종류

설명

Stress

​ ​

Urge

overflow

Neurogenic

Functional

eg. Dementia, Immobility

Enuresis

• Bed-wetting in a child at least 5 years old

• Nocturnal overactivity of the detrusor muscle

Nursing interventions for incontinence

• Lifestyle changes - weight loss, reducing caffeine intake and avoiding constipation

• Pelvic floor muscle training(for urge incontinence)=(Kiegel exercises)

• Bladder training - drink a measured amount of fluid every 2 hours. Then, attempt to void 30 minutes later; increase the time interval gradually

Causes

• Infection(E.coli), chemical irritants, stones, trauma

• Mostly result from infection originating in the urethra

Predisposing factors

Female(urethra), Increased age, Urinary catheter, DM, poor hygiene, urinary stasis

Assessment(Manifestations, 증상)

• Urinary frequency and urgency

• "Burning sensation"

• Dysuria(요통) or voiding small amount

• Suprapubic(치골상부) and back pain

• Cloudy urine with foul smelling

• Symptoms in older adults - confusion; children - fever, irritability

Nursing interventions

• Obtain a urine specimen for culture and sensitivity BEFORE administering of antibiotics

• Administer a prescribed antibiotics; anlagesics and antispasmodics

👉 Antibiotic : sulfamethoxazole-trimethoprim (Bactrim)

👉 Urinary tract analgesics(진통제)/Antispasmoic(항경련제) : phenazopyridine

• Encourage fluid intake 3L/day

• Maintain acidic urine(cranberry juice)

• Avoid urinary catheter. Use aseptic technique when inserting one.

• Application of heat to relieve pain and bladder spasm

• Avoid urinary tract irritants such as coffee, tea, citrus, spices, coke and alcohol

• Educate about personal hygiene : wipe front to back

• Teach females to void before and after inercoures

Assessment(Manifestations, 증상)

• Urinary frequency and urgency

• "Burning sensation"

• M : clear to mucopurulent discharge from the penis

• F : lower abdominal pain

Nursing interventions

• Have the patient undergo STI testing

• Encouage fluid intake

• Administer a prescribed antibiotics

Assessment

• fever, chills, malaise(피로감), flank(옆구리) pain

• CVA(Costovertebral angel, 늑골척주각, 12th 늑골 부위) tenderness

• Urinary frequency, dysuria

• Cloudy urine with strong odor

Predisoposing factors

• Recurrent UTI

• Pregnancy, Tumor, obstruction

Nursing interventions

• Bedrest during acute phase

• Antibiotic therapy, analgesics, antispasmodic med.

• Encourage fluid intak 3L/day

• Moniotr V/S, I/O

• administer renal diet (high caloric with low protein)

• Monitor for signs of AKI or CKD

• Damage to glomerulus caused by an immunological reaction that results in proliferative(증식하는) and inflammatory changes within the glomerular structure

• Acute glomerulonephritis

👉 Commonly caused by group A beta hemolytic streptococcal infection

• • URI(Upper respiratiory infection), skin infection

  • Occures 10 days after a skin or throat infection

  • A child with persistent URI

👉 Autoimmune disease(자가면역질환)

Assessment(Manifestations, 증상)

• Fever, chills

• Hematuria, red cell casts

• Proteinuria, dark colored urine

• Dypnea, weight gain

• lung creackles, fluid overload

• Generalized or periobital(눈주위) edema

• N/V

• Oliguria

Nursing interventions

• Administer the following medications

  • antibiotics - to eliminate infeciton

  • corticosteroids - to alter immune reaciton to reduce infection

  • antihypertensive, diuretics

  • immunosuppressive medications(면역억제제)

• Restrict Na+ intake ; Restrict fluid intake

• Obtain daily weight

• Assess I/O

• Monitor electrolytes

• Dialysis or plasma electrophoresis if AKI develpos

Complications : Kidney failure, Pulmonary edema, Uncotrolled hypertension, Heart failure

Pathophysiology

• Inflammation ➡️ occlusion of glomeruli and damage of endothelial cells of glomerulus

• Glomerular dabage casues

  • Increased permeability(침투성)

  • Large loss of plasma proteins(proteinuria)

  • Decreased albumin in the body

  • Decreased oncotic pressure(단백질이 모세 혈관 내에서 발휘하는 흡수 힘, 삼투압)

  • Hypovolemia

  • Increased aldosterone & ADH

  • Na+ & water retention

  • Edema

  • Foamy urine

Assessment

• Proteinuria ➡️ Decreased serum osmotic pressures ➡️ edema

• Loss of immunoglobulins(proteins)

• Increased risk infection

• Loss of proteins for hormones

• Hypothyrodism

• Hyperlipidemia

• Foamy urine

Dx

24-hour urine for protein

Med

Corticosteroid therapy, Immunosuppressant therapy, diuretics

Nursing interventions

• Monitor V/S, urine output, edema and daily weight

• Monitor signs of incfection

• Monitor urine for protein and specific gravity

• Diet- Low cholesterol diet, sodium restriction

Causes

Hypercalcemia, dehydration, immobility, gout(통풍), increased intake of oxalate(spinach, peanuts, chocolate, avocado)

Dx

IV pyelogram(신우조영도), renal ultrasound, X-ray of KUB

Assessment

• Sharp, severe pain with sudden onset

• Pain - depending on location of stone

  • Renal calculi ➡️ flank pain

  • Ureter or bladder stone ➡️ radiating flack pain(방사통)

• N/V, Diaphoresis(발한)

• Hematuria, WBCs and bacteria in the urine

• Fever and chills

Nursing interventions

• Patient education

  • Diet for prevention of stone - most stones contain calcium, phosphorus or oxalate

  • Avoid milk, cheese, dairy products(유제품)

  • Avoid oxalates(spinach, coke, tea, chocolates)

  • Avoid purine sources(uric acid- organ meat)

• Administer antibiotics, thiazide diuretics, orthophosphate, sodium cellulose phosphase, allopurinol

Treatment

Cystoscopy, ureteroscopy, ESWL, Percutaneous lithotripsy

Surgery

Ureterolithotomy, Pyelolithotomy, Nephrolithotomy, Nephrectomy