Test 4 Flashcards
Ureters
Ducts allowing urine to pass from the kidney to the bladder
Bladder
- sterile urine storage
- can store up to 600ml
- feel urge at 200 ml
- under voluntary control until greater than 700ml
Urethra
- channels urine to outside of body from bladder
- 1-2in F 8in M
Color of urine
-pale to dark yellow
Transparency of urine
Clear
-if cloudy suspect infection
Odor of urine
- aromatic
- vitamins, antibiotics can cause strong, sharp odor
Volume of urine
1200-1500 ml/day
Specific gravity of urine
- measures urine density/concentration
- normal 1.003-1.030
- dilute if
pH of urine
5-7 is normal
Urine is acidic
Cells/cast/crystals in urine
- Detected on microscope exam
- RBC’s (2-3) & WBC’s (4-5) are normal
- casts are rare
- hyaline may be found after strenuous exercise or diet therapy. Others may indicate a pathological dysfunction
- crystals found normally. If increase, can cause renal stones (uric acid)
Electrolytes in urine
No glucose, ketones, or protein
Kidneys
- 2 bean shaped structures
- contain about 1million nephrons
- nephrons are functional units
- urine drains into the kidney pelvis
- less than 30ml per HR may be due to kidney failure
- hypertension may lead to renal insufficiency
Micturation
another name for urination
Urgency
sudden need to urinate
may be related to fluid intake, inflammation, or infection. may cause incontinence
Nocturia
excessive voiding at night
may be related to heart failure, diuretics, CHF, or elderly
Enuresis
bedwetting
normal if under 3 yo
Dysuria
painful urination
Hesitancy
difficulty starting flow
may be neurological problem, UTI, Meds (antihistamines)
Dribbling
involuntary passage
weak sphincter muscle, prostate problems or prostate surgery
Hematuria
blood in urine
pyuria
pus in urine
Polyuria
large or excessive amounts of urine
> 2500 mL/day
Oliguria
scant amount of urine
Anuria
no urine output
continence
country urine control
incontinence
unable to control urination
retention
urine that is retained in the bladder (often after surgery)
residual urine
urine that remains in the bladder after voiding
Clinical problems with renal-urinary system
may be associated with:
- stress
- prolonged catherization
- medications
- pathological problem
Residual Urine
urine left in the bladder after voiding
- increased risk for UTI
- Check MD prameters
Urinary Tract Infections
Lower:
-Cystitis
*culture to confirm
*have increased WBC & RBC’s, and bacteria with dysuria frequency, urgency, cloudy urine, voiding multiple small amounts.
Upper(these people are really sick and dehydrated):
-Pyleonephritis (infection of kidney which is more serious)
*lethargy, fever, chills, HA, vomiting, abdominal pain
TO PREVENT: increase fluids, shower not bath, wipe front to back, wash hands, increase acid in urine
Renal Stones
same a kidney stones
S/S depending on locale:
-can cause colicky pain in lower back and abdomen that radiates to lower legs
Spasms can cause dysuria, urgency, and frequency
backing up of urine can be serious (hydronephrosis)
Renal Failure
Acute:
when normal kidney function suddenly ceases
labs: fluid & electrolyte imbalance with increase serum creatinine, BUN, K+, & phosphate
S/S: anorexia, N&V, HTN, & fatigue. Can be fatal
Chronic:
Over a period of time ex. people on DY
Incontinence
loss of voluntary control interventions include: -fluid restriction -toilet schedules -depends -intermittent self-catherization -kegel's exercises 3x daily
Studies for Assessing Bladder Elimination
Intravenous Pyelogram
-Radographic dye test to study renal pelvis, uretes, and bladder. XRay to see structures
Cystometrogram
-study to measure bladder pressures, reflex activity, and bladder strength
-uses a 2 way catheter to instill fluid in to bladder
Electromyography
-determines muscle strength via responses to muscle stimulus
-important for urinary continence
Corrective surgery/urinary diversions
Ileal conduit: -ileum portion with ureters implanted and brought to abdominal wall Ureterostomy: -ureter(s) to abdominal wall Ureterosigmoidostomy: -ureters to sigmoid colon Kock Pouch: -pouch made from ileum with a nippe valve -catheterize to remove urine
Corrective surgery/urinary diversions (cont)
Nephrostomy:
-opening into the renal pelvis with insertion of nephrostomy tubes
Nephrectomy:
-kidney removal
Lithotrypsy:
-crushing renal stones with sound waves
-strain urine for particles
Biopsy:
-tissue sample
TURP (trans urethral resection of the prostate)
-resection of prostate glad thru the urethra
Specimen Collection
Clean catch: -clean specimen, avoid contamination -pt will need instructions -used to assess for UTI UA: -routine specimen done on admission Sterile: -urine from bladder via catheter (straight vs. indwelling) 24 hr: -full day urine collection -keep on ice unless contraindicated
Intake & Output
Intake:
-ingestion of fluids orally (and anything liquid at room temperature, IV, and feeding tube)
ex: water, jello, popsicles, ice cream
Output:
-expulsion of fluids, emesis, drainage, dirrhea
NANDA for GU
- Incontinence
- Constipation
- Diarrhea
- Fluid volume deficit
- Impaired skin integrity
- Body image disturbance
- Self care deficit
Why is sexuality and the reproductive system important?
- Sexuality is behavioral expression of sexual identity:
* perception of being male, female
* sexual orientation - Importance of discussing with clients needs to be made clear with good judgment used in approaching the client
- Nurse realize sexuality is an aspect of health
- Assessment is important because it is affected by: illness, disability, medications, aging, recreational drugs.
- Approach needs to consider: age groups and culture
Reasons for assessing this pattern (sex and repo)
- AIDS: increasing in women, heterosexual couples
- STDs/STIs: herpes, HPV
- Sex education
- Community protection
- Teen pregnancy
- Menstruation/ menopause
Reasons for assessing sex and repo system is related to
- Illnesses: cardiac, respiratory, musculoskeletal
- Surgeries: hysterectomy, mastectomy, prostate
- Medications: cardiac, BP, antidepressants
Two types of adult sexuality
- Procreative: childbearing
- Non-procreative: sexual satisfaction
Sexual response cycle
- desire
- excitement
- plateau
- orgasm: females may have multiple, males have refractory period of hrs to days before next orgasm
- resolution
4 levels of care
- Professional Nurse: assess health history, screen for sexual function/ dysfunction, gather limited sexual info, feelings, behaviors
- Professional nurse with post graduate education: sexual history, education, counseling, referral
- Professional Nurse, MD, Psychologist, MSW, Sexual Therapist: sexual problem, counseling (individual/group), refer to level 4 if needed
- Masters in Psychology, Nurse Clinician, MSW: intensive therapy
Interviewing
Assessment focus:
- identify any immediate sexual concerns
- identify problems that need referral
- identify teaching needs
- identify problems that need treatment
- evaluate client understanding
- determine stage of development and expected physiological changes
- monitor development of reproductive organs and structures
Interviewing topics
- gender
- lifestyle/practices
- sexual satisfaction
- sexual abuse
- STD’s
- family risk factors
- reproductive history
- data from labs, xrays, physical exams
general guidelines
- ensure privacy/confidentiality
- keep to minimum initially
- facilitate communication
- appropriate terminology
- be in the know, don’t judge
FEMALE physical examination
- inspect and palpate
- breasts: size, color, shape, symmetry, texture, lesions, tissue, quality, lymphatics, nipple discharge
- genitalia
- pelvic
MALE physical examination
- inspect and palpate:
* genitalia, male genitals: color, size, hape, symmetry, masses, lumps, lesions. discharge, pymphatics, hypospadias - inguinal canal
- rectal
Diagnostic tests for Sex and Repo system
- STDS: microscope wet mounts, cultures, blood tests (VDRL/RPR/Serology, Western Blot, ELISA)
- Breasts: mammograms, ultrasound, Needle biopsy/aspiration, MRI
- Cervix/Uterine: pap smear, biopsy, colposcopy
- Prostate: digital exam, blood tests, ultrasound
STDs are…
- Any infection transmitted by sexual intercourse (vaginal, oral, or anal)
- Every sexually active person is at risk
- They can affect general and reproductive health
- Some are life threatening: AIDS, Hep B
- More easily transmitted from male to female
- risk factors: multiple partners, unprotected sex, drug abuse
Gonorrhea
-causative organism: Neisseria gonorrhea, late adolescents, young adults, 1st diagnosed in male
-S/S: Men- dysuria, frequency, urethral purulent discharge. Women- asymptomatic early, vaginal discharge, dysuria, cystitis.
-treatment: antibiotic therapy
CURABLE
Chlamydia
-causative organism: chlamydia trachomatis
-S/S: yellow discharge, urethritis, dysuria, frequency
-Treatment: antibiotics
CURABLE
Syphilis
-causative organism: treponema pallidum. bacterial spirochete incubation is 10-90 days
-S/S: Primary stage: painless chancre sore, heals in weeks. Secondary stage: systemic, affecting all body systems. lesions on skin, mucus mucosa, vulva or anus, lymphadenopathy. fever. malaise. patchy alopecia.
S/S for non treatable phases: Latent stage- asymptomatic. Tertiary stage- advanced with tumors. gumma lesions that affect skin, bones, liver. inflammation of the aorta, aneurysms, heart failure. CNS degeneration, blindness, paralysis, mental disease
Treatment: primary and secondary phase: penicillin
Genital Herpes
- Causative organism: Sperpes simples virus. HSV (1 &2)
- S/S: vesicles genitalia, mouth or anus. Dysuria, pain, edema, fever
- Treatment: NO CURE. treat symptoms with topical anesthetic and antiviral medications like acyclovir
Human Papilloma Virus (HPV)
MOST COMMON
- causative organism: human papilloma virus
- S/S: may be asymptomatic, genital warts
- Treatment: vaccine
Trichomoniasis
- Causative organism: trichomonas vaginalis, flagellated protozoan
- S/S: frothy green discharge with strong odor, inflammation, itching
- Treatment: antibiotic (metronidazole)
Hepatitis B
- Causative organism: Hep B virus
- S/S: can range from none to minimal in the early stages of the illness, to jaundice, nausea, abdominal pain, fever, an malaise in the acute phase. Appitate loss, fatifue, itching, dark urine, and pale stools are common symptoms.
- Treatment: NOT CURABLE. antiviral medications
Human Immunodeficiency Virus (HIV)
Acquired Immunodeficiency Syndrome (AIDS)
-Causative organism: retrovirus
-S/S: asymptomatic early stage. Decease resistance, fatigue, enlarged lymph nodes, and may last up to 10+ years. Compromised immune system. AIDS is the later stages when body loses ability to infections.
Opportunistic infections include: phneumocystic carini pneumonia, TB, esophageal candidiasis, toxoplasmosis, histoplasmosis. Other conditions: Kaposi sarcorma, lymphoma.
-Treatment: NO CURE. Antiviral medications
Other female disorders
- Vaginal infections: vaginitis- yeast: candidiasis, moniliasis. bacterial vaginosis
- Cystolcele
- Rectocele
Other male disorders
- urethritis: purulent discharge
- epididymitis: inflammation from STD, infected prostate or urethra
- phimosis: unretractable foreskin r/t stenosis or cancer
- hydrocele
- varicocele
- scrotal edema: associated with CHF
- Testicular cancer: mass, nodules in testes
- prostate cancer
- impotence (erectile dysfunction): unable to sustain erection: diseases: DM, prostatectomy, arteriosclerosis, medications: BP, cardiac, antidepressants
NANDA for sex and repo
- Ineffective Sexuality Pattern
- Sexual Dysfunction
- Infection
- Disturbed Body Image
Why is GFHP #5 Sleep & Rest important?
- sleep is restorative: repais ad renews cells. info integrated from ST into LT memeort
- Sleep deprivation: fast paced societies. Cause by paiin, anxiety, fear, and hospitalization
- snoring may be a sign of sleep apena
- Lack of adequate sleep is associated with: decreased immune fuction, relationship disturances, depression, hypertension, diminished alertness, falls.
Sleep & Rest:
- Sleep: state of unconsciousness from which one can be awakened by sensory or other stimuli
- Rest: waking state
Stages of Sleep: REM
(rapid eye movement)
- active sleep state
- symathetic activity
- mind active, body relaxed
- dreams (vivid, elaborate)
- brain waves on EEG
- 80mins after onset
Stages of Sleep: Non-REM
- quiet sate
- motor tone
- change positions, move extremities
4 stages of Non-REM sleep
Stage 1: Wakefulness vs. Sleep -5min -eyes roll -VS decrease -easy to awaken -muscle tone high: jerky -2-5% of sleep time Stage 2: 10-25min, sleep deeper -40-55% of sleep time -Little or no eye movement -body function continues to drop Stage 3: 20min, deeper sleep -3-8% of sleep time -restfull -slow wave sleep -hard to awake -parasympathetic system Stage 4: 15-30min, deepest sleep -Difficult to awaken -eyes still -slow wave -decreased muscle tone -VS decreased 50% -bedwetting -sleep walking -quality of sleep judged in this
Sleep Deprivation
- impaired cognitive function
- mental fatigue
- impaired memory
- decreased concentration
- poor judgment
- personality changes
Causes of Insomnia
- Stress
- pain
- enviromental factors
- drugs
- caffeine
- headache
- nocturia
- SOB
Types of Insomnia
- Initial: >30min tofall asleep
- Intermittent: several brief periods of awakening
- Terminal: awake early and cant return to sleep
- Transient: lasts several days, weeks
Sleep Disorders
- Sleep Apnea: no breathing while sleep (obstruction, ovesity, enlarged tonsil or adenoids)
- Narcolepsy: daytime sleepiness, loss of motor tone (fall)
- Kleine Levine Syndrome: sleep attack that lasts hours, days (3-4times a year)
- Nocturnal Myoclonus: calf muscle spasms
- EDS (escessive daytime sleepiness): occurs at inappropriate times (working, driving)
- Parasomnias: sleepwalking, bedwetting, neigh terrors
Data Collection for Sleep Interview
- sleep pattern
- habits
- medication history
- caffeine
- alcohol
Diagnostic Tests for Sleep
Sleep Lab Evaluation: -Electroencephalgram (EEG) -Electro-oculargram (EOG) -Electro-myogram (EMG) when all three are done together its called a Polysomnographic evaluation
NANDA for Sleep
- Sleep Deprivation
- Insomnia
- Readiness for Enhanced Sleep
urge incontinence
occurs after a strong sensation to void
- occurs immediately after a strong sensation to void
- R/T: UTI, PID, long term catheterization, pregnancy, diuretics
stress incontinence
most common
involuntary leakage during times of increased intra abdominal pressure
often in women with multi births, pregnancy, pelvic tumor
prolonged catheterization.
cough sneeze laugh
reflex incontinence
permanent neuro lesion causing voiding to be controlled by the spinal cord.
spinal cord injury, MS, CVA, brain tumor
may have high residual urine volumes
functional incontinence
unpredictable loss of urine
cant get to bathroom in time- no warning or feeling
assoc. with neuro problems
urinary retention
inability to empty bladder
r/t hypotonic bladder, neuro lesions, urethral obstruction or increased sphincter muscle tone.
