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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
UTI: definition and s/o
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
Upper UTI
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
Pyelonephritis S/O
``` acute: rapid onset fever/chills vomiting flank/groin pain frequency/dysuria CVA tenderness ```
28
Pyelonephritis Dx tests
``` UA Urine cultures Blood cultures CBC - left shift (see baby WBC aka bands d/t infection) IVP or CT U/S ```
29
Pyelonephritis Intervention
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
Complications of Pyelonephritis
Urosepsis Chronic Pyelonephritis: causing inflammation and scarring. Kidney shrinks and loses function. May lead to HTN, CRF, ESRD.
31
BPH definition and cause
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
BPH S/O
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
BPH Dx
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
BPH: Tx
active surveillance Meds: hormone manipulation (SE: ED), alpha 1 blockers (relaxes bladder muscles) Saw Palmetto
35
BPH: non surgical invasive tx
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
BPH: surgical tx
removal of prostate when danger of hydronephrosis TURP (transurethral resection of the prostate) after surgery: continuous bladder irrigation aka Murphy's Drip
37
BPH: Post-Op Interventions/Complications
``` 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
BPH: Surgical Discharge Teaching
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
Prostate Ca
``` 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
Prostate Ca: Dx
asymptomatic unless advanced and found on routine rectal exam or increased PSA DRE PSA Transrectal US (necessary to confirm dx of Ca)
41
Prostate Ca: Intervention Options
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
Prostate Ca: effects of tx
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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