GU Obstruction Flashcards
What is a urinary obstruction?
obstruction of the flow of urine within the urinary tract
can occur at any level of the tract and at any age
Conditions that Cause Urinary Tract Obstructions?
- anatomical
- functional (not functioning properly)
Sites of obstruction?
upper urinary tract (unilateral)
bilateral vs unilateral
Unilateral - the most common causes are calculi and neuromuscular malfunction at the junction of the renal pelvis and ureter.
Bilateral - usually with lesions in the bladder base or retroperitoneal tissues.
Classification of Obstructions - Degree?
partial obstruction (enlarged prostate) complete obstruction (kidney stone)
Acute obstruction= what type of onset?
sudden
chronic obstruction=what type of onset?
slow
Outcome of Chronic Urinary Tract Obstruction?
Atrophy of renal tissue and kidney failure if both sides affected for a longer period of time.
determined by the degree and duration of urinary tract infection
what is hydrpnephrosis?
complication of UTI
Progressive dilation of renal collecting ducts and renal tubular structures.
buildup of urine causing swelling of the kidney
Clinical manifestations of Acute Upper Tract Obstruction?
Flank pain
Nausea and vomiting are common with acute obstruction.
Anuria suggests bilateral complete obstruction.
Clinical manifestations of Chronic Lower Tract Obstruction?
Urinary hesitancy.
Narrow and weak urine stream.
Dribbling at end of micturition.
Feeling of incompletely emptied bladder.
Renal calculi- complication of UTI
- solid mass of crystal (kidney stone)
- Polycrystalline aggregates composed of minerals the kidney normally excretes in urine
most common in early-middle adulthood (20-55)
more common in men than women with the exception of one type of stone associated with UTI which is more common in women
50% recurrence rate
more common in summer than winter
Etiology of Stone Formation?
-Complex process involving multiple factors that leads to stone formation and the type of stone formed.
Stones more common in?
ppl with gout/ increases uric acid increased protein intake drinking a lot of tea and fruit juice low fluid consumption genetic factors (Hx of stones/gout) warmer climate/season sedentary lifestyle recurrent UTI
Pathophysiology of Stone Formation?
- sediments from concentrate urine can form the stones
- can be formed in acidic or alkaline environments for people who produce a lot of stones
What is calculus?
abnormal stone formed in the body tissues by an accumulations of mineral salts
what is lithiasis?
stone formation
What is nephrolithiasis?
Formation of stones in the urinary tract
Types of renal stones?
calcium, uric acid, struvite, cystine
Manifestations of stones?
agony, pain, misery, kidney tender on palpation
Pain that spreads to the lower abdomen and groin
Pain that comes in waves and fluctuates in intensity
Pain on urination
Pink, red or brown urine
Cloudy or foul-smelling urine
Nausea and vomiting
Persistent need to urinate
Urinating more often than usual
Fever and chills if an infection is present
Urinating small amounts of urine
Types of Pain by Location of Stone? Renal Calyx
Renal Calyx (flank area between pelvis + diaphragm)
- dull pain
- pain intensifies when drinking
Types of Pain by Location of Stone? Renal colic
stone moves from kidney to ureters
associated with stretching of ureter
is acute and pain can be intermittent and is very intense **
tends to be in the flank area in upper outer quadrant
diaphoretic, cool clammy skin, nausea + vomiting
Diagnostic Studies?
urine analysis
Blood analysis
What to look for in urine analysis?
urine C&S
Ph level
What to look for in blood analysis?
blood urea nitrogen (BUN)
creatinine
What does collaborative care involve?
- management of acute attack
- determination of cause of stone and treatment
- prevention of further stone development
Nursing Care in Acute Phase-promote comfort by?
analgesics (narcotics) heat over affected kidney guided imagery, relaxation techniques manage nausea + vomiting reducing fever
Maintain/improve urinary elimination by?
I&O monitoring
filtering urine
manage intake as per orders
promote ambulation
Decrease anxiety by?
provide knowledge of situation
Indications for Removal of Stones?
stones are too large to be passed spontaneously
stones associated with bacteriuria or symptomatic infection
stone causing impaired renal function
stones causing persistent pain, nausea or ileus
patient with one kidney
Procedures for stone removal?
- Endourological procedures (minimally invasive)
- Lithotripsy (shock waves break stones into small pieces)
- Open Surgical Procedure (monitor for haemorrhage, UTI after procedure )
Determining Cause of Stone?
- Family history of stones
- Geographic residence
- Illness with immobilization
- Disease or surgery involving the GI or GU tracts
- Nutritional assessment including intake of vitamins A & D
- Activity pattern
- Dehydration
Prevention of Further Stone Development?
- Understand the risks for stone formation and adopt SCPs to minimize the risks by:
- produce 2L urine/day
- reduce cola, fruit juice, tea intake
- increase water intake
- reduce salt intake
- limit oxalate rich foods (strawberry,radish,chocolate, coffee,cola)
- strain urine
medication (allopurinol)
Allopurinol reduces the production of uric acid
- can lower immunity
- do not consume alcohol with medication
- They should be encouraged to increase fluid intake during therapy to prevent renal stones.
- increase fluid to 2L/day
- monitor I&O
The most common health problems related to the prostate are?
- Benign Prostatic Hyperplasia (BPH)
- Prostate Cancer
Differentiating between BPH and Prostate Cancer?
BPH: grows around urethra, can obstruct urine flow
Prostate cancer: malignant growth (prostatic carcinoma)
What is BPH?
Age-related, non-malignant enlargement of the prostate gland
- if obstruction is left untreated, it can cause kidney problems
- common among aging men
Etiology of BPH?
- Results from endocrine changes associated with aging.
- Exact mechanism not completely understood.
Risk Factors for BPH?
- family Hx
- diet high in zinc, butter, margarine
- overweight
- men from western cultures
-prevention: moderate alcohol intake, more vegetables + fibre
Clinical Manifestations-Obstructive Symptoms BPH
- difficulty initiating a stream of urine
- decreased force of urine
- intermittency of urine flow during void
- dribbling at end of urination
Clinical Manifestations-Irritative Symptoms BPH
frequency, nocturia, urgency
Diagnostic studies-BPH?
- symptom index
- history + physical exam
BPH findings: symmetrically enlarged, smooth, firm
Additional tests: Urine analysis PSA blood test Serum creatinine Transurethral Ultrasound Uroflowmetry Post-void residual Cystourethroscopy
Understand BPH and adopt SCPs to manage/relieve the symptoms of BPH?:
- dietary changes
- restrict evening fluid intake
- timed voiding
- physical activity
- maintain a healthy weight
Flowmax medication?
.
Alpha-blockers (Tamsulosin) medication
(alpha blocker; relaxes muscles to make urine passage easier) works quickly
.
5-alpha-reductase inhibitors (Finasteride)
(inhibits conversion of testosterone to DHT which causes enlargement of prostate) works slowly because it shrinks the prostate
.
Minimally Invasive Tx-BPH?
- Transurethral microwave therapy
- Transurethral needle ablation
- Laser prostatectomy
- Intraprostatic urethral stents
Invasive Tx-BPH?
- Transurethral Resection of the Prostate (TURP)
- Transurethral Incision of the Prostate (TTUIP)
- Prostatectomy
Collaborative care for BPH pts?
- assessment of elimination
- watch for complications associated with BPH
- use strategies to decrease urinary stasis + UTI
Pre-Operative Care-BPH
Restore/facilitate bladder emptying and functioning
Maintain/restore/improve sexuality/sexual functioning
Post-operative Care-BPH?
Promote comfort by:
bladder irrigation
avoid forcing for BM (could rupture incision)
Post-operative Care-BPH?
Facilitate/promote urinary elimination by:
check catheter for clots
keegle exercise
Follow post-operative treatment plan by-BPH:
no driving, sex, heavy lifting for 2-3 weeks
Understand and manage the effects of TURP on elimination functions by-BPH
increase fiber
Non-modifiable risk factors for prostate cancer?
Age
Ethnicity
Family history
Modifiable risk factors for prostate cancer?
Diet
Occupational exposure
Clinical Manifestations- Prostate Ca?
- asymptomatic in early stages
- symptoms similar to BPH
- pain associated in the lumbosacral area which radiates to hips + legs with urinary symptoms may indicate metastasis
Diagnostic Studies-Prostace Ca?
-Annual health surveillance with GRE
Abnormal prostate may feel hard, nodular and asymmetrical
-Blood test for PSA(prostate-specific-antigen)
Indicate a pathological condition of the prostate
Useful marker of tumour volume with prostate cancer (the higher the level, the greater the tumour mass).
-Biopsy
Goals of Collaborative Care-Prostate Ca?
- Cancer is staged and graded
- Care will then depend on the stage of the cancer and the overall health of the patient.
- Multiple treatment options exist at each stage of disease.
- Decision is made jointly with the patient and health care provider.
Treatment Approaches-Prostate Ca?
- Conservative (non-surgical)
- Surgery
- Radiation Therapy
- Drug Therapy
- Hormone Therapy
- Chemotherapy
Nursing Care – Standard Action Demands- Prostate Ca?
- Promote active participation in decision making and participation in treatment
- Promote comfort
- Acknowledge effect of diagnosis on sexual function and develop strategies to cope with this.
- Acknowledge effect of diagnosis on bowel and bladder functioning and develop strategies to cope with this
