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medsurg 2 > KUBP Dysfunction > Flashcards

KUBP Dysfunction Flashcards

1
Q

Urinary Retention: Definition

A

-Inability to empty bladder despite voiding
-Accumulation of urine in bladder d/t inability to urinate
-can be acute or chronic:
acute = medical emergency (ex. swollen penis that you can’t insert a catheter)
chronic = incomplete bladder emptying after voiding (ex. elderly women, ligaments that hold up bladder become weaker and not as compliant)

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2
Q

Normal Urine Output

A

0.5-1.5 ml/kg/hour

urinating at least every 6 hours

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3
Q

Oliguria

A

Decreased urine output (24 hour urine output of 100-400ml)

< 0.5 ml/kg/hour

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4
Q

Anuria

A

No or minimal urine output

usually < 100ml/day

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5
Q

Nighttime voidings

A

1-2 voidings are considered normal

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6
Q

How to check if pt is retaining urine

A
  • have the pt void first
  • nurse palpates bladder to check for distention
  • bladder scan
  • decides if straight cath is needed
  • need evaluation by provider if PVR (post-void residual) is greater than 150-200ml OR lesser amount and has sx of retaining urine
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7
Q

Causes of Urinary Retention

A

Obstructions: inability for urine to leave bladder
Detrusor muscle dysfunction: decreased ability to contract forcefully enough or long enough to empty bladder
Post-op complication: d/t surgical manipulation of bladder or anesthesia

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8
Q

Urinary Retention: Interventions

A 
Acute retention: catheter/st cath (intermittent cath is most common)
Promote voiding
Monitor I&O
Push fluids (small frequent amounts)
Offer caffeine
Double voiding
Meds
Surgery (TURP, pelvic reconstruction for obstructions, GYN surgeries)
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9
Q

Meds for Urinary Retention

A

alpha 1 blockers: relax smooth muscle of bladder

anticholinergics: decrease bladder spasms
cholinergics: increase contraction of detrusor muscle

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10
Q

Types of Incontinence

A

Stress: d/t increased intra-abdominal pressure
Urge: sudden urge prior to leaking, common at nighttime
Mixed: combo of stress and urge
Overflow: d/t immobility or environment factors (like location of bathroom)
Reflex: problem with neuro conduction of bladder or spinal cord problem (stroke can cause this)

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11
Q

Medications and Urinary Issues

A 
medications can cause:
frequency
urgency
retention
fecal impaction (leading to pressure on bladder and less space for bladder)
polyuria
nocturia
immobility 
sedation
delirium
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12
Q

Incontinence Screening: DRIP

A

D: delirium, depression
R: restricted mobility, rectal impaction
I: infection, inflammation, impaction
P: polyuria, polypharmacy

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13
Q

Incontinence Interventions

A

bladder diary
toileting schedule
do not stop drinking
lose weight (decreases intra-abdominal pressure)
decrease caffeine/spicy foods/ETOH (bladder irritants)
kegel exercises (helps with stress, urge and mixed incontinence)

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14
Q

Incontinence Interventions

A

Medications: anticholinergics (relax detrusor muscle, SE = dry mouth and eyes, constipation, blurred vision, sleepiness)
Surgery (last resort)

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15
Q

Urinary Tract Obstructions

A

Calci (stones) of urinary tract

Tumors (Renal cell or Bladder Ca)

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16
Q

Hydronephrosis

A

Kidney is backed up with urine

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17
Q

Urinary Reflux

A

ureter gets backed up with urine

18
Q

UTO Calculi: Risk Factors

A 
male
caucasian
20-55YO
FHx
regional (climate, hotter places like SE)
obesity
sedentary occupation
summer
immobility
19
Q

Types of Stones

A 
Calcium oxalate (more common in men)
calcium phosphate 
struvite (more common in women)
uric acid
cystine
20
Q

UTO - Calculi: S/O

A 
renal colic (intense sudden pain that makes you want to throw up when stone is heading towards ureters)
abdominal pain
CVA pain 
N/V
Fever
Chills
Hematuria
21
Q

UTO - Calculi: Dx tests

A

UA, Urine C&S
Renal U/S or IVP
Strain urine to collect stone for analysis
CBC w/ diff, CMP (includes Creatinine & BUN)

22
Q

UTO - Calculi: Interventions

A 
pain relief
anticholinergic (if ureteral spasms)
IV fluids
measure and strain urine
analysis of stones
antibiotics (if related to UTI)
nutritional therapy
hydration
light exercise
small stones: decrease or remove stones via alteration of urine pH
big stones: cystoscopy, lithotripsy
surgical removal (last resort)
23
Q

UTO - Tumors (Renal Cell Carcinoma)

A

most common renal ca, begins in epithelial tissue of tubules usually
associated w/ smoking and obesity
s/o: hematuria, CVA, palpable mass, wt loss, htn
dx: u/s, angiogram, ct
tx: nephrectomy or radical nephrectomy

24
Q

UTO - Tumors (Bladder Cancer)

A

most common ca of the urinary system
associated w/ smoking, industrial chemicals, long term cath use, frequent bladder infections, calculi
s/o: asymptomatic or painless hematuria, later pelvic pain and frequency
dx: CT, u/s, MRI, cystoscopy
tx: chemo, radiation, surgery (TURBT, segmental cystectomy, radical cystectomy)

25
Q

UTI: definition and s/o

A

most common bacterial infection in women d/t shorter urethra and proximity to rectum

can be upper or lower

s/o: dysuria, hesitancy, retention or incomplete emptying, incontinence, frequency

26
Q

Upper UTI

A

Pyelonephritis
a complication of cystitis (lower UTI infection) which travels to kidney where it infects the renal pelvis and parenchyma
acute or chronic
usually bacterial
associated with reflux or obstruction
kidney infected, edematous w/ tissue destruction
can lead to chronic pyelonephritis which can lead to CKD

27
Q

Pyelonephritis S/O

A 
acute: rapid onset
fever/chills
vomiting
flank/groin pain
frequency/dysuria
CVA tenderness
28
Q

Pyelonephritis Dx tests

A 
UA
Urine cultures
Blood cultures
CBC - left shift (see baby WBC aka bands d/t infection)
IVP or CT 
U/S
29
Q

Pyelonephritis Intervention

A

Tx at home or in hospital depending on severity
admitted to hospital for pain control, antibiotics, IV fluids for N/V

Tx: antibiotics x 2wks, push fluids
analgesics
urinary analgesics (pyridium)
f/u urine culture @ 1 and 4 weeks

30
Q

Complications of Pyelonephritis

A

Urosepsis
Chronic Pyelonephritis: causing inflammation and scarring. Kidney shrinks and loses function. May lead to HTN, CRF, ESRD.

31
Q

BPH definition and cause

A

benign prostatic hyperplasia or hypertrophy
slow enlargement of prostate gland with extension into the bladder causing lower UTI sx
urinary outflow through urethra is weak d/t narrowing
stasis of urine in bladder (causes UTI and calculi)
cause: unknown but r/t aging

32
Q

BPH S/O

A

obstructive voiding sx: weak force of stream, hesitancy initiating voiding, post-voiding leaking, sensation of incomplete emptying of bladder, urinary retention
irritative sx: nocturia (>3x more at night in men >60YO), frequency, urgency

increase chance of UTI and calculi

33
Q

BPH Dx

A

DRE (digital rectal exam): palpate for enlarged, boggy prostate
Urine: UA and C&S
PSA
Urine flow studies (looking at post-void residual volume)
TRUS (can do bx)

34
Q

BPH: Tx

A

active surveillance
Meds: hormone manipulation (SE: ED), alpha 1 blockers (relaxes bladder muscles)
Saw Palmetto

35
Q

BPH: non surgical invasive tx

A

if meds don’t work:
placement of stents or coils in area of enlargement
urethroplasty (enlarges urethra)
TUMT (transurethral microwave thermotherapy) or TUNA (transurethral needle ablation - head to cause cell death)

36
Q

BPH: surgical tx

A

removal of prostate when danger of hydronephrosis

TURP (transurethral resection of the prostate)
after surgery: continuous bladder irrigation aka Murphy’s Drip

37
Q

BPH: Post-Op Interventions/Complications

A 
increased bleeding
obstruction (by clots)
monitor I&O
keep urine output pink
analgesics and antispasmotics
discuss concerns re sexual function
notify MD if unable to maintain catheter patentcy
catheter removal 2-4 days post-op (should void w/in 6 hours of removal)
discharge teaching
38
Q

BPH: Surgical Discharge Teaching

A

incontinence/dribbling common for few months
fluids (2-3 L/day)
avoid lifiting >10-20lbs
s/sx infection
no driving or intercourse until seen by surgeon for f/u
avoid constipation (may need to be on stool softeners)

39
Q

Prostate Ca

A 
malignant tumor of prostate
cause: unknown, r/t aging
2nd most common male Ca >50YO
Sx: seldom till advanced stages
common site of metastasis: bone, lymph nodes, lung, and liver
40
Q

Prostate Ca: Dx

A

asymptomatic unless advanced and found on routine rectal exam or increased PSA
DRE
PSA
Transrectal US (necessary to confirm dx of Ca)

41
Q

Prostate Ca: Intervention Options

A

no Tx
total prostatectomy (tx of care if <70YO)
hormonal therapy
radiation therapy
chemotherapy
cryosurgery
combonation
palliative tx: w/ goal to relieve urinary sx d/t bladder obstruction
tx at early stage is curative, at advanced stage can extend life and decrease tumor and sx

42
Q

Prostate Ca: effects of tx

A

loss of urinary control (returns to normal after several wks or months)
artificial sphincter to tx permanent incontinence
complications include urethral strictures and. impotence
ED
Post prostatectomy care is similar to TURP

medsurg 2 (18 decks)

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