Lower Urinary System Male/Female Urinary & Reproductive Disorders Flashcards
1
Q
Ureters: (2)
A
- Carries urine from renal pelvis to the bladder.
2.The Ureteral lumens are narrow.
(tube off kidney that connects to bladder)
2
Q
What is the function of the ureterovesical junction?
A
Space where urine is carried away from the kidneys, if it doesn’t work properly back flow will happen.
3
Q
Who has the longer urethra?
A
Women have a shorter urethra: 1-2 inch
Men have a longer urethra: 8- 10 inch
4
Q
Bladder: 3
A
- Reservoir for urine
- Capacity 600-1000ml
- Urination, micturation, voiding
5
Q
What is the bladder muscle called?
A
Detrusor muscle
6
Q
What happens if there is an issue with the detrusor muscle?
A
If not functioning, then there is an issue with passing urine.
7
Q
How does urine flow? (protecting mechanism)
(8)
A
- Flows downward to prevent urine back flowing to kidneys
- Ureters connect to bladder = ureterovesical valves (one-way valves)
- Muscles of bladder (detrusor)
- Pressure created by urine in bladder
- Urine itself is sterile
- pH of urine is acidic: prevents bacteria
- Prostate gland: secrete antimicrobial fluid to prevent infection
- Normal flora of vagina: Lactobacillus
8
Q
Maintaining a healthy bladder: (9)
A
- Use the bathroom often and when needed.
- Should void every 2-4 hours
- Wipe from front to back after toileting
- Urinate after intercourse
- Do pelvic floor muscle exercises (Kegels) contract or squeeze muscles around rectum and vagina at the same time
- Wear cotton underwear
- Limit alcohol, caffeine – smoking cessation
- Drink lots of fluids
- Exercise and weight management
9
Q
What is urinary incontinence?
A
Involuntary or uncontrolled loss of urine in any amount
10
Q
List the 3 types of urinary incontinence:
A
- Stress
- Urge (overactive bladder)
- Functional
11
Q
what is stress incontinence?
A
physical movement or activity – coughing, laughing, sneezing, running, heavy lifting puts pressure (stress) on bladder, causing leakage of urine
12
Q
What are some causes of stress incontinence? (3)
A
- pelvic floor muscle & urinary sphincter weaken due to
-Childbirth in women
-Prostate surgery in men
13
Q
(Stress incontinence)
Devices: 2
Surgery 3
A
Devices: vaginal pessary, urethral inserts
Surgery: Vaginal sling, injectable bulking agents, inflatable artificial sphincter
14
Q
Sling Procedure:
A
lifts up the urethra: like a hammock
bladder suspension ( another name )
best thing though is KEGELS
15
Q
Other names for urge incontinence:
A
- overactive bladder
- bladder spasms
- irritable bladder
- detrusor instability
16
Q
what is urge incontinence?
A
- Involuntary urination with little or no warning
- Frequent urination or nocturia
- Enuresis - Bed wetting
17
Q
Functional Incontinence:
A
Inability to get to or use the toilet in time to urinate
18
Q
(Functional Incontinence)
Usually due to physical or cognitive impairment:
A
- Inability to walk well
- Furniture in way
- Good lighting
19
Q
(Functional Incontinence)
treatment aimed at manipulating environment:
A
- Easy access to toilet
- Scheduled times for toileting
- Wearing clothes easy to remove
20
Q
What is an Anticholinergic and what do they do?
A
Treat urinary incontinence (more for urge and stress)
Can’t see, can’t pee, can’t spit, can’t sh…, poop
Dries everything!!!!
21
Q
Oxybutynin (Ditropan): 2
A
1.Decreases urgency, frequency and nocturia in overactive bladder
2.Causes urinary retention***
22
Q
What patient would you not give an anticholinergic?
A
- BHP: Benign prostatic hypertrophy
- or give with a decongestant (claritin, benadryl, sudafed)
- will cause hypertension: they raise the bp
23
Q
Why would someone who uses hot tubs, hot baths or sweats profusely not want to take an anticholinergic?
A
decrease the ability sweat: careful about being in the heat or hot tubs or baths, heavy exercise (heatstroke,dehydration, the dry mouth)
24
Q
Incontinence treatments include: (4)
*non-medication
A
- Kegel exercises
- Scheduled toileting times
- Botox injections
- Nerve stimulator
25
Incontinence medications: 2
1. tolterodine (Detrol)
2. oxybutynin (Ditropan)
26
What is urinary retention?
Inability to empty bladder all the way
27
what is the number one cause of urinary retention?
BPH (Benign Prostatic Hypertrophy) - # 1 cause
28
Other possible causes of urinary retention: (6)
1. Obstruction – kidney stone
2. Narrowing - urethral opening
3. Tumors
4. Certain medications – anticholinergics, opioids
5. Being dehydrated
6. Constipation***** teach pt about this, tell them to get on a stool softener.
29
how long can you go with urinary retention?
healthy individual: (2cups of urine, 9-10hrs to produce that much urine)
30
Acute Urinary Retention:
1. Sudden & often painful inability to urinate at all despite bladder fullness
2. Requires intervention
31
What intervention can be used for acute urinary retention:
A catheter
32
Chronic Urinary Retention:
Gradual inability to empty the bladder; painless retention associated with increased volume of residual urine
- maybe hard to stop and start the flow of urine (Older Gentlemen/sometimes women)
33
Overflow incontinence:
Overflow incontinence – leaking urine without being able to control it
(involved with chronic incontinence)
34
Nursing Management for acute urinary retention: 7
1. Bladder scan
2. palpate height: where is the bladder cant palpate if full ,above synthesis pubis
3. Ask about voiding history****
4. needs indwelling urinary catheter
5. drink small amounts of fluids
6. Avoid alcohol, caffeine, acidic fruits……
7. sitting in tub of warm water or warm shower
35
Why / what would you ask about voiding history for acute urinary retention?
(nursing management)
You need to get a better understanding of possible reasons this is occurring.
What is your pattern of voiding?
36
Nursing Management for chronic urinary retention: (2)
1. intermittent or indwelling urinary catheter
2. schedule toileting time
37
How common is bladder cancer in both men and women?
4th most common cancer in men
8th most common cancer in women
38
What is the most important risk factor for bladder cancer?
Smoking is the most important risk factor
39
What should you never ignore when it comes to possible bladder cancer?
never ignore painless hematuria.
40
what are some other risk factors causing bladder cancer? (4)
1. exposed to alot of dye or chemotherapy that drug can cause a secondary bladder cancer
2. having a catheter in for a while
3. cervical radiation
4. cancer can spread to the liver bone and lungs and into the rectum and vagina
41
Clinical manifestation and diagnosis: (6)
( BLADDER CANCER)
1. ***Painless hematuria – gross or microscopic
2. Bladder irritability – dysuria, frequency & urgency
3. Urine cytology
4. Lab for tumor markers
5. Cystoscopy
6. Imaging
42
Urinary Diversions- ileal conduit & neobladder (permanent): (2)
1. Most common after complete removal of bladder for bladder cancer
2. Urostomy – ileal conduit – portion of ileum is resected & one end of segment is closed; ureters are attached to closed end of ileum and open end of ileum is brought through abdomen to form a stoma; a bag is placed over stoma.
43
Continent Cutaneous reservoir:
self catheterized and stick tube into opening and empty bladder q2-4hrs as needed, infection rate got super high.
44
Orthotopic Neobladder:
formed from small intestine formed into pouch and put where the bladder normally was and ur gonna urinate through the urethra some incontinence and leakage so might have to self catheterization.
45
Nursing Management: Urinary Diversions (4)
Preoperative-
1. involve family in teaching about the diversion
2. address psychosocial aspect of stoma, stoma care & pouch application
3. encourage patient to talk about feelings related to stoma creation
4. enterostomal therapist consult to visit with patient
46
with any urinary diversion the stoma must remain:
needs to be pink: ashen gray cyanotic looking is not good no oxygenated blood supply
47
Neurogenic Bladder:
Nerves between spinal cord and brain don’t work
48
Causes of Neurogenic Bladder (4)
Parkinson's, Multiple Sclerosis, stroke, diabetes
49
Neurogenic Bladder- Nursing Interventions: (5)
1. Provide routine voiding measures
2. Avoid caffeine and alcohol
3. Kegel exercises
4. Catheter care when indicated, pr catheterize prn
5. Medication – tamsulosin (Flomax) improves bladder storage and emptying
50
Diagnostic Studies for Urinary System ( Urinalysis) : 3
Urinalysis -
1. Measurement of color, pH, specific gravity
2. Determination of present of glucose, protein, blood, & ketones
3. Microscopic exam for crystals, bacteria
first morning void
examine urine within 1 hour
51
Diagnostic Studies continued... 2
URINE STUDIES
Urine studies-
1. Urine culture and sensitivity
2. Creatinine clearance:
- Collect 24-hour urine specimen
- Creatinine clearance closely approximates GFR (glomerular filtration rate)
52
Diagnostic Studies continued (lab values): (4)
SERUM CREATININE:
BUN:
1. Serum creatinine – greater than 1.2 mg/dl is abnormal for women & in men 1.4 mg/dl is abnormal
2. Blood urea nitrogen (BUN) 7-20 mg/dl
3. A high BUN with normal creatinine = dehydration
4. Creatinine clearance
Glomerular Filtration Rate (GFR) probably most accurate measurement of kidney function
53
Interstitial Cystitis: (3)
1. Painful bladder syndrome
2. Difficult to diagnose
3. Mistaken for urinary tract infection but urine culture shows no bacteria
54
Interstitial Cystitis- clinical manifestations: (6)
1. Pain in perineum
2. Persistent urgent need to void
3. Painful intercourse
4. Frequent urination (up to 60 times per day)
5. Pain while bladder fills and relief after urinating
6. May have autoimmune component
55
Urinary Tract Infections-
HARDTOVOID:
H ormones: birth control, menopause
A ntibiotics : affect normal flora
R enal stones: bc back up of fluid
D iabetes : decrease of fluid, sugar in the urine (ketones)
T oiletries : bubble baths, scented tampons
O obstructive prostate: BPH presses on urethra does not allow urine to pass= back-flow
V esicoureter reflux: narrowing/structural deviation
O verextended bladder: urine remains in bladder too long
I ndwelling urinary catheter
D ecreased immune system
56
UTI- preventions/teaching: 5
1. Fluids – avoid alcohol, caffeine; drink water, cranberry juice, green tea
2. Food – avoid acidic (lemons) artificial sweeteners, spicy foods
3. Eat – high fiber (whole grains, beans, bananas)
4. Void q 2-4 hours; wear cotton-lined underwear
5. Exercise
57
##1 cause of UTI in the hospital setting:
Indwelling catheters
58
UTI Pathophysiology:
Bacteria enters the sterile bladder causing inflammation
May be caused by a variety of disorders
Bacterial infection most common
Escherichia coli (E. coli) most common pathogen
Fungal and parasitic infections may cause UTIs
59
Catheter-associated urinary tract infection (CAUTI) :
Most common hospital acquired infection
#1 cause = prolonged use of urinary catheter
60
Common bacteria of CAUTI: 3
E. coli
Pseudomonas
Proteus marabilis
61
who is more at risk to get a CAUTI: 7
Pediatric & female population, congenital defects, urinary retention, pregnancy, menopause, multiple partners
62
Routes of CAUTI: 3
Catheter Meatal Junction
Catheter tubing connection
Outlet Device
63
Signs and Symptoms of UTI: 5
Hesitancy, frequency, urgency
Dysuria
Suprapubic pain
64
Diagnose UTI with: 5
1. UA/urine culture
2. +RBC (gross hematuria)
3. Cloudy
4. positive WBC
5. +Nitrites
65
Elderly/Geriatric Manifestations of UTI's: 5
1. sudden change in LOC
2. falls
3. tachypnea
4. anorexia
5. low grade fever or no fever (VS appear normal)
66
If a UTI is not caught early or not treated what can it cause?
Urosepsis
67
UTI nursing management: 4
1. Urinalysis & urine culture – clean catch (midstream)
2. Medication
- antibiotics
- analgesic for pain
3. Prevention of CAUTI
4. Prevention of Urosepsis
68
Clean catch (midstream):
Wash hands
Clean urinary opening with towelette front to back
Void into toilet a few seconds & stop
Place sterile container into path of stream
Restart urine and collect midstream of urine
Do not touch inside of sterile cup
Do not hold cup tightly to perineum
69
Risk Factors that can cause Urosepsis: 6
1. Urinary catheters
2. advanced age
3. compromised immune system
4. diabetes
5. female gender
6. surgical procedures involving urinary tract
70
Clinical manifestations of urosepsis- initially UTI symptoms: 6
Abnormal WBC count (either too high or too low)
urgency, frequency, foul smelling urine, dysuria, lower abdominal pain
71
5 Clinical manifestations of urosepsis- more serious signs and symptoms (pyelonephritis) :
Nausea, vomiting, fever, chills, pain in lower spine (CVA -tenderness costovertebral angle tenderness)
72
Clinical manifestations of urosepsis- sepsis symptoms:
Respiratory rate 22 or higher
Systolic pressure ≤ 100 mm HG
WBC too high or too low (4500 – 10,000 per microliter)
(MEWS)
73
Severe sepsis/ septic shock: 4
1. Organ failure, such as kidney (low urine output)
2. Low platelet count
3. Change in mental status
4. High levels of lactic acid in blood (cells aren’t utilizing oxygen in the right way)
74
disorders in the male population: 11
1. Peyronies
2. Priapism
3. Phimosis
4. Hypospadius
5 .Diphalia
6. PRE
7. Prostatitis
8. BPH/TURP
9. Prostate cancer
10. Testicular cancer
11. Testicular torsion
12. Erectile Dysfunction (ED)
75
Peyronies:
Scar tissues forms under skin
of penis; plaque pulls on surrounding
tissue & causes penis to curve or bend during an erection.
76
Priapism:
Prolonged painful erection without sexual desire
Can lead to impaired circulation & inability to urinate (4 or more hrs)
Causes: neurological & vascular disorders
Medication,
Injury
77
Phimosis:
Inability to retract the foreskin
covering the head of the penis
(seen more in toddlers and babies)
78
Hypospadius:
Birth defect in which opening
of the urethra is located at
the tip of the penis, along
the shaft, or where penis &
scrotum meet
79
Diphalia:
Genetic condition present at birth in which a person has 2 penises
80
Penile Ring Entrapment (PRE):
Penile ring 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
81
Prostate Gland:
Male organ that produces semen & transports sperm during ejaculation
Enlarged prostate can put pressure on urethra causing difficulty urinating
82
Acute Bacterial Prostatitis:
a bacterial infection of the prostate usually with sudden, severe symptoms
83
Chronic Bacterial Prostatitis:
ongoing or recurring bacterial infection usually with less severe symptoms
84
Chronic Prostatitis/ Chronic pelvic pain syndrome:
ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection
85
Prostatitis symptoms: 4
1. Flu-like
2. Pain in abdomen, groin, or back
3. dysuria
4. Pain with ejaculation
86
Is prostatitis easy to treat?
not easy to cure: antibiotics 4 weeks or more
on and off antibiotics
87
Prostatitis treatment: 2
Acute bacterial – antibiotics 4 - 6 weeks
Chronic bacterial – antibiotics 8-12 weeks
88
Prostatitis Teaching: 6
1. Safe sex
2. Weight loss
3. Avoid spicy or acidic foods
4. Avoid alcohol and caffeine
5. Eat more fresh/unprocessed foods & less sugar
6 .Water, water, water!!
89
BPH:
Prostate gland enlarges disrupting outflow of urine from pressure on the urethra
Main cause of urinary retention in men
90
BPH risk factors: 6
age, obesity, high protein diet, alcohol & smoking
family history in first degree relative
91
What is the #1 complaint in men with BPH:
STREAM IS WEAK.
92
BPH & prostate gland- Obstructive symptoms 3 :
weak stream, difficulty starting & stopping stream, dribbling
93
BPH & prostate gland- Irritative: 3
nocturia, frequency,
urgency
94
Diagnostic Studies (BPH): 4
History & Physical
Digital Rectal exam (DRE)
Prostatic specific antigen (PSA)
Transrectal ultrasound
95
#1 diagnostic test - PSA blood test:
produces psa liquifies semen small amount will circulate in blood
higher than normal amount can show prostate cancer
96
Medication for BPH: (OSIN) (3)
adrenergic receptor blockers (most end in osin)
1. Tamsulosin (Flomax) Tamsulosin will help you lose urine; also used to help pass renal calculi
2. Doxazosin (Cardura)
3. Terazosin (Hytrin) change positions slowly
97
Mode of action for OSIN medications:
1. Antagonize alpha 1 receptors, relaxing smooth muscles of the prostate which helps to improve urine flow
2. Also causes vasodilation
NOTE: side effect is hypotension; change positions slowly
98
Medication for BPH (RIDE):
1. Finasteride (Proscar) also helps with male propecia
2. Dutasteride (Avodart)
99
Mode of action for RIDE medications:
1. 5a reductase inhibitor is the enzyme that prevents conversion of testosterone
2. Reduces the size of the prostate
NOTE: side effects – erectile dysfunction, gynecomastia; pregnant women should not handle finasteride
100
Complications of BPH:
Hydronephrosis is swelling of kidney/s due to build up of urine causing swelling
Urine cannot drain out from kidney to bladder
101
Complications of BPH- Causes 5 :
1. blockage of outflow of urine or reflux of urine from bladder to kidney
2. BPH
3. Renal stones
4. Narrowing of ureters
5. Treatment – may need nephrostomy tube if severe
102
TURP for BPH:
Surgery to remove parts of prostate tissue through the penis (for BPH)
(trans-urethral resection of prostate)
103
POST TURP:
Post procedure 3 way indwelling urinary catheter inserted to provide hemostasis & urinary drainage
Continuous 3-way bladder irrigation (murphy drip) to prevent obstruction of the catheter after surgery
104
Intermittent Irrigation:
Manual irrigation for bladder
spasms, clots decreasing outflow
105
3 way catheter:
Bladder irrigation helps keep the Urinary catheter from obstructing
106
What are you going to do with a patient with bladder irrigation? 5
1. Assess for bleeding & clots
- titrate the saline irrigation by increasing or decreasing flow
2. Monitor inflow and outflow
3. Manually irrigate catheter for bladder spasms or if decreased outflow occurs
4. Antispasmodics & analgesics as needed
5. Monitor for increase in gross hematuria could mean —->(hemorrhage)
107
Nursing management- for the patient going home teaching ( POST TURP) : 7
1. kegel exercises
2. no heavy lifting
3. s/s of infection
4. stool softeners to prevent straining
5. fluid intake 2-3 L per day
6. avoid caffeine & alcohol
7. patience:
- incontinence is common for several weeks after surgery
108
2nd leading cause of cancer death in men:
Prostate cancer
109
Good Prognosis if diagnosed early?
Prostate cancer
110
risk factors/ who has a higher risk of prostate cancer: 4
Age, obesity, alcohol, family history (risk factors)
111
at what age are you at a higher risk of developing prostate cancer?
increased risk after 50
112
prostate cancer: 4
1. No symptoms in early stages
2. Diagnosed often with PSA & biopsy
3. TNM system, Gleason score, & PSA (to stage tumor)(determines fast growing or slow growing)
4. Early recognition & treatment to prevent metastasis
113
Radical Prostatectomy: 2
1. Removal of prostate, seminal vesicles, & part of bladder
2. Large indwelling catheter with 20-30 mL balloon is placed (pt goes home with catheter)****
114
Radical Prostatectomy: adverse reactions 2
erectile dysfunction
urinary incontinence
115
Testicular Cancer: 6
1. More common in young males
2. Cryptorchidism or family history of testicular cancer
3. Very curable caught early
4. tumor marker blood test for diagnosis
5. Radical inguinal orchidectomy
6. Staging 0-3
116
what is the risk factor with testicular cancer:
Infertility :
Cryopreservation of sperm prior to removal
117
Testicular Cancer- self exam: 3
1. Recommended to do self-exam monthly
2. Examine testicles right after a hot bath or shower
3. Examine while standing
Roll the testicle between the thumbs and forefingers
Feel for lumps, swelling, hardness or other changes
118
s/s of testicular cancer: 5
1. Most found in early stage
2. Lump or swelling on testicle
3. Feeling of heaviness in scrotum
4. Dull ache in lower belly or groin
5. Usually painless in early stages
119
MEDICAL EMERGENCY – blood flow must be restored withing 6 hours or testicle will atrophy:
Testicular torsion:
- No surgery within 6 hours testicle may be removed**
- No testicular torsion can fix itself***
120
What is testicular torsion? 3
1. Testicle rotates, twisting the spermatic cord that brings blood to the scrotum
2. Occurs more on left
3. Reduced blood flow causes sudden and severe pain on one side of the scrotum
121
causes of torsion: 6
1. Occurs in about 1 in 4000 males under age 25
2. Vigorous activity: sports
3. Minor injury to testicles: kicked in nuts
4. While sleeping
5. Undescended testicle: more prone to torsion
6. Bell clapper deformity
Born with no tissue holding testes to scrotum allowing testes to swing inside the scrotum
122
Erectile Dysfunction (ED):
Inability to attain or maintain an erection
Increases with age (40 to 70
123
Erectogenic drugs :
sildenafil (Viagra) do not take if on a nitrate
tadalafil (Cialis) do not take if on a nitrate
***no if on nitrate - vasodilator ,causes major HYPOTENSION do not mix the two
do not take with : rides and sosins(on a slide in beginning)
124
medications for ED: mode of action:
increases blood flow to the penis and vasodilation of the pulmonary vasculature
DO NOT take these medications with any nitrates
Nitroglycerin
125
side effects of ED medications
Priapism, increased risk for heart attack
126
HOUDINI:
(Criteria need for Urinary Catheter: If patient meets one or more of the criteria below, the Foley Catheter should remain and be reassessed in 24 hours.)
H-hematuria
O-obstruction
U-urologic
D-decubitits: To assist in healing of open sacral or perineal wounds in incontinent patients
I-IandO
N-neurogenic bladder: bladder dysfunction or chronic indwelling catheter
I- immobilization
