GU, Bladder Flashcards
1
Q
what assessment techniques are you going to use for the Gentialia and reproductive tract?
A
inspection and palpation
2
Q
do you need to understand cultural sensitivity for a genitle exam?
A
yes
3
Q
what should you ask the patient during a routine head to toe assessment for a GU GR exam?
A
if they’ve had any s/s of problems
thorough history
4
Q
t/f: internal exam is done by physicians and APRNs except for cervical dilation in OB?
A
true
5
Q
whats important to remember culturally about GU GR exams?
A
embarrassed to have this assessment done,
some cultures dont openly discuss these issues
some women may not allow male to examine them
6
Q
what position is this?
A
dorsal recumbent
7
Q
what position is this?
A
lithotomy
8
Q
what precautions do you use for a GU and GR exam?
A
standard precautions (wear clean gloves)
9
Q
what do you need to do before touching patient?
A
explain procedure and tell them what youre going to do
10
Q
what will you need to retract on a female patient?
A
labial folds
11
Q
should be dry or moist, usually symmetrial, may become atrophied in older age
A
labia majora
12
Q
what should the mucous membranes appear like?
A
dark pink moist
13
Q
should be intact, pink in color, located above the vaginal orifice.
A
urethral orfice (urethral meatus)
14
Q
what should you do before you inspect a male patient?
A
have them void first
15
Q
what is hypospadias?
A
a displaced urethral meatus
16
Q
which testicle is normally lower?
A
the left testicle
17
Q
is a painless enlargement of one tests and a small hard palpable lump the size of a pea on the front or side
A
testicular cancer
18
Q
is located on either side of the vertebral column behind the peritoneum and against the dep muscle of the back
A
kidney
19
Q
this organ sits behind the symphysis pubis
A
bladder
20
Q
how long is the female urethra?
A
1 to 1.5 inches
21
Q
how long is the male urethra?
A
7 to 8 inches
22
Q
when can children voluntarily control urination?
A
18 to 24 months
23
Q
nocturnal enuresis is?
A
bedwetting that doesnt wake child at night
24
Q
t/f: Older adults may have decrease in bladder capacity and increased bladder irritability and frequency of contractions. Ability to hold urine decreases.
A
true
25
chronic illness, mobility, cognition, and manual dexterity issues put you at an increased risk for?
UTI
26
how can diabetes affect the bladder?
can cause overactivity of bladder or decrease bladder emptying
27
how can arthritis/Parkinson's disease affect toileting?
less timely access to toilet
28
how does a spinal injury affect urination?
loss of urine control
29
what does an enlarged prostate cause with urination?
urinary retention
30
do diuretics change color of urie?
yes
31
what is phenazopyridine?
a diuretic that changes urine color to orangge
32
how do anticholinergics affect the bladder?
inhibits bladder contractility
33
how do sedatives affect the bladder?
reduce ability to recognize/act
34
what can cystoscopy cause?
trauma
transient dysuria
hematuria
35
suddenly inability to void when bladder is full or overfull
acute retention
36
bladder does not empty completely during voiding and urine is held in the bladder
chronic retention
37
one of the most common types of healthcare associated infection.
urinary tract infection
38
upper UTI affects?
kidneys
39
Lower UTI affects?
bladder and urethra
40
pyelonephritis
severe upper UTI
41
urosepsis
life-threatening blood infection
42
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
43
transient incontinence
caused by medical conditions
## Footnote
acute confusion
UTI
acute urinary retention
medications, excessive output
mobility issues
depression
44
is transient incontinence treatable or reversible?
yes
45
obstacle or disability makes it hard for you to reach or use a toilet in time to urinate
## Footnote
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
46
can urinate but cannot completely empty the urine from their bladders
## Footnote
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
47
when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure on your bladder, causing you to leak urine.
## Footnote
Urethra can’t stay closed d/t increased intraabdominal pressure, weakened urinary sphincter (childbirth trauma or prostatectomy) or pelvic floor muscles
stress incontinence
48
leakage of small amounts of urine when coughing, laughing, sneezing, exercise, walking, standing up from chair) is due to?
stress incontinence
49
when you have a strong, sudden need to urinate that is difficult to delay.
## Footnote
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
50
occurs when the bladder muscle contracts and urine leaks (often in large amounts) without any warning or urge
## Footnote
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
51
puts you at risk for developing autonomic dysreflexia (life-threatening condition causing elevated blood pressure, heart rate, and diaphoresis)
reflex incontinence
52
are for patients who have either had their bladder removed (cystectomy) for significant bladder dysfunction
urinary diversions
53
the patient must catheterize the pouch 4 to 6 x per day (permanent).
continent urinary reservoir
54
is placed in the same position as the bladder and the patient can void through the urethra using the Valsalva technique. (permanent)
orthotopic neobladder
55
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
56
tubes are inserted into the kidneys at the renal pelvis, through the skin, and urine drains into bags. Temporary.
nephrostomy
57
what are some symptoms of urinary alterations? (4)
urgency
dysuria
frequency
nocturia
58
decreased urine output in relation to fluid intake.
oliguria
59
all pts with indwelling catheters need to have the _______ _______assessed for damage from the catheter or infection (inflammation or discharge).
urinary meatus
60
Pulling on the catheter can cause damage to the ______ ______ or the catheter can even erode through the ______ ______ in severe cases.
urinary meatus
61
how many times a day should you assess the perineal skin?
at least once, more if incontinent
62
can indicate fluid imbalance, kidney dysfunction, or decreased blood volume.
change in urine output volume
63
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
64
what do you immediately need to assess for with urine output of less than 30 mL/hour?
blood loss
65
If a pt has not voided for ____-_____ hours and has had fluid intake, they should be assessed for urinary retention.
3-6 hours
66
dark red could be bleeding from ?
kidney or ureters
67
bright red is from?
bladder or urethra
68
Foul odor indicates what for urine?
UTI
69
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)
70
May require urine collected at certain time of the day or over a specified time period (2, 12, or 24 hrs).
timed urine samples
71
measures the concentration of particles in the urine
specific gravity
72
the higher the specific gravity value, the more _____ it is
concentrated
73
high specific gravity indicates?
dehydration
reduced renal blood flow
increase in ADH
74
low specific gravity can indicate?
overhydration
early renal disease
inadequate ADH secretion
75
indicates trauma or disease Can also be caused from urethral catheters or surgery of lower urinary tract.
RBC elevation
76
may be present with poorly controlled diabetes, dehydration, starvation, or excessive aspirin ingestion.
high ketones
77
indicate renal disease.
casts
78
indicate risk of renal calculi development (kidney stones) or patients with gout may have high uric acid levels
crystals
79
what is the normal speciic gravity range?
1.005 to 1.030
80
are proteins suppose to be in urine?
no, should normally be negative?
81
WBC count in urine normal range?
< 5/hpf
82
RBC normally present in urine?
RBC <5/hpf
83
normal pH range in urine
4.5 to 8
84
ketones should be ?
negative
85
glucose should be?
negative
86
casts and crystals should be ?
negative
87
Abdominal roentgenogram
is an x-ray of the abdomen to visualize the structures of the lower urinary tract.
88
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
89
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
90
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
91
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
92
for a patient with normal heart and renal function with no intake restrictions how much water should they be encouraged to drink?
2300 mL
93
what catheter is this?
straight catheter
94
indwelling retentioin catheter
95
triple lumen catheter
96
_______ _______ is used to measure PVR when ultrasound or bladder scanner is unavailable, or to manage chronic urinary retention.
intermittent catheterization
97
has a single lumen and is used for intermittent catheterization. Usually made of rubber or polyvinyl chloride (PVC).
straight catheter
98
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
99
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
100
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
101
adult women french size?
10-12
102
most adult men french size?
12-14
103
children french size?
8-10
104
french size for infants?
5-6
105
Sometimes larger Fr. is needed, such as when there is __________ a that could develop clots and cause blockage.
hematuria
106
For ___________, change the catheter every 4 to 6 weeks.
long term catheterization
107
If catheter is not draining what should you first check for?
kinks or occlusions in tubing
108
t/f: irrigation increases risk of CAUTI ?
YES IT DOES
109
when should you drain the bag?
when half full or before transferring patient or activity
110
programs should be in place that provide continuing education on catheter care.
Quality improvement programs
111
how long should you monitor time, and amount of each void after catheter removal?
1-2 days
112
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
113
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
114
are used to treat urinary urgency
antimuscarinics
115
Adverse effects are constipation, dry mouth, and blurred vision. (cant see, spit, shit, piss)
antimuscarinics
116
can also treat urgency. Blood pressure needs to monitored for increases.
mirabegron
117
can help treat stress incontinence in postmenopausal women.
vaginal estrogen
118
can treat urinary retention.
bethanechol
119
relax smooth muscles to relax smooth muscle in men with obstruction caused by enlarged prostate.
tamsulosin and silodosin
120
can shrink the prostate.
finasteride and dutasteride
121
may also be prescribed to reduce pain associated with UTI. This medication turns the urine orange.
phenazopyridine
122
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
123
PureWick device
124
what are safety guidelines for catheter and urinary nursing skills?
surgical and medical asepsis
identify latex, iodine allergies
