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IM 2 Exam 3 > Lower Urinary Systems and Disorders > Flashcards

Lower Urinary Systems and Disorders Flashcards

1
Q

What is the role of the ureters

A

To carry urine from the renal pelvis to the bladder

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2
Q

What capacity of the bladder?

A

600-1000mL

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3
Q

What is the function of the detrusor muscle

A

To contraction to expel urine out of the bladder

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4
Q

Which patients will have a prostate glad

A

Men

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5
Q

Is urine sterile?

A

Yes

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6
Q

How often should you urinate

A

2-4 hours

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7
Q

Tips for maintaining a healthy bladder ( Patient Education )
(8)

A

Use the bathroom often and when needed
Wipe from front to back
Urinate after intercourse
De pelvic floor muscle exercises (Kegels)
Wear cotton underwear
Limit alcohol, caffeine, and smoking
Drink lots of fluids
Exercise and weight management

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8
Q

What is urinary Incontinence

A

The involuntary or uncontrolled loss of urine in any amount

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9
Q

What are the three types of incontinence

A

Stress
Urge(overactive bladder)
Functional

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10
Q

When does stress incontinence occur

A

When physical movement or activity puts pressure on the bladder causing leakage of urin
Coughing, laughing, sneezing, running, heavy lifting

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11
Q

What causes stress incontinence

A

The pelvic floor muscle & urinary sphincter weaken
-Childbrith in women
-Prostate surgery in men

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12
Q

What can help with Stress Incontinence

A

Surgery
-vaginal sling
Injectable bulking agent
Inflatable artificial sphincter

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13
Q

What are some synonyms of urge incontinence

A

-overactive bladder
-bladder spasms
-irritable bladder
-detrusor instability

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14
Q

What are some symptoms of urge incontinence (3)

A

-Involuntary urinate with little to no warning
- Frequent urination or nocturia
- Bed wetting (Enuresis)

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15
Q

What is functional incontinence

A

the inability to get to or use the toilet in time

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16
Q

What is a common cause of functional incontinence

A

Physical or cognitive impairment
-Inability to walk well
-Obstacles in the way

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17
Q

Ways to help with functional incontinence

A

Easy access to toilet
Scheduled times for toileting
wearing clothes easy to remove

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18
Q

What is the pharmaceutical treatment for Incontinence ?

A

Anticholinergics
- tolterodine (detrol
-Oxybutynin (ditropan)

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19
Q

What are some non-pharmaceutical means of treatment for incontinence

A

Kegels Exercises
Scheduled toileting times
Botox injections
Nerve Stimulator

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20
Q

What is the intended effect of Oxybutynin (Ditropan)?

A

Causes urinary retention

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21
Q

What is the unintended effect of oxybutynin (ditropan)

A

raise the blood pressure (Hypertension)

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22
Q

Which patients shouldnt get oxybutynin (3)

A

-Patients with BPH
-Patients already on decongestants
-Patients with hypertension

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23
Q

What is urinary retention

A

The inability to empty the bladder all the way

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24
Q

What are some causes of urinary retention (7) (BOMB-CUT)

A

-BPH-1# cause
-Obstuctions-kidney stones
-Urethral narrowing
-Tumors
-Medications -Anticholinergics, opiods
-Being dehydrated
-Constipation

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25
Q

What is a symptom of acute urinary retention

A

A sudden & often painful inability to urinate at all despite bladder fullness

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26
Q

What are symptoms of Chronic urinary retention (4)

A

-Painless retention associated with increased volume of residual urine
-Feeling like the bladder is still full after passing urine
-difficulty holding in urine
-overflow incontinence- leaking urine without being able to control it

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27
Q

What are some nursing interventions for acute urinary retention (7)

A

-palpate bladder
-Bladder scan
-ask about voiding history
- indwelling urinary catheter
-drink small amounts of fluids
-avoid alcohol, caffeine, and acidic fruits
-sitting in tub of warm water or warm shower

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28
Q

What are some nursing interventions for chronic urinary retention (2)

A

-Intermittent or indwelling urinary catheter
-schedule toileting time

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29
Q

What is the most important risk factor for bladder cancer

A

Smoking

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30
Q

What are the clinical manifestations of bladder cancer (2)

A

Painless hematuria
Bladder irritability

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31
Q

What are diagnosic tools for bladder cancer

A

Urine cytology
Labs for tumor markers
Cystoscopy
Imaging (Ultrasound)

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32
Q

What are some nursing interventions for a patient with a neurogenic bladder

A

-Provide routine vioding measures
-avoiding caffeine and alcohol
-kegel exercises
-catheter care when indicated
-Medication tamsulosin (flomax)

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33
Q

What does creatinine clearance closely measure

A

GFR

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34
Q

What is an abnormal range for serum creatinine

A

1.2 for women
1.4 for men

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35
Q

What does a high BUN with normal creatinine mean

A

Dehydration

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36
Q

What is a synonym for interstitial cystitis

A

Painful bladder syndrome

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37
Q

Why is Intersitial cystitis difficult to diagnose

A

It is easily is mistaken for urinary tract infection but urine culture shows no bacteria

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38
Q

What are some clinical manifestations for interstitial cystitis (6)

A

-Pain in perineum
-Persistent urgent need to void
-Painful intercourse
-Frequent urination (up to 60times a day)
- pain when bladder fills and relief after urinating
-May have autoimmune component

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39
Q

What are some causes of UTIs
(HARD TO VOID)

A

-Hormones
-Antibiotics
-Renal stones
-Diabetes
-Toiletries
-Obstructive prostate
-Vesicouteter reflux
-Overextended bladder
-Indwelling urinary catheter
-decreased immune system

40
Q

What is some patient education for UTI (6)

A

Fluids- Avoid alchohol, caffeine- drink water
Foods- avoid acidic foods, artifical sweetners, spicy foods
Eats-fiber
Void- every 2-4 hours
Wear cotton underwear
Exercise

41
Q

What is the most common cause of UTIs

A

E coli

42
Q

What is the most common nosocomial infection

A

CAUTI (catheter-associated urinary tract infection)

43
Q

What is the # 1 Causes of CAUTI

A

Prolonged use of urinary catheters

44
Q

What are some S/S of CAUTIs

A

Bladder irritability- dysuria, hesitancy, frequency, and urgency
-suprapubic pain

U/A
+RBC
Cloudy
+WBC
+nitrites

45
Q

What are some S/S for UTI in with geriatric

A

Sudden changes in LOC
Falls
tachypena
Anorexia
Low grade fever/ No fever

46
Q

Steps for Clean Catch Urine sample (Midstream)

A

-wash hands
-clean urinary opening with a towelette front to back
-Void into toilet a few seconds & stop
-place into a sterile container into path of stream
-Restart urine stream and collect sample

47
Q

Avoid with midstream collections

A

Do not touch inside of sterile cup
Do not hold cup to close to perineum

48
Q

What are the guidelines for an indwelling catheter

A

-Acute urinary retention or bladder outlet obstruction
-Need for accurate I&O ( hourly mointoring
-Assist in healing of open sacral or perineal wounds
-Prior to certain surgical procedures
-Patient required prolonged immobilizaion
-To improve comfort for end of life care

49
Q

What can cause Urosepsis

A

An untreated UTI that spreads to the kidneys

50
Q

Which patients are at risk for Urosepsis

A

-Urinary catheters
-Advanced age
-Compromised immune system
-Diabetes
-Females
-Surgical procedures involving urinary tract

51
Q

What are some S/S for urosepsis?

A

Initial UTI symptoms
-Abnormal WBC
-Irritable Bladder, foul smelling urine, lower abdominal pain
More serious S/S
N/V, fever, chills, pain in lower spine
Sepsis symptoms
RR >22
Systolic pressure <100mg
WBC abnormal

52
Q

What are symptoms of septic shock (LOCH)

A

Organ failure (kidneys)
Low platelet count
Change in mental status
High lvls of lactic acids (cells aren’t utilizing oxygen in the right way)

53
Q

What are the nursing interventions for UroSepsis (8)

A

Early goal directed therapy (EGDT)
Broad spectrum antibiotics
Control pain
IV fluids to maintain blood pressure
O2 therapy
Strict I&O
Removal of any catheter or devices that may be infected
Supportive care- stabilizing lungs and blood flow

54
Q

What is Peyronies

A

Scar tissues formed under the penis.
Plaque pulls the tissue causing the penis to bend

55
Q

What is Priapism

A

A prolonged painful erection
Can lead to impaired circulation
& inability to urinate

56
Q

What is phimosis

A

The inability to retract the foreskin covering the head of the penis

57
Q

What is hypospadius

A

A defect in which the opening of the urethra is located on other locations on the genitals

58
Q

What is diphalia

A

A genetic condition which a person has 2 penises

59
Q

What is the function of the prostate gland

A

Produces semen & transports sperm during ejaculation

60
Q

What is the term for an enlarged prostate?

A

Benign Prostatic hypertrophy (BPH)

61
Q

How does BPH effect a patient

A

It puts pressure on the urethra causing difficulty urinating

62
Q

What are the S/S prostatitis (4)

A

Flu-like symptoms
Pain in abdomens, groin, or back
Dysuria
Pain with ejaculation

63
Q

What are the types of Prostatitis

A

Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Chronic Prostatitis/ Chronic Pelvic pain syndrome (no sign of infection)

64
Q

What is the treatment for Bacterial Prostatitis

A

Acute- antibiotics (4-6wks)
Chronic- Antibiotics (8-12wks)

65
Q

What is patient education for prostatitis

A

-Safe sex
-weight loss
-avoid spicy or acidic foods
-avoid alcohol and caffeine
-eat more fresh/unprocessed foods &less sugar
-Drink water

66
Q

What are some risk factors of BPH

A

-age
-obesity
-high protein diet
-alcohol &smoking
-family history

67
Q

What are some S/S of BPH

A

Irritative bladder- Nocturia, frequency, urgency
-Weak stream, difficulty starting and stopping stream, dribbling

68
Q

What are some diagnostic studies for BPH

A

history and physical
Digital Rectal Exam
Prostatic Specific Antigen
Transrectal Ultrasound

69
Q

What are the 2 classes of BPH medication

A

Adrenergic Receptor Blockers (Osins)
5a reductase inhibitors (ride)

70
Q

What are the Adrenergic Receptor Blockers (3)

A

Tamsulosin
Doxazosin
Terazosin

71
Q

What is the mode of action of Adrenergic receptor blockers

A

To relax the smooth muscles in the prostate
(Vasodilation)

72
Q

What is the unintended effect of Adrenergic receptor blockers

A

Hypotension

73
Q

What are the 5a reductase inhibitors

A

Finasteride ( helps with male baldness)
Dutasteride

74
Q

what is the mode of action of 5a Reductase inhibitors

A

Inhibits the enzyme that prevents conversion of testosterone
Reduces the size of the prostate

75
Q

What is the unintended effect of 5a reductase inhibtors

A

erectile dysfunction
Gynecomastia
Pregnant women shouldnt handle finasteride

76
Q

What can cause Hydronephrosis

A

A blockage of outflow of urine or reflux of urine from the bladder to kidney
-BPH
-Renal stones
-Narrowing of ureters
-Treatment may need nephrostomy tube

77
Q

What can cause hydronephrosis

A

BPH
Renal stones
Narrowing of ureters

78
Q

What is the treatment for BPH

A

Transurethral Resection of Prostate (TURP)

79
Q

What is done during a TURP

A

Surgical removal of parts of prostate tissue through the penis

80
Q

What is placed after a TURP

A

A 3 way indwelling urinary catheter for bladder irrigation ( A Murphy drip)

81
Q

What are the risk factors of prostate cancer

A

Age (increases after 50), Obesity, alcohol, family history

82
Q

How is Prostate cancer diagnosed?

A

PSA and biopsy

83
Q

What is the treatment for Prostate cancer

A

Radical Inguinal Prostatectomy

84
Q

What are some adverse outcomes of prostatectomy

A

Erectile dysfunction
Urinary incontinence

85
Q

What is the treatment for Testicular Cancer

A

Radical inguinal orchidectomy

86
Q

What are some risk factors for testicular cancer

A

Cryptorchidism or family history
common in young males

87
Q

S/S of Testicular Cancer (4)

A

Lumps or swlling on testicles
Feeling of heaviness in scrotum
Dull ache in lower belly or groin
Usually painless in early stages

88
Q

What is Testicular Torsion

A

Twisting of the spermatic cord reducing blood flow to the testicle

89
Q

When must blood flow be restored to the testicle

A

Within 6 hours or the testicle will atrophy- surgery is needed

90
Q

What are some treatments for Erectile dysfunction (3)

A

Penile injections
Erectile Devices
Erectongenic drugs

91
Q

What are the some erectogenic drugs

A

Sildenafil (Viagra)
Tadalafil (Cialis)

92
Q

What is the mode of action of Erectogenic Drugs

A

Increase blood flow to the penis and vasodilation of the pulmonary vasculature

93
Q

What patients shouldnt take any erectogenic drugs

A

Patients that are taking nitrates

94
Q

What are the risk factors for erectogenic effects

A

Priapism, and increased risk for a heart attack

95
Q

What criteria is for catheter assesment

A

Hematuria
Obstruction
Urologic
Decubitus
I&O
Neurgenic
Immoblizaion/ Improved patient comfort

96
Q

What urinary diversion would be best for an incontinent patient

A

Ileal conduit

97
Q

What urinary diversion would be best for a continent patient

A

An orthotopic neobladder

IM 2 Exam 3 (2 decks)

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