Med-Surg - Renal System, part 3: Incontinence, Urinary Tract Infection, Pyelonephritis
December 03, 2021 Updated: January 17, 2022 4 min read
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.
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