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
