
 Toileting training
 Environmental – Obstacles, access, privacy
 Position, running water
 Fluid intake
 Medications
88

89. Nursing Process: Evaluation
 Measure & Document Output
 Assess characteristics of Urine, S/SX of UTI,
Hydration status
 Urinary Patterns
 Pt/ Family statements
 Goal met? Partially met? Not Met?
 Revision or continuation of plan?
89