Week 7: Urinary and Kidney Flashcards

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1
Q

Structures of the Renal System

A

Kidneys and Nephrons x2

Ureters x2

Bladder

Urethra

Male Prostate

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2
Q

Nephrons ____

A

filter

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3
Q

Are the left and right kidneys perfectly symmetrical?

A

No, the left kidney is higher than the right one because of the location of the liver

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4
Q

Functions of the Kidney

A
  1. Urine Formation:

Glomerular Filtration

Tubular Reabs and Secretion

  1. Regulation Functions:

Osmolarity and water excretion

Lyte and AcideBase Balance

BP (RAA System)

RBC Production (Erythropoietin)

Vitamin D Synthesis

Secretion of Prostaglandins

  1. Waste Excretion

End products of metabolism, bacterial toxins, water soluble drugs, and drug metabolites

Urine storage (bladder) and emptying

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5
Q

As a risk factor, childhood diseases can lead to what possible renal/urologic disorder

A

chronic kidney disease

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6
Q

As a risk factor, advanced age can lead to what possible renal/urologic disorder

A

incomplete bladder emptying, etc

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7
Q

As a risk factor, cystoscopy or catheterization can lead to what possible renal/urologic disorder

A

UTI or incontinence

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8
Q

As a risk factor, immobilization can lead to what possible renal/kidney disorder

A

kidney stone formation

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9
Q

As a risk factor, diabetes can lead to what possible renal/urologic disorder

A

Chronic Kidney Disease (CKD)

Neurogenic Bladder

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10
Q

As a risk factor, HTN can lead to what possible renal/urologic disorder

A

renal insufficiency

CRF

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11
Q

As a risk factor, multiple sclerosis can lead to what renal/urologic disorder

A

incontinence

neruogenic bladder

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12
Q

As a risk factor, Parkinsons Disease can lead to what renal/urologic disorder

A

incontinence

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13
Q

As a risk factor, Gout, Chrohns, and Hyperparathyroidism can lead to what renal/urologic disorder

A

Kidney stones

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14
Q

As a risk factor, BPH can lead to what renal/urologic disorder

A

obstruction

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15
Q

What information should be taken upon reanl/urologic assessment in the health history

A

Chief Complaint

Pain (Reason, pattern, intensity, what makes it worse or better etc)

Past health history (hx of UTi, tests, renal angiograms, caths, STDs, etc)

Family Hx

Social Hx (Habits and behaviors)

Voiding Patterns (when is normal, how much, smell, at night a lot?)

Medications (What is taken, what may affect UO/micturation/renal toxicity)

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16
Q

What is an important bit of information to teach elderly patients about their renal function

A

to drink plenty of water everyday even if they are not thirsty as it is good for their renal function

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17
Q

What information should we gather about renal system pain patterns

A

Is the pain from distention, obstruction, or inflammation of renal tissue?

Are we discovering these diagnoses when they seek care for other symptoms?

Are they experiencing any pain even?

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18
Q

Is absence of pain or symptoms for issues lik STIs common

A

yes 50% of people wont even report pain or symptoms

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19
Q

When is a lot of renal/urologic issues and diagnoses found

A

they tend to be found when clients are seeking care for other symptoms like for a cold

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20
Q

Urinary Frequency

A

voiding more than every 3 hours

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21
Q

Urinary Urgency

A

Having a strong desire to void

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22
Q

Dysuria

A

Painful urination

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23
Q

Urinary Hesitancy

A

delay in initiation

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24
Q

Nocturia

A

excessive urination at nightr

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25
Q

Incontinence

A

Involuntary loss of urine

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26
Q

Enuresis

A

Bed wetting

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27
Q

Polyuria

A

increased volume of urine

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28
Q

Oliguria

A

UO less than 500 mL a day

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29
Q

Anuria

A

Less than 50 mL of UO a day

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30
Q

When are oliguria and anuria most common

A

chronic renal failure

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31
Q

Hematuria

A

RBC in urine

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32
Q

Proteinuria

A

Protein in urine (should not be there)

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33
Q

The most accurate indicator of fluid loss or gain in patients who are acutely ill is ___

A

weight

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34
Q

Areas of Emphasis for the Renal/Urologic Physical Exam

A
Abdomen
Suprapubic Region
Genitalia
Lower Back 
Lower Extremities

KIDNEYS - Not always palpable

Bladder percussion

Areas of Edema

Checking DTRs and Gait

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35
Q

Renal dysfunction may produce tenderness…

A

at the CVA (can very rarely palpate the kidney here too)

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36
Q

Why are DTRs and Gait checked with renal physical exams

A

Because the peripheral nerve innervating the bladder also innervates the lower extremities

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37
Q

What are some possible urine colors to find in patients and what do they mean

A

Colorless/Pale Yellow - Dilute Urine, Alcohol, Lots of Fluid Intake

Yellow/Milky White - pyuria, vaginal cream

Bright Yellow - mult vitamin preparations

Pink/Red - Hgb breakdown, RBCs, blood, certain drugs

Blue/Blue Green - dyes and certain pseudomonas species

Orange/Amber - concentrated urine, dehydration, fever, bile, meds

Brown/Black - old blood, very concentrated urine, iron, certain compounds

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38
Q

It is important to document ____ and ____ of urine

A

color and amount

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39
Q

What are some urinary diagnostic tests commonly seen

A

Urinalysis and Urine Culture

Renal Fxn Tests: Specific Gravity and 24 hour Urine Test

Serum Tests: Creatinine, BUN, BUN:Creatinine

Biopsy

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40
Q

Another name for 24 hour urine test is…

A

creatinine clearance test

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41
Q

What is normal urine specific gravity

A

1.010 - 1.025

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42
Q

Urine C&S is often used for suspected ___

A

UTIs

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43
Q

Some of the most common urologic nursing diagnosese are…

A
  1. Knowledge Deficits
  2. Pain r/t infection, edema, obstruction, bleeding along tract, etc
  3. Fear for potential alteration in renal function and embarassment s/t urinary function
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44
Q

Normal BUN:Creatinien ratio

A

10:1

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45
Q

What is the process of urine collection/clean catch (midstream)

A
  1. Nurse has pt wash genitals and perineal area prior w/ soap and water
  2. Males: Void directly into container; Females - Hold container between legs
  3. Begin voiding, then place specimen container in stream of urine and collect 30-60 mL
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46
Q

How should males clean their genitals prior to a clean catch

A

clean the meatus and head of penis with a circular motion

Use each towelette (3 total) once

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47
Q

How should females clean their genitals prior to a clean catch

A

front to back

use each towelette (3 total) once

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48
Q

What is the gold standard of urine collection for determining renal fxn

A

24 hour urine collection

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49
Q

How does a 24 hour urine collection work

A

A special orange speciment container with a preservative is obtained from the lab in order to collect urine (unless the pt has an indwelling catheter)

Signs are posted in the client room, chat, and bathroom regarding all urine needing to be collected in the next 24 hours

Client will void and discard the first urination at the start of the 24 hour period and then begin collecting everything after that

Once 24 hours is up container is put on ice and the client should void one last time to collect that urine before being sent to the lab

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50
Q

What are some diagnostic imaging tests for urinary function / renal function

A

KUB (Kidney Ureter Bladder Radiograph) - Likea kidney x ray

US - high frequency waves through the body - non invasive

CT - 3D image

Bladder Scan 0- INjectible scan

MRI

IVP - intravenous polygraphy - injectnle dye and X rays of the kidney/urinary tract

Nuclear Scans

Cystography - small cystoscope goes in and looks

Renal Angiography - injectible medium looks at renal blood flow

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51
Q

What is needed before any diagnostic test

A

consent form signed

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52
Q

What is needed before urologic testing using contract sgents

A
  1. have emergency equipment ready for anaphylactic shock and double check for allergies to things like iodine and shellfish
  2. Informed consent
  3. Know kidney baseline function because some dyes can cause more injury
    * If a renal angiograph, catheter may need to be inserted first
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53
Q

What are 3 common renal nursing dx

A
  1. Knowledge deficit r/t lack of understanding about procedures and diagnostic tests AEB ___
  2. Chronic pain r/t ____ AEB ___ (Infection, edema, obstruction, bleeding along urinary tract)
  3. Fear (Anxiety) r/t potential alteration in renal fxn AEB ___
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54
Q

What are some examples of Renal Nursing Goals

A
  1. Pt demonstrates increased understanding of tests and procedures by ___
  2. Patient reports a pain level of <3 by ___
  3. Patient reports decreased anxiety by ___
  4. Patient experiences improved elimination patterns by ___
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55
Q

Urinary Retention

A

Inadequate bladder emptying disorder

Residual urine stays in the bladder after voiding and can result in overflow incontinence

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56
Q

Results of Urinary Retention

A

Overflow Incontinence

Urinary Stasis –> Bacterial Growth –> Infection/Stones

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57
Q

If urinary retention is left untreated what will happen

A

A UTI will begin or possible stone formation

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58
Q

Etiology of Urinary Retention

A

Detrusor fxn deficit

Calculi

Fecal Impaction

Obstruction at or below the bladder outlet

BPH

Prostate Carcinoma

Urethral stricture or distortion

Medications

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59
Q

Things to assess with Urinary Retention

A

Nursing Hx

Q-A: S/S / Accurate Health History and Assessment

Inspection Percussion Palpation

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60
Q

Nursing Dx for Urinary Retention

A

THINK OBSTRUCTION:

Risk for INfection …

Risk for Renal Calculi…

Urinary retention r/t detrusor fxn deficit …

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61
Q

Goals for urinary retneiton are based on …

A

the nursing diagnoses

thinking obstructions you want to address risk for infection and calculi but also work on that retention itself

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62
Q

Interventions for Urinary Retention

A

Privacy

Warm Sitz Bath

Normal Standing or Sitting Position to Void

Faucets and Warm Water

Bedside Commode or Toilet

Analgesia after surgical interventions

Catheterizations

Establish normal voiding and evaluate outcomes

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63
Q

Urinary Incontinence

A

Involuntary loss of urine caused by functional issues, neurogenic issues, etc

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64
Q

What are the 5 main types of incontinence

A

Stress

Urge

Functional

Iatrogenic

Mixed

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65
Q

Stress Incontinence

A

Involutnary loss of urine through an intact urethra as a result of sneezing, coughing or CofP

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66
Q

Urge Incontinence

A

involuntary loss of urine alongside a strong urge to void that cannot be suppressed

Need to void but cannot reach the toilet in time

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67
Q

Functional Incontinence

A

Instances in which lower Urinary tract fxn is intact but other factors like cognition make it difficult

68
Q

Iatrogenic Incontinence

A

involuntary loss of urine d/t extrinsic factors and medical factors - primarily medications like alpha adrenergic agents

69
Q

Mixed Incontinence

A

Empasses several types of urinary incontinence, is involuntary leakage associated with urgency and also exertion, sneeze, or cough

70
Q

How can treatment for incontinence vary

A

Could be as simple as behavioral treatment or as complex as neuromodulation

71
Q

Risk Factors for Urinary Incontinence

A

Age related changes

caregiver or toilet unavailable

cognitive disturbances like dementia or Parkinsons

Diabetes

genitourinary surgery

high impact exercise

immobility

incompetent urethra due to trauma or sphincter relaxation

medications like diuretics sedatives hypnotics and opioid agents

menopause

morbid obesity

pelvic muscle weakness

pregnancy - vaginal delivery, episiotomy

stroke

72
Q

Common Nursing Dx with urinary Incontinence

A

Anxiety

Impaired Skin Integrity

73
Q

Goals for Urinary incontinence should be…

A

measurable and derviced from the nursing dx like anxiety reduction or maintenance of skin intgegrity

74
Q

Interventions for Urinary Incontinence

A

Treat underlying cause

Behavioral therapy - kegal exercise, voiding diary, prompted voiding, habit retraining, bladder retraining

Administer meds as ordered

educate about surgical options appropriate

75
Q

Are anticholinergic drugs good for urinary incontinence

A

yes because they lead to urinary retention by inhibiting the bladder contractions adn blocking involuntary movement of smooth muscles

76
Q

Strategies for Promoting Continence to educate the pt on

A

avoid bladder irritants - caffeine, alcohol, aspartame

avoid diuretic agents after 4 pm

increase awareness of amount and timing of fluid intake

perform pelvic floor muscle exercises x2 pid

stop smoking - coughing causes incontinence

avoid constipation - drink adequate fluid, a good high fiber diet, exercise, and stool softeners if recommended

void 5-8 times a day every 2-3 hours - first in morning, before a meal, before bed, once during night if needed

77
Q

Urinary Tract Infections

A

Infections of the urinary tract that can be acute, chronic, uncomplicated, complicated, lower or upper

78
Q

Examples of lower UTIs

A

Cystitis

Urethritis

Prostatitis

79
Q

Examples of Upper UTIs

A

pyelonephritis

interstitial nephritis

renal abscesses

80
Q

Cystitis

A

lower UTI of the bladder

81
Q

Urethritis

A

lower UTI of the urethra

82
Q

Prostatitis

A

lower UTI of the prostate gland

83
Q

Pyelonephritis

A

inflammation of the renal pelvis

Upper UTI

84
Q

Interstitial Nephritis

A

inflamamtion of the kidney

upper UTI

85
Q

Clinical Manifestatiosn of Uncomplicated UTIs

A

Burning on urination

Frequency, urgency, nocturia, incontinence

Suprapubic or pelvic pain

Hematuria and back pain

86
Q

Clinical manifestations of complicated UTIs

A

can range from asymptomatic to Gram Negative sepsis with chock (aka urosepsis)

have a lower response rate to treatment

tend to reoccur

87
Q

UTI Nursing Dx

A

Acute paint r/t infection within the urinary tract

Deficient knowedge about factors predisposing the patient ot infection and recurrence, detection and prevention of recurrence and pharmacologic therapy

88
Q

Major Goal for UTIs

A

Controlling Pain

Teach and educate patients and make sure they know when to come to the hospital

89
Q

What are some potential complications from UTIs

A

Urosepsis

Acute kidney injury and/or chronic kidney disease

90
Q

Risk Factors for UTIs

A
Female Gender
Diabetes
Pregnancy 
Neurologic Disorders
Gout
Altered States caused by incomplete emptying of the bladder and urinary stasis

Decreased natural host defenses or immunosuppression

Inability or failure to empty the bladder completely

Inflammation or abrasion of the urethral mucosa

Instrumentation of the urinary tract (cath, cytoscopic, procedure)

Obstructed Urinary flow from:
congenital abnormalities, urethral strictures, contractures of bladder neck, bladder tumors, calculi, and compression of ureters

91
Q

Why are females more likely to get a UTI

A

they have a shorter urethra/anatomy

92
Q

What are some area of education to provide the patient to prevent recurrent UTI

A

hygiene - showering rather than bathing, cleaning area front to back each bowel movement

Fluid intake - flush the system and bacteria

Voiding habits - every 2-3 hours to prevent bacteria buildup

Absorbic acid or other treatments as prescribed like probiotics

93
Q

Urosepsis

A

gram engative becteremia originating in urinary tract

it is an infection from the urinary tract spreading into the blood leading to systemic infection

94
Q

The most common organism cause of Urosepsis is ___

A

E. Coli

95
Q

the most common cause of urosepsis is

A

presence of indwelling catheter or untreated UTI in medically compromised patients

96
Q

What is the 2 major problems regarding urosepsis

A
  1. Bacterium ability to develop resistant straints

2. Urosepsis can lead to septic shock if not treated aggressively

97
Q

The most common s/s of urosepsis are

A

FEVER - most common and earliest

Perfuse/Sweat more than normal

Different Vitals

C&S Results from Urine

98
Q

Interventions for urosepsis are done…

A

after the culture and sensitivity

99
Q

Interventions for Urosepsis

A

adminsiter IV antibiotics as prescribed - usually until afebrile for 3-5 days

use of oral antibiotics

secure, smallest, and aseptic catheterization only when needed

great perineal care

100
Q

Bacteriuria increases with ___ and ___

A

age and disability

101
Q

What is the most common cause of bacterial sepsis in those 65+

A

UTIs

102
Q

What is the mortality rate like for older patients with UTIs

A

> 50%

103
Q

S/S of UTI in Older Populations

A

Fatigue (most common and subjective complaint in this gorup)

Altered confusion, cognition

104
Q

Factors that contribute to UTIs in older adults

A

cognitive impairment

frequent use of antimicrobial agents

high incidence of multiple chronic medical conditions

immunocompromise

immobility and incomplete bladder emptying

obstructed flow of urine

indwelling catheters

105
Q

Clinical Manifestations of Cystitis

A

R/t actual inflammatory response

Frequency, urgency, and voiding in small amounts

Burning upon urination and inability to void

incomplete bladder emptying and spasm

lower abdominal or back discomfort

cloudy, dark foul smelling urine

hematuria

malaise, chills, fever, n/v

nocturia

incontinence

suprapubic, pelvic, or back pain

confudion in older populations

106
Q

What does hematuria indicate in cystitis

A

infection and inflammation spreading up toward the kidneys (also cloudy dark foul smelling urine)

107
Q

Important Nursing Dx for Cystitits

A

Pain

Infection

108
Q

Education for Cystitis Patient

A

Pharmacological Therapy

Prevent recurrence

Deficient knowledge gaps

109
Q

Interventions for Cystitits

A

Collect urine for C&S - ID bacteria

Instruct to force fluids - especially if taking a sulfonamide

Use strict aseptic technique when inserting a urinary catheter and provide meticulous perineal care

Maintain closed urinary drainage systems for clients with indwelling catheters

administer prescribed meds

education

110
Q

How many fluids should be forced a day for cystitis

A

300 mL/day or 10 oz/hr x 10 hour

111
Q

Why is it particularly important to force fluids if a patient is on a sulfonamide

A

because they can form crystals in concentrated urine

112
Q

Education Points for Cystitis

A

acid ash diet - discourage caffeine products and avoid alcohol

heat to abdomen or sitz bath for c/o discomfort

avoid bubble baths and perfumed hygiene products

avoid tight fitting clothing and nylon undergarments

follow up urine culture following treatment

Medications (Analgesic, antiseptic, antispasmodic, antibiotic, antimicrobial)

113
Q

What is the msot frequent cause of Urethritis in men

A

gonorrhea and chlamydia

114
Q

What is the most frequent cause of Urethritis in women

A

feminine hygiene sprays

perfumed toilet paper and sanitary napkins

spermicidal jellies

UTIs and change in vaginal mucosa lining

115
Q

What are the s/s on assessment of urethritis in men

A

Frequency

Uregncy

Nocturia

Difficulty Voiding

Burning on urination

Penile discharge

116
Q

What are the s/s of on assessment of urethritis in women

A

Frequency

Urgency

Nocturia

Difficulty Voiding

Painful urination

lower abdominal discomfort

117
Q

How do the s/s of urethritis differ in men and women

A

men have burning in urination and penile discharge

meanwhile women have more painful urination and lower abdominal discomfort

118
Q

Interventions for Urethritis

A

encourage fluids

testing for STIs

administer antibiotics as prescribed

instruct client in SITZ Bath

if stricture occurs prepare for dilation of urethra and instillation of antiseptic solution

instruct to avoid intercourse until symptoms subside or STI treatment is complete

Instruct women to avoid using perfumed toilet paper, sanitary napkins, and feminine hygiene sprays

119
Q

BPH - Benign Prostatic Hyperplasia

A

hyperplastic process - increased number of cells - of the prostate gland in men

a NON CANCEROUS enlargement

120
Q

The most common disease or condition in aging men is…

A

BPH (51% of men have it with no clear cause known)

121
Q

S/S of BPH

A

frequency

urgency

nocturia

difficulty initiating

when they do have a stream feels like nothing empties fully - hard to fully empty

dribbling

person QOL decrease

sleep patterns change

122
Q

Complications from BPH

A

Stasis

Retention

UTI

Obstruction

123
Q

Treament for BPH is tailored toward…

A

improving patient QOL - we want to make sure we improve urine output, relieve obstruction, and prevent further progression of the disease

124
Q

Treatments for BPH

A

encouraging fluids

catheterization in severe PH (or urology has to do it if its too large and needs a metal cath)

medications - PROSCAR + Hytrin/Cardua/Flomax (Proscar shrinks gland)

Surgery

125
Q

Prostatitis

A

inflammation of the prostate gland cause dby infectious agents (Bacterial) or tissue hyperplasia (Abacterial)

126
Q

Bacterial Prostatitis

A

organism reaches the prostate through the urethra or bloodstream to cause infection and inflammation

127
Q

Abacterial Prostatitis

A

inflammation occurring following viral illness or decreases in sexual activity

128
Q

S/S of Bacterial Prostatitis

A

fever and chills

dysuria and urethral discharge when prostate is palpated

boggy and tender prostate

WBCs found in prostatic secretions

129
Q

S/S of Abacterial Prostatitis

A

backache

dysuria

perineal pain

frequency and hematuria may be present

irregularly enlarged, firm, and tender prostate!!

130
Q

Interventions for Prostatitis

A

encourage fluid intake

instruct to use sitz baths for comfort

administer antibiotics, analgesics, anti spasmodics, stool softeners as prescribed

inform client of activities to drain prostate: intercourse, masturbation, and prostatic massage

education to avoid spicy foods, coffee, alcohol, prolonged auto rides, and sex during acute inflammation

131
Q

Surgeries for Prostate Enlargement

A

TURP - Transurethral Resection

Suprapubic Prostatectomy

Transurethral Incision

Ablation

Perineal

Retropubic

132
Q

Why is screening for DRE and PSA important

A

because if DRE is abnormal of PRE is high it could mean prostate cancer

however, diagnosis requires confirmation via biopsy

133
Q

Which prostate surgical procedure requires no incisions

A

TURP - Transurethral resection

Technically ablation too

134
Q

Suprapubic Prostatectomy

A

There is an incision in the ambdomen AND bladder to access the prostate

Longer recovery process and monitoring for blood/hemorrhaging is important

135
Q

Perineal Prostate Surgery

A

incision between scrotum and anus to get to prostate gland

can lead to impotence, sexual dysfunction, or rectal damage

136
Q

Retropubic Prostate Surgery

A

AVOIDS BLADDER INCISION

Incision in abdomen while avoiding the bladder

Increased infection risk

137
Q

Important Prostate Surgery PreOp and PostOp Nursing Diagnoses

A

PreOp:
Anxiety
Acute Pain
Deficient Knowledge

Post Op:
Risk for imbalanced fluid volume
Acute pain
Deficient knowledge about post op care

138
Q

Transurethral Incision

A

Similar results to TURP but has an incision made (1-2 to relieve pressure on the urethra itself)

139
Q

Transurethral Resection (TURP)

A

Prostatic tissue is removed through the urethra by optical instruments

Used for glands of various sizes and ideal for those who are at surgical risk

140
Q

Advantages of TURP

A

avoids abdominal incision

safer for surgical risk pateints

shorter length of stay in hospital and recovery periods

lower morbidity rates

causes less pain

can be used as a palliative approach with hx of radiation therapy

141
Q

Disadvantages of TURP

A

requires a highly skilled surgeon

recurrent obstruction, urethral trauma, and strictures can develop

delayed bleeding can occur

142
Q

Important Nursing Consideration Post Op with TURP

A

monitor for hemorrhage

observe for symptoms or urethral stricture such as dysuria, straining, weak urinary stream

CBI - cont. bladder irradiation

give antispasmodics

143
Q

Nursing Dx for Prostate Cancer

A

Anxiety

Urinary Retention

Deficient Knowledge

Imbalanced Nutrition: Less than body requirements

Sexual dysfunction

Acute pain

Impaired physical mobility

Hemorrhage, infection, bladder neck obstruction

144
Q

Important Nursing Considerations Post Op with Suprapubic Surgery

A

abdominal and bladder incision needs frequent dressing changes - 2 incisions were made

longer healing process

sterility needs and issues

145
Q

Important nursing considerations post op with retropubic surgery

A

less bleeding than most others

drainage and bladder spasms occur - need to monitor

146
Q

Collaborative Problems/Potential Complications from any prostate surgery

A

hemorrhage and shock

infection

VTE/DVT

catheter obstruction

complications with catheter removal

urinary incontinence

sexual dysfunction

147
Q

Nursing Interventions Post TURP

A

Assess for bleeding

Assess and treat pain

Infection

DVT Prevention/prophylaxis - get them walking ASAP

Obstruction monitoring

Antispasmodics as prescribed

Teach exercises for sphincter control

Continuous Bladder Irrigation (CBI)

148
Q

What bleeding may be normal at first following TURP

A

Bleeding should be red/pink for 24 hours after and then turn a more tea like color

but if color remains bright red or has clots in it, then it is abnormal bleeding and indicates arterial bleeding - contact the provider

149
Q

Continuous Bladder Irrigation

A

a 3 way (lumen) irrigation system to decrease bleeding and keep the bladder free from clots

Its a bag putting fluid into the stomach and it continuously allows bladder irrigation to prevent clot buildup and keep things moving

150
Q

What is one major potential complication that can occur from CBI

A

TURP Syndrome

151
Q

TURP Syndrome

A

A syndrome caused by CBI caused by neurologic, lyte, and cardiac imbalance from too much absorption of the irrigated fluid

152
Q

S/S of TURP Syndrome

A

HTN

NV

Confusion

Cardiac Issues

153
Q

What should be done if you suspect TURP syndrome

A

stop CBI and let the provider know

154
Q

What are the 3 lumens on CBI used for

A

1 is for inflating a balloon (30 mL) to hold it in place

1 is for outflow

and 1 is for instillation (inflow)

155
Q

How much fluid should be given to Post Op TURP Patients

A

2400-3000 mL/d if possible

156
Q

When can you begin ambulating a post op TURP patient

A

ASAP - so as soon as the urine is more clear (not when pink/red)

157
Q

What does arterial bleeding appear like post TURP and what should be done if this occurs

A

bright red urine with numerous clots –> If this occurs increase CBI and notify physicial immediately

158
Q

What does venous bleeding appear like Post TURP and what should be done if this occurs

A

burgundy colored UO –> If this occurs inform MD who may apply traction on catheter

159
Q

Important rule to CBI

A

What is put in must come out - so what is instilled better be in bag outflow or else something is wrong like tube kinking, urinary retention etc which can cause overdistention leading to secondary hemorrhage

160
Q

Catheter Traction

A

Maintaining tautness to the catheter (straight leg not bent) taped to the abd/thigh which is done by the MD

Never released without MD order - usually after bright red/burgundy colored drainage diminished

Important to Post TURP Care

161
Q

What should be run through the CBI

A

Normal Saline (or glycine) to prevent water intoxication

162
Q

At what rate should CBI be run

A

at a rate to keep the urine pink

If bright red or has clots than run it faster (40 gtt/minute once bright red clears)

163
Q

What should be done if the CBI catheter is obstructed

A

Turn off CBI, irrigate catheter with 30-50 mL NS and notify MD if obstruction is unresolved

164
Q

What two things are important to watch for when using CBI / post TURP

A

Turp Syndrome

Severe Hyponatremia (Water intoxication)

(Both caused by excessive CBI absorption)

165
Q

Important TURP Post Op Care Considerations

A

Expect red-light pink urine 24 hours - then amber for 3 days

Continuous feelings of urge to void is normal

Avoid attempts to void around catheter - causes bladder spasms

Antibitoics, Analgesics, Stool Softeners, and AntiSpasmodics as prescriped

Monitor 3 way foley cath: 30-45 mL retention balloon

Maintain CBI with NS

Educate on post op diet, s/s to watch for

Control pain

Stress importance of doctor follow up