Exam 3 Part 2 (Urinary)

The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. A cystometrogram b. Transrectal ultrasound c. Uroflowmetry d. Postvoiding catheterization

C

To assist a patient with stress incontinence, what should the nurse teach the patient to do? a. Void every two hours to prevent leakage b. Use absorptive perineal pads to contain urine c. Perform pelvic floor muscle exercises 40 to 50 times per day d. Increase intra-abdominal pressure during voiding to empty the bladder completely

C

What can patients at risk for kidney stones do to prevent them in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

C

What is included in nursing care that applies to the management of all urinary catheters and hospitalized patients? a. Measuring urine output every 1 to 2 hours to ensure patency b. Turning the patient frequently from side to side to promote drainage c. Using strict sterile technique during irrigation and obtaining culture specimens d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

C

What is the most common cause of acute Pyelonephritis resulting from an ascending infection from the lower urinary tract? a. The Kidney is scarred and fibrotic b. The organism is resistant to antibiotics c. There's a pre-existing abnormality of the urinary tract d. The patient does not take all the antibiotics for treatment of a UTI

C

When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. Nocturia, dysuria, and bladder spasms b. Urinary frequency, hematuria, and perineal pain c. Urinary hesitancy, postvoid dribbling, and weak urinary strain d. Urinary urgency with a forceful urinary stream and cloudy urine

C

Which intervention should be done for a client with urinary calculus? a. Save any calculus larger than 0.25 cm b. Strain the urine, limit oral fluids, and give pain medications c. Encourage fluid intake, strain the urine, and give pain medication d. Insert an indwelling urinary catheter, check intake and output, and give pain medication

C

Which type of urinary tract stones are the most common and often obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

C

While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. Which clinical manifestations of the patient likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

C

Types - Nephrolithiasis

Calcium phosphate •Risks factors - Alkaline urine & hyperparathyroidism Calcium oxalate •Risk factors - hypercalciuria, hyperoxaluria, family hx Uric acid •Risk Factors - gout, acidic urine, inherited condition Cystine (rare) •Risk Factors - genetic**, acidic urine Struvite (Magnesium ammonium phosphate) •Risk factor - UTI

During assessment of the patient who had an open nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right in left lower lobes

B

Urinary Tract Infection (UTI)

- Most common bacterial infection in women - 70-95% of cases without UT structural abnormalities or stones - Pregnant women at increased risk - Bladder and its contents are free of bacteria in majority of healthy pts - Candida albicans is the 2nd most common pathogen for a UTI associated with catheter Minority of healthy individuals have colonizing bacteria in bladder - Called asymptomatic bacteriuria, doesn't justify tx Escherichia coli most common pathogen - Primarily seen in women Fungal and parasitic infections can cause UTIs - Pts at risk - Immunosuppressed, have diabetes, undergone multiple antibiotic courses, traveled to certain 3rd-world countries

Water Vapor Thermal Therapy

- New minimally invasive tx - Heated water vapor to destroy obstructive prostate tissue - Directed transurethrally via hand-held device - Complications of UTI, hematuria, and irritative voiding symptoms

Drugs That Affect The Lower Urinary Tract Function

- Alcohol (frequency, urgency) - Pseudoephrine (retention on males) - Alpha blockers (incontinence in women) - ACE inhibitors (incontinence) - Anticholinergics (retention) - Tricyclic antidepressants (retention) - Beta blockers (retention) - Calcium channel blockers (retention) - Opioids (retention) - Sedatives (muscle relaxation) - Diuretics (frequency, urgency)

Urinary Incontinence - 5 alpha reductase inhibitors

- Androgen suppression that results in epithelial atrophy and a decrease in total prostate size - Examples: Proscar, Avodart

Recurrent Infection

- Caused by 2nd pathogen in a person who experienced a previous infection that was eradicated - If occurs because original infection was not eradicated, it is classified as unresolved bacteriuria or bacterial persistence

Home Care - BPH

- D/c instructions on indwelling catheter - Managing incontinence (pelvic floor exercises) - 2-3 L fluids per day - S/S of UTI, wound infection - Prevent constipation - Avoid heavy lifting (<10 lbs) - Refraining from driving, intercourse after surgery as directed - Sexual counseling if erectile dysfunction becomes a problem - Avoid bladder irritants - Bladder may take 2 mos. to return to normal - Void every 2-3 hours - Yearly digital rectal examination (DRE)

Invasive (Surgery) therapy indicated when:

- Decrease in urine flow sufficient to cause discomfort - Persistent residual urine - Acute urinary retention

Transurethral Incision of the Prostate

- Done under local anesthesia - Indicates for moderate to severe symptoms and a small prostate who are a poor surgical risk - For pts with a small or moderately enlarged prostate gland

Transurethral Vaporization of Prostate (TUVP)

- Electrosurgical vaporization and desiccation are used together to destroy prostate tissue - SE - retrograde ejaculation and intermittent hematuria

Initial Infection

- First or isolated - Uncomplicated UTI in person never had one or experiences one remote from a previous UTI (separated by period of years)

UTI - Antifungals

- Fluconazole (Diflucan) - UTIs secondary to fungi

BPH - Health Promotion

- Focus: Early detection and tx - Yearly PMH and DRE for men >50 - Instruct pt with obstructive symptoms to urinate q2-3h and when first feeling urge - Minimizes urinary stasis - Teach need for adequate fluid intake; alcohol, caffeine, cold and cough meds can increase symptoms

UTI - diagnostic studies

- H&P - Cystoscopy - Ultrasound Urinalysis (Obtain as a midstream catch) - presence of nitrates, WBCs, and leukocyte esterase Urine for culture and sensitivity (if indicated) - Clean-catch sample preferred - Specimen by catheterization or suprapubic needle aspiration more accurate - Determine bacteria susceptibility to antibiotics - Collect before antibiotic tx begins to avoid affecting results. Imaging studies - IVP or abdominal CT when obstruction suspected

BPH Diagnostic Studies

- H&P - DRE - Urinalysis with culture - PSA level (over 4) - Serum creatinine - Postvoid residual - TRUS scan - Bx can be taken - Uroflometry - measures expelled urine - Cystourethroscopy

Photoselective Vaporization of Prostate (PVP)

- High power green laser light - Improved urine flow - Works well for large prostate gland but irritative voiding symptoms may persist for several weeks. - Catheter for 7 days - Fast recovery

Urinary Incontinence - Diagnostic Studies

- History - Physical exam - general health and functional issues - Bladder log or voiding record - Urinalysis - Post-void residual (may use ultrasound) - Urodynamic testing Pelvic examination - strength of pelvic muscles - Pelvic organ prolapse

Urinary Incontinence - Alpha-adrenergic agonists

- Increase urethral resistance (may be used for stress incontinence) - Ex: phenylpropanolamine - SE - hypertension and tachycardia

Acute Pyelonephritis

- Inflammation of renal parenchyma and collecting system. - Most commonly a bacteria infection - Prompt dx needed may lead to septic shock - Usually begins in the lower tract and there is a preexisting abnormality

Anti-Incontinence Device

- Intrvaginal support devices (Pessaries) - Intraurethral occlusion device (Urethral plug) - Intraurethral valve pump - Penile compression device

Prostatic Urethral Lift (PUL)

- Involves permanent transprostatic implants or tension sutures transurethrally via cystoscope - Opens by compression without ablation - Minimally invasive tx - Lack of long term data since a new procedure

Uncomplicated Infection

- Occurs in otherwise normal urinary tract - Usually only involve the bladder

Transurethral microwave therapy (TUMT)

- Outpatient procedure: Delivers microwaves directly to prostate through a transurethral probe - Heat causes death of tissue and relief of obstruction - Takes about 90 mins - Postop urinary retention is common - Pt sent home with catheter 2-7 days - Antibiotics, pain meds, and bladder antispasmodic meds given - Not appropriate therapy when rectal problems exist (rectal probe used to check temperature) - SE: Bladder spasm, hematuria, dysuria, and retention

Interprofessional Care - Stress

- Pelvic floor muscle exercises - Weight loss if obese - Cessation of smoking - Topical estrogen products - Condom catheter or penile clamp in men - Surgery - Urethral inserts, patches, or bladder neck support devices (incontinence pessary) to correct underlying problem

Urinary Incontinence - Tricyclic antidepressants

- Reduce sensory urgency and burning pain of interstitial cystitis - Reduce overactive bladder contractions - Example : Tofranil, Elavil

Urinary Incontinence - Alpha-adrenergic antagonists

- Reduce urethral sphincter resistance to urinary outflow - Examples: Cardura, Hyrin, Flomax, Uroxatral

Transurethral resection (TURP)

- Relatively low risk - Performed under spinal or general anesthesia and requires hospital stay of 1-2 days - No incision - Bladder irrigated for first 24 hours to prevent mucus and blood clots - Complications: bleeding, clot retention, dilutional hyponatremia, retrograde ejaculation - Pts must stop anticoagulants before surgery - A resectoscope is inserted through the urethra to excise and cauterize obstructing prostatic tissue. - A large 3-way indwelling catheter with a 30-mL balloon is inserted into the bladder after the procedure to provide hemostasis and to facilitate urinary drainage.

Upper Tract Infection

- Renal parenchyma, pelvis, and ureters - Causes fever, chills, flank pain - Urosepsis is a UTI that has spread systemically and can be life threatening. Example - Pyelonephritis: Inflammation of renal parenchyma and collecting system Upper tract is much worse Most kidney infections start from a bladder infection

Acute Pyelonephritis - Ambulatory and Home Care

- Rest to increase comfort - Long-term, low-dose antibiotics to prevent relapses or reinfections - Explain rationale to increase compliance

Urinary Incontinence - Lifestyle Modifications

- Smoking cessation - Weight reduction - Good bowel regimen - Reduce caffeine - Fluid modification for urge incontinence

Interprofessional Care - Incontinence after trauma or surgery

- Surgery to correct fistula - Urinary diversion surgery to bypass urethra and bladder - External condom catheter - Penile clamp - Placement of artificial implantable sphincter

Scheduled Voiding

- Timed voiding - q2-3h - Habit retraining - based on pattern - Prompted voiding - prompted by caregiver - Bladder retraining and urge-suppression strategies

Interprofessional Care - Reflex

- Tx of underlying cause - Bladder decompression to prevent ureteral reflux and hydronephrosis - Intermittent self-catheterization - Diazepam (Valium) or baclofen (Lioresal) to relax external sphincter - Prophylactic antibiotics - Surgical sphincterotomy

Interprofessional Care - Urge

- Tx of underlying causes, behavioral interventions including bladder retraining with urge suppression, decrease in dietary irritants, bowel regularity, and pelvic floor muscle exercises - Anticholinergic drugs - External condom catheters - Vaginal estrogen creams - Absorbent products

Urinary Incontinence

- Uncontrolled leakage of urine - Young to middle aged women, prevalence is 30-40%. - Increases to 30-50% in elderly women - Not a natural consequence of aging - Effects quality of life

Interprofessional Care - Overflow

- Urinary catheterization - Crede or valsalva maneuver - Alpha-adrenergic blocker - 5 alpha-reductase inhibitors (Proscar) - Bethanechol (Urecholine) to enhance bladder contractions - Intravaginal devices such as a pessary to support prolapse - Intermittent catheterization - Surgery to correct underlying problem

Preoperative Care - BPH

- Use aseptic technique when using urinary catheter - Restore urinary drainage - Coude - curved-tip catheter - Filiform - rigid catheter - Aseptic technique very important in preventing infection - Administer antibiotics preoperation - Provide opportunity to express concerns over alterations in sexual function - Inform possible complications of procedures

Laser Enecleation of the Prostate

- Used to rapidly vaporize and coagulate prostate tissue. - Doesn't penetrate deep tissues - 2 types of lasers - Holmium laser enucleation and thulium laser enucleation - Catheter removed after 24-48 hours - Fast recovery - Can cause hematuria and retrograde ejacuation

Pelvic Floor Muscle Rehabilitation

- Vaginal weight training - bid - Biofeedback - Electrical Stimulation

Transurethral needle ablation (TUNA)

- ↑ Temperature of prostate tissue for localized necrosis - Low-wave frequency used - Only tissue in contact with needle affected - 70% of pts show improvement in symptoms - Outpatient using local anesthesia and sedation - Lasts 30 mins with little pain and quick recovery - Typically experiences little pain with an early return to regular activities. - Complications: urinary retention, UTI, and irritiative voiding symptoms - Some pts require catheter - Hematuria up to a week

Defense Mechanisms

-Acidic pH -High urea concentration -Abundant glycoproteins

Benign Prostate Hyperplasia

-Benign enlargement of prostate gland -Most common urologic problem in males -Some signs begin around 50 increases with age. -Occurs in 70% of men in their lifetime will develop BPH -Of these men, half will have bothersome symptoms -Research is not clear about whether having BPH leads to an increased risk of developing prostate cancer.

Types of Incontinence

-Stress incontinence -Urge incontinence -Overflow incontinence -Reflex incontinence -Incontinence After Trauma or Surgery -Functional Incontinence

Drug therapy: Offers symptomatic relief of BPH

5-α-Reductase inhibitors - Ex: Finasteride (Proscar), Dutasteride (Avodart) - Block the enzyme 5-α-Reductase , which is necessary for the conversion of testosterone to DHT, the principal intraprostatic androgen. - ↓ Size of prostate gland - Takes up to 6 mos. for improvement - SE: Decreased libido, decreased volume of ejaculation, ED - Alert for Proscar - risk of orthostatic hypotension; women who are or may be pregnant should not handle the tablet - Teach SE - May lower the risk of prostate cancer - Not recommended in the prevention of prostate cancer d/t an increased risk of developing an aggressive form of prostate cancer

A 47-year-old patient who has hypogonadism has decided to try the testosterone gel Testim. What should the nurse teach the patient and his wife about this gel? a. Wash the hands with soap and water after applying b. His wife should apply it to help him feel better about using it c. Do not wear clothing over the area until it has been absorbed d. The gel may be taken buccally if it is not effective on the abdomen

A

A client presents with a possible urinary tract infection. Which urine characteristic should the nurse assess first? a. Urine clarity b. Urine specific gravity c. Urine acetone d. Urine protein

A

A patient is admitted to the hospital with severe renal colic. The nurses first priority and management of the patient is to a. Administer opioids as prescribed b. Obtain supplies for straining all urine c. Encourage fluid intake of 3 to 4 L a day d. Keep the patient NPO in preparation for surgery

A

A patient is seeking medical intervention for ED. Why should he be thoroughly evaluated? a. It is important to determine if ED is reversible before treatment to started b. Psychological counseling can reverse the problem and 80% to 90% of the cases c. Most treatments for ED are contraindicated in patients with systemic diseases d. New invasive an experimental techniques currently used have unknown risks

A

Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective gastrointestinal (GI) and kidney absorption

A

The nurse is assessing a client who reports painful urination during and after voiding. The nurse suspects the client may have a problem with which area of the client's urinary system? A. Bladder B. Kidneys C. Ureters D. Urethra

A

The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing? a. Reflex incontinence b. Overflow incontinence c. Functional incontinence d. Incontinence after trauma

A

What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

A

When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer? a. Smoking b. Family history of cancer c. Chronic use of phenacetin d. Chronic, recurrent kidney stones

A

Which characteristic is more likely with acute Pyleonephritis than with a lower UTI? a. Fever b. Dysuria c. Urgency d. Frequency

A

Which classification of urinary tract infection is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

A

W.B. is scheduled for a TURP. When you assesses his knowledge of the procedure and its effects, you realize he needs further teaching when he says, a. "It is possible that I'll be sterile following this procedure." b. "It is likely that I will become impotent from this procedure." c. "I understand that some retrograde ejaculation may occur." d. "I will have a catheter for a couple of days to keep my urinary system open."

A?

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with BPH? a. Voiding patterns b. Size of the prostate c. Creatinine clearance d. Serum testosterone level

A?

UTI - Acute Intervention

Adequate fluid intake - Pt may think will worsen condition d/t discomfort - Dilutes urine, making bladder less irritable - Flushes out bacteria before they can colonize Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods - Potential bladder irritants - Application of local heat to suprapubic or lower back may relieve discomfort - Instruct about drug therapy and SE - Emphasize taking full course despite disappearance of symptoms - Second or reduced drug may be ordered after initial course in susceptible pts - Watch urine for changes in color and consistency and decrease in cessation of symptoms - Counsel on persistence of lower tract symptoms beyond tx or onset of flank pain or fever should be reported immediately

Urinary Tract Calculi - Implementation

Adequate fluid intake to produce 2 l/day of urinary output (2000-2200 fluids/day) •Increase intake in highly physically active Immobile patients •Adequate fluid intake, sit or stand to void, and turn q2h • Purine reduction for pts at risk for uric acid stones • Reduce oxalates for pts with reoccurring calcium oxalates calculi • Selected pts may be taught to self monitor pH • Teach about meds to reduce stones • Pain management • Strain urine in an effort to detect urine • Ambulation encouraged to promote movement of the stone to lower urinary tract

Postoperative care for TURP

Assess for complications - Hemorrhage - Bladder spasms - Urinary incontinence - Infection Postop bladder irrigation to remove blood clots and ensure drainage or urine (manual and/or continuous) - Administer antispasmodics - Teach Kegel exercises - Observe for signs of infection - Dietary intervention - Stool softeners to prevent straining

A female patient has a UTI and kidney stones. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric Acid d. Calcium phosphate

B

A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient immediately after the procedure, what is the most appropriate nursing action? a. Milk or strip the catheter every two hours b. Measure ureteral urinary drainage every 1 to 2 hours c. Encourage ambulation to promote urinary peristaltic action d. Irrigate the catheter with 30 mL of sterile saline every four hours

B

A patient scheduled for a radical prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that a. PD5 inhibitors are not recommended in prostatectomy patient b. Erectile dysfunction can occur even with a nerve sparing procedure c. The most common complication of the surgery is bowel incontinence d. The provider will place a penile implant during surgery to treat any dysfunction

B

A patient with continuous bladder irrigation after a prostatectomy tells a nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation b. Assess the patency of the catheter c. Encourage the patient to try to urinate around the catheter d. Administer a belladonna and opium (B&O) suppository as prescribed

B

Following electrohydraulic lithotripsy for treatment of kidney stones, the patient has a nursing diagnosis of risk for infection. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria b. Encourage fluid intake of 3 L/day c. Apply moist heat to the flank area d. Strain all urine through gauze or a special strainer

B

The nurse provides discharge teaching to a patient after a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I will avoid heavy lifting, climbing, and driving until my follow-up visit." c. "at least I don't have to worry about developing cancer of the prostate now." d. "every day I should drink 10 to 12 glasses of fluids, such as coffee, tea, or soft drinks."

B

The nurse teaches the female patient who has frequent UTIs that she should a. Take bubble baths b. Void before and after sexual intercourse c. Take prophylactic sulfonamides for the rest of her life d. Restrict fluid intake to prevent the need for frequent voiding

B

What should the nurse include in the teaching plan for a female patient with a UTI? a. Empty the bladder at least four times a day b. Drink at least 2 quarts of water every day c. Wait to urinate until the urge is very intense d. Clean the urinary meatus with an anti-infective agent after voiding

B

Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVT)

B

With which diagnosis will the patient benefit from being taught to do self-catheterization? a. Renal trauma b. Urethral stricture c. Renal artery stenosis d. Accelerated nephrosclerosis

B

A patient with a history of gout has been diagnosed with renal calculi. Which treatment will be used with this patient (select all that apply)? a. Reduce dietary oxalate b. Administer allopurinol c. Administer alpha-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

B, E

A 35-year-old male presents to the ER with hematuria, flank pain, nausea, and vomiting. He is admitted and passes a "stone." The stone is sent to the laboratory and is found to be composed of uric acid. The client is placed on allopurinol (Zyloprim). The nurse understands that allopurinol is prescribed to a. decrease the client's serum creatinine b. reduce the urinary concentration of uric acid c. acidify the urine d. bind oxalate in the GI tract

C

A 55-year-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease his risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging b. Treatment of any enlargement of the prostate gland will help prevent prostate cancer c. Substituting fresh fruits and vegetables for high fat foods in the diet may lower the risk of prostate cancer d. Using a natural herb, such as saw palmetto, has been found to be an effective protection against prostate cancer

C

A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which factor? a. Antibodies b. Type of infection c. Composition of calculus d. Size and number of calculi

C

A woman presents to the urgent care center with dysuria and hematuria. The woman reveals that she has a history of cystitis. The nurse should also assess for which of the following clinical manifestations suggesting cystitis? a. frequency and urgency of urination, flank pain, nausea, and vomiting b. abscess formation and flank pain c. frequency and urgency of urination, suprapubic pain, and foul smelling urine d. fever, nausea, vomiting, and flank pain

C

A woman with no history of UTI who has urgency, frequency, and dysuria comes to the clinic. A dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity b. No treatment with medication unless she develops fever, chills, and flank pain c. Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

C

An 84-year-old man had just returned to the nursing unit after a transurethral resection. He has a 3-way indwelling catheter for continuous bladder irrigation connected to straight drainage. Immediately after surgery, the nurse would expect his urine to be a. clear b. light yellow c. pink or dark red d. bright red

C

Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Manually irrigate the catheter until the drainage is clear. c. Increase the rate of the irrigation and take the patient's vital signs. d. Clamp the drainage tube and notify the patient's health care provider.

C

On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what? a. The effects of general anesthesia b. The possibility of short-term incontinence c. Home management of an indwelling catheter d. Monitoring for postoperative urinary retention

C

On assessment of a patient with a kidney stone passing down the ureter, what should the nurse expect the patient to report? a. A history of chronic UTIs b. Costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

C

Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, you should A. deflate the catheter balloon to 10 mL to decrease bulk in the bladder. B. deflate the catheter balloon and then reinflate it to ensure that it is patent. C. encourage the patient to try to have a bowel movement to relieve colon pressure. D. explain that this feeling is normal and that he should not try to urinate around the catheter.

C

Health care-associated UTI accounts for 31% of all HCI infections

Causes - Often: E. coli - Seldom: Pseudomonas Catheter-acquired UTIs - Bacteria biofilms develop on inner surface of catheter

BPH Complications

Complications are relatively rare R/t urinary obstruction Acute urinary retention: insert a foley to drain the bladder temporarily. Possible surgical intervention UTI and sepsis - Incomplete bladder emptying with residual urine provides medium for bacterial growth Calculi may develop in bladder because of alkalinization of residual urine Renal failure: Caused by hydronephrosis (distention of pelvis and calyces of kidney by urine) Pyelonephritis Bladder damage Must keep urine flowing to prevent complications!!!

Endourologic Procedures

Cystoscopy - remove small stone Cystolitholapaxy - large stone broken up with an instrument called a lithotrite (stone crusher). Bladder then irrigated Flexiable ureteroscopes - Via cysto remove stone from renal pelvis and upper urinary tract Percutaneous nephrolithotomy - nephroscope inserted through a sinus tract from the skin into the kidney pelvis

A 66-year-old male patient is experiencing ED. He and his wife have used tadalafil (Cialis), but because he had priapism, they decided to change treatment to an intraurethral device. How should the nurse explain how this device works? a. The device relaxes smooth muscle in the penis b. Blood is drawn into corporeal bodies and held with a ring c. The device is implanted into corporeal bodies to firm the penis d. The device directly applies drugs that increase blood flow in the penis

D

A patient asks the nurse what the difference is between BPH and prostate cancer. The best response by the nurse include what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland b. BPH is a precursor to prostate cancer but does not yet show any malignant changes c. BPH is an enlargement of the gland caused by an increase in the size of existing cells d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells

D

Gender Differences

Male: - Usually d/t benign or malignant prostate enlargement - Overflow d/t urinary retention Female - Usually stress and urge incontinence

A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis (IC)? a. Residual urine greater than 200 mL b. A large atonic bladder on urodynamic testing c. A voiding pattern that indicates psychogenic urinary retention d. Pain with bladder filling that is transiently relieved by urination

D

Before undergoing a TURP, what should the patient be taught? a. This surgery requires an external incision b. This procedure is done under local anesthesia c. Recurrent urinary tract infections are likely to occur d. An indwelling catheter will be used to maintain urinary output until healing is complete

D

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. Milk and milk products b. Dried beans and dried fruits c. Liver, kidney, and sweetbreads d. Spinach, cabbage, and tomatoes

D

The couple has not been able to become pregnant. The wife has not been diagnosed with any infertility problems. Which treatment will the nurse expect to teach the couple about if the problem is the most common testicular problem causing male infertility? a. Antibiotics b. Semen analysis c. Avoidance of scrotal heat d. Surgery to correct the problem

D

The nurse identifies that the patient with the greatest risk for a urinary tract infection is a. A 37-year-old man with renal colic associated with kidney stones. b. A 26-year-old pregnant woman who has a history of urinary tract infections. c. A 69-year-old man who has urinary retention caused by benign prostatic hyperplasia. d. A 72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence

D

The nurse recommends genetic counseling for the children of a patient with a. Nephrotic syndrome b. Chronic pyelonephritis c. Malignant nephrosclerosis d. Adult onset polycystic kidney disease

D

To decrease the patient's discomfort related to discussing his reproductive organs, the nurse should a. Relate his sexual concerns to his sexual partner b. Arrange to have male nurses care for the patient c. Give him written material and ask if he has questions d. Maintain a non-judgemental attitude toward his social practices

D

What is the most common screening intervention for detecting BPH in men over age 50 years? a. PSA level b. Urinalysis c. Cystoscopy d. Digital rectal examination

D

When caring for the patient with IC, what can the nurse teach the patient to do? a. Avoid foods that make the urine more alkaline b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation

D

When providing discharge teaching for a client with uric acid calculi, the nurse should include an instruction to avoid which type of food? a. Cottage cheese b. Beets c. Spinach d. Organ meats

D

Which instruction is given to clients with chronic pyelonephritis? a. Stay on bed rest up to 2 weeks b. Use analgesia on a regular basis for up to 6 months c. Have a urine culture every 2 weeks for up to 6 months d. Antibiotic treatment may be needed for several weeks or months

D

Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

D

Urinary Incontinence - Causes (DRIP)

D - delirium, depression, dehydration R - Restricted mobility, rectal impaction I - Infection, inflammation, impaction P - Polyuria, polypharmacy

A client had transurethral prostatectomy for benign prostatic hypertrophy and is currently being treated with continuous bladder irrigation. He's complaining of an increase in severity of bladder spasms. Which intervention should be done first? a. Administer oral analgestic b. Stop the irrigation and call the physician c. Administer a belladonna and opium suppository as ordered by the physician d. Check for the presence of clots, and make sure the catheter is draining properly

D?

Acute Pyelonephritis - Health Promotion

Early tx for cystitis to prevent ascending infections - Pts with structural abnormalities are at high risk - Stress the need for regular medical care - Continue drugs as prescribed - Follow up urine culture to ensure proper management - Identify risk for recurrence or relapse - Drink 8 glasses of fluid every day - Rest - Possible low dose antibiotics

UTI - Ambulatory and Home Care

Emphasize compliance with drug regimen - Take as ordered - Maintain adequate fluids (at least 2 L/day) - Regular voiding (every 3-4 hrs) - Void after intercourse - Temporarily d/c use of diaphragm - Instruct on follow-up care - Recurrent symptoms typically occur 1-2 weeks after therapy

α-Adrenergic receptor blockers

End in "osin" - Ex: Tamsulosin (Flomax), doxazosin (Cardura), terazosin (Hytrin), prazosin (Minipress), silodosin (Rapaflo), alfuzosin (Uraxatral) - Promotes smooth muscle relaxation in prostate; facilitates urinary flow - Improvement in 2-3 weeks - SE: Orthostatic hypotension (teach to avoid sudden movements) and dizziness, retrograde ejaculation, nasal congestion - Relieve symptoms but do not treat hyperplasia

Containment Device

External collection device, absorbent products

UTI - predisposing factors

Factors increasing urinary stasis - Ex: BPH, tumor, neurogenic bladder Foreign bodies - Ex: catheters, calculi, instrumentation Anatomic factors - Ex: obesity, congenital defects, fistula Compromising immune response factors - Ex: age, HIV, diabetes Functional disorders - Ex: constipation Other factors - Ex: pregnancy, multiple sex partners (women)

Minimally invasive therapies are alternatives to watchful waiting and invasive procedures

Generally do not require hospitalization - Photoselective Vaporization of the Prostate (PVP) - Laser Enucleation of the Prostate - Prostatic Urethral Lift (PUL) -Transurethral Microwave Thermotherapy (TUMT) - Transurethral Needle Ablation (TUNA) - Transurethral Electrovaporization of Prostate (TUVP)

BPH Interprofessional Care

Goals -Restore bladder drainage -Relieve symptoms -Prevent/treat complications Active surveillance - for no symptoms or mild symptom (wait-and-see) Dietary changes - avoiding caffeine, artificial sweeteners, limiting spicy and acidic foods Avoiding decongestants and anticholinergics Timed voiding schedule Intermittent catheterization can reduce symptoms and bypass obstruction Long-term catheter use contraindicated because of risk for infection Choice of tx depends on size and location of prostatic enlargement as well as age and surgical risk

Bladder Emptying

Hesitancy - Difficulty starting the urine stream Intermittency - Interruption of urinary stream while voiding Postvoid dribbling - Urine loss after completion of voiding Urinary retention - Inability to empty urine from bladder Dysuria -Difficulty voiding Pain on urination

Etiology and Pathophysiology - UTI

If above urethra, normally sterile Defense mechanisms exist to maintain sterility/prevent UTIs - Complete emptying of bladder - Ureterovesical junction competence - Peristaltic activity Organisms introduced via the ascending route from urethra and originate in the perineum Less common routes - Bloodstream - Lymphatic system Gram-negative bacilli normally found in GI tract: common cause Urologic instrumentation allows bacteria to enter urethra and bladder Sexual intercourse promotes "milking" of bacteria from perineum and vagina - May cause minor urethral trauma Kidney infection occurring from hematogenous transmission (rare) always preceded by injury to urinary tract - Obstruction of ureter - Damage from stones - Renal scars

Acute Pyelonephritis - Diagnostic Studies

If bacteremia is a possibility, close observation and vital sign monitoring are essential Prompt recognition and tx of septic shock may prevent irreversible damage or death

Lithotripsy

Laser lithotripsy •break up ureteral and large bladder stones. •Ureteroscopy is used to get close to the stone. •A small fiber is inserted up the endoscope so that the tip (which emits the laser energy) can come in contact with the stone. •A holmium laser in direct contact with the stone is commonly used to break up the stone. •Hematuria common after lithotripsy •Stent is typically removed 2 weeks **after lithotripsy, you have to watch for obstruction**

Functional Incontinence

Loss of urine resulting from cognitive, functional, or environmental factors Causes: - Elderly often have problems that affect balance and mobility

Urinary Tract Calculi - Interprofessional Care

Management of the acute attack - Tx Pain: opioids - Infection - Obstruction (Tamsulosin [Flomax], Terazosin [Hytrin]) − Hydration Evaluation of cause of the stone formation and prevention of further development of stones. Prevention of further stone development •Pt and family hx •Geographic residence •Nutritional assessment •Activity patterns •Immobilization or dehydration •Surgery of GI or GU tract Patients with active stone formation •Teaching −Adequate hydration −Dietary sodium restrictions −Dietary changes −Drugs to minimize stone formation Struvite stones •Antibiotics •Acetohydroxamic acid •Surgical removal Cystine •Increase hydration •Captopril or tiopronin to prevent cystine crystallization •Potassium citrate to keep urine alkaline •Many stones pass spontaneously •Stones >4 mm are unlikely to pass through the ureter and pt may require ureteral stent

Risk Factors - Nephrolithiasis

Metabolic •Adnormalities that result in increased urine levels of calcium, oxaluric acid, uric acid, or citric acid Climate •Warm climates cause increase fluid loss and increased solute concentration in urine Genetic Factors •Family hx of stone formation Diet •Large intake of dietary proteins that increases uric acid excretion •Excessive amounts of tea or fruit juices that elevate urinary oxalate level •Large intake of calcium and oxalate •Low fluid intake that increases urinary concentration Lifestyle •Sedentary occupation, immobility

Acute Pyelonephritis - Clinical Manifestations

Mild fatigue to sudden chills, fever, vomiting, malaise, flank pain and symptoms of cystitis Costovertebral tenderness UA shows pyuria, bacteriuria, and varying degrees of hematuria -WBC casts may be found in the urine Leukocytosis and a shift to the left with an increase in immature neutrophils (bands)

Acute Pyelonephritis - Interprofessional Care

Mild symptoms tx as an outpatient with 14-21 days of antibiotics -May be given parenteral antibiotics initially -Symptoms should improve in 48-72 hours Severe symptoms may require hospitalization Relapse may be tx with 6 weeks antibiotics

Interprofessional Care - Functional

Modifications of environment or care plan that facilitate regular, easy access to toilet and promote pt safety

Reflex Incontinence

No warning or stress precedes incontinence Moderate in volume and occurs day or night Causes: - Spinal cord lesion above S2 interferes with CNS inhibition - Disorders results in detrusor hyperreflexia and interferes with pathways coordinating detrusor contraction and sphincter relaxation

Etiology and Pathophysiology - BPH

Not completely understood Thought to result from endocrine changes from aging process Possible causes - Excessive accumulation of dihydroxytestosterone - Stimulation by estrogen - Local growth hormone action - Typically develops in inner part of prostate - Enlargement gradually compresses urethra (partial or complete obstruction) - Compression leads to clinical symptoms - No direct relationship between prostate size and obstruction - Location of enlargement determines obstructive symptoms

Bacterial persistence

Occurs when - Bacteria develop resistance to antibiotic agent - Foreign body in urinary system allows bacteria to survive

Unresolved bacteriuria

Occurs when - Bacteria resistant to antibiotic - Drug d/c before bacteriuria is completely eradicated - Antibiotic agent fails to achieve adequate concentrations in bloodstream or urine to kill bacteria Most common antibiotics are the sulfur drugs

UTI - Urinary Analgesics

Phenzopyridine (Pyridium) - Do NOT take this before getting diagnosed Used in combination with antibiotics Provides soothing effect on urinary tract mucosa Stains urine reddish orange - Can be mistaken for blood and may stain underclothing OTC

Urge Incontinence

Preceded by urinary urgency Overactive bladder; noctural frequency; leakage is periodic usually large Causes: -Uncontrolled contraction or overactivity of destrusor muscle -CNS disorders -Bladder disorders -Interference with spinal inhibitory pathways -Bladder outlet obstruction

Overflow Incontinence

Pressure of urine in overfull bladder overcomes sphincter Leakage of small amounts throughout the day and night Bladder remains distended Causes: - Neurogenic bladder (Flaccid type) - After anesthesia or surgery - Disorders caused by bladder or urethral outlet obstruction or by underactive detrusor muscle (DM or herniated disk)

UTI - drug therapy

Prophylactic or suppressive antibiotics sometimes administered to pts with repeated UTIs Suppressive therapy often effective on short-term basis - Limited because of antibiotic resistance ultimately leading to breakthrough infections

UTI - Health Promotion

Recognize individuals at risk - Debilitated - Older adults - Underlying diseases (HIV, diabetes) - Taking immunosuppressive drug or corticosteroids Prevention of CAUTI - Unnecessary catheterization - Early removal of indwelling catheter - Wear gloves when caring for the catheter - Emptying bladder regularly and completely - Evacuating bowel regularly - Wiping perineal area front to back - Drinking adequate fluids (15 ml/lb) - 20% fluid comes from food - Cranberry juice or cranberry essence may decrease risk (enzyme inhibits the pathogen) - Avoid unnecessary catheterization and early removal of indwelling catheters - Aseptic technique must be followed during instrumentation procedures - Routine and thorough perineal care for all hospitalized pts - Avoid incontinent episodes by answering call light and offering bedpan at frequent intervals

Nursing Management - Urinary Incontinence

Recognize the physical and emotional problems Two step - Containment device - Plan of management designed to reduce or resolve the factors leading to UI Consumption of adequate volume of fluids and reduction or elimination of bladder irritants (caffeine and alcohol) - Regular voiding q2-3h - Quit smoking-makes stress incontinence worse - Prevent constipation - Behavior tx, bladder retraining, and pelvic floor exercises - Protect skin - Use appropriate incontinence products - Establish a toileting program and assist the patient with it.

Urinary Incontinence - Muscarinic Receptor Antagonist and Anticholinergics

Reduce overactive bladder contractions in urge urinary incontinence and overactive bladder Ex: oxybutynin (Ditropan), tolterodine (Detrol), flavoxate (Urispas), solifenacin (VESIcare) SE - dry mouth, dry eyes, constipation, blurred vision, and somnolence Drug alert Detrol - severe anticholinergic effects (severe dry mouth, dry eyes, urinary retention), GI cramping, diaphrosis, blurred vision, and urinary urgency.

BPH Risk Factors

Risk factor -Aging Factors that may increase risk: - Family history - Obesity(Increased waist circumference) - Diet - High fat - Erectile dysfunction - Smoking - Alcohol - Physical activity level - Diabetes

Herbal therapy - BPH

Saw palmetto - May alleviate nocturia, improve urinary flow, reduce residual bladder volume - SE: Mainly GI, may increase BP, increase risk of bleeding - Long-term effectiveness and ability to prevent complications unknown - Studies show effects similar to placebo

UTI - Antibiotics

Selected on empiric therapy or results of sensitivity testing Uncomplicated cystitis - Short-term course (1-3 days) Complicated UTIs - Requires long-term tx (7-days) Trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrium & Septra) used to tx uncomplicated or initial - Inexpensive - Taken BID - E. coli resistance to TMP-SMX ↑ - Trimethoprim alone in pts with sulfa allergies Nitrofurantoin (Macrodantin) -Given 3-4x/day -Long acting given bid -Long-term use (Pulmonary fibrosis, Neuropathies) -Avoid sunlight -Avoid if creatinine clearance is <30mL/min Fosfomycin (Monurol) Ampicillin, amoxicillin, cephalosporins -Treat uncomplicated UTI Fluoroquinolones -Treat complicated UTIs -Ex: Ciprofloxacin (Cipro), levofloxin (Levaquin)

Urinary Tract Calculi - Surgical Therapy

Small group need open surgery Nephrolithotomy •Incision into the kidney Pyelolithotomy •Incision into the renal pelvis Cystotomy - indicated for bladder calculi

Surgical Therapy - Urinary Incontinence

Stress incontinence - Reposition the urethra and/or create a backboard of support - Sling or periurethral injectables; Retropubic colposuspension and pubovaginal sling placement Bulking agents can be injected underneath the mucosa of the urethra to correct stress incontinence in men and women Artificial sphincter surgery

Stress Incontinence

Sudden increase in intraabdominal pressure causes involuntary passage Occurs during coughing, laughing, sneezing, and activity Causes: -Multiple pregnancies -Female urethra atrophy -Prostate surgery

Urinary Tract Calculi - Clinical manifestations

Sudden severe pain d/t obstruction Common sites of obstruction •Ureteropelvic junction (UPJ) − Dull pain in costovertebral flank −Renal colic • Ureterovesicular junction (UVJ) • Abdominal or flank pain (varied may be very intense and by location of the stone) • Hematuria, Renal colic, N/V, Cool, moist skin, Fever, Chills, Men may have testicular pain, Woman may have labial pain

Irritative Symptoms

Symptoms associated with inflammation or infection - Urinary frequency and urgency - Dysuria - Bladder pain - Nocturia - Incontinence

Obstructive Symptoms

Symptoms d/t urinary retention - Decrease in caliber of force of urinary stream - Difficulty in initiating urination - Intermittency - Dribbling at end of voiding

BPH Clinical Manifestations

Symptoms usually gradual in onset Early symptoms usually minimal because bladder can compensate Worsen as obstruction increases Symptoms categorized into 2 groups - Obstructive symptoms - Irritative symptoms

Erectogenic Drugs

Tadalifil (Cialis) effectively reduces symptoms of both BPH and ED.

Electrohydraulic lithotripsy

The probe is positioned directly on a stone, but it breaks the stone into small fragments that are removed by forceps or by suction. A continuous saline irrigation flushes out the stone particles, and all of the outflow drainage is strained so that the particles can be analyzed. The calculi can also be removed by basket extraction.

Complicated Infection

Those with coexisting presence of - Obstruction - Stones - Catheters - Existing diabetes/neurologic disease - Pregnancy-induced changes - Recurrent infection

Bladder Storage

Urinary frequency - Abnormally frequent (> every 2 hours) Urgency - Sudden strong desire to void immediately Incontinence - Loss or leakage or urine Nocturia - Waking up ≥2 times at night to void Nocturnal enuresis - Complaint of loss of urine during sleep

UTI - Clinical Manifestations

Urine may contain visible blood or sediment, giving cloudy appearance Flank pain, chills, and fever indicate upper UTI -Pyelonephritis Pts with significant bacteriuria -May have no symptoms -Nonspecific symptoms such as fatigue or anorexia In older adults -Symptoms often absent -Experience nonlocalized abdominal discomfort rather than dysuria -May have cognitive impairment -Less likely to have a fever (Patients > 80 may even have a slight decrease in temp.) Multiple factors may produce UTI symptoms -Bladder tumors -Interstitial cystitis Symptoms r/t either bladder storage or bladder emptying

Acute Pyelonephritis - Etiology and Pathophysiology

Urosepsis -Systemic infection from urologic source -Prompt diagnosis/treatment critical - Can lead to septic shock and death - Septic shock: outcome of unresolved bacteremia involving gram-negative organism - Usually begins with colonization and infection of lower tract via ascending urethral route - Commonly starts in renal medulla and spreads to adjacent cortex - Recurring episodes lead to scarred, poorly functioning kidney and chronic pyelonephritis Frequent causes -Escherichia coli -Proteus -Klebsiella -Enterobacter

Lower Tract Infection

Usually no systemic manifestations Example - Cystitis-inflammation of bladder wall - Urethritis - inflammation of the urethra

Acute Pyelonephritis - Preexisting factors usually present

Vesicoureteral reflux - Backward movement of urine from lower to upper urinary tract Dysfunction of lower urinary tract - Obstruction from BPH - Stricture - Urinary stone

Incontinence after trauma or surgery

Vesicovaginal or urethrovaginal fistula may occur in women Alteration in continence control in men involves proximal urethral sphincter Causes: - Fistula may occur during pregnancy, delivery of a baby, after hysterectomy, and invasive cervical cancer - Postoperative complication after transurethral, perineal, or retropubic prostatectomy

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes (select all that apply)? a. Teaching the patient to use Kegel exercises b. Clamping and releasing a catheter to increase bladder tone c. Teaching the patient biofeedback mechanisms to train pelvic floor muscles d. Counseling the patient concerning choice of incontinence containment device e. Developing a fluid modification plan, focusing on decreasing intake before bedtime

a, c

What accurately describes prostate cancer detection and/or treatment (select all that apply)? a. Symptoms of lumbosacral pain in lower urinary tract symptoms may be present b. Orchiectomy as a treatment option for all patients with prosthetic cancer except those with stage four tumors c. Palpation of the prostate reveals hard and asymmetrical enlargement with areas of induration or nodules d. The preferred hormonal therapy for treatment of prostate cancer include estrogen and androgen receptor blockers e. Early detection of prostate cancer is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements f. An annual prostate examination is recommended starting at age 45 years for black men with a first degree relative with prostate cancer at an early age

a, c, f

Which factors would place a patient at a higher risk for prostate cancer (select all that apply)? a. Older than 65 years b. Asian or Native American c. Long-term use of an indwelling urethral catheter d. Father diagnosed and treated for early stage prostate cancer e. Previous history of undescended testicle and testicular cancer

a, d

Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor their response to therapy include a. Tumor necrosis factor (TNF) and C-reactive protein (CRP) b. Alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) c. PSA and PAP d. Carcinoembryonic antigen (CEA), anti-nuclear antibody (ANA), and human epidermal growth factor receptor to (HER-2)

b

Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents b. TUNA c. Photovaporization of the prostate (PVP) d. Transurethral incision of prostate (TUIP) e. TUMT

b, c, d, e

The nurse should explain to the patient who has erectile dysfunction that (Select all that apply) a. The most common cause is BPH b. ED may be due to medications or conditions such as diabetes c. Only men who are 65 years or older benefit from PDE5 inhibitors d. There are medications and devices that can be used to help with erections e. This condition is primarily due to anxiety and best treated with psychotherapy

b, d

Which drugs are used to treat overflow incontinence (select all apply)? a. Baclofen (Lioresal) b. Anticholinergic drugs c. Alpha adrenergic blockers d. 5alpha reductase inhibitors e. Bethanecol (Urecholine)

c, d, e,

Which characteristics are associated with urge incontinence (select all that apply)? a. Treated with Kegel exercises b. Found following prostatectomy c. Common in postmenopausal women d. Involuntary urination preceded by urgency e. Caused by over activity of the detrusor muscle f. Bladder contracts by reflex, overriding central inhibition

d, e, f

When working with patients with urologic problems, which nursing interventions could be delegated to the UAP (select all that apply)? a. Assess the need for catheterization b. Use bladder scanner to estimate residual urine c. Teach patient pelvic floor muscle exercises d. Insert indwelling catheter for uncomplicated patient e. Assist incontinent patient to commode at regular intervals f. Provide perineal care with soap and water around a urinary catheter

e, f

Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incision into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue

e, f

Percutaneous ultrasonic lithotripsy

• An ultrasonic probe is placed in the renal pelvis via a percutaneous nephroscope inserted through a small incision in the flank, and the probe is then positioned against the stone. • The pt is given general or spinal anesthetic • The probe produces ultrasonic waves, which break the stone into sandlike particles.

Urinary Tract Calculi - Nutritional Therapy

• Drink fluid adequate to avoid dehydration • 3000 ml/day - after urolithiasis • Water is the preferred fluid • Low sodium - High Na excretes high calcium in the urine • Increase fluids during hot weather and activity Purine stone • Decrease foods high in purine (sardine, herring, mussels, kidney, goose, venison, and sweetbreads Calcium stone • Decrease foods high in calcium (milk, cheese, ice cream, yogurt, sauces containing milk, all beans except green beans; fish with fine bones; dried fruits; nuts; Ovaltine; chocolate; cocoa Oxalate Stone • Avoid foods high in oxalate: dark roughage; spinach; rhubarb; asparagus; cabbage; tomatoes; beets; nuts; celery; parsley; chocolate; cocoa; instant coffee; ovaltine; tea; worcestershire sauce • Calcium oxalate stone has nothing to do with calcium • Huge amounts of tea is a risk factor • Will be asked what are things you would teach the patient to avoid getting a calcium oxalate stone

Pathophysiology - Nephrolithiasis

• Many theories have been proposed to explain the formation of stones in the urinary tract • No single theory can account for stone formation in all cases • Keeping urine dilute and free flowing reduces the risk of recurrent stone formation in many individuals • Urinary pH, solute, and inhibitors of the urine affect the formation of stones

Urinary Tract Calculi - Diagnostic Studies

• Noncontrast spiral CT (CT/KUB) • Ultrasonography • Intravenous pyelorography (IVP) • Retrieval and analysis of stones • Serum calcium, phosphorus, sodium, potassium, bicarbonate, uric acid, BUN, creatinine measurements • Careful history • 24 urine Urine pH •Struvite stones and renal tubular acidosis - tendency to alkaline or high pH •Uric acid stone - tendency to acidic or low pH Complete urinalysis to assess for •Hematuria, Crystalluria

Extracorporeal shock wave lithotripsy (ESWL)

• The pt receives anesthetic (spinal or general) • Fluoroscopy or ultrasonography is used to focus the lithotripter on the affected kidney, and a high-voltage spark generator produces high-energy acoustic shock waves that shatter the stone without damaging the surrounding tissues. • The stone is broken into fine sand (steinstrasse) and excreted in the urine.

Nephrolithiasis

•1-2 million people affected •Majority of the pt between 20-55 •High incidence with a family hx •More frequent in whites •More common in men except struvite stone •Stones recur up to 50% of pts •Seen more in the Southwest and Southeast and then followed by midwest

Urinary Tract Calculi - Therapeutic Regime

•Hydration •Dietary sodium restriction •Drugs to minimize urinary stone formation •Tx of struvite stones requires control of infection (antibiotics and acetohydroxamic acid) •If the infection can't be controlled the stone needs to be surgically removed

Indications for Endourologic, Lithotripsy, or Open Surgical Stone Removal

•Stones too large for spontaneous passage •Stones associated with bacteriuria or symptomatic infection •Stones causing impaired renal function •Stones causing persistent pain, nausea, or ileus •Inability to be treated medically •Patient with 1 kidney