Urinary and Reproductive Exam Study Guide Flashcards
1
Q
What are the nursing intervention in caring for a client with history of nocturia?
A
- Make available devices or pads to absorb leaks for ambulatory clients
- Make sure sufficient bed pads are in place. Use cloth pads
- Provide a bedside commode for easy access
2
Q
What is the impact of adequate erythropoietin and insufficient erythropoietin?
A
- Adequate Erythropoietin (EPO), stimulates the stem cells in red bone marrow to increase formation of red blood cells (RBCs, erythrocytes).
- This is known as erythropoiesis.
- EPO is secreted when hypoxia (impaired oxygenation) is recognized, usually the result of injury or cardiac or pulmonary disorders.
- (Erythropoietin is produced in the liver in the fetus.)
- Inadequate Erythropoietin
- In chronic renal failure, end-stage renal disease (ESRD), the kidneys do not function properly, resulting in inadequate erythropoietin production, usually resulting in anemia.
- Synthetic erythropoietin (epoetin alfa) is often given to alleviate this anemia.
3
Q
What are nursing interventions in patients care with micturition and incontinence?
A
- Micturition= urination
Incontinence= loss of bladder control - Nursing interventions/teaching:
- Relieving stress
- Pelvic exercises
- Timing urination
- Bladder training
- Reducing caffeine intake
4
Q
What are the different types of incontinence and what occurs in them?
A
- Transient (Temporary) Incontinence
- Transient (temporary) incontinence refers to incontinence that can be reversed with diagnosis and treatment.
- Factors causing transient incontinence include reversible contributing factors such as changes in mental status, infections, medications, fluid intake, mobility problems, or stool impaction.
- After the precipitating cause is discovered and treated, the incontinence usually resolves without further intervention.
- Transient (temporary) incontinence refers to incontinence that can be reversed with diagnosis and treatment.
- True or Total Incontinence
- True or total incontinence is defined as urinary leakage that is nearly continuous.
- The most common cause of true incontinence in men is surgical removal of the prostate (prostatectomy) .
- Other causes of true incontinence include:
- Injury to the male’s external (voluntary)
- Urethral sphincter
- Injury to the female’s perineal musculature (muscles)
- Congenital or acquired neurogenic disease (e.g., spina bifida or spinal cord injury)
- Congenital anomaly in which the urinary bladder is exposed on the lower abdomen (exstrophy)
- Abnormally placed ureteral orifices in the female (opening distal to the neck of the bladder or into the vagina)
- Vesicovaginal fistula secondary to situations such as injuries during delivery or surgery (may include defects caused by an infection after surgery)
- Invasive cancer of the cervix or prostate
- Radiation injury after treatment of cervical cancer
- Abdominal perineal resection for rectal cancer in men and women
- Other causes of true incontinence include:
- Stress Incontinence
- Stress incontinence is urinary leakage following a sudden increase in intra-abdominal pressure (e.g., coughing, sneezing, or other physical strain).
- Urine leakage may be a few drops or a stream of urine; however, clients can almost always tell the healthcare provider when it occurs and what they do to prevent the leakage.
- Stress incontinence primarily affects women with pelvic relaxation caused by childbirth, trauma, loss of tissue tone, or aging.
- Men frequently have stress incontinence after surgery to the prostate.
- Urodynamic tests are often used to confirm or rule out stress incontinence.
- Stress incontinence is urinary leakage following a sudden increase in intra-abdominal pressure (e.g., coughing, sneezing, or other physical strain).
- Reflex Incontinence and Urge Incontinence
- Reflex incontinence and urge incontinence are similar in that in both types clients experience urgency before voiding caused by bladder spasm.
- Reflex incontinence is caused by bladder instability as a result of upper motor lesions or neuropathies.
- Urge incontinence is caused by irritation of the bladder wall, possibly because of urine components.
- In both conditions, involuntary loss of urine follows a sudden, strong desire to urinate.
- Clients usually cannot stop their urinary stream once it starts and often cannot get to a bathroom in time.
- The client often reduces fluid intake to decrease incontinent episodes.
- However, this concentrates the urine further and increases spasms.
- Clients with urge incontinence also use the toilet frequently and void small amounts to prevent incontinent episodes.
- Again, however, this frequency ultimately decreases the bladder’s functional capacity.
- If the client continues this practice for a long time, the detrusor muscle weakens.
- Distention of the bladder then causes it to spasm at lower volumes of urine.
- Overflow Incontinence
- Overflow incontinence happens when the bladder overfills with urine and is not able to release it because either the detrusor muscle no longer contracts (usually because of local nerve injury, as in diabetes or central spinal cord injury) or a blockage is preventing the urine from emptying.
- Examples of obstruction include benign prostatic hyperplasia (BPH), cancer of the prostate that presses on the urethra, and postoperative urinary retention (see Chapter 90).
- The client typically has a large, distended bladder but dribbles urine either continuously or with stress maneuvers such as coughing or bearing down.
- If the incontinence is caused by a blockage, it is very important to either remove the blockage or bypass the blockage by using a catheter before reflux of the urine into the kidneys causes kidney damage.
- In addition, clients who have this type of incontinence are generally more susceptible to urinary tract infections because the stagnant urine provides an ideal place for bacteria to grow.
5
Q
What are the likely problems with the juxtaglomerular apparatus?
A
- Likely problems associated with the juxtaglomerular apparatus (JGA) are:
- Blood pressure regulation issues (Low and high Blood pressures)
- Cardiac Issues
- A structure within the kidney called the juxtaglomerular apparatus produces a hormone called renin (part of the renin–angiotensin–aldosterone [RAA] mechanism), which acts on the vascular system to assist in blood pressure control.
- Erythropoietin (renal erythropoietic factor) is a glycoprotein (protein and carbohydrate combination) hormone produced in the extraglomerular mesangial cells of the adult’s kidneys and in the child’s liver.
- It stimulates red blood cell production.
- Also secreted in the kidneys is calcitriol , an active form of vitamin D 3 , which influences absorption of calcium and phosphate.
6
Q
What are the cycles of ovulation and uterine?
A
- Ovulation Cycle:
- The three phases of the ovarian cycle are:
- The follicular phase
- Ovulation
- The luteal phase
- About day 14, a surge of hormones causes the ovum to burst through the ovary, ovulation.
- It usually occurs in the middle of the 28-day menstrual cycle (about 14 days before the onset of the next menses (period)).
- Some fertility control and fertility enhancement methods are based on calculation of the time of ovulation.
- Some women experience sharp pains or cramps when ovulation occurs.
- This is known as mittelschmerz (meaning “middle pain” in German).
- Luteal Phase
- During the luteal phase, the empty, ruptured Graafian follicle becomes the corpus luteum and begins to secrete progesterone and estrogen.
- These hormones cause the endometrium (the endometrial lining of the uterus) to become greatly thickened and vascular (engorged).
- If the ovum is fertilized, it becomes embedded in the endometrium and becomes a fetus.
- If the ovum is not fertilized, the secretion of progesterone decreases, the corpus luteum begins to decline, and menstruation occurs.
- Levels of FSH start to rise on about day 2 of the cycle, to begin preparation for the next cycle.
- The three phases of the ovarian cycle are:
- Uterine Cycle:
- The three phases of the uterine cycle are the proliferative phase, the secretory phase, and the menstrual (menstruation) phase.
- Proliferative (Buildup) Phase
- While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth.
- It thickens from about day 4 to about day 14.
- Secretory Phase
- If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall.
- Withdrawal of hormones causes the endometrial cells to change, and menstruation begins.
- Menstruation
- The sloughing off of the endometrium and unfertilized ovum causes menstruation.
- Menstruation averages 3– 5 days but may last 2– 8 days.
- During menstruation, FSH levels rise and several ovarian follicles begin to develop again.
- Thus begins the next endometrial cycle
- Proliferative (Buildup) Phase
- The endometrium of the uterus has a similar cycle, the uterine cycle or endometrial cycle.
- This process prepares the uterus for implantation of an ovum (egg).
- The uterine cycle is controlled by the ovarian cycle and will vary, depending on whether or not fertilization of the ovum occurs.
- The three phases of the uterine cycle are the proliferative phase, the secretory phase, and the menstrual (menstruation) phase.
7
Q
What are the phases of the uterine cycle?
A
- Uterine Cycle:
- The three phases of the uterine cycle are the proliferative phase, the secretory phase, and the menstrual (menstruation) phase.
- Proliferative (Buildup) Phase
- While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth.
- It thickens from about day 4 to about day 14.
- Secretory Phase
- If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall.
- Withdrawal of hormones causes the endometrial cells to change, and menstruation begins.
- Menstruation
- The sloughing off of the endometrium and unfertilized ovum causes menstruation.
- Menstruation averages 3– 5 days but may last 2– 8 days.
- During menstruation, FSH levels rise and several ovarian follicles begin to develop again.
- Thus begins the next endometrial cycle.
- Proliferative (Buildup) Phase
- The three phases of the uterine cycle are the proliferative phase, the secretory phase, and the menstrual (menstruation) phase.
8
Q
What are nurse instructions on prevention of vaginal infections?
A
- Wipe from front to back after going to the bathroom.
- Wash hands thoroughly after using the bathroom or changing perineal pads.
- Change tampons or sanitary pads frequently. Dispose of them safely. Place them in sealed plastic bags in the trash.
- Pull panties, with perineal pad attached, straight down to avoid spreading infection during menses.
- Remove a tampon immediately and call a healthcare provider if fever, nausea, vomiting, diarrhea, or weakness (signs of toxic shock syndrome) appear. Do not use deodorant tampons.
- Do not use vaginal deodorant sprays or scented powders.
- Douche only when absolutely necessary. Use the cleanest technique possible. Dispose of all equipment each time in a safe way.
- Clean the bathtub carefully before use or take showers.
- Do not use bubble bath or bath oil, especially if susceptible to infection.
- Do not use colored or scented toilet tissue.
- Wear only cotton panties, ventilated pantyhose, or hose with garters; avoid nylon panties.
- Avoid tight pants or jeans, nonventilated clothes, or tight exercise clothing.
- Change out of a wet bathing suit immediately after swimming. Stay out of swimming pools or hot tubs if you are susceptible to infection. (The chlorine in the pool may predispose to infection. An infected person also can spread the infection to others.)
- Cut down on intake of sugar.
- Wear a condom when having sexual intercourse. A water-soluble lubricant, such as K-Y jelly, may be needed to increase comfort and prevent irritation.
- Check with a healthcare provider at the earliest sign of pain or infection. (Sexual partner should also be checked.)
- Consult healthcare provider regarding use of oral contraceptives or other hormones.
- Reaffirm the necessity of a yearly Pap test, breast examination, and serology tests for sexually transmitted infections (STIs).
- Stress the need for adequate nutrition, including vitamin D and calcium intake, as well as fruits and vegetables.
- Teach the client about the dangers of smoking.
9
Q
Hormonal influences, functions in secondary sexual characteristics in male and females
A
- The male reproductive system
- During puberty, male glandular development becomes very active and also influences the development of secondary sexual characteristics, including the typical male beard, pubic, and axillary hair, as well as increased body hair.
- Unique musculature develops; the shoulders become broader and the hips remain narrow.
- The voice deepens, and the “Adam apple” (unique to the male) develops in the anterior throat.
- The male reproductive system develops during childhood and adolescence and is influenced by specific hormones.
- As hormones from the hypothalamus, pituitary, and gonads are secreted during puberty (pubescence), the male is able to reproduce.
- In boys, puberty usually occurs between 12 and 16 years;
- full adult maturity is reached about age 20 years.
- Before puberty (prepubescence), blood concentrations of androgens (male hormones) and estrogens (female hormones) are the same in every person.
- The fetal precursor of specific male gonads is the Wolffian duct, which develops into the epididymis, vas deferens, ductus deferens, ejaculatory duct, and seminal vesicles.
- When a boy reaches puberty, the hypothalamus stimulates the secretion of both interstitial cell-stimulating hormone (ICSH) and follicle-stimulating hormone (FSH) from the anterior pituitary (Chapter 20); both are gonadotropic hormones.
- In the man, these hormones have two main effects:
- They stimulate the gonads (sex glands) to secrete specific male hormones (androgens).
- FSH stimulates the formation of sperm.
- The major androgen is testosterone; its production is stimulated by ICSH.
- Testosterone also maintains the functioning of male accessory organs and stimulates protein anabolism.
- As a result, a man usually has larger and stronger musculature than a woman.
- The female reproductive system
- All female secondary sex characteristics depend on secretion of estrogens and progesterone.
- Characteristic secondary sexual characteristics of the female include a smaller stature, higher percentage of body fat, pubic and axillary hair, and development of breasts.
- The female pubic arch (subpubic angle) of the pelvis and hip structure is wider than that of the male, to facilitate childbirth.
- Sweat glands become more active.
- Although voice changes are not as marked as those in a boy, the voice does deepen and mature in tone and quality.
- The hypothalamus, pituitary, and gonads all contribute to hormonal regulation of the female reproductive system.
- (Remember that before puberty, androgens [male hormones] and estrogens [female hormones] are at similar levels in both boys and girls.)
- The hypothalamus stimulates the secretion of gonadotropic hormones, which include luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in women.
- The main effects of LH and FSH include stimulating both the formation of ova and the secretion of hormones from sex organs.
- Gonadotropic hormones also stimulate development of secondary female sexual characteristics.
- The ovaries begin to secrete estrogens, including estradiol, estriol, and estrone.
- After puberty, the corpus luteum of the ovary produces another hormone, progesterone, which functions primarily during pregnancy.
- The pubescent girl exhibits many changes as a result of estrogen production.
- As glands of reproduction become active, menstruation occurs.
10
Q
What are the male and female reproductive system organs and their various functions?
A
- The male reproductive system consists of:
- The testes (produce sperm)
- Ductal system and seminal vesicles (transport and store sperm)
- Scrotum (holds testes and regulates their temperature)
- Penis (deposits sperm in female)
- Accessory glands (produce male hormones and other secretions).
- The area between the scrotum and anus is the male perineum.
- The female reproductive system consists of:
- Paired ovaries:
- The gonads (sex organs) in women are the ovaries , which produce female gametes or ova (singular: ovum) and secrete female sex hormones (estrogens).
- Oviducts:
- Sometimes called uterine tubes, ovarian tubes, or fallopian tubes, the oviducts are the passageway for the ovum between the ovary and the uterus
- The uterus:
- The uterus ( womb ) is a hollow, muscular, upside-down pear-shaped organ in the center of the pelvic cavity above and behind the urinary bladder.
- The uterus is considered to be the major female sex organ, even though the gonads are the ovaries.
- Vagina:
- The vagina’s functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal.
- The vagina is attached to the uterus through the cervix and meets the external organs at the vulva.
- The vagina’s superior, domed portion has deep recesses, fornices (singular: fornix), around the portion of the cervix extending into the vagina.
- Glandular secretions from Bartholin glands (greater vestibular glands) and the mucous membrane lining its walls moisten the vagina.
- The mucus is acidic and retards microbial growth.
- (The alkaline semen can temporarily neutralize the vagina’s acidic environment.)
- Rugae, expandable folds within the vaginal walls, accommodate insertion of the penis and passage of the fetus during childbirth.
- Paired ovaries:
11
Q
What are the functions of the following hormones and how do they influence the body?
- Prolactin
- Calcitonin
- LH
- Oxytocin
A
- Prolactin:
- Stimulates growth and hormone activity of ovarian follicles
- Stimulates growth of testes
- Calcitonin (Thyrocalcitonin):
- Involved in the maintenance of calcium levels.
- When the circulating calcium level is high, calcitonin responds by promoting increased storage of calcium in bones and increased renal excretion of calcium, resulting in lowered serum calcium.
- LH:
- In women stimulates ovulation and the formulation of the corpus luteum (luteinization), which then produces progesterone.
- In men, LH stimulates the production of sex hormones, including testosterone, in specialized areas of the testes and is also called interstitial cell-stimulating hormone
- Oxytocin:
- Causes muscle contraction of uterus; causes ejection of milk from mammary glands
12
Q
What are the internal and external structures in the female’s reproductive system ?
A
The internal organs:
- Uterus
- Vagina
- Ovaries—are located within the pelvis between the urinary bladder and rectum and are held in place by a group of ligaments.
- The external structures make up the vulva.
- The external genitalia are collectively called the vulva ( pudendum ), including the vestibule and surrounding structures.
- The vestibule contains the openings of the urethra, vagina, and Bartholin glands
- The external structures also include the mons pubis, labia majora, labia minora, clitoris, and prepuce
- The mammary glands (breasts) are also considered female reproductive organs.
13
Q
What are the sperm cell structures, How do they survive and what are their functions
A
- The head:
- Contains 23 chromosomes (half of the human genetic material)
- The tip of the head, the acrosome , contains enzymes that can dissolve the tough cell wall of the ovum (female sex cell).
- The body (center sections) contains mitochondria, providing energy for locomotion.
- The whiplike tail is a flagellum that propels the sperm with a lashing motion.
- After sperm and semen combine in the ejaculatory duct, the ejaculatory fluid contains about 60–100 million sperm cells per milliliter.
- (Semen with a sperm count of less than 10–20 million per milliliter may have difficulty fertilizing an ovum.)
- The amount of semen ejaculated (expelled) varies from 2 to 5 mL.
- After ejaculation into a woman’s vagina, a sperm cell can survive up to 3 days .
- Of the average 250 million sperm cells ejaculated, only about 100 survive to contact the ovum in the oviduct, although usually only one sperm fertilizes the ovum.
14
Q
What are the functions, importance and location of ejaculatory fluid, seminal vesicle, prostate glands
A
- Ejaculatory fluid:
- The ejaculatory ducts are about 1 in. (2 cm) long, each originating where the ampulla of the ductus deferens joins the duct from the seminal vesicle.
- The ejaculatory ducts receive secretions from the prostate gland, to make up semen and empty into the urethra. (The semen, mixed with various secretions, is now ejaculatory fluid.)
- Seminal vesicle:
- The two seminal vesicles ,convoluted, sac-shaped glands about 2 in. (5 cm) long, are located posterior to the urinary bladder and secrete a sticky, alkaline, yellowish substance, semen , the fluid medium for sperm.
- They secrete about 60% of all of a man’s semen.
- Prostate glands
- The prostate , a donut-shaped muscular structure just larger than a walnut, lies below the bladder and surrounds the neck of the urethra as it emerges from the bladder.
- Glandular prostate tissue adds an alkaline secretion to semen, which increases sperm motility.
- Prostatic contractions during ejaculation expel semen from the urethra.
15
Q
What patient teaching could you provide for a Vasectomy procedure?
A
- This operation does not affect erection or ejaculation;
- it just prevents sperm from passing.
- A form of male sterilization
