Test #2 Urinary Obstruction

Front 1

Urine backup can create enlargement of kidneys and infection T or F

Back 1

T

Front 2

The ___ kidney is higher than the ___ kidney

Back 2

left, right

Front 3

3 causes of intrinsic urinary obstruction?

Back 3

Anomalies, Growths, Tumors

Front 4

_____ causes of urinary obstruction come from outside of urinary system.

Back 4

Extrinsic

Front 5

Prolapsed uterus- Extrinsic or Intrinsic?

Back 5

Extrinsic

Front 6

BPH - Extrinsic or intrinsic?

Back 6

Intrinsic

Front 7

Abdominal tumor - E or I?

Back 7

Extrinsic

Front 8

Urethral stricture - I or E?

Back 8

Intrinsic

Front 9

Adhesions- I or E?

Back 9

Extrinsic

Front 10

Spinal Cord injury- I or E?

Back 10

Extrinsic

Front 11

Severity of obstruction depends on 4 factors?

Back 11

-Location
-Duration
-Amt of pressure
-Presence of urinary stasis

Front 12

Hydroureter?

Back 12

dilation of ureter due to stone or other obstruction; urine backup goes to kidney

Front 13

Hydronephrosis?

Back 13

urine backs up to kidney due to obstruction and makes kidney distended; if you don't solve this, then pyelonephritis develops

Front 14

Pyelonephritis?

Back 14

kidney infection from urinary stasis from obstruction; leads to kidney failure

Front 15

Nephrolithiasis?

Back 15

kidney stones, renal stones, renal calculi

Front 16

Are men or women more affected by nephrolithiasis?

Back 16

men; 3:1 ratio
- 50% of kidney stone episodes recur within 10 yrs
- incidence: 2-3% of gen pop
- living in warm, humid climate
- family history

Front 17

There are 5 types of stones?

Back 17

-Calcium phosphate
- Calcium Oxalate
- Uric Acid
- Cystine
- Struvite

Front 18

the 2 most common types of stones are?

Back 18

Calcium oxalate: most common; due to genetics
calcium phosphate: due to high circulating calcium (hypercalcemia); may be drug induced

Front 19

Uric acid stones are more common in ____ ; half of pts with uric acid stones have ____

Back 19

men; gout

Front 20

Struvite stones caused by ___; found mostly in ____ due to continuous catherization where they get UTI; develops when a urinary tract infection (e.g., bladder infection) affects the chemical balance of the urine. Bacteria in the urinary tract release chemicals that neutralize urinary acid, which enables bacteria to grow more quickly and promotes struvite stone development.

Back 20

bacteria; women;
- are the biggest stones

Front 21

Pain from stones present differently for men and women.
In men, pain will radiate down to ______
In women, pain will radiate down to _____

Back 21

testicles
vulva

Front 22

stones also present as ____ pain and _____ pain

Back 22

abdominal; flank

Front 23

3 main ways to assess pt for possible stones?

Back 23

- History - 75% of dx is from hx; learn about diet, exercise, how much fluids
- Urinalysis- if urine is high for WBCs, could indicate urinary stasis which are cause of stones
- Imaging to confirm: xray, CT, MRI

Front 24

Why is exercise important to prevent stones?

Back 24

- if pt doesn't use bones via exercise, calcium will be gotten rid of via kidneys.
- can also happen due to osteoporosis.

Front 25

What are the 4 diagnostic tests for stones?

Back 25

- abdominal ultrasound - can identify hydronephrosis or hydroureter
- abdominal xray (KUB) -Kidneys, Ureters, Bladder
- Noncontrast CT
- Intravenous pyelogram (IVP- contrast can hurt kidneys; use only if absolutely necessary.

Front 26

What is priority action for kidney stones?

Back 26

pain mgmt; treat first!

Front 27

What else do you assess for pt w kidney stones?

Back 27

- assess for adequate hydration
- check urine output
- check for urine characteristics, ie conc or not
- check for fluid overload if CHF pt

Front 28

Kidney stones are not emergency, but very important since if not treated can lead to _____

Back 28

urosepsis

Front 29

Stones < ___ in size will pass by themselves, but with pain. If larger, need medical procedure

Back 29

4 mm

Front 30

why is it important to strain urine for stones?

Back 30

send any stone to be analyzed to see what it is made of, which can help you prevent future ones by changing diet, etc

Front 31

2 medical therapies for kidney stones?

Back 31

ESWL: Extracorporeal Shock Wave Lithotripsy- done under flouroscopy; OR procedure that is done as outpatient;
- machine gives 500-1500 continuous punches; pt must be sedated and monitored; can become black & blue

- Ureteroscopy - endoscopic procedure; place stent in ureter to maintain patency.

Front 32

Explain Percutaneous nephrolithotomy?

Back 32

ultrasound guided procedure; doc makes small incision in pt's back to remove kidney stones
- useful for larger stones
- high risk of infection
- puts hollow tube (called nephrostomy tube) into kidney and passes a probe wire through tube & grabs stone in kidney & pulls out through tube

Front 33

- if urine is blocked, use _____ tube to drain urine; high risk of infection

Back 33

nephrostomy tube

Front 34

for pt with urinary obstruction, what would you monitor for infection?

Back 34

monitor vital signs esp temp; tachy HR could mean inf; hypotension could indicate sepsis

Front 35

Nursing care for pt with urinary obstruction (surgery)

Back 35

- Pain meds- #1 priority
- Prevent infection
- Encourage fluids
- Prevent obstruction
- Pt teaching to prevent future stones

Front 36

How to prevent stones made from calcium phosphate?

Back 36

lower calcium intake

Front 37

Prevent stones made from Calcium Oxalate?

Back 37

- eat low oxalate diet: limit beets, cocoa, tea
- treat with Vit C to make urine acidic
- take diuretics - help make urine acidic

Front 38

Prevent Uric Acid stones?

Back 38

can't eat red meat, red wine which are high in purines; need low purine diet
- need to make urine acidic

Front 39

what med treats Uric Acid stones?

Back 39

Allopurinol- blocks uric acid production

Front 40

What to eat to prevent Cystine stones?
what med?

Back 40

-increase veggies
- penicillamine

Front 41

to prevent struvite stones, need to make urine more ____ by eating acid/ash diet.

Back 41

acidic

Front 42

BPH?

Back 42

- Benign Prostatic Hypertrophy
- part of normal aging process
- affects 1/2 men by age 50; 80% by age 80
- AA more likely to develop than Caucasians and Asian- American are less likely to dev

Front 43

1 in ___ men who reach 80 will require some type of treatment for BPH

Back 43

-4
- enlarged prostate constricts ureter interrupting urine flow and increasing frequency of urination.

Front 44

Signs of BPH?

Back 44

- dec force of urine stream
- nocturia- urinate at night
- difficulty starting to urinate
- urgency- ie, feel the need to go but can't
- frequency - little urine at a time
-incomplete bladder emptying
- terminal dribbling
- urinary retention

Front 45

Main way to assess for BPH?

Back 45

-DRE: Digital Rectal Exam
- normal prostate is 2.5 x 3 cm

Front 46

Normal healthy prostate feels like _____ during rectal exam

Back 46

tip of nose

Front 47

BPH prostate feels like______

Back 47

hard meaty area of fist

Front 48

Prostate cancer feels how?

Back 48

hard like a knuckle

Front 49

Prostatitis? It feels like ___

Back 49

- inflammation or infection of prostate
-cheek

Front 50

PSA stands for?

Back 50

-Prostate Specific Antigen
- to rule out prostate cancer

Front 51

Cystoscopy?

Back 51

Done to inspect urethra and bladder; tube is inserted in urethra through penis

Front 52

"Watchful waiting" is associated with ____

Back 52

BPH where you & doctor decide to monitor symptoms to see if getting better or worse.

Front 53

Why shouldn't you take OTC decongestants for BPH like pseudoephedrine?

Back 53

can constrict urethra and veins and make it harder to pee.

Front 54

Why dec alcohol with BPH?

Back 54

alcohol inhibits ADH; with less ADH body can't retain water and it will flow continuously
- also limit fluid intake & no caffeine

Front 55

Meds for BPH?

Back 55

- Finasteride (Proscar, Propecia) anti-androgens, block testosterone prod. Preg women sh not handle pills
- Terazosin (Hytrin) & tamsulosin (Flomax) - alpha adrenergic blockers; relax smooth muscle of bladder & prostate
-

Front 56

Tamsulosin aka ____ treats ____ and is an alpha-adrenergic blocker which ____ smooth muscle of bladder & ___

Back 56

Flomax; BPH; relaxes

Front 57

Finasteride aka ___ and ___ is used to treat ___ and is an anti-androgen which ____ testosterone.

Back 57

Proscar; Propecia; BPH; blocks production

Front 58

Which herbal remedies may work for BPH?

Back 58

Saw Palmetto; Pygeum africanum
- if it works, allow pt to have, but make sure it doesn't effect metabolism.

Front 59

What are the 6 invasive therapies for BPH?

Back 59

- Microwave
- TUNA - Transurethral Needle Ablation; less side effects than TURP; uses radio waves to heat & destroy enlarged prostate
- TURP- Transurethral Removal of Prostate; requires anesthesia; most common BPH surgery
- Laser surgery
- Open surgery
- Balloonplasty and stents

Front 60

After TURP surgery, what sh nurse assess for?

Back 60

- post-op bleeding
- clot retention
- pain
- Genitourinary infection
- failure to void due to clot

Front 61

Post op TURP pt comes with CBI (which is?)

Back 61

Continuous Bladder Irrigation
- provides continuous flushing to the bleeding area and doesn't allow it to close
- 3-way foley; expect pink urine
- continue for 24 hrs

Front 62

For CBI mgmt, nurse sh check drainage bag for____

Back 62

amount, color, consistency and position.

Front 63

For CBI, drainage bag should never go above foley or bladder. T or F

Back 63

T

Front 64

For CBI, if there is no fluid draining from catheter and pt complains of abdominal discomfort, what is likely cause? Actions?

Back 64

Pt has clot; check I &O, palpate, assess for pain and discomfort, irrigate catheter; reassure pt & explain your actions

Front 65

4 nursing dx for post-TURP?

Back 65

- knowledge deficit r/t indwelling urinary catheter
- fluid volume imbalance r/t bleeding
- risk for infection
- risk for constipation - provide stool softener

Front 66

Teaching pt w foley catheter?

Back 66

- keep drainage bag below bladder
- bleeding can occur after walking and pooping?

Front 67

Retrograde ejaculation?

Back 67

when semen enters bladder

Front 68

Radical Cystectomy?

Back 68

-removal of bladder and surrounding tissue
- "radical" means everything

Front 69

3 main reasons to have a radical cystectomy?

Back 69

- bladder cancer
- Neurogenic bladder dysfunction
- Chronic bladder disease

Front 70

Urostomy?

Back 70

diversion of urine from through a surgically created opening in skin called a stoma

Front 71

Ileal conduit?

Back 71

piece of small bowel (ileum) acts as a conduit to take urine from ureters and bring to surface of abdomen. The small hole on surface of abdomen, through which the urine now passes out of the body, is called a stoma.

A fwatertight bag is placed over opening on abdomen (known as stoma) to collect the urine. It is kept in place with a special type of glue. The bag will fill with urine and need to be emptied.

Front 72

uro-rectal conduit?

Back 72

divert urine into rectum so that both urine and stool are passed through rectum (back passage). If this is done the person does not need a urostomy bag, or to pass a catheter to drain the urine.

Front 73

Urinary diversion surgery is major abdominal surgery. T or F

Back 73

T
- Nurse must make sure pt has bowel sounds; assess urinary output

Front 74

Nurse who cares for stoma is called?

Back 74

Enterostomal Therapy Nurse