Hi, I'm Cathy with Level Up RN. In this video,
we are going to get into renal system disorders, starting with incontinence, urinary tract
infections, and pyelonephritis. At the end of the video, I'm going to give you guys a little quiz to
test your understanding of some of the key facts I'll be covering in this video, so definitely
stay tuned for that. And if you have our Level Up RN medical surgical nursing flashcards, pull those
out so you can follow along with me. First up, let's talk about incontinence. There are several
different types of incontinence. A couple types that I would be more familiar with include stress
incontinence and urge incontinence. With stress incontinence, we have a small amount of urine loss
that occurs with abdominal pressure from laughing, coughing, or sneezing, for example. And this type
of incontinence is caused by a weakened pelvic floor. So risk factors for stress incontinence
include menopause, obesity, constipation, as well as pelvic surgeries. Treatment can include Kegel
exercises, weight reduction, estrogen, as well as vaginal cone therapy. With urge incontinence, the
patient is unable to reach the bathroom in time due to an overactive detrusor muscle, which is
that smooth muscle in the bladder. This can be caused by a neurologic disorder, such as a stroke
or Parkinson's or multiple sclerosis. So treatment of urge incontinence can include anticholinergic
medications, such as oxybutynin. We can also implement bladder training as well as a toileting
schedule, and then we should advise our patient to avoid caffeine and alcohol. Next, let's
talk about urinary tract infections, or UTIs.
So a UTI is where we have an infection
anywhere in the urinary tract. The most common type is a bladder infection or cystitis. So the
pathophysiology behind a UTI is we have bacteria, usually E. coli, which is contaminating the
periurethral area, and then that bacteria will colonize the urethra and then migrate up to the
bladder. So risk factors associated with a UTI include female gender - lucky us - because of
the close proximity of the urethra to the anus. Other risk factors include Foley or indwelling
catheters. That's why, in the hospital, we take out the indwelling catheter as soon as
possible because of that increased risk for UTIs. Other risk factors include uncircumcised males,
menopause, frequent sexual intercourse, as well as constipation. Signs and symptoms of a UTI can
include abdominal pain, dysuria, so difficulty with urination, urinary frequency and urgency. The
patient may have cloudy-colored urine. The urine may have a foul odor. In older patients, they may
have confusion. This is very common. So when you have an older patient with new-onset confusion,
then you need to suspect the possibility for a UTI or an electrolyte imbalance. Those are two key
causes of new-onset confusion in older patients, so you want to get your urinalysis for that
patient as well as their blood for blood work.
In terms of labs, when we run a urinalysis, the
patient's urine may be positive for bacteria, white blood cells, hematuria, so there may be some
blood in the urine. The patient's urine will also be positive for leukocyte estuaries as well as
nitrates. Treatment of a UTI requires antibiotics. An additional medication that can be helpful is
phenazopyridine, which is a bladder analgesic that can decrease the pain and urgency associated with
the UTI. In terms of patient teaching regarding prevention, we should reinforce to females
that it's important to wipe from front to back. They should wear cotton underwear, avoid bubble
baths, and avoid sitting in wet clothing or bathing suits. In addition, urinating after
intercourse can help prevent UTIs. In general, patients need to make sure they are emptying
their bladder regularly, and they need to prevent constipation by increasing their fluid intake as
well as their fiber intake. Uncircumcised males should clean under the foreskin, and cranberry
juice has been shown to decrease the risk of UTIs. Next, we have pyelonephritis, which is a kidney
infection. With acute pyelonephritis, we have a UTI in the bladder that spreads up the
ureters to the kidneys. Symptoms can include costovertebral tenderness. So this is a
hallmark symptom of this disorder. So how do you check for that? Well, you stand behind
the patient, so you're facing their back, and if you feel down to the twelfth rib,
which is the end of the rib cage, the angle where the curve of the rib meets the spine,
that's the costovertebral angle. And if you put one hand like this and make a fist with
your other hand and give it a little thump, if that causes pain and tenderness, then that may
be indicative of pyelonephritis. Other symptoms include flank or back pain, fever and chills,
nausea and vomiting, tachycardia, tachypnea, as well as hypertension. Blood work will show
an elevation in white blood cells as well as an elevation in creatinine and BUN. We may also see
an elevation in CRP and ESR. So C-reactive protein and erythrocyte sedimentation rate would show the
presence of inflammation in the body, which we definitely have with this condition. Urinalysis
will show the presence of leukocyte estuaries, nitrates, white blood cells, and bacteria. And
then, in terms of treatment, we're going to need to give the patient antibiotics, antipyretics,
and analgesics. So, depending on their pain level, they may only require NSAIDs. But many
patients have severe pain with pyelonephritis, and that may necessitate opioid analgesics.
All right, it's time for a quiz. I've got three questions for you. First question. What type of
incontinence is caused by a weakened pelvic floor? The answer is stress incontinence. Question number
two. Urine that contains leukocyte estuaries and nitrates is indicative of a UTI. True or false?
The answer is true. Question number three. Costovertebral tenderness is a key symptom of
blank. The answer is pyelonephritis. All right. That's it for this video. Take
care, and good luck with studying. I invite you to subscribe to our channel
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