Lower Urinary System, M/F disorders Flashcards
Ureters
carry urine from the renal pelvis to the bladder
- urethral lumen is narrow
The male urethra is how long
8-10 inches
The female urethra is how long
1-2 inches
What gender is more prone to UTIs and why?
females
- urethra is smaller in length
Bladder
reservoir for urine
- urination, micturition, and voiding
What is the capacity of bladders in mL?
600-1000
What muscle is located in the bladder?
detrusor
What does the detrusor muscle do?
contracts during urination when full (ideal)
How does urine flow? Protective mechanisms
- 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
What connects the ureters to the bladder?
ureterovesical valves (one-way)
How to maintain a healthy bladder?
- 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
What bacteria from feces causes the most common UTIs?
e coli.
Kegel exercises do what?
contract or squeeze muscles around the rectum and vagina at the same time
Urinary incontinence def
involuntary/uncontrolled loss of urine in any amount
Types of incontinence
Stress
Urge
Functional
Stress Urinary Incontinence
sudden, involuntary passage of urine by physical mvmt
- brought on by laughing, coughing, sneezing, and heavy lifting outs stress on bladder
Urge Urinary Incontienece
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**
Functional Urinary Incontinence
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
Physiological causes of stress incontinence
pelvic floor muscles and urinary sphincter weaken
What are the gender-causing differences in stress incontinence?
childbirth in women
prostate surgery in men
What devices help if they have stress incontinence?
vaginal pessary - presses on urethra and support bladder base
urethral inserts - like tampon barrier one-time
If the pt has stress incontinence, what surgery might the patient consider?
vaginal sling
injectable bulking agents
inflatable artificial sphincter
Other names for urge incontinence
overactive bladder
bladder spasms
irritable bladder
detrusor instability
BPH puts pressure on what
prostate pressure on urethra
Terazosin can cause what
hypotension
- change position slowly
Enuresis
bed wetting
Tamsulosin (FLOMAX) does treat
empty bladder and kidney stones
Don’t take what type of drugs with Terazosin and FLOMAX?
erectile drugs
antacids
Anticholinergics treat
overactive bladder and urinary incontinence
- dries up everything
** can not see, pee, spit, or poop**
What type of drug is Oxybutynin (Daytrol)?
anticholinergic
Oxybutynin (Daytrol) purpose
decreases urgency, frequency, and nocturia in overactive bladder
- causes urinary retention
DO NOT use anticholinergics if a patient has
- 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
Treatments for urinary incontinence
- Kegel
- bladder retraining
- Botox injections
- nerve stimulator
- Anticholinergic medications (Detrol and Ditropan)
Urinary Retention
inability to empty bladder
Acute urinary retention is a
medical emergency
- example = enlarged prostate
Chronic urinary retention examples
alcoholic, drug abuse, diabetes, anticholinergic pt
What 2 dysfunctions are caused by the urinary system?
- bladder outlet obstruction - BPH (enlarged prostate)
- deficient detrusor contraction strength
Acute Phase = Nursing Management
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
If you can palpate the bladder, it is
full
Chronic Urine Retention Nursing Mngmt
an intermittent or indwelling urinary catheter (straight)
- schedule toilet times
Bladder Cancer is the ____ th most common cancer in men and ___th most common in women
4; 8
What is the most important risk factor of bladder cancer?
smoking
S/S of bladder cancer
Painless hematuria - large or micro
- bladder irritability
- dysuria, frequency, and urgency
Diagnosis of bladder cancer
urine cytology
lab for tumor markers
cystoscopy
imaging
The main indicator of bladder cancer is
painless hematuria
Urinary diversions
ideal conduit and neobladder (permanent)
What is the most common after complete removal of the bladder for bladder cancer?
Urostomy (ideal conduit)
What is a urostomy?
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
Ideal Conduit
incontinent diversion to skin
Continent Cutaneous Reservoir
continent diversion to skin
- with stoma and pouch
Orthotopic Neobladder
continent diversion to urethra
Preoperative Nurse Management for Urinary Diversions
- 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
Neurogenic Bladder
nerves between spinal cord and brain don’t work
- Parkinson’s, MS, stroke, diabetes
Neurogenic Bladder Nursing Interventions
- routine void measures
- avoid caffeine and alcohol
- Kegel exercises
- Catheter care prn
- Tamsulosin (FLOMAX)
What does Tamsulosin (Flomax) do?
improves bladder storage and emptying
Diagnostic Studies for Urinary Systems
Urinalysis
Urine studies
Serum creatinine
BUN
Creatinine clearance
What does a urinalysis show?
- measurement of color, pH, specific gravity
- presents of glucose, protein, blood, and ketones
- microscopic of crystals, bacteria
In an urinalysis, what is the best specimen?
- 1st morning void
- catch midstream
- wipe with clean cloth first
By what time should the urine specimen be examined or otherwise it is considered contaminated?
1 hour
High specific gravity means
dehydrated
If ketones in urine,
dieting or diabetes
Urine studies include
- Culture and sensitivity
- Creatinine clearance
Creatinine clearance collect ___ hour urine specimen
24
Creatinine clearance closely shows
approximate GFR (glomerular filtration rate)
How many mL are used in urinalysis?
10
Creatinine is the breakdown of
protein
Serum creatinine is abnormal
Men: greater than 1.4 mg/dL
Women: greater than 1.2 mg/dL
BUN normal values
7-20 mg/dL
High BUN with normal creatinine means
dehydration
What is the most accurate measurement of kidney function?
GFR
What 2 tests would you look at to determine the kidney’s function?
Creatinine
BUN
What types of test would you need to know before giving EVERY medication?
Kidney function (Creatinine and BUN)
During creatinine clearance, what should you do with the first urine?
discard
24 Hour Urine test requirements
- 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
If the patient forgets to place a specimen in the collection, then
start over
Interstitial Cystitis aka
Painful bladder syndrome
What makes interstitial cystitis difficult to diagnose?
because it is mistaken for UTI
but urine shows no bacteria
Interstitial cystitis is most common in
women and chronic
If creatinine and BUN are high
renal failure
S/S of Interstitial Cystitis
- 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
What is a common medication taken along with Painful bladder syndrome?
antianxiety or antidepressant
UTI causes
- 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)
UTI Pathophysiology
- bacteria enters sterile bladder
- inflammation is cuased
- inflammation spread upwards to organs
Most common Bacterial infection for UTI
E coli.
T/F: Fungal and parasitic infections can cause UTIs
True
Cystitis
inflammation of bladder
Pyelonephritis
inflammation of kidneys
Urethritis
inflammation of ureters
Urosepsis
untreated UTI spreads to kidneys
CAUTI
Catheter-associated Urinary Tract Infection
What is the most common hospital acquired infection?
CAUTI
1 Cause of CAUTI
prolonged use of urinary catheter
1 Cause of CAUTI
- and others
prolonged use of urinary catheter
-Others: e coli., pseudomonas, proteus marabilis
Risk factors of CAUTI
- Pediatric and female population
- congenital defects
- urinary retention
- pregnancy
- menopause
- multiple partners
S/S CAUTI
- hesitancy, frequency, urgency
- dysuria
- suprapubic pain
- UA/urine culture
~gross hematuria
~cloudy
~positive for WBC and nitrites
Nursing Management for CAUTI
- UA and culture - clean catch
- Antibiotics and analgesic
- Prevention of CAUTI and urosepsis
CDC Guidelines: Indications for Indwelling Catheter
- 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
Risk factors of Urosepsis
urinary catheters
- advanced age with different signs
- compromised immune system
- diabetes
- females
- surgical procedures involving urinary tract
Geriatric S/S of urosepsis
- sudden LOC
- falls
- tachypnea
- low fever or afebrile
- VS appear normal
What is the initial s/s of UTI?
abnormal WBC (TOO LOW OR HIGH)
- urgency
- frequency
- foul-smelling urine
- dysuria
- lower abdominal pain
Why do geriatric patients not notice if they a UTI?
the initial symptoms are normal in them
Pyelonephritis / Serious symptoms of UTI
- nausea and vomiting
- fever and chills
-
pain in lower spine
CVA tenderness = costovertebral angle tenderness
Sepsis Symptoms MEWS Score
RR 22+
Systolic less than 100
WBC abnormally high or low
Septic Shock S/S
- organ failure (kidney)
- low platelet count
- LOC change
- High lactic acid in blood
High lactic acid in blood means
cells are not utilizing O2 in the right way
What can a nurse do if a patient is in septic shock?
- 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
What size is the prostate in adult males?
Almond size
What size is the prostate in male children?
pea sized
What reproductive organs are unique to males?
penis
testicles
prostate
scrotum
What urinary/reproductive organs are unique to females?
Peyronies
crooked penis
Priapism
too much blood flow to the penis (viagra or ring)
Phimosis
foreskin stuck
Hypospadius
urethra located under testicles
Diaphalia
2 penises
Penile stragulation
blood flow is cut off from penis
Prostate gland PURPOSE
- produces semen
- transports sperm during ejaculation
Enlarged prostate puts pressure on
urethra causing dysuria
Medical term for enlarged prostate
Benign prostatic hypertrophy (BPH)
What is the main cause of urinary retention in men?
BPH
BPH Risk factors
- age
- Obesity
- high protein diet
- alcohol and smoking
- family hx in 1st degree relative
BPH Obstructive symptoms
difficulty starting and stopping
dribbling
slow and weak stream
BPH ** Irritative** symptoms
nocturia
frequency
urgency
dysuria
BPH Diagnostic Studies
- history and physical
- digital rectal exam (DRE)
- prostatic specific antigen (PSA - blood test) = not always cancer
- transrectal ultrasound if enlarged
What are the 2 main classes of BPH Medications?
-adrenergic receptor blockers
- 5a reductase inhibitors
Adrenergic receptor blockers PURPOSE
relax smooth muscles of prostate
What medications are adrenergic receptor blockers
tamsulosin FLOMAX
Terazosin (Hytrin)
tamsulosin (FLOMAX) does
empty bladder and kidney stones
Terazosin (Hytrin) causes
- precaution
hypertension
change positions slowly
DO NOT take ________ with Terazosin
Viagara (sildenafil)
5a reductase inhibitors does
reduces size of prostate gland
What medications are 5a reductase inhibitors?
finasteraide (Proscar) - hx of BPH (TROUBLE WITH CATHETER)
dutasteride (Avodart)
Anticholinergics are not used with
BPH or decongestants (claratin, benadryl, sudafed) bc of hypertension
Anticholonergics treat
overactive bladder and urinary incontinence
Oxybutynin (Ditropan)
decreases urgency, frequency, and nocturia in overactive bladder
- causes urinary retention
Hydronephrosis
swelling of kidneys due to build up of urine causing swelling
Complications of BPH
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
Transurethral Resection of Prostate (TURP) for BPH
Surgery to remove parts of prostate tissue through penis
Post TURP what is used to provide hemostasis and urinary drainage
3 way indwelling catheter
- Continuous 3 way for irrigation (Murphy) for clots and hematuria
Intermittent irrigation
manual irrigation for bladder spasms
clots decreasing outflow
Patients with Bladder Irrigation
- 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
When the patient goes home after TURP, what would the nurse teach them?
- 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
Prostate Cancer is the ___ leading cause of cancer death in men
2
Risk factors of prostate cancer
age (50+)
obesity
heavy abuse alcohol
family hx
Prostate Cancer
no symptoms in early
early recognition and tx to prevent metastasis
diagnosed through PSA and biopsy
TNM and Gleason score to stage
If you have a low gleason score
then removal of the organ is low
Radical Prostatectomy
removal of prostate, seminal vessels, and part of bladder
- large catheter with 20-30 mL balloon in place (and goes home with it in)
Adverse outcomes f Radical Prostatectomy
erectile dysfunction
urinary incontience
Testicular Cancer is seen in ______ ______
young males
Testicular Cancer is found through
cyptorchidism or family hx
Testicular Cancer is ______ curable
very
- radical inguinal orchiectomy and regional lymph nodes
- chemotherapy and radiation
- rick of infertility but cryopreserve sperm
S/S of testicular cancer
lump or swelling
heavy scrotum
dull ache in belly or groin
swelling sudden in scrotum
pain or discomfort
Prostatitis
inflammation or noninflamed prostate
Main symptom of prostatitis
pain when ejaculating
Treatment of Prostatitis
acute bacterial - antibiotics for 4 weeks
chronic bacterial - antibiotic for 8-12 weeks
cause ejaculatory pain
Erectile dysfunction
inability to attain or maintain an erectin
- increase with age 40-70
Tx erectile dysfunction
penile injections
erectile deices
erectogenic drugs (Viagara and tadafil) not with nitrate
Priapsim
erection longer than 4 hours
Dysuria
painful urination
Oliguria
abnormally small amounts of urine
Anuria
no urination
Polyuria
too much frequent urination
Which part of the bladder keeps the same shape during bladder filling?
Trigone of a bladder
Differences between stress and urge incontinence
stress is a physical reaction with peeing
urge is pee right then and there urgently
UTI S/S
burn with pee
might bleed
discomfort
