Genitourinary-Renal Flashcards
what is benign prostatic hyperplasia
enlargement of the prostate gland
impedes the passage of urine
benign prostatic hyperplasia manifestations
early stages: aympstomatic
as enlargement progresses:
difficulty starting or stopping stream
smaller than usual stream
less frequency urinating and dribbling
nocturia
BPH diagnostic studies
digital rectal exam DRE
urinalysis creatinine BUN PSA transrectal ultrasound
BPH management
if symptomatic: antihypertensives - wont decrease prostate size but will relax muscle of prostate and bladder - Prazosin - Doxazosin - Terazosin
finasteride = hormone
- decreases prostate size
decreases urinary urgency, hesitancy, dribbling, retention and nocturia
balloon dilation = temporary relief of urinary urgency, hesitancy
surgery if needed:
- TURP
- open prostacteomy
- laser surgery
- insertion of prostatic stent
FDA approved saw palmetto extract to manage symptoms of BPH
- checi with HCP because of interactions with anticoagulants and NSAIDs
BPH complications
acute urinary retention
involuntary bladder spams
hydronephrosis
- swelling of a kdiney due to build up of urine
urinary tract infections
gross heamturia
BPH management
assess:
- presence of urgency, dribblinb, hesitancy, retention and nocturia
- presence of bladder distention
- present of post void residual
watch urinary elimination
provide privacy for client sduring elimination
monitor intake and output
weigh on daily basis
post op surgery treatment:
- maintain catheter patency
- monitor urine output for volume and color every 1-2 hours
maintain continuous bladder irrigation
- important to prevent complications like hemorrhage and blood clots
- medicate for bladder spams and pain
- kegel exercises AFTER catheter removal
what is prostate cancer
most common cause of cancer death
can originate in posterior prostate gland
prostate cancer manifestations
early: asymptomatic
advanced:
- weak urine stream
- heamturia
- urinary hesitancy
- incomplete bladder emptying
- dysuria
prostate cancer diagnostic studies
DRE
increased PSA
biopsy of prostate
MRI
CT scan
neither a PSA nor DRE is a definite dianogstic test for cancer
- biopsy is needed to confirm
prostate cancer management
radical prostectomy
crythotherapy
radiation - external beam and barchytherapy
checmotherapy
drug therapy
kegel exercises
maintain high fluid intak enad report any signs of infection
maintain closed system to prevent bacterial contamincation
- avoid switching “leg” bags
regular prostate screening
if discharged with indwelling catheter, then teach how to clean urethral meatus
- keep collection bag lower than the bladder at all times
what is erectile dysfunction
inability to achieve or maintain an erection
client first notices diminishing firmness and a decrease in frequency of erections
causes of erectile dysfunction
inflammation of the prostate, urethra or seminal vesicles
prostectomy
lumbosacral injuries
hypertension
chronic neurologic conditions - Parkinsons
diabetes
smoking
alcohol consumption
antihypertensives
poor overall health
erectile dysfunction diagnostic studeis
hx and physical exam
serum hormone levels
- testosterone
doppler ultrasound to evaluate blood flow to penis
erectile dysfunctio interventions
most common approach is: drug therapy
- phosphodiesterase inhibitors
- ends with “afil”
other less common intervnetions:
- vacuum devices
- intracorporal injection
- prosthesis
nurse should:
- teach about timing in relation to sexual intercourse
- avoid alcohol before sex
- those taking nitrates to avoid PDE 5 inhibitors because it can cause hypotension
monitor for priapism
- prolonged erectile dysfunction
- erection lasting more than 4 hours or off and on several hours
- prompt treatment of aspirating blood is needed or meds to restrict blood flow
emotional support
what is pelvic inflammatory disease
infection of the cervic ascending to the fallopian tubes and broad ligaments
causes of pelvic inflammatory disease
gonorrhea
chlamydia
mycoplasma hominis
history of multiple sexual partners
base of intrauterine device
hx of therapeutic abortion
vaginal douching
pelvic inflammatory disease manifestations
pelvic pain
fever
abnormla cervial discharge
cervial motion tenderness
irregular cervical bleeding
nausea
vomiting
acute abodminal pain
dysuria frequent urination chlamydia gonorrhea other STI
pelvic inflammatory disease diagnostic studies
endocervical culture
CBC with differntial
laprascopy to view fallopian tubes
culdocentesis
- procedure performed in which peritoneal fluid is aspirated
pelvic inflammatory disease management
anti infectives - tetrcyclines penicillins quinolones cephalosporins
analgesics
surgical intervention to drain ascess
pelvic inflmmatory disease comploications
ectopic pregnancy
infertility
rupture or abscess
sepsis
chronic pelvic pain
pelvic inflammatory disease nursing interventions
assess for:
- menstruation history and contraceptive use
- level of pain
- vitals
- emotional response
- fluid imbalance
teach:
- complete entire course of antibiotics
- yearly pelvic exams
how to prevent cauti
insert catheter only for appropriate interventions
dont use urinary catheters in client sand nurse home residents for incontinence
leave catheter in place only as long as needed
consider antibiotic
maintain closed system and strict aseptic technique
what is acute kidney injury
abrupt loss o fkidney function
causes retention of urea and other nitrogenous waste products and extracellular volume and electrolytes
types of acute kidney injury
prerenal:
- decreased renal blood flow due to acute systemic injury
- hemorrhage
- trauma
- burns
intrarenal:
- injury to renal tissue due to toxins (rhabdomylosis)
- vascular disorders
- immunologic process
postrenal:
- urine flow is obstructed or stopped somewhere in the urinary tract
- BPH
- tumors
- strictures
- calculi
acute kidney injury prerenal manifestations
hypotension
hypoperfusion
reduced urine output
AKI intratrenal manifestation
edema
rash
chronic changes in kidney function
history of glomerulonephritis
phases of AKI
- onset phase:
initial insult to kidneys - oliguric phase:
reduction in urine
- fluid overload because youre not peeing - diuretic phase:
excrete waste but cannot concentrate urine
- hypovolemia
- hypotension
will be losing an excessive amount of urine (3-6 liters/day) - recovery phase:
GFR is getting better
AKI postrenal manifestations
history of obstruction
difficulty voiding
AKI diagnostic studies
urinalysis
urine for culture and sensitivity
creatinine
BUN
electrolytes
inflammatory markers
calcium and phosphate levels
CBC and ABG
24 hour urine collections
AKI is reversible but has high mortality rate
- follows severe prolonged hypotension (MAP less than 60)
- hypotension
no nephrotoxic drugs, vancomycin, or aminoglycosides
AKI management
to identify and treat the cause of AKI:
- discontinue all nephrotoxic drugs
- eliminate exposure to nephrotoxins
treat life threatening situations:
- administer IV fluids
- meds to control potassium, calcium, glucose and Na+
meds to restore alcium levels
may require hemodialysis
risk factors for AKI
reduced renal perfusion
significant blood loss or fluid loss
myocardial infarction
septic shock
AKI complications
systemic infections
arrhythmias secondary to hyperkalemia
GI bleeding
hyperkalemia
persistent kidney damage
permanent need for dialysis
AKI interventions
24 hour urine output - start with 2nd pee
neuro function
daily weight
hx of cardiac disease malignancy, sepsis, or recent infection
minimize stress
ensure compliance with prescribed fluid restriction
prevent infection
regular protein intake
offer high carb options
restrict foods high in potassium, phsophorus, and albumin
what is chronic kidney disease
irreversible deterioration in renal function
body cannot balance metabolism and fluid/electrolytes
results in uremia
- raised level in blood of waste products
- means kidnyes are no longer filtering properly
CKD causes
hypertension
prolonged diabetes mellitus
glomerulopathy
interstitial nephritis
polycystic disease
obstructive uropathy
CKD diagnostic studes
ABG
increased creatinine, potassium, phosphorus, BUN
CBC
decreased bicarb, calcium, proteins (albumin)
GFR = preferred test to determine kidney function
- used to determine the stage of CKD
clients near or in stage 5 will require renal replacement therapy
CKD management
monitor for hypertension
- ACE inhibitors
- angiotensin II blockers
lower cholesterol
- statins
watch for anemia
- epoetin or epoetin alpha
reduce fluid volume excess
- diuretics
protect bones
- calcium and vitamin D
progressive deterioration of kidneys in CKD causes:
- electrolyte imbalances
- hyperkalemia
- hypocalcemia
- hyperphosphatemia
anemia - due to lack of erythropoietin
low protein diet avoid products with added salt restrict dietary potassium restrict dietary phsophorus - no chicken, milk, legumes, carbonated drinks
CKD interventions
assess and monitor for:
- halitosis
- ulcers at oral mucous membranes
- dry, itchy skin
- anorexia
- weight loss
- nausea and vomiting
- neuro status
- inflammatory and infectious response
- peripheral edema and findings of circulatory overload
take labs:
- prolonged QT intervals
- Hct and Hgb
- hyperkalemia
hemodialysis
vascular catheter, fistula or shunt
requires specifically trained personnel
3-4 hours
hemodialysis disadvantages
dietary and fluid restrictions
hemodynamic instability
hemodialysis complications
disequilibrium syndrome
- fatigue
- mild headaches
- nausea
- vomiting
- distrubed conscious
- convulsions
- coma
hypotension
dysrhythmias
septicemia
bleeding
worsens anemia due to RBC destruction
peritoneal dialysis
intra-abdominal catheter
simple, easier for in home use
low risk for hemodynamic instability
flexible scheduling
fewer dietary restrictions and fluid
peritoneal dialysis disadvantages
longer treatment time
overnight, up to 12 hours
peritoneal dialysis complocations
peritonitis
protein loss
bowel preforation
resp distress
discomfort during dwell time
what is glomerulonephritis
inflammation of the glomeruli
affecting both kdiney equally
slow, progressive disorder
- often causes inflammation, sclerosis, scarring and renal failure
glomerulonephritis manifestations
decreased urination or oliguria
tea or coffee colored urine
SOB
orthopnea
- SOB when lying down
- goes away when you sit upright
periorbital edema
hypertension
crackles
nausea
malaise
weight loss
acute poststreptococcal glomerulonephritis develops about 1-2 weeks after streptococcal sore throat
glomerulponephritis diagnostic studies
increased BUN, creatinine
decreased protein
increased antistreptolysis O titers
increased phosphorus levels
decreased calcium levels
urinalysis
KUB
renal biopsy
glomerulonephritis management
symptoms relief
rest
treat edema with low salt diet and fluid restrictions
low protein diet
antibiotics
chlamydia manifestations
women = asymptomatic, but may experience:
- lower abdominal pain
- burning pain with urination
- vaginal discharge
men = asymptomatic, but may experience:
- discharge pain
- burning with urination
- inflammation or an infection in a duct in testicle
chlamydia management
azithromycin
doxycycline
in newborns = prophylactic erythromycin eye ointment
should be screened yearly for chlamydia
preferred method for diagnosing chlamydial infection = nucleic acid amplification testing
gonorrhea manifestations
women:
- itching
- burning of the vagina
- thick yellow green discharge
- bleeding between menstrual periods
- need to urinate often
men:
- pain or burning during uriantion
- thick, yellow penile discharge
- inflammation or infection of duct in testicles
- sore thraot
- rectal pain and discharge
- inflammation / infection of prostate fland
gonorrhea management
cephalosporin
molecular testing for gonorrhea culture
gonorrhea complications
meningitis
perihepatitis
arthritis
women:
- PID
- ectopic pregnancy
- infertility
men:
- arhtiritis
- painful swelling of testicles
- epididymitis: inflammation of the tube at the back of the testicle that carries and store sperm
regular pap smears and pelvic examinations
syphilis
caused by Treponema pallidum
4 stages of syphilis
primary phase
- starte with a sore or lesions
secondary phase
- 4-10 weeks after appearance of chancres
- flu-like symptoms, patchy hair loss
latent phase
- occurs one year or more after the first chancre
tertiary phase:
- occurs 4-20 weeks after primary phase
syphilis management
pencillin = drug of choice
- if allergic, then doxycycline or erythromycin
HSV-1 herpes
lesions above the waist
HSV-2 herpes
lesions below the waist
herpes interventions
encourage client to avoid tight fitting clothing
keep blisters or sores clean and dry
apply ice packs locally to reduce pain and swelling
herpes treatment
"ovir" acyclovir famiciclovir valacyclovir - to shorten and prevent outbreaks
pregnant women with herpes = requires C-section
what are renal calculi
kidney stones
more prevalent in men
peak age of onset between 20-30 years of age
spontaneous passage can occur in majority of clients
renal calculi manifesations
severe pain
- site is dependent on location of obstruction
increaed hydrostatic pressure
renal colic and ureteral colic
with obstruction
- client will show findings of UTI with fever and chills
nausea
vomiting
diarrhea
abdominal discomfort
renal calculi diagnostic studies
intravenous pyelogram
- determine site and degree of obstruction
others:
analyis of stone
urinalysis culture and sensitivity
24 hour urine test
retrograde or antegrade pyelography
renal calculi pharmacological interventions
diuretics
allopurinol
- help prevent calcium and uric acid stones
opioid analgesics
- pain relief
antibiotics
renal calculi surgical interventions
extracorporeal shock wave lithotripsy
percutaneous nephrolithotomy
ureteroscopic stone removal
percutaneous stone dissolution
ureteroscopy
temp or permanent stent placement
pyelolithotomy
nephrolithotomy
ureterolithotomy
cystolithotomy
nephrectomy
renal calculi complications
obstructions can occur from fragments
infection
chronic renal function impairments - if obstruction persists
renal calculi intervnetions
assess:
-hx of UTIs
dietary habits
family hx of kidney stones
findings of UTI
findings of urinary obstruction
pain management
maintenance of urine flow
strain urine to collect stones
client teaching:
- increase fluid intake so that they produce at least 2 quarts of urine every 24 hours
- collaborate with nutrition therapy based on the type of stone
Abdomen assessment
- Empty bladder
- Inspect abdomen for color, contour
- Auscultation
- Percuss for kidney border sand palpate
- Document all findings
