NUR 170/171 Unit 9: Genitourinary Disorders Exhaustive Study Guide
Fundamental Standards of Urinary Elimination and Abnormal Findings
In the study of genitourinary health, establishing the normal baseline for urinary elimination is essential for identifying pathological exceptions. Under normal physiological conditions, urine output should remain roughly equal to fluid intake. Quantitatively, this is measured as an average of approximately , with an absolute minimum acceptable threshold of or . Normal urine is characterized as being sterile, clear to pale yellow in color, and devoid of any significant odor.
Clinicians must identify specific abnormal output patterns that deviate from these standards. Polyuria refers to excessive urination, which can be remembered by the phrase "POLY = MANY pees." Oliguria is defined as a significantly decreased output falling below the threshold, associated with the memory trick "OLIGO = Oh-Little-Goes-Out." Anuria is the total absence of urine output, remembered by "A = ABSENT urine." Nocturia describes the necessity of nighttime urination, termed "NOCTURIA = NOCTURNAL trips." Dysuria involves pain or discomfort during the act of voiding, remembered as "DYS = DISCOMFORT when you pee." Finally, hematuria is the presence of blood in the urine, associated with the trick "HEMA = HEMORRHAGE in urine."
Classifications and Management of Urinary Incontinence
Urinary incontinence is categorized into four primary types, which can be collectively recalled using the mnemonic "SUMO Wrestlers," standing for Stress, Urge, Mixed, and Overflow. Stress incontinence is characterized by the leakage of urine during physical strain such as coughing, sneezing, or laughing; the memory trick for this is "STRESS = SNEEZE & pee." Priority nursing interventions for stress incontinence include teaching the patient Kegel exercises and advising them to avoid caffeine. Urge incontinence involves a sudden, intense need to void that cannot be suppressed, accompanied by the trick "URGE = can't wait, URGENT!" Management strategies include bladder training and timed voiding schedules.
Overflow incontinence occurs when the bladder becomes overly distended and subsequently dribbles urine, often described by the phrase "OVERFLOW = cup runneth OVER." This is typically caused by an obstruction, such as Benign Prostatic Hyperplasia (BPH), and is treated by addressing the obstruction or through catheterization. Mixed incontinence is a clinical presentation containing a combination of both stress and urge incontinence features, necessitating a combination of the aforementioned interventions. The memory trick for this type is simply "MIXED = MIX of both."
Inflammatory Disorders: Cystitis and Urethritis
Cystitis refers to the inflammation of the bladder. While a normal bladder has no inflammation, the abnormal findings associated with cystitis include frequency, urgency, dysuria, and foul-smelling urine. Patients may also present with systemic signs such as fever, chills, and nausea/vomiting. It is a critical clinical pearl that confusion is a primary symptom of cystitis in elderly populations. Priority interventions include administering antibiotics if the cause is bacterial, increasing fluid intake, encouraging the consumption of cranberry juice, and teaching proper hygiene, specifically wiping from front to back. The mnemonic for this condition is "CYSTITIS = SIS is PISSED (irritated bladder)."
Urethritis is the inflammation of the urethra, with the most common cause being Sexually Transmitted Infections (STIs), particularly prevalent in individuals in their early 20s. Clinical findings include dysuria, hematuria, urinary frequency and urgency, discharge from the penis, and pain during sexual intercourse or ejaculation. Priority teaching for urethritis includes the use of cotton underwear (avoiding nylon), cleaning the perineum from front to back, urinating both before and after intercourse, voiding every , and maintaining high water intake. The memory trick is "URETHRITIS = YOU-REEK (discharge & odor)."
Urinary Tract Infections and Urolithiasis Management
Urinary Tract Infections (UTI) represent a significant departure from a healthy state, with critical risk factors including catheter use, female anatomy, sexual activity, diabetes, and immunosuppression. Priority interventions center on the administration of antibiotics and a heavy increase in fluids, specifically . Acidifying the urine with cranberry juice and providing hygiene education are also essential. The memory trick is "UTI = Urinate Totally Infected - flush it out with fluids!"
Urolithiasis, or Renal Calculi, refers to the presence of stones within the urinary tract. Abnormal findings include renal colic, which is severe flank pain, as well as hematuria, nausea, vomiting, pallor, and Costovertebral Angle (CVA) tenderness. Priority interventions involve pain management utilizing Ketorolac (Toradol), straining all urine to catch stones for analysis, and increasing fluid intake to . Patients should be encouraged to ambulate to help the stone pass, and lithotripsy may be required if the stone is too large. The memory trick is "STONES = Strain, Toradol, Observe, Narcotics, Encourage fluids, Surgery (lithotripsy)."
Upper Urinary Tract Disorders: Pyelonephritis and Glomerulonephritis
Acute Pyelonephritis is a kidney infection that typically occurs when a UTI spreads upward toward the kidneys. Critical findings include high fever and chills, indicating a systemic infection, along with flank pain (CVA tenderness), nausea, vomiting, dysuria, nocturia, bacteriuria, pyuria, and an elevated White Blood Cell (WBC) count. Interventions include IV antibiotics, potential hospitalization if the patient is septic, fluid restriction only if edema or fluid overload is present, monitoring sodium intake, and watching for signs of sepsis. The trick is "PYELONEPHRITIS = PEE-LOW (kidney infection from below)."
Acute Glomerulonephritis involves the inflammation of the glomeruli, often occurring following a streptococcal infection such as a sore throat, mononucleosis, or an STI. Findings include hematuria, proteinuria, edema, shortness of breath (indicating fluid overload), hypertension, and tachycardia. Lab results often show elevated BUN, creatinine, and hyperkalemia. In elderly patients, circulatory overload is a major concern. Management includes daily weights, vital signs, I&O monitoring, treating the underlying infection, limiting potassium-rich foods, cardiac management, and potentially dialysis. The trick is "GLOMERULO = GLOW-MERRY (kidneys glow red with inflammation after strep)."
Structural and Genetic Disorders: BPH and PKD
Benign Prostatic Hyperplasia (BPH) occurs when the prostate enlarges and obstructs urine flow. Abnormal findings include hesitancy (difficulty starting the stream), reduced force of the stream, incomplete bladder emptying, post-void dribbling, and elevated creatinine or BUN levels. Interventions include encouraging fluids and avoiding caffeine, alcohol, tea, and "drying" medications such as anticholinergics, antihistamines, and decongestants. Pharmacological treatment includes Finasteride, and surgical intervention often involves a Transurethral Resection of the Prostate (TURP). Post-operative priorities for TURP include monitoring for clots, bleeding, and shock, maintaining fluid balance, and performing continuous bladder irrigation (CBI). The trick is "BPH = Big Prostate Hesitancy - avoid the 3 C's (Caffeine, antiCholinergics, Constipation)."
Polycystic Kidney Disease (PKD) is a hereditary condition where grape-like cysts replace healthy kidney tissue. Abnormal signs include back, flank, or abdominal pain, hematuria, proteinuria, pyuria, and hypertension (which is a priority for management to prevent further damage). Patients are also at risk for UTIs and calculi, and cysts may appear in other organs. Interventions include controlling hypertension, managing pain through guided imagery or dry heat, increasing fluids to prevent dehydration, and using antibiotics for infections. Genetic counseling is recommended before childbearing, and dialysis or transplant may be necessary if failure occurs. The memory trick is "PKD = Puffy Kidney Disease (cysts = puffy grapes)."
Assessment Protocols and Critical Laboratory Values
For priority assessments, the mnemonic "URINE FIRST" should be used to ensure all critical factors are checked. This stands for: Urine output ( minimum); Renal function (BUN, creatinine, GFR); Infection signs (fever, WBC, dysuria); Nutrition/hydration status; Electrolytes (, ); Flank pain/CVA tenderness; Intake & output; Retention/incontinence; Skin integrity (edema); and Temperature.
Specific medications for genitourinary disorders include Ketorolac (Toradol) for renal colic pain ("TORADOL = TORE-a-hole"), Finasteride for BPH ("FINASTERIDE = FINISH the prostate growth"), and Thiazide diuretics to prevent stone formation by "tying up" calcium ("THIAZIDE = TIES up calcium").
Critical lab value exceptions that indicate kidney dysfunction include a BUN higher than the normal range of and a Creatinine higher than the normal . A GFR lower than the normal indicates kidney failure. Urine specific gravity moving below the normal range of suggests the kidneys can no longer concentrate urine. Finally, a WBC count exceeding the normal range indicates infection.
Summary Mnemonic: KIDNEYS FILTER BLOOD
The comprehensive care of the genitourinary system can be summarized by the acronym "KIDNEYS FILTER BLOOD." This reminds the clinician to: Keep fluids up; promote Infection prevention; recognize that Dysuria constitutes a problem; ensure there is No holding of urine; acknowledge that Elevated labs signify a kidney issue; remember Yellow urine is a good sign; Strain urine for stones; recognize Flank pain signifies a kidney origin; perform I&O monitoring; monitor Lab values (BUN, creatinine); check Temperature for infection; monitor for Edema (fluid overload); differentiate between Retention vs incontinence; perform Bladder training; Limit caffeine; monitor for Obstruction (BPH); recognize Oliguria as output less than ; and utilize Dialysis as a last resort.