Urinary elimination Flashcards
1
Q
hypospadius
A
- Urethral opening is below normal placement on glans of penis (ventral surface-underside)
- May also have short chordee (fibrous band of the penis, will cause it to curve downward)
2
Q
epispadius
A
Dorsal placement of urethral opening
3
Q
chordee
A
undescended testes and inguinal hernia
4
Q
surgical correction of hypospadius, epispadius, and chordee is preformed?
A
- 12-18 months of age
- no circumcision
- stent
5
Q
cryptorchidism
A
- One or both testes fail to descend through the inguinal canal into the scrotal sac
- Testis may be retractable
- In 85% right testis is affected
- The affected side or bilateral scrotum appears flaccid or smaller than normal
- Unknown why this fails: Increased abd pressure, Hormonal influences
6
Q
Cryptorchidism management?
A
- Observation for first year
- HCG - stimulates testosterone production and helps with descent
- If testis fail to descend between 1-2 years of age then surgical treatment: Orchiopexy
7
Q
____________ necessary before child can control bowel and bladder function; occurs between 12-18 months
A
myelination of spinal chord
8
Q
child is usually not ready for potty training until ?
A
- 18-24 months
- Waiting until 24-30 months makes the job easier
9
Q
urinates regularly?
A
1.5 years
10
Q
aware of voiding
A
2 years
11
Q
can hold urine?
A
2.5 years
12
Q
daytime control
A
3 years
13
Q
nighttime control
A
3.5 years
14
Q
primary enuresis
A
Never achieved dryness for 3 months
15
Q
secondary enuresis
A
Dry for 3-6 months then resumes wetness
16
Q
organic enuresis etiology
A
- Neurological delay
- UTI
- Structural disorder
- Chronic renal failure
- Disease with polyuria (DM)
- Chronic constipation
17
Q
non-organic enuresis etiology
A
- Sleep arousal problem
- Sleep disorders from enlarged tonsils, sleep apnea
- Psychological stress
- Family history
- Inappropriate toilet training
18
Q
DDAVP
Ditropan
Tofranil (Imipramine)
A
medications for enuresis
19
Q
- Sequela of obstruction
- increased risk of infection
- Hydronephrosis
- Hydroureter: enargement of the bladder of the ureter
A
urinary stasis
20
Q
- Alteration in neural innervation of the bladder
- Spastic bladder: ** SCI (above sacral vertebrae) Stroke, MS
- Flaccid bladder: ** SCI, Diabetic neuropathy, non-relaxing external sphincter
A
neurogenic bladdder
21
Q
- Abnormal movement of urine from the bladder into ureters or kidneys
- frequently occurs during urination
- often occurs in those with frequent UTI
- malfomation of valves at the ureter and/or the bladder
A
Vesicoureteral Reflux (VUR)
22
Q
- Genetic origin
- Girls > boys
- Symptoms: Frequent UTI’s (most common), Enuresis, Flank pain, Abdominal pain
A
vesicoureteral reflux etiology and symptoms
23
Q
vesicoureteral reflux treatment
A
- Grades 1-3: will usually resolve on own
- Grades 4-5: valve repair
- Prophylactic ABX
- Teach child to double void
- Urine C & S q 2-4 months until 3 negative
24
Q
Classified according to region and primary site affected
- Lower urinary tract?
- Upper urinary tract?
A
- urethritis, cystitis
- pyelonephritis
25
* Inflammation of the bladder
* _Causes_: Bacterial infection, Radiation, Chemotherapeutic agents, Metabolic disorder
cystitis
26
* Nonspecific
* Fever or hypothermia (neonate)
* Irritability
* Dysuria (crying when voiding)
* Change in urine odor or color
* Poor weight gain
* Feeding difficulties
infant s/s of uti
27
* Abdominal or suprapubic pain
* Voiding frequency
* Voiding urgency
* Dysuria
* New or increased incidence of enuresis
* Fever
* Malodorus urine
* Hematuria
children s/s of UTI
28
* An inflammation affecting the renal pelvis and parenchyma.
* Usually begins in lower urinary tract & ascends into kidneys.
* Organisms: E. coli (85%), Proteus, Klebsiella
* Acute: bacterial infection
* Chronic: non-bacterial inflammation
pyelonephritis
29
chronic pyelonephritis
* Urinary obstruction
* Vesicoureteral reflux
30
Inflammation from infection
↓
Destruction of the endothelial lining of the nephron
and/or
Destruction of the basement membrane
↓
Loss of tubular function
↓
Loss of ability to concentrate urine
↓
polyuria
dilute urine
patho: pyelonephritis
31
* Abrupt onset of fever
* Chills
* Back pain
* Costovertebral tenderness
* Leukocytosis
* Pyuria
* bacteriura
acute pyelonephritis clinical manifestations
32
* Vague
* Polyuria
* Nocturia
chronic signs of pyelonephritis
33
UTI: Pharmacological Management
* Sulfonamides
* Quinolones
* Urinary antiseptics
* Urinary analgesics
34
* Age related non-malignant enlargement of the prostate gland
* Expanding prostatic tissue compresses the urethra causing partial or complete obstruction of the outflow of urine from the bladder
Benign Prostatic Hyperplasia
35
* Urgency, frequency, hesitancy
* Change in size and force of urinary stream
* ↑ time to void
* Dribbling
* Nocturia
* Retention
* Hematuria
* UTIs
BPH Clinical Manifestations
36
BPH medications?
_Alpha blockers_:
- Flomax (tamsulosin)
- Minipress (prazosin)
- Cardura (doxazosin)
- Hytrin (terazosin)
\*take these type of medications in the evening to reduce side effects of hypotension and fatigue
_5-alpha reductase inhibitors_
- Avodart (dutasteride)
- Proscar (finasteride)
\*reduce the size of the prostate. Very slow in addressing problems they may be having
37
TURP
_Transurethral Resection of Prostate:_
-Obstructing prostate tissue is removed using a loop wire of a resectoscope & electrocautery inserted through the urethra
_Surgical complications_:
-Post-op hemorrhage or clots,inability to void, UTI, incontinence, impotence, retrograde ejaculation
38
TURP: Post-op Nursing Care
* Monitor color/ characteristics of urine
* Strict I & O, including amounts of irrigation fluid
* Monitor VS closely
* Belladonna and opium suppositories: help control bladder spasm
* Encourage liberal intake of fluids (2-3 liters) to decrease risk of UTI
* Stool softener
* Antibiotics
\*big risk is clot causing obstruction. Keep area well flushed through hydration and an irrigation system
39
* Transurethral Microwave Thermotherapy (TUMT)
* Transurethral Needle Ablation (TUNA)
* Transurethral Laser Therapy or Interstitial Laser Coagulation (ILC)
BPH minimally invasive surgery
40
Urolithiasis
Urinary calculi
41
Nephrolithiasis
Kidney calculi
42
* Idiopathic
* Inadequate hydration
* Hypercalciuria
* Gout
* Urine stasis
* Urinary tract infection
* Genetic predisposition (cystinuria)
* Dietary excess of calcium, oxalates, purines
urinary calculi etiology
43
5 major types of urinary calculi
* Calcium phosphate
* Calcium oxalate
* Struvite (magnesium-ammonium phosphate)
* Uric acid
* Cystine
44
Nidus (nucleus) development--\> Crystal precipitation--\>
Obstruction of urine flow
renal calculi patho
45
Common Locations of Urinary Calculi
* Kidney
* Ureteropelvic junction
* Pelvic brim (over iliac vessels)
* Ureterovesical junction
* Bladder
* Urethra
\*like to be in places where there are angles and junctions
46
* Stone movement
* Sharp & intermittent
* Flank and outer quadrant
Renal colic: urinary calculi
47
* Distention of the renal pelvis or calices
* Dull & achy
* Flank & back
Noncolicky pain: urinary calculi
48
urinary calculi pain management: pharm
* Narcotic agents (morphine, meperidine)
* NSAIDS (ketorolac)
* _Spasmolytic agents: _oxybutynin chloride (Ditropan), propantheline bromide (Pro-Banthine), methantheline bromide (Banthine)
* Antiemetics
49
urinary calculi post-op care
* Monitor VS; I & O; urine color & clarity.
* Maintain placement and patency of urinary devices.
* Never irrigate the catheter without physician’s order.
* Strain all urine; Teach client how to strain urine.
* Send stones for analysis.
50
assess for allergies of iodine and shellfish?
assessing for allergy to a dye if they've never had that proceedure done before
51
urinary calculi nutrition recommendations
- _Calcium stones_:
- Limit high calcium foods, Milk, cheese, green leafy vegetables, yogurt
- Limit Na intake
- Limit intake of oxalate: rhubarb, spinach, strawberries, chocolate, wheat bran, nuts, beets, and tea
- Avoid vitamin C supplements
- _Uric acid stones:_
- Limit intake of foods high in purines: Organ meats, beef, veal, pork, venison, chicken, goose, sardines, herring, crab, salmon
52
Pharm treatment of the different kinds of stones
_Calcium stones_
- sodium cellulose phosphate (Calcibind)
- Thiazide diuretics
_Uric acid stones_
- sodium bicarbonate
- allopurinol (Zyloprim)
_Cystine stones_
- penicillamine (Cuprimine)
- alpha-mercaptopriopionylglycine (AMPG)
- Tiopronin (Thiola )
53
* Inflammation in the kidneys which begins in the glomerulus
* Acute aka nephritic
* Antibody reaction with antigens in the glomerulus
* Entrapment of antigen-antibody complexes
glomerular disease
54
* Inflammation of capillary loops in glomeruli of kidneys
* Cause: group A beta-hemolytic streptococcus
* Risk:Upper respiratory infection, Skin infection, Autoimmune process
glomerular nephritis
55
acute glomerulonephritis
* Sudden inflammation of the glomeruli of the kidney resulting in acute renal failure
* Peak age 5-10 years, boys\>girls
* Capillary walls of kidney become permeable; allows red blood cells and protein to pass into urine
* Usually seen 7-10 days after a strep infection (immune response to strep), may be other organisism
* APSGN (Acute Post Streptococcal Glomerulonephritis)
* etiology: Streptococcus A,
Viruses:Chicken pox, Mumps, Measles
56
* Severe glomerular injury without a specific cause
* Rapid decline in glomerular function over 2-3 months
* Etiology:Systemic or renal immunologic disorders
- SLE
- Goodpasture’s Syndrome
Rapidly Progressive Glomerulonephritis
57
Streptococcal infection (group A Beta hemolytic)
↓
antigen-antibody reaction
↓
formation of antigen-antibody complexes
↓
entrapment in the glomerular basement membrane
↓
Cells lining the glomeruli proliferate
↓
Capillary membrane edema & increased permeability
↓
Hematuria, hypertension, proteinuria,
edema, azotemia, RBC breakdown
## Footnote
Glomerulonephritis Pathogenesis
58
* Gross hematuria
* Dark, smoky, cola-colored, cocoa-colored urine
* Oliguria or anuria
* Headache
* Abdominal / flank pain
* Chills & fever
* Fatigue & weakness
* Anorexia, nausea/vomiting
* Peripheral edema
* Hypertension
Glomerulonephritis: Clinical Manifestations
59
* Urinalysis
* Proteinuria, RBCs, WBCs
* ↑ BUN & creatinine
* ↓ Creatinine clearance
* ↑ antistreptolysin O titer
* Biopsy
glomerulonephritis dx tests
60
Glomerulonephritis: Achieving Fluid Balance
* Monitor vital signs, I & O & daily weight
* Monitor for fluid overload
* _Monitor serum studies: _Electrolytes, BUN, creatinine, Hemoglobin, hematocrit, WBCs
* Maintain fluid restriction
* Na+ / K+ restriction
* Diet – ↓ protein, ↑ CHO
* _Medications: _Antibiotics, Immunosuppressives, Steroids, Diuretics, Angiotensin II receptor blockers, Potassium-binding resins, Antihypertensives
61
* _Massive proteinuria_ (\>3.5 grams/day)
* -Hypoalbuminemia
* -Edema
* Hyperlipidemia
* _Etiologies_: Glomerular disease, Diabetes, SLE
nephrotic syndrome
62
antigen-antibody reaction
Sclerosis of the GBM (diabetes, hypertension)
↓
glomerular basement membrane permeability to plasma proteins
↓
proteinuria
↓
hypoalbuminemia
nephrotic syndrome patho
63
* Severe edema
* Hypertension
* Sequela: Pulmonary edema, Pleural effusion, Ascites, Hyperlipidemia and atherosclerosis, Infection, Poor nutrition, Growth retardation
Nephrotic SyndromeClinical Manifestations
64
Nephrotic SyndromeDiagnostics
* Proteinuria
* Hypoalbuminemia
* Hyperlipidemia
* Urine appears dark and frothy
* Negative ASO titer
65
Reduce edema in nephrotic syndrome pt. nursing interventions/pharm
* Prednisone 2mg/kg/day for 4-8 weeks
* Long term steroid use is concern
* Treat until child is in remission
* Diuretic therapy used only if poor response to steroids
* May need IV albumin
* Give parental support and education re: urine protein checks
66
Risk for fluid volume deficit r/t effects of diuretics in pts with nephrotic syndrome nursing interventions
* Watch for low BP & increased pulse
* Report if child has output of less than 1 ml/kg/hr of urine
* Increased Hbg, Hct and platelets
* Observe for s/s dehydration
