Test 2 Adult Health Urinary part 2

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Questions and Answers

What is the primary characteristic of acute urinary retention?

Involuntary leakage of urine during exertion.

The sudden, strong urge to urinate followed by leakage.

A persistent urge to urinate without complete bladder emptying.

The inability to urinate despite a full bladder. (correct)

Which of the following conditions is NOT a typical cause of urinary retention?

Congenital Conditions (correct)

Kidney Stones

Medication Side Effects

Urinary Tract Infection

A patient complains of involuntary urine leakage when sneezing. Which type of incontinence is MOST LIKELY?

Urge incontinence

Overflow incontinence

Functional incontinence

Stress incontinence (correct)

Overflow incontinence results from which of the following?

An inability to fully empty the bladder, causing leakage. (B) Signup and view all the answers

What is the primary cause of neurogenic bladder?

A lesion in the nervous system affecting nerve conduction to the bladder. (C) Signup and view all the answers

Which of the following is a common characteristic of spastic bladder?

A lesion above the voiding reflex, typically above T12. (C) Signup and view all the answers

What is the significance of measuring residual urine after urination?

To identify chronic urinary retention. (C) Signup and view all the answers

Which of the following is NOT a possible treatment for urinary incontinence?

Anti-spasmodic medications (A) Signup and view all the answers

Which condition is characterized by a lesion in the lower motor neuron, resulting in urine pooling and incomplete bladder emptying?

Flaccid Bladder (D) Signup and view all the answers

What is a common cause of urinary tract infections (UTIs), particularly in women?

Fecal or vaginal bacteria contamination (D) Signup and view all the answers

Which of the following is a typical sign or symptom of a urinary tract infection (UTI)?

Dysuria (painful urination) (A) Signup and view all the answers

Which of these is a nursing intervention for a patient with a UTI?

Instructing patients to complete all prescribed antibiotics (B) Signup and view all the answers

What is a distinctive characteristic of urethritis?

Inflammation of the urethra with possible pus discharge (D) Signup and view all the answers

Which symptom is most characteristic of cystitis?

Pyuria (pus in urine) (D) Signup and view all the answers

Which condition is described as a severe form of cystitis, causing significant bladder pain?

Interstitial Cystitis (A) Signup and view all the answers

What is a common cause of prostatitis?

Bacteria ascending the urethra (D) Signup and view all the answers

What is a primary treatment for prostatitis, regardless of whether the infection is acute or chronic?

Broad-spectrum antibiotics for 2 to 16 weeks (B) Signup and view all the answers

What clinical manifestation is particularly associated with Pyelonephritis?

Flank pain and CVA tenderness (D) Signup and view all the answers

Which of the following is a common diagnostic test for pyelonephritis?

Renal Ultrasound (A) Signup and view all the answers

What can cause a urinary obstruction?

Enlarged prostate (D) Signup and view all the answers

What is a potential consequence of prolonged hydronephrosis?

Fibrosis and loss of function due to damaged nephrons (D) Signup and view all the answers

Which of these is NOT a clinical manifestation of a urinary obstruction?

Decreased blood pressure (D) Signup and view all the answers

Which condition involves the dilation of the renal pelvis and calyces?

Hydronephrosis (D) Signup and view all the answers

Study Notes

Urinary Retention

Urinary retention is the inability to urinate despite having the urge.
It can be acute or chronic.
Acute retention is the complete inability to urinate despite a full bladder.
Chronic retention is a persistent urge to urinate but an inability to empty the bladder completely.
Causes include: stress, surgery involving the sphincter, kidney stones (calculi), infection, tumors, medication side effects, trauma (especially in women with rapid deliveries), and strictures.
Urinary retention is painful and uncomfortable, leading to anxiety.
A full bladder can feel like a baseball above the symphysis pubis.
Patients with retention may be restless and irritable.
Treatment typically involves a urinary catheter or surgical release of an obstruction.
Analgesia and antispasmodics can assist with bladder relaxation.
Post-void residual (PVR) urine is measured using a catheter.
A PVR exceeding 50 milliliters suggests retention.

Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine.
Types include:
- Stress incontinence: Leakage during exertion, like lifting or sneezing.
  - Causes include: infection, loss of sphincter control, and pressure changes in the abdomen.
  - Treatment options include: collagen implant injections and Kegel exercises.
- Urge incontinence: A sudden, strong urge to urinate resulting in leakage before reaching the bathroom.
- Overflow incontinence: Repeated inability to fully empty the bladder, leading to leakage because the bladder is overfull.
- Mixed incontinence: A combination of stress and urge incontinence.
- Functional incontinence: Incontinence due to a physical or mental impairment preventing timely access to the bathroom.
- Total incontinence: Complete, involuntary urine loss unresponsive to treatment.
  - Treatment may involve temporary or permanent urinary diversion or management with an indwelling catheter.

Neurogenic Bladder

Neurogenic bladder is the loss of voluntary control over urination, leading to retention or incontinence.
It arises from a lesion in the nervous system affecting bladder nerve pathways.
Causes include: congenital conditions, neurological disorders (like stroke), or trauma.
Types:
- Spastic bladder: Caused by a lesion above the voiding reflex (typically T12 or higher).
  - Loss of sensation and motor control leads to bladder atrophy and decreased capacity.
  - Urine release is reflexive, with little to no conscious control.
- Flaccid bladder: Caused by a lesion in the lower motor neuron (T12 to L1/L2).
  - Results in urine pooling and incomplete bladder emptying due to lacking sensation.
  - Patients may be unaware of retention.
Treatment includes bladder training, self-stimulation (every 2 hours for emptying), and monitoring PVR.
Manifestations can include infections from retention, urinary reflux, diaphoresis (sweating), flushing, nausea, and infrequent voiding.

Urinary Tract Infection (UTI)

UTI is the presence of bacteria in the urinary tract.
Women are more prone due to a shorter urethra and potential fecal/vaginal contamination.
Causes include: improper catheterization, bladder obstruction, incomplete bladder emptying, decreased prostate secretions, sexual activity, diabetes, multiple sclerosis, spinal cord injury, and kidney disease.
Bacteria enter through the meatus, causing infection.
Symptoms:
- Urgency and frequency of urination.
- Burning during urination (dysuria).
- Microscopic or gross hematuria (blood in urine).
- Nocturia (nighttime urination).
- Asthenia (fatigue or weakness).
- Back pain, abdominal discomfort, perineal pain, and confusion, especially in the elderly.
- Urosepsis: Systemic infection from urinary products entering tissues, potentially life-threatening.
Nursing interventions:
- Monitor for drug interactions.
- Encourage hydration (at least 2,000 mL daily).
- Instruct patients to complete antibiotic course to prevent resistance.
- Soothe skin irritation with cornstarch, baking soda baths, or diluted vinegar.
- Implement an ash diet (high in fruits, vegetables, legumes) to maintain urine pH near 5.5.
- Educate patients on prevention:
  - Frequent sanitary product changes during menstruation.
  - Cotton underwear and avoiding irritating products.
  - Wipe from front to back.
  - Urinate before and after sexual activity.
  - Adequate hydration.
  - Proper catheter care and handwashing.
  - Avoid powders near urethra.

Urethritis

Urethritis is inflammation of the urethra.
Can be associated with or without gonorrhea.
It's an acute infection of the urethral mucous membrane, causing pus discharge and urination discomfort.

Cystitis

Cystitis is bladder wall inflammation.
Often associated with catheterization or fecal contamination.
More common in women.
Symptoms: dysuria, urinary frequency, nocturia, pyuria (pus in urine), and lower abdominal discomfort.
Diagnosed via urinalysis and urine culture.
Treatment: adequate hydration (2,000 mL daily), good perineal hygiene, early symptom treatment (urine dipsticks), and avoidance of urinary irritants (alcohol, tea, coffee, chocolate).

Interstitial Cystitis

Interstitial cystitis is a severe bladder pain syndrome.
Management often involves dietary modifications and avoidance of urinary irritants.

Prostatitis

Prostatitis is inflammation/infection of the prostate gland.
Frequently caused by bacteria ascending the urethra.
Can also be non-bacterial, often involving urethral occlusion.
Symptoms: burning sensations, discomfort in perineum, urethra, lower back, and abdomen; urinary frequency and urgency; edema causing urethral occlusion.
Complications include epididymitis, pyelonephritis, and sepsis.
Treatment involves broad-spectrum antibiotics (2 to 16 weeks), regardless of acute or chronic nature.
Avoid sexual arousal and intercourse during acute phases for prostate rest.

Pyelonephritis

Pyelonephritis is inflammation of kidney structures (renal pelvis, tubules, and interstitial tissue).
Commonly caused by E. coli.
Associated with pregnancy, other chronic conditions, catheterization, infection, obstruction, trauma.
Kidney inflammation with congested blood vessels leading to pus formation.
Clinical manifestations: chills, fever, fatigue, flank pain, costovertebral angle (CVA) tenderness.
Diagnosis: urinalysis (bacteria, pus, blood, WBCs), urine culture, ultrasound (abnormalities, obstruction, hydronephrosis), IVP (obstruction or degenerative changes), and blood tests (BUN, creatinine).
Treatment: high fluid intake, urinary analgesics, and antibiotics targeted to the cultured organism.

Urinary Obstruction

Urinary obstruction can be caused by strictures, kinks, cysts, tumors, calculi, or enlarged prostate.
Results in alterations in blood chemistry, infection, ischemia, and renal tissue atrophy.
Clinical manifestations: frequent urination urge, pain, distended bladder, and dribbling urine.
Diagnosis: KUB (X-ray), renal ultrasound, IVP, and blood tests.
Treatment: indwelling catheter, pain management, anticholinergics, suprapubic catheterization, and stenting.

Hydronephrosis

Hydronephrosis is dilation of the renal pelvis and calyces (cup-shaped structures of the kidney).
Can be unilateral or bilateral.
Causes: congenital conditions or urinary tract obstruction.
Obstruction creates pressure, leading to functional or anatomical kidney damage.
The renal pelvis and ureters dilate and hypertrophy.
Prolonged hydronephrosis causes fibrosis and nephron damage leading to decreased function.
Clinical manifestations: pain, nausea, vomiting, urinary frequency/urgency, trouble starting urine stream, dribbling urine, nocturia, dysuria, hematuria, decreased output, edema, palpable abdominal mass, bladder distention, tenderness over kidneys/bladder.
Treatment: surgical intervention to relieve obstruction.
Severe cases may require nephrectomy (kidney removal).

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Description

This quiz covers the essential aspects of urinary retention, including its definitions, causes, symptoms, and treatment options. Participants will learn about acute and chronic urinary retention and the impact it has on patients. Knowledge of management strategies such as catheterization and medication will also be assessed.