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Adult Nursing Exam 5 > Management of Urinary Disorders > Flashcards

Management of Urinary Disorders Flashcards

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1
Q

Urosepsis meaning?

A

When the UTI has spread systemically

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2
Q

Lower UTI regions

A

Cystitis - bladder
Prostatitis - prostate
Urethritis - urethra

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3
Q

Upper UTI regions

A

Pyelonephritis - UTI in kidneys

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4
Q

What is Uretervesical reflex or urethrovesical reflux

A

When urine flows backwards up urinary tract

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5
Q

When is the urinary tract sterile?

A

It is sterile once you are passed the uretha

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6
Q

What defenses do we have to make sure it stays sterile?

A

GAG or glycoproteins
Complete bladder emptying
Urinary flow going in correct direction
Acidic urine so less than 6.0 ph

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7
Q

Risk factors of UTI

urinary retention, why?
what can cause retention?

catheters, why?

fistulas, why?

urine reflux, why?

short uretha of women, why?

Aging and menopause, why?

Poor hygiene in general, why?

Immune response issues?

A

urinary retention is an issue because old urine stays in the urinary tract. prostate issues are a main cause

catheters are risky bc you may not insert them with sterile technique

a fistula can cause an abnormal opening of the urinary tract & allow bacteria in

urine reflux can cause uti because this can cause old urine to remain in the urinary tract

the short urethra in women allows for a shorter distance for bacteria to travel

Menopause and aging can cause continence issues & so hygiene could be compromised

People may wipe the wrong way. Need to wipe front to back.

People with Diabetes are at more risk for UTI’s

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8
Q

Common symptoms of uti:

UO

Painful sites

Elderly symptoms

Can there be no symptoms though?

A

Common symptoms

UO will be painful and frequent. May need to pee more at night (nocturia) and may not even be able to control the need to pee . Blood or hematuria in the urine also.

While peeing is painful, they will also have suprapubic, pelvic, or back pain

Elderly will probably present more confused

Yes, the patient may be asymptomatic.

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9
Q

What are some questions to ask if suspect a UTI?

UO

sex

contraceptive practices

A

How often do you urinate? Is it painful? Is there anything unusual for you that you notice?

Ask about sexual activity. Ask if they pee after sex?

IUD that is manually inserted in vagina for BC can cause uti so ask if they use any of these

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10
Q

Diagnostics/tests that they can do for UTI?

A

Urine analysis
culture and sensitivity
sti risk

cystoscopy or bladder check
ultrasound

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11
Q

What are some complications we want to avoid from a UTI?

Prevention?

can they risk of infection

A

Urosepsis and renal failure

Good way to prevent UTI is avoid catheters, pee after sex, don’t hold pee in, do good pericare. no bubble bath

yes, they may have a uti but they can be at risk for kidney infection

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12
Q

What to educate patients about wen taking antibiotics for their uti?
What is a good analgesic for soothing bladder lining? side effect?

Antispasmotic example?

A

Take all of the medicine

Piridium or AZio
side effect is orange urine

Ditripan

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13
Q

Should a uti patient drink coffee?

Can you put heat on perineal area?

A

no. avoid caffeine.

yes perineal heat can help pain

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14
Q

What are the main goals we are working towards with these interventions?

A

We want to help relieve some of the pain

We want to educate patient so this doesn’t happen again

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15
Q

Upper Urinary tract infections begin..

A

Upper infections begin in the renal pelvis.

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16
Q

How can ascending bacteria lead to upper uti?

How can an incompetent valve cause infection?

Urine stasis causing a uti?

systemic infection causing a uti?

A

The bacteria can ascend upwards and cause infection wherever it dwells

The urinary tract has valves to make sure urine flows in one direction and if a valve is not working urine can flow backwards

urine stasis can cause a uti bc the old urine stays in one spot and heards bacteria

systematic infection or sepsis can infiltrate and cause uti

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17
Q

What happens to the kidney in an upper uti?

A

The kidney develops edema and abscesses form from scar tissue

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18
Q

What is pyelonephritis?

A

This is when there is inflammation of pelvis and medulla which began in the lower urinary tract
- so it traveled

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19
Q

Common causes of pyelonephritis?

A

E. coli

Bladder reflux of urine

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20
Q

What is acute pyelonephritis?

A

When there is an active bacterial infection causing renal dysfunction
inflammation and necrosis occur to form abscess

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21
Q

What is chronic pyelonephritis?

A

Chronic pyelonephritis is a repeat of infection which leads to progressive damage that is permanent

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22
Q

Common cause of chronic pyelonephritis?

A

Obstruction of urinary tract

Reflux of urine

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23
Q

What can chronic pyelonephritis lead to in kidneys?

What are some complications of chronic pyelonephritis?

A

Chronic Kidney Disease
End stage renal disease

HTN
stones

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24
Q

Major risk factors of acute and chronic pyelonephritis?

A

Old age
Prostate issues
Stones
chronic illness

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25
Q

Best labs to check for pyelonephritis?

A

Urine analysis
Blood check
IVP
KUB or Kidney, ureter, bladder x ray

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26
Q

Symptoms of pyelonsphritis?

A

Similar to UTI symptoms
but with fever and chills
Pain on flanks or kidneys

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27
Q

What will probably be prescribed for pyelonephritis?

How much fluids should patient be getting?

A

Long term antibiotics - so tell patient to take them all.

Enough to keep them hydrated. Don’t want them to stop drinking

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28
Q

Surgeries done for pyelonephritis?

A

nephrectomy

ureteral diversion

uerteroplasty

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29
Q

What do do after surgery of pyelonephritis?

A

Basic post op interventions

Educate on antibiotics

Make sure they are drinking

Check UO

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30
Q

Which meds can affect urinary output and cause urinary incontinence?
What foods/drinks?

A

Diuretics
Ace inhibitors

Artificial sweeteners
Carbonated drinks

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31
Q

What is a bladder spasm?

Can it cause incontinence?

A

Bladder spasm is what it sound like. The spasm itself can cause urine to outflow.

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32
Q

T/F

multiple vaginal births can cause incontinence

A

true. this weakens pelvic floor muscles

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33
Q

What behaviors can cause leakage?

A

Laughing, coughing.

Straining

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34
Q

What is residual urine volume?

What is urodynamic testing?

A

This is when they check to see how much urine is left in the bladder after voiding.

Tests how well the urinary tract empties.

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35
Q

Stress incontinence

Example?

A

Stress causing intra-abdominal pressure. So laughing

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36
Q

Overactive bladder incontinence

A

This can cause a person to think they need to use the restroom due to a bladder that spasms and tightens.
But if it is overactive, it just means the urge to pee is overactive.

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37
Q

Iatrogenic incontinence

A

Incontinence from hospital fluids

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38
Q

Mixed incontinence

A

A mix of stress and overactive bladder

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39
Q

Overflow incontinence

A

When the nerves can’t sense that the bladder is full so then it begins to leak and overflow causing incontinence

40
Q

Anatomical incontinence

A

Strictures
Fistulas

(I would think an enlarged prostate would be one too but idk)

41
Q

Functional incontinence

A

not being able to get to the bathroom in time for whatever reason
maybe your slow
can’t walk etc

42
Q

Why would we want someone who is continent to lose weight if they are obese?

A

Obesity can cause extra pressure

43
Q

What is the point of timing fluids and amounts?

A

Time the fluid so a person doesn’t drink after a certain amount of time. Maybe they have nocturia and so no fluids after dinner

44
Q

What are pessaries?

A

Ring that holds the bladder in position to prevent incontinence

45
Q

Should you give a pure wick external catheter to a patient who is mobile?

A

No.
It sort of just sits in between labia and perineal area so it can easily be moved out of place. If they are mobile, best to just use it at night.

46
Q

What is an external condom catheter also called?

A

Texas catheter.

It just works sort of like a condom.

47
Q

Anticholinergics are used for incontinence. Why?

Examples?

Side effects?

A

Anticholinergics blocks acH which reduces bladder contraction

Oxybutynin
Tolterodine
Solifenacin
Fesoterodine

Think DRY meds. So dry mouth and constipation

48
Q

Beta 3 adrenergic agonists are also used for incontinence. why?

Side effect?

A

It just relaxes the bladder so it can hold more urine

Common example is Mirabegron

Can raise BP, cause dizziness and headache

49
Q

Botulinum Toxin A does what?

Side effects

A

Paralyzes the bladder. Will need yearly injections

Side effects:
UTI, respiratory arrest

50
Q

Estrogen for incontinence age group?

Contraindication?

A

For older patients.

Contraindication for breast cancer

51
Q

Which med would you use for mixed incontence specifically?

A

Impramine - 3x antidepressant

52
Q

You need a med to relax the urethral spincter. Which do you choose?

A

Duloextine

53
Q 
Lift and stabilize urethra purpose?
Using what?
Injectables?
Artificial?
pacemaker?
A

Helps with incontinence by repositioning of the urethra by using tape or body tissue.
Can also use periurethral injectables of collagen to bulk it up
An artificial spincter can be inserted as well- a fluid filled ring with a valve
Pacemaker for the bladder that helps stimulate nerves

54
Q

What is urinary retention?

A

When the bladder retains urine and does not empty

55
Q

Causes of urinary retention:
age
other medical conditions

meds?

A

Old Age making detrusor muscle weak

Diseases like diabetes or prostate issues
neurological issues
pregnancy

Meds can do too good of job when trying to treat the urinary incontinence. Anticholinergis, Beta 3’s, botulin, etc

56
Q

Assessments for urinary retention:

What will voiding be like?

Have they been on anesthesia?

A

Voiding will be frequent with little output. so check the I&O

Ask about anesthesia bc it can cause retention

57
Q

What are some voiding triggers?

A

Start the water
Move around
Give them privacy

58
Q

Causes of retention that may need surgery?

A

BPH

Bladder neck contracture

Urethral spincters

59
Q

Cholinergics are used for retention. why?

Example

A

It does the exact opposite of anticholinergic and will stimulate urinary tract

Bethanechol/Urencholine

60
Q

Why use an alpha adrenergic blocker for retention?

Examples

suffic

A

Reduces the resistance of sphincters involved with urination
And decreases prostatic hyperplasia (enlarged prostate can cause the retention)

Tamsulosin
Doxazosin
Alfuzosin

  • osin
61
Q

Urolithiasis and Nephrolithiasis

A

Kidney stones in ureter or nephron

62
Q

Lithiasis

A

stone formation

63
Q

How does Urolithiasis and Nephrolithiasis happen?

A

Salts stick together to form kidney stones

64
Q

Main symptoms of kidney stones

A

pain
hematuria
cloudy urine with smells
renal colic or spasm

65
Q

metabolic abnormalities that cause kidney stones?

A 
increase in
calcium
uric acid
citric acid
and infection
66
Q

how can summer months cause kidney stones?

A

Due to dehydration

67
Q

What foods cause kidney stones

A

protein
tea or juice
no water
salt

68
Q

Genetic factors of kidney stones

A

family hx of stones

family hx of gout

69
Q

lifestyle choices that cause kidney stones

diseases

surgery?

A

inactivity and obesity which causes urine stasis

digestive diseases

really any surgery can cause decreased UO

70
Q

Staghorns

A

Type of stone. Sort of sharp. Can be very painful if in ureters

71
Q

Types of calculi/stones

3

A

Calcium oxalate
Cystine
Uric acid

72
Q

calcium oxalate

examples

A

can cause stones.
it is naturally found in foods and sticks together to form crystals

nuts and grains

potatoes

chocolate

73
Q

Hyperparathyroidism puts you at risk of stones. T/F

A

true. more common to develop calcium oxalate stone

74
Q

digestive diseaes that can increase of stones?

A

crohns
ulcerative colitis
ibs

75
Q

should you avoid calcium to avoid stones?

A

no. need to include 1000-1200 mg/day.

calcium and oxalate bind together to move through kidneys

76
Q

What are cystine stones from

A

Amino acid that occurs in the body used for muscle and nerve building

77
Q

what to avoid with cystine stones?

A

fatty foods
red meat
processed food

78
Q

Uric acid stones are caused by?

associated with?

A

high purine intake leading to high amounts of uric acid and therefore acidic urine. assoicated with gout

79
Q

foods with purines to avoid for uric acid sstones?

A 
red meat
alcohol
sardines, anchovies, shellfish
refined carbs
sugary drinks
80
Q

How to prevent stones:

water intake?

oxalate?

calcium?

protein?

salt?

A

stone prevention

water: 2-3 L a day

Limit foods with oxalate (nuts, potatoes, chocolate)

get enough calcium from dairy

eat moderate amounts of protein

low salt intake

81
Q

Alpha blockers for stones?

examples

A

relaxes the ureter so the stone can pass

tamsulosin
dutasteride combo with tamsulosin to decrease prostate size

82
Q

potassium citrate for stones?

exmaples

A

raises ph of urine

OJ, lemonade, apple cider vinegar

83
Q

allopurinol for stones?

examples

A

allopurinol decreases uric acid level

zyloprim and aloprim

84
Q

cellulose phosphate

example

A

prevents calcium from reaching kidneys to form stones

can be used for hyperparathyroidism

Calcibind

85
Q

Lithroscopy

A

shock wave to break up stone

ESWL so more shock
or LASER

86
Q

Percutaneous Nephrolithotomy

A

small back incision

nephrolithotripsy or sound waves

87
Q

why might a strainer be sent home with patient?

A

To catch the stone so it can be used for biopsy

88
Q

Bladder cancer cause?

A

Not clear.

Could be from smoking, carcinogen exposure, or familial

89
Q

where does bladder cancer often travel?

A

liver, bones, and lungs

90
Q

major symptoms of bladder cancer?

A

painless hematuria
UTI symptoms
pain where metasis is

91
Q

Bladder cancer management

A

Transurethral resection of bladder tumor

Radiation
Chemo

Immunotherapy

Partial or total cystectomy (bladder removal)

reconstruction as a urinary diversion

92
Q

incontinent urinary diversion?

control?

A

diversion to skin requiring appliance
patient control
tube is created from a piece of intestine. the tbe runs from ureters to outside of body to urostomy bag

93
Q

continent urinary diversion?

A

Use of stoma , koch pouch, indiana pouch

use section of intestine to create small pouch in order to collect urine inside body

94
Q

orthotopic neobladder

A

to construct a new bladder from intestines

after a bladder removal

95
Q

nursing dx for urinary diversion

A 
anxiety
imbalanced nutrition
defieicent knowledge
risk for skin integrit
acute pain
disturbed body image
sexual dysfunction
deficient knowledge
wound care

Adult Nursing Exam 5 (6 decks)

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