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Adult Nursing Exam 5 > Management of Urinary Disorders > Flashcards

Management of Urinary Disorders Flashcards

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1
Q

Urosepsis meaning?

A

When the UTI has spread systemically

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2
Q

Lower UTI regions

A

Cystitis - bladder
Prostatitis - prostate
Urethritis - urethra

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3
Q

Upper UTI regions

A

Pyelonephritis - UTI in kidneys

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4
Q

What is Uretervesical reflex or urethrovesical reflux

A

When urine flows backwards up urinary tract

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5
Q

When is the urinary tract sterile?

A

It is sterile once you are passed the uretha

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6
Q

What defenses do we have to make sure it stays sterile?

A

GAG or glycoproteins
Complete bladder emptying
Urinary flow going in correct direction
Acidic urine so less than 6.0 ph

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7
Q

Risk factors of UTI

urinary retention, why?
what can cause retention?

catheters, why?

fistulas, why?

urine reflux, why?

short uretha of women, why?

Aging and menopause, why?

Poor hygiene in general, why?

Immune response issues?

A

urinary retention is an issue because old urine stays in the urinary tract. prostate issues are a main cause

catheters are risky bc you may not insert them with sterile technique

a fistula can cause an abnormal opening of the urinary tract & allow bacteria in

urine reflux can cause uti because this can cause old urine to remain in the urinary tract

the short urethra in women allows for a shorter distance for bacteria to travel

Menopause and aging can cause continence issues & so hygiene could be compromised

People may wipe the wrong way. Need to wipe front to back.

People with Diabetes are at more risk for UTI’s

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8
Q

Common symptoms of uti:

UO

Painful sites

Elderly symptoms

Can there be no symptoms though?

A

Common symptoms

UO will be painful and frequent. May need to pee more at night (nocturia) and may not even be able to control the need to pee . Blood or hematuria in the urine also.

While peeing is painful, they will also have suprapubic, pelvic, or back pain

Elderly will probably present more confused

Yes, the patient may be asymptomatic.

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9
Q

What are some questions to ask if suspect a UTI?

UO

sex

contraceptive practices

A

How often do you urinate? Is it painful? Is there anything unusual for you that you notice?

Ask about sexual activity. Ask if they pee after sex?

IUD that is manually inserted in vagina for BC can cause uti so ask if they use any of these

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10
Q

Diagnostics/tests that they can do for UTI?

A

Urine analysis
culture and sensitivity
sti risk

cystoscopy or bladder check
ultrasound

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11
Q

What are some complications we want to avoid from a UTI?

Prevention?

can they risk of infection

A

Urosepsis and renal failure

Good way to prevent UTI is avoid catheters, pee after sex, don’t hold pee in, do good pericare. no bubble bath

yes, they may have a uti but they can be at risk for kidney infection

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12
Q

What to educate patients about wen taking antibiotics for their uti?
What is a good analgesic for soothing bladder lining? side effect?

Antispasmotic example?

A

Take all of the medicine

Piridium or AZio
side effect is orange urine

Ditripan

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13
Q

Should a uti patient drink coffee?

Can you put heat on perineal area?

A

no. avoid caffeine.

yes perineal heat can help pain

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14
Q

What are the main goals we are working towards with these interventions?

A

We want to help relieve some of the pain

We want to educate patient so this doesn’t happen again

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15
Q

Upper Urinary tract infections begin..

A

Upper infections begin in the renal pelvis.

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16
Q

How can ascending bacteria lead to upper uti?

How can an incompetent valve cause infection?

Urine stasis causing a uti?

systemic infection causing a uti?

A

The bacteria can ascend upwards and cause infection wherever it dwells

The urinary tract has valves to make sure urine flows in one direction and if a valve is not working urine can flow backwards

urine stasis can cause a uti bc the old urine stays in one spot and heards bacteria

systematic infection or sepsis can infiltrate and cause uti

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17
Q

What happens to the kidney in an upper uti?

A

The kidney develops edema and abscesses form from scar tissue

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18
Q

What is pyelonephritis?

A

This is when there is inflammation of pelvis and medulla which began in the lower urinary tract
- so it traveled

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19
Q

Common causes of pyelonephritis?

A

E. coli

Bladder reflux of urine

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20
Q

What is acute pyelonephritis?

A

When there is an active bacterial infection causing renal dysfunction
inflammation and necrosis occur to form abscess

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21
Q

What is chronic pyelonephritis?

A

Chronic pyelonephritis is a repeat of infection which leads to progressive damage that is permanent

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22
Q

Common cause of chronic pyelonephritis?

A

Obstruction of urinary tract

Reflux of urine

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23
Q

What can chronic pyelonephritis lead to in kidneys?

What are some complications of chronic pyelonephritis?

A

Chronic Kidney Disease
End stage renal disease

HTN
stones

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24
Q

Major risk factors of acute and chronic pyelonephritis?

A

Old age
Prostate issues
Stones
chronic illness

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25
Best labs to check for pyelonephritis?
Urine analysis Blood check IVP KUB or Kidney, ureter, bladder x ray
26
Symptoms of pyelonsphritis?
Similar to UTI symptoms but with fever and chills Pain on flanks or kidneys
27
What will probably be prescribed for pyelonephritis? How much fluids should patient be getting?
Long term antibiotics - so tell patient to take them all. Enough to keep them hydrated. Don't want them to stop drinking
28
Surgeries done for pyelonephritis?
nephrectomy ureteral diversion uerteroplasty
29
What do do after surgery of pyelonephritis?
Basic post op interventions Educate on antibiotics Make sure they are drinking Check UO
30
Which meds can affect urinary output and cause urinary incontinence? What foods/drinks?
Diuretics Ace inhibitors Artificial sweeteners Carbonated drinks
31
What is a bladder spasm? | Can it cause incontinence?
Bladder spasm is what it sound like. The spasm itself can cause urine to outflow.
32
T/F | multiple vaginal births can cause incontinence
true. this weakens pelvic floor muscles
33
What behaviors can cause leakage?
Laughing, coughing. | Straining
34
What is residual urine volume? What is urodynamic testing?
This is when they check to see how much urine is left in the bladder after voiding. Tests how well the urinary tract empties.
35
Stress incontinence | Example?
Stress causing intra-abdominal pressure. So laughing
36
Overactive bladder incontinence
This can cause a person to think they need to use the restroom due to a bladder that spasms and tightens. But if it is overactive, it just means the urge to pee is overactive.
37
Iatrogenic incontinence
Incontinence from hospital fluids
38
Mixed incontinence
A mix of stress and overactive bladder
39
Overflow incontinence
When the nerves can't sense that the bladder is full so then it begins to leak and overflow causing incontinence
40
Anatomical incontinence
Strictures Fistulas (I would think an enlarged prostate would be one too but idk)
41
Functional incontinence
not being able to get to the bathroom in time for whatever reason maybe your slow can't walk etc
42
Why would we want someone who is continent to lose weight if they are obese?
Obesity can cause extra pressure
43
What is the point of timing fluids and amounts?
Time the fluid so a person doesn't drink after a certain amount of time. Maybe they have nocturia and so no fluids after dinner
44
What are pessaries?
Ring that holds the bladder in position to prevent incontinence
45
Should you give a pure wick external catheter to a patient who is mobile?
No. It sort of just sits in between labia and perineal area so it can easily be moved out of place. If they are mobile, best to just use it at night.
46
What is an external condom catheter also called?
Texas catheter. | It just works sort of like a condom.
47
Anticholinergics are used for incontinence. Why? Examples? Side effects?
Anticholinergics blocks acH which reduces bladder contraction Oxybutynin Tolterodine Solifenacin Fesoterodine Think DRY meds. So dry mouth and constipation
48
Beta 3 adrenergic agonists are also used for incontinence. why? Side effect?
It just relaxes the bladder so it can hold more urine Common example is Mirabegron Can raise BP, cause dizziness and headache
49
Botulinum Toxin A does what? Side effects
Paralyzes the bladder. Will need yearly injections Side effects: UTI, respiratory arrest
50
Estrogen for incontinence age group? Contraindication?
For older patients. Contraindication for breast cancer
51
Which med would you use for mixed incontence specifically?
Impramine - 3x antidepressant
52
You need a med to relax the urethral spincter. Which do you choose?
Duloextine
53
``` Lift and stabilize urethra purpose? Using what? Injectables? Artificial? pacemaker? ```
Helps with incontinence by repositioning of the urethra by using tape or body tissue. Can also use periurethral injectables of collagen to bulk it up An artificial spincter can be inserted as well- a fluid filled ring with a valve Pacemaker for the bladder that helps stimulate nerves
54
What is urinary retention?
When the bladder retains urine and does not empty
55
Causes of urinary retention: age other medical conditions meds?
Old Age making detrusor muscle weak Diseases like diabetes or prostate issues neurological issues pregnancy Meds can do too good of job when trying to treat the urinary incontinence. Anticholinergis, Beta 3's, botulin, etc
56
Assessments for urinary retention: What will voiding be like? Have they been on anesthesia?
Voiding will be frequent with little output. so check the I&O Ask about anesthesia bc it can cause retention
57
What are some voiding triggers?
Start the water Move around Give them privacy
58
Causes of retention that may need surgery?
BPH Bladder neck contracture Urethral spincters
59
Cholinergics are used for retention. why? Example
It does the exact opposite of anticholinergic and will stimulate urinary tract Bethanechol/Urencholine
60
Why use an alpha adrenergic blocker for retention? Examples suffic
Reduces the resistance of sphincters involved with urination And decreases prostatic hyperplasia (enlarged prostate can cause the retention) Tamsulosin Doxazosin Alfuzosin - osin
61
Urolithiasis and Nephrolithiasis
Kidney stones in ureter or nephron
62
Lithiasis
stone formation
63
How does Urolithiasis and Nephrolithiasis happen?
Salts stick together to form kidney stones
64
Main symptoms of kidney stones
pain hematuria cloudy urine with smells renal colic or spasm
65
metabolic abnormalities that cause kidney stones?
``` increase in calcium uric acid citric acid and infection ```
66
how can summer months cause kidney stones?
Due to dehydration
67
What foods cause kidney stones
protein tea or juice no water salt
68
Genetic factors of kidney stones
family hx of stones | family hx of gout
69
lifestyle choices that cause kidney stones diseases surgery?
inactivity and obesity which causes urine stasis digestive diseases really any surgery can cause decreased UO
70
Staghorns
Type of stone. Sort of sharp. Can be very painful if in ureters
71
Types of calculi/stones 3
Calcium oxalate Cystine Uric acid
72
calcium oxalate examples
can cause stones. it is naturally found in foods and sticks together to form crystals nuts and grains potatoes chocolate
73
Hyperparathyroidism puts you at risk of stones. T/F
true. more common to develop calcium oxalate stone
74
digestive diseaes that can increase of stones?
crohns ulcerative colitis ibs
75
should you avoid calcium to avoid stones?
no. need to include 1000-1200 mg/day. | calcium and oxalate bind together to move through kidneys
76
What are cystine stones from
Amino acid that occurs in the body used for muscle and nerve building
77
what to avoid with cystine stones?
fatty foods red meat processed food
78
Uric acid stones are caused by? | associated with?
high purine intake leading to high amounts of uric acid and therefore acidic urine. assoicated with gout
79
foods with purines to avoid for uric acid sstones?
``` red meat alcohol sardines, anchovies, shellfish refined carbs sugary drinks ```
80
How to prevent stones: water intake? oxalate? calcium? protein? salt?
stone prevention water: 2-3 L a day Limit foods with oxalate (nuts, potatoes, chocolate) get enough calcium from dairy eat moderate amounts of protein low salt intake
81
Alpha blockers for stones? examples
relaxes the ureter so the stone can pass tamsulosin dutasteride combo with tamsulosin to decrease prostate size
82
potassium citrate for stones? exmaples
raises ph of urine OJ, lemonade, apple cider vinegar
83
allopurinol for stones? examples
allopurinol decreases uric acid level zyloprim and aloprim
84
cellulose phosphate example
prevents calcium from reaching kidneys to form stones can be used for hyperparathyroidism Calcibind
85
Lithroscopy
shock wave to break up stone ESWL so more shock or LASER
86
Percutaneous Nephrolithotomy
small back incision | nephrolithotripsy or sound waves
87
why might a strainer be sent home with patient?
To catch the stone so it can be used for biopsy
88
Bladder cancer cause?
Not clear. | Could be from smoking, carcinogen exposure, or familial
89
where does bladder cancer often travel?
liver, bones, and lungs
90
major symptoms of bladder cancer?
painless hematuria UTI symptoms pain where metasis is
91
Bladder cancer management
Transurethral resection of bladder tumor Radiation Chemo Immunotherapy Partial or total cystectomy (bladder removal) reconstruction as a urinary diversion
92
incontinent urinary diversion? | control?
diversion to skin requiring appliance patient control tube is created from a piece of intestine. the tbe runs from ureters to outside of body to urostomy bag
93
continent urinary diversion?
Use of stoma , koch pouch, indiana pouch use section of intestine to create small pouch in order to collect urine inside body
94
orthotopic neobladder
to construct a new bladder from intestines after a bladder removal
95
nursing dx for urinary diversion
``` anxiety imbalanced nutrition defieicent knowledge risk for skin integrit acute pain disturbed body image sexual dysfunction deficient knowledge wound care ```

Adult Nursing Exam 5 (6 decks)

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