Lower Urinary System, M/F disorders Flashcards
1
Q
Ureters
A
carry urine from the renal pelvis to the bladder
- urethral lumen is narrow
2
Q
The male urethra is how long
A
8-10 inches
3
Q
The female urethra is how long
A
1-2 inches
4
Q
What gender is more prone to UTIs and why?
A
females
- urethra is smaller in length
5
Q
Bladder
A
reservoir for urine
- urination, micturition, and voiding
6
Q
What is the capacity of bladders in mL?
A
600-1000
7
Q
What muscle is located in the bladder?
A
detrusor
8
Q
What does the detrusor muscle do?
A
contracts during urination when full (ideal)
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
10
Q
What connects the ureters to the bladder?
A
ureterovesical valves (one-way)
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
12
Q
What bacteria from feces causes the most common UTIs?
A
e coli.
13
Q
Kegel exercises do what?
A
contract or squeeze muscles around the rectum and vagina at the same time
14
Q
Urinary incontinence def
A
involuntary/uncontrolled loss of urine in any amount
15
Q
Types of incontinence
A
Stress
Urge
Functional
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
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**
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
19
Q
Physiological causes of stress incontinence
A
pelvic floor muscles and urinary sphincter weaken
20
Q
What are the gender-causing differences in stress incontinence?
A
childbirth in women
prostate surgery in men
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
22
Q
If the pt has stress incontinence, what surgery might the patient consider?
A
vaginal sling
injectable bulking agents
inflatable artificial sphincter
23
Q
Other names for urge incontinence
A
overactive bladder
bladder spasms
irritable bladder
detrusor instability
24
Q
BPH puts pressure on what
A
prostate pressure on urethra
25
Terazosin can cause what
hypotension
- change position slowly
26
Enuresis
bed wetting
27
Tamsulosin (FLOMAX) does treat
empty bladder and kidney stones
28
Don't take what type of drugs with Terazosin and FLOMAX?
erectile drugs
antacids
29
Anticholinergics treat
overactive bladder and urinary incontinence
- dries up everything
** can not see, pee, spit, or poop**
30
What type of drug is Oxybutynin (Daytrol)?
anticholinergic
31
Oxybutynin (Daytrol) purpose
decreases urgency, frequency, and nocturia in overactive bladder
- causes urinary retention
32
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
33
Treatments for urinary incontinence
- Kegel
- bladder retraining
- Botox injections
- nerve stimulator
- Anticholinergic medications (Detrol and Ditropan)
34
Urinary Retention
inability to empty bladder
35
Acute urinary retention is a
medical emergency
- example = enlarged prostate
36
Chronic urinary retention examples
alcoholic, drug abuse, diabetes, anticholinergic pt
37
What 2 dysfunctions are caused by the urinary system?
- bladder outlet obstruction - BPH (enlarged prostate)
- deficient detrusor contraction strength
38
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
39
If you can palpate the bladder, it is
full
40
Chronic Urine Retention Nursing Mngmt
an intermittent or indwelling urinary catheter (straight)
- schedule toilet times
41
Bladder Cancer is the ____ th most common cancer in men and ___th most common in women
4; 8
42
What is the most important risk factor of bladder cancer?
smoking
43
S/S of bladder cancer
**Painless hematuria** - large or micro
- bladder irritability
- dysuria, frequency, and urgency
44
Diagnosis of bladder cancer
urine cytology
lab for tumor markers
cystoscopy
imaging
45
The main indicator of bladder cancer is
**painless** hematuria
46
Urinary diversions
ideal conduit and neobladder (permanent)
47
What is the most common after complete removal of the bladder for bladder cancer?
Urostomy (ideal conduit)
48
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
49
Ideal Conduit
incontinent diversion to skin
50
Continent Cutaneous Reservoir
continent diversion to skin
- **with stoma and pouch**
51
Orthotopic Neobladder
continent diversion to urethra
52
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
53
Neurogenic Bladder
nerves between spinal cord and brain don't work
- Parkinson's, MS, stroke, diabetes
54
Neurogenic Bladder Nursing Interventions
- routine void measures
- avoid caffeine and alcohol
- Kegel exercises
- Catheter care prn
- Tamsulosin (FLOMAX)
55
What does Tamsulosin (Flomax) do?
improves bladder storage and emptying
56
Diagnostic Studies for Urinary Systems
Urinalysis
Urine studies
Serum creatinine
BUN
Creatinine clearance
57
What does a urinalysis show?
- measurement of **color, pH, specific gravity**
- presents of **glucose, protein, blood, and ketones**
- microscopic of **crystals, bacteria**
58
In an urinalysis, what is the best specimen?
- 1st morning void
- catch midstream
- wipe with clean cloth first
59
By what time should the urine specimen be examined or otherwise it is considered contaminated?
1 hour
60
High specific gravity means
dehydrated
61
If ketones in urine,
dieting or diabetes
62
Urine studies include
- Culture and sensitivity
- Creatinine clearance
63
Creatinine clearance collect ___ hour urine specimen
24
64
Creatinine clearance closely shows
approximate GFR (glomerular filtration rate)
65
How many mL are used in urinalysis?
10
66
Creatinine is the breakdown of
protein
67
Serum creatinine is abnormal
Men: greater than 1.4 mg/dL
Women: greater than 1.2 mg/dL
68
BUN normal values
7-20 mg/dL
69
High BUN with normal creatinine means
dehydration
70
What is the most accurate measurement of kidney function?
GFR
71
What 2 tests would you look at to determine the kidney's function?
Creatinine
BUN
72
What types of test would you need to know before giving EVERY medication?
Kidney function (Creatinine and BUN)
73
During creatinine clearance, what should you do with the first urine?
discard
74
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
75
If the patient forgets to place a specimen in the collection, then
start over
76
Interstitial Cystitis aka
Painful bladder syndrome
77
What makes interstitial cystitis difficult to diagnose?
because it is mistaken for UTI
but urine shows no bacteria
78
Interstitial cystitis is most common in
women and chronic
79
If creatinine and BUN are high
renal failure
80
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
81
What is a common medication taken along with Painful bladder syndrome?
antianxiety or antidepressant
82
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)
83
UTI Pathophysiology
- bacteria enters sterile bladder
- inflammation is cuased
- inflammation spread upwards to organs
84
Most common Bacterial infection for UTI
E coli.
85
T/F: Fungal and parasitic infections can cause UTIs
True
86
Cystitis
inflammation of bladder
87
Pyelonephritis
inflammation of kidneys
88
Urethritis
inflammation of ureters
89
Urosepsis
untreated UTI spreads to kidneys
90
CAUTI
Catheter-associated Urinary Tract Infection
91
What is the most common hospital acquired infection?
CAUTI
92
#1 Cause of CAUTI
prolonged use of urinary catheter
93
#1 Cause of CAUTI
- and others
prolonged use of urinary catheter
-Others: e coli., pseudomonas, proteus marabilis
94
Risk factors of CAUTI
- Pediatric and female population
- congenital defects
- urinary retention
- pregnancy
- menopause
- multiple partners
95
S/S CAUTI
- hesitancy, frequency, urgency
- dysuria
- suprapubic pain
- UA/urine culture
~gross hematuria
~cloudy
~positive for WBC and nitrites
96
Nursing Management for CAUTI
- UA and culture - clean catch
- Antibiotics and analgesic
- Prevention of CAUTI and urosepsis
97
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**
98
Risk factors of Urosepsis
**urinary catheters**
- advanced age with different signs
- compromised immune system
- diabetes
- females
- surgical procedures involving urinary tract
99
Geriatric S/S of urosepsis
- sudden LOC
- falls
- tachypnea
- low fever or afebrile
- VS appear normal
100
What is the initial s/s of UTI?
abnormal WBC (TOO LOW OR HIGH)
- urgency
- frequency
- foul-smelling urine
- dysuria
- **lower abdominal pain**
101
Why do geriatric patients not notice if they a UTI?
the initial symptoms are normal in them
102
Pyelonephritis / Serious symptoms of UTI
- nausea and vomiting
- fever and chills
- **pain in lower spine**
**CVA tenderness = costovertebral angle tenderness**
103
Sepsis Symptoms **MEWS Score**
RR 22+
Systolic less than 100
WBC abnormally high or low
104
Septic Shock S/S
- organ failure (kidney)
- low platelet count
- LOC change
- High lactic acid in blood
105
High lactic acid in blood means
cells are not utilizing O2 in the right way
106
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
107
What size is the prostate in adult males?
Almond size
108
What size is the prostate in male children?
pea sized
109
What reproductive organs are unique to males?
penis
testicles
prostate
scrotum
110
What urinary/reproductive organs are unique to females?
111
Peyronies
crooked penis
112
Priapism
too much blood flow to the penis (viagra or ring)
113
Phimosis
foreskin stuck
114
Hypospadius
urethra located under testicles
115
Diaphalia
2 penises
116
Penile stragulation
blood flow is cut off from penis
117
Prostate gland PURPOSE
- produces semen
- transports sperm during ejaculation
118
Enlarged prostate puts pressure on
urethra causing dysuria
119
Medical term for enlarged prostate
Benign prostatic hypertrophy (BPH)
120
What is the main cause of urinary retention in men?
BPH
121
BPH Risk factors
- age
- Obesity
- high protein diet
- alcohol and smoking
- **family hx in 1st degree relative**
122
BPH **Obstructive** symptoms
difficulty starting and stopping
dribbling
slow and weak stream
123
BPH ** Irritative** symptoms
nocturia
frequency
urgency
dysuria
124
BPH Diagnostic Studies
- history and physical
- digital rectal exam (DRE)
- prostatic specific antigen (PSA - blood test) = not always cancer
- transrectal ultrasound if enlarged
125
What are the 2 main classes of BPH Medications?
-adrenergic receptor blockers
- 5a reductase inhibitors
126
Adrenergic receptor blockers PURPOSE
relax smooth muscles of prostate
127
What medications are adrenergic receptor blockers
tamsulosin **FLOMAX**
Terazosin (Hytrin)
128
tamsulosin (FLOMAX) does
empty bladder and kidney stones
129
Terazosin (Hytrin) causes
- precaution
hypertension
change positions slowly
130
DO NOT take ________ with Terazosin
Viagara (sildenafil)
131
5a reductase inhibitors does
reduces size of prostate gland
132
What medications are 5a reductase inhibitors?
finasteraide **(Proscar)** - hx of BPH (TROUBLE WITH CATHETER)
dutasteride (Avodart)
133
Anticholinergics are not used with
BPH or decongestants (claratin, benadryl, sudafed) bc of hypertension
134
Anticholonergics treat
overactive bladder and urinary incontinence
135
Oxybutynin (Ditropan)
decreases urgency, frequency, and nocturia in overactive bladder
- causes urinary retention
136
Hydronephrosis
swelling of kidneys due to build up of urine causing swelling
137
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
138
Transurethral Resection of Prostate (TURP) for BPH
Surgery to remove parts of prostate tissue through penis
139
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
140
Intermittent irrigation
manual irrigation for bladder spasms
clots decreasing outflow
141
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
142
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
143
Prostate Cancer is the ___ leading cause of cancer death in men
2
144
Risk factors of prostate cancer
age (50+)
obesity
heavy abuse alcohol
family hx
145
Prostate Cancer
no symptoms in early
early recognition and tx to prevent metastasis
diagnosed through PSA and biopsy
TNM and Gleason score to stage
146
If you have a low gleason score
then removal of the organ is low
147
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)
148
Adverse outcomes f Radical Prostatectomy
erectile dysfunction
urinary incontience
149
Testicular Cancer is seen in ______ ______
young males
150
Testicular Cancer is found through
cyptorchidism or family hx
151
Testicular Cancer is ______ curable
very
- radical inguinal orchiectomy and regional lymph nodes
- chemotherapy and radiation
- **rick of infertility but cryopreserve sperm**
152
S/S of testicular cancer
lump or swelling
heavy scrotum
dull ache in belly or groin
swelling sudden in scrotum
pain or discomfort
153
Prostatitis
inflammation or noninflamed prostate
154
Main symptom of prostatitis
pain when ejaculating
155
Treatment of Prostatitis
acute bacterial - antibiotics for 4 weeks
chronic bacterial - antibiotic for 8-12 weeks
cause ejaculatory pain
156
Erectile dysfunction
inability to attain or maintain an erectin
- increase with age 40-70
157
Tx erectile dysfunction
penile injections
erectile deices
erectogenic drugs (Viagara and tadafil) **not with nitrate**
158
Priapsim
erection longer than 4 hours
159
Dysuria
painful urination
160
Oliguria
abnormally small amounts of urine
161
Anuria
no urination
162
Polyuria
too much frequent urination
163
Which part of the bladder keeps the same shape during bladder filling?
Trigone of a bladder
164
Differences between stress and urge incontinence
stress is a physical reaction with peeing
urge is pee right then and there urgently
165
UTI S/S
burn with pee
might bleed
discomfort
