Genitourinary Flashcards
What is the role of the kidneys in regulating fluid and electrolyte balance?
Regulating fluid, electrolyte and acid-base balances, remove waste, provides hormones involved in RBC production, bone metabolism, BP control
The kidneys filter blood, reabsorb essential substances, and excrete waste.
What structures are involved in the urinary system?
Kidneys, Ureters, Bladder, Urethra
Each structure plays a critical role in urine formation and transport.
What substances are filtered during urine formation?
- Sodium
- Chloride
- Bicarbonate
- Potassium
- Glucose
- Urea
- Creatinine
- Uric acid
These substances are crucial for maintaining homeostasis.
What substances are reabsorbed during urine formation?
- Amino acids
- Glucose
These substances are crucial for maintaining homeostasis.
What is osmolality?
Concentration of a solution in terms of osmoles of solutes per kg of solution
Osmoles are the standard unit of osmotic pressure.
What is osmolarity?
Ratio of solute to water; concentration of a solution in terms of osmoles of solutes per liter of solution
Osmoles are the standard unit of osmotic pressure.
How do the kidneys control water balance?
Absorption/secretion of H2O regulated by antidiuretic hormone (ADH)
ADH plays a significant role in conserving water in the body.
What do the kidneys excrete?
urea, creatinine, phosphates, sulfates, uric acid, drug metabolites
How do the kidneys regulate electrolytes?
Absorption/secretion K+, Na+, Mg;
↑NA = ↓Aldosterone
How do the kidneys regulate acid-base balance?
Reabsorption of bicarbonate
Excrete or reabsorb acids
Synthesize ammonia, and
Excrete ammonium chloride
How do the kidneys regulate blood pressure?
Vasa recta (blood vessels of the kidney) detect ↓in BP and cause secretion of renin which initiates RAAS (renin-angiotensin-aldosterone system) activation
How does the RAAS system increase blood pressure?
Renin converts Angiotensin I into
Angiotensin II which causes vasoconstriction and aldosterone increases Na+ and water reabsorption
What are common risk factors for kidney disorders?
- Benign prostatic hyperplasia (enlarged prostate)
- Diabetes
- Hypertension
- Immobilization
- Exposure to chemicals
- Pregnancy
- Sickle cell disease
- Spinal cord injury
These factors can contribute to the development of various kidney-related issues.
What are common symptoms of kidney dysfunction?
- Pain
- Changes in voiding
- Urinary frequency
- Urgency
- Dysuria (burning)
- Oliguria (output < 400 mL/day)
- Anuria (no urine production)
- GI symptoms
Symptoms can vary widely depending on the underlying condition.
What is the normal urine production rate?
0.5ml/kg/hr or >90 ml/hr
What diagnostic evaluations are used for kidney disorders?
- Urinalysis/urine culture
- Renal function tests
- Ultrasonography
- CT and MRI
- IV Urography
- Retrograde pyelography
- Cystography
- Renal angiography
- Endoscopic procedures
- Biopsies
Each test provides critical information about kidney function and health.
What is the significance of GFR in kidney assessment?
GFR < 90 mL/min/1.73 m² indicates chronic kidney damage; < 60 mL/min/1.73 m² indicates irreversible kidney damage
Glomerular Filtration Rate (GFR) is a measure of how well the kidneys are filtering waste products from the blood
What are the clinical manifestations of nephrotic syndrome?
- Increased permeability leading to massive proteinuria
- Hypoalbuminemia
- Diffuse edema
- Hyperlipidemia/High serum cholesterol
Nephrotic syndrome is excessive protein leaked into urine and can lead to significant complications if not managed properly.
What is the primary treatment for chronic glomerulonephritis?
Reduce blood pressure and manage symptoms
This condition often requires ongoing management and monitoring.
What are the common causes of renal cancer?
- Smoking
- Obesity
- Genetic factors
- Hypertension
- Occupational exposure to chemicals
These factors significantly increase the risk of developing renal cancer.
What are the nursing management strategies for a patient undergoing hemodialysis?
- Monitor dialyzer for complications
- Protect vascular access
- Monitor for hypotension, cramping, and blood leaks
Patient safety and comfort are paramount during dialysis.
What are the signs of kidney transplant rejection?
- Oliguria
- Edema
- Fever
- Increasing blood pressure
- Weight gain
- Swelling or tenderness over the transplanted kidney
Early detection of rejection is crucial for patient outcomes.
What is the role of the RAAS system in kidney function?
Regulates blood pressure and fluid balance through secretion of renin, angiotensin II, and aldosterone
RAAS activation leads to vasoconstriction and increased sodium and water reabsorption.
What is the typical urine output for a healthy adult?
0.5ml/kg/hr or >90 ml/hr
This output is essential for assessing kidney function.
What is the primary treatment for acute nephritic syndrome?
- Corticosteroids
- Managing hypertension
- Controlling proteinuria
Treatment focuses on reducing inflammation and managing symptoms.
What is the definition of bacterial cystitis?
Inflammation of the urinary bladder
A common type of lower UTI.
What are the types of upper urinary tract infections?
- Pyelonephritis (acute & chronic)
- Interstitial nephritis
- Renal abscess
- Perirenal abscess
Upper UTIs are less common than lower UTIs.
What are common risk factors for lower UTIs?
- Female anatomy
- Menopause
- Urethrovesical/reflux
- Diabetes
- Pregnancy
- Neurologic disorders
- Gout
- Immunosuppression
- Incomplete bladder emptying
- Catheterization
- Inflammation of urethral mucosa
These factors increase the likelihood of developing a lower UTI.
What are the clinical manifestations of lower UTIs?
- Burning with urination
- Urinary frequency
- Urgency
- Nocturia
- Incontinence
- Suprapubic or pelvic pain
- Hematuria
- Back pain
- Can be asymptomatic
These symptoms can vary in intensity and presence.
What are potential complications of lower UTIs?
- Bacteriuria & septic shock
- AKI or CKD
Early recognition and treatment are essential to prevent these complications.
What are gerontologic considerations for lower UTIs?
- Most common infection in older adults
- Increases with age
- More common in women, but gap narrows
- Higher incidence of obstruction from enlarged prostate
- Structural abnormalities like decreased bladder tone
- Increased risk in postmenopausal women
Older adults may present with atypical symptoms.
What are the key diagnostic methods for lower UTIs?
- Urine cultures (clean-catch midstream, straight catheterization)
- Cellular studies (WBCs)
- Multiple-test dipstick
- STI testing
These tests help confirm the presence of a UTI.
What is the typical medical management for lower UTIs?
- Antibiotics (usually short course)
- Longer courses for complicated cases (men, pregnant women, pyelonephritis)
Treatment duration and type depend on severity and patient factors.
Fill in the blank: Encourage fluid intake of _______ for lower UTI prevention.
[water & cranberry juice]
What are common nursing interventions for lower UTIs?
- Encourage fluid intake
- Discourage urinary tract irritants
- Frequent voiding
- Administer antibiotics
- Manage pain with analgesics and antispasmodics
- Patient education on prevention
These interventions help manage symptoms and prevent recurrence.
What are the prevention strategies for lower UTIs?
- Hygiene practices (shower instead of bathe, proper wiping)
- Fluid intake (cranberry juice)
- Frequent voiding
- Voiding after intercourse
- Regular urination (every 2-3 hours)
- Taking antibiotics as prescribed
Preventative measures are crucial for at-risk populations.
What is acute pyelonephritis?
Bacterial infection of the renal pelvis, tubules, and interstitial tissue of the kidney(s)
Typically caused by bacteria from the bladder or systemic sources.
What are the clinical manifestations of acute pyelonephritis?
- Fever
- Chills
- Leukocytosis
- Bacteriuria
- Pyuria
- Lower back & flank pain
- N/V
- Headache
- Malaise
- Painful urination
Symptoms may overlap with those of a lower UTI.
What diagnostic tests are used for acute pyelonephritis?
- Ultrasound or CT scan
- IV pyelogram (X-ray w/ contrast)
- Radionuclide imaging
- Urine cultures and sensitivity
These tests help identify obstructions and assess kidney function.
What is the medical management for uncomplicated acute pyelonephritis?
- 2-week course of antibiotics
- Hydration
- Pain management
Patients may require longer courses if symptoms persist.
What is nephrolithiasis?
Calculi (hard, mineral deposits) in the kidney (kidney stones)
Urolithiasis refers to calculi in the urinary tract.
What are the common types of stones found in nephrolithiasis?
- Calcium oxalate
- Calcium phosphate
- Struvite
- Cystine
- Uric acid
The composition of stones can influence treatment and dietary recommendations.
What are the clinical manifestations of urolithiasis/nephrolithiasis (stones in the urinary tract)?
- Severe pain (renal colic)
- Hematuria
- N/V
- Urinary frequency
- Inability to void
Symptoms can vary based on the location and size of the stones.
Fill in the blank: Bladder cancer is the _______ leading cause of death among cancers.
[6th most common cancer]
What are the leading risk factors for bladder cancer?
- Tobacco use
- Age
- Gender (more common in men)
Risk factors can vary based on environmental and genetic factors.
What is the most common clinical manifestation of bladder cancer?
Painless hematuria
Early detection is crucial for effective treatment.
What is the typical treatment approach for bladder cancer?
- Medical management (chemotherapy, BCG therapy)
- Surgical management (TUR, cystectomy)
Treatment depends on tumor grade and stage.
What is benign prostatic hyperplasia (BPH)?
Noncancerous enlargement or hypertrophy of the prostate
BPH can lead to urinary obstruction.
What are common clinical manifestations of BPH?
- Frequent or urgent need to urinate
- Nocturia
- Difficulty starting urination
- Weak stream
- Dribbling after urination
- Straining with urination
- Incomplete bladder emptying
Symptoms can significantly impact quality of life.
What are the risk factors for prostate cancer?
- African American race
- Increasing age
- Family history
- Genes (HPC1, BRCA1, BRCA2 mutations)
- High fat/red meat diet
Awareness of risk factors can aid in early screening.
What is the primary treatment for localized prostate cancer?
Radical prostatectomy
Other options include radiation and hormone therapy.
What is continuous bladder irrigation (CBI)?
A method providing a continuous infusion of sterile solution into the urinary bladder to remove tissue and blood clots
CBI is often used post-surgery to prevent clot formation.
What is the purpose of assessing lung and heart sounds in patients?
To evaluate for pulmonary edema and heart failure
This assessment helps in identifying complications related to fluid overload.
What should be maintained to ensure patient safety post-surgery?
Fluid/electrolyte balance
This is crucial to prevent complications such as dehydration or electrolyte imbalances.
What complications should be monitored for in patients?
Hemorrhage, infection, venous thromboembolism (VTE), catheter problems
Early detection can significantly improve patient outcomes.
What is a recommended practice for post-surgical recovery?
Early ambulation
This helps reduce the risk of complications such as VTE.
What is the goal of pain control in post-operative patients?
To ensure comfort and facilitate recovery
Effective pain management can enhance patient mobility and participation in care.
What does Continuous Bladder Irrigation (CBI) involve?
Continuous infusion of sterile solution into the urinary bladder using a three-way irrigation system with a triple-lumen catheter
CBI is used to remove loose tissue, blood clots, and mucous shreds from the bladder.
What must the amount of fluid recovered in the drainage bag equal for a CBI?
The amount of fluid instilled
This balance is critical for monitoring the effectiveness of CBI.
What should be done if bright red drainage is observed during CBI?
Increase infusion rate until clear; if not clear, leave wide open and notify provider
Bright red drainage may indicate active bleeding.
What action is recommended for pink or tea-colored drainage?
Continue infusion at moderate rate
This indicates that some bleeding may still be present but is not severe.
What should be done when clear drainage is achieved during CBI?
Slow infusion rate
This indicates that the bladder is clearing and less irrigation is needed.
What should be monitored during CBI, besides the drainage bag?
Tubing
Ensuring the tubing is not obstructed is critical for effective irrigation.
Fill in the blank: CBI provides a continuous infusion of _______ into the urinary bladder.
sterile solution
This is essential for flushing out the bladder contents.
