Lower Urinary system exam 3 Flashcards
1
Q
- carry urine from renal pelvis to the bladder
- ureteral lumens are narrow
A
ureters
2
Q
reservior for urine
capacity 600-1000ml
A
bladder
3
Q
Contracts to push out urine
A
detrusor muscle
4
Q
ureterovesical valves
A
one way valves; uteres that connect to the bladder
5
Q
urine itself is
A
sterile
6
Q
pH of urine is
A
acidic
7
Q
should void how often
A
2-4 hours
8
Q
wipe from
A
front to back
9
Q
pelvic floor muscle exercise
A
kegels
10
Q
squeeze muscles around rectum and vagina at the same time
A
kegels
11
Q
irritates bladder
A
alcohol, caffeine, smoking
12
Q
involuntary or uncontrolled loss of urine in any amount
A
urinary incontinence
13
Q
three types of incontinence
A
- stress
- urge
- functional
14
Q
when physical movement or activity occurs
A
stress incontinence
15
Q
What causes the pelvic floor muscle and urinary sphincter to weaken ?
A
Stress incontinence
Ex:
Childbirth in women
Prostate surgery in men
16
Q
Vaginal sling procedure helps..
A
Helps lift up the urethra
17
Q
Overactive bladder **
Bladder spasms
Irritable bladder
Detrusor instability
A
Urge Incontinence
18
Q
Involuntary urination with little or no warning
- frequent urination or Nocturia
A
Urge incontinence
19
Q
Enuresis
A
Bed wetting
20
Q
Enuresis happens with - incontinence
A
Urge incontinence
21
Q
Inability to get to or use the toilet in time to urinate
A
Functional incontinence
22
Q
Usually due to physical or cognitive impairment ?
Give some examples
A
Functional incontinence
- inability to walk well
- furniture in way
23
Q
What treatment of incontinence aims at manipulating environment
A
Functional incontinence
- easy access to toilet
- scheduled times for toileting
- wearing clothes easy to remove
24
Q
Anticholinergics treat
A
Urinary incontinence
25
What Anticholinergics treat urinary incontinence?
Oxybutyin (ditropan)
26
- Decreases urgency, frequency and Nocturia in overactive bladder
- causes urinary retention
Oxybutyin (ditropan)
27
Side effects of Oxybutyin
Hypertension
28
If a patient has BPH what can we not give?
Anticholinergics- Oxybutyin
29
What do we not give with decongestants?
- Claritin, Benadryl, Sudafed
30
Treatments for incontinence including medications
- Kegel exercises: helps strengthen muscles
- scheduled toileting times
- Botox injections
- nerve stimulator
Meds
- tolterodine (Detrol)
- Oxybutyin (Ditropan)
31
Inability to empty bladder all the way
Urinary retention
32
BPH is the #1 cause of
Urinary retention
33
If a patient is experiencing urinary retention and they have a obstruction what may they have?
A kidney stone
34
What medications can cause urinary retention?
Anticholinergics, opioids
35
Tumors, being dehydrated, and constipation can be signs of what?
Urinary retention
36
Sudden and often painful inability to urinate at all despite bladder fullness
Acute urinary retention
37
Gradual inability to empty the bladder; PainLESS retention associated with increased volume of residual urine
Chronic urinary retention
38
What is considered painful and an emergency?
Acute urinary retention
39
Straining to pass urine or a weaker flow of urine?
Chronic Urinary retention
40
Feeling like bladder is still full after passing urine
Chronic urinary retention
41
Overflow incontinence
Chronic urinary retention
42
Difficulty holding in urine while coughing/laughing
Chronic urinary retention
43
What are some things we can do for acute urinary retention? (7)
- bladder scan
- palpate height
- ask about voiding history
- needs indwelling catheter
- drink small amounts of fluids
- avoid alcohol, caffeine, acidic fruits
- sitting in tub of warm water or warm shower
44
What are some things we can do to help with chronic urinary retention?
- intermittent or indwelling catheter
- schedule toileting times
45
If a patient has a weak stream - what comes to mind first?
Prostate
46
Smoking is the most important risk factor with
Bladder cancer
47
PainLESS Hematuria can indicate what
Bladder cancer
48
Bladder irritability - Dysuria, frequency, and urgency can indicate what
Bladder cancer
49
Neurogenic bladder
Nerves between spinal cord and brain don’t work
> Parkinson’s, MS, stroke, diabetes
50
What can we do as a nurse for a patient with neurogenic bladder? (5)
- routine voiding measures
- avoid caffeine and alcohol
- kegel exercises
- catheter care when needed
- medication: tamsulosin
51
The med: tamsulosin (flomax) improves bladder storage and emptying for what condition?
Neurogenic bladder
52
Creatinine clearance (2)
- collect 24hour urine specimen
- closely approximates GFR
53
Serum creatinine (women)
What is the lab range?
1.2mg/dL and anything greater is abnormal
54
Serum creatinine for men
Normal lab value
1.4mg/dL and anything greater is abnormal
55
A patient has a high BUN with normal creatinine, what does this indicate?
Dehydration
56
7-20mg/dL
BUN normal ranges
57
What do we do with the first urine -creatinine clearance
Discard
58
Painful bladder syndrome
Interstitial cystitis
59
- difficult to diagnose
- mistaken for UTI but urine culture shows no bacteria
Interstitial cystitis
60
If a patient is experiencing
- pain in perineum
- persistent urgent need to void
- painful intercourse
- frequent urination 60x per day
- pain while bladder fills and relief after
What condition might they have?
Interstitial cystitis
61
H - what is this?
A
R
D
T
O
V
O
I
D
H - hormones
62
H
A - what is this?
R
D
T
O
V
O
I
D
Antibiotics
63
H
A
R- what is this?
D
T
O
V
O
I
D
Renal stones
64
H
A
R
D - what is this?
T
O
V
O
I
D
Diabetes
65
H
A
R
D
T- what is this
O
V
O
I
D
Toiletries
66
H
A
R
D
T
O- what is this?
V
O
I
D
Obstructive prostate
67
H
A
R
D
T
I
V - what is this?
O
I
D
Vesicoureter reflux
68
H
A
R
D
T
O
V
O - what is this
I
D
Overextended bladder
69
H
A
R
D
T
I
V
O
I - what is this?
D
Indwelling catheter
70
H
A
R
D
T
O
V
O
I
D- what is this
Decreased immune system
71
A patient has a UTI what do we teach them about fluids ?
- avoid alcohol, caffeine, drink water
- cranberry juice
- green tea
72
A patient has a UTI what do we teach them about food ?
Avoid acidic foods
Artificial sweeteners
Spicy foods
73
A patient has a UTI what do we teach them about what to eat
High fiber
- whole grains, beans, bananas
74
A patient has a UTI what do we teach them about voiding
Every 2-4 hours
Wear cotton lined underwear
75
What is the number one cause of a UTI
Indwelling catheter
76
What is the most common bacteria in UTIs
E.Coli
77
Fungal and parasitic infections may cause
UTIs
78
Bacteria enters the sterile bladder causing
Inflammation
79
Most common hospital acquired infection is
CAUTI
80
What is the #1 cause of a CAUTI
Prolonged use of urinary catheter
81
Risk factors related to CAUTI
- most common in women
- congenital defects
- urinary retention
- pregnancy
- menopause
- multiple partners
82
What are some s/s of CAUTI?
- hesitancy, frequency, urgency
- Dysuria
- Suprapubic pain
83
The doctor orders a UA/ urine culture what might we look for with labs
- RBCs
- WBC
- nitrites
84
When a geriatric patient gets a UTI what do we look for?
- change in LOC
- more falls
- Tachypnea
- anorexia
- low grade fever or no fever, VS can appear normal
85
What are the steps to prepare for a clean catch urine sample
- wash hands
- clean urinary opening with towelette front to back
- void into toilet a few seconds and then stop
- place sterile cup into path of stream
- collect midstream of urine
86
Caused by infection from UTI
urosepsis
87
Risk factors for urosepsis (6)
- urinary catheters
- advanced age
- compromised immune system
- diabetes
- female gender
- surgical procedures involving urinary tract
88
Initial UTI symptoms
- abnormal WBC count ~ too high or too low
- urgency, frequency, foul smelling urine, Dysuria, lower abdominal pain
89
Pyelonephritis symptoms
- nausea, vomiting, fever, chills, pain in lower spine
~ CVA tenderness
90
What happens in our body when he go into septic shock/ severe sepsis
- organ failure, such as kidney (low urine output)
- low platelet count
- change in mental status
- high levels of lactic acid in blood
91
- scar tissue forms under skin of penis
- plaque pulls on surrounding tissue and causes penis to curve or bend during an erection
PEYRONIES
92
- prolonged painful erection without sexual desire
- can lead to impaired circulation
- inability to urinate
PRIAPISM
93
Inability to retract the foreskin covering the head of the penis
Phimosis
94
This condition is more common in babies or children
Phimosis
95
Birth defect in which opening of the urethra is located at the tip of the penis, along the shaft, or where penis and scrotum meet
Hypospadius
96
Genetic condition present at birth in which a person has 2 penises
Diphalia
97
Works by reducing outflow of blood, sustaining a longer erection. If left for extended period can lead to swelling of shaft, strangulation, gangrene, and even complete loss of distal penis
Penile ring entrapment
98
Male organ that produces seamen and transports sperm during ejaculation
Prostate gland
99
If the prostate is enlarged what does it do?
Puts pressure on urethra causing difficulty urinating
100
Enlarge prostate is
Benign prostatic hypertrophy
101
A bacterial infection if the prostate usually with sudden, severe symptoms
Acute bacterial prostatitis
102
Ongoing or recurring bacterial infection usually with less severe symptoms
Chronic bacterial prostatitis
103
Ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection
Chronic prostatitis / chronic pelvic pain syndrome
104
Symptoms of prostatitis
- flu like
- pain in abdomen, groin, or back
- Dysuria
- pain with ejaculation
105
Treatment for acute prostatitis
Antibiotics 4-6 weeks
106
Treatment for chronic prostatitis
Antibiotics 8-12 weeks
107
Teaching for prostatitis
- safe sex
- weight loss
- avoid spicy or acidic foods
- avoid alcohol and caffeine
- eat more fresh/ unprocessed foods and less sugar
- WATER, water, water!!
108
Prostate gland enlarges disrupting outflow of urine from pressure on the urethra
BPH
109
Main cause of urinary retention in men
BPH
110
Risk factors of BPH in men
- age
- obesity
- high protein diet
- alcohol and smoking
- family history
111
BPH and prostate gland - irritative
- Nocturia
- frequency
- urgency
112
BPH and prostate gland - obstructive
- weak stream
- difficulty starting and stopping stream
- dribbling
113
What diagnostic studies do we do for BPH
- H&P
- digital recital exam (DRE)
- prostatic specific antigen (PSA)
- transrectal US
114
2 main classes of adrenergic receptor blockers for BPH are
- Tamsulosin
- Doxazosin
- Terazosin
115
Tamsulosin
Will help you lose urine; also used to help pass renal calculi
116
“osin” meds help improve urine flow by?
Relaxing smooth muscles of the prostate
- also causes vasodilation
117
Side effects of “OSIN” meds
Hypotension ~ change positions slowly
118
Reductase inhibitors
End in “RIDE”
119
What are the two medications we give to patients with BPH that end in “RIDE”
1. Finasteride
2. Dutasteride
120
Finasteride helps with
Male propecia
121
5a reductase inhibitor is the enzyme that prevents
Conversion of testosterone
122
Reductase inhibitor meds reduce the size
Of the prostate
123
Side effects of the “RIDE” meds
- ED
- gynecomastia ~ male breast growth
124
Is swelling of kidneys due to build up of urine causing swelling
Hydronephrosis
125
Urine cannot drain out from kidney to bladder
Hydronephrosis
126
Causes of Hydronephrosis
- blockage of outflow of urine or reflux of urine from bladder to kidney
> BPH
> Renal Stones
> narrowing of ureters
127
Treatment of Hydronephrosis
May need nephrostomy tube if severe
128
Surgery to remove parts of prostate tissue through the penis for BPH
Transurethral Resection of Prostate
129
What kind of catheter does a patient get after the TURP procedure?
3 way indwelling catheter
130
What does the continuous 3 way indwelling catheter provide?
Hemostasis and urinary drainage
131
Manual irrigation for bladder spasms, clots decreasing outflow
Intermittent irrigation
132
Bladder irrigation helps keep the urinary catheter from
Obstructing
133
What do we assess a patient with bladder irrigation
Assess for bleeding and clots
134
What do we monitor a patient with bladder irrigation
Inflow and outflow
For increase in gross Hematuria
135
Your patient with bladder irrigation is going home what do you teach them? (6)
- kegel exercises
- no heavy lifting
- s/s of infection
- stool softeners to prevent straining
- fluid intake 2-3 L per day
- avoid caffeine and alcohol
136
2nd leading cause of cancer death in men
Prostate cancer
137
What is the key in prostate cancer
Diagnosed early
138
Risk factors of prostate cancer
- Age
- obesity
- alcohol
- family history
139
Men are at a increased risk for this after 50
Prostate cancer
140
Diagnosed often with PSA and biopsy
Prostate cancer
141
Treatment for prostate cancer
Depending on age and Gleason score, no treatment
142
Removal of prostate, seminal vesicles and part of the bladder
Radical prostatectomy
143
Adverse outcomes to prostatectomy
- ED
- urinary incontinence
144
After a prostatectomy what is placed
Large indwelling catheter with 20-30mL balloon is placed and the pt goes home with it
145
More common in young males between the ages 15-25 y/o
Testicular cancer
146
Undescended testicle
Cryptochidism
147
Very curable if caught early ?
Testicular cancer
148
What happens if testicular cancer is caught early
Radical inguinal orchidectomy ~ removal of testicle
149
What stage is testicular cancer when it’s caught early
Staging 0-3
150
What test is done to diagnose testicular cancer ?
Tumor maker blood test
151
Risk for testicular cancer
Infertility
152
When performing a testicular self exam what should you look for
Lumps, swelling, hardness, or other abnormal changes
153
S/S of testicular cancer
- lump or swelling on testicle
- feeling of heaviness of scrotum
- dull ache in lower belly or groin
- usually painless in early stages
154
Testicle rotates, twisting the spermatic cord that brings blood to the scrotum
Testicular torsion
155
Reduced blood flow causes sudden and severe pain on one side of the scrotum ~ usually the left
Testicular torsion
156
This is considered a medical emergency and blood flow must be restored within 6 hours
Testicular torsion
157
Causes of torsion
- vigorous activity
- minor injury to testicles
- while sleeping
- undescended testicle
158
Born with no tissue holding testes to scrotum allowing testes to swing inside the scrotum
Bell clapper deformity
159
Inability to attain or maintain an erection
ED
160
Erection lasting longer then 4 hours
PRIAPISM
161
Erectogenic drugs
- sildenafil (viagra)
- Tadalafil (Cialis)
162
Erectogenic drugs - mode of action
Increased blood flow to penis and vasodilation of the pulmonary vasculature
DO NOT TAKE WITH NITRATES
163
Side effects of ED
- priapism
- increased risk for heart attack
164
Dysuria
Difficulty to urinate
165
Oliguria
Scant amount of urine
166
Anuria
No urine
167
Polyuria
Frequency, lots of urine
~ diabetics are more likely to get this
