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GU Obstruction Flashcards

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1
Q

What is a urinary obstruction?

A

obstruction of the flow of urine within the urinary tract

can occur at any level of the tract and at any age

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2
Q

Conditions that Cause Urinary Tract Obstructions?

A
  • anatomical

- functional (not functioning properly)

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3
Q

Sites of obstruction?

A

upper urinary tract (unilateral)
bilateral vs unilateral

Unilateral - the most common causes are calculi and neuromuscular malfunction at the junction of the renal pelvis and ureter.

Bilateral - usually with lesions in the bladder base or retroperitoneal tissues.

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4
Q

Classification of Obstructions - Degree?

A 
partial obstruction (enlarged prostate)
complete obstruction (kidney stone)
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5
Q

Acute obstruction= what type of onset?

A

sudden

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6
Q

chronic obstruction=what type of onset?

A

slow

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7
Q

Outcome of Chronic Urinary Tract Obstruction?

A

Atrophy of renal tissue and kidney failure if both sides affected for a longer period of time.

determined by the degree and duration of urinary tract infection

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8
Q

what is hydrpnephrosis?

A

complication of UTI

Progressive dilation of renal collecting ducts and renal tubular structures.

buildup of urine causing swelling of the kidney

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9
Q

Clinical manifestations of Acute Upper Tract Obstruction?

A

Flank pain
Nausea and vomiting are common with acute obstruction.
Anuria suggests bilateral complete obstruction.

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10
Q

Clinical manifestations of Chronic Lower Tract Obstruction?

A

Urinary hesitancy.
Narrow and weak urine stream.
Dribbling at end of micturition.
Feeling of incompletely emptied bladder.

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11
Q

Renal calculi- complication of UTI

A
  • solid mass of crystal (kidney stone)
  • Polycrystalline aggregates composed of minerals the kidney normally excretes in urine

most common in early-middle adulthood (20-55)
more common in men than women with the exception of one type of stone associated with UTI which is more common in women
50% recurrence rate
more common in summer than winter

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12
Q

Etiology of Stone Formation?

A

-Complex process involving multiple factors that leads to stone formation and the type of stone formed.

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13
Q

Stones more common in?

A 
ppl with gout/ increases uric acid
increased protein intake 
drinking a lot of tea and fruit juice
low fluid consumption 
genetic factors (Hx of stones/gout)
warmer climate/season
sedentary lifestyle 
recurrent UTI
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14
Q

Pathophysiology of Stone Formation?

A
  • sediments from concentrate urine can form the stones

- can be formed in acidic or alkaline environments for people who produce a lot of stones

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15
Q

What is calculus?

A

abnormal stone formed in the body tissues by an accumulations of mineral salts

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16
Q

what is lithiasis?

A

stone formation

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17
Q

What is nephrolithiasis?

A

Formation of stones in the urinary tract

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18
Q

Types of renal stones?

A

calcium, uric acid, struvite, cystine

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19
Q

Manifestations of stones?

A

agony, pain, misery, kidney tender on palpation

Pain that spreads to the lower abdomen and groin
Pain that comes in waves and fluctuates in intensity
Pain on urination
Pink, red or brown urine
Cloudy or foul-smelling urine
Nausea and vomiting
Persistent need to urinate
Urinating more often than usual
Fever and chills if an infection is present
Urinating small amounts of urine

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20
Q

Types of Pain by Location of Stone? Renal Calyx

A

Renal Calyx (flank area between pelvis + diaphragm)

  • dull pain
  • pain intensifies when drinking
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21
Q

Types of Pain by Location of Stone? Renal colic

A

stone moves from kidney to ureters
associated with stretching of ureter
is acute and pain can be intermittent and is very intense **
tends to be in the flank area in upper outer quadrant
diaphoretic, cool clammy skin, nausea + vomiting

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22
Q

Diagnostic Studies?

A

urine analysis

Blood analysis

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23
Q

What to look for in urine analysis?

A

urine C&S

Ph level

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24
Q

What to look for in blood analysis?

A

blood urea nitrogen (BUN)

creatinine

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25
What does collaborative care involve?
- management of acute attack - determination of cause of stone and treatment - prevention of further stone development
26
Nursing Care in Acute Phase-promote comfort by?
``` analgesics (narcotics) heat over affected kidney guided imagery, relaxation techniques manage nausea + vomiting reducing fever ```
27
Maintain/improve urinary elimination by?
I&O monitoring filtering urine manage intake as per orders promote ambulation
28
Decrease anxiety by?
provide knowledge of situation
29
Indications for Removal of Stones?
stones are too large to be passed spontaneously stones associated with bacteriuria or symptomatic infection stone causing impaired renal function stones causing persistent pain, nausea or ileus patient with one kidney
30
Procedures for stone removal?
- Endourological procedures (minimally invasive) - Lithotripsy (shock waves break stones into small pieces) - Open Surgical Procedure (monitor for haemorrhage, UTI after procedure )
31
Determining Cause of Stone?
- Family history of stones - Geographic residence - Illness with immobilization - Disease or surgery involving the GI or GU tracts - Nutritional assessment including intake of vitamins A & D - Activity pattern - Dehydration
32
Prevention of Further Stone Development?
- Understand the risks for stone formation and adopt SCPs to minimize the risks by: - produce 2L urine/day - reduce cola, fruit juice, tea intake - increase water intake - reduce salt intake - limit oxalate rich foods (strawberry,radish,chocolate, coffee,cola) - strain urine
33
medication (allopurinol)
Allopurinol reduces the production of uric acid - can lower immunity - do not consume alcohol with medication - They should be encouraged to increase fluid intake during therapy to prevent renal stones. - increase fluid to 2L/day - monitor I&O
34
The most common health problems related to the prostate are?
- Benign Prostatic Hyperplasia (BPH) | - Prostate Cancer
35
Differentiating between BPH and Prostate Cancer?
BPH: grows around urethra, can obstruct urine flow | Prostate cancer: malignant growth (prostatic carcinoma)
36
What is BPH?
Age-related, non-malignant enlargement of the prostate gland - if obstruction is left untreated, it can cause kidney problems - common among aging men
37
Etiology of BPH?
- Results from endocrine changes associated with aging. | - Exact mechanism not completely understood.
38
Risk Factors for BPH?
- family Hx - diet high in zinc, butter, margarine - overweight - men from western cultures -prevention: moderate alcohol intake, more vegetables + fibre
39
Clinical Manifestations-Obstructive Symptoms BPH
- difficulty initiating a stream of urine - decreased force of urine - intermittency of urine flow during void - dribbling at end of urination
40
Clinical Manifestations-Irritative Symptoms BPH
frequency, nocturia, urgency
41
Diagnostic studies-BPH?
- symptom index - history + physical exam BPH findings: symmetrically enlarged, smooth, firm ``` Additional tests: Urine analysis PSA blood test Serum creatinine Transurethral Ultrasound Uroflowmetry Post-void residual Cystourethroscopy ```
42
Understand BPH and adopt SCPs to manage/relieve the symptoms of BPH?:
- dietary changes - restrict evening fluid intake - timed voiding - physical activity - maintain a healthy weight
43
Flowmax medication?
.
44
Alpha-blockers (Tamsulosin) medication (alpha blocker; relaxes muscles to make urine passage easier) works quickly
.
45
5-alpha-reductase inhibitors (Finasteride) (inhibits conversion of testosterone to DHT which causes enlargement of prostate) works slowly because it shrinks the prostate
.
46
Minimally Invasive Tx-BPH?
- Transurethral microwave therapy - Transurethral needle ablation - Laser prostatectomy - Intraprostatic urethral stents
47
Invasive Tx-BPH?
- Transurethral Resection of the Prostate (TURP) - Transurethral Incision of the Prostate (TTUIP) - Prostatectomy
48
Collaborative care for BPH pts?
- assessment of elimination - watch for complications associated with BPH - use strategies to decrease urinary stasis + UTI
49
Pre-Operative Care-BPH
Restore/facilitate bladder emptying and functioning | Maintain/restore/improve sexuality/sexual functioning
50
Post-operative Care-BPH? Promote comfort by:
bladder irrigation avoid forcing for BM (could rupture incision)
51
Post-operative Care-BPH? Facilitate/promote urinary elimination by:
check catheter for clots | keegle exercise
52
Follow post-operative treatment plan by-BPH:
no driving, sex, heavy lifting for 2-3 weeks
53
Understand and manage the effects of TURP on elimination functions by-BPH
increase fiber
54
Non-modifiable risk factors for prostate cancer?
Age Ethnicity Family history
55
Modifiable risk factors for prostate cancer?
Diet | Occupational exposure
56
Clinical Manifestations- Prostate Ca?
- asymptomatic in early stages - symptoms similar to BPH - pain associated in the lumbosacral area which radiates to hips + legs with urinary symptoms may indicate metastasis
57
Diagnostic Studies-Prostace Ca?
-Annual health surveillance with GRE Abnormal prostate may feel hard, nodular and asymmetrical -Blood test for PSA(prostate-specific-antigen) Indicate a pathological condition of the prostate Useful marker of tumour volume with prostate cancer (the higher the level, the greater the tumour mass). -Biopsy
58
Goals of Collaborative Care-Prostate Ca?
- Cancer is staged and graded - Care will then depend on the stage of the cancer and the overall health of the patient. - Multiple treatment options exist at each stage of disease. - Decision is made jointly with the patient and health care provider.
59
Treatment Approaches-Prostate Ca?
- Conservative (non-surgical) - Surgery - Radiation Therapy - Drug Therapy - Hormone Therapy - Chemotherapy
60
Nursing Care – Standard Action Demands- Prostate Ca?
- Promote active participation in decision making and participation in treatment - Promote comfort - Acknowledge effect of diagnosis on sexual function and develop strategies to cope with this. - Acknowledge effect of diagnosis on bowel and bladder functioning and develop strategies to cope with this

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