GU Exam
How many ports does a triple lumen catheter have
1. balloon inflation port 2. continuous outflow of urine/continuous outflow of irrigation port 3. continuous inflow of irrigation port
potential complications with a cytoscopy?
1. hemorrhage 2. infection 3. pain
you need at least ____mL of urine for a sample
15
patients who had a TURP are normally discharged 1-2 days post procedure but are at risk for hemorrhaging for up to
2 weeks
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
Assessing present voiding patterns
A client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are treating my infection?" What should the nurse tell the client?
Your health care provider will take a urine culture
hematuria and pyuria are common with kidney stones but not
a fever unless they have an infection. (an infection is abnormal with a kidney stone).
Erthyropoietin
a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.
shock wave lithotripsy
a method for removing stones from the urinary tract by breaking them into small bits that can be excreted in the urine
Prostate Cancer overview
Cancerous cells present, may spread PSA and alkaline phosphatase elevated Sides of prostate often affected Urinary symptoms
Which nursing action is most appropriate for a client who has urge incontinence?
Have the client urinate on a timed schedule
Overview of BPH
Cells are not cancerous and do not spread PSA elevated Central portion of prostate often affected Urinary symptoms Range of treatment to relieve symptoms
A client is admitted with a diagnosis of hypronephrosis. Which assessment finding requires immediate action or will assist the nurse in planning care?
Clients blood urea nitrogen is 32 mg/dL
Which instruction would a nurse include in the discharge teaching for a client who has an ileal conduit?
Mucous in the pouch is expected
A nurse is providing post op care for a client who underwent percutaneous lithotripsy. The nurse should instruct the client to
Notify the physician about cloudy or foul smelling urine
symptoms of urosepsis include which of the following
Oliguria Confusion Hypotension
At what age should digital exams be initiated?
Over the age of 40
Which lab is indicative of prostate cancer if elevated?
PSA (greater than 10)
signs and symptoms of hydronephrosis
frequency retention incontinence nausea/vomiting renal failure if both kidneys are blocked
overflow incontinence
frequent or constant dribbling of urine that is due to a bladder that never completely empties
PSA
greater than 10 increases risk of prostate cancer. Indicative of prostate cancer.
post obstructive diuresis
greater than 200mL an hour of urine
primary hormonal functions of the kidneys
help regulate blood pressure removing waste regulate fluid/electrolytes urine formation glomerular formation regulate acid-base balance control water balance
what are the most frequent complications of a surgical urinary diversion? Select all that apply
hemorrhage and shock
Risk factor for BPH surgery
hemorrhaging
BUN can also be elevated with a
high protein diet (you must drink a lot of fluids with a high protein diet)
how can a prostate diagnoses be confirmed?
histologic exam
calcium stones diet
increase fluid restrict sodium and protein
What does the LDH do?
increased risk of cancer in general
LDH
increases serum levels in cancer
greater than 100,000 count of bacteria is a sign of
infection
complications of hydronephrosis
infection renal failure bladder distention
Pyelonephritis
inflammation of the renal pelvis and the kidney
glomerulonephritis
inflammation of the tiny filters in your kidneys can be caused by infection, autoimmune disease, or vasculitis, hypertension, strep
A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client? A. Inability to empty the bladder. B. Loss of urine when coughing. C. Involuntary urination with minimal warning. D. Frequent dribbling of urine.
involuntary urination with minimal warning.
polycystic kidney disease (PKD)
kidney enlargement normally occuring in the 40-50s Abdominal/lumbar pain hematuria, hypertension, palpable renal masses, recurrent UTI's
all the blood in the body moves through the
kidneys
What does it mean if your body is in metabolic alkalosis?
kidneys need to excrete bicarbonate and quit producing as much.
dipstick urine test
looks for albumin, glucose, nitrites... indicative of UTI's
potassium supplements are often given with these type of diuretics
loop
which diuretic does lasix fall under
loop
which diuretic would be the first choice diuresis
loop
which diuretic can be given po and IV
loop diuretic
what classification of diuretic does this apply too? increased dose = increased urinary output
loop diuretics
what diuretic works on the loop of henle
loop diuretics
which diuretic causes arrhythmia and muscle cramps
loop diuretics
Renal Diets
low in sodium, phosphorous, and protein limit potassium and calcium intake limit fluid intake
cysteine stone diet
low protein diet avoid strawberries, spinach, chocolate, tea, rhubarb, peanuts, and wheat bread
uric acid stone diet
low purine diet avoid shellfish, mushrooms, asparagus, archovies
where else can prostate cancer spread?
lymph nodes and bones. spreads quickly!
Clinical manifestations for testicular cancer
mass or lump on the testicle painless enlargement of the testis heaviness in the scrotum back-ache abdominal pain weightloss
CT or MRI can show
masses, kidney stones, chronic renal infections, trauma, metastatic disease, soft tissue abnormalities
AFP
may indicate testicular cancer
iatrogenic incontinence
medical factor or medication
In chronic glomerulonephritis you would expect what?
metabolic acidosis, hyperkalemia, hyperphospotemia, and anemia
a recurrent UTI is defined by
more than two UTI's in 6 months OR more than three in 12 months
Upper UTI infection includes
nephritis (pyelonephritis and glomerulonephritis) and renal abscesses
chronic pyelonephritis symptoms
no symptoms of infection- more vague fatigue, headache, poor appetite, polyuria, excessive thirst, weightloss scarring occurs- can lead to end stage renal disease
IN prostate cancer, the digital rectal exam would show a
nodular, bumpy, firm, enlarged prostate
BPH (benign prostatic hyperplasia)
noncancerous enlargement of the prostate
ultra sound can show
obstruction, tumors, and cysts
serum creatinine is the most sensitive indicator
of renal function because renal impairment is virtually the only cause for the serum creatinine to be elevated
if the person's kidneys ARE NOT WORKING WELL then the urea will stay in
the client's body and BUN will be elevated
The nurse is instructing the UAP about the correct technique for obtaining a clean catch culture from a female client. Which statement indicates that the teaching was successful?
"I will ask the client
The nurse is instructing an UAP to collect a urine specimen from an indwelling catheter. Which statement indicates that the UAP understands the instructions?
"I'll get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container."
therapy for renal calculis
(8-10) 8oz glasses a day of water= 3000mL of water by mouth or IV unless it is contraindicated urine output to exceed 2L per day encourage ambulation send home with a strainer
Pre-procedure for a cytoscopy
- NPO - ENEMA - SEDATIVE - BREATHING EXERCISES - monitor for pre-procedure hypotension
Other reasons for elevated BUN
- Urinary tract obstruction - tissue breakdown - increased protein metabolism (burn victims) - heart failure - volume level changes
why would you straight cath someone?
- a urine specimen - urinary retention and you are emptying your patients bladder
changes with aging
- decrease in size (atrophy) - decrease in blood flow - decrease in urine concentration - decrease in hormone secretion GFR decreases 1% per year after age 30 (by 65, GFR is about 65mL per minute... half the rate of a young person)
Triple Lumen Foley Catheter
- glycine irrigation - rate adjusted to maintain pink drainage - tension on foley balloon to reduce hemorrhage - tension removed after 12-24 hrs
Post-procedure for a cytoscopy
- increase fluids - monitor I/O - it is OKAY if the urine is slightly discolored (just not bright red). - pain meds - assess for leg cramps/back pain/AB pain - sitz bag
how do you calculate urine output when irrigation is also flowing into the foley bag
- keep track of how much irrigation you are infusing - subtract irrigation from urine output= just the urine Example: you have 1500mL of urine + glycine over 4hrs. you infused 1000mL of glycine. 1. 1500-1000= 500mL 2. 500/4= 125mL of urine per hour
Elevated BUN can indicate
- kidney dysfunction - dehydration
straight catheter facts that will be on the exam
- one time use - no balloon - one single port for urine outflow - sterile procedure still!
benign prostatic hyperplasia
- rare under age 40 - increases after age 50 50% of men over 60 90% of men over 85
most common symptoms for BPH
- reduction in the urine stream. - hesitancy, frequency - nocturia it may cause as it progresses: straining to urinate
clinical manifestations for BPH
- reduction in urine stream - hesitancy - frequency - nocturia - straining to urinate - post-void dribbling - dysuria - urinary retention
Reasons for decreased BUN level
- severe hepatic damage - overhydration - malnutrition
24hr urine
- starts whenever the doctor wants it to - lay catheter bag in ice basin
Your patient just had a TURP and you notice their bladder is distended... what do you do?
- stop irrigation - call the doctor
long term complications of TURP
- urethral strictures - bladder net contractures - retrograde ejaculation (semen goes back up into the bladder) - urinary incontinence
serum creatinine will not increase until
50% of renal function is already lost ANY elevation is important
When you calculate urine output post TURP... would should the patient have AT MINIMUM
50mL per hr
normal serum ph level
7.35-7.45
A registered nurse and an unlicensed assistive personnel are caring for a group of clients. Which client's care will the nurse safely delegate to the UAP?
A client diagnosed with a renal calculi who is encouraged to ambulate four times daily
what labs would be elevated to show testicular cancer?
AFP and beta-HCG
Renal function tests
BUN and creatinine elevate the severity of kidney disease. assess status of kidney function
most common form of cerebral aneurysm with PKD
Berry aneurysm
Clinical manifestations of Testicular Cancer include all of the following except? A. Backache B. Painless enlargement of testis C. Rectal Discomfort D. Heaviness of Scrotum
C. rectal discomfort
most common kidney stone
Calcium oxalate (present in fruits, nuts, chocolate, and vegetables)
A middle aged male client comes to the clinic for evaluation of difficulty urinating and nocturia. His father died from prostate cancer. He asks the nurse what he can do to ensure early detection of this disease. What question will the nurse ask next?
Do you have a digital rectal examination and prostate specific antigen tests yearly?
80-90% of UTI's are caused by
E-coli
Glomeruli do what?
Each kidney contains hundreds of thousands of nephrons. Each nephron is composed of a glomerulus and a tubule. The glomerulus filters wastes and excess fluids, while the tubules modify the waste to form urine.
A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?
Ensure sufficient hydration
Treatment for BPH
Flomax- 0.4 mg once daily low fat diet
Testerone
Hormone is produced by both men and women. Below normal levels is Hypogonadism.
The nurse is collecting data on a client with a UTI. Which statements should the nurse expect the client to make?
I need to urinate frequently, it burns when I urinate, I need to urinate urgently
A client undergoes extracorporeal shock wave lithotripsy to break up and remove renal calculi. Which nursing measure is appropriate for the postop care of this client?
Instruct the client to anticipate hematuria for about 24 hours after the procedure
Estrogen
Men presenting with BPH or prostate cancer have high levels of estrogen and low testosterone levels.
57 year old man with complains of deep pain felt in the lower AB, back and pelvis. He reported to the doctor when he noticed pain the urine. Urine stream is decreased and has to urinate all the time.
Prostate cancer!
When caring for a client with hx of BPH. What should the nurse do?
Provide privacy and time for the client to void, monitor I&O, ask the client if he has urinary retention, test the urine for hematuria
antispasmotic drug for UTI
Pyridium
Diagnostic test for BPH
Renal Labs (BUN, Creatinine, electrolytes) WBC: 4.55-10 billion cells/L UA: color, pH, specific gravity, osmolality PSA: 0.2- 4.0 mg/ml
T/F: you only irrigate the catheter if there is a doctors order to do so
TRUE
T/F: you want to keep tension on the triple lumen catheter so it is being pulled towards the neck of the bladder to prevent hemorrhage. (keep tension for 12-24 hrs after surgery)
TRUE!!!!!!
Surgery for BPH
TURP (transurethral resection of the prostate)
a 28-year old male patient presents: heaviness in scrotum, backache, AB pain, weightloss, and the AFP and Beta-HCG are elevated. What are these signs of?
Testicular cancer!
After having a transurethral resection of the prostate, a client returns to the unit with a three way indwelling catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
The client reports bladder spasms and the urge to void
treatment for UTI's
Trimethoprim/sulfamethoxazole (Bactrim and Septra) BID for 3 days Nitrofurantoin Fluoroquinolones (resistant building)
What type of catheter is used after a TURP procedure?
Triple Lumen Catheter
T/F: having BPH doesn't mean a man is more or less likely to get prostate cancer.
True
second most common infection in the body is
UTI's
Risk factors for testicular cancer
Undescended testicle Abnormal testicular development Family history History of testicular cancer
What is the difference in prostate cancer and BPH?
Unlike prostate cancer, BPH is not cancerous nor is it fatal. During a physical exam, if you have BPH, your healthcare provider will notice your prostate feels larger than it should be. Your PSA tests will also come back elevated. Whereas in prostate cancer, the sides of the prostate are usually affected, in BPH the central portion of the prostate is usually affected. Also, unlike cancer, BPH cannot spread. - PSA goes UP with BOTH. - prostate cancer would have: nodular, bumpy, firm, enlarged prostate
leukocyte esterase test and nitrite testing
a positive leukocyte esterase test alone is insufficient to make the diagnosis If both nitrites and leukocyte esterase are positive, it is strongly suggestive of UTI.
the blue port on triple lumen catheter is for a
a urine sample
a client is to undergo a kidney biopsy, what education should be provided for this procedure? Select all that apply
a. remain NPO for 6-8 hrs pre procedure c. hold your breath when the needle is inserted pt would be in the prone position
clinical manifestations of BPH include: (select all that apply) a. urinary hesitancy b. blood in the semen c. nocturia d. urinary retention
a. urinary hesitancy c. nocturia d. urinary retention (not blood in the semen because that would be prostate cancer).
how can you diagnose prostate cancer?
abnormal DRE (digital rectal exam) serum PSA ultrasound guided biopsy
lungs and kidneys work together to maintain
acid-base balance in the blood
At below 7.35 pH the blood is considered to be:term-57
acidosis
our kidneys convert inactive vit D to
activated
Above 7.45 pH the blood is considered to be:
alkalosis
which diuretic would you check potassium levels for?
all of them
A client is admitted to the hospital with a dx of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6. Which outcome would be a priority for this client?
alleviation of pain
HCG
also many indicate testicular cancer
Glycine irrigation
anti-coagulant effect which is very important. the prostate is very vascular so a TURP is a bloody procedure and could result in blood clots. Pay close attention that the glycine does not run out. Hang next bag immediately after one runs out and order another one. DANGEROUS urine output color: dark red/bright red color (indicative of blood clots) NORMAL urine output color for this: pink or amber. if urine starts getting to red, increase irrigation. if urine starts getting to clear, back off irrigation. catheter must remain patent (continuous flow).
zinc and vitamin e
are recommended to reduce nocturnal urinary symptoms
skeletal muscle metabolism is filtered
at the glomerulus and is passed through the tubles and then excreted
patient teaching for antibiotics
avoid coffee, tea, alcohol - irritants drink 2-3 L of water a day
if a client is diagnosed with a renal tumor, where would they complain of pain?
back
What can cause UTI's?
bacteria, virus, fungus, parasites
smoking, coffee, alcohol is a
bladder irritant
why would you need a cytoscopy?
bladder signs/symptoms diagnose urinary/bladder diseases treats bladder diseases diagnose enlarged prostate
kidney's filter waste from the
blood
BUN
blood carries proteins to cells throughout the body after the cells use those proteins, the remaining waste product is returned to the blood as UREA
IN BPH, the digital rectal exam would show a
boggy prostate
uretoscope complications
bright red blood in the urine a fever higher than 100 degrees pain/burning during urination after 2 weeks
How might the nurse best prevent infection in a client with an indwelling urinary catheter a. irrigate the catheter with saline every 8hrs b. initiate antibiotics with all foley catheter insertions c. empty the drainage bag at least every 8hrs d. vigorously clean the meatus area daily
c. empty the drainage bag every 8 hrs
patients in renal failure will have a low
calcium level. treatment: cholecalciferol (treats vitamin d deficiency)
suprapubic catheter
catheter inserted into the bladder through a small abdominal incision above the pubic area
serum osmolality test looks for
chemical imbalances in the blood. can be indicative of: dehydration, over-hydration, abnormal serum level, diabetes insipidus, hypo or hyper natremia, uremia, diabetes ketoacidosis
signs and symptoms of glomerulonephritis
cola-colored urine (or tea colored), high blood pressure, headache, increased BUN level, fluid retention, edema in the face/hands/feet/AB (ascites), fatigue, flank or ab pain.
Uncomplicated UTI's
community acquired
Lower UTI infection includes
cystitis, prostatitis, urethritis
tubular changes that occur with age cause
decreased ability to concentrate urine which leads to nocturnal polyuria.
if the BUN is elevated and the creatinine is normal, the first thing you look for is
dehydration
when initiating 24hr urine, what should be done with the first void
discard it
Uric Acid stones form in people who
dontdrink enough fluids or lose too many fluids. they have gout eat high-protein diets
What do you do first... digital rectal exam or draw the PSA
draw the PSA! the DRE can alter your blood level and give you a false positive.
stress incontinence
due to sneezing, coughing, laughing or exercise. - most common in middle-aged women - most common after a vaginal birth or a radical prostatectomy
a urine sample for a urinalysis
educate on peeing in a cup: clean catch specimen - clean yourself first - start peeing then stop - put cup into place and pee into cup - take the cup out when you have enough and continue peeing
what would you monitor with post obstructive diuresis
electrolytes (due to so much fluid loss) replace with half normal saline (0.45%)
Urine culture is done when the WBC is
elevated
renal angiogrpahy
elevates renal blood flow and hypertension
PKD can lead to what?
end stage renal disease
goal for renal calculi
eradicate the stone and prevent nephron destruction
The kidney's help maintain acid-base balance by
excreting hydrogen ions into the urine (catabolism of proteins) OR reabsorbing the bicarbonate from the urine (renal tubules)
acute pyelonephritis symptoms
fever, chills, leukocytosis, bacteriuria, pyruia, low back pain, flank pain, nausea, n/v, headache, malaise, painful urination
glomerular formation is the
first part of urine formation
pain meds for kidney stones
opioids and spasmodic drugs
What to avoid with BPH
over the counter meds antihistamines coffee/tea
the liver produces
oxalate
a client has a suspected bladder cancer. What is the most common first symptom of a malignant tumor of the bladder?
painless hematuria
IVP preparation
patient needs a laxative the night before fluid intake (helps flush dye out afterwards) may complain of: facial flushing salty metallic taste in the mouth
Which characteristic is seen with a healthy stoma
pink color if it is purple/gray (not getting enough blood flow) if it is dry (dehydrated)
what diuretic stops potassium from excreting
potassium sparing
which diuretic includes spirolactone?
potassium sparing
which diuretic is weak when used alone
potassium sparing
which diuretic works on the collecting duct of the distal convoluted tubule
potassium sparing
which diuretic would potassium be contraindicated
potassium sparing
the first void in the morning is
preferable for a urine sample
Struvite stones
produce from infection
kidneys produce
prostaglandin-E and prostacycline= maintains renal blood flow
the most common cancer in men other than nonmelanoma skin cancer is
prostate
you will see rectal discomfort with
prostate cancer, not testicular
CA-125
protein marker elevated in ovarian cancer It is normally present in low levels in the blood of all adult men.
Urea is an end product of
protein metabolism
Patient teaching for pyridium
puritis, headache, GI upset, dizziness orange or reddish colored urine
Post renal-angiography you will need to check peripheral pulses
q15 min for an hour
Surgery for Prostate cancer
radical prostatectomy
what does activated vitamin d do?
regulates phosphate excretion promotes intestinal calcium absorption
how do you adjust the rate of irrigation flowing?
roller clamp
What is the best intervention for testicular cancer?
self-testicular exams
Which lab is the most sensitive indicator of renal function? this is important
serum creatinine
if your kidney's start shutting down what diagnostic test would be high?
serum creatinine
mixed-urinary incontinence
several types of incontience
serum creatinine is an end product of
skeletal muscle metabolism
Urosepsis
starts in the Urinary tract and spreads into the bloodstream can be fatal if not treated HR up, BP down, Respirations up, Temp goes up or down treatment: antibiotics, oxygen and IV fluids
A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:
stress incontinence
urge incontinence
sudden, involuntary intense urge to urinate followed by involuntary loss of the urine. have to urinate often uninhibited contraction muscle
hydronephrosis is
swelling of the kidney due to the buildup of urine... can cause infection!
when the kidneys do not get enough oxygen, a distress signal is sent to the brain and the brain
tells the kidneys to produce erthyropoietin and they send a message to the bone marrow to produce more red blood cells.
the most common type of cancer diagnosed in men ages 15-35 includes
testicular
AFP elevated means
testicular cancer
What does it mean if the body is in a metabolic acidosis?
the blood has too much acid in it... so it needs base. To add base, the kidneys produce/reabsorb bicarbonate.
urinalysis
the examination of urine to determine the presence of abnormal elements. looks at color, characteristics, urine pH (5.0-8.0), specific gravity of the urine (1.010-1.025), glucose, protein, nitrites, ketones you should have negative glucose, protein, nitrites, ketones
functional incontinence
the person has bladder control but cannot use the toilet in time the urinary tract is intact they just could not get up in time for example.
Percutaneous nephrolithotomy
the surgical removal of a nephrolith through a small incision in the back risk: infection/bleeding because it is invasive
which diuretic can lead to mild hypokalemia
thiazide
which diuretic includes hctz, zaroxolyn, diuril
thiazide
which diuretic works on the distal convoluted tubule
thiazide
which diuretic is given po only
thiazide and potassium sparing
cysteine stones from in relation
to hereditary disorders that cause the client to excrete too much of the amino acid cysteine urea.
leading risk factor for bladder cancer is
tobacco
procedure choice for men who have recurrent UTI's
transrectal ultrasonography- looks for abscesses in the prostate and the bladder.
TURP means
transurethral resection of the prostate TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including: Frequent, urgent need to urinate. Difficulty starting urination. Slow (prolonged) urination.
Epoetin alfa is used to
treat severe anemia in patients on kidney dialysis or for those not on dialysis. the stimulation of RBC production!!!
stones can be in all areas of the urinary tract...t/f
true
causes of pyelonephritis
upward spread of bacteria from the bladder or the spread of systemic sources reaching the kidneys via the blood stream
renal calculi
urinary concentrations of substances such as uric acid, calcium oxalate, and calcium phosphate increase. this is called super-saturation
Ileal Conduit (Urostomy)
urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall
clinical manifestations for prostate cancer
urinary obstruction
BPH can obstruct
urine flow
Complicated UTI's
urological abnormality or you get it from the hospital
you will NEVER clamp and only irrigate when ordered by the doctor
urostomy tubes
cystoscopy
visual examination of the urinary bladder
cytoscopy
visual examination of the urinary bladder and urethra
how do we absorb calcium?
vitamin d
older clients have a decreased renin and aldosterone levels and the ability to activate
vitamin d
Immediately before a renal angiography the patient needs to
void
When is the best time to a self-testicular exam?
when you are in the shower or immediately after scrotum is relaxed
Stress incontinence is the most common form of incontinence for
women
if the kidneys cannot convert vitamin D
your body will absorb less calcium