Module 4: Genital urinary assessment Flashcards
1
Q
What position should female be in for urinary catheter care
A
dorsal recumbant (knees bent)
2
Q
what position should male be in for urinary catheter care
A
supine or fowlers
3
Q
Factors that commonly influence urinary elimination
A
- Psychological factors (anxiety, stress, lack of privacy or time)
- sociocultural factors
- fluid balance (alchohol and caffeine will make u pee more)
- diagnositic examination (may cause trauma)
- sugery
- pathological condition
- medications
4
Q
What are some pathological conditions that could affect micturition
A
stoke, parkinson’s, MS, diabetes, spinal cord injury, advanced dementia, hindered mobility , dehydration, kidney disease, obstructed urine flow
5
Q
what are some meds that could affect micturition
A
-diuretics, anticholinergics, sedatives, hypnotics, opioids
6
Q
What is considered urinary retention
A
can hold up to 1 liter of urine
7
Q
what is a normal bladder capacity
A
400-600 ml
8
Q
measures to reduce urinary tract infection
A
- hand hygiene
- encourage fluid intake
- closed drainage system
- no obstructions, kinks or poooling
- bag below bladder
- provide pt. teaching
9
Q
what are some methods to preserve and protect healthy elimination
A
- Assist pt. to understand and participate in appropriate self care practices
- pt. education on specific elimination problem
- promote complete bladder emptying
- prevent infection
10
Q
what is regular micturition
A
every 3-4hr
11
Q
what may happen if you void too frequently
A
small-capacity bladder
12
Q
what may happen if you infrequently void (8hr)
A
may contribute to hypotonic bladder
13
Q
3 best ways to prevent infection
A
1) Hygiene
2) cleaning after elimination
3) adequate fluid intake
14
Q
developmental considerations for infants and children
A
- reproductive organs developed but evolve with ae
- cannot concentrate urine effectively (appears light yellow or clear)
- large volumes of urine
- may not gain full control until 4-5
15
Q
developmental considerations for preadolescent and adolescent
A
- Puberty
- hair growth
- enlargement of sexual organs
- menarche
16
Q
What is a normal amt to void a ay
A
1500ml
or 2200-2700ml
17
Q
when does menopause begin around
A
48-51
18
Q
when does sperm production decrease
A
around 40
19
Q
what does decreased testosterone (around 40) do to males
A
decreased testosterone slower and less intense sexual response
20
Q
developmental considerations for older adults
A
- ability to concentrate urine decrease or reabsorb water or sodium
- dysuria, incontineence, nocturia
- alterations in sexual function
- thin, grey body hair
- sex organs smaller
- prostate enlargement
21
Q
what is dysuria
A
painful urination
22
Q
what subjective data would you do for genitourinary assessment
A
- urinary frequency, urgency, nocturia
- dysuria
- hesistancy & strianing
- urine color
- urinary and sexual health history
- pain, lesions, discharge, swelling, lumps, change in appearance
- current sexual health status
23
Q
what to assess for in a pt. with urinary catheter
A
- assess meatus for redness, swelling, discharge, discomfort
- Cauti symtoms
- no kinds in tubing
- secured properly
- collection bag below bladder level
- assess urine
24
Q
What are typical symptoms of CAUTI
A
- Urgency
- tenderness
- pain
- fever over 38
- urine that’s bloody
- foul smelling
- cloudy or increased sediment
- worsening mental or functional status
25
what are some risk factors for CAUTI
- cathetarization over 6 days
- female
- diabetes
- malnutrition
- old age
- impaired immunity
26
What should you assess about the urine
- Amount (1500ml+ a day is good)
- color (pale to amber)
- odor
- unusual characteristics
27
where should you secure a catheter for a male
abdomen or upper thigh
28
where should you secure a catheter for a female
inner thigh
29
will antiseptic cleaners help prevent CAUTI
no
30
when could symptoms of a CAUTI show up after removal of catheter
2-3 days after
31
how much should pt. first void be after removal of cath
150ml, should occur 6-8 era & encourage pt to keep bladder diary 24-48 hr
32
how often should u change condom catheter
everyday
33
what is appropriate amount for specimen collection of urine
30-60ml
34
what is urinalysis for
commonly used to evaluate a variety of renal and non renal problems
35
What is normal ph range for urine
4.6-8
36
what is normal protein for urine
none or up to 8mg / 100 ml
37
What is a normal glucose amount for urine
none
38
what is a normal ketones about for urine
none
39
what is a normal blood amount for urine
up to 2 blood cells
40
what is a normal specific gravity for urine
1.010-1.025
41
what is a normal amount of WBC in blood
0-4
42
what is normal amount of bacteria in urine
none
43
what is a normal amount of casts in urine
none
44
when does the urinalysis need to be sent to the lab by
2 hrs
45
what is a specific gravity
the ratio of the weight of a given fluid to the weight of an equal volume of distilled water
*helps determine fluid balance
46
what is a urine culture
in the lab a variety of methods are used to determine the findings of bacterial growth over time (24-48hr)
47
how much fluid should a regular person drink per day
1500-2000ml
48
how much should someone with a cath drink a day
2000-2500
49
what kind of output would need to be reported and investigated
less than 30ml an hour
50
what to include in intake for fluid balance
- Gelatin, ice cream, soup, water ect.
- blood
- any IV's
51
What to include in fluid output
urine, diarrhea, vomit, gastric suction, drainage from wounds or other tubes
52
what is a daily weight
a daily weight is the most accurate measurement in evaluation of fluid balance. Patient should be weight at the same time each day, wearing the same clothes, after they void
53
what will a normal fluid balance look like?
Intake should equal outtake plus 500ml to account for evaporative water loss, skin, respiratory
54
what do FVD eyes look like
sunken, dry, conjustivae (red), absence of tears
55
what do FVE eyes look like
periorbital edema, blurred vision, papillledema
56
what does a FVD mouth look like
sticky, dry mucous membrane, cracked lips, less saliva, viscous saliva, shrunken tongue
57
what does FVE mouth look like
excessive saliva
58
what does FDV skin look like
increased temp, dry, scaly, poor turgor
59
what does FVE skin look like
edema
60
what does FVD cardiovascular do
increased pulse rate, weak pulse, hypotension, decreased pulse volume, decreased capillary filling, increased hematocrit, flat neck veins
61
what does FVE cardiovascular show
bounding pulse, blood pressure normal without orthostatic changes, third heart sound, distended neck veins
62
what does FVD show in the gastrointenstinal system
sunken abdomen
63
what does FVE show in GI system
vomit, diarrhea, cramps
64
what does FVD show in renal system
oliguria or anuria, increased urine gravity
65
what is oliguria
small amounts of urine
66
what is anuria
failure of kidneys to produce urine
67
how much urine stays in bladder after voiding normally
50 ml
68
who may require intermittent cath?
someone who consistently has more than 100ml of urine
69
bladder scanner protocol for women with hysterectomy
should be designated as a male
70
What is the 1st sign of male puberty
larger testis, pubes, penis larger
71
developmental considerations for male adults
- no finale end to fertility
- 55/60 slightly less testosterone
- decreased pubes and grey
- penis size decreased, testies sag
- longer refractory period
- may withdraw from sexual activity
72
Pros and cons of circumcision
Pro: Hygiene, medical indications, fathers, religion, values, decreased STI's
Cons: Not recommend or covered, some complications,
73
Subjective data for male genitourinary
1) Frequency, urgency, nocturia
2) Dysuria
3) Hesitancy & Straining
4) urine colour
5) past genitourinary history
6) Penis
7) scrotum, self-care behaviour
8) Sexual activity & contraceptive use
9) STI contact
74
how to make it more comfortable for adolescents
- ask appropriate Q
- Aware that norms may vary
- clear up misconceptions
- avoid judgement
- start with a permission statement : Some boys your age feel.. "
- ubiquity approach: When did u not do you
- May not wanna talk - come back when they're ready
75
Additional history for adolescents
```
1- puberty
2- nocturnal emission
3- erotic feelings
4- sexual activity
5- self-exam
6- molestation
```
76
Additional history for older adults
1) Prostate enlargement
2) Incontinence
3) Nocturia
4) Sexual function
77
What are some fears males may have during the objective data phase
* Modesty
* Pain
* Cold hands
* Judgement
* Memory of uncomfortable
* Comparrison
* Erection
78
how does the nurses demeanour needs to be..
* Confident
* Relaxed
* Unhurried
* business like
- Firm deliberate touch
- dont stop if erection
79
What is phimosis
Inability to retract foreskin
80
What is paraphimosis
inability to pull forsaken forward again
81
What could scrotal edema mean
- heart failure
| - local inflammation
82
What does an abnormal lymph node feel like
enlarged, hard, matted, fixed
83
Developmental considerations for female infants/adolescents
- @ birth engorged bc of estrogen
- puberty 8.5-13 (breasts first)
- ovaries migrate from abdomen to pelvis
84
developmental considerations for pregnant women
- cervix softens
- cyanotic cervix
- uterus capacity inc.
- mucus plug forms
85
Developmental considerations for older women
- hormones decrease rapidly
- menopause (35-60)
- vagina: shorter, wider, less elastic
- dry, painful intercourse
86
Dangers of female circumcision
- Servere pain, hemorrhage, urinary retention, infection, sepsis, death
- disfunction, painful menstration, sex and birth control difficulties, pregnancy/ birth complication, psychological drainage
87
What subjective data should u collect
1) menstration history
2) obstetrical history
3) menopause
4) self-care
5) urinary symptoms
6) vaginal discharge
7) history of surgery
8) sexual activity
9) contraceptives
10) STI's
11) STI risk reduction
88
What position should women be in
Lithotomy position
89
Inspect the external genetalia
- skin color
- hair distribution
- labia majora (symetrical, plump, meet @ midline)
- skin texture
90
Developmental considerations for genitourinary exam for a infant or child
- Infant on table
- toddler/pre-school on lap of parent in frog position
- school-age on exam table (EXTERNAL ONLY)
91
Developmental considerations for adolescents
- Examine pt. alone if they wanna be alone
| - pelvic floor exam when contraception is desired or when sexual activity or 18
92
Developmental considerations for pregnant women
- tummy grows
- increased vascularity
- hemorohids
- variocose veins
- wall, violet or blue
93
What do they kidneys do
Remove waste from blood
94
what do the ureters do
transfer urine from kidney to bladder
95
what does the urethra do
urine leaves
96
what do the glomerular capillaries permit filtration of
- water
- glucose
- amino acids
- urea
- creatinine
- major electrolytes
97
What are the factors influencing urination
- Psychological stress
- Sociocultural factors
- Fluid balance
- dignostic exam
- surgical proceedures
- pathological (ex. dementia)
- medicines
- pereferal edema ( increases nocturne)
- sedatives/opioids (decreases alertness)
98
what is pyelonephritis
long term kidney damage
99
what are key women risk factors for UTI
- sexual activity
- pregnancy
- diaphragm/spermacide use
- low estorgen
- obstruction of tract
- incomplete emptying
- abnormal anatomy
- older
- antibioitics
- decreased immunity
100
Symptoms of UTI
- dysuria
- fever, chills, nausea, vomiting
- inflammed bladder (cystitis)
101
what are the key signs of urinary retention
- absense of urine output
- bladder distension
- restlessness
- diaphoresis
- abdominal discomfort
102
What is transient incontinence
urine loss from causes outside of urinary system. resolves when underlying problem is treated. (depression, meds, delirium ect. )
103
What is urgency incontinence
urinary loss proceeded by sudden need to void, overactive bladder. (nervous system disorder or outflow obstruction)
104
What is stress incontinence
increased intra-abdominal pressure (women, obesity, hysterectomy) (from laughing, coughing)
105
Urinary incontinence with chronic retention of urine
residual urine remains after void (prostate enlarge, pelvic prolapse, decreased contractility of bladder)
106
Functional urinary incontinence
inability to reach toilet (decreased mobility)
107
Muiltifactoral incontinence
(comorbid, age, meds, environment)
108
to be able to be potty trained toddler must be able to...
-recognize bladder as full
-be able to hold for 1-2hr
-communicate
(may take till 4-5)
109
Polyuria?
peeing large amounts
110
what is a random urine test
urinalysis, electrolytes (collected anywhere & anytime in clean cup)
111
What is a clean void/midstream urine test
culture and sensitivity (sterile cup)
112
What is a catheter urine test
culture & sensitiivty, aseptic technique, sterile syringe
113
ways to stimulate micturition
- normal position
- tap water sound
- stroke inner thigh
- pour warm water
114
Ability to urinate depends on
- Feeling urge
- being able to control urethral sphincter
- being able to relax
115
conditions that require a catheter
- monitor urine output
- relif of urinary obstruction
- post-op
- bladder that emptiness inadaquetly
116
what does testosterone do
secondary male sex male characteristics
117
what does progesterone do
prevent breakdown of wall
118
what does estrogen do
secondary sex characteristics triggers ovulation
119
What is benign prostatic hypertrophy
the prostate gland is enlarged, nontender, firm, and smooth, with a palpable central groove.
120
What is pruritis
an itching or burning sensation, which can be caused by hemorrhoids.
121
When can child start potty training
Voluntary control of the external anal sphincter cannot occur until the nerves supplying the area have become fully myelinated, usually around age 1½ to 2 years.
122
what is encopresis
persistent passing of stools into clothing in a child age 4 years or older, when continence would be expected.
123
Dyschezia
is the painful passage of stools, resulting from a local condition (e.g., hemorrhoids, fissure) or constipation.
124
Epispadias
is a meatus opening on the dorsal side of the glans or shaft.
125
Orchitis
is an acute inflammation of the testes.
126
A spermatocele
is a retention cyst in the epididymis filled with milky fluid containing sperm.
127
Testicular torsion
is a sudden twisting of the spermatic cord; blood supply is cut off, and the testis can become gangrenous in a few hours. Emergency surgery is required.
128
Cryptorchidism
Failure of testes to descend
129
The rectouterine pouch
deep recess between rectum and cervix
130
A caruncle
a small, deep red mass protruding from the urinary meatus.
131
Amenorrhea
absence of mestraution
132
what is hypertrophy
make new muscles
133
what is hyperplasia
making new muscles
