GU Exam

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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


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