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74 Cards in this Set
- Front
- Back
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what is the urethrovesical system made up of
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bladder, bladder neck, urethra, and pelvic floor muscles
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what vertebrae are affect in a paraglegic
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T11-L2
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what vertebrae are affect in a quadriplegic
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S2-S4
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what is the detrusor
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mesh like muscle in the bladder
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what forms the inner sphincter or opening into the urethra
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bundles of smooth muscle layers at the base of the bladder
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where does innervation of the bladder occur
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from the sympathetic, parasympathetic and somatic nerves
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how long is the male urethra
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4 cm
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how long is the female urethra
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20 cm
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when is the urge to void felt
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when bladder is 150 cc full
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when is the bladder full
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at 400cc
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what is hydronephrosis
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swelling of the kidney form back up of urine caused by obstruction
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what is hydroureter
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distention of ureter form obstruction
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what is reflux
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increase pressure leading to backflow of urine, uretral dilitation, kinking and renal artery damage
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what happens with obstruction in urinary system
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urine will back up and put pressure on the kidneys. Long term effects will lead to kidney damage and failure
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what are the manifestations of hydronephrosis
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renal colic, changes in urinary output, hematuria, palpable bladder, hypertension, hesitancy, urgency, incontinence, post-void dribble, diminished urinary stream
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how do you diagnose hydronephrosis
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catheterize for residual, cytoscopy, BUN, creatinine, lytes, IVP, renal ultrasound, CT scan
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what is an IVP
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intravenous pyelography. Looks at kidney size, obstruction, cysts, stones, tumors, outlines renal pelvis, ureters and bladder
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what is the treatment of hydronephrosis
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dilation or removal of occlusion. Treat underlying problem
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what is the cause of BPH
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related to endocrine changes associated with aging process
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what are the manifestations of BPH
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initailly decrease in urinary flow. As obstruction increases- decrease in force of stream, hesitancy in initiating stream, dribbling upon completion, urinary retention
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how do you diagnose BPH
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history, use american urological association symptom index, digital exam
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what meds to you take for BPH
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alpha blockers-smooth muscle relaxation- doxazosin, terazosin, tamulosin
5-alpha reducase inhibitors-dutasteride, finasteride |
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what are the adverse effects of BPH meds
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orthostatic hypotension
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what are the surgical treatments of BPH
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transurethral resection of the prostate, laser prostatectomy
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what is urolithiasis
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process of forming stones or renal calculi in bladder
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what is nephrolithiasis
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process of forming stones or renal calculi in kidney
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what are the risk factors for kidney stones
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men, familiy history, increase levels of calcium and uric acid, fluid loss, increase in protein , tea, fruit juice, inadequate fluid intake, sedentary lifestyle, UTI
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what is the patho of kidney stones
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urine saturation- high mineral salts, low urine volume
urine pH- increase acid in the urine will cause stone formation Stasis- from dehydration |
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what are the types of kidney stones
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calcium phosphate-form in acidic urine , usually men in 30's
calcium oxalate-most common, usually in men, also acidic urine Struvite-from UTI, difficult to eliminate, seen in women Uric Acid-seen with gout or high purine diet, seen in Jews cystine-hereditary-also seen in teens |
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what are the symptoms of kidney stones
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flank pain, vomiting, hematuria fever, chills
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how do you assess a patient with kidney stones
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pain-pqrst-flank pain=ureter stone, intense, spasms, colicky
nausea, vomiting chills, fever, GI symptoms, hematuria |
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what does urine look like in kidney stones
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bloody or may look smoky or rusty, increase in urine
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how do you diagnose kidney stones
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urinalysis, culture and sample, microscopic crystals, Urine pH, elevated WBCs, Xrays- KUB/Flat plate if greater than 2mm, IVP, CT, renal ultrasound, renal stone analysis, uric acid serum calcium and oxalate
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if urine pH is less than 6 what kinds of stone will you see
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calcium and uric acid
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if pH is greater than 7.2 what kinds of stones will you see
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struvite
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what are the nursing management's of kidney stones
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control pain with narcotics or antispasmodics, force at least 3000mL to decrease solute in urine, void every 2 hours, dietary changes, strain all urine and send stones for analysis
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what are the nutritional managements of kidney stones
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depends on type, change calcium to 2 servings per day, oxalate restriction, decrease sodium, increase citrus, decrease red meat to 2 moderate servings per day, increase fluid intake
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what is on an oxalate restriction
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spinach, asparagus, cabbage, tomatoes, beets, nuts, celery, chocolate, coffee, tea
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what surgeries do you get for a kidney stones
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cytoscopy, percutaneous nephrolithotomy, lithotripsy
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what are the indications for a surgical procedure
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stones are too large for spontaneous passage, association with bateriuria or symptomatic infection, causing impaired renal function, persistent pain, nausea or ileus, patient unable to be treated medically, patient only has one kidney
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what is required in post op care
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strain all urine, drains, maintain fluid balance, pain control avoid infection, urine may be blood tinged but not frank bleeding may have foley, fluid status, ureteral stents-never clamp, penrose drain-require frequent dressing change, nephrostomy tube-drainage may promote skin breakdown
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what are the lower UTI sites called
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cystitis, urethritis, prostatis
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what are the upper UTI sites called
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pyelonephritis
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what are the sources for UTI infection
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usually introduced via ascending tract, urologic instrumentation, nosocomial infection
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how does cystitis occur
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compromised normal defense systems, stasis, loss of mucosal lining, bladder distention, bladder ischemia
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what are the manifestations cystitis
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burning on urination, frequency, urgency, inability to void, incomplete emptying of bladder, change in color, clarity or odor, blood or mucus in urine, abdominal or back pain, fever, chills, nausea and vomiting
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what are the manifestations in the elderly with cystitis
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confusion, irritated perineal area, not dysuric
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what are the lab findings for cystitis
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urinalysis-WBC, RBC, bacteria
urine culture- colony count greater than 100000 positive. if lower get another sample |
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what are the meds for cystitis
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analgesics-percocet
antibiotics-cipro, keflex, bactrim, levoquin Urinary analgesics-pyridium anticholinergics-decrease spasm-probanthine, urecholine urinary antiseptics-urised, mandelamine, macrodantin, furodantin. may discolor urine |
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what diet should you follow for cystitis
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Acid-Ash diet, increased fluid intake
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what health promotion can you give to patients with cystitis
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proper wiping, shower, cotton underwear, avoid pantyhose, increase fluids, spermicides increase pH, void immediately after sex
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what are some causes of urinary incontinence
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multiple child births, pelvic surgery, prostate gland, confusion, spinal injury
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what can exercises can you do to help incontinence
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kegel- 10 contractions 5 times a day
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what are the types of urinary incontinence
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stress, urge, reflex, overflow, functional, iartrogenic, mixed incontinence
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what are symptoms of urinary retention
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unable to empty bladder completely, bladder distended, fullness feeling, voiding less than 30 cc at a time
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what causes urinary retention
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prostate englarged, pregnancy, spinal injury, meds (antihypertensices, antihistamines, sedative, anesthesia), age, diabetes, neurologic disorders
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what is the patho of pyelonephritis
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bacteria enters the renal pelvis inflammatory response, edema involved tissue, scarring and fibrosis, renal damage.
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what are the manifestations of pyelonephritis
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high fever, chills, nausea, flank pain, marked tenderness over the costrovertebral angle, headache, muscular pain, may be signs of cystitis recently.
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what are the diagnostic tests for acute pyelonephritis
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enlarged tender kidney, urine C&S, CUB, IVP, cystourethrogram
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what are the signs of chronic pyelonephritis
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often found when screening for hypertension, may have azotemia, anemia, proteinuria, pyuria, acidosis
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what are the treatments for pyelonephritis
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PO antibiotic for 14-21 days, IV antibiotics in severe cases, increase fluid intake, find cause. For relapse- 6 week course of antibiotics
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what are the nursing interventions for pyelonephritis
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education, finish antibiotics, 8 glasses of fluid a day, rest
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what usually causes chronic pyelonephritis
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long standing UTI
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fwhat is urethritis
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inflammation of the urethra, most common is gonorhea
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what are the symptoms of urethritis
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burning dysuria
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what is treatment for urethritis
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antibiotics, fluids, avoid sexual intercourse
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what do you ensure for pre-op renal and urethral surgery
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ensure adequate fluid intake, normal electrolyte balance
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what do you look at for urine output for post op renal and urethral surgery
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monitor q 1-2 hours, should be 30-50 ml/hr, monitor color and consistency, never clamp or irrigate catheter without order, daily weight
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what do you look at for respiratory status after renal and urethral surgery
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removal of 12th rib, adequate pain meds, cough, turn and deep breath every 2 hours
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what do you look at for GI status after renal and urethral surgery
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abdominal distention, paralytic ileus, IV fluids until able to take oral
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what is a suprapubic catheter
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catheter is palced directly into bladder, placement is above pubic symphysis, temporary, strict aseptic technique with manipulation, ensure patency
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what is a nephrostomy tube
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inserted temporarily to preseve renal function if there is ocmpete urter obstuction. never clamp, watch for kinks
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what do you do if there is an order to irrigate a nephrostomy tube
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strict aseptic technique, do not instill more than 5 ml of sterile water/NS
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what is an ileal conduit
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urters are implanted into part of ileum or colon that has been resected from intestinal tract and stoma is created. Urine will have sediment.
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