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69 Cards in this Set
- Front
- Back
What are common lower UTI's?
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bacterial cystitis, bacterial prostatitis, bacterial urethritis
-can be bacterial or nonbacterial |
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What is the difference between complicated and uncomplicated?
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complicated-occur from urologic abnormalities or recent catheterization
uncomplicated-community acquired |
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What are the risk factor for UTI?
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failure to empty bladder completely, obstruction of urinary flow, immunosuppression, instrumentation into UT, imflammatino of urethral mucosa, other contributing factors (DM, preg, neuro, gout, altered LOC)
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What is urthrovesical reflux?
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reflux of urine from urethra into bladder
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What is ureterovesical reflux?
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backward flow of urine from bladder into one or bother ureters
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Define bacteriuria
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>100000 colonies/mL of clean catch urine
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What are the routes of in UTI?
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transurethral, bloodstream, fistula in intestine, sexual intercourse, massage of urethra
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What are the s/s of UTI?
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dysuria, burning, frequency, nocturia, incontinence, suprapubic or pelvic pain, hematuria, back pain
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What are elderly patient s/s of UTI?
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altered sensorium, lethargy, anorexia, new incontinence, hyperventilation, low-grade fever
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What factors contribute to UTI's in older adults?
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chronic illness, use of antimicrobial agents, infected pressure ulcers, immunocompromised, cognitive impairment, immobility, bedpan use
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What else could hematuria indicate?
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urinary cancer
early stream blood- urethral late stream blood- bladder lesion |
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What studies will be done to diagnosis?
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urine, std, WBC, CT, ultrasonography,
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What are complications of UTI's?
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renal failure, sepsis, strictures, obstructions
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How are UTI's treated?
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antibiodic, liberal fluid intake, frequent voiding, hygenic measures
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What are some contributing factors to UTI?
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disfx of glycosaminoglycan, urethrovesical reflux, ureterovesical relux, uropathogenic bacteria, shortened urethra
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What are common upper UTI's?
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acute or chronic pyelonephritis, interstitual nephritis, renal abscesses
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What causes upper UTI's?
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upward spread of bacterial from the bladder or bloodstream to the kidney
bladder tumors, strictures, BPH, stones, systemic infection |
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S/S of acute pyelonephritis?
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(imflammation of renal pelvis)
ill with chills, fever, leukocytosis, bacteriuria, pyuria, low back pain, N/V, headache, malaise, dysuria, frequency |
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Diagnosis and treatment of pyelonephritis?
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ultrasound, CT to see obstruction, WBC, urine culture and sensitivity tests
antibiodics, hydration, voiding |
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What are the s/s of chronic pyelonephritis?
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fatigue, headache, poor appetite, polyuria, excressive thrist, weight loss
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What are the complications of chronic pyelonephritis?
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ESRD, from scarring, hypertension, kidney stones
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What diagnosis tests are used for chronic pyelonephritis?
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IV urogram, creatinine clearance, BUN, creatinine levels, bacteria in urine
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What could be causes of voiding disyfuction?
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incomplete bladder emptying from poor detrusor pressure from recurrent bladder infections
incomplete bladder emptying due to bladder outlet obstruction |
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Define stress incontinence?
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intact urethra, invol loss of urine by sneezing, coughing, changing position
(causes-dec ligament support of urethra, absent estrogen levels, readical prostatectomy) |
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Define urge incontinence?
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strong urge to void that cannot be suppressed
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Define reflex incontinence?
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absence of normal sensation usually assoc with voiding (SCI)
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Define functional incontinence?
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cognitive impairment
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Define Iatrogenic incontinence?
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invol loss of urine due to medical factors, usually meds
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What are the risk factors for urinary incontinence?
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preg, menopause, GU surgery, pelvic muscle weakness, imcomplete urethra due to trauma, immobility, high impact exercise, DM, stroke, age-related changes in UT, morbid obesity, cognitive disturbances, meds, toilet unavailable
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What are causes of transient incontinence?
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delirium, UTI, vaginitis, urethritis, meds, psychological factors, excessive urine production, stool impaction
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What are treatments for incontinence?
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pelvic floor muscle exercises, voiding diary, anticholingergic agents, antispasmodics, fluid management, vaginal cone
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Define urinary retention?
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inability to empty the bladder completely
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What is a normal residual urine volume?
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<100 mL
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What causes urinary retention?
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DM, BPH, urethral pathology, preg, neuro disorder, anticholinergic, antispasmodic, tricyclic antidep, alph-adrenegric agents, beta adrenergic lcokers, estrogens
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What are complications of urinary retention?
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chronic infection, renal calculi, pyelonephritis, sepsis, hydronephrosis, urine leakage causing skin breakdown
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What nursing management strategies can be used for urinary retention?
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warm/cold compresses, get up to commode, open faucet, privacy, catherization, bladder retraining
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What is neurogenic bladder?
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dysfunction that results from a lesion of the NS
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What are the 2 types of neurogenic bladder?
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spastic
flaccid |
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What are urolithiasis and nephrolithiasis?
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renal calculi
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When do renal calculi occur?
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with an increase in calcium oxalate, calcium phosphate, uric acid
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What increases the risk for renal calculi?
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periods of immobility, urinary stasis, infection, IBS, ileostomy, bowel resection, antacids, acetazolamide, Vit D, laxative, high doses of asprin
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What is hypercalcemia and hypercalciuria?
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hypercalcemia- high serum calcium levels
hypercalciuria- high urine calcium |
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What causes hypercalcemia and hypercalciuria?
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hyperparathyroidism (Ca+ gets pulled out of the bones), renal tubular acidosis, cancer, granulomatous disease (inc in Vit D production), excess Vit D intake, excessive intake of milk and alkali, myeloproliferative disease
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What causes uric acid stones?
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gout or myeloproliferative disorders
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What causes struvite stones?
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urease-splitting bacteria, neurogenic bladder, foreign bodies, recurrent UTI
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What causes cystine stones?
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rare inherited defect in renal absorption of cystine
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What are s/s of renal calculi?
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infection, deep ache in costovert region, hematuria, pyuria, N/V/D, renal colicky pain radiating down thigh into genitalia, urinary retention
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What mediates the colic pain?
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prostagladin E, increases ureteral contractility and renal blood flow and that leads to increased intraureteral pressure and pain
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Diagnostic tools for renal calculi?
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x-rays of KUB (kidney, ureters, bladder), ultrasound, IV urography, retrograde pyelography, blood chem, 24 hr urine collection (calcium, uric acid, creatinine, sodium, pH, vol), family hx, diet, meds
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What is the medical management of renal calculi?
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1. relieve the pain, NSAIDS work well- also inhibit prostagladin E
2. inc hydrostatic pressure with inc fluids 3. low protein and sodium diet |
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What interventional procedures might be done for renal calculi?
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ureteroscopy (lasar), extracorporeal shock wave lithotripsy (electrical charge), endourologic stone removal (forceps removal), nephrolithotomy (stone removal), cystotomy, pyelolithotomy
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What type of diet is specified for the following types of stones
calcium, uric acid, cystine, oxalate? |
calcium-low protein and sodium
uric acid- low purine (organ meats, shellfish, mushrooms, asparagus cystine- low protein oxalate- low oxalate (spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran) |
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What are potential complications of renal calculi?
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infection, urosepsis (UTI), obstruction, edema
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What are nursing management techniques for renal calculi?
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inc fluid intake, ambulation, all urine should be strained, VS, temp, hematuria is expected for a few days following treatment, treat UTI asap, s/s of complications
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What are common causes of GU trauma?
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gunshot wounds, blow to lower abdomen
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What is the medical and nursing management for GU trauma injuries?
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control hemorrhaging, infection and maintain urinary drainage, look for signs of oliguria, hemorrhagic shock, acute peritonitis, hypertension
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What are the risk factors for bladder cancer?
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smoking, environmental exposures, recurring UTIs, bladder stones, high urine pH, high chol intake, pelvic radiation therapy, cancers from prostrate, colon, rectum
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What are s/s of bladder cancer?
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painless hematuria, pelvic or back pain, UTI- frequency, urgency, dysuria
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What diagnosistic techniques are used for bladder cancer?
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CT, ultrasonography, bimanual exam, urography, cystoscopy, antigen, growth factor
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What are the treatments for bladder cancer?
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transurethral resection or fulguration (cauterization), BCG, radial cystectomy, chemo, radiation, photodynamic techniques
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What is a radical cystectomy?
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removal of bladder, prostate, seminal vesicles, lower urether, uterus, fallopian tubes, ovaries, anterior vagina, urethra, and may be pelvic lymph nodes
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What is a cutaneous urinary diversion?
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when urine is drained through an opening created in the abdominal wall and skin
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Describe an ileal conduit
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ureters are connected to a ileal segment that has one end brought to the abdominal wall, urine drains into ileostomy bag
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What are possible complications of ileal conduits?
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wound infection, leakage, ureteral obstruction, hyperchloremic acidosis, small bowel obstruction, ileus, gangrene, stenosis, pyelonephritis, renal calcuil, renal deterioration
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What are some nursing considerations for ileal conduit?
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drain bag when 1/3 full, inspect skin often, keep urine pH <6.5, avoid foods that cause urine to smell, take ascorbic acid by mouth to suppress urine odor
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What is a cutaneous ureterostomy?
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one ureter is brought to skin, usually caused by ureteral obstruction
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What is a continent ileal urinary reservoir?
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bladder is removed and replaced by using the ileum and cecum along with a cecostomy tube to bring to abdominal wall. Urine is then drained by regular catheterization into cecostomy tube
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What is a ureterosigmoidostomy?
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implantation of ureters into sigmoid colon. Voiding occurs from the rectum.
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What are complications of ureterosigmoidostomy?
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infection, electrolyte imbalance/acidosis (bowel reabsorption of electrolytes), diarrhea, gas can cause urinary incontinence, pyelonephritis
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