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MS_Primers for Exam 3 Content > GU Disorders Primer > Flashcards

GU Disorders Primer Flashcards

1
Q

Most common bacterial disease in women is…

A

• E. coli

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2
Q

What is Pyelonephritis?

A
  • Upper UTI
  • Inflammation of the upper tract involving renal parenchyma and collecting system
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3
Q

What are the types of lower UTIs?

A
  • Cystitis (bladder)
  • Urethritis (urethra)
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4
Q

What is Urosepsis?

A

• UTI spread to systemic circulation (requiring emergency treatment)

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5
Q

What are complicated UTIs?

A

• UTIs with pre-existing conditions such as: obstruction, stones, urinary catheter ,existing diabetes, neurologic conditions, pregnancy or recurrent infection

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6
Q

Normal physiological defenses against UTI include:

A
  • Normal voiding with complete emptying of bladder
  • Peristaltic activity that propels urine towards the bladder
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7
Q

Normal urine pH is…

A

• < 6

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8
Q

What is the number one cause of nosocomial UTIs?

A

• Catheterization

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9
Q

What are some common factors of UTI for women?

A
  • Post menopause causes a rise of vaginal pH allowing an environment for bacterial growth
  • Sex can lead to minor urethral trauma in women
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10
Q

How may women combat the post menopause rise in vaginal pH?

A

• Low dosage intra-vaginal estrogen, which will help lower the pH

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11
Q

Catheter infection can lead to comications such as

A
  • renal abscess
  • arthritis
  • epididymitus
  • periurethral gland infections
  • bacturemia
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12
Q

What are some preventative measures that can be taken against UTI?

A
  • Emptying bladder regularly & completely
  • Evacuating bowels regularly
  • Wiping perineal area from front to back
  • Stay hydrated
  • Daily intake of cranberry juice
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13
Q

What are some general s/s of UTI?

A
  • Dysuria
  • Hesitancy
  • Urinary retention, freq, urgency
  • Nocturnal emisis
  • Nocturia
  • Incontinence
  • Fatigue and anorexia
  • Hematuria/ Sediments in urine
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14
Q

What are some causes of atonic bladder that leads to urinary retention?

A
  • Surgery
  • Spinal problems
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15
Q

What are the specific s/s of pyelonephritis?

A
  • Suprapubic discomfort/pressure
  • Flank pain
  • Chills
  • Fever
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16
Q

What are some clinical manifestations of UTI for older adults?

A
  • Non localized abdominal discomfort
  • Cognitive impairment
  • Generalized clinical deterioration
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17
Q

True or False
Fever is unreliable as they are less likely to present with fever

A
  • Urine Analysis
  • Urine Culture & Sensitivity
  • Clean-catch Urine
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18
Q

What results of a dipstick urinalysis indicate UTI?

A
  • Positive Nitrites,
  • Positive WBCs,
  • Positive Leukocyte Esterase
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19
Q

What is the purpose of the Urine Culture & Sensitivity?

A
  • Identify organism
  • Determine bacteria’s susceptibility to antibiotics
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20
Q

Explain the process of a clean-catch urine sample.

A
  • Women: Wipe periurethral area from front to back w/ clean gauze
  • Men: Wipe glans penis around the urethra
  • Collect specimen 1-2 seconds after voiding begins
  • Refrigerate urine immediately on collection
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21
Q

What are the nursing assessment items for UTIs?

A
  • Nutrition and fluid intake
  • Previous UTIs
  • Pain
  • GI problems
  • Elimination pattern
  • Urine appearance – smell, color, amount
  • Diagnostic findings
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22
Q

What are some hospital UTI prevention measures?

A
  • Hand washing between patients,
  • Aseptic technique
  • Early removal of indwelling catheters
  • Routine & thorough perineal hygiene
  • Offer bedpan or urinal to bedridden patients at frequent intervals
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23
Q

What are some ambulatory/homecare UTI prevention measures?

A
  • Compliance with drug regimen
  • Adequate daily fluid intake
  • Regular voiding
  • Appropriate hygiene
  • Urinating before & after intercourse
  • Temporarily discontinuing diaphragm use
  • Relapse need further evaluation
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24
Q

Where does pyelonephritis generally begin?

A

• In the lower GU tract as a lower UTI

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25
Q

What are some usual pre-existing conditions to pyelonephritis?

A
  • Pregnancy
  • Renal calculi
  • Urinary catheterization
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26
Q

Why is an obstruction at the lower neck of the bladder of concern?

A
  • It will cause retention of urine with high residual urine.
  • The increasing pressure can led to backflow and as a consequence chronic pyelonephritis and renal atrophy.
  • Correction is required
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27
Q

What are the chemicals that contribute to urinary calculi formation?

A
  • Calcium
  • Oxaluric acid
  • Uric acid
  • Citric acid
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28
Q

What diet component can increase uric acid excretion?

A

• Protein

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29
Q

What type of food will increase oxaluric acid?

A

• Tea and fruit juices

30
Q

What environmental situations may contribute to development of urinary calculi formation?

A
  • Warm climate & dehydration
  • Sedentary lifestyle
  • Genetics (gout, renal acidosis)
31
Q

Lower urine pH will produce what type of stones?

A

• Uric acid & cystine stones

32
Q

Higher urine pH will produce what type of stones?

A

• Calcium & phosphate stones

33
Q

What is the patho for struvite stones?

A

• Urinary obstruction/UTIs cause higher pH thus produce struvite stones

34
Q

Where can urinary stones develop?

A

• in the bladder, kidneys, ureters or urethra

35
Q

What are some clinical manifestations of bladder stones?

A
  • Abdominal pain
  • Dull costovertebral flank pain
  • Hematuria
  • Renal Colic from increase ureteral peristalsis
  • Nausea/Vomiting
  • Mild shock
  • Groin pain
36
Q

What dx studies are done for bladder stones?

A
  • Urine studies
  • CT
  • IVP
  • Retrograde pyelogram
  • Ultrasound
  • Cystoscopy
37
Q

True or False
We should avoid an IVP with renal failure pts.

A

• True

38
Q

What labs are we looking at for development of bladder stones?

A
  • Ca
  • PO
  • Na
  • K
  • HCO3
  • Uric acid
  • BUN
  • Creatinine
  • Urine pH
39
Q

What is the general collaborative care for stones?

A
  • Manage pain
  • Treat infection
  • Treat obstruction
40
Q

Many stones pass spontaneously, however, stones > __mm cannot pass through the ureter.

A

• 4mm

41
Q

What are the main indications for surgical removal of stones?

A
  • Stones too large for spontaneous passage
  • Stones associated w/ bacteriuria or symptomatic infection
  • Stones causing impaired renal function
  • Stones causing persistent pain, nausea, ileus
  • Inability of patient to be treated medically
  • Patient with one kidney
42
Q

What are two common surgical procedures used for removal of urinary stones?

A

• Laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL)

43
Q

What are some possible complications of lithotripsy procedures?

A
  • Hematuria
  • Retained stone fragments
  • Infection
44
Q

What is the dietary guidance regarding sodium for pts with urinary caliculi?

A

• Keep it low, don’t add to sodium amounts

45
Q

What is the dietary guidance regarding calcium for pts with urinary caliculi?

A
  • Reduce dietary intake of calcium
  • Take thiazide diuretics to reduce calcium serum levels
  • Take potassium citrate to maintain alkaline (high pH) urine
46
Q

What common electrolyte do Thiazide diuretics and potassium citrate help reduce?

A

• Sodium

47
Q

Why would a pt that a predisposing factor for stones (gout) take potassium citrate?

A

• Because it increases urine pH

48
Q

Why do we want to limit dietary purines for pts w/ urinary caliculi?

A

• Because purines break down into uric acid

49
Q

What types of food are high in Purine?

A

• Sardines, mussels, liver, sweetbreads, goose, venison, meat soups

50
Q

What types of food are high in Calcium?

A

• Dairy, beans (except green), fish w/ bones, dried fruits, nuts, chocolate, ovaltine

51
Q

What types of food are high in Oxalate?

A

• Darke roughage, spinach, cabbage, asparagus, beets, celery, chocolate

52
Q

What is Urinary Incontinence (UI)?

A

• Uncontrolled leakage of urine

53
Q

Why is there a higher prevalence of stress and urge incontinence w/ older women?

A

• Pregnancy

54
Q

True or False
Urinary incontinence is not a natural consequence of aging.

A

• True

55
Q

What are some causes of urinary incontinence?

A
  • Confusion
  • Depression
  • Infection
  • Atrophic Vaginitis
  • Urinary Retention
  • Restricted Mobility
  • Fecal Impaction
  • Drugs/alcohol
56
Q

What drugs may cause incontinence and how may it manifest?

A
  • Loop diuretics, calcium channel blockers, ACE inhibitors
  • Cough triggering stress urinary incontinence
57
Q

What is overflow incontinence?

A
  • Overflow incontinence occurs when you are unable to completely empty your bladder
  • This leads to overflow, which leaks out unexpectedly
  • You may or may not sense that your bladder is full
58
Q

What is stress incontinence?

A

• This happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine.

59
Q

True or False
Stress incontinence is not related to psychological stress

A

• True

60
Q

What is Urge incontinence?

A
  • Urge incontinence occurs when you have a strong, sudden need to urinate that is difficult to delay.
  • The bladder then squeezes, or spasms, and you lose urine.
61
Q

What is Functional incontinence?

A

• Occurs when an individual with normal bladder and urethral function has difficulty getting to the toilet before urination occurs

62
Q

Those with impaired mobility or mental confusion may have what type of incontinence?

A

• Functional

63
Q

What are some dx studies/methods used for incontinence?

A
  • H&P
  • Bladder log or voiding record
  • Incontinence tests
  • Pelvic exam of perineal skin
64
Q

In our care of pts w/ urinary incontinence, we maintain a patient’s…

A
  • Dignity
  • Privacy
  • Feelings of self-worth
65
Q

What are two types of bladder irritants that should be avoided for pts with incontinence?

A
  • Alcohol
  • Caffeine
66
Q

What are some methods for helping pt’s overcome incontinence?

A
  • Scheduled voiding regimens and bladder training
  • Pelvic floor muscle training
67
Q

Acute urinary retention is a…

A

• Medical emergency

68
Q

What is urinary retention?

A

• Incomplete bladder emptying despite urination or accumulation of urine in the bladder b/c cannot urinate

69
Q

Besides bladder outlet obstruction, enlarged prostate, or deficient detrusor contraction strength, what are some other factors that cause urinary retention?

A
  • Neurological Diseases
  • Diabetes Mellitus
  • Over-distention
  • Chronic Alcoholism
  • Anticholinergic Drugs
70
Q

What methods of dx are used for urinary retention?

A
  • H&P
  • Ultrasound
  • Volume study: Urinate, followed by catheterization 10-20 mins later
71
Q

Urinary retention can trigger what condition for spinal injury patients?

A

• Autonomic dysreflexia

72
Q

What is autonomic dysreflexia?

A
  • An abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation.
  • This reaction may include:
    • Change in heart rate
    • Excessive sweating
    • High blood pressure
    • Muscle spasms
    • Skin color changes (paleness, redness, blue-gray skin color)

MS_Primers for Exam 3 Content (13 decks)

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