elimination - lower GU Flashcards
lower GU system consists of:
kidney, urethra, bladder, ureters
ureters do what?
carry urine from renal pelvis to the bladder
ureteral lumens are ___
narrow
urinary system: male
kidney, ureters, bladder, prostate gland, uretha
urinary system: female
kidney, ureter, uterus, bladder, sphincter, urethra
urethra length in men/women:
8-10 inches; 1-2 inches
bladder is the:
capacity:
reservoir for urine; 600-1,000 mL
bladder muscle- detrusor muscle
relaxes to hold urine and contracts to let urine out - pushes urine out of the bladder into the urethra
cystitis is a:
infection of the bladder, most common type of UTI in women
how does urine flow? protective mechanisms:
flows downward, ureters connect to bladder, muscles of bladder, pressure created by urine in bladder, urine itself is sterile, pH of urine is acidic, prostate gland, normal flora of vagina
bacticili:
important bacteria in vagina that keeps urogenital tract healthy and free of pathogens
maintaining a healthy bladder:
use the bathroom often and when needed - every 3-4 hrs, wipe front to back, urinate after sex, kegels, wear cotton underwear, limit alcohol/caffeine, smoking cessation, drink lots of fluid, and exercise and weight management
urinary incontinence:
involuntary or uncontrolled loss of urine in any amount
types of incontinence: stress
sudden involuntary passage of urine - can be brought on by laughing, sneezing, coughing, heavy lifting
types of incontinence: urge
often referred to as overactive bladder - involuntary urination brought on by urgency, can’t make it to the toilet
type of incontinence: functional
urinary tract is functioning properly but an illness or disability is causing urine leakage. medications like diuretics and disabilities like dementia can decrease awareness to go to the bathroom
stress incontinence: causes
pelvic floor muscle and urinary sphincter weaken - childbirth in women or prostate surgery in men
devices for stress incontinence:
vaginal pessary, urethral inserts
surgery for incontinence:
vaginal sling, injectable bulking agents, inflatable artificial sphincter
sling procedure:
most common performed in women with stress urinary incontinence. In this procedure the surgeon uses the person’s own tissue, synthetic material (mesh), or animal or donor tissue to create a sling or hammock that supports the urethra
urge incontinence: other names
overactive bladder, bladder spasms, irritable bladder, detrusor instability
enuresis is:
bed wetting
functional incontinence treatment:
aimed at manipulating environment, easy access to toilet, scheduled times for toileting, wearing clothes easy to remove
anticholinergics treat:
urinary incontinence (more for urge or stress) - can’t see, can’t pee, can’t spit, can’t poop
oxybutynin (Ditropan)
decreases urgency, frequency, and nocturia in overactive bladder, causes urinary retention, DO NOT use on a patient with BPH, do not give with decongestants - will cause hypertension
treatment for urinary incontinence:
kegel exercises, scheduled toileting times, botox injection, nerve stimulators
medications - anticholinerics
- tolterodine (Detrol)
-oxybutynin (Ditropan)
urinary retention is the:
inability to empty bladder all the way
1 cause of urinary retention:
other causes:
BPH; obstructions- kidney stones, narrowing - urethral, tumors, certain medications-anticholinergics, opioids, being dehydrated, constipation
urinary retention: acute
sudden & often painful inability to urinate at all despite bladder fullness, requires intervention
urinary retention: chronic
gradual inability to empty the bladder; painless retention associated with increased volume of residual urine
what are the symptoms of chronic urinary retention?
straining to pass urine or a weaker flow of urine with a slow start, feeling like your bladder is still full after you pass urine, overflow incontinence, difficulty holding urine when you cough or sneeze, wetting yourself or needing to urinate frequently at night, swelling and mild pain in your abdomen
nursing management for acute urinary retention:
bladder scan, palpate height, ask about voiding history, needs indwelling urinary catheter, drink small amount of fluids, avoid alcohol/caffeine/acidic fruits, sitting in tub of warm water or warm shower
nursing management for chronic urinary retention:
intermittent or indwelling urinary catheter, toileting schedule
bladder cancer:
4th most common in men, 8th in women
-smoking is the most important risk factor
best treatment or intervention for urge incontinence:
bladder training
clinical manifestations & diagnosis for bladder cancer:
painless hematuria: gross or microscopic
-urine cytology (test that screens urine for cancer)
-bladder irritability- dysuria, frequency, & urgency
-lab for tumor markers
-cystoscopy (examines lining of bladder and the urethra)
-imaging
urinary diversions: ileal conduit and neobladder
most common after complete removal of bladder for bladder cancer
ileal conduit- urostomy:
portion of ileum is resected and one end of segment is closed; ureters are attached to closed end of ileum and open end of ileum is brought through the abdomen to form a stoma; a bag is placed over the stomach
neobladder:
piece of small intestine formed into a pouch and positioned in the same position of original bladder - comes out the urethra
continent cutaneous reservoir:
an internal pouch stores the urine, pt uses a catheter or plastic tube to empty urine through the stoma - straight caths stoma
nursing management: urinary diversions- pre-op
involve family in teaching, address psychosocial aspect of stoma, stoma care & pouch application, encourage pt to talk about feelings, and enterostomal therapist
neurogenic bladder:
nerves between spinal cord and brain don’t work, causing lack of bladder control
urinalysis:
-measurement of color, pH, specific gravity
-determination of present of glucose, protein, blood, and ketones
-microscopic exam for crystals, bacteria (first morning void, examine urine within 1 hr)
serum creatinine
greater than 1.2 mg/dl is abnormal for women & 1.4 mg/dl abnormal for men
BUN:
7-20 mg/dl
-a high BUN with normal creatinine = dehydration
interstitial cystitis:
painful bladder syndrome, difficult to diagnose, mistaken for UTI but urine culture shows no bacteria
clinical manifestations for interstitial cystitis:
pain in perineum, persistent urgent need to void, painful intercourse, frequent urination (up to 60x per day), pain while bladder fills and relief after urinating, may have autoimmune component
UTI: HARD TO VOID
hormones, abx, renal stones/scarring, diabetes, toiletries, obstructive prostate, vesicoureteral reflux, overextended bladder, indwelling catheter, decreased immunity (structural deviations)
teaching for UTI
-fluids: avoid alcohol, caffeine; drink water, cranberry juice, green tea
-food: avoid acidic, spicy foods, artificial sweetener
-eat: high fiber (whole grains, banana, beans)
-void every 3-4 hours; wear cotton underwear
-exercise
pathophysiology for UTI:
bacteria enters the sterile bladder causing inflammation
-may be caused by a variety of disorders
-most common bacterial infection if from e.coli (most common pathogen)
4 units of the lower GU tract:
bladder- cystitis
kidney- pyelolonephritis - bacteria is easier to get into blood stream = sepsis
urethra - urethritis
ureters- ureteritis
CAUTI:
catheter associated UTI; most common hospital acquired infection
-#1 cause = prolonged use of urinary catheter, bacteria in a catheterized pt
-common bacteria: e.coli, pseudomonas, proteus marabilis
-risk factors: pregnancy, pediatrics/women population, menopause, congenital defects, urinary retention, multiple partners
S&S of CAUTI:
-hesitancy, frequency, urgency
-dysuria
-suprapubic pain
-diagnose with: UA/urine culture - RBC (gross hematuria), WBC, nitrites, cloudy
elderly/geriatric manifestations for CAUTI:
sudden change in LOC, falls, tachypnea, anorexia, low grade fever or no fever (VS appear normal)
nursing management for CAUTI:
-UA and urine culture- clean catch
-medication: abx, analgesic for pain
-prevention of CAUTI & urosepsis
CDC guidelines - indications for indwelling urinary catheter
-acute urinary retention or bladder obstruction
-need accurate I&O hourly monitoring (30 ml/hr)
-assist in healing of open sacral or perineal wounds
-prior to certain surgical procedures
-patient requires prolonged immobilization
-to improve comfort for end-of-life care
urosepsis:
untreated UTI spreads to kidneys
risk factors of urosepsis:
urinary catheters, advanced age, compromised immune system, diabetes, female gender, surgical procedures involving urinary tract
clinical manifestations of urosepsis:
-initially UTI symptoms: abnormal WBC count (too low or too high), foul smelling urine, frequency, urgency, and lower abdominal pain
-more serious symptoms: pyelonephritis- n/v, fever, chills, pain in lower spine (CVA)
-sepsis symptoms: respiratory rate 22 or higher, systolic less than/equal to 100 mmHg, WBC too high or too low (4,500 - 10,000 per microliter)
severe sepsis/septic shock
organ failure, such as kidney (low urine output), low platelet count, change in mental status, high levels of lactic acid in blood (cells aren’t utilizing oxygen in the right way)
management for severe sepsis/septic shock:
early goal-directed therapy, oxygen therapy, broad spectrum of abx, control pain, IV fluids to maintain BP support, removal of any catheters or devices that may be infected, and supportive care- stabilizing lungs and flow of blood
suprapubic catheter:
flexible tube inserted into the bladder through the abdomen a few inches under belly button
suprapubic catheter used for:
urethral trauma, some gynecological surgeries (prolapsed uterus or bladder), people who require long-term catheterization & are sexually active
male reproductive system:
makes, stores, moves sperm
testicles produce ____
sperm
fluid from the ____ _____ & ____ ____ combine with sperm to make ____
seminal vesicles and prostate gland; semen
priapism:
prolonged erection of penis, usually longer than 4 hours - ischemic and non-ischemic, ischemic is medical emerge - can lead to impaired circulation and inability to urinate
phimosis:
inability to retract the foreskin covering the head of the penis
hypospadius:
birth defect in which opening of the urethra is located at the tip of the penis, along the shaft, or where penis and scrotum meet
diphalia:
genetic condition present at birth in which a person has two penises
penile ring entrapment:
urological emergency in which a constricting device is around the head of the penis; an object is placed around the penis, leading to swelling of the penile shaft, which can result in strangulation and even amputation, gangrene
peyronies:
scar tissue forms under skin of penis- plaque pulls on the surrounding tissues and causes penis to curve or bend during an erection
peyronies is __ in ___men diagonsed, higher risk with:
1 in 100; family disease, older male, vigorous sexual activities, prostate cancer tx with surgery, connective tissue and autoimmune disorders
causes of priapism:
neurological and vascular disorders
prostate gland:
produces semen and transports sperm during ejaculation, enlarged prostate can put pressure on the urethra causing difficulty urinating
medical term for enlarged prostate is ____
benign prostatic hypertrophy (BPH)
acute prostatitis:
acute bacterial prostatitis, bacterial infection of the prostate usually with sudden, severe symptoms
chronic bacterial prostatitis:
ongoing or recurring bacterial infection usually with less severe symptoms
chronic prostatitis/chronic pelvic pain syndrome:
ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection
symptoms of prostatitis:
flu-like, pain in abdomen, groin, or back, dysuria, and pain with ejaculation
prostatitis treatment:
acute bacterial - abx 4-6 weeks; chronic bacterial - abx 8-12 weeks
teaching for prostatitis:
safe sex, weight loss, avoid spicy or acidic foods, avoid alcohol and caffeine, eat more fresh/unprocessed foods and less sugar, DRINK WATER
nonbacterial prostatitis is:
inflammation of the prostate that causes pain but not due to a bacterial infection and may be from stress, nerve irritation, injuries, or past UTI.
can prostatitis be prevented?
most cases of prostatitis cannot be prevented, having safe sex can lower your chance of getting it caused by some infections
bph:
prostate gland enlarges disrupting outflow of urine pressure on the urethra
main cause from BPH:
urinary retention
risk factors of BPH:
age, obesity, alcohol/smoking, high protein diet, family hx in first degree relative
BPH & prostate gland you will have:
obstructive weak stream, difficulty starting and stopping stream, dribbling and irritative nocturia, frequency, and urgency
diagnostic studies (BPH):
hx & physical, digital rectal exam, prostatic specific antigen, and transrectal ultrasounds
medications for BPH: 2 classes
-antagonize alpha 1 receptors/adrenergic receptor blockers (-osin)
-tamsulosin (flomax): helps max flow of urine and pass renal calculi
-doxazosin
-terazosin: change position slowly
-5a reductase inhibitors (end in ride)
-finasteride- also helps with male propecia (balding)
-dutasteride
mode of action for antagonize alpha 1 receptors:
relaxing smooth muscles of prostate which helps to improve urine flow
-also causes vasodilation (do not use viagra)
side effect of adrenergic receptor blockers:
hypotension; change positions slowly
mode of action: 5a reductase inhibitor
enzyme that prevents conversion of testosterone, reduces the size of the prostate
side effects for 5a reductase inhibitors:
erectile dysfunction, gynecomastia (enlargement of breast tissue in men); pregnant women should not handle finasteride
complications of BPH:
hydronephrosis (swelling of kidneys due to urine build up), urine cannot drain out from kidney to bladder
causes of hydronephrosis:
blockage of outflow of urine or reflux of urine from bladder to kidney
-BPH, renal stones, narrowing of ureters, tumors (bladder, colon, prostate), vesicoureteral reflux/ureteral obstruction
transurethral resection of prostate (TURP) for BPH:
surgery to remove parts of prostate tissue through the penis
-post procedure is a 3-way indwelling catheter (murphy drip) inserted to provide homeostasis & urinary drainage
-INT irrigation: mainly to keep indwelling catheter from obstructing - clots and hematuria
pt with bladder irrigation you will:
-assess for bleeding & clots
-monitor I&O
-manually irrigate catheter for bladder spasms or if decreased outflow occurs, -antispasmodics & analgesics as needed
-monitor for increase in gross hematuria (hemorrhage)
nursing management for pt with bladder irrigation: teach for pt going home
-patience
-no heavy lifting (no more than 10 lbs)
-s/s of infection
-avoid alcohol and caffeine
-kegel exercises
-fluid intake 2-3 L per day
-stool softener to prevent straining
prostate cancer:
2nd leading cause of cancer death in men but good prognosis if diagnosed early- no symptoms in early age
risk factors of prostate cancer:
age, obesity, alcohol, family hx, increased risk after 50
prostate cancer diagnosed often with:
PSA (prostate specific antigen) and biopsy
to stage tumor: (prostate cancer)
TNM system, Gleason score, and PSA
radical prostatectomy:
removal of prostate, seminal vesicles, and part of bladder and large indwelling catheter with 20-30 ml balloon is placed (goes home w it)
adverse outcomes of radical prostatectomy:
erectile dysfunction, urinary incontinence
testicular cancer most common in males age:
in young males 15-44 yrs old
risk factors of testicular cancer:
cryptorchidism (undescended testicles) and family hx of testicular cancer
testicular cancer is curable if caught early:
tumor marker blood test for diagnosis, radical inguinal orchidectomy, staging 0-3, bladder and pelvic CT scan
tumor markers for testicular cancer cells include:
beta-human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase
s/s of testicular cancer:
-most found in early stage
-lump or swelling on testicle
-feeling of heaviness in scrotum
-dull ache in lower belly or groin
-usually painless in early stages
testicular torsion:
testicles rotate, twisting the spermatic cord that brings blood to the scrotum, occurs more on the left, reduced blood flow causes sudden and severe pain on one side of the scrotum
testicular torsion is a medical emergency because:
blood flow must be returned within 6 hours or testicles will atrophy - cannot fix itself and no surgery within 6 hours testicle may be removed
causes of torsion:
occurs in about 1 in 4,000 males under 25 yrs, vigorous activity, minor injury to testicles, while sleeping, undescended testicle, bell clapper deformity
bell clapper deformity:
born with no tissue holding testes to scrotum allowing testes to swing inside the scrotum
erectile dysfunction (ED)
inability to attain or maintain an erection
ED increases with age __ to ___
40 to 70
treatments for erectile dysfunction:
penile injections, erectile devices, erectogenic drugs (sildenafil: viagra or tadalafil (cialis) - do not take either if on a nitrate
medications for ED:
erectogenic drugs(phosphodiesterase type 5 inhibitors)
-sildenafil (viagra) - will help you “fill out the penis”
-tadalafil (cialis)
mode of action for erectogenic drugs:
increases blood flow to the penis and vasodilation of the pulmonary vasculature
-do not take with any nitrates (nitroglycerin)
side effects of ED meds:
priapism, increased risk of heart attack
oliguria:
urinary output less than 400 ml per day or less than 20 ml per hour and is one of the earliest signs of impaired renal function
polyuria:
urinate more than normal
anuria:
absence of urine production, defined as a urine output of fewer than 100 ml daily. If left untreated, it can be a life-threatening emergency that usually indicates decreased kidney function or the presence of a complete urinary tract obstruction
causes of neurogenic bladder
parkinsons, MS, stroke, diabetes, and spinal cord injuries
