3 Genitourinary Flashcards
1
Q
blood urea nitrogen (“normal”)
A
5 - 25 mg/dl
2
Q
creatinine (“normal”)
A
0.5 - 1.5 mg/dl
3
Q
phimosis
A
narrowing or stenosis of the opening of the foreskin that prevents retraction of the foreskin
4
Q
paraphimosis
A
retracted foreskin that cannot be replaced in normal position over glans
5
Q
paraphimosis significance?
A
urological emergency!!!
6
Q
hydrocele: non-communicating
A
often subsides spontaneously
surgery if not spontaneously resolved at one year
7
Q
hydrocele: communicating
A
requires surgery if not spontaneously resolved at one year
- scrotum smaller in the morning, larger after activity
8
Q
hydrocele
A
presents as soft, painless swelling of scrotum (palpable bulge in inguinal/scrotal area)
- asymptomatic
9
Q
acute scrotum
A
acute PAINFUL swollen scrotum in prepubertal child
urgent/emergent finding!!!
- requires immediate diagnosis and possibly surgery
- treatment delay may result in loss of testicle
10
Q
cryptorchidism
A
undescended testicles (one or both)
- not painful
- doesn’t interrupt urination
- scrotum appears underdeveloped on affected side
- WATCH AND SEE WHAT HAPPENS
11
Q
orchiopexy
A
surgical treatment for cryptorchidism - happens at 1 to 2 years of age
12
Q
why orchiopexy?
A
- prevents teste overexposure to body heat (protect fertility)
- decrease incidence of malignancy (high in undescended testes)
- avoid rigorous activity for 2 weeks (education needed!)
13
Q
AMS significant…
A
in geriatric populations with UTI. Usually no other symptoms.
14
Q
blood urea nitrogen (BUN)
A
normal range: 5-25 mg/dl
- by-product of protein breakdown in liver. Urea nitrogen is produced mostly from liver metabolism of food
- other factors influential. elevation does not always mean kidney disease present
- elevated BUN level is highly suggestive of kidney dysfunction
15
Q
creatinine
A
normal range: 0.5 - 1.5 mg/dl
- produced with muscle/protein breaks down
- constant so good measure of kidney function
- No common pathologic condition other than kidney disease increases the serum creatinine level
- does not increase until at least 50% of kidney function lost
16
Q
BUN vs creatinine
A
creatinine is more specific reflection of kidney function and renal disease
17
Q
waste products in blood reflective of kidney function
A
BUN
creatinine
18
Q
severe phimosis treatment
A
circumcision
19
Q
hypospadias
A
urethral opening below glans penis (anywhere along ventral surface)
20
Q
mild hypospadias
A
meatus just below tip of penis
21
Q
severe hypospadias
A
meatus on perineum (+ chordee)
22
Q
chordee
A
ventral curvature of penis accompanying severe hypospadias
23
Q
- hypospadias care key point
A
thorough assessment important - must inform parents that circumcision cannot happen because foreskin may be used in repair of penis
don’t want to take newborn into surgery - need to allow baby to feed and grow and THEN do surgery (better outcome)
24
Q
epispadias
A
defect on dorsal surface of penis
25
bladder extrophy
severe defect with externalization of bladder (males and females)
repair in newborns a MUST
26
bladder extrophy in males...
is almost always seen with epispadias
27
bladder extrophy/epispadias correction...
may require multiple stages of repair depending on severity of defect
- first stage: repair bladder
- second stage: repair epispadias and create urethral sphincter
28
GFR + "normal"
glomerular filtration rate - 115 to 125 ml/min
| controlled by dilation/constriction of afferent arterioles
29
decreased GFR with aging
- decreased ability to regulate water balance
- GFR drops about 10% for adults 45+
- a concern with chronic comorbidities like DM2, htn, CHF; which further decrease blood flow to kidneys
30
problems related to decreased GFR
- dehydration
- increased renal blood flow
- increase in nephrotoxic potential of many meds
31
nocturia
tubular changes lead to decreased ability to concentrate urine resulting in sense of urgency + nocturia
32
nocturia nursing implications
- encourage nighttime lighting and clutter free environment
- encourage fall risk clients to use bedpan, urinal, bedside commode
- discourage fluid intake 2-4 hours prior to bedtime
33
decreases in bladder capacity and spincter tone due to...
(aging)
- changes in detrusor muscle elasticity = decreased capacity
- sphincters lose tone and become weak
34
urinary retention causes (x3)
(men) enlarged prostate = narrowing of the prostatic urethra = hesitancy, decreased force of stream, urinary retention
(anticholinergic medications)
(diseases affecting CNS = neurogenic bladder)
35
urinary retention nursing implications
- assess for bladder distension
- monitor for s/s of UTI
- provide stimuli to encourage urination
36
UTI s/s
- dysuria
- confusion
- foul smelling urine
37
top 7 contributing factors of chronic disease
- hypertension
- tobacco use
- elevated cholesterol
- poor dietary choices
- obesity
- physical inactivity
38
polycystic kidney disease - acquired how?
genetically
39
polycystic kidney disease characteristics
- multiple cysts in nephrons
- compromised function
- larger than average kidneys
- hypertension
40
polycystic kidney disease risks
- cyst rupture
- bleeding
- infection
41
polycystic kidney disease most common complication
chronic UTI
42
* polycystic kidney disease most SERIOUS complication
end stage renal disease
43
polycystic kidney disease s/s
* * PAIN ** abdominal or flank. almost always first sign.
- distended abdomen, increased abdominal girth
* * BLOODY ** or cloudy urine
- constipation
- nocturia
- hypertension
- kidney stones
44
vesicoureteral reflux
the backward flow of urine from the bladder into the kidneys
FINDING NOT A DIAGNOSIS
45
* vesicoureteral reflux determination
by radiology study: voiding cystouretholgram (VCUG)
- *done 3-6 weeks after active infection resolved
46
glomerulonephritis
inflammation of glomerulus
- acute or chronic
- caused by variety of diseases
- immunologic reaction
- third leading cause of ESRD!!
47
glomerulonephritis consequences
- decreased GFR
- edema
- hypertension
- scar tissue, irreversible damage
48
acute glomerulonephritis
- most causes infectious or other systemic diseases
| - renal symptoms 10 days after onset of infection
49
* acute post-streptococcal GN
- 1 to 3 weeks after strep infection
- preschool children most likely (males 3-7yo most likely)
- usually completed, rapid recovery
- 1 to 2% develop ESRD
50
* acute post-streptococcal GN - prevention
proper medical treatment of strep throat important!!!
51
* acute glomerulonephritis s/s
- *generalized edema
- *decreased UOP
- *proteinuria
- hematuria
- increased SG
- hypertension
- elevated BUN, creatinine
- decreased GFR, serum albumin
- elevated ESR-erythrocyte sedimentation rate
52
* acute glomerulonephritis nursing care
- *monitor for s/s of fluid volume overload
- compare VS to baseline
- accurate I/O
- daily weight
- urine color changes: cola, smoky reddish brown, rusty
- maybe 24 hour urine collection
- meds (abx, immunosupressants, diuretics)
- Na restriction if fluid retention, possible fluid restriction, possible K and protein restriction
- bedrest
- dialysis if fluid volume overload cannot be controlled and presence of uremic symptoms
53
* system presentation of fluid volume overload
increased BP, HR, RR;
dyspnea, adventitious lung sounds
* significant finding for acute glomerulonephritis *
54
nephrotic syndrome
NOT A DISEASE
increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted
- renal manifestation of multiple underlying causes
- renal biopsy = definitive diagnosis
55
*nephrotic syndrome pathophysiology
- *proteinuria (massive)
- *edema
- *hypoalbuminemia
- increased glomerular permeability
- increased aldosterone secretion = decreased GFR
- increased Na+ reabsorbption
56
proteinuria
massive loss of protein in urine
57
hypoalbuminemia
decreased plasma albumin level
58
*nephrotic syndrome client presentation
- *generalized edema
- *decreased UOP
- hypertension
- massive proteinuria
- lipiduria and hyperlipidemia
- hypoalbuminemia
- anorexia
- malaise
59
nephrotic syndrome medical/nursing management
goal: reduce albuminuria, control edema, promote general health
diagnostic tests: urinalysis, serum tests, renal biopsy = definitive diagnosis
meds (corticosteroids, possibly immunosuppresive, diuretics)
diet: if GFR normal, more protein. if GFR decreased, less protein.
bedrest
60
*nephrotic syndrome nursing care
* daily measure of abdominal girth, especially in kids = evaluates fluid retention!
61
*UTI etiology for females
* shorter urethra, proximity to vagina and rectum
- lack of prostatic fluid = protective
- elderly: hormonal changes alter vaginal pH/flora
- sexual activity: urethral inflammation
- pregnancy: spontaneous clearing decreased, 60% asymptomatic
62
*UTI etiology (general)
- instrumentation
- *CAUTI (most common!)
- UTIs 40% of HAI
- 80% due to indwelling vs straight catheter
63
*UTI pathophysiology
GRAM NEG #1 CAUSE
- E coli 85-90%
- Klebsiella, Proteus, Pseudomonas
- originate in GI tract
- vesicoureteral reflux
- urinary stasis (incomplete or infrequent voiding; alkaline urine facilitates bacterial growth)
- impaired host resistance + break in mucus membrane of urinary tract
- erosions caused by indwelling catheter
64
pediatric UTI
most are uncomplicated and respond to outpatient abx treatment
65
*pediatric UTI requiring hospitalization
- patient toxic/septic
- signs of urinary tract obstruction or significant underlying disease
- patient unable to tolerate PO fluids/meds
- < 2yo with febrile UTI
- all < 3 months
66
*urethritis etiology (adult)
* infection: STI!
| - inflammation: instrumentation, trauma, postmenopausal tissue changes
67
urethritis risk factors (adult)
```
male 20-35
female (reproductive years)
- multiple sexual partners
- high risk sexual behavior
- history of STI
```
68
* urethritis adult s/s (male)
- dysuria
- discharge
- frequency
- urgency
69
* urethritis adult s/s (female)
- dysuria
- discharge
- frequency
- urgency
70
* urethral strictures
scar tissue causing narrowing of the urethra and resulting in decreased force of urination or urinary retention
* etiology: complications of STI (especially gonorrhea)
71
urethral strictures s/s
- obstruction of urine
- UTI s/t urinary stasis
- overflow incontinence
- bladder distension
male client with STI hx and any of the s/s, encourage to see urologist
72
cystitis
infection, inflammation, or irritation of the urinary bladder
73
cystitis etiology
infectious: UTI, CATUI
| non infectious: irritation, inflammation
74
* cystitis s/s
- frequency
- urgency
- dysuria
- fever, chills, cloudy/foul urine, hematuria, hesitancy, low back pain, nocturia, suprapubic tenderness, feeling of incomplete emptying
75
* cystitis UA & culture results
positive leukocyte esterase and nitrate
results take approximately 48 hours
- bacteriuria, hematuria, pyuria, positive urine culture and sensitivity (growth of single pathogen, technique of gathering - sterile or clean catch?)
76
cystitis treatment
- abx (cover most pathogens or tailor for culture results)
- lower urinary tract analgesics (relief of symptoms only)
- - pyridium: turns urine orange
- - uroblue: turns urine blue
- urinary bladder antispasmodics
- prophylactic abx for clients with freq re-infection
- - treat for 6-12 months, periodic UA and C&S
77
*cystitis nursing care
*early detection of cystitis to prevent ascending infection
- adequate treatment (based on C&S)
- follow up: culture urine 2 weeks after abx therapy ends (chronic? continued therapy)
- client education
- relief of symptoms
- prevent recurrent infections, CAUTI
78
*cystitis client education
- *increase fluid intake to increase urine volume
- urinate with regular frequency: void at first urge
- complete emptying
- perineal hygiene
- void after intercourse
- avoid bubble baths (irritant)
- cranberry juice (urinary pH)
79
pyelonephritis
infection, inflammation, or irritation of the kidneys
80
pyelonephritis
infectious: ascending originating in urethra or bladder; UTA or CAUTI
noninfectious: irritation, inflammation
81
*acute pyelonephritis
ACTIVE INFECTION
- ascending infection
- *E Coli most common
82
chronic pyelonephritis
may be associated with structural abnormality of urinary tract such as vesicoureteral reflux
83
*pyelonephritis s/s
- *fever, chills, tachycardia, tachypnea
- * CVA/flank tenderness/pain
- lower UTI symptoms
- malaise, fatigue, n/v, abdominal pain
- increased serum WBCs
- UA and culture (WBC, bacteria, casts)
84
urosepsis
systemic infection originating in the urinary tract
85
urinary incontinence
leakage of urine related to bladder or sphincter dysfunction
86
* stress incontinence
leakage of urine related to weakness of urinary sphincter and pelvic floor musculature
87
* urge incontinence
involuntary spasm
88
overflow/reflex incontinence
mechanical obstruction
89
functional incontinence
CNS disorders leading to neurogenic bladder (damage to nerves innervating the urinary bladder)
90
bladder scan
non-invasive method to measure post-voice residual
91
urolithiasis
stones in urinary tract
92
nephrolithiasis
kidney stone
93
ureterolithiasis
stone in ureter
94
cystolithiasis
stone in bladder
95
urolithiasis assessment
- CVA flank pain radiating to groin
| - gold standard imaging study: non-contrasted CT scan (abdomen and pelvis)
96
urinary obstruction
primary etiology: stones
| early treatment of causes is critical
97
*urinary obstruction leads to
hydronephrosis
| hydroureter
98
*hydronephrosis
enlarged kidney as urine collects in renal pelvis, caused by obstruction in upper part of ureter
99
*hydroureter
enlarged ureter above level of obstruction, caused by obstruction in lower part of ureter
100
urinary obstruction nursing care
- pain management
| - constipation
101
prostratitis
infection or inflammation of prostrate (acute or chronic)
102
benign prostatic hypertrophy (BPH)
benign growth of prostrate with or without obstruction
103
prostratitis risk factors
```
male
unprotected sexual activity
history of prostratitis
pelvic trauma
compromised immunity
recent prostrate biopsy
```
104
prostratitis s/s
acute: onset often accompanied by flu-like symptoms
- dysuria
- frequency
- urgency
- pain (lower back, groin, perineum, upper thighs)
105
BPH risk factors
males 41 - 75
family history
changes in urination (pattern)
106
BPH assessment
H&P, UA & culture, post-void residual
| PSA blood test: measures prostate specific antigen (non-specific)
107
BPH management
- promote regular urination
- prevent urinary obstruction
- prevent infection
108
*BPH surgical management
* transurethral resection of the prostate (TURP) - most common
- endoscopic procedure (no incision, through the urethra)
- removes prostate tissue from around the prostatic urethra
holmium laser enucleation of the prostate (HoLEP)
- modern alternative to TURP
- particularly indicated for men with >60cc^2 prostate (large!)
109
urothelial cancers
arising from lining of urinary tract and defined by location
- renal pelvis
- ureter
- bladder
- urethra/prostatic urethra
110
urologic cancer
affects structures outside urinary tract but related to GU system
- testicular, prostate
