KUBP Dysfunction Flashcards
Urinary Retention: Definition
-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)
Normal Urine Output
0.5-1.5 ml/kg/hour
urinating at least every 6 hours
Oliguria
Decreased urine output (24 hour urine output of 100-400ml)
< 0.5 ml/kg/hour
Anuria
No or minimal urine output
usually < 100ml/day
Nighttime voidings
1-2 voidings are considered normal
How to check if pt is retaining urine
- 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
Causes of Urinary Retention
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
Urinary Retention: Interventions
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)
Meds for Urinary Retention
alpha 1 blockers: relax smooth muscle of bladder
anticholinergics: decrease bladder spasms
cholinergics: increase contraction of detrusor muscle
Types of Incontinence
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)
Medications and Urinary Issues
medications can cause: frequency urgency retention fecal impaction (leading to pressure on bladder and less space for bladder) polyuria nocturia immobility sedation delirium
Incontinence Screening: DRIP
D: delirium, depression
R: restricted mobility, rectal impaction
I: infection, inflammation, impaction
P: polyuria, polypharmacy
Incontinence Interventions
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)
Incontinence Interventions
Medications: anticholinergics (relax detrusor muscle, SE = dry mouth and eyes, constipation, blurred vision, sleepiness)
Surgery (last resort)
Urinary Tract Obstructions
Calci (stones) of urinary tract
Tumors (Renal cell or Bladder Ca)
Hydronephrosis
Kidney is backed up with urine
Urinary Reflux
ureter gets backed up with urine
UTO Calculi: Risk Factors
male caucasian 20-55YO FHx regional (climate, hotter places like SE) obesity sedentary occupation summer immobility
Types of Stones
Calcium oxalate (more common in men) calcium phosphate struvite (more common in women) uric acid cystine
UTO - Calculi: S/O
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
UTO - Calculi: Dx tests
UA, Urine C&S
Renal U/S or IVP
Strain urine to collect stone for analysis
CBC w/ diff, CMP (includes Creatinine & BUN)
UTO - Calculi: Interventions
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)
UTO - Tumors (Renal Cell Carcinoma)
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
UTO - Tumors (Bladder Cancer)
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)
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
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
Pyelonephritis S/O
acute: rapid onset fever/chills vomiting flank/groin pain frequency/dysuria CVA tenderness
Pyelonephritis Dx tests
UA Urine cultures Blood cultures CBC - left shift (see baby WBC aka bands d/t infection) IVP or CT U/S
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
Complications of Pyelonephritis
Urosepsis
Chronic Pyelonephritis: causing inflammation and scarring. Kidney shrinks and loses function. May lead to HTN, CRF, ESRD.
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
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
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)
BPH: Tx
active surveillance
Meds: hormone manipulation (SE: ED), alpha 1 blockers (relaxes bladder muscles)
Saw Palmetto
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)
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
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
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)
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
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)
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
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
