Genitourinary 2 Flashcards
(68 cards)
1
Q
What is Bacterial Cystitis?
A
Inflammation of the urinary bladder
Lower UTI
2
Q
What is Bacterial Prostatitis?
A
Inflammation of the prostate gland
Lower UTI
3
Q
What is bacterial urethritis?
A
Inflammation of the urethra
Lower UTI
4
Q
What are the different types of Upper UTIs?
A
- Pyelonephritis: acute or chronic
- Interstitial nephritis
- Renal abscess
- Perirenal abscess
5
Q
What is Urethrovesical reflux?
A
- Backward flow of urine from the urethra into the bladder
- Caused by dysfuntion of the bladder neck or urethra
6
Q
What is Ureterovesical or vesicoureteral reflux?
A
- Backward flow of urine from the bladder into one or both ureters
- Normally the uretevesical junction prevents urine from traveling back into the ureter
- Impaired by congenital causes or ureteral abnormalities
7
Q
Routes of bacteria entering the urinary tract
A
- Transurethral: Ascending Infection Most common, bacteria (most often from fecal contamination), colonize the periurethral area and enter the bladder by means of the urethra
- Hematogenous spread: Through the bloodstream
- Direct Extension: Through a fistula from the intestine
8
Q
Lower UTI
Risk Factors
A
- Female anatomy (shorter urethra, closer to perianal area)
- Menopause (lower acidity of urine, more susceptible to colonization and increased adherence of bacteria)
- Urethrovesical/ureterovesical reflux
- Diabetes (Inc. glucose in the urine, better environment for bacteria)
- Pregnancy
- Neurologic Conditions (Inability to empty bladder/incontinence)
- Gout
- AMS
- Immunocompromised
- Obstructed urinary flow: (renal calculi, tumors, abnormalities, strictures, compression)
- Catheterization
- Urine stasis
9
Q
Lower UTI
Clinical Manifestations
A
- Burning with urination
- Frequency
- Urgency
- Nocturia
- Incontinence
- Suprapubic or pelvic pain
- Back pain
- Hematuria
- asymptomatic (especially CAUTI patients)
10
Q
Lower UTI
Complications
A
- Bacteriuria
- Septic Shock/Urosepsis
- AKI
- CKD
11
Q
Lower UTI
Gerontologic Considerations
A
- Most common infection in older adults
- Increases with age
- Incidence Gap between sexes narrows with age
- Unable to completely empty bladder = urine stasis = inc. risk of infection
- Postmenopausal women: More susceptible to colonization and increased adherence of bacteria d/t dec. estrogen levels
- Lower fluid intake, excessive fluid loss
- High incidence of multiple chronic conditions
- Immobility
12
Q
Lower UTI
Diagnostics
A
Urine Culture:
* Clean Catch midstream
* Straight cath
* diagnosed by bacteria in the urine
Cellular Studies:
* Inc. WBCs in the urine found in all pts with UTIs (but not specific to UTIs)
Multiple Test Dipstick:
* WBCs, Nitrate testing
STI testing
13
Q
Lower UTI
Medical Management
A
Antibiotics:
* Common: Bactrim or Cipro
* Usually PO, short course (3 days), especially for women - to avoid yeast infections
* Also have single dose, 7 day course, and IV antibiotics when necessary
* Longer courses indicated for men, pregnant women, women with pyelonephritis, other complicated UTIs
Cranberry capsules/juice
* Helps to prevent UTIs and reduce symptoms
Urinary Analgesic:
* Phenazopyridine
* Helps with symptom relief - burning, pain, etc.
Urinary Anti-spasmodics
* Oxybutynin
* Helps relieve bladder irritability
14
Q
Lower UTI
Nursing Management
A
- Encourage fluid intake (water, cranberry juice)
- Discourage urinary tract irritants (coffee, tea, citrus, soda, alcohol)
- Encourage frequent voiding (every 2-3 hours)
- Administer antibiotics
- Manage pain: Analgesics, antispasmodics, heat therapy
- Patient education (prevention measures, recognizing early signs)
- Monitor for signs of strictures, obstructions, or stones in pts with recurrent UTIs
15
Q
Lower UTIs
Prevention measures
A
- Showers instead of baths
- Proper wiping technique - front to back
- Fluid intake (include at least 1 glass of cranberry juice/day)
- Avoid coffee, tea, soda, alcohol
- Frequent voiding, completely empty bladder
- Women - void immediately after intercourse
- Take antibiotics as prescribed
- Cranberry capsules
16
Q
Nursing Management for Bladder Scan
A
- Patient unable to void for 4-6 hours
- Symptomatic
- If > 300 mL, perform straight cath, document
- Monitor patient, recheck every 4 hours if not voiding or symptomatic
- After 2 straight catheterizations, notify provider to obtain order to insert a Foley catheter
17
Q
Upper UTI: Acute pyelonephritis
Definition
A
Bacterial infection of the renal pelvis, tubules, and/or interstitial tissue of the kidney
Common cause of urosepsis
Acute: typically from E. coli
Chronic: repeated or persistant infections
18
Q
Upper UTI: Acute Pyelonephritis
Causes
A
- Spread of bacteria from bladder or from systemic sources
- Incompetent ureterovesical valve (reflux)
- Obstruction: Bladder or prostate tumors, strictures, BPH, urinary stones
19
Q
Upper UTI: Acute Pyelonephritis
Clinical Manifestations
A
- Fever
- Chills
- Leukocytosis
- Bacteriuria
- Pyruria
- Lower back and flank pain
- Nausea/vomiting
- Headache
- Malaise
- Painful urination
- Pain/tenderness at CVA
- Symptoms from Lower UTI involvement
20
Q
Upper UTI: Acute Pyelonephritis
Diagnostics
A
- Ultrasound or CT
- IV pyelogram: for suspected functional/structural renal abnormalities
- Radionuclide imaging - can visualize abnormalities not seen on CT scan or US
- Urine cultures and sensitivities
21
Q
Upper UTI: Acute Pyelonephritis
Medical and Nursing Management
A
- Uncomplicated cases - treated outpatient
- 2 week course of antibiotics recommended (usually same Abx as lower UTIs)
- Patient may need 6 week antibiotic course if relapsed
- Hydration
- Pain management
22
Q
Upper UTI: Chronic Pyelonephritis
Definition
A
- Repeated bouts of acute pyelonephritis causes the kidneys to become scarred, contracted, and non-functioning
- Can result in RRT
- Usually asymptomatic
- Can have similar symptoms to acute pyelonephritis
23
Q
Upper UTI: Chronic Pyelonephritis
Complications
A
- Hypertension
- End Stage Renal Disease
- Renal Calculi
24
Q
Upper UTI: Chronic Pyelonephritis
Diagnostics
A
To assess the extent of the disease
* IV urogram
* Creatine clearance and serum levels
* BUN serum level
25
**Upper UTI: Chronic Pyelonephritis**
Medical/Nursing Management
Similar to acute
Patient Education:
* Adequate fluid intake 3-4L/day recommended
* Emptying bladder frequently
* Perineal hygiene
* Take abx exactly as prescribed
Inpatient setting:
* Strict I&Os
* Monitor temperature Q4H
* Administer antipyretics and antibiotics
26
**Renal Calculi**
Definition
**Nephrolithiasis:** presence of stones in kidney
**Urolithiasis:** presence of stones anywhere in urinary system (including kidneys)
Stones are formed when urinary substance concentrations increase *(calcium oxalate, calcium phosphate, struvite, cystine, and uric acid)*
27
Which type of renal calculi are most common in men?
**Uric acid stones**
28
Which type of renal calculi are most common in women?
**Struvite stones**
29
What influences the formation of renal calculi?
* Infection
* Urinary stasis
* Periods of immobility
30
**Renal Calculi**
Risk Factors
* Polycystic kidney disease
* Inflammatory Bowel Disease
* Ileostomy or bowel resection
* Frequent use of: antacids, acetazolamide, Vitamin D, laxatives, and high doses of aspirin
* Family History
* Obesity
* Male
* Low fluid consumption
* Diet high in: protein, sodium, sugar, purine, oxalate
31
**Urolithiasis/ Nephrolithiasis**
Clinical Manifestations
*Depends on location of stone*
**Bladder**
* Similar to UTI
* Possible hematuria
* Urinary Retention
**Kidney**
* Intense deep ache in CVA area
* Hematuria
* Pyuria
* Acute flank pain with N/V indicative of renal colic
* Diarrhea, abdominal discomfort
**Ureter**
* Ureteral Colic: acute, excruciating, wave-like pain radiating down thigh and to the genitalia
* Desire to void, little urine is passed
32
**Urolithiasis/ Nephrolithiasis**
Diagnostics
* Confirmed with CT scan w/o contrast
* Blood chemistries
* 24 hr. urine test *(measures calcium, uric acid, creatinine, sodium, pH, and total volume)*
* Dietary and medication history
* Family history of calculi
* Chemical analysis of stone if collected
33
**Urolithiasis/ Nephrolithiasis**
Medical/Nursing Management
* Pain control *(opioids, NSAIDs)*
* Determine location and type of stone
* Control infection
* Increase fluid intake
* Strain all urine output to collect stone
**Pt. can typically pass 0.5cm stones**
**Stones > 1 cm need to be medically/surgically removed**
34
**Urolithiasis/ Nephrolithiasis**
Extraction methods
* Ureteroscopy
* ESWL: Extracorporeal Shock Wave Lithotripsy
* Percutaneous Nephrolithotomy
* Chemolysis using percutaneous nephrostomy
35
What is ESWL?
* Commonly referred to as **lithotripsy**
* Noninvasive procedure used to break up stones in the calyx of the kidney
* Shock wave is transmitted through water and soft tissue causing the renal calculus to fragment
* Repeated shock waves to the stone breaks it into many small pieces
* After stones are broken up, they are able to be excreted spontaneously
36
**Bladder Cancer**
Risk Factors
**A leading cause of death in the US: *6th most common cancer***
* Male
* > 55 years old
* Smoking is biggest risk factor
* Genetic mutations
* Exposure to arsenic and other chemicals
* Family history of bladder cancer
* Pelvic radiation therapy for other cancers
37
**Bladder Cancer**
Clinical Manifestations
**Painless hematuria**
Change in urine or voiding patterns
Pelvic or back pain with metastasis
38
**Bladder Cancer**
Diagnostics
* Cystography: *gives info on prognosis and staging*
* Excretory urography
* CT & MRI
* Ultrasound
* Bimanual examination
* Tumor Biopsy
39
**Bladder Cancer**
Medical Management
***Depends on grade of tumor and stage of growth***
* **Chemotherapy:** BCG *(bacilli Calmetter-Guerin)* Live promotes tumor destruction
* **Radiation:** Performed preoperatively/ controls disease w/inoperable tumors
40
**Bladder Cancer**
Surgical Treatment
**Transurethral Resection or Fulguration:**
* Followed by BCG live chemo
* For benign epithelial tumors
**Cystectomy (simple/radical):**
* Requires a urinary diversion
* For invasive/ multifocal bladder cancer
41
When is a Urinary Diversion used?
***Usually performed with cystectomy***
* Pelvic Malignancy
* Birth defects
* Strictures
* Trauma to the ureters or urethra
* Neurogenic Bladder
* Chronic Infection
* Intractable interstitial cystitis
* Incontinence
42
**Urinary Diversion: Ileal Conduit**
Definition
***Incontinent Diversion to skin: Most Common***
* Surgeon transplants the ureters into a 12 cm loop of the ileum that is led through the abdominal wall
* Ileostomy bag is used to collect urine
43
**Urinary Diversion: Ileal Conduit**
Complications
* Wound infection/ dehiscence
* Urinary leakage
* Ureteral Obstruction
* Hypercholeremic acidosis
* Small Bowel obstruction
* Ileus
* Gangrene of the stoma
**Delayed complications:**
* Ureteral obstruction
* Narrowing of stoma
* Kidney deterioration
* Peristomal hernia
* Retraction
* Pyelonephritis
* Renal Calculi
44
**Urinary Diversion: Ileal Conduit**
Nursing Management
* Educate: self care *(managing ostomy application, controlling odor, cleaning and deodorizing)*
* WOC nurse consultation
* I&O monitoring
* Provide stoma and skin care *(inspect color: red or pink, monitor for skin irritation & integrity)*
* Ensure proper application
* Check for leakage
* Encourage fluids
* Manage anxiety
*(Large amounts of mucous in urine is normal)*
45
**Urinary Diversion: Orthotopic Neobladder**
Definition
***Continent diversion to urethra***
* Performed in 38% of cases
* New bladder is constructed from segments of the intestines
* Achieves near functional and anatomical restoration of the bladder
46
**Urinary Diversion: Orthotopic Neobladder**
Complications
* Fluid/ Electrolyte Imbalances
* Postoperative ileus
* Incontinence
* Metabolic acidosis
47
**Urinary Diversion: Orthotopic Neobladder**
Nursing Management
* Educate: *(Bladder retraining, risk for incontinence)*
* Catheter care: *Indwelling and suprapubic)*
* Monitor fluids & electrolytes
* Encourage adequate nutrition
48
**Urinary Diversion: Continent Cutaneous Reservoir**
Definition
***Continent diversion to skin***
* Indiana Pouch: uses a segment of the ileum and cecum to form a reservoir for urine
* Pouch drained via catheterization
49
**Urinary Diversion: Continent Cutaneous Reservoir**
Nursing Management
* **Pre-op:** relieve anxiety, ensure adequate nutrition, explain surgery
* **Post op:** prevent complications, maintain skin integrity, manage drainage system and ensure patency, address anxiety
50
**Benign Prostatic Hyperplasia (BPH)**
Definition
* Noncancerous enlargement or hypertrophy of the prostate
* Obstructs the bladder neck and urethra
* Develops over time
* Affects 50% of men over 60 and 90% of men over 85
51
**Benign Prostatic Hyperplasia (BPH)**
Risk Factors
* > 40 years
* Smoking
* Heavy alcohol consumption
* Obesity
* Reduced activity level
* Hypertension
* Heart disease
* Diabetes
* High fat/ high protein diet
52
**Benign Prostatic Hyperplasia (BPH)**
Clinical Manifestations
* Frequent or urgent need to urinate
* Nocturia
* Difficulty starting urination
* Weak stream *(starts and stops)*
* Dribbling after urination
* Inability to completely empty bladder
* Complication of acute urinary retention and recurrent UTIs
53
**Benign Prostatic Hyperplasia (BPH)**
Complications
* Azotemia *(nitrogenous waste in the blood)*
* Kidney failure
54
**Benign Prostatic Hyperplasia (BPH)**
Diagnostics
* Digital Rectal Examination *(DRE)*
* Prostate-Specific Antigen *(PSA)*
* Urine analysis
* Cysctoscopy
* Ultrasound
* MRI
55
**Benign Prostatic Hyperplasia (BPH)**
Medical Management
* **Alpha-Adrenergic Blockers**: Alfuzosin, Tamsulosin, Terazosin
* **Anti-Androgen Agents**: Finasteride, dutasteride
* **Measures to reduce pain/spasms**
* **Catheter for acute condition** *(inability to void)*
56
**Benign Prostatic Hyperplasia (BPH)**
Minimally Invasive
Surgical Treatment
* **Transurethral Microwave Thermotherapy (TUMT):** Probe inserted through urethra and microwaves prostate tissue, which becomes necrotic and sloughs off
* **Transurethral Needle Ablation (TUNA):** Probe with interstitial RF needles inserted through urethra into the lateral lobes of the prostate, causing heat-induced coagulation necrosis
57
**Benign Prostatic Hyperplasia (BPH)**
Surgical Resection Treatment
**Transurethral Resection of the Prostate (TURP):**
* Surgical removal of the inner portion of the prostate through the urethra
**Prostatectomy:**
* Suprapubic: Removal of the prostatic tissue through an abdominal incision
* Retropubic: Low abdominal incision; bladder is not entered
* Laparoscopic/Robotic-Assisted Radical Prostatectomy
**Transurethral Incision of the Prostate (TUIP):**
* 1-2 cuts are made in the prostate and prostate capsule to reduce pressure on the urethra
58
**Transurethral Resection of the Prostate (TURP)**
Post-Surgical Care
* CBI: Continuous Bladder Irrigation (24-48hrs)
* Pain Control
* Monitor for hemorrhage/ infection
* Early Ambulation
59
**Continuous Bladder Irrigation**
Complications
* Possible FVE
* Bladder spasms
* Urgency
* Bladder Pressure
* Bleeding from urethra
60
**Continuous Bladder Irrigation**
Nursing Management
* Output must equal input plus anticipated UOP
* Always have a backup bag of solution
* Physician will order "Titrate to pink or clear output"
* Monitor the TUBING not the bag
* Look for overdistension of the abdomen
* Regulate flow rate
61
**Continuous Bladder Irrigation**
Flow Rate Regulation
* **Bright Red drainage:** increase infusion rate until clear. If drainage does not clear, leave wide open, *notify PCP*
* **Pink or Tea colored drainage:** Continue infusion at moderate rate
* **Clear drainage:** Slow infusion rate
62
**Continuous Bladder Irrigation**
Definition
CBI provides a continous infusion of sterile solution into the urinary bladder using a 3-way irrigation system with a Triple Lumen Catheter to remove loose tissue, blood clots, and mucous shreds from the bladder
63
**Prostate Cancer**
Statistics
* Most common cancer in men
* 2nd most common cause of cancer related deaths in American men
64
**Prostate Cancer**
Risk Factors
* African American race
* Increasing age
* Family history
* Genes with hereditary prostate cancer *(HPC1) and BRCA 1/BRCA 2 genes*
* Diet high in fat and red meat
65
**Prostate Cancer**
Clinical Manifestations
*Early: few/no symptoms*
* Urinary obstruction
* Hematuria or Hematospermia
* Painful ejaculation
* Sexual dysfunction
* Symptoms of metastasis may be first manifestations:
*Back/hip pain*
*Perineal/ rectal discomfort*
*Anemia*
*Weight loss*
*Nausea*
*Oliguria*
*Spontaneous pathologic fractures - weakening of bones*
66
**Prostate Cancer**
Diagnostics
* Digital Rectal Examination
* Serum Prostate Specific Antigen
* TRUS w/biopsy: confirmed via histologic examination
67
**Prostate Cancer**
Medical Management
* Watchful waiting
* Therapeutic Vaccines
* Radiation
* Chemotherapy
* Hormonal Therapy: Adrogen deprivation therapy
* Radical Prostatectomy
68
**Prostate Cancer**
Post-surgical Management
* Observe for signs of **Transurethral Resection Syndrome** *(rare - 2% of surgeries)*:
*Fall, headache, hypotension, lethargy, confusion, muscle spasms, N/V, seizures, tachycardia*
* Interventions for TRS: d/c irrigation, administer diuretic, monitor: I&O, vital signs, LOC, lung and heart sounds
* Maintain fluid/electrolyte balance
* Monitor for complications: hemorrhage, infection, venous thromboembolism, catheter problems
* Early ambulation
* Pain control
* Continuous Bladder Irrigation
