Urinary system

Question 1

at what volume will the sensation to void present?

Answer 1

In adults 150 ml

Question 2

What are the ureters for?

Answer 2

To allows urine to pass down from kidney to bladder

Question 3

What is considered urinary retention?

Answer 3

Great than 300ml < x2 episodes

Greater than 100ml< after voiding

Question 4

What is normal urinary retention?

Answer 4

30-50ml usually remains in bladder and is considered normal

Question 5

What type of muscle is in both ureters and internal urethral sphincter?

Answer 5

Smooth muscle

Involuntary

Question 6

What muscle is in the external urethral sphincter and why?

Answer 6

Skeletal muscle
The external sphincter has to be relaxed in order for urine to pass through and be excreted, normally it is contracted
Skeletal muscle is voluntary control

Question 7

What is a UTI? What are the different sub groups

Answer 7

An infection involving any part of the urinary system
Lower urinary tract infection
Upper urinary tract infection
Complicated vs uncomplicated UTI

Question 8

Which infections are of the lower urinary tract?

Answer 8

Cystitis- inflammation of the urinary bladder
Bacterial prostatitis- Inflammation of the prostate gland
Bacterial urethritis- Inflammation of the Urethra

Question 9

Which conditions are associated with upper urinary tract infections?

Answer 9

Acute pyelonephritis- inflammation of renal pelvis
Chronic Pyelonephritis- inflammation of renal pelvis
Renal abscess
Perineal abscess
Interstitial nephritis- Inflammation of the kidney

Question 10

If a UTI is acquired in the hospital what is it dx as?

Most common cause?

Answer 10

Complicated UTI
Catheterization
Also- occur in Pts with urological abnormalities
pregnancy
Immunocompromised
Obstructions

Frequent recurrence!

Question 11

Define uncomplicated UTI

Answer 11

Community acquired, common among young women, not usually recurrent

Question 12

s/s of UTI

Answer 12

Increased frequency of urination with urgency
Delay, hesitancy
Dysuria- pain w/ urination
Nocturia
Hematuria
Cloudy foul smelling urine
Incontinence
Bladder spasms/bladder pressure

Question 13

s/s of pyelonephritis

Answer 13

Fever, chills
N/V
Flank pain
CVA tenderness over affected kidney
Dysuria

Question 14

What are some considerations regarding UTI and geriatric

Answer 14

Patients on many medications, tx of chronic medical conditions
Frequent use of antimicrobial agents
May be immunocompromised
Cognitive impairment
Immobility
Incomplete emptying of bladder
Use of bedpan rather than commode

Question 15

Atypical presentation of UTI with older clients

Answer 15

Anorexia
fatigue
change in cognitive function
New incontinence 
Hyperventilation
Low grade fever

Question 16

What test is preformed for UTI

Answer 16

Urinalysis

Urine Culture and sensitivity (urine C&S)

Question 17

Describe the steps of a urinalysis

Answer 17

Collect 10ml of urine in sterile cup using clean void or Cath
Deliver to laboratory immediately or must be refrigerated/ put on ice

Question 18

What will be present if UTI

Answer 18

Leukoesterase
Nitrates
WBC
Cloudy/foul smelling
Bacteria over 100,000

Question 19

What is the difference between urinalysis and Urine culture and sensitivity

Answer 19

Urinalysis shows that abnormal material is in urine

If urinalysis is c/w infection such as WBC, nitrates, leukoesterase, bacteria greater than 100,000

Question 20

How long do urine culture results take?

Answer 20

48 hours

Question 21

Which medication is primarily given with community acquired UTI

Answer 21

Trimethoprim/sulfamethoxazole BACTRIM DS 3-7 days

Monitor for adverse rxn- rash common s/e

Question 22

Which medication can be used in low doses prophylactivley?

Answer 22

Bactrim DS

Used for clients that have chronic reoccurring UTI

Question 23

What other medications are given for UTI

Answer 23

Cephalexin- Keflex- NO with PCN allergy
Ciprofloxacin- cipro
Ceftriaxone

Question 24

Which medication is given if UTI is Fungal?

Answer 24

Fluconazole (diflucan)
for IV/oral use only
Many medication interactions
no PO w/ pregnancy/ breast feeding

Question 25

If patient is still presenting with fever 24-48 hours after starting medication what is the concern?

Answer 25

If client still has fever after this time frame considering abx not working

Question 26

A patient with UTI no longer has fever but complains of pain and dysuria, what medications can be given?

Answer 26

Phenazopyridine (Pyridium)

• Analgesic effects
• May turn urine red-orange

Hyoscyamine (anaspaz)
-antispasmoic effects on detrusor 
-c/o constipation
urinary retention (remember contraction of detrusor is needed to urinate)
Drowsiness
Dry mouth

Question 27

What are some key points for patient teaching regarding care for UTI

Answer 27

Meds need to be finished!
Try to void Q2-3 hours
Drink 2-3 L of fluid daily

Question 28

Teaching for prevention of UTI

Answer 28

Avoid bubble baths, nylon underwear, scented toilet tissues
Wear loose fitting cotton underwear
Void before and after sex
Avoid douching
Avoid vigorous cleaning or perineum with harsh soaps

Question 29

How do you assess for kidney tenderness?

Answer 29

CVA test- make a fist and tap on CVA area, + if tender, swelling, bruising or redness
occurs w/ kidney infection
Located- b/l sides below portion of 12th rib and spinal column

Question 30

Where would you auscultate and what would you hear?

Answer 30

Bruits b/l midclavicular side

Can palpate for thrill

Question 31

What does a bruit indicate?

Answer 31

Usually renal artery stenosis

Question 32

What can cause a UTI?

Answer 32

Bacterial- feces
Fungal- candida
Parasite (trichomonas)
Viruses- rare

Question 33

Risk factors for UTI

Answer 33

Female sex
Renal calculi
DM
Sexual activity

Question 34

What are the different types of incontinence

Answer 34

Stress incontinence
Urge incontinence
Overflow/ reflex incontinence
Functional incontinence
Iatrogenic incontinence