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Module 2 > Lower Urinary System > Flashcards

Lower Urinary System Flashcards

1
Q

Ureters

A

Carry urine from renal pelvis to the bladder

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2
Q

Ureteral lumens are

A

Narrow

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3
Q

Male vs female urethra length

A

Male: 8 to 10 inches
Female: 1 to 2 inches

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4
Q

Females are more prone to

A

UTI because of short urethra

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5
Q

UTI bacteria

A

E. Coli

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6
Q

Bladder

A

Reservoir for urine

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7
Q

Bladder capacity

A

600-1000 mL

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8
Q

Bladder muscle

A

Detrusor

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9
Q

Other names for urinating

A

Urination, micturition, voiding

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10
Q

detrusor muscle

A

Remains relaxed when bladder is empty, contracts when full (mostly) and pushes urine out

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11
Q

How does urine flow?

A

Flows downwards to prevent urine back flowing into kidneys

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12
Q

Ureters connect to bladder=

A

Ureterovesical valves (one-way valves)

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13
Q

Urine is

A

Sterile
Once it hits air, it is no longer sterile

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14
Q

pH of urine is

A

Acidic

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15
Q

Prostate gland is in

A

Men

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16
Q

Maintaining a healthy bladder

A

-should void every 3-4 hours
-wipe from front to back
-urinate after intercourse
-do kegels
-cotton underwear
-limit alcohol/smoking
-drink lots of fluids

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17
Q

Kegels are good for

A

Stress incontinence

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18
Q

Kegels

A

Pelvic floor muscle exercises
-contract/squeeze muscles around rectum and vagina at the same time

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19
Q

Urinary incontinence

A

Involuntary or uncontrolled loss of urine in any amount

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20
Q

Stress incontinence

A

When physical movement or activity (coughing, laughing, sneezing, running, heavy lifting) puts pressure (stress) on bladder, causes leakage of urine

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21
Q

Stress incontinence causes

A

Pelvic floor muscle and urinary sphincter weaken
-childbirth in women
-prostate surgery in men

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22
Q

Stress incontinence devices

A

Vaginal pessary, urethral inserts

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23
Q

Stress incontinence surgery

A

Vaginal sling, injectable bulking agents, artificial sphincter

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24
Q

Urge incontinence

A

Involuntary urination with little or no warning
(Overactive bladder, bladder spasms, irritable bladder, Detrusor instability)

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25
Q

What occurs with urge incontinence?

A

Frequent urination or nocturia
Enuresis (bed wetting!)

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26
Q

Urge incontinence treatment

A

Bladder training

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27
Q

Functional incontinence

A

Inability to get to or use the toilet in time to urinate
-usually due to physical or cognitive impairment (inability to walk well, furniture in the way)

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28
Q

Functional incontinence treatment

A

Aimed at manipulating environment
-easy access to toilet
-scheduled times for toileting
-wearing clothes easy to remove

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29
Q

Anticholinergics

A

Treat urinary incontinence (more for urge and stress)
-can’t see, can’t pee, can’t spit, can’t shit

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30
Q

Oxybutynin (Ditropan)

A

Decreases urgency, frequency, and nocturia
-causes urinary retention!

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31
Q

Do not use Oxybutyin (Ditropan) or anticholinergics

A

With patients with BPH (large prostate)
With decongestants (Claritin, Benadryl, Sudafed) — WILL CAUSE HTN

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32
Q

Avoid what when taking anticholinergics

A

Hot baths, hot tubs, and use caution when exercising or in hot weather

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33
Q

Treatment of urinary incontinence

A

Kegel exercises
Scheduled toileting times
Botox injections
Nerve stimulator

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34
Q

Medications for urinary incontinence

A

Tolterodine (detrol)
Oxybutynin (Ditropan)

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35
Q

Urinary retention

A

Inability to empty bladder all the way

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36
Q

Causes of urinary retention

A

BPH — #1 cause!
Obstruction (kidney stone)
Narrowing - urethral
Tumors
Certain meds (anticholinergics, OPIOIDS!!)
Being dehydrated
Constipation

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37
Q

Acute urinary retention

A

Sudden and often painful inability to urinate at all despite bladder fullness
-requires intervention

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38
Q

Chronic urinary retention

A

Gradual inability to empty the bladder; painless retention associated with increased volume of residual urine

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39
Q

Chronic urinary retention s/s

A

Straining to pass urine/weaker flow
Feels like bladder is still full after voiding
Overflow incontinence
Difficulty holding in urine when coughing, laughing etc
Nocturia/enuresis
Swelling/mild pain in abdomen

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40
Q

Overflow incontinence

A

Leaking urine without being able to control it

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41
Q

Acute urinary retention
Nursing management

A

Bladder scan
Voiding history
Needs indwelling urinary catheter
Drink small amounts of fluid

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42
Q

Chronic urinary retention
Nursing management

A

Intermittent or indwelling urinary cath
Schedule toileting time

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43
Q

What is the most important risk factor for bladder cancer?

A

Smoking

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44
Q

Clinical manifestations
Bladder cancer

A

Painless hematuria
Bladder irritability (dysuria, frequency & urgency)

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45
Q

Urinary diversions

A

ileal conduit and neobladder
-most common after complete removal of bladder for bladder cancer

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46
Q

ileal conduit

A

Portion of ileum is resected and one end of segment is closed; ureters are attached to closed end of ileum and open end of ileum is brought through abdomen to form a stoma; a bag is placed over the stoma

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47
Q

Neobladder

A

Piece of small intestine formed into a pouch and positioned in same position of original bladder, urine comes out urethra

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48
Q

Neurogenic bladder

A

Nerves between spinal cord and brain don’t work
(Parkinson’s, multiple sclerosis, stroke, diabetes)

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49
Q

Neurogenic bladder nursing interventions

A

Avoid caffeine and alcohol
Kegels
Catheter prn
Meds — tamsulosin (FLOmax) improves bladder storage and emptying

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50
Q

Urinalysis

A

-Measurement of color, pH, specific gravity
-determination of presence of glucose, protein, blood, and ketones
-microscopic exam for crystals, bacteria (first morning void, examine urine within 1 hour)

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51
Q

Urine studies

A

-urine culture and sensitivity
-creatinine clearance
-collect 24 hour urine specimen
- closely approximates GFR (Glomerular filtration rate)

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52
Q

GFR

A

Glomerular filtration rate
-most accurate measure of kidney function!!!!!

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53
Q

Serum creatinine

A

Greater than 1.2 mg/dl is abnormal for women
Greater than 1.4 mg/dl is abnormal for men

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54
Q

BUN

A

7-20 mg/dl

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55
Q

High BUN with normal creatinine =

A

Dehydration

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56
Q

Interstitial cystitis

A

Painful bladder syndrome
Difficult to diagnose
Mistaken for UTI!! But urine culture shows no bacteria

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57
Q

Clinical manifestations
Interstitial cystitis

A

-pain in perineum
-persistent, urgent need to void
-painful intercourse
-frequent urination (up to 60x per day!)
-pain while bladder fills and relief after urinating
-may have AUTOIMMUNE component

58
Q

Urinary tract infection causes
(HARD TO VOID!)

A

Hormones
Antibiotics
Renal stones, scarring
Diabetes —> high risk for uti
Toiletries
Obstructive prostate
Vesicoureter reflux
Overextended bladder
Indwelling catheter
Decreased immunity (structural deviations)

59
Q

UTI teaching

A

Fluids- avoid alcohol and caffeine, drink water, cranberry juice, green tea
Foods- avoid acidic, spicy, artificial sweeteners
Eat- high fiber (whole grains, beans, bananas)
Void- every 2-4 hours, cotton lines underwear
Exercise

60
Q

Patho of UTI

A

Bacteria enters sterile bladder causing inflammation
Bacterial infection most common
Fungal and parasitic infections may also cause utis

61
Q

most common pathogen for UTI

A

E. coli

62
Q

The 4 units of the lower GU tract

A

Bladder, kidney, urethra, ureter

63
Q

Kidney infections

A

Pyelolonephritis
Bacteria are easier to get into blood stream = sepsis

64
Q

Bladder infection

A

Cystitis

65
Q

Urethra infection

A

Urethritis

66
Q

Ureter infection

A

Ureteritis

67
Q

CAUTI

A

Catheter associated urinary tract infection

68
Q

CAUTI #1 cause

A

Prolonged use of urinary catheter (goal is to keep urinary cath OUT)
-most common hospital acquired infection

69
Q

CAUTI common bacteria

A

E. Coli
Pseudomonas
Proteus marabilis

70
Q

CAUTI risk factors

A

-pedi and females
-urinary retention
-pregnancy
-menopause
-multiple partners

71
Q

CAUTI routes of infection

A

Meatal junction
Outlet device
Catheter tubing connection

72
Q

S/S of CAUTI

A

-hesitancy, frequency, urgency
-dysuria
-suprapubic pain

73
Q

Diagnose CAUTI with

A

+ RBC (gross hematuria)
Cloudy
+ WBC
+ Nitrates

74
Q

Elderly/geriatric manifestations (CAUTI)

A

-sudden change in LOC
-falls
-tachypnea
-anorexia
-low grade fever or no fever (VS appear normal)

75
Q

Nursing management
CAUTI

A

Urinalysis and urine culture (clean catch)
Meds (antibiotics, analgesic for pain)
Prevention of CAUTI
Prevention of urosepsis

76
Q

Clean catch urine (midstream)

A

Clean urinary opening with towelette front to back
Void into toilet a few seconds then stop
Place sterile container into path of stream
Restart urine and collect

77
Q

Indications for indwelling urinary catheter

A

Acute urinary retention or bladder obstruction
Need for accurate I&O (hourly monitoring, should be at least 30mL)
Assist in healing of open sacral or perineal wounds
Prior to certain surgeries
Pt requires prolonged immobilization
To improve comfort for end of life care

78
Q

Urosepsis

A

Caused by infection from UTI that moves to kidneys

79
Q

Urosepsis risk factors

A

Urinary catheters
Advanced age
Diabetes
Female
Compromised immune system
Surgical procedures involving urinary tract

80
Q

Clinical manifestations of Urosepsis

A

-initially uti symptoms
-more serious s/s (pyelonephritis)
-N/V, fever, chills, pain in lower spine

81
Q

Sepsis symptoms

A

MEWS tool!!!!
-respiratory rate 22 or higher
-systolic pressure < 100 mmHg
-WBC too high or too low (4500-10,000)

82
Q

Severe sepsis/septic shock

A

Organ failure, such as kidney (low urine output)
Low platelet count
Change in mental status
High levels of lactic acid in blood (cells aren’t utilizing oxygen in the right way)

83
Q

Urosepsis management

A

Early goal-directed therapy (EGDT)
Antibiotics
Strict I&O
Removal of any catheters or devices that may be infected

84
Q

Suprapubic catheter

A

Flexible catheter tube inserted into bladder through the abdomen a few inches below umbilicus

85
Q

Suprapubic catheters are used for

A

-urethral trauma
-some gynecological surgeries (prolapsed uterus or bladder)
-people who require long-term catheterization & are sexually active

86
Q

Priapism

A

Prolonged painful erection without sexual desire (usually longer than 4 hours)

87
Q

Priapism can lead to

A

Impaired circulation and inability to urinate

88
Q

Priapism causes

A

Neurological and vascular disorders

89
Q

Phimosis

A

Inability to retract the foreskin covering the head of the penis

90
Q

Hypospadius

A

Birth defect in which opening of urethra is located at the tip of the penis, along shaft, or where penis and scrotum meet

91
Q

Diphalia

A

Genetic condition present at birth in which a person has 2 penises

92
Q

Penile ring entrapment (PRE)

A

Works by reducing outflow of blood, sustaining a longer erection
-IF LEFT for an extended period of tie can lead to swelling of the shaft, strangulation, gangrene, and even complete loss of distal penis

93
Q

Prostate gland

A

-male organ that produces semen and transports sperm during ejaculation

94
Q

Enlarged prostate

A

Benign prostatic hypertrophy (BPH)
-can put pressure on urethra causing difficulty urinating

95
Q

Acute bacterial prostatitis

A

Bacterial infection of the prostate, usually with less severe symptoms

96
Q

Chronic bacterial prostatitis

A

Ongoing/recurring bacterial infection usually with less severe symptoms

97
Q

Chronic prostatitis/chronic pelvic pain syndrome

A

Ongoing/recurring pelvic pain and uti symptoms with no evidence of infection

98
Q

Chronic prostatitis/chronic pelvic pain syndrome symptoms

A

Flu-like
Pain in abdomen, groin, or back
Dysuria
Pain with ejaculation

99
Q

Can prostatitis be prevented?

A

No

100
Q

Prostatitis treatment

A

Acute bacterial- antibiotics 4-6 weeks
Chronic bacterial- antibiotics 8-12 weeks

101
Q

Prostatitis teaching

A

-safe sex!!!!
-weight loss
-avoid spicy/acidic foods
-avoid alcohol/caffeine
-unprocessed/less sugar
-water!!

102
Q

Benign prostatic hyperplasia (BPH) enlarged prostate

A

Prostate gland enlarges, disrupting outflow of urine from pressure on the urethra
-main cause of urinary retention in men

103
Q

Irritative BPH

A

Nocturia, frequency, urgency

104
Q

Obstructive BPH

A

Weak stream, difficulty starting and stopping stream, dribbling

105
Q

Diagnostic studies (BPH)

A

-history and physical
-digital rectal exam (DRE)
-prostatic specific antigen (PSA)
-transrectal ultrasound

106
Q

Adrenergic receptor blockers

A

Most end in “osin”
Tamsulosin (FLOmax) - will help you lose urine; helps urine FLOW
Doxazosin (cardura)
Terazosin (Hytrin) change positions slowly!!

107
Q

Adrenergic receptor blockers
Mode of action

A

Antagonize alpha 1 receptors, relaxing smooth muscles of the prostate, which helps improve urine flow
-also causes VASODILATION

108
Q

Do not take Adrenergic receptor blockers with

A

Antiacids or viagra! These can further cause hypotension!!

109
Q

5a reductase inhibitors

A

End in “ride”
Finasteride (proscar) helps with male propecia
Dutasteride (avodart)

110
Q

5a reductase inhibitor is the enzyme that

A

-prevents conversion of testosterone
-reduces size of prostate!

111
Q

Side effects of 5a reductase inhibitors

A

Erectile dysfunction, gynecomastia

112
Q

Pregnant women should not handle

A

Finasteride

113
Q

Complications of BPH

A

Hydronephrosis is swelling of kidneys due to build up of urine causing swelling
Urine cannot drain out from kidney to bladder = urinary retention!

114
Q

Hydronephrosis causes

A

-Blockage of outflow of urine or reflux of urine from bladder to kidney
-renal stones
-narrowing of ureter
-tumors
-vesicoureteral reflux/ureteral obstruction

115
Q

Transurethral resection of prostate (TURP) for BPH

A

Surgery to remove parts of prostate tissue through the penis

116
Q

Usually __________ after TURP

A

Bleeding

117
Q

Post TURP procedure

A

3 way indwelling catheter inserted to provide hemostasis and urinary drainage

118
Q

What is used to prevent obstruction of the catheter after TURP?

A

Continuous 3 way bladder irrigation (Murphy drip)

119
Q

Intermittent irrigation for bladder

A

Manual irrigation for bladder spasms, clots decreasing outflow

120
Q

Sudden gross hematuria =

A

Possible bleed

121
Q

Patient with bladder irrigation

A

-assess for bleeding & clots
-monitor inflow and outflow
-monitor for increase in gross hematuria (hemorrhage)

122
Q

Nursing management
Bladder irrigation

A

-kegels
-no heavy lifting
-s/s of infection
-stool softeners
-patience

123
Q

Prostate cancer is diagnosed with

A

PSA and biopsy

124
Q

Radical prostatectomy

A

Removal of prostate, seminal vesicles, and part of the bladder

125
Q

What is placed with prostatectomy?

A

Large indwelling catheter with 20-30mL balloon (pt goes home with catheter)

126
Q

radical prostatectomy adverse reactions

A

Erectile dysfunction
Urinary incontinence

127
Q

Testicular cancer is more common in

A

Young males (15-44)

128
Q

Testicular cancer

A

-very curable if caught early
-risk for infertility
-tumor marker blood test
-recommended to do self-exam monthly

129
Q

S/S of testicular cancer

A

-lump/swelling on testicle
-feeling of heaviness in scrotum
-dull ache in lower belly or groin
-usually painless in early stages

130
Q

Testicular torsion

A

Testicle rotates, twisting the spermatic cord that brings blood to the scrotum

131
Q

Testicular torsion occurs more on the

A

Left

132
Q

Testicular torsion results in

A

Reduced blood flow that causes sudden and severe pain on one side of the scrotum

133
Q

Testicular torsion medical emergency =

A

Blood flow must be restored within 6 hrs or testicle will atrophy

134
Q

Causes of testicular torsion

A

-vigorous activity
-minor injury to testicles
-while sleeping

135
Q

Erectile dysfunction

A

Inability to attain or maintain an erection

136
Q

Erectile dysfunction increases with

A

Age (40 to 70)

137
Q

Erectile devices and drugs

A

Sildenafil (viagra)
Tadalafil (cialis)
** do not take if on a nitrate!!

138
Q

Erectogenic drugs (phosphodiesterase type 5 inhibitors) mode of action

A

Increases blood flow to penis and vasodilation of the pulmonary vasculature

139
Q

Side effects of erectogenic drugs

A

Priapism, increased risk for heart attack

140
Q

Oliguria

A

Urine output abnormally low

141
Q

Anuria

A

A sense of urine production

142
Q

Polyuria

A

Excessive urination

Module 2 (15 decks)

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