Lower Urinary System Flashcards
(142 cards)
1
Q
Ureters
A
Carry urine from renal pelvis to the bladder
2
Q
Ureteral lumens are
A
Narrow
3
Q
Male vs female urethra length
A
Male: 8 to 10 inches
Female: 1 to 2 inches
4
Q
Females are more prone to
A
UTI because of short urethra
5
Q
UTI bacteria
A
E. Coli
6
Q
Bladder
A
Reservoir for urine
7
Q
Bladder capacity
A
600-1000 mL
8
Q
Bladder muscle
A
Detrusor
9
Q
Other names for urinating
A
Urination, micturition, voiding
10
Q
detrusor muscle
A
Remains relaxed when bladder is empty, contracts when full (mostly) and pushes urine out
11
Q
How does urine flow?
A
Flows downwards to prevent urine back flowing into kidneys
12
Q
Ureters connect to bladder=
A
Ureterovesical valves (one-way valves)
13
Q
Urine is
A
Sterile
Once it hits air, it is no longer sterile
14
Q
pH of urine is
A
Acidic
15
Q
Prostate gland is in
A
Men
16
Q
Maintaining a healthy bladder
A
-should void every 3-4 hours
-wipe from front to back
-urinate after intercourse
-do kegels
-cotton underwear
-limit alcohol/smoking
-drink lots of fluids
17
Q
Kegels are good for
A
Stress incontinence
18
Q
Kegels
A
Pelvic floor muscle exercises
-contract/squeeze muscles around rectum and vagina at the same time
19
Q
Urinary incontinence
A
Involuntary or uncontrolled loss of urine in any amount
20
Q
Stress incontinence
A
When physical movement or activity (coughing, laughing, sneezing, running, heavy lifting) puts pressure (stress) on bladder, causes leakage of urine
21
Q
Stress incontinence causes
A
Pelvic floor muscle and urinary sphincter weaken
-childbirth in women
-prostate surgery in men
22
Q
Stress incontinence devices
A
Vaginal pessary, urethral inserts
23
Q
Stress incontinence surgery
A
Vaginal sling, injectable bulking agents, artificial sphincter
24
Q
Urge incontinence
A
Involuntary urination with little or no warning
(Overactive bladder, bladder spasms, irritable bladder, Detrusor instability)
25
What occurs with urge incontinence?
Frequent urination or nocturia
Enuresis (bed wetting!)
26
Urge incontinence treatment
Bladder training
27
Functional incontinence
Inability to get to or use the toilet in time to urinate
-usually due to physical or cognitive impairment (inability to walk well, furniture in the way)
28
Functional incontinence treatment
Aimed at manipulating environment
-easy access to toilet
-scheduled times for toileting
-wearing clothes easy to remove
29
Anticholinergics
Treat urinary incontinence (more for urge and stress)
-can’t see, can’t pee, can’t spit, can’t shit
30
Oxybutynin (Ditropan)
Decreases urgency, frequency, and nocturia
-causes urinary retention!
31
Do not use Oxybutyin (Ditropan) or anticholinergics
With patients with BPH (large prostate)
With decongestants (Claritin, Benadryl, Sudafed) — WILL CAUSE HTN
32
Avoid what when taking anticholinergics
Hot baths, hot tubs, and use caution when exercising or in hot weather
33
Treatment of urinary incontinence
Kegel exercises
Scheduled toileting times
Botox injections
Nerve stimulator
34
Medications for urinary incontinence
Tolterodine (detrol)
Oxybutynin (Ditropan)
35
Urinary retention
Inability to empty bladder all the way
36
Causes of urinary retention
BPH — #1 cause!
Obstruction (kidney stone)
Narrowing - urethral
Tumors
Certain meds (anticholinergics, OPIOIDS!!)
Being dehydrated
Constipation
37
Acute urinary retention
Sudden and often painful inability to urinate at all despite bladder fullness
-requires intervention
38
Chronic urinary retention
Gradual inability to empty the bladder; painless retention associated with increased volume of residual urine
39
Chronic urinary retention s/s
Straining to pass urine/weaker flow
Feels like bladder is still full after voiding
Overflow incontinence
Difficulty holding in urine when coughing, laughing etc
Nocturia/enuresis
Swelling/mild pain in abdomen
40
Overflow incontinence
Leaking urine without being able to control it
41
Acute urinary retention
Nursing management
Bladder scan
Voiding history
Needs indwelling urinary catheter
Drink small amounts of fluid
42
Chronic urinary retention
Nursing management
Intermittent or indwelling urinary cath
Schedule toileting time
43
What is the most important risk factor for bladder cancer?
Smoking
44
Clinical manifestations
Bladder cancer
Painless hematuria
Bladder irritability (dysuria, frequency & urgency)
45
Urinary diversions
ileal conduit and neobladder
-most common after complete removal of bladder for bladder cancer
46
ileal conduit
Portion of ileum is resected and one end of segment is closed; ureters are attached to closed end of ileum and open end of ileum is brought through abdomen to form a stoma; a bag is placed over the stoma
47
Neobladder
Piece of small intestine formed into a pouch and positioned in same position of original bladder, urine comes out urethra
48
Neurogenic bladder
Nerves between spinal cord and brain don’t work
(Parkinson’s, multiple sclerosis, stroke, diabetes)
49
Neurogenic bladder nursing interventions
Avoid caffeine and alcohol
Kegels
Catheter prn
Meds — tamsulosin (FLOmax) improves bladder storage and emptying
50
Urinalysis
-Measurement of color, pH, specific gravity
-determination of presence of glucose, protein, blood, and ketones
-microscopic exam for crystals, bacteria (first morning void, examine urine within 1 hour)
51
Urine studies
-urine culture and sensitivity
-creatinine clearance
-collect 24 hour urine specimen
- closely approximates GFR (Glomerular filtration rate)
52
GFR
Glomerular filtration rate
-most accurate measure of kidney function!!!!!
53
Serum creatinine
Greater than 1.2 mg/dl is abnormal for women
Greater than 1.4 mg/dl is abnormal for men
54
BUN
7-20 mg/dl
55
High BUN with normal creatinine =
Dehydration
56
Interstitial cystitis
Painful bladder syndrome
Difficult to diagnose
Mistaken for UTI!! But urine culture shows no bacteria
57
Clinical manifestations
Interstitial cystitis
-pain in perineum
-persistent, urgent need to void
-painful intercourse
-frequent urination (up to 60x per day!)
-pain while bladder fills and relief after urinating
-may have AUTOIMMUNE component
58
Urinary tract infection causes
(HARD TO VOID!)
Hormones
Antibiotics
Renal stones, scarring
Diabetes —> high risk for uti
Toiletries
Obstructive prostate
Vesicoureter reflux
Overextended bladder
Indwelling catheter
Decreased immunity (structural deviations)
59
UTI teaching
Fluids- avoid alcohol and caffeine, drink water, cranberry juice, green tea
Foods- avoid acidic, spicy, artificial sweeteners
Eat- high fiber (whole grains, beans, bananas)
Void- every 2-4 hours, cotton lines underwear
Exercise
60
Patho of UTI
Bacteria enters sterile bladder causing inflammation
Bacterial infection most common
Fungal and parasitic infections may also cause utis
61
most common pathogen for UTI
E. coli
62
The 4 units of the lower GU tract
Bladder, kidney, urethra, ureter
63
Kidney infections
Pyelolonephritis
Bacteria are easier to get into blood stream = sepsis
64
Bladder infection
Cystitis
65
Urethra infection
Urethritis
66
Ureter infection
Ureteritis
67
CAUTI
Catheter associated urinary tract infection
68
CAUTI #1 cause
Prolonged use of urinary catheter (goal is to keep urinary cath OUT)
-most common hospital acquired infection
69
CAUTI common bacteria
E. Coli
Pseudomonas
Proteus marabilis
70
CAUTI risk factors
-pedi and females
-urinary retention
-pregnancy
-menopause
-multiple partners
71
CAUTI routes of infection
Meatal junction
Outlet device
Catheter tubing connection
72
S/S of CAUTI
-hesitancy, frequency, urgency
-dysuria
-suprapubic pain
73
Diagnose CAUTI with
+ RBC (gross hematuria)
Cloudy
+ WBC
+ Nitrates
74
Elderly/geriatric manifestations (CAUTI)
-sudden change in LOC
-falls
-tachypnea
-anorexia
-low grade fever or no fever (VS appear normal)
75
Nursing management
CAUTI
Urinalysis and urine culture (clean catch)
Meds (antibiotics, analgesic for pain)
Prevention of CAUTI
Prevention of urosepsis
76
Clean catch urine (midstream)
Clean urinary opening with towelette front to back
Void into toilet a few seconds then stop
Place sterile container into path of stream
Restart urine and collect
77
Indications for indwelling urinary catheter
Acute urinary retention or bladder obstruction
Need for accurate I&O (hourly monitoring, should be at least 30mL)
Assist in healing of open sacral or perineal wounds
Prior to certain surgeries
Pt requires prolonged immobilization
To improve comfort for end of life care
78
Urosepsis
Caused by infection from UTI that moves to kidneys
79
Urosepsis risk factors
Urinary catheters
Advanced age
Diabetes
Female
Compromised immune system
Surgical procedures involving urinary tract
80
Clinical manifestations of Urosepsis
-initially uti symptoms
-more serious s/s (pyelonephritis)
-N/V, fever, chills, pain in lower spine
81
Sepsis symptoms
MEWS tool!!!!
-respiratory rate 22 or higher
-systolic pressure < 100 mmHg
-WBC too high or too low (4500-10,000)
82
Severe sepsis/septic shock
Organ failure, such as kidney (low urine output)
Low platelet count
Change in mental status
High levels of lactic acid in blood (cells aren’t utilizing oxygen in the right way)
83
Urosepsis management
Early goal-directed therapy (EGDT)
Antibiotics
Strict I&O
Removal of any catheters or devices that may be infected
84
Suprapubic catheter
Flexible catheter tube inserted into bladder through the abdomen a few inches below umbilicus
85
Suprapubic catheters are used for
-urethral trauma
-some gynecological surgeries (prolapsed uterus or bladder)
-people who require long-term catheterization & are sexually active
86
Priapism
Prolonged painful erection without sexual desire (usually longer than 4 hours)
87
Priapism can lead to
Impaired circulation and inability to urinate
88
Priapism causes
Neurological and vascular disorders
89
Phimosis
Inability to retract the foreskin covering the head of the penis
90
Hypospadius
Birth defect in which opening of urethra is located at the tip of the penis, along shaft, or where penis and scrotum meet
91
Diphalia
Genetic condition present at birth in which a person has 2 penises
92
Penile ring entrapment (PRE)
Works by reducing outflow of blood, sustaining a longer erection
-IF LEFT for an extended period of tie can lead to swelling of the shaft, strangulation, gangrene, and even complete loss of distal penis
93
Prostate gland
-male organ that produces semen and transports sperm during ejaculation
94
Enlarged prostate
Benign prostatic hypertrophy (BPH)
-can put pressure on urethra causing difficulty urinating
95
Acute bacterial prostatitis
Bacterial infection of the prostate, usually with less severe symptoms
96
Chronic bacterial prostatitis
Ongoing/recurring bacterial infection usually with less severe symptoms
97
Chronic prostatitis/chronic pelvic pain syndrome
Ongoing/recurring pelvic pain and uti symptoms with no evidence of infection
98
Chronic prostatitis/chronic pelvic pain syndrome symptoms
Flu-like
Pain in abdomen, groin, or back
Dysuria
Pain with ejaculation
99
Can prostatitis be prevented?
No
100
Prostatitis treatment
Acute bacterial- antibiotics 4-6 weeks
Chronic bacterial- antibiotics 8-12 weeks
101
Prostatitis teaching
-safe sex!!!!
-weight loss
-avoid spicy/acidic foods
-avoid alcohol/caffeine
-unprocessed/less sugar
-water!!
102
Benign prostatic hyperplasia (BPH) enlarged prostate
Prostate gland enlarges, disrupting outflow of urine from pressure on the urethra
-main cause of urinary retention in men
103
Irritative BPH
Nocturia, frequency, urgency
104
Obstructive BPH
Weak stream, difficulty starting and stopping stream, dribbling
105
Diagnostic studies (BPH)
-history and physical
-digital rectal exam (DRE)
-prostatic specific antigen (PSA)
-transrectal ultrasound
106
Adrenergic receptor blockers
Most end in “osin”
Tamsulosin (FLOmax) - will help you lose urine; helps urine FLOW
Doxazosin (cardura)
Terazosin (Hytrin) change positions slowly!!
107
Adrenergic receptor blockers
Mode of action
Antagonize alpha 1 receptors, relaxing smooth muscles of the prostate, which helps improve urine flow
-also causes VASODILATION
108
Do not take Adrenergic receptor blockers with
Antiacids or viagra! These can further cause hypotension!!
109
5a reductase inhibitors
End in “ride”
Finasteride (proscar) helps with male propecia
Dutasteride (avodart)
110
5a reductase inhibitor is the enzyme that
-prevents conversion of testosterone
-reduces size of prostate!
111
Side effects of 5a reductase inhibitors
Erectile dysfunction, gynecomastia
112
Pregnant women should not handle
Finasteride
113
Complications of BPH
Hydronephrosis is swelling of kidneys due to build up of urine causing swelling
Urine cannot drain out from kidney to bladder = urinary retention!
114
Hydronephrosis causes
-Blockage of outflow of urine or reflux of urine from bladder to kidney
-renal stones
-narrowing of ureter
-tumors
-vesicoureteral reflux/ureteral obstruction
115
Transurethral resection of prostate (TURP) for BPH
Surgery to remove parts of prostate tissue through the penis
116
Usually __________ after TURP
Bleeding
117
Post TURP procedure
3 way indwelling catheter inserted to provide hemostasis and urinary drainage
118
What is used to prevent obstruction of the catheter after TURP?
Continuous 3 way bladder irrigation (Murphy drip)
119
Intermittent irrigation for bladder
Manual irrigation for bladder spasms, clots decreasing outflow
120
Sudden gross hematuria =
Possible bleed
121
Patient with bladder irrigation
-assess for bleeding & clots
-monitor inflow and outflow
-monitor for increase in gross hematuria (hemorrhage)
122
Nursing management
Bladder irrigation
-kegels
-no heavy lifting
-s/s of infection
-stool softeners
-patience
123
Prostate cancer is diagnosed with
PSA and biopsy
124
Radical prostatectomy
Removal of prostate, seminal vesicles, and part of the bladder
125
What is placed with prostatectomy?
Large indwelling catheter with 20-30mL balloon (pt goes home with catheter)
126
radical prostatectomy adverse reactions
Erectile dysfunction
Urinary incontinence
127
Testicular cancer is more common in
Young males (15-44)
128
Testicular cancer
-very curable if caught early
-risk for infertility
-tumor marker blood test
-recommended to do self-exam monthly
129
S/S of testicular cancer
-lump/swelling on testicle
-feeling of heaviness in scrotum
-dull ache in lower belly or groin
-usually painless in early stages
130
Testicular torsion
Testicle rotates, twisting the spermatic cord that brings blood to the scrotum
131
Testicular torsion occurs more on the
Left
132
Testicular torsion results in
Reduced blood flow that causes sudden and severe pain on one side of the scrotum
133
Testicular torsion medical emergency =
Blood flow must be restored within 6 hrs or testicle will atrophy
134
Causes of testicular torsion
-vigorous activity
-minor injury to testicles
-while sleeping
135
Erectile dysfunction
Inability to attain or maintain an erection
136
Erectile dysfunction increases with
Age (40 to 70)
137
Erectile devices and drugs
Sildenafil (viagra)
Tadalafil (cialis)
** do not take if on a nitrate!!
138
Erectogenic drugs (phosphodiesterase type 5 inhibitors) mode of action
Increases blood flow to penis and vasodilation of the pulmonary vasculature
139
Side effects of erectogenic drugs
Priapism, increased risk for heart attack
140
Oliguria
Urine output abnormally low
141
Anuria
A sense of urine production
142
Polyuria
Excessive urination
