Unit 4 Lower Urinary System Flashcards
1
Q
What is the purpose of our Ureters?
A
- Carry Urine from renal pelvis to the bladder
2
Q
True or false: Ureters lumens are narrow?
A
True
3
Q
How long is a males urethra? Double check
A
8-10inches
4
Q
How long is a female’s urethra? Double check notes
A
1-2inches
5
Q
What is a reservoir for our urine?
A
- Bladder
6
Q
What is our bladder capacity range?
A
600-1000mL
7
Q
True or false: The bladder controls urination, micturition, and voiding?
A
True– basically all mean to pee
8
Q
What is the detrusor muscle and why is it important?
A
- Located up in the wall of the bladder and remains laxed to allow the bladder to fill with urine. The muscle will contract during urination to aid in the release of urine.
9
Q
True or false: Men typically encounter more problems with there detrusor muscle than women?
A
True- The problems– are typically when the muscle contracts even when the bladder is not full…
10
Q
How does urine flow?
A
- Flows downward to prevent urine back flowing to kidneys
- Ureters connect to the bladder and have ureterovesical valves (one-way) valves that help urine not black flow into the kidneys
11
Q
True or false: Urine does not create pressure on the bladder?
A
False- Pressure is created by urine in the bladder
12
Q
Is urine sterile?
A
Yes
13
Q
Is the PH of urine acidic or non-acidic?
A
Acidic
14
Q
How is the prostate gland a protective mechanism to the bladder?
A
- Secretes antimicrobial fluid which helps kill bacteria
15
Q
How is the normal flora of the vagina a protective mechanism to the bladder?
A
- Lactobacilli (the normal flora) keeps the vaginal wall and area surrounding acidic
16
Q
What are the protective mechanisms in the bladder? (list 8) – FYI the answers to this card have also been broken into separate flashcards.
A
- Urine flows downward to prevent urine backflow into the kidneys
- ureters connect to bladder = ureterovesical valves (one-way valves)
- Muscles of bladder
- Pressure created by urine in the bladder
- Urine itself is sterile
- PH of urine is acidic
- Prostate gland- secretions help kill bacteria
- Normal flora of vagina- Lactobacilli
17
Q
Maintaining a healthy bladder includes using the bathroom __A__ and when ___B___.
Should void ever __C__to__D__ hours.
A
A. Often
B. needed
C. 2
D. 4
18
Q
It is important to wipe ____ to ____ after toileting?
A
- Front
- Back
19
Q
True or false: Urinating after intercourse helps maintain a healthy bladder?
A
True
20
Q
What pelvic floor muscle exercises help maintain a healthy bladder?
A
Kegels- contract or squeeze muscles around rectum and vagina at the same time
21
Q
True or false: Wearing cotton underwear does nothing as far as maintaing a healthy bladder
A
False
22
Q
True or false: Limiting alcohol, caffeine – smoking cessation helps maintain a healthy bladder?
A
True
23
Q
Drinking lots of fluids helps maintain a healthy _____?
A
Bladder
24
Q
True or false: Exercise and weight management help maintain a healthy bladder?
A
True
25
What is urinary incontinence?
1. involuntary or uncontrolled loss of urine in any amount
26
What are the 3 types of urinary incontinence that we discussed during lecture?
1. Stress
2. Urge
3. Functional
27
What is functional incontinence and what are some patient populations that are affected most by this type?
1. Urinary tract system is functioning properly but due to an illness or disability the patient has urinary leakage....
2. Patients with Alzheimer's and dementia because they often forget to go so they do better when on a schedule. Patients on a large amount of diuretics may also suffer from this type of incontinences
28
What is stress incontinence?
1. When physical movement or activity- coughing, laughing, sneezing, running, heavy lifting puts pressure (stress) on the bladder causing leakage of urine
29
What causes stress incontinence?
1. Pelvic floor & urinary sphincter weaker
30
When are women at an increased risk for stress incontinence?
1. after childbirth
31
When are men at an increased risk for stress incontinence?
1. if they have prostate surgery
32
What are some devices that can help with stress incontinence?
1. Vaginally pessary-device that fits over the urethra and puts pressure on the urethra to help urine from leaking, helps support bladder base
2. Urethral insert- similar to tampon- inserted into the urethra to prevent leakage and removed after a certain time frame
33
What surgeries can help with stress incontinence?
1. Vaginal sling - mesh like sling that is used to bring up bladder and urethra to help prevent leakage
2. Injectable bulking agents
3. Artificial sphincter
34
What are other names for urge incontinence?
1. Overactive bladder
2. Bladder spasms
3. Irritable bladder
4. Detrusor instability
35
What is urge incontinence?
Involuntary urination with little or no warning
36
What are some symptoms associated with urge incontinence?
1. Frequent urination or nocturia
2. Enuresis (bed-wetting)
37
What meds are used to treat incontinence?
Anticholinergics
38
What are anticholinergics used to treat?
1. Treat overactive bladder and & urinary incontinence
39
What is the saying that goes along with anticholinergics? and why?
1. Can't see, can't pee, can't spit, can't shit...
2. Anticholinergics dry everything up.
40
What should we know about oxybutynin (ditropan)
1. It is an anticholinergic
2. Decreases the urgency, frequency and nocturia in overactive bladder
3.
41
What are some DO NOT's and NEED to know's with anticolinergics?
1. DO NOT use anticholinergics on a patient with BPH
2. DO NOT give with decongestants (Claritin, benadryl, sudafed)
3. CAN CAUSE hypertension
4. Want these patients to be careful when they are excersing or in a hot tub. They do not sweat the same
42
What are some DO NOT's and NEED to know's with anticolinergics?
1. DO NOT use anticholinergics on a patient with BPH
2. DO NOT give with decongestants (Claritin, benadryl, sudafed)
3. DO NOT use with patient with Glucoma
3. CAN CAUSE hypertension
4. Want these patients to be careful when they are exercises or when in a hot tub because they are more prone to dehydration since they do not sweat the same.
43
What are some common treatments for urinary incontinence?
1. Kegal excercises
2. Bladder retraining
3. Botox injections
4. Nerve stimulator
5. Medications- anticholinergics
-Tolterodine (detrol)
- Oxybutynin (ditropan)
44
What is Urinary Retention?
1. Inability to empty bladder
45
True or false: There is acute and chronic types of urinary retention?
True
46
True or false: Acute urinary retention is not considered a medical emergency?
False- It is considered a medical emergency. Very painful--- more common in males with enlarged prostates. This patient will need to be catharized to relieve the pressure
47
What are the causes of urinary retention?
Caused by 2 dysfunctions of the urinary system
1. Bladder outlet obstruction-- enlarged prostate (BPH)
2. Deficient detrusor contraction strength
48
If you have a patient that has been able to urinate fine but all of a sudden can't what would be the first question they will likely be asked by the HCP?
If they are taking any OTC meds because a lot of times, they contain anticholinergic effects.
49
For acute urinary retention what are some nurse management things we could do?
1. Bladder scan
2. Palpate height of bladder (synthesis pubis bone-- right above that you can feel your bladder when FULL
3. Ask about voiding hx
4. Needs indwelling urinary catheter
5. Drink small amounts of fluid- the more fluid we drink the more we will have to pee.. this could be an issue if we cant urinate
6. Avoid alcohol
7. sitting in tub of warm water or warm shower
50
For chronic urinary retention what are some nurse management things we can do?
1. intermittent or indwelling urinary catheter if needed
2. Scheduled toleting time.
51
What is the most important risk factor in bladder cancer?
Smoking
52
What are the clinical manifestations & diagnosis of bladder cancer?
1. Painless hematuria - gross or microscopic
2. bladder irritability- dysuria, frequency & urgency
3. Urine cytology
4. Lab for tumor markers
5. Cystoscopy
6. Imaging
53
What is the earliest sign of bladder cancer?
1. Painless hematuria
54
What are two types of Urinary diversions?
1. Ileal conduit
2. Neobladder
55
What is the most common time we will see a urinary diversion device in a patient?
1. Most common after complete removal of bladder for bladder cancer
56
What is a urostomy- aka Ileal conduit
It is when a portion of the ileum is resected & one end of the segment is closed; ureters are attached to closed end of ileum and open end of ileum is brough through abdomen to form a stoma; a bag is placed over the stoma
57
What is a neobladder?
A bladder is rebuilt out of the intestine and is placed where the previous bladder was. Ureters are connected to the urethra so urine can flow through normally.
58
What are some common problems with a neobladder?
1. urine leakage
2. infection
59
What are some preoperative nursing managment things we should do for urinary diversions?
1. Involve family in teaching about the diversion
2. address psychosocial aspect of stoma, stoma care & pouch application
3. Encourage patient to talk about feelings related to stoma creation
4. Enterostomal therapist consult to visit with patient
60
What is a neurogenic bladder?
1. Nerves between spinal cord and brain don't work
61
What type of patient may we see with a neurogenic bladder?
Patients with
1. Parkinsons,
2. Multiple sclerosis
3. Stroke
4. Diabetes
62
What are some nursing interventions for neurogenic bladder?
1. Provide routine voiding measures
2. Avoid caffeine and alcohol
3. Kegel exercises
4. Catheter care when indicated, pr catheterize prn
5. Medication- tamsulosin (flomax) improves bladder and storage and emptying.
63
What are some diagnostic studies for urinary systems?
Urinalysis
1. Measurement of color, PH, specific gravity
2. Determination of presence of glucose, protien, blood & ketones
3. Microscopic exam for crystals, bacteria
- Use the first morning void and examine urine within 1 hour.
Urine studies
1. Urine culture and sensitivity
-(need at least 10mL of urine)
- if a UA shows bacteria, blood, positive nitrates a C&S will be done.
2. Creatinine clearance
- collect 24 hour urine specimen
- creatinine clearance closely approximates GFR (glomerular filtration rate) probably more accurate measurement of kidney function
Serum creatinine-
1.greater than 1.2 mg/dl is abnormal for women & men 1.4 mg/dL
Blood urea nitrogen (BUN) 7-20 mg/dL
1. A high BUN with normal creatinine = dehydration
64
When are routine UA typically done?
Annual visits.
65
Why is it best to collect the first void of the morning for your UA?
More concentrated and chances of bacteria in it increase
66
What instructions would you give a patient needing a UA?
Clean with wipe before catching.
1. Make sure not to touch the inside of the cup.
2. Urinate a little before placing cup under neath stream
3. Place cup under stream being careful not to touch perineal area.
67
What do we need to know about creatinine clearance collection?
1. Discard 1st urine
2. Collect 24 hours in large collection container placed on ice (or refrigerator if testing at home) or place urine bag over ice if they have a folley bag.
3. Empty bladder initally; Record time; save all urine after first urine specimen discarded
4. Collect for 24 hours
5. have patient urinate at end of 24 hours & add to specimen collection
68
What should we know about interstitial cystitis?
1. Painful bladder syndrome
2. Difficult to diagnose
3. Mistaken for urinary tract infection but urine culture shows no bacteria
4. May need a an antianxiety or antidepressant
69
True or false: interstitial cystitis is believed to have a autoimmune component?
true
70
True or false: Interstitial cystitis is more common in women but can happen in men
true
71
What are the clinical manifestations of interstitial cystitis?
1. Pain in perineum
2. Persistent urgent need to void
3. Painful intercourse
4. Frequent urination (up to 60 times per day)
5. Pain while bladder fills and relief after urinating
6. May have an autoimmune component.
72
Using the Hard to void acronym what do we need to know about UTI's
H-Hormones: menopause & birth control can change our normal flora.
A-Antibiotics: Also change normal flora- take a probiotic
R-Renal stones- Stuck in ureter- going to cause bloackage and back flow to kidneys
D-Diabetes- decreases circulation and immune system and if sugar is not under good control we will be spilling glucose into our urine
T- Toiletries- Powders, bubble baths, perfumes, scented tampons, cleaning from front to back cotton underwear.
O-Obstructive prostate- enlarged prostate, can cause urine retention and back flow
V- Vesicoureter bladder- one way valve
O- Overextended bladder- someone not able to empty blader, chronically increases chance
I- Indwelling urinary catheter- invasive procedures, intercourse, use of spermicides
D- Decreased immune system- as we age immune system weakens, menopausal and hormone supplements
73
What is the pathophysiology of a UTI?
1. Bacteria enters the sterile bladder causing inflammation
2. Cystitis vs Pyelonephritis, urethritis, ureteritis, vs urosepsis
74
What may cause a UTI?
May be caused by a variety of disorders
1. Bacteria infection most common
2. Escherichia coli (E.Coli) most common pathogen
3. Fungal and parasitic infections may cause UTIs
75
What do we need to know about a Catheter-Associated Urinary tract infection (CAUTI)
1. Most common hospital acquired infection
2. #1 cause = prolonged use of urinary catheter
76
What are the causes of CAUTI?
1. E.Coli
2. Pseudomonas
3. Proteus Marabilis
77
What are the risk factors of CAUTI?
1. Pedi and female population
2. Congenital defects
3. Urinary retention
4. Pregnancy
5. Menopause
6. Multiple partners
78
What are the s/s of CAUTI?
1. Hesitancy, freguency, urgency
2. Dysuria
3. Suprapubic pain
4. Diagnose with UA/Urine culture
- +RBC (gross hematuria)
- cloudy
- +wbc
- +Nitrites
79
What are some nursing management we could do for a UTI?
1. Urinalysis & Urine Culture- clean catch
2. Medication
-Antibiotics
- Analgesic for pain
3. Prevention of CAUTI
4. Prevention of urosepsis
80
What are the CDC guidelines -- indications for indwelling urinary catheter?
1. Acute urinary retention or bladder outlet obstruction
2. Need for accurate I &O (hourly monitoring)
3. Assist in healing of open sacral or perineal wounds
4. Prior to certain surgical procedures
5. Patient requires prolonged immobilization
6. to improve comfort for end-of-life care.
81
What is Urosepsis?
Untreated UTI spreads to kidneys
82
What are the risk factors of urosepsis?
1. Urinary catheters
2. Advanced age
3. compromised immune system
4. Diabetes
5. Female gender
6. Surgical procedures involving urinary tract
7. Geriatric- sudden change in LOC, falls, tachypnea, low grade fever or no fever (VS appear normal)
83
What are the clinical manifestations of urosepsis?
1. Initially UTI symptoms
- Abnormal WBC count (either too high or to low)
- Urgency, frequency, foul smelling urine, dysuria, lower abdominal pain
2. More serious s/s (pyelonephritis)
- Nausea, vomiting, fever, chills, pain in lower spine (CVA tenderness), costovertebral angle tenderness
3. Sepsis symptoms -- (MEWS tool)
- Respiratory rate 22 or higher
- systolic pressure less than or equal to 100 mm hg
- WBC too high or too low (4500-10000 per microliter)
84
What do we need to know about severe sepsis/septic shock?
1. organ failure, such as kidney (low urine output)
2. Low platelet count
3. Change in mental status
4. High levels of lactic acid in blood (cells aren't utilizing oxygen in the right way)
85
What is the management of septic shock/sepsis?
1. Early goal-directed therapy (EGDT)
2. Broad spectrum antibiotics
3. Control pain
4. IV fluids to maintain blood pressure support
5. Oxygen therapy
6. Stric I & O
7. Removal of any catheters or devices that may be infected
8. supported care-- stabilizing lungs and flow of blood
86
What are some disorders in the male population?
1. Pyronines- bend in penis
2. Priapism- erection for longer than 4hrs
3. Phimosis- foreskin stuck
4. Hypospadias- urethra on the underneath of penis
5. diphallia ( 2 penis's)
6. Penile strangulation
7. BPH/TURP
8. Prostate cancer
9. Testicular cancer
10. Prostatitis
11.Erectile dysfunction
87
What do we need to know about prostate gland?
1. Male organ that produces semen & transports sperm during ejaculation
2. Enlarged prostate can put pressure on urethra causing difficulty urinating
3. Medical term for enlarged prostate is benign prostatic hypertrophy (BPH)
88
What is BPH?
1. Prostate gland enlarges disrupting outflow of urine from pressure on the urethra
89
What is the main cause of urinary retention of men?
1.BPH
90
What are the risk factors of BPH?
1. Age,
2. Obesity,
3. high protein diet,
4. alcohol & smoking
5. Family history in first degree relative
91
What are some irritative and obstructive s/s of BPH?
Irritative
1. Nocturia
2. Frequency
3. Urgency
4. Dysuria
obstructive
1. Difficulty starting and stopping stream
2. Dribbling
92
What are some diagnostic studies for BPH
1. History & Physical
2. Digital rectal exam (DRE)
3. Prostatic specific antigen (PSA)
4. Transrectal ultrasound
93
What are some medications to treat BPH?
2 main classes
1. Adrenergic receptor blockers- relax smooth muscle of prostate
- Tamsulosin (flomax) - help urine flow to max
-Terazosin (hytrin) - change position slowly
*do not take sildenafil (viagra)
* change positions slowly
2. 5a reductase inhibitors work by reducing size of gland
- finasteride (proscar)
- dutasteride (avodart)
AVOID ANTI ACIDS
94
What are some complications of BPH?
1. Hydronephrosis
2. Urine cannot drain out from kidney to bladder
95
What is hydronephrosis?
1. is swelling of kidney/s due to build up of urine causing swelling
96
What are the causes of Hydronephrosis
1. Blockage of outflow of urine or reflux of urine from bladder to kidney
2. BPH
3. Renal stones
4. Narrowing of ureters
5. Treatment- may need nephrostomy tube if severe
97
What is a TURP (transurethral resection of prostate for bph)
1. Surgery to remove parts of prostate tissue through the penis (for bph)
98
What should we know about post procedure TURP care?
1. Post procedure 3 way indwelling urinary catheter inserted to provide hemostasis & urinary drainage (murphy drip for hematuria & clots irrigating system)
99
What is intermittent irrigation?
1. manual irrigation for bladder spasms, clots decreasing outflow
100
What do we need to know about a patient with bladder irrigation?
1. Assess for bleeding & clots
2. Monitor inflow and outflow
3. Manually irrigate catheter for bladder spasms or if decreased outflow occurs
4. Antispasmodics & analgesics as needed
5. Monitor for increase in clots or gross hematuria
101
What things can we teach a patient with BPH? Double check
For patient going home tech....
1. Kegel exercises
2. No heavy lifting
3. s/s of infection
4. Stool softeners to prevent straining
5. fluid intake 2-3 L per day
6. Avoid caffeine & alcohol
7. Patience- may take time for urinary continence
102
What do we need to know about prostate cancer?
1. No symptoms in early stages
2. Diagnosed often with PSA & Biospy
3. TNM system, gleason score, & PSA (to stage tumor)
4. Early recognition & treatment to prevent mets
103
What should we know about radical prostatectomy?
1. Removal of prostate, seminal vesicles & part of bladder
2. Large indwelling catheter with 20-30 mL balloon is places (pt goes home with catheter)
104
What are some adverse outcomes from a radical prostatectomy?
1. Erectile dysfunction
2. Urinary incontinence
105
What should we know about testicular cancer?
1. More common in young males (15-40)
2. Cryptorchidism or family history of testicular cancer
3.Very curable
- radical inguinal orchiectomy & RLN
- Chemotherapy and/or radiation depending on stage
- risk for infertility
4. cryopreservation of sperm prior to removal)
106
What are the s/s of testicular cancer?
1. Lump or swelling
2. Feeling of heaviness in scrotum
3. Dull ache in lower belly or groin
4. Sudden swelling in the scrotum
5. Pain or discomfort in testicle or scrotum
107
What do we need to know about prostatitis?
1. inflammatory & non-inflammatory conditions affecting the prostate
108
What is the treatment for prostatitis?
1. Acture bacterial- antibiotics 4 weeks
2. Chronic bacterial- antibiotics 8-12 weeks
109
True or false: Chronic prostatitis can cause ejaculatory pain?
true
110
What do we need to know about Erectile dysfunction (ED)?
1. Inability to attain or maintain an erection
2. Increases with age (40-70)
3. Priapism
-erection lasting longer than 4 hours
111
What are some treatments for Erectile dysfunction (ED)
1. Penile injections
2. Erectile devices
3. Erectogenic drugs
-sildenafil (viagra) do not take if on a nitrate
- tadalafil (cialis) do not take if on a nitrate
112
What is dysuria?
Painful urination
113
What is oliguria?
Small amount of urine
114
What is anuria?
No urine
115
What is polyuria?
"peeing alot"
