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NCLEX > Genitourinary-Renal > Flashcards

Genitourinary-Renal Flashcards

(68 cards)

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1
Q

what is benign prostatic hyperplasia

A

enlargement of the prostate gland

impedes the passage of urine

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2
Q

benign prostatic hyperplasia manifestations

A

early stages: aympstomatic

as enlargement progresses:
difficulty starting or stopping stream
smaller than usual stream
less frequency urinating and dribbling

nocturia

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3
Q

BPH diagnostic studies

A

digital rectal exam DRE

urinalysis 
creatinine 
BUN
PSA
transrectal ultrasound
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4
Q

BPH management

A 
if symptomatic:
antihypertensives
- wont decrease prostate size but will relax muscle of prostate and bladder
- Prazosin
- Doxazosin
- Terazosin

finasteride = hormone
- decreases prostate size
decreases urinary urgency, hesitancy, dribbling, retention and nocturia

balloon dilation = temporary relief of urinary urgency, hesitancy

surgery if needed:

  • TURP
  • open prostacteomy
  • laser surgery
  • insertion of prostatic stent

FDA approved saw palmetto extract to manage symptoms of BPH
- checi with HCP because of interactions with anticoagulants and NSAIDs

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5
Q

BPH complications

A

acute urinary retention
involuntary bladder spams

hydronephrosis
- swelling of a kdiney due to build up of urine

urinary tract infections
gross heamturia

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6
Q

BPH management

A

assess:

  • presence of urgency, dribblinb, hesitancy, retention and nocturia
  • presence of bladder distention
  • present of post void residual

watch urinary elimination
provide privacy for client sduring elimination

monitor intake and output
weigh on daily basis

post op surgery treatment:

  • maintain catheter patency
  • monitor urine output for volume and color every 1-2 hours

maintain continuous bladder irrigation
- important to prevent complications like hemorrhage and blood clots

  • medicate for bladder spams and pain
  • kegel exercises AFTER catheter removal
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7
Q

what is prostate cancer

A

most common cause of cancer death

can originate in posterior prostate gland

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8
Q

prostate cancer manifestations

A

early: asymptomatic

advanced:

  • weak urine stream
  • heamturia
  • urinary hesitancy
  • incomplete bladder emptying
  • dysuria
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9
Q

prostate cancer diagnostic studies

A

DRE
increased PSA
biopsy of prostate

MRI
CT scan

neither a PSA nor DRE is a definite dianogstic test for cancer
- biopsy is needed to confirm

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10
Q

prostate cancer management

A

radical prostectomy
crythotherapy

radiation - external beam and barchytherapy
checmotherapy

drug therapy
kegel exercises
maintain high fluid intak enad report any signs of infection

maintain closed system to prevent bacterial contamincation
- avoid switching “leg” bags

regular prostate screening

if discharged with indwelling catheter, then teach how to clean urethral meatus
- keep collection bag lower than the bladder at all times

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11
Q

what is erectile dysfunction

A

inability to achieve or maintain an erection

client first notices diminishing firmness and a decrease in frequency of erections

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12
Q

causes of erectile dysfunction

A

inflammation of the prostate, urethra or seminal vesicles

prostectomy
lumbosacral injuries

hypertension
chronic neurologic conditions - Parkinsons

diabetes
smoking
alcohol consumption

antihypertensives
poor overall health

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13
Q

erectile dysfunction diagnostic studeis

A

hx and physical exam
serum hormone levels
- testosterone

doppler ultrasound to evaluate blood flow to penis

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14
Q

erectile dysfunctio interventions

A

most common approach is: drug therapy

  • phosphodiesterase inhibitors
  • ends with “afil”

other less common intervnetions:

  • vacuum devices
  • intracorporal injection
  • prosthesis

nurse should:

  • teach about timing in relation to sexual intercourse
  • avoid alcohol before sex
  • those taking nitrates to avoid PDE 5 inhibitors because it can cause hypotension

monitor for priapism

  • prolonged erectile dysfunction
  • erection lasting more than 4 hours or off and on several hours
  • prompt treatment of aspirating blood is needed or meds to restrict blood flow

emotional support

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15
Q

what is pelvic inflammatory disease

A

infection of the cervic ascending to the fallopian tubes and broad ligaments

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16
Q

causes of pelvic inflammatory disease

A

gonorrhea
chlamydia
mycoplasma hominis

history of multiple sexual partners
base of intrauterine device

hx of therapeutic abortion
vaginal douching

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17
Q

pelvic inflammatory disease manifestations

A

pelvic pain
fever

abnormla cervial discharge
cervial motion tenderness
irregular cervical bleeding

nausea
vomiting
acute abodminal pain

dysuria
frequent urination
chlamydia
gonorrhea
other STI
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18
Q

pelvic inflammatory disease diagnostic studies

A

endocervical culture
CBC with differntial

laprascopy to view fallopian tubes
culdocentesis
- procedure performed in which peritoneal fluid is aspirated

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19
Q

pelvic inflammatory disease management

A 
anti infectives
- tetrcyclines
penicillins
quinolones
cephalosporins

analgesics

surgical intervention to drain ascess

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20
Q

pelvic inflmmatory disease comploications

A

ectopic pregnancy
infertility
rupture or abscess

sepsis
chronic pelvic pain

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21
Q

pelvic inflammatory disease nursing interventions

A

assess for:

  • menstruation history and contraceptive use
  • level of pain
  • vitals
  • emotional response
  • fluid imbalance

teach:

  • complete entire course of antibiotics
  • yearly pelvic exams
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22
Q

how to prevent cauti

A

insert catheter only for appropriate interventions

dont use urinary catheters in client sand nurse home residents for incontinence

leave catheter in place only as long as needed
consider antibiotic

maintain closed system and strict aseptic technique

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23
Q

what is acute kidney injury

A

abrupt loss o fkidney function

causes retention of urea and other nitrogenous waste products and extracellular volume and electrolytes

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24
Q

types of acute kidney injury

A

prerenal:

  • decreased renal blood flow due to acute systemic injury
  • hemorrhage
  • trauma
  • burns

intrarenal:

  • injury to renal tissue due to toxins (rhabdomylosis)
  • vascular disorders
  • immunologic process

postrenal:

  • urine flow is obstructed or stopped somewhere in the urinary tract
  • BPH
  • tumors
  • strictures
  • calculi
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25
acute kidney injury prerenal manifestations
hypotension hypoperfusion reduced urine output
26
AKI intratrenal manifestation
edema rash chronic changes in kidney function history of glomerulonephritis
27
phases of AKI
1. onset phase: initial insult to kidneys 2. oliguric phase: reduction in urine - fluid overload because youre not peeing 3. diuretic phase: excrete waste but cannot concentrate urine - hypovolemia - hypotension will be losing an excessive amount of urine (3-6 liters/day) 4. recovery phase: GFR is getting better
28
AKI postrenal manifestations
history of obstruction | difficulty voiding
29
AKI diagnostic studies
urinalysis urine for culture and sensitivity creatinine BUN electrolytes inflammatory markers calcium and phosphate levels CBC and ABG 24 hour urine collections AKI is reversible but has high mortality rate - follows severe prolonged hypotension (MAP less than 60) - hypotension no nephrotoxic drugs, vancomycin, or aminoglycosides
30
AKI management
to identify and treat the cause of AKI: - discontinue all nephrotoxic drugs - eliminate exposure to nephrotoxins treat life threatening situations: - administer IV fluids - meds to control potassium, calcium, glucose and Na+ meds to restore alcium levels may require hemodialysis
31
risk factors for AKI
reduced renal perfusion significant blood loss or fluid loss myocardial infarction septic shock
32
AKI complications
systemic infections arrhythmias secondary to hyperkalemia GI bleeding hyperkalemia persistent kidney damage permanent need for dialysis
33
AKI interventions
24 hour urine output - start with 2nd pee neuro function daily weight hx of cardiac disease malignancy, sepsis, or recent infection minimize stress ensure compliance with prescribed fluid restriction prevent infection regular protein intake offer high carb options restrict foods high in potassium, phsophorus, and albumin
34
what is chronic kidney disease
irreversible deterioration in renal function body cannot balance metabolism and fluid/electrolytes results in uremia - raised level in blood of waste products - means kidnyes are no longer filtering properly
35
CKD causes
hypertension prolonged diabetes mellitus glomerulopathy interstitial nephritis polycystic disease obstructive uropathy
36
CKD diagnostic studes
ABG increased creatinine, potassium, phosphorus, BUN CBC decreased bicarb, calcium, proteins (albumin) GFR = preferred test to determine kidney function - used to determine the stage of CKD clients near or in stage 5 will require renal replacement therapy
37
CKD management
monitor for hypertension - ACE inhibitors - angiotensin II blockers lower cholesterol - statins watch for anemia - epoetin or epoetin alpha reduce fluid volume excess - diuretics protect bones - calcium and vitamin D progressive deterioration of kidneys in CKD causes: - electrolyte imbalances - hyperkalemia - hypocalcemia - hyperphosphatemia anemia - due to lack of erythropoietin ``` low protein diet avoid products with added salt restrict dietary potassium restrict dietary phsophorus - no chicken, milk, legumes, carbonated drinks ```
38
CKD interventions
assess and monitor for: - halitosis - ulcers at oral mucous membranes - dry, itchy skin - anorexia - weight loss - nausea and vomiting - neuro status - inflammatory and infectious response - peripheral edema and findings of circulatory overload take labs: - prolonged QT intervals - Hct and Hgb - hyperkalemia
39
hemodialysis
vascular catheter, fistula or shunt requires specifically trained personnel 3-4 hours
40
hemodialysis disadvantages
dietary and fluid restrictions hemodynamic instability
41
hemodialysis complications
disequilibrium syndrome - fatigue - mild headaches - nausea - vomiting - distrubed conscious - convulsions - coma hypotension dysrhythmias septicemia bleeding worsens anemia due to RBC destruction
42
peritoneal dialysis
intra-abdominal catheter simple, easier for in home use low risk for hemodynamic instability flexible scheduling fewer dietary restrictions and fluid
43
peritoneal dialysis disadvantages
longer treatment time overnight, up to 12 hours
44
peritoneal dialysis complocations
peritonitis protein loss bowel preforation resp distress discomfort during dwell time
45
what is glomerulonephritis
inflammation of the glomeruli affecting both kdiney equally slow, progressive disorder - often causes inflammation, sclerosis, scarring and renal failure
46
glomerulonephritis manifestations
decreased urination or oliguria tea or coffee colored urine SOB orthopnea - SOB when lying down - goes away when you sit upright periorbital edema hypertension crackles nausea malaise weight loss acute poststreptococcal glomerulonephritis develops about 1-2 weeks after streptococcal sore throat
47
glomerulponephritis diagnostic studies
increased BUN, creatinine decreased protein increased antistreptolysis O titers increased phosphorus levels decreased calcium levels urinalysis KUB renal biopsy
48
glomerulonephritis management
symptoms relief rest treat edema with low salt diet and fluid restrictions low protein diet antibiotics
49
chlamydia manifestations
women = asymptomatic, but may experience: - lower abdominal pain - burning pain with urination - vaginal discharge men = asymptomatic, but may experience: - discharge pain - burning with urination - inflammation or an infection in a duct in testicle
50
chlamydia management
azithromycin doxycycline in newborns = prophylactic erythromycin eye ointment should be screened yearly for chlamydia preferred method for diagnosing chlamydial infection = nucleic acid amplification testing
51
gonorrhea manifestations
women: - itching - burning of the vagina - thick yellow green discharge - bleeding between menstrual periods - need to urinate often men: - pain or burning during uriantion - thick, yellow penile discharge - inflammation or infection of duct in testicles - sore thraot - rectal pain and discharge - inflammation / infection of prostate fland
52
gonorrhea management
cephalosporin | molecular testing for gonorrhea culture
53
gonorrhea complications
meningitis perihepatitis arthritis women: - PID - ectopic pregnancy - infertility men: - arhtiritis - painful swelling of testicles - epididymitis: inflammation of the tube at the back of the testicle that carries and store sperm regular pap smears and pelvic examinations
54
syphilis
caused by Treponema pallidum
55
4 stages of syphilis
primary phase - starte with a sore or lesions secondary phase - 4-10 weeks after appearance of chancres - flu-like symptoms, patchy hair loss latent phase - occurs one year or more after the first chancre tertiary phase: - occurs 4-20 weeks after primary phase
56
syphilis management
pencillin = drug of choice | - if allergic, then doxycycline or erythromycin
57
HSV-1 herpes
lesions above the waist
58
HSV-2 herpes
lesions below the waist
59
herpes interventions
encourage client to avoid tight fitting clothing keep blisters or sores clean and dry apply ice packs locally to reduce pain and swelling
60
herpes treatment
``` "ovir" acyclovir famiciclovir valacyclovir - to shorten and prevent outbreaks ``` pregnant women with herpes = requires C-section
61
what are renal calculi
kidney stones more prevalent in men peak age of onset between 20-30 years of age spontaneous passage can occur in majority of clients
62
renal calculi manifesations
severe pain - site is dependent on location of obstruction increaed hydrostatic pressure renal colic and ureteral colic with obstruction - client will show findings of UTI with fever and chills nausea vomiting diarrhea abdominal discomfort
63
renal calculi diagnostic studies
intravenous pyelogram - determine site and degree of obstruction others: analyis of stone urinalysis culture and sensitivity 24 hour urine test retrograde or antegrade pyelography
64
renal calculi pharmacological interventions
diuretics allopurinol - help prevent calcium and uric acid stones opioid analgesics - pain relief antibiotics
65
renal calculi surgical interventions
extracorporeal shock wave lithotripsy percutaneous nephrolithotomy ureteroscopic stone removal percutaneous stone dissolution ureteroscopy temp or permanent stent placement pyelolithotomy nephrolithotomy ureterolithotomy cystolithotomy nephrectomy
66
renal calculi complications
obstructions can occur from fragments infection chronic renal function impairments - if obstruction persists
67
renal calculi intervnetions
assess: -hx of UTIs dietary habits family hx of kidney stones findings of UTI findings of urinary obstruction pain management maintenance of urine flow strain urine to collect stones client teaching: - increase fluid intake so that they produce at least 2 quarts of urine every 24 hours - collaborate with nutrition therapy based on the type of stone
68
Abdomen assessment
1. Empty bladder 2. Inspect abdomen for color, contour 3. Auscultation 4. Percuss for kidney border sand palpate 5. Document all findings

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