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Lower Urinary system exam 3 Flashcards

1
Q
  • carry urine from renal pelvis to the bladder
  • ureteral lumens are narrow
A

ureters

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2
Q

reservior for urine
capacity 600-1000ml

A

bladder

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3
Q

Contracts to push out urine

A

detrusor muscle

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4
Q

ureterovesical valves

A

one way valves; uteres that connect to the bladder

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5
Q

urine itself is

A

sterile

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6
Q

pH of urine is

A

acidic

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7
Q

should void how often

A

2-4 hours

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8
Q

wipe from

A

front to back

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9
Q

pelvic floor muscle exercise

A

kegels

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10
Q

squeeze muscles around rectum and vagina at the same time

A

kegels

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11
Q

irritates bladder

A

alcohol, caffeine, smoking

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12
Q

involuntary or uncontrolled loss of urine in any amount

A

urinary incontinence

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13
Q

three types of incontinence

A
  • stress
  • urge
  • functional
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14
Q

when physical movement or activity occurs

A

stress incontinence

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15
Q

What causes the pelvic floor muscle and urinary sphincter to weaken ?

A

Stress incontinence

Ex:
Childbirth in women
Prostate surgery in men

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16
Q

Vaginal sling procedure helps..

A

Helps lift up the urethra

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17
Q

Overactive bladder **
Bladder spasms
Irritable bladder
Detrusor instability

A

Urge Incontinence

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18
Q

Involuntary urination with little or no warning
- frequent urination or Nocturia

A

Urge incontinence

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19
Q

Enuresis

A

Bed wetting

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20
Q

Enuresis happens with - incontinence

A

Urge incontinence

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21
Q

Inability to get to or use the toilet in time to urinate

A

Functional incontinence

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22
Q

Usually due to physical or cognitive impairment ?

Give some examples

A

Functional incontinence

  • inability to walk well
  • furniture in way
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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
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24
Q

Anticholinergics treat

A

Urinary incontinence

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25
Q

What Anticholinergics treat urinary incontinence?

A

Oxybutyin (ditropan)

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26
Q
  • Decreases urgency, frequency and Nocturia in overactive bladder
  • causes urinary retention
A

Oxybutyin (ditropan)

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27
Q

Side effects of Oxybutyin

A

Hypertension

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28
Q

If a patient has BPH what can we not give?

A

Anticholinergics- Oxybutyin

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29
Q

What do we not give with decongestants?

A
  • Claritin, Benadryl, Sudafed
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30
Q

Treatments for incontinence including medications

A
  • Kegel exercises: helps strengthen muscles
  • scheduled toileting times
  • Botox injections
  • nerve stimulator

Meds
- tolterodine (Detrol)
- Oxybutyin (Ditropan)

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31
Q

Inability to empty bladder all the way

A

Urinary retention

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32
Q

BPH is the #1 cause of

A

Urinary retention

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33
Q

If a patient is experiencing urinary retention and they have a obstruction what may they have?

A

A kidney stone

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34
Q

What medications can cause urinary retention?

A

Anticholinergics, opioids

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35
Q

Tumors, being dehydrated, and constipation can be signs of what?

A

Urinary retention

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36
Q

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

A

Acute urinary retention

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37
Q

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

A

Chronic urinary retention

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38
Q

What is considered painful and an emergency?

A

Acute urinary retention

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39
Q

Straining to pass urine or a weaker flow of urine?

A

Chronic Urinary retention

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40
Q

Feeling like bladder is still full after passing urine

A

Chronic urinary retention

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41
Q

Overflow incontinence

A

Chronic urinary retention

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42
Q

Difficulty holding in urine while coughing/laughing

A

Chronic urinary retention

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43
Q

What are some things we can do for acute urinary retention? (7)

A
  • 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
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44
Q

What are some things we can do to help with chronic urinary retention?

A
  • intermittent or indwelling catheter
  • schedule toileting times
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45
Q

If a patient has a weak stream - what comes to mind first?

A

Prostate

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46
Q

Smoking is the most important risk factor with

A

Bladder cancer

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47
Q

PainLESS Hematuria can indicate what

A

Bladder cancer

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48
Q

Bladder irritability - Dysuria, frequency, and urgency can indicate what

A

Bladder cancer

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49
Q

Neurogenic bladder

A

Nerves between spinal cord and brain don’t work

> Parkinson’s, MS, stroke, diabetes

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50
Q

What can we do as a nurse for a patient with neurogenic bladder? (5)

A
  • routine voiding measures
  • avoid caffeine and alcohol
  • kegel exercises
  • catheter care when needed
  • medication: tamsulosin
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51
Q

The med: tamsulosin (flomax) improves bladder storage and emptying for what condition?

A

Neurogenic bladder

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52
Q

Creatinine clearance (2)

A
  • collect 24hour urine specimen
  • closely approximates GFR
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53
Q

Serum creatinine (women)
What is the lab range?

A

1.2mg/dL and anything greater is abnormal

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54
Q

Serum creatinine for men
Normal lab value

A

1.4mg/dL and anything greater is abnormal

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55
Q

A patient has a high BUN with normal creatinine, what does this indicate?

A

Dehydration

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56
Q

7-20mg/dL

A

BUN normal ranges

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57
Q

What do we do with the first urine -creatinine clearance

A

Discard

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58
Q

Painful bladder syndrome

A

Interstitial cystitis

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59
Q
  • difficult to diagnose
  • mistaken for UTI but urine culture shows no bacteria
A

Interstitial cystitis

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60
Q

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?

A

Interstitial cystitis

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61
Q

H - what is this?
A
R
D
T
O
V
O
I
D

A

H - hormones

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62
Q

H
A - what is this?
R
D
T
O
V
O
I
D

A

Antibiotics

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63
Q

H
A
R- what is this?
D
T
O
V
O
I
D

A

Renal stones

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64
Q

H
A
R
D - what is this?
T
O
V
O
I
D

A

Diabetes

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65
Q

H
A
R
D
T- what is this
O
V
O
I
D

A

Toiletries

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66
Q

H
A
R
D
T
O- what is this?
V
O
I
D

A

Obstructive prostate

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67
Q

H
A
R
D
T
I
V - what is this?
O
I
D

A

Vesicoureter reflux

68
Q

H
A
R
D
T
O
V
O - what is this
I
D

A

Overextended bladder

69
Q

H
A
R
D
T
I
V
O
I - what is this?
D

A

Indwelling catheter

70
Q

H
A
R
D
T
O
V
O
I
D- what is this

A

Decreased immune system

71
Q

A patient has a UTI what do we teach them about fluids ?

A
  • avoid alcohol, caffeine, drink water
  • cranberry juice
  • green tea
72
Q

A patient has a UTI what do we teach them about food ?

A

Avoid acidic foods
Artificial sweeteners
Spicy foods

73
Q

A patient has a UTI what do we teach them about what to eat

A

High fiber
- whole grains, beans, bananas

74
Q

A patient has a UTI what do we teach them about voiding

A

Every 2-4 hours
Wear cotton lined underwear

75
Q

What is the number one cause of a UTI

A

Indwelling catheter

76
Q

What is the most common bacteria in UTIs

77
Q

Fungal and parasitic infections may cause

78
Q

Bacteria enters the sterile bladder causing

A

Inflammation

79
Q

Most common hospital acquired infection is

80
Q

What is the #1 cause of a CAUTI

A

Prolonged use of urinary catheter

81
Q

Risk factors related to CAUTI

A
  • most common in women
  • congenital defects
  • urinary retention
  • pregnancy
  • menopause
  • multiple partners
82
Q

What are some s/s of CAUTI?

A
  • hesitancy, frequency, urgency
  • Dysuria
  • Suprapubic pain
83
Q

The doctor orders a UA/ urine culture what might we look for with labs

A
  • RBCs
  • WBC
  • nitrites
84
Q

When a geriatric patient gets a UTI what do we look for?

A
  • change in LOC
  • more falls
  • Tachypnea
  • anorexia
  • low grade fever or no fever, VS can appear normal
85
Q

What are the steps to prepare for a clean catch urine sample

A
  • 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
Q

Caused by infection from UTI

87
Q

Risk factors for urosepsis (6)

A
  • urinary catheters
  • advanced age
  • compromised immune system
  • diabetes
  • female gender
  • surgical procedures involving urinary tract
88
Q

Initial UTI symptoms

A
  • abnormal WBC count ~ too high or too low
  • urgency, frequency, foul smelling urine, Dysuria, lower abdominal pain
89
Q

Pyelonephritis symptoms

A
  • nausea, vomiting, fever, chills, pain in lower spine
    ~ CVA tenderness
90
Q

What happens in our body when he go into septic shock/ severe sepsis

A
  • organ failure, such as kidney (low urine output)
  • low platelet count
  • change in mental status
  • high levels of lactic acid in blood
91
Q
  • scar tissue forms under skin of penis
  • plaque pulls on surrounding tissue and causes penis to curve or bend during an erection
92
Q
  • prolonged painful erection without sexual desire
  • can lead to impaired circulation
  • inability to urinate
93
Q

Inability to retract the foreskin covering the head of the penis

94
Q

This condition is more common in babies or children

95
Q

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

A

Hypospadius

96
Q

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

97
Q

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

A

Penile ring entrapment

98
Q

Male organ that produces seamen and transports sperm during ejaculation

A

Prostate gland

99
Q

If the prostate is enlarged what does it do?

A

Puts pressure on urethra causing difficulty urinating

100
Q

Enlarge prostate is

A

Benign prostatic hypertrophy

101
Q

A bacterial infection if the prostate usually with sudden, severe symptoms

A

Acute bacterial prostatitis

102
Q

Ongoing or recurring bacterial infection usually with less severe symptoms

A

Chronic bacterial prostatitis

103
Q

Ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection

A

Chronic prostatitis / chronic pelvic pain syndrome

104
Q

Symptoms of prostatitis

A
  • flu like
  • pain in abdomen, groin, or back
  • Dysuria
  • pain with ejaculation
105
Q

Treatment for acute prostatitis

A

Antibiotics 4-6 weeks

106
Q

Treatment for chronic prostatitis

A

Antibiotics 8-12 weeks

107
Q

Teaching for prostatitis

A
  • 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
Q

Prostate gland enlarges disrupting outflow of urine from pressure on the urethra

109
Q

Main cause of urinary retention in men

110
Q

Risk factors of BPH in men

A
  • age
  • obesity
  • high protein diet
  • alcohol and smoking
  • family history
111
Q

BPH and prostate gland - irritative

A
  • Nocturia
  • frequency
  • urgency
112
Q

BPH and prostate gland - obstructive

A
  • weak stream
  • difficulty starting and stopping stream
  • dribbling
113
Q

What diagnostic studies do we do for BPH

A
  • H&P
  • digital recital exam (DRE)
  • prostatic specific antigen (PSA)
  • transrectal US
114
Q

2 main classes of adrenergic receptor blockers for BPH are

A
  • Tamsulosin
  • Doxazosin
  • Terazosin
115
Q

Tamsulosin

A

Will help you lose urine; also used to help pass renal calculi

116
Q

“osin” meds help improve urine flow by?

A

Relaxing smooth muscles of the prostate
- also causes vasodilation

117
Q

Side effects of “OSIN” meds

A

Hypotension ~ change positions slowly

118
Q

Reductase inhibitors

A

End in “RIDE”

119
Q

What are the two medications we give to patients with BPH that end in “RIDE”

A
  1. Finasteride
  2. Dutasteride
120
Q

Finasteride helps with

A

Male propecia

121
Q

5a reductase inhibitor is the enzyme that prevents

A

Conversion of testosterone

122
Q

Reductase inhibitor meds reduce the size

A

Of the prostate

123
Q

Side effects of the “RIDE” meds

A
  • ED
  • gynecomastia ~ male breast growth
124
Q

Is swelling of kidneys due to build up of urine causing swelling

A

Hydronephrosis

125
Q

Urine cannot drain out from kidney to bladder

A

Hydronephrosis

126
Q

Causes of Hydronephrosis

A
  • blockage of outflow of urine or reflux of urine from bladder to kidney
    > BPH
    > Renal Stones
    > narrowing of ureters
127
Q

Treatment of Hydronephrosis

A

May need nephrostomy tube if severe

128
Q

Surgery to remove parts of prostate tissue through the penis for BPH

A

Transurethral Resection of Prostate

129
Q

What kind of catheter does a patient get after the TURP procedure?

A

3 way indwelling catheter

130
Q

What does the continuous 3 way indwelling catheter provide?

A

Hemostasis and urinary drainage

131
Q

Manual irrigation for bladder spasms, clots decreasing outflow

A

Intermittent irrigation

132
Q

Bladder irrigation helps keep the urinary catheter from

A

Obstructing

133
Q

What do we assess a patient with bladder irrigation

A

Assess for bleeding and clots

134
Q

What do we monitor a patient with bladder irrigation

A

Inflow and outflow
For increase in gross Hematuria

135
Q

Your patient with bladder irrigation is going home what do you teach them? (6)

A
  • 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
Q

2nd leading cause of cancer death in men

A

Prostate cancer

137
Q

What is the key in prostate cancer

A

Diagnosed early

138
Q

Risk factors of prostate cancer

A
  • Age
  • obesity
  • alcohol
  • family history
139
Q

Men are at a increased risk for this after 50

A

Prostate cancer

140
Q

Diagnosed often with PSA and biopsy

A

Prostate cancer

141
Q

Treatment for prostate cancer

A

Depending on age and Gleason score, no treatment

142
Q

Removal of prostate, seminal vesicles and part of the bladder

A

Radical prostatectomy

143
Q

Adverse outcomes to prostatectomy

A
  • ED
  • urinary incontinence
144
Q

After a prostatectomy what is placed

A

Large indwelling catheter with 20-30mL balloon is placed and the pt goes home with it

145
Q

More common in young males between the ages 15-25 y/o

A

Testicular cancer

146
Q

Undescended testicle

A

Cryptochidism

147
Q

Very curable if caught early ?

A

Testicular cancer

148
Q

What happens if testicular cancer is caught early

A

Radical inguinal orchidectomy ~ removal of testicle

149
Q

What stage is testicular cancer when it’s caught early

A

Staging 0-3

150
Q

What test is done to diagnose testicular cancer ?

A

Tumor maker blood test

151
Q

Risk for testicular cancer

A

Infertility

152
Q

When performing a testicular self exam what should you look for

A

Lumps, swelling, hardness, or other abnormal changes

153
Q

S/S of testicular cancer

A
  • lump or swelling on testicle
  • feeling of heaviness of scrotum
  • dull ache in lower belly or groin
  • usually painless in early stages
154
Q

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

A

Testicular torsion

155
Q

Reduced blood flow causes sudden and severe pain on one side of the scrotum ~ usually the left

A

Testicular torsion

156
Q

This is considered a medical emergency and blood flow must be restored within 6 hours

A

Testicular torsion

157
Q

Causes of torsion

A
  • vigorous activity
  • minor injury to testicles
  • while sleeping
  • undescended testicle
158
Q

Born with no tissue holding testes to scrotum allowing testes to swing inside the scrotum

A

Bell clapper deformity

159
Q

Inability to attain or maintain an erection

160
Q

Erection lasting longer then 4 hours

161
Q

Erectogenic drugs

A
  • sildenafil (viagra)
  • Tadalafil (Cialis)
162
Q

Erectogenic drugs - mode of action

A

Increased blood flow to penis and vasodilation of the pulmonary vasculature
DO NOT TAKE WITH NITRATES

163
Q

Side effects of ED

A
  • priapism
  • increased risk for heart attack
164
Q

Dysuria

A

Difficulty to urinate

165
Q

Oliguria

A

Scant amount of urine

166
Q

Anuria

167
Q

Polyuria

A

Frequency, lots of urine

~ diabetics are more likely to get this

IM 2 (17 decks)

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