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GU Flashcards

1
Q

Functions of the Kidneys

A
  1. Remove metabolic waste from blood in the form of urine
  2. Regulate electrolytes and acid-base balance
  3. Control of blood pressure
  4. Regulates RBC production
  5. Synthesis of vitamin D to active form
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2
Q

Glomerulus

A

Network of capillaries that act as filter for filtrate to proximal tubules

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3
Q

Bowman’s capsule

A

Contains the glomerulus and acts as filter for urine

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4
Q

Proximal tubule

A

Site of reabsorption

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5
Q

Loop of Henle

A

U-shaped nephron tubule, site for further concentration of filtrate through reabsorption. This is where loop diuretics work (Lasix)

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6
Q

Distal tubule

A

Site where filtrate enters collecting tubule

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7
Q

Collecting tubule

A

Releases urine

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8
Q

Risk Factors for GU disorders

A
  1. Strep disorders => chronic renal failure
  2. Increased age => UTI’s, BPH
  3. Invasive procedures (cysto, foley) => UTI’s
  4. Immobilization => stones
  5. Diabetes => renal failure, neurogenic bladder
  6. Hypertension => renal failure
  7. Multiparous women => stress urinary incontinence
  8. Neurologic Disorders => MS, Parkinson’s
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9
Q

S/Sx of Urinary Tract Disease

A
  1. Pain
  2. Changes in voiding
  3. GI symptoms
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10
Q

What kind of pain can there be in a urinary tract disease?

A
  1. Kidney
  2. Ureteral
  3. Bladder
  4. Urethral
  5. Prostatic
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11
Q

Describe kidney pain

A

Dull ache in costovertebral angle (CVA) radiates to umbilicus

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12
Q

Describe ureteral pain

A

Pain in costovertebral angle (CVA) and/or flank which can radiate to abdomen, thigh, and genital area

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13
Q

Describe bladder pain

A

Pain in lower abdomen and suprapubic area

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14
Q

Describe prostatic pain

A

Pain in perineum and rectum

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15
Q

Urinary Frequency

A

Voiding more often, associated with infection, disease, diuretics

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16
Q

Urinary Urgency

A

Strong desire to void, associated with prostate, infection

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17
Q

Dysuria

A

Pain or difficulty voiding

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18
Q

Nocturia

A

Excessive urination at night (usually getting up more than twice a night)

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19
Q

Urinary Retention

A

Inability to empty the bladder

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20
Q

Urinary Incontinence

A

Involuntary loss of urine

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21
Q

Urinary Hesistancy

A

Delay in voiding

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22
Q

Enuresis

A

Involuntary voiding during sleep

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23
Q

Hematuria

A

Blood in the urine

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24
Q

Proteinuria

A

Proteins in the urine

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25
Q

Bacteriuria

A

Bacteria in the urine

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26
Q

Normal urine output per hour

A

30 mL per hour

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27
Q

Anuria

A

Output is less than 50 mL in 24 hours

*Hemodialysis patients

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28
Q

Oliguria

A

Output is less than 400 mL per 24 hours

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29
Q

Polyuria

A

Output is more than 2500 mL per 24 hours

*DKA and CHF patients

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30
Q

What kind of GI symptoms can one have if there is urinary tract disease present?

A
  1. N/V
  2. Abdominal discomfort or distention
  3. Diarrhea
    * GI symptoms occur because the GI tract and urinary tract have shared autonomic and sensory innervations and reflexes
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31
Q

Physical examination of the kidneys

A
  1. Inspect the skin for edema, skin turgor, hydration, and pallor
  2. Attempt to palpate but you shouldn’t be able to due to costovertebral angle tenderness
  3. Listen for bruits (renal artery stenosis)
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32
Q

Physical examination of bladder

A

Palpate for fullness and location of bladder (usually can only do this if it is distended)

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33
Q

Physical examination of the meatus

A

Inspection for edema, redness, and drainage

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34
Q

Physical examination of prostate

A

Digital rectal exam (done by MD); done to detect hyperplasia of prostate in older men

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35
Q

Urinalysis

A

Analysis of urine. Analysis is used to identify abnormalities. Clean catch or mid-stream specimen may be used - want it clean as possible

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36
Q

Urine C & S

A

Identify if bacteria are present and treat with appropriate antibiotics

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37
Q

Normal urine specific gravity

A

1.005 - 1.030

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38
Q

A decrease in specific gravity can indicate what?

A
  1. Diabetes insipidus
  2. Glomerulonephritis
  3. Renal failure
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39
Q

An increase in urine specific gravity can indicate what?

A
  1. CHF
  2. Hepatic disorders
  3. Dehydration
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40
Q

Normal osmolality of urine

A

250 - 900

*Tells diluting and concentrating ability of kidneys

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41
Q

Normal pH of urine

A

5.0 - 8.0

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42
Q

A urine pH greater than 7.0 can indicate what?

A
  1. UTI
  2. Alkaline diet
  3. Alkalosis
  4. Medications
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43
Q

A urine pH less than 5.0 can indicate what?

A
  1. High protein diet
  2. Fever
  3. Acidosis
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44
Q

If glucose, ketones, and/or proteins are positive in the urinalysis what can this indicate?

A
  1. Severe infection
  2. Renal disease
  3. Diabetes
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45
Q

If RBCs and WBCs are present in the urinalysis what can this indicate?

A
  1. UTI

2. Stones

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46
Q

Normal GFR

A

125 mL/min (varies per age)

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47
Q

Glomerular Filtration Rate (GFR)

A

Rate at which glomeruli filter blood. Most accurate measure of GFR is creatinine clearance - that is because creatinine filtered by glomeruli but is not reabsorbed by tubules

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48
Q

Creatinine Clearance

A

Most accurate measure of glomerular filtration. Do a 24 hour urine collection and check the volume of urine and the urine creatinine level. Also do a serum creatinine halfway through the test.

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49
Q

Serum Creatinine

A

Endogenous waste product of skeletal muscle

  1. Reflects balance between production and filtration by glomerulus
  2. Best serum indicator of renal function. If elevated, indicates a decrease in GFR
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50
Q

Normal serum creatinine

A

0.7 - 1.4 mg/dL

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51
Q

Blood Urea Nitrogen (BUN)

A

Urea is nitrogenous end product of protein metabolism; test the ability of kidneys to excrete nitrogenous wastes; it’s an estimate of GFR

  1. Can be affected by medications and dehydration
  2. Can also be affected by protein intake, tissue breakdown, and fluid volume changes
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52
Q

Normal BUN

A

10 - 20 mg/dL

For patient over 60 (8 -20 mg/dL)

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53
Q

Types of X-ray/Imaging of GU system

A
  1. KUB
  2. Ultrasonography
  3. Bladder U/S
  4. CT/MRI
  5. Nuclear Scans
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54
Q

KUB X-ray

A

(Kidney, Ureter, Bladder)
X-ray shows kidney, ureters, and bladder size, position, and shape of structure. May show calculi or lesions. Limited purposes

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55
Q

Ultrasonography

A

Noninvasive, uses high frequency sounds and reveals depth of a structure below the skin. Usually done with a full bladder for better visualization. No special care afterwards.

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56
Q

Bladder U/S

A

Noninvasive, measures urine volume in bladder

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57
Q

CT/MRI

A

Provides cross sectional views of kidney and urinary tract, can use oral or IV contrast

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58
Q

Nuclear Scans

A

Injection of radioisotope, shows kidney perfusion, encouraged increase fluids to promote excretion of isotope

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59
Q

Intravenous Pyelogram (IVP)

A

Visualizes the entire urinary tract. Will show calculi, size and shape of structures, tumors, and pyelonephritis

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60
Q

Nursing Implications of Intravenous Pyelogram

A
  1. Check for allergies because of contrast
  2. Give laxative the night before
  3. NPO 8 hours or clear liquids
  4. May feel flushed, warm with salty taste when dye is injected
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61
Q

Voiding Cystourethrography

A

Urinary catheter allows instillation of contrast into the bladder, X-rays are taken while client is voiding. Shows stricture, ureteral reflux

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62
Q

Renal Angiogram

A

Catheter is advanced up femoral-iliac arteries and dye is injected. Can detect tumors or cysts. Femoral stick so check for bleeding and color, pulse, temp of extremities, frequent VS

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63
Q

Cystoscopy

A

Cystoscope with a lens is inserted into the urethra up to the bladder. Magnifies a view of the urethra, bladder, and orifices

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64
Q

Nursing Implications of cystoscopy

A
  1. NPO after midnight
  2. Monitor for UTI
  3. May have slight pink-tinged urine post procedure
  4. Relieve discomfort with warm, moist heat. Sitz bath
  5. Observe for complications: bleeding, infection, and pain with urination
  6. Urinary retention
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65
Q

Ureteroscopy

A

Scope through ureter; general anesthesia

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66
Q

Percutaneous Renal Biopsy

A

MD uses needle to excise tissue. Used to diagnose presence or progression of disease. Not done as much now because of CT and ultrasound tests.

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67
Q

Nursing Implications for Percutaneous Renal Bx

A
  1. NPO after midnight
  2. Post-op VS
  3. Prone immediately after procedure and then bedrest for 8 hours
  4. Need IVF after to prevent clots
  5. Post-op pain/responsive to analgesics
  6. Assess s/sx bleeding and inspect urine
  7. Avoid strenuous activity for 2 weeks
  8. Report backache, flank pain radiating to groin (clot in ureter)
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68
Q

Renal and ureteral brush biopsy

A

Provides specific info when abnormal xray findings of the ureter or renal pelvis is detected
*Cystoscope/ureteral catheter introduced and brush biopsy done

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69
Q

Risk Factor for Chronic Kidney Disease

A
  1. CAD
  2. DM
  3. HTN
  4. Obesity
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70
Q

Causes of Chronic Kidney Disease

A
  1. DM
  2. HTN
  3. Glomerulonephritis/pyelonephritis
  4. Hereditary or congenital disorders
  5. Renal cancer
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71
Q

Clinical Manifestations of Chronic Kidney Disease

A
  1. Increased creatinine
  2. Anemia
  3. Metabolic acidosis
  4. Calcium and phosphorus imbalances
  5. Fluid retention
  6. As the disease progresses abnormalities in electrolytes occur, heart failure worsens, and hypertension becomes more difficult to control
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72
Q

What is nephrosclerosis?

A

Hardening of renal arteries - most often due to HTN, DM

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73
Q

Treatment of nephrosclerosis

A

Control of BP and BG, renal replacement therapy

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74
Q

What is acute glomerulonephritis (AGN)?

A

Inflammation of kidney that affects the capillary bundles in glomeruli. Changes the permeability of glomeruli. Onset usually follows URI (strep), impetigo, mumps, hepatitis B, HIV infections, varicella
*Strep infection 2-3 weeks before glomerulonephritis. The strep product acts as an antigen and stimulates antibodies and results in deposits of molecules in glomeruli which injures the kidney

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75
Q

S/Sx of acute glomerulonephritis

A
  1. Hematuria (urine may be cola colored because of RBC’s)
  2. Edema
  3. Azotemia
  4. Proteinuria
  5. Malaise
  6. Also decreased output, CVA tenderness and flank pain
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76
Q

Diagnostic Tests for acute glomerulonephritis

A
  1. UA
  2. CBC (may have low H/H from blood loss)
  3. Strep titer
  4. May need renal bx
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77
Q

Potential Complications of Acute Glomerulonephritis

A
  1. End stage renal disease (ESRD)
  2. Hypertensive encephalopathy
  3. HF
  4. Pulmonary edema
  5. Elderly patients - circulatory overload with dyspnea, cardiomegaly, pulmonary edema, atypical neuro changes
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78
Q

Medical Management of acute glomerulonephritis

A
  1. Antibiotics - if residual strep infection, PCN unless allergic - erythromycin
  2. Bed Rest - during acute phase until hematuria and proteinuria subside
  3. Steroids - May be given to decrease inflammation
  4. Diet - low protein, low sodium, high calories, high carbs, fluids may be restricted
  5. Diuretics may be given if HTN
  6. May have to go on dialysis or may recover
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79
Q

Nursing Management of Acute Glomerulonephritis

A
  1. Ensure carbs given liberally for energy and reduce catabolism of protein
  2. I and O
  3. Fluids as ordered
  4. Education
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80
Q

Patient Education of Acute Glomerulonephritis

A
  1. Fluid and diet restrictions
  2. Notify HCP for s/sx of renal failure (fatigue, N/V, decreased urine output)
  3. Notify HCP for s/sx of infection
  4. F/U labs
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81
Q

What is Chronic Glomerulonephritis?

A

May present first time with chronic from hypertension, hyperlipidemia, or diabetic nephrosclerosis. Kidney tissue becomes fibrous and shrinks to 1/5th normal size. Renal arteries thicken.
*Acute may progress to chronic

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82
Q

S/Sx of chronic glomerulonephritis

A
  1. HTN
  2. Edema
  3. Weight loss
  4. Nocturia
  5. Headache, dizziness
  6. Increased BUN and creatinine
  7. Retinal changes
  8. Peripheral neuropathy and confusion late in the disease
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83
Q

Laboratory Abnormalities of chronic glomerulonephritis

A
  1. Hyperkalemia
  2. Metabolic acidosis
  3. Anemia
  4. Hypoalbuminemia
  5. Increased phosphorus
  6. Decreased calcium
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84
Q

Nursing Interventions of Chronic GLomerulonephritis

A
  1. Monitor weight daily
  2. HBV (High Biological Value)proteins (dairy products, eggs, meats)
  3. Adequate calories to spare protein
  4. Detection of UTI promptly
  5. Patient teaching = diet
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85
Q

Discharge Teaching for Chronic Glomerulonephritis

A
  1. F/U appointments
  2. BP control
  3. Teaching about long-term dialysis, care for access site, dietary and fluid restrictions
  4. Report s/sx, N/V, decrease urine output, hematuria, edema
  5. Compliance with medications
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86
Q

What is nephrotic syndrome?

A

Not a specific syndrome, but a cluster of clinical findings.

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87
Q

Causes of nephrotic syndrome

A
  1. Chronic glomerulonephritis
  2. DM
  3. Lupus
  4. Multiple myeloma
  5. Renal vein thrombosis
88
Q

S/Sx of nephrotic syndrome

A
  1. Proteinuria (primary symptom) may be tea/coke color > 3.5 g/d hallmark of diagnosis
  2. Hypoalbuminemia
  3. Pitting edema (major manifestation) commonly periorbital
  4. Hyperlipidemia
89
Q

Diagnostic Test for nephrotic syndrome

A

Needle bx of kidney

90
Q

Medical Management of nephrotic syndrome

A

GOAL = reserve renal function

  1. Diuretics
  2. ACE inhibitors
  3. Steroids
  4. Treatment of hyperlipidemia controversial (dietary modifications of protein and cholesterol)
91
Q

S/Sx of renal trauma

A
  1. Pain
  2. Hematuria (most common manifestation)
  3. Mass swelling in flank
  4. Ecchymosis or wounds to abdomen or flank
  5. S/Sx of shock or hemorrhage (70% of patients in shock when admitted)
92
Q

Medical Management of renal trauma

A
  1. Control hemorrhage (H/H frequently), pain, and infection
  2. Surgery if bleeding - must treat quickly
  3. Bed rest if gross hematuria or a minor laceration; stay on bedrest till hematuria clears
93
Q

How can bladder injuries occur?

A

May occur with pelvic fractures and multiple trauma or blow to lower abdomen when bladder is full

94
Q

Complications of bladder injuries

A
  1. Hemorrhage
  2. Shock
  3. Sepsis
95
Q

Medical Management of bladder injuries

A

Surgery and repair of laceration

96
Q

Urinary Tract Infection

A

Caused by pathogenic microorganisms in the urinary tract. Most common site is bladder (cystitis) but urethra (urethritis), prostate (prostatitis) and kidney (pyelonephritis) also possible. Normal urinary tract is sterile above the urethra

97
Q

How are UTI’s classified?

A
  1. Lower (bladder)

2. Upper (kidney)

98
Q

Diagnostic Tests for UTI

A
  1. UA and C/S (clean catch or cath specimen)

2. May test for STD - urethritis frequently from STD

99
Q

Urethrovesical Reflux

A

Can also be from reflux of urine. Coughing, sneezing, etc. increases pressure in bladder forcing urine into urethra. When pressure returns to normal then urine flows back into bladder taking bacteria with it

100
Q

Risk Factors for UTI’s

A
  1. Inability to empty bladder completely
  2. Decreased natural host defenses or immunosuppression
  3. Indwelling catheterization or urinary tract instrumentation
  4. Urine stasis and residual > 100 mL
  5. Bladder distention or obstruction
  6. Metabolic disorders such as diabetes or gout
  7. Neurologic disorders, cognitive impairment
  8. Pregnancy
  9. Risk increases with age
101
Q

Prevention of UTI’s

A
  1. Void every 2-3 hours
  2. Wipe back to front
  3. Take shower instead of bath
  4. Avoid bubble baths - cause irritation
  5. Wear cotton underpants
  6. Pericare before sexual intercourse and void immediately after
  7. Drink lots of fluids - avoid UT irritants (coffee, tea, cola, alcohol). Acidify urine with vitamin C and cranberry juice
102
Q

Cystitis (lower UTI)

A

Bladder infection. Usually caused by ascending infection from urethra. May be caused by urine flowing back from urethra into the bladder (urethrovesical reflux), fecal contamination, or catheter

103
Q

S/Sx of cystitis

A
  1. Frequency and urgency
  2. Burning and pain on urination - hesitancy
  3. Nocturia
  4. Suprapubic pain
  5. Hematuria
  6. Pyuria
  7. N/V
104
Q

Medical Management of cystitis

A
  1. Antibiotics (Co-trimoxazole and Nitrofurantoin); uncomplicated UTIs can be treated with one-time dose, 3-4 day regimen or 7-10 day regimen; chronic UTI may require treatment for months
  2. Fluid intake
  3. Preventative measures
105
Q

What is urethritis?

A

Inflammation of urethra. In males usually caused by gonorrhea. Non-gonorrheal usually caused by chylamydia

106
Q

S/Sx of urethritis

A

Males - inflammation, purulent drainage and burning on urination
Females - may not have symptoms. May have discharge. Frequently not diagnosed and sterility may occur.

107
Q

Treatment of urethritis

A

Antibiotics and follow up care to ensure infection gone

All sexual partners must be tested

108
Q

What is acute pyelonephritis?

A

Infection of renal pelvis, tubule, interstitial tissue of kidney
Frequently secondary to urine back up or obstruction

109
Q

Causes of acute pyelonephritis

A
  1. Bacterial infection of the kidney
  2. Obstruction or renal disease
    * Most common organism is E. coli but can also be from proteus, pseudomonas, staph, or strep
110
Q

S/Sx of acute pyelonephritis

A
  1. Flank or back pain
  2. CVA tenderness
  3. Fever, chills
  4. Dysuria, frequency, and urgency
  5. Malaise
  6. Pus, bacteria and white cells in urine
111
Q

Diagnostic Tests for acute pyelonephritis

A
  1. US
  2. CT scan
  3. Urine C/S
  4. Gallium scan
112
Q

What is chronic pyelonephritis

A

Persistent kidney inflammation. Usually asymptomatic except for vague/intermittent flank pain, fatigue, headache, occasional fever, and bacteriuria. Can lead to chronic renal failure

113
Q

Medical Management for Acute and Chronic Pyelonephritis

A
  1. Antibiotics for 2 weeks up to 6 months
  2. Antiemetics to control N/V
  3. Fluids to prevent dehydration and increase urine output
  4. Pain meds and urine antiseptics to relieve discomfort
  5. Bed rest needed to promote healing
114
Q

Nursing interventions for acute and chronic pyelonephritis

A
  1. Administer meds - antibiotics, antiemetics, analgesics, and antiseptics as ordered
  2. Explain to patient that they must continue antibiotics and keep F/U appointments
  3. Explain cause, effect etc. of disorder
  4. Encourage bed rest and gradual increase activity with frequent rest periods
115
Q

Diet for all UTI’s

A
  1. Acid diet - cranberry, prune, plums, vitamin C, breads, meat, eggs
  2. At least 3000 mL fluid per day
116
Q

Urolithiasis

A

Bladder stones

117
Q

Nephrolithiasis

A

**Kidney Stones
Calculi stones that form in the urinary tract, most common site is the kidney, where they can cause ischemia, altered elimination and UTI due to stasis. Can lead to kidney damage or failure.
*More common in men than women and rare in blacks and children
*Most common cause of urinary obstruction

118
Q

Factors that favor stone formation

A
  1. Fluid volume status
  2. Diet
  3. Immobility
  4. Obstruction
  5. Foreign Body (stones forming on a Foley)
  6. Metabolic factors
  7. Inflammatory bowel disease
  8. Family history
  9. Medications
119
Q

How does fluid volume status affect stone formation?

A

A lower fluid intake increases concentration of stone forming substances in the urine. Changes in urine pH favor stone formation

120
Q

How does diet affect stone formation?

A
  1. High intake of calcium
  2. Oxalates
  3. Purines
121
Q

Foods high in oxalate

A
  1. Spinach
  2. Beets
  3. Potato chips
  4. French fries
  5. Nuts
  6. Nut butters
122
Q

Foods high in purines

A
  1. Organ meat
  2. Game meat
  3. Anchovies
  4. Beer
  5. Bacon
123
Q

How does immobility affect stone formation?

A

Immobility allows calcium to be released into circulation from bones and filtered by kidneys promoting stone formation. Also slows renal drainage.

124
Q

How does obstruction affect stone formation?

A

Urine stasis allows stone forming substances to collect and form stones. Obstruction also encourages infection which compounds the problem

125
Q

How do metabolic factors affect stone formation?

A
  1. Hyperparathyroidism
  2. Elevated uric acid
  3. Oxalate metabolism problems
  4. Genetic defect in cystine metabolism
  5. Excess intake of calcium/vitamin D
126
Q

How does inflammatory bowel disease affect stone formation?

A

Patients with IBD, ileostomy, or bowel resection absorb more oxalate.

127
Q

What medications encourage stone formation?

A
  1. Laxatives
  2. Antacids
  3. High doses ASA
  4. Diamox
  5. Vitamin D
128
Q

Types of Stones

A
  1. Calcium
  2. Oxalate
  3. Struvite
  4. Uric Acid
  5. Cystine
129
Q

Clinical Manifestations of Stones in Renal Pelvis

A

Intense deep ache in CVA can radiate down toward the bladder; N/V (renal colic)

130
Q

Clinical Manifestations of Stones in Ureter

A

Acute, wave-like flank pain radiates down thigh and to genitalia. May have the urge to void but little urine passed and usually contains blood - (ureteral colic)

131
Q

Clinical Manifestations of Stones in the Bladder

A
  1. UTI
  2. Hematuria
  3. Retention if stone obstructs the bladder neck
132
Q

General S/Sx of stone formation

A
  1. Diaphoresis
  2. Restlessness
  3. Pain
  4. GI (N/V/D)
133
Q

Diagnostic Tests to confirm GU stones

A
  1. UA
  2. KUB and/or IVP
  3. Serum chemistries
  4. CT
  5. Cystoscopy
134
Q

Potential Complications of Stone Formation

A
  1. Obstruction
  2. Pyelonephritis
  3. Tissue irritation leads to renal abscess and can contribute to cancer
  4. Urosepsis
135
Q

Ways to relieve pain in patients with GU stones

A
  1. Narcotics
  2. Heating pad
  3. Hot bath
  4. Report increases in severity promptly
  5. Positions of comfort
136
Q

Teaching for patients with GU stones

A
  1. Restrict protein 60 g per day
  2. Na 3-4 g per day
  3. Avoid intake of oxalate high foods
  4. Generally don’t want to limit calcium intake because it could lead to osteoporosis
  5. High fluids every 1-2 hours, 2 glasses of water at bedtime, every time upon awakening, 2 L/day
  6. Avoid dehydration
  7. Strain urine at home
  8. Notify MD any sudden increase in pain may indicate obstruction
  9. Contact HCP at first sign of UTI
137
Q

Surgical Procedures for patients with GU stones

A
  1. Extracorporeal Shock Wave Lithotripsy (ESWL)
  2. Ureteroscopy or cystoscopy
  3. Percutaneous Nephrostomy or nephrolithotomy
138
Q

Extracorporeal Shock Wave Lithotripsy (ESWL) (Stones)

A

Shock waves directed at location to crush stones (patient may be submerged in large bath of warm water). Stones are then passed in the urine in a few days. Client needs to increase fluid intake to facilitate passage

139
Q

Ureteroscopy or cystoscopy (Stones)

A

Visualize stone through ureteroscope and then destroy stone with a laser, lithotriptor, or U/S wave device. May remove stone with basket. Stent may be inserted for a few days to keep ureter patent (observed for obstruction/infection). May have hematuria until stent removed. Strain all urine after.

140
Q

Percutaneous Nephrostomy or Nephrolithotomy (Stones)

A

Percutaneous tract to kidney through which nephroscope is introduced. Stone may be extracted or ultrasonic waves may be used to pulverize the stone

141
Q

Diet and Medication Treatment for Calcium Stones

A
  1. No longer recommend calcium restriction unless true hypercalcemia
  2. High fluid intake
  3. Restrict protein
  4. Restrict sodium
  5. Acid diet
  6. Medications (cellulose sodium phosphate, thiazide diuretics, lithostat)
  7. Avoid antacids that contain calcium
142
Q

Diet and Medications Uric Acid Stones

A
  1. Avoid foods high in purine
  2. Other proteins may be limited
  3. Teach client to avoid alcohol, fasting and crash diets - may increase uric acid
  4. Alkaline diet
  5. Avoid high purine foods
  6. Medications (allopurinol)
143
Q

Recommended Diet for Oxalate Stones

A
  1. High fluid intake

2. Avoid these high oxalate foods

144
Q

Recommended Diet for Cystine Stones

A
  1. Low protein

2. Alkaline diet

145
Q

Alkaline Diet

A
  1. Milk
  2. Vegetables
  3. Rhubarb
  4. Most fruit including citrus
146
Q

Acid Diet

A
  1. Cranberries
  2. Prunes
  3. Plums
  4. Eggs
  5. Bread
  6. Meat
147
Q

What is a urethral stricture?

A

Narrowing of urethra that can be conginital or acquired. Urine flow outside bladder restricted and dilation of system proximal to stricture occurs

148
Q

Causes of urethral strictures

A
  1. Injury (could be from Foley, surgical instruments, or straddle injury)
  2. Untreated gonorrhea urethritis
  3. Congenital abnormalities
149
Q

S/Sx of urethral stricture

A
  1. Decreased force or volume of stream
  2. Retention
  3. Hesitancy, straining
  4. Overflow incontinence
150
Q

Potential Complications Urethral Strictures

A

Hydronephritis

151
Q

Diagnostic Tests

A
  1. UA, C/S
  2. IVP - intravenal pyelogram
  3. Voiding cysto
  4. Urethroscopy
152
Q

Medical Management of Urethral Stricture

A
  1. Dilation - begin with smaller and progress

2. Surgical removal

153
Q

Hydronephrosis

A

Distention of renal pelvis and calices by obstruction of urine flow. Urine is trapped proximal to obstruction. Renal tissue is destroyed, uremia results. Permanent damage may occur.

154
Q

Causes of hydronephrosis

A
  1. Stones
  2. Tumor
  3. Scar tissue
  4. Urethral stricture or ureter stricture
  5. BPH
155
Q

S/Sx of hydronephrosis

A

If gradual may be none, otherwise acute flank pain. If infection will have will have s/sx of UTI (pain, fever, chills, tenderness, pyuria, decreased output) may have hematuria

156
Q

Medical Management of Hydronephrosis

A

Identify and correct the cause - antibiotics, remove obstruction
May need urinary diversion

157
Q

Risk Factors for Bladder Cancer

A
  1. Caucasian men (4X more than women), age > 55
  2. Smoking
  3. Chemicals (environment)
  4. Recurrent or chronic UTI’s
  5. High urinary pH
  6. High cholesterol intake
  7. Pelvic radiation therapy
  8. Metastasis from prostate, colon, rectum
158
Q

S/Sx of bladder cancer

A

Painless hematuria is usually only symptom

Any alteration in voiding needs to be investigated especially if have risk factors

159
Q

Diagnostic Tests

A
  1. UA - cytology to see what kind of cells are present
  2. IVP - assess bladder and surrounding structures
  3. Cystoscopy - direct visualization of tumor
160
Q

Medical Management of Bladder Cancer

A
  1. Radiation
  2. Medication - Bacillus Calmette Guerin
  3. Surgery - local resection or total cystectomy
161
Q

Urinary Diversions

A

Performed to divert urine from bladder to new exit site

162
Q

Two types of urinary diversions

A
  1. Cutaneous

2. Continent

163
Q

Pre-Op Preparation for Urinary Diversions

A
  1. Bowel cleaning
  2. Low residue diet
  3. Antibiotics for bowel disinfection
  4. Hydration
  5. May need hyperalimentation (TPN)
  6. ET (stoma nurse) for pre-op teaching and to mark stoma location
164
Q

Ileal Conduit

A

Oldest type of diversion, transplant ureters to an isolated section of the terminal ileum (intestine) and bring one end to the abdominal wall as an ileostomy

165
Q

Complications of Ileal Conduit

A
  1. Infection
  2. Dehiscence
  3. Urinary leakage
  4. Ureteral obstruction
  5. Small bowel obstruction
  6. Stomal gangrene
    * Not normal to see stool in drainage
166
Q

How to assess and manage diversion

A
  1. Change appliance early a.m. decrease urine output
  2. Skin barrier essential
  3. Avoid moisturizing soaps
  4. Avoid foods with strong odors
  5. Liquid deodorizer, diluted white vinegar into bottom of pouch, ascorbic acid PO
  6. No ASA in pouch/will ulcerate stoma
  7. Change pouch regularly
  8. Empty when 1/3 full
167
Q

Ureterosigmoidostomy

A

Implant ureters into sigmoid colon. Urine excreted during bowel movements. Voiding is through rectum. This procedure usually done for patient who has had pelvic radiation, previous small bowel resection or small bowel disease

168
Q

Nursing Implications for ureterosigmoidostomy

A
  1. May require adjustment of lifestyle b/c frequency
  2. Bowel incontinence may occur. May have frequency (q2h). Will be like watery diarrhea - some degree of nocturia
  3. Anal sphincter training will help patient gain control and learn to differentiate between need to void and need to defecate
  4. F/E imbalances - large areas of bowel are exposed to urine and electrolyte reabsorption - so imbalances may occur
  5. May have catheter in rectum, can irrigate but never force, danger of introducing bacteria into newly implanted ureters
169
Q

Cutaneous Ureterostomy

A

Ureter brought through abdominal wall and attached to opening. Used for patients with ureteral obstruction such as pelvic cancer, for poor risk patients because requires less extensive surgery than others procedures. May also used for patients who have had previous abdominal radiation

170
Q

Cutaneous Ureterostomy Nursing Implications

A
  1. Appliance to collect urine needed

2. Stoma usually flush with skin or retracted

171
Q

Vesicostomy

A

Bladder sutured to abdominal wall and stoma created for urine drainage
*Appliance to collect urine needed

172
Q

Nephrostomy

A

Catheter inserted into renal pelvis via incision in flank. Do not clamp nephrostomy tubes
*Appliance is needed

173
Q

Continent Ileal Urinary Reservoir (Indiana Pouch)

A

Most common continent diversion. Uses segment of ileum and cecum to form reservoir. Ureters tunneled and anastomosed. Reservoir made by narrowing part of the ileum and sewing terminal ileum to SQ tissue. Pouch is sewn to abdominal wall around a cecostomy tube.

174
Q

Nursing Implications for Indiana Pouch

A
  1. Urine collects in pouch until catheter inserted and urine drained
  2. Have to be taught self-catheterization = reservoir must be drained at regular intervals to prevent absorption of metabolic waste products from the urine. Also needs to be done to prevent UTI
  3. Kock pouch has a nipple with one way valve - the valve prevents leakage of urine and drainage of urine is under patients control
  4. In males Kock pouch can be attached to one end of urethra to allow for more normal voiding. Female urethra too short
175
Q

Post-Op Interventions for Indiana Pouch

A
  1. Stoma - should be beefy, red, moist
  2. Urinary output - monitor hourly < 30 mL/hr dehydration or obstruction
  3. Pain - postop pain control
  4. Body image - learning to cope with body image change and increase self-esteem. Learn to accept altered urinary function and sexuality
176
Q

Potential Complications of Indiana Pouch

A
  1. Respiratory complications - atelectasis
  2. Fecal/urine leakage that leads to skin irritation: irritation, bleeding, infections
  3. Peritonitis
  4. Stoma ischemia
  5. Stoma retraction and separation
  6. F/E imbalances
  7. Ascorbic acid to keep urine pH <6.5 - alkaline incrustation around stoma
177
Q

Discharge Planning for Indiana Pouch

A
  1. Provide diet instructions - avoid gas forming foods if diversion into the GI tract
  2. Teach care of pouch
  3. Self cath if continent pouch
178
Q

Risk Factors for Benign Prostatic Hyperplasia (BPH)

A
  1. Smoking
  2. Heavy alcohol consumption
  3. HTN
  4. CV disease
  5. DM
  6. Increase age
179
Q

S/Sx of BPH

A
  1. Frequency
  2. Urgency
  3. Retention
  4. Hesitancy
  5. Straining
  6. Decrease volume and force of stream
  7. Dribbling
  8. UTI
  9. Nocturia
  10. Enlarged prostate on digital rectal exam
  11. Chronic urinary retention - azotemia, renal failure
180
Q

Diagnostic Tests to confirm BPH

A
  1. Digital exam
  2. UA
  3. Urodynamics
  4. PSA - prostate specific antigen
  5. CBC before surgery to correct clotting defects
181
Q

Potential Complications of BPH

A
  1. Hydroureter
  2. Hydronephrosis
  3. Pyelonephritis
  4. Renal failure
182
Q

Medical Management of BPH

A
  1. Watchful waiting
  2. Balloon dilation
  3. Suprapubic cystoscopy/suprapubic catheter
  4. Medication
  5. Transuretheral Needle Ablation
  6. Microwave Therapy
  7. Transurethral Laser Resection
  8. Transurethral Incision of Prostate (TUIP)
  9. Transurethral Resection Prostate (TURP)
183
Q

Transurethral Needle Ablation

A

For BPH

Uses radio frequency to destroy tissue

184
Q

Microwave Therapy

A

For BPH

Microwave heat. Tissue sloughs off. Water cooling system used so patient not burned.

185
Q

Transurethral Laser Resection

A

For BPH
Treated tissue vaporizes or becomes necrotic and sloughs off. Body reabsorbs dead tissue. Done as output. Less post-op bleeding than TURP

186
Q

Transurethral Incision of Prostate (TUIP)

A

For BPH
Electric current/laser beam used to make incisions in prostate to decrease resistance to flow of urine. No tissue removed

187
Q

Transurethral Resection Prostate (TURP)

A

For BPH

Scope introduced through the urethra to prostate. Inner portion of prostate removed or entire gland

188
Q

Post-Op Care BPH Surgery

A
  1. Bladder irrigation
  2. Assess for bleeding or clot formation
  3. Use antispasmodics for bladder spasms
  4. Teach perineal exercises to improve bladder control
  5. Fluid intake to keep urine clear
  6. Teach to watch for bleeding up to 2 weeks after TURP
  7. MD should manipulate catheter
189
Q

Suprapubic Prostatectomy

A

For BPH
Remove gland through abdominal incision
1. Change dressings frequently using sterile technique
2. Foley catheter in place

190
Q

Perineal Prostatectomy

A

For BPH

Remove the gland through incision in perineum. Used for radical cancer treatment

191
Q

Nursing Implications for perineal prostatectomy

A
  1. Better for very old, frail, and poor surgical risk patient with large prostate
  2. Higher risk post-op impotence and incontinence
  3. Possible damage to rectum and external sphincter
  4. Greater risk for infection
192
Q

Retropubic prostatectomy

A

Abdominal incision without opening bladder. Approaches the prostate between the pubic arch and bladder. More common than suprapubic

193
Q

Laparoscopic Radical Prostatectomy

A

Provides better visualization, experience less bleeding, shorter hospital stays, less post-op pain

194
Q

Potential Complications after Prostatectomy

A
  1. Hemorrhage - irrigation
  2. Infection - antibiotics
  3. DVT - elevate HOB, O2, notify MD, early ambulation
  4. Catheter obstruction - irrigation
  5. Sexual dysfunction
195
Q

Prostate Cancer

A
  1. Most common cancer in men
  2. More prevalent in African American males
  3. Growth of prostate gland depends on presence of testosterone
  4. Recommended men over 40 have digital rectal exam yearly
196
Q

Risk Factors for Prostate Cancer

A
  1. Family history
  2. Diet
  3. Chemical exposure
  4. Age
  5. African American
197
Q

Clinical Manifestations of Prostate Cancer

A
  1. Usually none in early stages
  2. Symptoms from obstruction later
  3. Blood in urine if invades bladder, painful ejaculation
  4. May get symptoms from metastasis late in diagnosis usually to bone or lymph nodes
198
Q

Diagnostic Tests to confirm Prostate Cancer

A
  1. Examine tissue from prostatectomy
  2. PSA (normal <4) [remember it could be elevated due to BPH or infection]
  3. PAP (prostate acid phosphatase 2.5-3.7) - tells if cancer metastasized. Also tells effectiveness of treatment
  4. DRE - advanced lesion is stony hard and fixed
199
Q

Medical Management of Prostate Cancer

A
  1. Surgery - standard treatment
  2. Radiation
  3. Hormone treatment
200
Q

Radiation (Prostate Cancer)

A

Can be done if found early enough

  1. External (teletherapy) 6-8 weeks of daily radiation
  2. Internal (brachytherapy) radioactive seeds implanted; avoid close contact with pregnant women and infants for 2 months; strain urine for seeds and use condom for up to 2 weeks after implant
201
Q

Hormone Treatment (Prostate Cancer)

A

Prostate cancers are androgen-dependent, used to control not cure - monthly injections of hormone leuprolide prevents progression of disease - very expensive. Or may do orchiectomy (remove testes). May take estrogen, female hormone

202
Q

Epididymitis

A

Inflammation of epididymis

Usually unilateral and caused by infection from prostate gland or UTI

203
Q

Complications of Epididymitis

A
  1. Orchitis (infection of testes)
  2. Abscess
  3. Sterility
204
Q

S/Sx of Epididymitis

A
  1. Severe pain and tenderness in groin and scrotum
  2. N/V
  3. Fever, chills
  4. Dysuria
  5. Frequency and urgency
  6. Elevated WBC (20,000-30,000)
205
Q

Medical Management of Epididymitis

A
  1. Bedrest, usually for 3-5 days
  2. Elevate scrotum
  3. Ice packs
  4. Analgesics
  5. Antipyretics
  6. Antibiotics
  7. Later - local heat, sitz bath
  8. Avoid straining, lifting, sexual stimulation until infection under control
206
Q

Prostatitis

A

Inflammation of prostate; most commonly carried from urethra, prostate secretes fluid that forms part of seminal fluid
*Can be acute or chronic, bacterial or viral

207
Q

Clinical Manifestations of Prostatitis

A
  1. Burning
  2. Urgency
  3. Frequency
  4. Nocturia
  5. Dysuria
  6. Pain in perineal and rectal area
  7. Pain with or after ejaculation
  8. Fever
208
Q

Acute Bacterial Prostatitis S/Sx

A
  1. Sudden fever
  2. Chills
  3. Perineal, rectal, lower back pain
  4. Urinary symptoms
209
Q

Chronic Bacterial Prostatitis

A

Major cause of recurrent UTI’s

*Fever/temps uncommon

210
Q

Management of Viral Prostatitis

211
Q

Management of Bacterial Prostatitis

A
  1. Antibiotics (sulfa drugs)

2. Chronic - difficult to treat, antibiotics diffuse poorly into prostatic fluid

212
Q

Patient Education for Prostatitis

A
  1. Bed rest
  2. Analgesics
  3. Sitz baths
  4. Complete antibiotics
  5. Do not force fluids
  6. Avoid diuretics
  7. During acute periods avoid sexual activity
  8. F/U 6 months to a year
213
Q

Causes of ED

A
  1. Psychogenic - anxiety, fatigue, depression, and pressure to perform
  2. Organic - occlusive vascular disease, endocrine disorders, chronic renal failure, GU conditions, hematologic conditions, neurologic conditions, trauma, alcohol, medication, and drug abuse
214
Q

Phimosis

A

Foreskin cannot be retracted

  1. Usually caused by poor hygiene or medical conditions such as DM
  2. Glans penis should be cleaned to prevent inflammation
  3. Steroid cream to reduce constriction
    * May require circumcision after inflammation resolves
215
Q

Paraphimosis

A

Once retracted, foreskin cannot be returned over glans -> venous congestion, edema, and enlargement of glans

  1. Arterial occlusion and necrosis may occur
  2. Treated by firmly compressing glans for 5 minutes to reduce edema and size, then moving foreskin forward while pushing glans back
    * May require circumcision after inflammation resolves

GU (1 decks)

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