Module 9: GU Flashcards
Structures of the Kidneys
Renal Arteries Renal Veins Nephrons (Glomerulus, Bowmans Capsule, Proximal Convoluted Tubule, Henles Loop, Distal Convoluted Tubule) Two Ureters One Bladder One Urethra
Purpose of the kidneys
maintain overall fluid balance, regulate fluid and minerals from food/toxins/medications/etc
Nephrons
basic functional and structural unit of the kidneys that regulate water and soluble substances in the blood by filtering it and reabsorbing what is needed and excreting what is unneeded
Its function is vital for homeostasis of blood volume, plasma osmolarity, and pressure
Glomerulus
To filter plasma, produce glomerular filtrate which passes down the length of the nephron tube to produce urine
Bowmans Capsule
First step in the filtration of blood to form urine
surrounds the glomerulus
Proximal Convoluted Tubule
efficiently regulates pH of filtrate by exchanging hydrogen ions
Loop of Henle
U Shape
Recover of water and sodium chloride from urine occurs here
Distal Convoluted Tubule
In the kidney cortex
Reabsorbs Ca, Na, and Chloride, and regulates pH of urine by secreting protons and absorbing bicarbonate
Ureters
Carries urine from the kidneys to the bladder
Anuria
urinary output less than 100 mL/24 hours
oliguria
diminished urinary output (100-400 mL/24 hours)
Polyuria
excessive urinary output (diuresis)
common in diabetes patients
Hematuria
blood in the urine
Dysuria
pain on urination, difficulty voiding, burning sensation
Proteinuria
protein in the urine
Keotnuria
ketones in the urine
Nocturia
Excessive urination at night
Enuresis
Involuntary voiding
Nocturnal - nighttime; Diurnal - daytime
Important Developmental Considerations of the GU System for Infants
The kidneys function better/begin after 9-12 weeks
Infant kidneys have less ability to concentrate/dilute urine
Important Developmental Considerations of the GU System for Children
Incontinence
Night Wetting
UTIs
Important Developmental Considerations of the GU System for Males
Urethra is 20-21 cm (7.5-8 inches)
Slit is vertical
Urethra goes through the prostate gland
There is a reproductive function
Important Developmental Considerations of the GU System for Females
Urethra is 3.5 cm (1.5 inches) - a lot shorter than males
Questions to ask the patient during the subjective interview for the GU system?
Frequency and Amount (polyuria or oliguria)
color changes/blood presence
pain (dysuria), burning
incomplete emptying
hesitancy, nocturia, dribbling
straining, narrowing stream
incontinence, overflow, stress
PMH
UTIs, STD, injuries
Stones, Gout
Medications (Diuretics)
HTN
What is gout?
uric acid substance backs up in the blood stream and crystallizes in the toes and fingers leading to intense pain
Example of 4 Diuretics
Lasiz
HCTZ
Bumix
Aldactone
Extra Considerations for the GU Subjective Interview for Children
Get parent permission
Onset of control
Frequency, hydration routine
Diurnal enuresis
Vincent’s curtsy
hx of UTIs?
Vincent’s Curtsey
squatting on the heels, crossing the legs, and flexing the pelvic floor muscles while performing a curtsy maneuver
Extra considerations for the GU subjective interview for adolescents?
Smoking, Alcohol, Drugs
Sexual Activity
Urinary Difficulties
Order of Objective GU Assessment Techniques
Inspection –> Palpation –> Percussion
Objective Findings for the Inspection of the GU System
Inspect for abnormalities:
Back
Peritoneal Area
Objective Findings for the Palpation of the GU System
CVA Tenderness
Pelvic Area / Flank Area (where kidneys are in lower back) check for tenderness, warmth, swelling, etc
Do light and deep palpation of pelvic area
Objective Findings for the Percussion of the GU System
Tympany - Empty Bladder
Dullness - full bladder/ over liquid
CVA Tenderness
nursing technique where one hand goes on flank and the other gently hits it - if pain is elicited that means there is a positive for kidney issue
When does the normal bladder urge begin around? (cc)
150-250 cc
A health bladder can hold urine for up to …
2-5hours
The normal volume of urine that enters the bladder is …
1-2 L per day
Objective Findings to look at when inspecting urine?
Color (Hydration)
Smell (Glucose)
Acidity (Diet)
Density (Hydration)
Composition (Urea, Uric Acid, Creatinine, Sodium, other trace elements)
Check if they can hold it for the normal timing
Causes of Acute Renal Failure
Obstruction
Dehydration
Medications
(Acute can be fixed but chronic cannot, like in those with diabetes mellitus)
Causes of Chronic Renal Failure
HTN
DM (Diabetes Mellitus)
Causes of Kidney Stones
Diet
Hereditary Traits
Abnormal Bladder Findings
UTI
Urinary Retention (Prostate, tumor, bladder dysfunction)
Urinary Incontinence
Interstitial Cystitis
Abnormal GU System Assessment Findings
Lower Urinary Tract Symptoms (LUTS)
Benign Prostatic Hyperplasia (BPH)
Prostatitis
Cancer/Tumors
Anatomical Abnormalities (ex: Vesicoureteral Reflux)
Vesicoureteral Refluex
GU abnormality where the urine goes back up the ureter and into the kidneys
High Risk Population for UTI
Sexually Active Women
Post Menopausal Women
> Women have shorter urethra, thus higher risk
Individuals with DM
Individuals with Indwelling catheters
The Elderly (may not drink enough fluids)
Stress incontinence
Most common in women
Urine leaks when coughing, sneezing, or laughing
Overflow Incontinence
inability to empty the bladder
dribbling of urine is almost constant
can be due to DM, prostate issues (blocked urethra), or a damaged bladder
common in older men with prostate issues
Reflex Incontinence
Symptoms the same as urge incontinence due to spinal or neurological trauma
Urge Incontinence
overactive muscles cause spasms, sudden and intense urge to urinate, and sudden loss of frequency
Functional Incontinence
normal urge to urinate but physical ailments prevent the person from making it successfully to the bathroom on time
The kidney is about the size of …
your fist
Normal Kidney v Diseased Kidney
Normal: Healthy function, proper size, low urine protein
Diseased: Granular surface, decreased fxn, smaller size, high urine protein
Test and Surgeries for Acute Kidney Disease
Urinalysis (Clean Collection) C&S (Sterile Collection) 24 Hour Collection Straight and Retaining Catheterizations Bladder Scanner Kidney Stone Filter Transurethral Resection (TUR) (Prostate or Bladder)
TUR
Transurethral Resection
removal of cancerous bladder tissue or a section of the prostate
U/A and C&S Considerations
Clean the meatus with a peri wipe FRONT TO BACK
Clean Catch v Straight Catheter
Clean Catch
patient pees in a cup
Straight Cath
Cath kit is put up the urethra to catch urine
24 hour urine collection
Tests for kidney function
the patient voids in the am (first morning) which is discarded and then after that you put a time on the gallon when you started to measure and start collecting at the second urination
collect all of it for 24 hours
patient voids right before 24 hour mark ends too
What to assess urine for
Color Amount Odor Turbidity pH Specific Gravity Constituents
Pale v Amber Urine
Pale means well hydrated, while amber color means dehydrated
Less that ___ cc/hr of urine indicates kidney failure
30
Odor indicates what about urine
infection, concentration, glucose presence
Normal Urine turbidity is …
clear initially, and gets cloudy as it stands
pH of urine
normal around 6 (4.6 to 8)
Specific Gravity of urine is …
the concentration of urine / weight in comparison to distilled water
Normal Urine constituents
urea, uric acid, creatinine
Abnormal urine constituents
blood
pus
albumin
glucose
ketones
blood
bile
bacteria
A catheter can either be ___ or ___
internal or external
Catheters, like the condom cath, need to be …
inspected frequently (every 8 hours) for skin erosion or falling off
Foley Catheter / Indwelling Catheter
catheter put up the urethra and inflated with a balloon to be left there
Suprapubic Catheter
catheter inserted above the pubic bone into the bladder and stays there
For patients who cannot use a foley cath
Nephrostomy Tube
Catheter/Tube that is inserted into the kidney
The pore in the tube is how you gain samples, not directly from the bag
Urinary Drainage Bags
urine collection bags that may be able to give specific amount measurements (like seen in ICU) or just used for collecting (like in long term care - less accurate)
Leg Bag
discrete urinary drainage bag that can be attached to the leg
gives PATIENT DIGNITY!!
The leg strap stabilizes the catheter to prevent it being pulled out and hurting the patient by ripping the balloon
Kidney Stone Filter
urinate into the filter to allow kidney stone collection - collect the calcified stones for analysis
Bladder Scanner
ID whether a patient has too much urine in the bladder and document whether a cath (Foley) is needed or if they need to try and void
ultrasound
Intermittent Catheter
a catheter inserted and removed several times a day for collection/aid
Important Bladder Health and Teaching Considerations
drink 8-10 (8 oz) glasses of water per day
limit alcohol and caffeine use
quit smoking
avoid constipation
keep healthy weight
regular exercise
dry perineal area after urination and defecation from front to back
wear underwear with a cotton crotch
void after intercourse
Testes
produces sperm and testosterone
Epididymis
sperm reservoir
Vas Deferens
Tube that carries sperm
Inguinal Area
area located between the anterior superior iliac spine laterally and the symphysis pubis medially
frequent site of hernia development
Prostate
Prostate
pear shaped/heart shape smooth gland in males examined through the rectum and produces some of the seminal fluids
Function of the Male GU System
Manufacturing (Spermatogenesis) and protecting sperm
Transporting Sperm
Secretion and regulation of male sex hormones (testosterone)
sexual stimulation and pleasure
drainage and excretion of urine
Reproduction Process in Males
Spermatogenesis –> Spermatogonia –> Primary Spermatocytes –> Secondary Spermatocytes –> Mature Spermatozoa
check in weber for more info
Male GU Health Assessment
Subjective Data (COLDSPA; PMH; Family Histories; Lifestyle; etc)
Objective Data (Prep client for comfort whenever possible; equipment ready; guaiac tests)
Document and Validate findings
Trusting Relationship
This relationship for the client occurs when the client feels open to sharing information about his genital’s
Nurses need to keep in mind client sensitives as well as feelings regarding body image, fear of cancer, and sexuality
How to Make your Patient comfortable for the GU Assessment
Maintain eye contact
take into consideration cultural differences
assure the patient
keep your nonverbals in check/face easily seen
dont be apologetic in an obvious or subtle way / remember you are a professional, doing the job of a professional
know the language
room should be comfortable
ask someone to be in the room with you
have patient empty bladder
provide privacy
assist into supine position with legs spread slightly
for a rectal exam assume sims or lay over the table
keep patient draped for privacy
have a good light source
Penis Physical Assessment
Inspection –> Palpation
Check base of penis, pubic hair, shaft, foreskin, glans
Look for urethral discharge
Scrotum Physical Assessment
Inspection –> Palpation
Inspection: Size, shape, position, scrotal sac
Palpation: Use thumb and two fingers to gently palpate testicles; note size, shape, consistency, mobility, tenderness, masses, or nodules
Transilluminate the scrotum - light should shine through
Inspect the inguinal and femoral areas for hernias too
When physically assessing the male genitalia move…
from the base of the penis outward and then back to the scrotum
Important Considerations for Male genitalia physical assessments in infants
Prematurity - undescended testes and few rugae on scrotum
Scrotal edema and ecchymosis typical
Hypospadias, Epispadias
Hydroceles
Hypospadias
urethral meatus opening is on the ventral portion of the glans (upperside)
Epispadias
urethral meatus opening on dorsal portion of the glans (below)
Hydroceles
fluid in the testicle area
Important Considerations for Male genitalia physical assessments in children
redness, swelling, discharge, odor
masses, asymmetry, lumps, crying from pain
trauma, toilet training, urine stream straight
Important Considerations for Male genitalia physical assessments in asolescents
address concerns
safe sex
tanner staging to track puberty development (pubic hair distribution, penile and teste size)
Important Considerations for Male genitalia physical assessments in older adults
pubic hair thinning
testicular atrophy
enlarged prostate
testosterone decrease by age 50
Important Considerations for Male genitalia physical assessments in regard to culture/ethnicity
circumcision
when assessing uncircumcised, pull down the foreskin to assess the glans and make sure to retract it back after being done so circulation is not cut off
Have the patient ___ ___ to note bulges that may indicate enlarged lymph nodes or inguinal hernia
bear down
When doing a rectal exam observe for ..
hemorrhoids
fissures
bleeding prolapse
Risk Factors for Prostate Cancer
Age - rare in those under 40, rapid increase post 50
Race/Ethnicity - highest in AA or Caribbean males of African origin; less common in Asian/Hispanic/Latino men then in whites
Geography - most common in NA, NW Europe, Australia, and Carrib Islands ; Less common in Asia, Africa, CA, and SA
Family History: Increases with father or brother having it
Certain Gene changes
Exposure to agent orange
working on a farm or tire plant or firefighting due to cadmium and toxic chemical exposure
High red meat or high fat diets with few vegis
Low melatonin levels (even sleeping with a small light source)
Symptoms of Prostate Cancer
Trouble urinating
decrease force in urine stream
blood in semen
swelling in legs
bone pain
ED
Education topics for prostate cancer
Dont overeat
eat a low fat and high fruit/vegi/fiber/omega 3 FA diet
soy products and other legumes have phytoestrogens with a potential positive effect
drink daily green tea
drink no more than 2 alcoho9lic drinks a day
get moderate exercise daily
sleep in a dark room and avoid light at night
Testicular Cancer
high mortality rate if not detected early
regular exam as part of cancer checkup recommended by ACS
males should do monthly self exams
Risk Factors for Testicular Cancer
90% age under 54
50% age 20-34%
Carcinoma in Situ
FH of testicular cancer
HIV
undescended teste
S/S of Testicular Cancer
non tender
hard
fixed mass
nodule
scrotal swelling
scrotal heaviness
Important Diagnostic Reasoning Types
- Nursing Diagnosis (Wellness, Risk, Actual)
- Selected Collaborative Problems
- Medical problems
Female Genitalia A&P
Ext: Mons Pubis, Labia Majora and Minora, Clitoris, Hymen
Rectum and Perineum
Internal: Vagina, Cervix, Uterus
Adnexae: Fall. Tubes, Ovaries, Ureters, Bladder, Urethra
function of the female (GU) system
Ova for Ovulation
Transporting the fertilized ovum
housing and nourishing the fetus
hormone reproduction and secretion of sex hormones
sexual stimulation and pleasure
drainage (loss of follicles and uterine lining) and excretion of urine
Physiological Process of the Ovarian Cycle
Hypothalamus/Pituitary/Ovaries secrete hormones
28 day cycle
Follicular Phase 4 to 14 days: Follicles mature, endometrium thickens and proliferation occurs
Ovulation after Follicular Phase
Luteal Phase 15 to 28 days: Corpus luteum, endometrial lining disintegrates (secretory), menses occurs in the last 3-7 days as well as ideal teaching from nurses
Reproductive Process
Mature ovum fert by sperm
zygote to embryonic dev
fall tubes to the uterus
implantation in the uterus
*if no implantation –> menstruation
Functions of the Uterus
House, Nourish, and Protect fetus
Menstruation
a cycle in which the body prepares for a fertilized ovum
Menarche
first menses
Menopause
occurs naturally in most women with approaching age between the age of 35 to 60
ovaries stop producing eggs and teh regular menstrual cycles cease
can also be due to aging, surgery, or chemical imbalance
Premenstrual Syndrome
50-90% of female population report symptoms
occurs several days before menstruations with: irritability emotional tension anxiety mood changes headache breast tenderness water retention
What is included among the external v internal female genitalia
external = structures readily ID through inspection
internal = female repro organs
Things to ask during female GU health history
menstrual cycles
age at time for menarche
menopause
vaginal discharge
pain or itching in genitals and groin
lumps, swelling. masses in genitalia/groin
urinating difficulty, changes in urine color, developed urine odor
diff controlling urine
sexual performance
sexual activity pattern
fertility problems
Important things to glean about past and family history during female GU health history
previous gyno problems and results of any treatment
date of last pelvic exa, by physicians
date of last pap smear and results
fever diagnosed with std at any point
pregnancies
reproductive or genital cancer
Important things to glean about lifestyle and health practices during female GU health history
smoker?
sexual partners
contraceptives
genitalia problems
sexual preference
comfort level in communication about sexuality
fears and stress with sex
fertility concerns
menopause concerns
genital self examinations?
HIV results
estrogen replacement ?
toxic shock syndrome at any point?
STDs?
*word it in a way that is not stressful
External Genitalia Physical Assessment for GU on Female Patients
Inspection (mons pubis, labias, openings, hair distribution and condition on tanner scale, nits and lice, symmetry, erythema, etc) –> Palpation (Bartholin glands and urethra and tenderness)
Inspection –> Palpation!!!
Concerning findings during a physical assessment for the labia minora, clitoris, anus, and urethral oriface?
Labia: s/s inflammation / irritation
clitoris: enlargement or atrophy
Urethral orifice: s/s of infection, fistulas, color issues, discharge, and lesions
Anus: hemorrhoids, s/s infection
Areas important to inspect on a female GU physical assessment?
Labia Minor
Clitoris
Urethral Orifice
Skenes Gland
Vaginal Introitus
Perineum
Bartholins Gland
Vulva
Anus
What makes up the vulva
labia majora and minora
clitoris
urethra
vagina
How to promote comfort in female GU physical exam?
Room should be comfortable
ask someone to be in the room with you
have patient empty bladder
provide privacy
elevate the HOB
assist into lithotomy position
have a good light source
*typically an RN just assists the physician, not actually do the exam
physical assessment of internal genitalia for female GU exam
inspection (vaginal opening and musculature, cervix, and vagina) –> bimanual examination involving palpation and rectovaginal edxamination
Bimanual Exam
Palpation and Inspection of the rectovaginal area, cervix, uterus, and ovaries
Lubricate the dom hand –> insert into vagina –> assess cervix/mobility –> place non dom hand on lower abdomen and press down for a pear shaped hollow muscular organ (uterus) while assessing it
What is not palpable during the bimanual examination?
Fallopian Tubes
Adnexae
the collection of ovaries, fallopian tubes, and ligaments
Cervix
opening into uterus from vagina
may be centered, posterior, anterior, lateral - every woman is different
should be inspected for color, position, lesions, discharge, and shape of the opening
Theres important differences between what kinds of cervixes?
Menopausal
Pregnant (Chadwicks Sign)
Non Pregnant
Chadwicks sign
bluish discoloration of cervix, vagina, and labia from increased bloodflow about 6-8 weeks after conception - early sign of pregnancy
Color of a Non Pregnant Cervix
pale-ish color
Normal Cervical Discharge relating to a normal cycle?
Menses Discharge:
Little discharge
during ovulation, “raw egg” like
flour paste consistency of discharge
Cervical Cancer Risk Factors
HPV
Smoking
Immunosuppression
Chlamydia Infection
Diet Low in Fruits and Vegetables
Being Overweight
Intrauterine Device Use
Multiple full term pregnancies
being younger than 17 at first full term pregnancy
poverty
having a mother who took DES while pregnant
FMH of cervical cancer
Risk Reduction for Cervical cancer
Avoid Risky Sexual Practices: early age, mult partners, high risk sexual activities or a partner who does them
Consult about HPV vacc for boys/girls as early as 9 and up to 26, but especially those between 10-11
Follow USPSTF pap smear guidelines
Screening schedule if mom took DES with you
Eat nutritious food and have routine care for illnesses that weaken immune system
talk to partner about expectations of sexual health before becoming intimate
Incidence of Cervical Cancer
lower rates are in E Mediterranean countries
unusually high rate found in African region where income levels tend to be low
Typical Older Female Client Findings during GU Examination
Vaginal infection d/t atrophy of the vaginal mucosa
gray and thinning pubic hair
cervix appears pale post menopause
urinary incontinence from muscle weakness or loss of urethral elasticity
Chlamydia Trachomatis Symptoms
Often there are none!!
Females: Painful urination, Vaginal Discharge, Pelvic Pain/Intercourse Pain
Males: Pain during urination, testicular pain, rarely can cause prostatitis, penal discharge
Female Complications of Chlamydia
Infertility
Increased Pelvic Pain
Ectopic Pregnancies
PID
Reiters Syndrome
Male Complications of Chlamydia
Epididymitis
Swollen / Tender Testicles
Prostatitis
Infant Complications of Chlamydia
Pneumonia
Blindness
Gonorrhea Symptoms
Often there are none!!
Females: Painful urination, vaginal discharge/bleeding, ab or pelvic pain
Males: painful urination, pus like discharge from penis, pain with one testicle or both, urge to pee more than usual
Gonorrhea commonly spreads to other sites like the rectum, eyes, throat, and joints
Male Complications of Gonorrhea
Scarring urethra
Painful testicles
Female complications of gonorrhea
PID
ectopic pregnancy
infertility
Infant complications of gonorrhea
blindness
joint infection
Syphilis Symptom Development
In both males and females:
Primary (10-90 days)–> Secondary (3-10 weeks) –> Tertiary (greater than 1 year)
Primary Stage Syphilis
chancre sores on genitals’ within 10 to 90 days
Secondary Stage Syphilis
fevers, rashes, lymph node involvement by 3-10 weeks
Tertiary Stage Syphilis
heart and NS issues and blindness after 1 years
PID Symptoms
Pelvic Inflammatory disease:
Abdominal Pain
Vaginal discharge
infertility
pain during urination
nausea
painful sex
increased or foul smelling vaginal discharge
tiredness
fever
HPV
Human Papillomavirus (group of viruses) that can cause various cancers (cervical, penile, oral)
can cause genital and anal warts
vaccination is available and offered to both boys and girls
Genital Herpes (HSV 1 and HSV 2)
HSV 1 is typically non-genital symptoms
vesicular lesions occurs with fever at onset of initial infection
lymph nodes get involved
can be transferred to an infant
HSV1 and 2 Effect on Infants
Liver Infection
Brain Infection
Skin Infection
Possible Death
HSV 1
cold sores
HSV 2
genital herpes
Hepatitis
Inflammation of the liver
B and C are bloodborne STIs (HBV / HCV)
needs treatment
HIV symptoms
fever
chills
rash
night sweats
muscle aches
sore throat
fatigue
swollen lymph nodes
Risk Factors for HIV
unsafe sex
sharing needles
alcohol and recreational drug use
STD
from mother to child upon birth
donated blood
Pubic Lice
Could be head or body lice but untreated head lice can move into the pubic area
causes intense itching
if left untreated skin damage occurs
can spread person to person
treat with shampoos, and bag up stuffed animals/linens
Trichomoniasis Symptoms
Females: Itching, Vaginal Discharge, Pain upon urination, premature birth if left untreated
Males: no symptoms
Bacterial Vaginosis Symptoms
Thin, gray white or green vaginal discharge
Foul Smelling “Fishy” Odor
Vaginal itching
Burning on urination
Makes them susceptible to STIs
How far do you insert a male catheter
6 to 8 inches
How far do you insert a female catheter
2-3 inches
Another name for intermittent catheter?
straight cath
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