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 childurgent/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 penisdon’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/mincontrolled 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 kidneysFINDING 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 DISEASEincreased 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 healthdiagnostic tests: urinalysis, serum tests, renal biopsy = definitive diagnosismeds (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 20-35female (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 distensionmale 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, CATUInon 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 nitrateresults 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 CAUTInoninfectious: 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
hydronephrosishydroureter
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
maleunprotected sexual activityhistory of prostratitispelvic traumacompromised immunityrecent 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 - 75family historychanges in urination (pattern)
106
BPH assessment
H&P, UA & culture, post-void residualPSA 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 urethraholmium 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
