GU/GI Exam Flashcards

1
Q

What is the average menstrual cycle?

A

24-38 days

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2
Q

What are the types of abnormal uterine bleeding?

A

1) Heavy Menstrual Bleeding
2) Intermenstrual bleeding
3) Chronic Abnormal Uterine Bleeding
4) Acute AUB

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3
Q

What type of abnormal uterine bleeding is a medical emergency?

A

Acute abnormal uterine bleeding

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4
Q

What are the common causes of AUB?

A

1) Uterine fibrosis
2) Polyps
3) Endometriosis
4) Ovulatory dysfunctions
5) Cancer
6) Eating disorders
7) Liver failure

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5
Q

What is primary amenorrhea?

A

Have not started cycle by age 16

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6
Q

What are causes of primary amenorrhea?

A

1) Chromosomal or congenital
2) Female atheletes (esp gymnasts)

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7
Q

What is secondary amenorrhea?

A

When cycle stops for 3-6 months

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8
Q

What are causes of secondary amenorrhea?

A

1) Primary ovarian insufficiency
2) Hypothalamic disorders
3) PCOS
4) Hyperprolactinemia

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9
Q

What is anovulation?

A

Erratic ovulation after menarche (onset of menses) – typically after 1st period

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10
Q

What screenings are diagnostic in AUB?

A

-Pelvic exam
-STD/STI screening

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11
Q

What imaging is diagnostic in AUB?

A

-Transvaginal US
-Endometrial biopsy
-Hysterectomy

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12
Q

What labs are considered in UAB?

A

1) CBC – anemia
2) Pregnancy test
3) TSH – hormone imbalances
4) Hormone levels – those done at PCP

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13
Q

What medications can be given for UAB?

A

1) OCs
2) Tranexamic acid
3) Estradiol valerate/dienogest
4) Mirena IUD

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14
Q

Name the med:
1) Helps stim regular shedding of the endometrium
2) Increases risk for blood clot (monitor for chest pain & SOB)
3) Helps with amenorrhea

A

Oral contraceptives

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15
Q

Name the med:
1) Used to prevent pregnancy & tx heavy bleeding
2) Suppresses ovulation and thickens cervical mucous to prevent sperm from traveling past the cervix
3) Thins uterine wall so it is
less hospitable for implantation
4) Contains estrogen & progesterone
5) Increased risk for blood clots

A

Estradiol valerate/dienogest (combo OCP)

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16
Q

What medication given for abnormal uterine bleeding can only be taken on your period?

A

Tranexamic acid (TXA)

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17
Q

Name the AUB medication?
1) Decreased risk for clotting
2) Implantable device
3) Progestin
4) Can last 5 years for pts who take it for heavy bleeding
5) Increases risk of PID if improper implantation

A

Minera IUD

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18
Q

What physiological effect do OCs have on the uterus?

A

Thins wall and thickens mucus

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19
Q

What are the S&S of toxic shock?

A

1) Fever
2) Vomiting
3) Diarrhea
4) Weakness
5) Aches
6) Rashes

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20
Q

What are the risk factors of PID?

A

1) Unprotected sex w/ multiple or new people
2) < 24 years old
3) Pts that regularly vaginal douche
4) Recent cervical manipulation
5) Previous hx of PID

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21
Q

Name the problem:
1) D/t untreated STI, sex with multiple partners, infection after terminating pregnancy, pelvic surgeries, and child birth
2) Results in thick white discharge, may go unnoticed d/t mild cold/flu-like sx

A

PID

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22
Q

What parts of the body are infected in PID?

A

1) Fallopian tubes
2) Ovaries
3) Pelvic peritoneum

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23
Q

What are the S&S of PID?

A

1) Lower back, abdominal, or pelvic pain
2) Heavy vaginal discharge w/ foul odor
3) Painful sex
4) Vomiting or diarrhea
5) Dysuria
6) Spotting w/ sex

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24
Q

What are comps assoc w/ PID?

A

1) Septic shock
2) Peri-hepatitis
3) Tubo-ovarian abscess
4) Peritonitis
5) Embolism
6) Adhesions/strictures in fallopian tubes

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25
Q

Name the comp of PID:
When the infection goes back into the system & crosses into the bloodstream (quick decompensation of the body)

A

Septic shock

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26
Q

Name the comp of PID:
Inflammation of serous lining of the liver & will RUQ pain

A

Peri-hepatitis

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27
Q

Name the comp of PID:
Develop in abdomen & are a problem because when they burst, they leak bacteria into the peritoneum and can lead to peritonitis

A

Tubo-ovarian abscess

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28
Q

Name the comp of PID:
Abdominal pain, may have rigid/hard abdomen

A

Peritonitis

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29
Q

Name the comp of PID:
Pelvic inflammation will trigger an inflammatory response which triggers thrombus formation

A

Embolism

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30
Q

Name the comp of PID:
D/t inflammation causing scarring (lumen size changes, and ovum when it gets released cannot get past tubes when fertilized)

A

Adhesions and strictures in fallopian tubes

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31
Q

What diagnostic testing is done for PID?

A

-Labs
-EST
-CBC
Pregnancy & urine tests
-Transvaginal US
-Endometrial biopsy or laparoscopy

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32
Q

What does a transvaginal US show?

A

How far the PID infection has traveled

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33
Q

What does ESR measure in PID?

A

Level of inflammation

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34
Q

What STIs need to be checked for in PID?

A

BV, G/C

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35
Q

What do corticosteroids do to help PID?

A

Reduce inflammation in the fallopian tubes

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36
Q

Name the problem:
Descent of 1 or more aspects of uterus and vagina

Bladder and rectum can herniate into vaginal space

A

Uterine & Pelvic Organ Prolapse

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37
Q

What are RFs of Uterine & Pelvic Prolapse?

A

1) Childbirth (esp vaginal) or multiple
2) Obesity – weakens pelvic floor muscle
3) Coughing/straining
4) Decreased estrogen
5) Chronic constipation
6) CT disorders

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38
Q

What are the sx of organ and uterine prolapse?

A

1) Dyspareunia
2) Backache
3) Incontinence

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39
Q

What is dyspareunia?

A

Painful sex (may c/o dragging or heavy feeling “like something is coming down inside of them”)

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40
Q

What are the 4 degrees of descent in uterine and pelvic organ prolapse?

A

1) Cervix into vagina
2) Cervix into introitus (external opening of vaginal canal)
3) Cervix outside of introitus (peeking at vaginal opening)
4) Uterus outside of introitus (see donut)

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41
Q

What are the 3 types of pelvic organ prolapse?

A

1) Cystocele
2) Uterine
3) Rectocele

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42
Q

Name the type of pelvic organ prolapse:
Portion of pelvic floor between bladder and vaginal canal that starts to weaken and the bladder prolapses into the vaginal canal

A

Cystocele

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43
Q

Name the type of pelvic organ prolapse:
Downward displacement of the uterus into the vaginal canal

A

Uterine

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44
Q

Name the type of pelvic organ prolapse:
Wall between rectum and vaginal canal weakens and rectum becomes lazy and prolapses into the vaginal canal

A

Rectocele

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45
Q

What are the tx of uterine and pelvic organ prolapse?

A

1) Kegels (stages 1 or 2)
2) Pessary
3) Surgery (stages 3 or 4)

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46
Q

How frequently do kegels need to be done?

A

10-20x/hr or 50-60/day
*** Consistency = key!!! (can take 4-6 weeks before starting to see results)
-Do in short & long intervals

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47
Q

What surgeries can be done to tx uterine and pelvic organ prolapse?

A

1) Vaginal hysterectomy (repair of vaginal wall)
2) Colporrhaphy

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48
Q

What do you need to educate a pt on how to use a pessary & what the risks are?

A

1) Inserted during day to keep exposed portion in body
2) Remove at night

Risk = infection or injury from scraping of vaginal line

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49
Q

What are the sx of BPH?

A

1) Difficulty starting stream
2) Weaker flow of urine
3) Urinary frequency

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50
Q

What are the hormonal changes that contribute to BPH?

A

1) Decreased testosterone
2) DHT increases prostate growth

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51
Q

What structure does an enlarged prostate compress?

A

Proximal urethra

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52
Q

What are the RFs of BPH?

A

1) Age
2) Obesity/sedentary
3) 1 degree relative
4) High protein diet – lots of red meat
5) Alcohol/smoking
6) DM
7) ED

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53
Q

Name the kind of sx of BPH:
-Nocturia
-Urinary frequency
-Incontinence
-Dysuria

A

Irritative sx

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54
Q

What is the most common reason people seek tx for BPH?

A

Nocturia

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55
Q

Name the kind of sx of BPH:
Can’t get urine out d/t narrowing of lumen, decreased urinary force, difficulty starting stream, dribbling, intermittency

A

Obstructive

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56
Q

What are comps of BPH?

A

1) Acute urinary retention (MED EMERGENCY)**
2) UTI (pyelonephritis or sepsis)
3) Bladder stones
4) Hydronephrosis (leads to renal failure)

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57
Q

How do you check for the med emergency of BPH, acute urinary retention?

A

-Bladder scan, cath, and post-void residual

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58
Q

True or false:
Pts who have surgery for BPH are more likely to need another surgery

A

True

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59
Q

What med is important to ask about during assessment of BPH?

A

Testosterone supplements (pts who had prostate cancer may still be on this)

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60
Q

WHat objective assessments need to be done for BPH?

A

-Age
-Abdominal assessment
-DRE

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61
Q

What does a DRE do?

A

Feels rectal sphinctor tone & prostate

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62
Q

What are the dx studies for BPH?

A

1) UA, Urine C/S
2) Prostate-Specific Antigen (PSA)
3) Serum creatinine
4) Transrectual US (TRUS)
5) Pelvic MRI
6) Prostate biopsy
7) Uroflowmetry
8) Cytoscopy

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63
Q

True or false:
PSA levels will be decreased in those with BPH

A

False- PSA levels will be elevated (doesn’t always mean cancer tho)

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64
Q

What dx study checks the prostate for BPH?

A

TRUS

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65
Q

What dx study measures how much urine is expelled from the bladder for BPH?

A

Uroflowmetry

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66
Q

What are the conservative tx for BPH?

A

1) Active surveilance
2) Drug therapy

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67
Q

What do you need to avoid if you have BPH?

A

1) Caffeine, alcohol, carbonated bevs
2) Spicy foods
3) Artificial sweeteners
4) Anticholinergics
5) Decongestants

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68
Q

What does active surveilance of BPH consist of?

A

Lifestyle changes and toileting schedule

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69
Q

What is the best drug therapy for BPH?

A

Combo therapy of 5 alpha reductase inhibitors & alpha adrenergic receptor blockers

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70
Q

What do 5 alpha reductase inhibitors do in BPH?

A

Reduce prostate size (block DHT)

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71
Q

What do alpha adrenergic receptor blockers do for BPH?

A

Relax muscles so they can urinate, but won’t grow more

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72
Q

What are the SEs of alpha adrenergic receptor blocker?

A

Dry orgasms, retrograde ejaculation

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73
Q

What are Ses of 5ARIs?

A

Decreased libidio

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74
Q

What people do you need to caution when administering 5ARIs?

A

Pregnant women – wear GLOVES when administering

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75
Q

What 5ARIs are used to tx BPH?

A

1) Finasteride
2) Dutasteride (combo of 5ARI & AARB)

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76
Q

What are the AARBs used to tx BPH?

A

1) Alfuzosin
2) Doxazosin
3) Prazosin
4) Tamsulosin (Flomax)
5) Silodosin

77
Q

What level of sx of BPH are 5ARIs used to tx?

A

Moderate to severe sx

78
Q

How long may it take to see improvement of BPH from Finasteride?

A

up to 6 months

79
Q

What level of BPH sx do AARBs tx?

A

Mild to moderate – pts receive relief of obstructive sx quicker

80
Q

What are the erectogenic drugs used to tx BPH?

A

1) Tadalafil
2) Sildenafil (Viagra)***

81
Q

Name the minimally invasive surgery for BPH:
-Laser tx that vaporizes prostate tissue
-Should have immediate relief
-Minimal bleeding, quicker recovery
-Can have slopping (skin sheds off), may have irriation for several weeks, retrograde ejaculation, may need catheter for up to 7 days post-op
-Minimally invasive so less comps post-op

A

Photo-selective Vaporization of the Prostate (PVP)

82
Q

Name the minimally invasive surgery for BPH:
-Take a laser & shoot beam at prostate to interefere with nucleus being able to produce things out & decrease enlargement
-SEs = retrograde ejaculation & irritation

A

Laser Enucleation of the Prostate

83
Q

Name the minimally invasive surgery for BPH:
-Put clamps that push back prostate so urethra is open & they can re-establish urine flow
-May have to repeat if it collapses & faila
-Outpatient, minimally invasive, minimal SEs, less chance of bleeding/ED/incontinence/retrograde ejaculation

A

Prostatic Urethral Lift (PUL)

84
Q

Name the minimally invasive surgery for BPH:
-Heat prostrate
-Cause necrosis — kills off cells
-Delivers a micorwave to tissue to heat prostate & destroy it
-Monitor temp (rectal)
-Cath needed 24-48 hrs post-op, retrograde ejaculation (go home w/ indwelling cath)
-Minimal bleeding, minimal chance of ED, minimal chance of retrograde ejaculation

A

Transurethral Microwave Thermotherapy

85
Q

Name the minimally invasive surgery for BPH:
-Increases temp of tissue and causes necrosis
-Outpatient, sedation
-Need cath afterwards & most common sx after = urinary retention
-Once cath is removed — they may have urinary retention again (good education for when to seek tx!!)

A

Transurethral Needle Ablation (TUNA)

86
Q

Name the minimally invasive surgery for BPH:
-“button TURP”
-Electrosurgical modification of TURP (less invasive than TURP)
-Destroy prostate tissue
-Minimal bleeding
-SEs = intermittent hematuria, retrograde ejaculation, irritative sx of BPH may return

A

Transurethral Vaporization of the Prostate

87
Q

Name the minimally invasive surgery for BPH:
-Heated water to destroy obstructive tissue
-Small prostates
-Catheter for procedure
-Minimal bleeding, still have chance of intermittent hematuria & retrograde ejaculation
-May need cath for a couple days after

A

Water Vapor Thermal Therapy

88
Q

What are the indications for invasive surgery for BPH?

A

-Decreased urination (severe)
-Discomfort r/t this
-Persitent residual urine
-May have suffered for numerous bouts of acute urinary retention
-May have hypdronephrosis

89
Q

What determines which procedure should be done for BPH?

A

Age and degree of prostate size determine which procedure to do

90
Q

Name the type of invasive BPH surgery:
1) Several surgical incisions into the prostate to expand urethra, completed under local anesthesia
2) Relieves pressure on urethra and improves urine flow
3) Outpt, minimal comps, low ED occurrence, cath may be needed
4) Good for those with small or moderately large prostate glands

A

Transurethral Incision of the Prostate (TUIP)

91
Q

Name the type of invasive BPH surgery:
1) Surgical removal of prostate tissue
2) Resectoscope via urethra
3) 3-way indwelling catheter with 30 ml balloon after procedure for irrigation afterward (if not irrigated for long enough — may develop clots that are difficult to void & may cause repeat urinary retention)

A

Transurethral Resection of the Prostate (TURP)

92
Q

What is the gold standard tx for BPH?

A

Transurethral Resection of the Prostate (TURP)

93
Q

What education needs to be given pre-op for BPH?

A

1) Possibility of sexual dysfunction (retograde or decreased ejaculation, decreased orgasms)
2) When trying to restore urinary drainage, increase fluid intake to 1-2 L/day
3) May have foley for a few days post-op

94
Q

How long after catheter removal post-op of BPH surgery is normal for small clots to be in the urine?

95
Q

How long into post-op of BPH surgery is the 3-way cath removed?

A

2-4 days typically

96
Q

Name the type of nursing management for BPH:
-Using sterile technique & saline to instil 50 mL and withdraw

**Pt may have bladder spasms

A

Manual irrigation

97
Q

Name type of nursing management of BPH:
1) Continuous inflow of sterile solution
2) Watch for color to lighten to light pink
3) Ensure catheter patency
4) Maintain asepsis

A

Continuous Bladder Irrigation

98
Q

How much fluid should a post-op pt for BPH be having/how often should they bet voiding?

A

2-3 L/day intake & voiding every 2-3 hrs

99
Q

What causes ED in a younger male?

A

Stress, drugs, increased anxiety

100
Q

What causes ED in older men?

A

Comorbidities – DM, HTN, multiple drug therapy

101
Q

What are the contributing factors to ED?

A

1) DM
2) Vascular disease
3) Previous surgery
4) Trauma
5) Chronic illness
6) Stress
7) Age-related changes

102
Q

What dx studies are done for ED?

A

1) DRE
2) BP
3) Perfusion check
4) HA1C
5) Hormone labs (testosterone, prolactin, LH, thyroid)
6) PSA
7) CBC
8) Nocturnal penile tumescence & rigidity
9) Vascular studies

103
Q

What erectogenic meds are given to tx ED?

A

1) Avafil
2) Sildenafil (Viagra)
3) Tadalafil
4) Vardenafil

104
Q

What do PDE5 (erectogenic) drugs do pathophysiologically for ED?

A

Dilate vessel & relax smooth muscle (NOT SPECIFIC TO PENIS)

105
Q

What are the SEs of erectogenic drugs (PDE5 inhibitors)?

A

1) HA
2) Skin flushing
3) Visual problems
4) Erection > 4hrs

106
Q

Name the ED device:
Pulls blood into corporeal bodies (testicles)

A

Vacuum Erection Devices

107
Q

Name the ED device:
Meds injected or inserted

A

Intraurethral devices

108
Q

Name the ED device:
-Surgical procedure
-Inflatable devices implanted into corporeal bodies

A

Penile implants

109
Q

What is the path of urine?

A

Kidney –> ureter –> bladder –> urethra

110
Q

What make up the upper urinary system?

A

2 kidneys & 2 ureters

111
Q

What make up the lower urinary system?

A

-Bladder
-Urethra
-Pelvic muslces
Ureterovesical unit

112
Q

How is urine formed?

A

Glomerular filtration –> renal tubular absorption & secretion –> water conservation

113
Q

What is the capacity of the bladder?

A

600-1000 mLs

114
Q

What volume does the urge to void come at?

A

200-250 mLs

115
Q

What volume of urine is discomfort felt at?

A

400-600 mLs

116
Q

Name the organ:
Detrusor muscle distends into abdomen with filling

116
Q

What is the mucosal lining same throughout bladder, ureters, renal pelvis, and bladder neck — prevents reabsorption of urine or waste in urine

A

Urothelium

117
Q

What are the functions of the urethra?

A

1) Urine excretion
2) Control voiding (voluntary)

118
Q

What area helps detect when the bladder is stretched?

A

Sacral area (S2-S4)

119
Q

Where are the impulses to void located?

A

Thoracic & lumbar (T11-L2)

120
Q

What are the secondary physiologic functions of the kidneys?

A

1) Control BP
2) Erythropoietin
3) Electrolyte balance
4) Regulate acid-base balance
5) Activate Vitamin D needed for Ca++ absorption

121
Q

What percent of CO goes through kidneys?

122
Q

What are the primary functions of the kidneys?

A

1) Excrete waste
2) Regulate volume & ECF composition

123
Q

What is the process of micturition?

A

Detrussor muscle contracts –> internal urethral sphincter relaxes –> pelvic floor muscles relax –> voiding –> external urethral sphincter closes

124
Q

What alters the specific gravity of urine?

A

Hydration, illness, kidney function

125
Q

What does a SGOU of > 0.030 mean and for who?

A

***More concentrated
Pts with UTI, dehydration, or DKS

126
Q

What does a SGOU of < 1.01 mean and for who?

A

***Less concentrated, clear/pale
Pts w/ Diabetes insipidus or those on diuretics for HF

127
Q

True or False:
The bladder should NOT be palpable unless distended

128
Q

Why is protein found in a UA concerning r/t UTIs?

A

-Sign or rhabdomyolysis
-Sign of dehydration
-Sign of acute kidney injury

129
Q

Name the type of urine sample:
doesn’t require prep, just first collection of urine in AM — may not be clean

A

Random urine sample

130
Q

Name the type of urine sample:
te some, then collect midstream, then finish urinate

A

Clean catch

131
Q

Name the type of urine sample:
needs to be cool, assess creatinine clearance, void & discard & then save all the rest of the urine of the day (don’t want bacteria to grow)

A

24 urine collection

132
Q

Which imaging requires dye for a UTI?

133
Q

If getting a CT scan for a UTI, what should the nurse assess for first?

A

Allergies to iodine or shellfish

134
Q

Name the type of dx imaging for a UTI:
Conscious sedation vs. general anesthesia

Consent required (more invasive )

Visualization of interior of bladder

IV fluids with general anesthesia

136
Q

What pt education for a cytoscopy?

A

1) Expect some pink tinged urine for a while
2) May feel more urinary frequncy/burning with urination d/t probe insertion
3) Should not be copious amts of bright red bleeding, S&S of ortho hypoTN
4) Pain can be releived with mild analgesics (tylenol, sitx bath or warm pads)

137
Q

Name the UTI dx imaging:
1) Contrast is instilled into bladder
2) Pt teaching (same as cystoscopy)
3) Pt may need to be pre-treated w/ fluids (esp if they have low GFR) to flush out dye

138
Q

Name the UTI dx imaging:
1) X-ray of urinary tract after IV injection of contrast media.
2) Assess for allergies to iodine or shellfish (contrast)
3) Structural evaluation
4) Show if pt has decreased renal function — will also have trouble getting dye out (pre & post treat with saline)

A

IV pyelogram

139
Q

What’s the most important thing to assess for in someone having a voiding cystourethrogram (VCUG)?

A

DYE ALLERGY

140
Q

Name the UTI dx testing:
Bladder filled with contrast media
X-ray done
Patient void
Repeat X-ray to evaluate residual urine

141
Q

What antbx can be given for a UTI?

A

1) TMP/SMX (trimethoprim/sulfamethoxazole; Bactrim)
2) Cephaloxin
3) Nitrofurantoin
4)Ciprofloxacin
5) Metronidazole
6) Levofloxacin

142
Q

What antifungals can be given for a UTI?

A

Fluconazole

143
Q

What analgesics can be given for a UTI?

A

Phenazopyridine

144
Q

Why are anticholinergics given to someone for a UTI?

A

Helps with spasming

145
Q

What anticholinergic is given for a UTI?

146
Q

What are the body’s natural defenses to prevent UTIs?

A

1) acidic pH
2) Downward peristalic movement
3) Complete bladder emptying
4) Highly concentrated urea

147
Q

What are the general lower UTI sx?

A

1) Pain
2) Discomfort
3) Hesitancy
4) Frequency or incontinence
5) Strong Smell
6) Burning w/ urination (may not have this)
7) Suprapubic pain

**DM pts may have higher BG/change in color

148
Q

What are the lower UTIs?

A

1) Urethritis
2) Cystitis

149
Q

What is the upper UTI?

A

Pyelonephritis

150
Q

What does it mean if you have an uncomplicated UTI?

A

Only involves bladder

151
Q

What does it mean if you have a complicated UTI?

A

Structural or functional problems (DM, kidney stones, caths, obstructions)

152
Q

What is cystitis inflammation of?

153
Q

What are sx of a lower UTI?

A

1) Dysuria
2) Frequency
3) Discomfort/pressure
4) Hematuria
5) Cloudy urine

154
Q

What are sx of an upper UTI?

A

1) Fever/chills
2) Flank pain
3) Fatigue, anorexia

155
Q

What are geriatric sx of UTIs?

A

1) Non-localized abdominal discomfort
2) Afebril (get good rectal temp)
3) Altered mental status
4) Clinical deterioration

156
Q

What can cause urethritis?

A

STIs (trich, g/c), monilial infection (yeast)

157
Q

What causes cystitis?

A

1) E. coli (bad hygiene wiping)
2) Candida albicans
3) Fungal (not common)
AKA “UTI”

158
Q

What is the 2nd most common infection in women?

159
Q

Name the type of pyelonephritis:
-Inflammation of kidneys
-Bacteria migrated up ureters to kidneys

160
Q

Name the type of pyelonephritis:
-Typically d/t structural abnormalities/recurrent infection/didn’t finish antbx tx

161
Q

What are complications of chronic pyelonephritis?

A

1) Fibrosis (scarring)
2) Kidney atrophy
3) Alteration in renal filtration

162
Q

What confirms pyelonephritis?

163
Q

What dx study checks the loss of function d/t pyelonephritis?

A

Renal biopsy

164
Q

What are S&S of pyelonephritis?

A

1) Fever/chills
2) N/V, malaise
3) Flank pain
4) WBCs in urine
5) Hematuria

165
Q

How do you tx urosepsis (progression of pyelonephritis)?

A

-IV antbx
-Wt-based fluids
-Monitor for septic shock

166
Q

True or False:
Pts do not get reimbursed for HA-CAUTIs

167
Q

What are comps of indwelling caths?

A

1) Bladder spasms
2) Periurethral abscesses
3) Chronic pyelonephritis
4) Urosepsis
5) Trauma
6) Fistula/stricture formation

168
Q

What are the dx tests of UTI?

A

1) H&P
2) UA (&c/s)
3) Clean catch urine sample
4) urine dipstick

169
Q

Name the type of incontinence:
Not r/t pathology or problem in urinary system — may be physicla or cognitive impairment — Alzheimers, head injury, immobility

A

Functional

170
Q

Name the type of incontinence:
Frequent dribbling over urine d/t incomplete/ineffective emptying of bladder
-Spinal cord injury, DM, enlarged prostate

171
Q

Name the type of incontinence:
R/t fact that pt urinates during activity (pregnancy, multiple childbirths, menopause, or surgical trauma)

172
Q

Name the type of incontinence:
Sudden need to urinate w/ large volume loss of urine (even though bladder is not full) — prgnancy, tauma, childbirth, neuro disorder (Parkinsons)

173
Q

Name the type of incontinence:
when bladder is spastic (fills with urine & involuntary reflex will cause it contract while bladder is trying to empty — spinal cord injury (around T12) — can cath, can use non-invasive urine collection devices

174
Q

What are the NIs for functional incontinence?

A

1) Thorough skin assessment
2) Consider consulting specialty services (e.g., wound RN)
3) Evaluate mobility and accessibility
4) Be aware of patient safety!
5) Assistance with hygiene

175
Q

What are the NIs of Overflow incontinence?

A

1)Consider intermittent catheterization
2) If prolapsed uterus is cause; consider pessary to support

176
Q

What are the NIs of Stress incontinence?

A

1) Consider pelvic floor exercises
2) Cessation of smoking
3) Estrogen replacement
4) Weight loss (if obese)

177
Q

What are the NIs of urge incontinence?

A

1) Treat underlying causes
2) Meds (may lead to retention)
3) Pelvic floor exercises
4) Absorbent products (poise or depends)

178
Q

What type of meds are given for UTIs?

A

1) Anticholinergics
2) Muscarinic Receptor Blockers
3) Botox

178
Q

What type of incontinence can be tx with injection of bulking agents?

179
Q

What do anticholinergics do for UTIs?

A

help reduce bladder contractions/spasms so bladder can fill more before voiding

180
Q

What do muscarinic receptor blockers do for UTIs?

A

help relax bladder muscle so pt can void

181
Q

What does botox do for UTIs?

A

helps reduce bladder contrx so bladder can fill to capacity — SE = urinary retention (freezes/hardens muscle so it does not contract quickly)

182
Q

Name the problem:
-immediately happens (MED EMERGENCY)
-If they start to feel pain or like bladder is going to explode — seek tx ASAP
-Usually deficient detrussor muscle that is not contracting properly or enlarged prostate

A

Acute urinary retention

183
Q

Name the problem:
d/t something else going on that is preventing them from completely emptying their bladder — enlarged prostate/obstruction, alcoholism, trauma

A

Chronic urinary retention

184
Q

What is the dx study for urinary retention?

A

Post-void residual

185
Q

What is a normal post-void residual?

A

50-75 mLs remaining

186
Q

True or False:
In acute urinary retention, you perform a post-void residual 2x

A

False- only 1x

187
Q

What post-void residual result requires further evaluation?

A

> 200 mL on 2 separate occasions