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Module 2 (Skills) > Lower Urinary System, M/F disorders > Flashcards

Lower Urinary System, M/F disorders Flashcards

1
Q

Ureters

A

carry urine from the renal pelvis to the bladder
- urethral lumen is narrow

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2
Q

The male urethra is how long

A

8-10 inches

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3
Q

The female urethra is how long

A

1-2 inches

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4
Q

What gender is more prone to UTIs and why?

A

females
- urethra is smaller in length

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5
Q

Bladder

A

reservoir for urine
- urination, micturition, and voiding

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6
Q

What is the capacity of bladders in mL?

A

600-1000

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7
Q

What muscle is located in the bladder?

A

detrusor

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8
Q

What does the detrusor muscle do?

A

contracts during urination when full (ideal)

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9
Q

How does urine flow? Protective mechanisms

A
  • flows downward to prevent urine back flowing to the kidneys
  • ureters connect to the bladder through oneway valves
    -muscles of the bladder
  • urine is sterile
  • pH of urine is acidic
  • prostate gland in male antimicrobial fluid
  • normal flora of the vagina
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10
Q

What connects the ureters to the bladder?

A

ureterovesical valves (one-way)

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11
Q

How to maintain a healthy bladder?

A
  • use the bathroom when needed (void every 2-4 hours)
  • wipe front to back
  • urinate after intercourse
  • Kegel exercises
  • cotton underwear
  • limit alcohol, caffeine, and smoking cessation
  • lots of fluids
  • exercise and weight management
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12
Q

What bacteria from feces causes the most common UTIs?

A

e coli.

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13
Q

Kegel exercises do what?

A

contract or squeeze muscles around the rectum and vagina at the same time

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14
Q

Urinary incontinence def

A

involuntary/uncontrolled loss of urine in any amount

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15
Q

Types of incontinence

A

Stress
Urge
Functional

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16
Q

Stress Urinary Incontinence

A

sudden, involuntary passage of urine by physical mvmt
- brought on by laughing, coughing, sneezing, and heavy lifting outs stress on bladder

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17
Q

Urge Urinary Incontienece

A

overactive bladder: involuntary urination brought on by the urgency
- strong urge to urinate, can’t make it to the toilet
involuntary urination with little or no warning
-frequent urination or nocturia**

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18
Q

Functional Urinary Incontinence

A

urinary tract functions properly BUT an illness or disability causing urine leakage
- affect anyone with a condition difficult to reach the bathroom
- diuretics and dementia decrease awareness for bathroom

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19
Q

Physiological causes of stress incontinence

A

pelvic floor muscles and urinary sphincter weaken

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20
Q

What are the gender-causing differences in stress incontinence?

A

childbirth in women
prostate surgery in men

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21
Q

What devices help if they have stress incontinence?

A

vaginal pessary - presses on urethra and support bladder base
urethral inserts - like tampon barrier one-time

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22
Q

If the pt has stress incontinence, what surgery might the patient consider?

A

vaginal sling
injectable bulking agents
inflatable artificial sphincter

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23
Q

Other names for urge incontinence

A

overactive bladder
bladder spasms
irritable bladder
detrusor instability

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24
Q

BPH puts pressure on what

A

prostate pressure on urethra

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25
Q

Terazosin can cause what

A

hypotension
- change position slowly

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26
Q

Enuresis

A

bed wetting

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27
Q

Tamsulosin (FLOMAX) does treat

A

empty bladder and kidney stones

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28
Q

Don’t take what type of drugs with Terazosin and FLOMAX?

A

erectile drugs
antacids

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29
Q

Anticholinergics treat

A

overactive bladder and urinary incontinence
- dries up everything
** can not see, pee, spit, or poop**

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30
Q

What type of drug is Oxybutynin (Daytrol)?

A

anticholinergic

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31
Q

Oxybutynin (Daytrol) purpose

A

decreases urgency, frequency, and nocturia in overactive bladder
- causes urinary retention

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32
Q

DO NOT use anticholinergics if a patient has

A
  • BPH or glaucoma
  • with decongestants (Claritin, Benadryl, Sudafed) bc will cause hypertension
  • careful exercising or hot bath bc they are dehydrate quickly and don’t sweat
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33
Q

Treatments for urinary incontinence

A
  • Kegel
  • bladder retraining
  • Botox injections
  • nerve stimulator
  • Anticholinergic medications (Detrol and Ditropan)
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34
Q

Urinary Retention

A

inability to empty bladder

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35
Q

Acute urinary retention is a

A

medical emergency
- example = enlarged prostate

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36
Q

Chronic urinary retention examples

A

alcoholic, drug abuse, diabetes, anticholinergic pt

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37
Q

What 2 dysfunctions are caused by the urinary system?

A
  • bladder outlet obstruction - BPH (enlarged prostate)
  • deficient detrusor contraction strength
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38
Q

Acute Phase = Nursing Management

A

bladder scan
palpate height of bladder distension
void hx
needs indwelling urinary catheter
small amounts of fluids
avoid alcohol and smoking
sitting in a tub or warm water/shower

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39
Q

If you can palpate the bladder, it is

A

full

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40
Q

Chronic Urine Retention Nursing Mngmt

A

an intermittent or indwelling urinary catheter (straight)
- schedule toilet times

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41
Q

Bladder Cancer is the ____ th most common cancer in men and ___th most common in women

A

4; 8

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42
Q

What is the most important risk factor of bladder cancer?

A

smoking

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43
Q

S/S of bladder cancer

A

Painless hematuria - large or micro
- bladder irritability
- dysuria, frequency, and urgency

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44
Q

Diagnosis of bladder cancer

A

urine cytology
lab for tumor markers
cystoscopy
imaging

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45
Q

The main indicator of bladder cancer is

A

painless hematuria

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46
Q

Urinary diversions

A

ideal conduit and neobladder (permanent)

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47
Q

What is the most common after complete removal of the bladder for bladder cancer?

A

Urostomy (ideal conduit)

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48
Q

What is a urostomy?

A

portion of ileum (s. intestine) resected
- one end of segment closed
- ureters attached to closed end of ileum
- open end of ileum brought through abdomen
- forms stoma and bag placed over it

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49
Q

Ideal Conduit

A

incontinent diversion to skin

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50
Q

Continent Cutaneous Reservoir

A

continent diversion to skin
- with stoma and pouch

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51
Q

Orthotopic Neobladder

A

continent diversion to urethra

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52
Q

Preoperative Nurse Management for Urinary Diversions

A
  • involve family in teaching
  • address psychological aspect of stoma, stoma care, and application
  • encourage talk of feelings related to creation of stoma
  • enterostomal therapist consult
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53
Q

Neurogenic Bladder

A

nerves between spinal cord and brain don’t work
- Parkinson’s, MS, stroke, diabetes

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54
Q

Neurogenic Bladder Nursing Interventions

A
  • routine void measures
  • avoid caffeine and alcohol
  • Kegel exercises
  • Catheter care prn
  • Tamsulosin (FLOMAX)
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55
Q

What does Tamsulosin (Flomax) do?

A

improves bladder storage and emptying

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56
Q

Diagnostic Studies for Urinary Systems

A

Urinalysis
Urine studies
Serum creatinine
BUN
Creatinine clearance

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57
Q

What does a urinalysis show?

A
  • measurement of color, pH, specific gravity
  • presents of glucose, protein, blood, and ketones
  • microscopic of crystals, bacteria
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58
Q

In an urinalysis, what is the best specimen?

A
  • 1st morning void
  • catch midstream
  • wipe with clean cloth first
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59
Q

By what time should the urine specimen be examined or otherwise it is considered contaminated?

A

1 hour

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60
Q

High specific gravity means

A

dehydrated

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61
Q

If ketones in urine,

A

dieting or diabetes

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62
Q

Urine studies include

A
  • Culture and sensitivity
  • Creatinine clearance
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63
Q

Creatinine clearance collect ___ hour urine specimen

A

24

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64
Q

Creatinine clearance closely shows

A

approximate GFR (glomerular filtration rate)

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65
Q

How many mL are used in urinalysis?

A

10

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66
Q

Creatinine is the breakdown of

A

protein

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67
Q

Serum creatinine is abnormal

A

Men: greater than 1.4 mg/dL
Women: greater than 1.2 mg/dL

68
Q

BUN normal values

A

7-20 mg/dL

69
Q

High BUN with normal creatinine means

A

dehydration

70
Q

What is the most accurate measurement of kidney function?

A

GFR

71
Q

What 2 tests would you look at to determine the kidney’s function?

A

Creatinine
BUN

72
Q

What types of test would you need to know before giving EVERY medication?

A

Kidney function (Creatinine and BUN)

73
Q

During creatinine clearance, what should you do with the first urine?

A

discard

74
Q

24 Hour Urine test requirements

A
  • discard first urine
  • place in ice or refrigerate
  • initially empty bladder, record time, save all after first
  • urinate at the 24 hour mark and add to collection
75
Q

If the patient forgets to place a specimen in the collection, then

A

start over

76
Q

Interstitial Cystitis aka

A

Painful bladder syndrome

77
Q

What makes interstitial cystitis difficult to diagnose?

A

because it is mistaken for UTI
but urine shows no bacteria

78
Q

Interstitial cystitis is most common in

A

women and chronic

79
Q

If creatinine and BUN are high

A

renal failure

80
Q

S/S of Interstitial Cystitis

A
  • pain in perineum
  • persistent urgent need to void
  • painful intercourse
  • frequent urination (60+ a day)
  • pain while bladder fills and relief after urinating
  • possible autoimmune or hereditary
81
Q

What is a common medication taken along with Painful bladder syndrome?

A

antianxiety or antidepressant

82
Q

UTI causes

A
  • Hormones (menopause, birth control
  • Antibiotics
  • Renal stones
  • Diabetes
  • Toiletries (bubble baths, not front to back)
  • Obstructive prostate
  • Vesicoureteral reflux
  • Overextended bladder
  • Indwelling urinary catheter
  • Decreased immune system (elderly)
83
Q

UTI Pathophysiology

A
  • bacteria enters sterile bladder
  • inflammation is cuased
  • inflammation spread upwards to organs
84
Q

Most common Bacterial infection for UTI

A

E coli.

85
Q

T/F: Fungal and parasitic infections can cause UTIs

A

True

86
Q

Cystitis

A

inflammation of bladder

87
Q

Pyelonephritis

A

inflammation of kidneys

88
Q

Urethritis

A

inflammation of ureters

89
Q

Urosepsis

A

untreated UTI spreads to kidneys

90
Q

CAUTI

A

Catheter-associated Urinary Tract Infection

91
Q

What is the most common hospital acquired infection?

A

CAUTI

92
Q

1 Cause of CAUTI

A

prolonged use of urinary catheter

93
Q

1 Cause of CAUTI

  • and others
A

prolonged use of urinary catheter
-Others: e coli., pseudomonas, proteus marabilis

94
Q

Risk factors of CAUTI

A
  • Pediatric and female population
  • congenital defects
  • urinary retention
  • pregnancy
  • menopause
  • multiple partners
95
Q

S/S CAUTI

A
  • hesitancy, frequency, urgency
  • dysuria
  • suprapubic pain
  • UA/urine culture
    ~gross hematuria
    ~cloudy
    ~positive for WBC and nitrites
96
Q

Nursing Management for CAUTI

A
  • UA and culture - clean catch
  • Antibiotics and analgesic
  • Prevention of CAUTI and urosepsis
97
Q

CDC Guidelines: Indications for Indwelling Catheter

A
  • acute urinary retention /bladder outlet obstruction
  • need for accurate I&O (hourly monitoring)
  • assist in healing of open sacral or perineal wounds
    ~ incontinence infects pressure ulcers
  • prior to certain surgical procedures
  • pt requires prolonged immobilization
  • improve comfort for end of life
98
Q

Risk factors of Urosepsis

A

urinary catheters
- advanced age with different signs
- compromised immune system
- diabetes
- females
- surgical procedures involving urinary tract

99
Q

Geriatric S/S of urosepsis

A
  • sudden LOC
  • falls
  • tachypnea
  • low fever or afebrile
  • VS appear normal
100
Q

What is the initial s/s of UTI?

A

abnormal WBC (TOO LOW OR HIGH)
- urgency
- frequency
- foul-smelling urine
- dysuria
- lower abdominal pain

101
Q

Why do geriatric patients not notice if they a UTI?

A

the initial symptoms are normal in them

102
Q

Pyelonephritis / Serious symptoms of UTI

A
  • nausea and vomiting
  • fever and chills
  • pain in lower spine
    CVA tenderness = costovertebral angle tenderness
103
Q

Sepsis Symptoms MEWS Score

A

RR 22+
Systolic less than 100
WBC abnormally high or low

104
Q

Septic Shock S/S

A
  • organ failure (kidney)
  • low platelet count
  • LOC change
  • High lactic acid in blood
105
Q

High lactic acid in blood means

A

cells are not utilizing O2 in the right way

106
Q

What can a nurse do if a patient is in septic shock?

A
  • Early goal-directed therapy
  • Broad spectrum antibiotics
  • Control pain
  • IV Fluids for BP support
  • O2 Therapy
  • Strict I&O
  • removal of any catheters and devices possibly infected
  • Support lung and flow of blood
107
Q

What size is the prostate in adult males?

A

Almond size

108
Q

What size is the prostate in male children?

A

pea sized

109
Q

What reproductive organs are unique to males?

A

penis
testicles
prostate
scrotum

110
Q

What urinary/reproductive organs are unique to females?

A
111
Q

Peyronies

A

crooked penis

112
Q

Priapism

A

too much blood flow to the penis (viagra or ring)

113
Q

Phimosis

A

foreskin stuck

114
Q

Hypospadius

A

urethra located under testicles

115
Q

Diaphalia

A

2 penises

116
Q

Penile stragulation

A

blood flow is cut off from penis

117
Q

Prostate gland PURPOSE

A
  • produces semen
  • transports sperm during ejaculation
118
Q

Enlarged prostate puts pressure on

A

urethra causing dysuria

119
Q

Medical term for enlarged prostate

A

Benign prostatic hypertrophy (BPH)

120
Q

What is the main cause of urinary retention in men?

A

BPH

121
Q

BPH Risk factors

A
  • age
  • Obesity
  • high protein diet
  • alcohol and smoking
  • family hx in 1st degree relative
122
Q

BPH Obstructive symptoms

A

difficulty starting and stopping
dribbling
slow and weak stream

123
Q

BPH ** Irritative** symptoms

A

nocturia
frequency
urgency
dysuria

124
Q

BPH Diagnostic Studies

A
  • history and physical
  • digital rectal exam (DRE)
  • prostatic specific antigen (PSA - blood test) = not always cancer
  • transrectal ultrasound if enlarged
125
Q

What are the 2 main classes of BPH Medications?

A

-adrenergic receptor blockers
- 5a reductase inhibitors

126
Q

Adrenergic receptor blockers PURPOSE

A

relax smooth muscles of prostate

127
Q

What medications are adrenergic receptor blockers

A

tamsulosin FLOMAX
Terazosin (Hytrin)

128
Q

tamsulosin (FLOMAX) does

A

empty bladder and kidney stones

129
Q

Terazosin (Hytrin) causes
- precaution

A

hypertension
change positions slowly

130
Q

DO NOT take ________ with Terazosin

A

Viagara (sildenafil)

131
Q

5a reductase inhibitors does

A

reduces size of prostate gland

132
Q

What medications are 5a reductase inhibitors?

A

finasteraide (Proscar) - hx of BPH (TROUBLE WITH CATHETER)
dutasteride (Avodart)

133
Q

Anticholinergics are not used with

A

BPH or decongestants (claratin, benadryl, sudafed) bc of hypertension

134
Q

Anticholonergics treat

A

overactive bladder and urinary incontinence

135
Q

Oxybutynin (Ditropan)

A

decreases urgency, frequency, and nocturia in overactive bladder
- causes urinary retention

136
Q

Hydronephrosis

A

swelling of kidneys due to build up of urine causing swelling

137
Q

Complications of BPH

A

Hydronephrosis - no urine draining out of kidneys
Causes blockage of outflow of urine from bladder to kidneys
- BPH
-Kidney stones
- Narrow of ureters
- nephrostomy tube if severe

138
Q

Transurethral Resection of Prostate (TURP) for BPH

A

Surgery to remove parts of prostate tissue through penis

139
Q

Post TURP what is used to provide hemostasis and urinary drainage

A

3 way indwelling catheter
- Continuous 3 way for irrigation (Murphy) for clots and hematuria

140
Q

Intermittent irrigation

A

manual irrigation for bladder spasms
clots decreasing outflow

141
Q

Patients with Bladder Irrigation

A
  • assess for bleeding and clots
  • monitor in and outflow
  • manually irrigate for spasms or if decreases outflow
  • antispasmodics and analgesics
  • monitor for increase in blood
142
Q

When the patient goes home after TURP, what would the nurse teach them?

A
  • Kegel
  • no heavy lifting
  • s/s of infection
  • stool softeners for straining
  • fluid intake of 2-3 L daily
  • avoid caffeine and alcohol
  • patience - time for continence
143
Q

Prostate Cancer is the ___ leading cause of cancer death in men

A

2

144
Q

Risk factors of prostate cancer

A

age (50+)
obesity
heavy abuse alcohol
family hx

145
Q

Prostate Cancer

A

no symptoms in early
early recognition and tx to prevent metastasis
diagnosed through PSA and biopsy
TNM and Gleason score to stage

146
Q

If you have a low gleason score

A

then removal of the organ is low

147
Q

Radical Prostatectomy

A

removal of prostate, seminal vessels, and part of bladder
- large catheter with 20-30 mL balloon in place (and goes home with it in)

148
Q

Adverse outcomes f Radical Prostatectomy

A

erectile dysfunction
urinary incontience

149
Q

Testicular Cancer is seen in ______ ______

A

young males

150
Q

Testicular Cancer is found through

A

cyptorchidism or family hx

151
Q

Testicular Cancer is ______ curable

A

very
- radical inguinal orchiectomy and regional lymph nodes
- chemotherapy and radiation
- rick of infertility but cryopreserve sperm

152
Q

S/S of testicular cancer

A

lump or swelling
heavy scrotum
dull ache in belly or groin
swelling sudden in scrotum
pain or discomfort

153
Q

Prostatitis

A

inflammation or noninflamed prostate

154
Q

Main symptom of prostatitis

A

pain when ejaculating

155
Q

Treatment of Prostatitis

A

acute bacterial - antibiotics for 4 weeks
chronic bacterial - antibiotic for 8-12 weeks
cause ejaculatory pain

156
Q

Erectile dysfunction

A

inability to attain or maintain an erectin
- increase with age 40-70

157
Q

Tx erectile dysfunction

A

penile injections
erectile deices
erectogenic drugs (Viagara and tadafil) not with nitrate

158
Q

Priapsim

A

erection longer than 4 hours

159
Q

Dysuria

A

painful urination

160
Q

Oliguria

A

abnormally small amounts of urine

161
Q

Anuria

A

no urination

162
Q

Polyuria

A

too much frequent urination

163
Q

Which part of the bladder keeps the same shape during bladder filling?

A

Trigone of a bladder

164
Q

Differences between stress and urge incontinence

A

stress is a physical reaction with peeing
urge is pee right then and there urgently

165
Q

UTI S/S

A

burn with pee
might bleed
discomfort

Module 2 (Skills) (12 decks)

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