Urology Flashcards

Urethra Anatomy

• Male: 15 to 20 cm in length.
• Female: Approximately 4 cm in length.

Urinary Conditions: Urinary Tract Infection (UTI)

• Classifications
  • Acute Pyelonephritis: Affects the upper urinary tract structures. Clinical manifestations include flank pain and a fever greater than 38°C. A nurse would expect a client admitted for pyelonephritis to report a history of UTIs, such as 2 UTIs in the past 10 months.
  • Pathophysiology: Usually caused by enteric coliform (E. coli) bacteria traveling up the urethra to the bladder, more frequently in females due to a shorter urethra.
• Impact on health
  • Psychosocial: Disruption of life activities, such as being unable to attend family activities. For example, a client might state they cannot attend their grandkids' school activities when they have a UTI.
  • Common symptoms: Increased urinary frequency and urgency, dysuria (pain with urination), foul-smelling urine, hematuria, and suprapubic pain.

Urinary Condition: Retention

• Pathophysiology: Inability to void or empty the bladder, which can be acute or chronic.
• Obstructive Causes: Pelvic organ prolapse and constipation.
• Other Causes: Complications from anesthesia.
• Risk factor/incidence: Complications from general anesthesia can cause acute urinary retention, which is usually temporary until the effects of anesthesia wear off. For example, a client who is 4 hours post-back surgery.
• Comorbidities: Neurological disorders such as Parkinson's Disease and Multiple Sclerosis.
• Symptoms: Dribbling of urine (not a full stream), complaints of bladder fullness after voiding with bladder distention.

Conditions of Kidney Function: Pyelonephritis

• Etiology: Usually caused by gram-negative bacteria such as E. coli found in fecal matter, which spreads to the kidneys.
• Nursing Role: Prevention and education of disease prevention.
  • Maintain adequate hydration to flush bacteria from the urethra and bladder.
  • Female: Wipe the perineal area from front to back after voiding to avoid contaminating the urethra with fecal matter, and avoid feminine sprays or douches.
  • Complete all antibiotics as prescribed!

Conditions of Kidney Function: Polycystic Kidney Disease (PKD)

• Etiology: A rare genetic disorder resulting from the child receiving a defective gene from one of their birth parents and cannot be prevented. It leads to the development of fluid-filled cysts in the kidneys, causing damage and impaired kidney function.
• Comorbidities: Cerebral aneurysms, aneurysm ruptures. A client who has PKD may present to the ED with reports of a severe headache, which would be a complication of a cerebral aneurysm.
• Clinical Presentation
  • Cysts may also obstruct the flow of urine through the kidneys, promoting urine stasis as urine stays in the urinary tract longer than it should.
  • The kidneys continue to enlarge due to the cyst growing, which increases the girth of the client's abdomen.
• Hypertension: Blood pressure control is important in clients who have PKD to slow the progression to End-Stage Renal Disease (ESRD). This would be an important client education point.

Conditions of Kidney Function: Renal Calculi

• Pathophysiology: Also called kidney stones, nephrolithiasis, or urolithiasis, are created by accumulations of minerals and salts, and can lodge in the kidney or any portion of the urinary tract and can cause pain and blood in the urine.
  • The renal papilla is a conical-shaped structure located at the apex of each renal pyramid in the kidney. It is the point where the collecting ducts, which carry urine from the nephrons to the calyces, empty into the renal pelvis.
  • Most renal calculi begin as plaques in the interstitial tissue of the renal papilla.
• Etiology
  • Risk factors: Lack of adequate hydration.
  • Epidemiology: In areas of high temperatures.
• Clinical Presentation: Acute onset of severe flank pain, nausea, vomiting, and fever. Depending on the severity, the client may be admitted to the hospital.

Conditions of Kidney Function: Acute Renal Failure

• Acute Tubular Necrosis: Most common type of intra-renal causation. The cells of the renal tubules become damaged and proceed to cell death, and the glomerular filtration rate (GFR) begins to decrease due to injury to renal tubular cells.

Conditions of Kidney Function: Chronic Kidney Disease (CKD)

• Impact on health
  • Physiological/Psychosocial: Anxiety, depression, and mental distress alter the quality of life of clients who have CKD, especially once it progresses into ESRD.
  • Hemodialysis treatment results in food (foods high in potassium, sodium & Phosphorus) and fluid restrictions, and the hours spent receiving treatment at the dialysis center related to treatment add to the decline of quality of life.
• Clinical Presentation
• Lab and Diagnostic Testing
  • Urine Albumin - 24-hour urine collection
    • Albumin passes into the urine with kidney damage. 30 \frac{mg}{g} or less is normal, greater than 30 \frac{mg}{g} indicates possible kidney disease.
    • For a client who has progressing chronic kidney disease (CKD) this would be an expected finding.
  • Glomerular Filtration Rate (GFR)
  • Creatinine and urine albumin-to-creatinine ratio