GU, Bladder Flashcards
what assessment techniques are you going to use for the Gentialia and reproductive tract?
inspection and palpation
do you need to understand cultural sensitivity for a genitle exam?
yes
what should you ask the patient during a routine head to toe assessment for a GU GR exam?
if they’ve had any s/s of problems
thorough history
t/f: internal exam is done by physicians and APRNs except for cervical dilation in OB?
true
whats important to remember culturally about GU GR exams?
embarrassed to have this assessment done,
some cultures dont openly discuss these issues
some women may not allow male to examine them
what position is this?
dorsal recumbent
what position is this?
lithotomy
what precautions do you use for a GU and GR exam?
standard precautions (wear clean gloves)
what do you need to do before touching patient?
explain procedure and tell them what youre going to do
what will you need to retract on a female patient?
labial folds
should be dry or moist, usually symmetrial, may become atrophied in older age
labia majora
what should the mucous membranes appear like?
dark pink moist
should be intact, pink in color, located above the vaginal orifice.
urethral orfice (urethral meatus)
what should you do before you inspect a male patient?
have them void first
what is hypospadias?
a displaced urethral meatus
which testicle is normally lower?
the left testicle
is a painless enlargement of one tests and a small hard palpable lump the size of a pea on the front or side
testicular cancer
is located on either side of the vertebral column behind the peritoneum and against the dep muscle of the back
kidney
this organ sits behind the symphysis pubis
bladder
how long is the female urethra?
1 to 1.5 inches
how long is the male urethra?
7 to 8 inches
when can children voluntarily control urination?
18 to 24 months
nocturnal enuresis is?
bedwetting that doesnt wake child at night
t/f: Older adults may have decrease in bladder capacity and increased bladder irritability and frequency of contractions. Ability to hold urine decreases.
true
chronic illness, mobility, cognition, and manual dexterity issues put you at an increased risk for?
UTI
how can diabetes affect the bladder?
can cause overactivity of bladder or decrease bladder emptying
how can arthritis/Parkinson’s disease affect toileting?
less timely access to toilet
how does a spinal injury affect urination?
loss of urine control
what does an enlarged prostate cause with urination?
urinary retention
do diuretics change color of urie?
yes
what is phenazopyridine?
a diuretic that changes urine color to orangge
how do anticholinergics affect the bladder?
inhibits bladder contractility
how do sedatives affect the bladder?
reduce ability to recognize/act
what can cystoscopy cause?
trauma
transient dysuria
hematuria
suddenly inability to void when bladder is full or overfull
acute retention
bladder does not empty completely during voiding and urine is held in the bladder
chronic retention
one of the most common types of healthcare associated infection.
urinary tract infection
upper UTI affects?
kidneys
Lower UTI affects?
bladder and urethra
pyelonephritis
severe upper UTI
urosepsis
life-threatening blood infection
symptoms of UTI
burning/pain with urination (dysuria)
urgency (immediate/strong urge to void)
frequency
incontinence (involuntary loss of urine)
tenderness
foul smelling
cloudy urine
transient incontinence
caused by medical conditions
acute confusion
UTI
acute urinary retention
medications, excessive output
mobility issues
depression
is transient incontinence treatable or reversible?
yes
obstacle or disability makes it hard for you to reach or use a toilet in time to urinate
causes from outside urinary tract. (sensory or cognitive impairments, altered mobility, environmental barriers [no assistance to bathroom available, pathway to bathroom not clear, tight clothing, incontinence briefs)
functional incontinence
can urinate but cannot completely empty the urine from their bladders
overdistention of bladder or poor bladder emptying (distended bladder on palpation, high postresidual volume (PVR = amount of urine left in the bladder after voiding and is measured with a bladder scanner [portable ultrasound] or straight catheterization), frequency, involuntary leakage of small amounts of urine, nocturia [awakened from sleep because of urge to void]
Chronic urine retention
when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure on your bladder, causing you to leak urine.
Urethra can’t stay closed d/t increased intraabdominal pressure, weakened urinary sphincter (childbirth trauma or prostatectomy) or pelvic floor muscles
stress incontinence
leakage of small amounts of urine when coughing, laughing, sneezing, exercise, walking, standing up from chair) is due to?
stress incontinence
when you have a strong, sudden need to urinate that is difficult to delay.
strong sense of urgency r/t overactive bladder (involuntary contractions of the bladder) = (strong urge, frequency, nocturia, trouble or inability to hold urine once urge occurs).
urgency incontinence
occurs when the bladder muscle contracts and urine leaks (often in large amounts) without any warning or urge
predictable intervals of loss of urine when bladder reaches a specific volume d/t spinal cord damage. (decreased or absent awareness of bladder, filling, urge to void, or leaking of urine. May not completely empty bladder
reflex incontinence
puts you at risk for developing autonomic dysreflexia (life-threatening condition causing elevated blood pressure, heart rate, and diaphoresis)
reflex incontinence
are for patients who have either had their bladder removed (cystectomy) for significant bladder dysfunction
urinary diversions
the patient must catheterize the pouch 4 to 6 x per day (permanent).
continent urinary reservoir
is placed in the same position as the bladder and the patient can void through the urethra using the Valsalva technique. (permanent)
orthotopic neobladder
pt has no sensation or control over the flow of urine. Requires a drainage bag that is changed every 4-6 days and switched to a bedside drainage bag at night. Permanent.
ureterostomy
tubes are inserted into the kidneys at the renal pelvis, through the skin, and urine drains into bags. Temporary.
nephrostomy
what are some symptoms of urinary alterations? (4)
urgency
dysuria
frequency
nocturia
decreased urine output in relation to fluid intake.
oliguria
all pts with indwelling catheters need to have the _______ _______assessed for damage from the catheter or infection (inflammation or discharge).
urinary meatus
Pulling on the catheter can cause damage to the ______ ______ or the catheter can even erode through the ______ ______ in severe cases.
urinary meatus
how many times a day should you assess the perineal skin?
at least once, more if incontinent
can indicate fluid imbalance, kidney dysfunction, or decreased blood volume.
change in urine output volume
If urine output is less than ___ mL/hour for ___consecutive hours or have excessive urine output, they need to be further assessed and this needs to be reported to the provider.
30 mL/hour for 2 consecutive hrs
what do you immediately need to assess for with urine output of less than 30 mL/hour?
blood loss
If a pt has not voided for ____-_____ hours and has had fluid intake, they should be assessed for urinary retention.
3-6 hours
dark red could be bleeding from ?
kidney or ureters
bright red is from?
bladder or urethra
Foul odor indicates what for urine?
UTI
Use a sterile specimen cup. May be collected by the pt if they are able to, after receiving instructions on cleaning and collection technique
clean-voided or midstream (culture and sensitivity)
May require urine collected at certain time of the day or over a specified time period (2, 12, or 24 hrs).
timed urine samples
measures the concentration of particles in the urine
specific gravity
the higher the specific gravity value, the more _____ it is
concentrated
high specific gravity indicates?
dehydration
reduced renal blood flow
increase in ADH
low specific gravity can indicate?
overhydration
early renal disease
inadequate ADH secretion
indicates trauma or disease Can also be caused from urethral catheters or surgery of lower urinary tract.
RBC elevation
may be present with poorly controlled diabetes, dehydration, starvation, or excessive aspirin ingestion.
high ketones
indicate renal disease.
casts
indicate risk of renal calculi development (kidney stones) or patients with gout may have high uric acid levels
crystals
what is the normal speciic gravity range?
1.005 to 1.030
are proteins suppose to be in urine?
no, should normally be negative?
WBC count in urine normal range?
< 5/hpf
RBC normally present in urine?
RBC <5/hpf
normal pH range in urine
4.5 to 8
ketones should be ?
negative
glucose should be?
negative
casts and crystals should be ?
negative
Abdominal roentgenogram
is an x-ray of the abdomen to visualize the structures of the lower urinary tract.
used to identify anatomical abnormalities.
Assess for allergies to contrast dye (iodine). The patient will be NPO (nothing by mouth). After, encourage fluids and assess for allergic reaction.
Ct of the abdomen and pelvis
intravenous injection of contrast media (iodine based) then taking a series of x-ray films to actively observe the passage of urine through the urinary tract.
Assess for allergies to contrast media (iodine) and dehydration. After assess for allergic reaction, encourage fluids, and assess urine output. <30 mL/hr = contrast induced nephropathy.
IVP intravenous pyelogram
provides imaging of the kidney, ureters and bladder to identify abnormalities and estimate the volume of urine in the bladder.
Pt may be instructed to either void before procedure or have a full bladder. Check your orders to confirm.
Do not schedule within 24 hrs of an IVP procedure.
ultrasound of renal bladder
introduction of a cystoscope through the urethra for direct visualization, specimen collection, and treatment of the bladder and urethra.
Different levels of anesthesia may be used.
Follow any bowel cleansing orders.
Pt may be ordered to drink fluids before the procedure.
Inform them that urine may be pink tinged afterward and to report s/s of UTI.
cystoscopy
for a patient with normal heart and renal function with no intake restrictions how much water should they be encouraged to drink?
2300 mL
what catheter is this?
straight catheter
indwelling retentioin catheter
triple lumen catheter
_______ _______ is used to measure PVR when ultrasound or bladder scanner is unavailable, or to manage chronic urinary retention.
intermittent catheterization
has a single lumen and is used for intermittent catheterization. Usually made of rubber or polyvinyl chloride (PVC).
straight catheter
have a double lumen with one lumen for the urine to drain and one to inflate the balloon that holds it in place. Made of latex or silicone.
Make sure to ask the patient about any latex allergies (many people who are allergic to bananas are also allergic to latex) before selecting the catheter.
indwelling catheter
have a triple lumen. One for the urine, one to inflate the balloon, and one for instilling medication in the bladder.
continuous bladder irrigation catheters
has a curved tip to maneuver past an enlarged prostate that is pressing into the urethra. Special training is needed to use this type.
A Coude’-tip catheter
adult women french size?
10-12
most adult men french size?
12-14
children french size?
8-10
french size for infants?
5-6
Sometimes larger Fr. is needed, such as when there is __________ a that could develop clots and cause blockage.
hematuria
For ___________, change the catheter every 4 to 6 weeks.
long term catheterization
If catheter is not draining what should you first check for?
kinks or occlusions in tubing
t/f: irrigation increases risk of CAUTI ?
YES IT DOES
when should you drain the bag?
when half full or before transferring patient or activity
programs should be in place that provide continuing education on catheter care.
Quality improvement programs
how long should you monitor time, and amount of each void after catheter removal?
1-2 days
a urinary drainage tube that is surgically inserted into the bladder through the abdominal wall above the symphysis pubis. See above pictures.
Placed when there is a urethral blockage or when long-term catheters cause irritation or discomfort.
May be suture to the skin, secured with an adhesive material, or retained in the bladder with a balloon, like with an indwelling catheter.
Same care that is required for an indwelling catheter, with new dry dressings applied per facility policy. Assess for signs of inflammation or the growth of overgranulation tissue.
suprapubic catheterization
condom catheter or penile sheath. A soft, pliable condom-like sheath that fits over the penis, containing urine.
Most made of silicone, but some still made of latex. Check for allergies before applying. Comes in different sizes.
Held in place with an adhesive on the inner lining and may be attached to a leg bag or beside bag.
Suitable for incontinent male patients who have complete and spontaneous bladder emptying.
Associated with decreased risk of UTI.
external catheter
are used to treat urinary urgency
antimuscarinics
Adverse effects are constipation, dry mouth, and blurred vision. (cant see, spit, shit, piss)
antimuscarinics
can also treat urgency. Blood pressure needs to monitored for increases.
mirabegron
can help treat stress incontinence in postmenopausal women.
vaginal estrogen
can treat urinary retention.
bethanechol
relax smooth muscles to relax smooth muscle in men with obstruction caused by enlarged prostate.
tamsulosin and silodosin
can shrink the prostate.
finasteride and dutasteride
may also be prescribed to reduce pain associated with UTI. This medication turns the urine orange.
phenazopyridine
that is for female incontinence. It is placed externally between the labia and buttocks and pulls the urine away from the skin and into a cannister. Best used with patients who are in a seated position, reclined, or lying on their side.
PureWick device
PureWick device
what are safety guidelines for catheter and urinary nursing skills?
surgical and medical asepsis
identify latex, iodine allergies
