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BEACON MedSurg/Peds > Urinary elimination > Flashcards

Urinary elimination Flashcards

1
Q

hypospadius

A
  • Urethral opening is below normal placement on glans of penis (ventral surface-underside)
  • May also have short chordee (fibrous band of the penis, will cause it to curve downward)
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2
Q

epispadius

A

Dorsal placement of urethral opening

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3
Q

chordee

A

undescended testes and inguinal hernia

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4
Q

surgical correction of hypospadius, epispadius, and chordee is preformed?

A
  • 12-18 months of age
  • no circumcision
  • stent
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5
Q

cryptorchidism

A
  • One or both testes fail to descend through the inguinal canal into the scrotal sac
  • Testis may be retractable
  • In 85% right testis is affected
  • The affected side or bilateral scrotum appears flaccid or smaller than normal
  • Unknown why this fails: Increased abd pressure, Hormonal influences
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6
Q

Cryptorchidism management?

A
  • Observation for first year
  • HCG - stimulates testosterone production and helps with descent
  • If testis fail to descend between 1-2 years of age then surgical treatment: Orchiopexy
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7
Q

____________ necessary before child can control bowel and bladder function; occurs between 12-18 months

A

myelination of spinal chord

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8
Q

child is usually not ready for potty training until ?

A
  • 18-24 months
  • Waiting until 24-30 months makes the job easier
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9
Q

urinates regularly?

A

1.5 years

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10
Q

aware of voiding

A

2 years

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11
Q

can hold urine?

A

2.5 years

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12
Q

daytime control

A

3 years

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13
Q

nighttime control

A

3.5 years

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14
Q

primary enuresis

A

Never achieved dryness for 3 months

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15
Q

secondary enuresis

A

Dry for 3-6 months then resumes wetness

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16
Q

organic enuresis etiology

A
  • Neurological delay
  • UTI
  • Structural disorder
  • Chronic renal failure
  • Disease with polyuria (DM)
  • Chronic constipation
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17
Q

non-organic enuresis etiology

A
  • Sleep arousal problem
  • Sleep disorders from enlarged tonsils, sleep apnea
  • Psychological stress
  • Family history
  • Inappropriate toilet training
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18
Q

DDAVP
Ditropan
Tofranil (Imipramine)

A

medications for enuresis

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19
Q
  • Sequela of obstruction
  • increased risk of infection
  • Hydronephrosis
  • Hydroureter: enargement of the bladder of the ureter
A

urinary stasis

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20
Q
  • Alteration in neural innervation of the bladder
  • Spastic bladder: ** SCI (above sacral vertebrae) Stroke, MS
  • Flaccid bladder: ** SCI, Diabetic neuropathy, non-relaxing external sphincter
A

neurogenic bladdder

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21
Q
  • Abnormal movement of urine from the bladder into ureters or kidneys
  • frequently occurs during urination
  • often occurs in those with frequent UTI
  • malfomation of valves at the ureter and/or the bladder
A

Vesicoureteral Reflux (VUR)

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22
Q
  • Genetic origin
  • Girls > boys
  • Symptoms: Frequent UTI’s (most common), Enuresis, Flank pain, Abdominal pain
A

vesicoureteral reflux etiology and symptoms

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23
Q

vesicoureteral reflux treatment

A
  • Grades 1-3: will usually resolve on own
  • Grades 4-5: valve repair
  • Prophylactic ABX
  • Teach child to double void
  • Urine C & S q 2-4 months until 3 negative
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24
Q

Classified according to region and primary site affected

  1. Lower urinary tract?
  2. Upper urinary tract?
A
  1. urethritis, cystitis
  2. pyelonephritis
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25
Q
  • Inflammation of the bladder
  • Causes: Bacterial infection, Radiation, Chemotherapeutic agents, Metabolic disorder
A

cystitis

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26
Q
  • Nonspecific
  • Fever or hypothermia (neonate)
  • Irritability
  • Dysuria (crying when voiding)
  • Change in urine odor or color
  • Poor weight gain
  • Feeding difficulties
A

infant s/s of uti

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27
Q
  • Abdominal or suprapubic pain
  • Voiding frequency
  • Voiding urgency
  • Dysuria
  • New or increased incidence of enuresis
  • Fever
  • Malodorus urine
  • Hematuria
A

children s/s of UTI

28
Q
  • An inflammation affecting the renal pelvis and parenchyma.
  • Usually begins in lower urinary tract & ascends into kidneys.
  • Organisms: E. coli (85%), Proteus, Klebsiella
  • Acute: bacterial infection
  • Chronic: non-bacterial inflammation
A

pyelonephritis

29
Q

chronic pyelonephritis

A
  • Urinary obstruction
  • Vesicoureteral reflux
30
Q

Inflammation from infection
↓
Destruction of the endothelial lining of the nephron
and/or
Destruction of the basement membrane
↓
Loss of tubular function
↓
Loss of ability to concentrate urine
↓
polyuria
dilute urine

A

patho: pyelonephritis

31
Q
  • Abrupt onset of fever
  • Chills
  • Back pain
  • Costovertebral tenderness
  • Leukocytosis
  • Pyuria
  • bacteriura
A

acute pyelonephritis clinical manifestations

32
Q
  • Vague
  • Polyuria
  • Nocturia
A

chronic signs of pyelonephritis

33
Q

UTI: Pharmacological Management

A
  • Sulfonamides
  • Quinolones
  • Urinary antiseptics
  • Urinary analgesics
34
Q
  • Age related non-malignant enlargement of the prostate gland
  • Expanding prostatic tissue compresses the urethra causing partial or complete obstruction of the outflow of urine from the bladder
A

Benign Prostatic Hyperplasia

35
Q
  • Urgency, frequency, hesitancy
  • Change in size and force of urinary stream
  • ↑ time to void
  • Dribbling
  • Nocturia
  • Retention
  • Hematuria
  • UTIs
A

BPH Clinical Manifestations

36
Q

BPH medications?

A

Alpha blockers:

  • Flomax (tamsulosin)
  • Minipress (prazosin)
  • Cardura (doxazosin)
  • Hytrin (terazosin)

*take these type of medications in the evening to reduce side effects of hypotension and fatigue

5-alpha reductase inhibitors

  • Avodart (dutasteride)
  • Proscar (finasteride)

*reduce the size of the prostate. Very slow in addressing problems they may be having

37
Q

TURP

A

Transurethral Resection of Prostate:
-Obstructing prostate tissue is removed using a loop wire of a resectoscope & electrocautery inserted through the urethra
Surgical complications:
-Post-op hemorrhage or clots,inability to void, UTI, incontinence, impotence, retrograde ejaculation

38
Q

TURP: Post-op Nursing Care

A
  • Monitor color/ characteristics of urine
  • Strict I & O, including amounts of irrigation fluid
  • Monitor VS closely
  • Belladonna and opium suppositories: help control bladder spasm
  • Encourage liberal intake of fluids (2-3 liters) to decrease risk of UTI
  • Stool softener
  • Antibiotics

*big risk is clot causing obstruction. Keep area well flushed through hydration and an irrigation system

39
Q
  • Transurethral Microwave Thermotherapy (TUMT)
  • Transurethral Needle Ablation (TUNA)
  • Transurethral Laser Therapy or Interstitial Laser Coagulation (ILC)
A

BPH minimally invasive surgery

40
Q

Urolithiasis

A

Urinary calculi

41
Q

Nephrolithiasis

A

Kidney calculi

42
Q
  • Idiopathic
  • Inadequate hydration
  • Hypercalciuria
  • Gout
  • Urine stasis
  • Urinary tract infection
  • Genetic predisposition (cystinuria)
  • Dietary excess of calcium, oxalates, purines
A

urinary calculi etiology

43
Q

5 major types of urinary calculi

A
  • Calcium phosphate
  • Calcium oxalate
  • Struvite (magnesium-ammonium phosphate)
  • Uric acid
  • Cystine
44
Q

Nidus (nucleus) development–> Crystal precipitation–>
Obstruction of urine flow

A

renal calculi patho

45
Q

Common Locations of Urinary Calculi

A
  • Kidney
  • Ureteropelvic junction
  • Pelvic brim (over iliac vessels)
  • Ureterovesical junction
  • Bladder
  • Urethra

*like to be in places where there are angles and junctions

46
Q
  • Stone movement
  • Sharp & intermittent
  • Flank and outer quadrant
A

Renal colic: urinary calculi

47
Q
  • Distention of the renal pelvis or calices
  • Dull & achy
  • Flank & back
A

Noncolicky pain: urinary calculi

48
Q

urinary calculi pain management: pharm

A
  • Narcotic agents (morphine, meperidine)
  • NSAIDS (ketorolac)
  • _Spasmolytic agents: _oxybutynin chloride (Ditropan), propantheline bromide (Pro-Banthine), methantheline bromide (Banthine)
  • Antiemetics
49
Q

urinary calculi post-op care

A
  • Monitor VS; I & O; urine color & clarity.
  • Maintain placement and patency of urinary devices.
  • Never irrigate the catheter without physician’s order.
  • Strain all urine; Teach client how to strain urine.
  • Send stones for analysis.
50
Q

assess for allergies of iodine and shellfish?

A

assessing for allergy to a dye if they’ve never had that proceedure done before

51
Q

urinary calculi nutrition recommendations

A
  • Calcium stones:
    - Limit high calcium foods, Milk, cheese, green leafy vegetables, yogurt
               - Limit Na intake
           - Limit intake of oxalate: rhubarb, spinach, strawberries, chocolate, wheat bran, nuts, beets, and tea
          - Avoid vitamin C supplements
  • Uric acid stones:
    - Limit intake of foods high in purines: Organ meats, beef, veal, pork, venison, chicken, goose, sardines, herring, crab, salmon
52
Q

Pharm treatment of the different kinds of stones

A

Calcium stones

  • sodium cellulose phosphate (Calcibind)
  • Thiazide diuretics

Uric acid stones

  • sodium bicarbonate
  • allopurinol (Zyloprim)

Cystine stones

  • penicillamine (Cuprimine)
  • alpha-mercaptopriopionylglycine (AMPG)
  • Tiopronin (Thiola )
53
Q
  • Inflammation in the kidneys which begins in the glomerulus
  • Acute aka nephritic
  • Antibody reaction with antigens in the glomerulus
  • Entrapment of antigen-antibody complexes
A

glomerular disease

54
Q
  • Inflammation of capillary loops in glomeruli of kidneys
  • Cause: group A beta-hemolytic streptococcus
  • Risk:Upper respiratory infection, Skin infection, Autoimmune process
A

glomerular nephritis

55
Q

acute glomerulonephritis

A
  • Sudden inflammation of the glomeruli of the kidney resulting in acute renal failure
  • Peak age 5-10 years, boys>girls
  • Capillary walls of kidney become permeable; allows red blood cells and protein to pass into urine
  • Usually seen 7-10 days after a strep infection (immune response to strep), may be other organisism
  • APSGN (Acute Post Streptococcal Glomerulonephritis)
  • etiology: Streptococcus A,
    Viruses:Chicken pox, Mumps, Measles
56
Q
  • Severe glomerular injury without a specific cause
  • Rapid decline in glomerular function over 2-3 months
  • Etiology:Systemic or renal immunologic disorders
                      - SLE
                 - Goodpasture’s Syndrome
A

Rapidly Progressive Glomerulonephritis

57
Q

Streptococcal infection (group A Beta hemolytic)
↓
antigen-antibody reaction
↓
formation of antigen-antibody complexes
↓
entrapment in the glomerular basement membrane
↓
Cells lining the glomeruli proliferate
↓
Capillary membrane edema & increased permeability
↓
Hematuria, hypertension, proteinuria,
edema, azotemia, RBC breakdown

A

Glomerulonephritis Pathogenesis

58
Q
  • Gross hematuria
  • Dark, smoky, cola-colored, cocoa-colored urine
  • Oliguria or anuria
  • Headache
  • Abdominal / flank pain
  • Chills & fever
  • Fatigue & weakness
  • Anorexia, nausea/vomiting
  • Peripheral edema
  • Hypertension
A

Glomerulonephritis: Clinical Manifestations

59
Q
  • Urinalysis
  • Proteinuria, RBCs, WBCs
  • ↑ BUN & creatinine
  • ↓ Creatinine clearance
  • ↑ antistreptolysin O titer
  • Biopsy
A

glomerulonephritis dx tests

60
Q

Glomerulonephritis: Achieving Fluid Balance

A
  • Monitor vital signs, I & O & daily weight
  • Monitor for fluid overload
  • _Monitor serum studies: _Electrolytes, BUN, creatinine, Hemoglobin, hematocrit, WBCs
  • Maintain fluid restriction
  • Na+ / K+ restriction
  • Diet – ↓ protein, ↑ CHO
  • _Medications: _Antibiotics, Immunosuppressives, Steroids, Diuretics, Angiotensin II receptor blockers, Potassium-binding resins, Antihypertensives
61
Q
  • Massive proteinuria (>3.5 grams/day)
  • -Hypoalbuminemia
  • -Edema
  • Hyperlipidemia
  • Etiologies: Glomerular disease, Diabetes, SLE
A

nephrotic syndrome

62
Q

antigen-antibody reaction
Sclerosis of the GBM (diabetes, hypertension)
↓
 glomerular basement membrane permeability to plasma proteins
↓
proteinuria
↓
hypoalbuminemia

A

nephrotic syndrome patho

63
Q
  • Severe edema
  • Hypertension
  • Sequela: Pulmonary edema, Pleural effusion, Ascites, Hyperlipidemia and atherosclerosis, Infection, Poor nutrition, Growth retardation
A

Nephrotic SyndromeClinical Manifestations

64
Q

Nephrotic SyndromeDiagnostics

A
  • Proteinuria
  • Hypoalbuminemia
  • Hyperlipidemia
  • Urine appears dark and frothy
  • Negative ASO titer
65
Q

Reduce edema in nephrotic syndrome pt. nursing interventions/pharm

A
  • Prednisone 2mg/kg/day for 4-8 weeks
  • Long term steroid use is concern
  • Treat until child is in remission
  • Diuretic therapy used only if poor response to steroids
  • May need IV albumin
  • Give parental support and education re: urine protein checks
66
Q

Risk for fluid volume deficit r/t effects of diuretics in pts with nephrotic syndrome nursing interventions

A
  • Watch for low BP & increased pulse
  • Report if child has output of less than 1 ml/kg/hr of urine
  • Increased Hbg, Hct and platelets
  • Observe for s/s dehydration

BEACON MedSurg/Peds (21 decks)

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