Nursing Exam: Urological and Reproductive Disorders PDF

MEDSURG 5 EXAM (UROLOGICAL AND REPRODUCTIVE DISORDERS) Chapter 36: Urinary System Function, Data Collection, and Therapeutic Measures Chapter 37: Disorders of Urinary System ❖ Urinary Tract Infections (UTI): most common HAI o Etiology ▪ Escherichia coli (feces) o...

MEDSURG 5 EXAM (UROLOGICAL AND REPRODUCTIVE DISORDERS) Chapter 36: Urinary System Function, Data Collection, and Therapeutic Measures Chapter 37: Disorders of Urinary System ❖ Urinary Tract Infections (UTI): most common HAI o Etiology ▪ Escherichia coli (feces) o Lower UTI- urethritis, prostatitis, and cystitis o Upper UTI- pyelonephritis, urethritis o Risk factors ▪ Aging (especially older than 65) ▪ Contamination in the perineal and urethral areas ▪ Faulty valves causing reflux of urine (may be congenital or acquired) ▪ Anatomical differences ▪ Instrumentation infection (most common is urinary catheter) ▪ Previous UTIs ▪ Urinary stasis (promotes bacterial growth) o S/S ▪ Voiding urgency and frequency ▪ Burning when voiding (dysuria) ▪ Cloudy and foul-smelling urine ▪ Hematuria ▪ Older adults- confusion, fatigue, delirium o Types ▪ Urethritis Inflammation of urethra Avoid bubble baths Treat with phenazopyramide (Pyridium)- urinary analgesic to treat dysuria o Educate that it turns urine orange ▪ Cystitis Inflammation of bladder wall (mostly caused by e. coli) Pelvic pain and pressure Treated with nitrofurantoin (Macrobid), sulfamethoxazole (Bactrim), fosfomycin (Monurol) o Educate to take entire course of prescription to prevent bacterial resistance  Encourage fluids to flush bladder ▪ Pyelonephritis Infection of one or both kidneys (can become serious) Costovertebral tenderness, high fever, chills, N/V Frequent kidney infections will eventually cause scarring and loss of kidney function ▪ Urosepsis Septic shock and death Prompt treatment is essential Older adults are at a greater risk Urological Obstructions ❖ Urethral Strictures: narrowing of lumen of urethral due to scar tissue o Catheterization is needed to drain obstructed urine o Mechanical dilation o Urethroplasty: surgical repair o Stent placements ❖ Renal Calculi (kidney stones): usually form in kidneys (nephrolithiasis); can be in ureters (ureterolithiasis) o Patho ▪ Concentrated of urine causes crystal formation (too much calcium) ▪ Citrate and substances that inhibit stone formation are too low ▪ Most stones are made of calcium oxalate o Etiology ▪ Chronic high pH ▪ Excessive sweating ▪ Medications- aspiring, topiramate, vit C supplements, vit D ▪ Diet low in calcium or calcium supplements ▪ More common with men o S/S ▪ Nephrolithiasis- costovertebral angle pain, hematuria ▪ Ureterolithiasis- severe and colicky pain, flank pain radiating to genitalia, intense urge to void, frequency, dysuria, reduced output, hematuria, N/V ▪ Bladder stones- hematuria, oliguria o Complications ▪ Hydronephrosis  ▪ Shock and sepsis ▪ Chronic kidney disease (CKD) o Prevention ▪ Adequate hydration (2-3 quarts daily) ▪ Avoid sweet drinks and grapefruit juice ▪ Encourage ambulation (reduce bone calcium reabsorption) ▪ Urcit-K (potassium citrate)- restore chemicals in urine to prevent crystals from forming o Therapeutic measures ▪ Stones 6 months or 3 cycles in a row Primary amenorrhea: not occurred by 17 Secondary amenorrhea: menses are absent after menarche Hypermenorrhea Menses last longer than 7 days Hypomenorrhea Less than normal amount of menstrual bleeding Menometrorrhagia Overly long, heavy, and irregular menses Menorrhagia Passing >80mL of blood per menses Oligomenorrhea Menstrual cycles last more than 35 days Polymenorrhea Menses are more frequently than 21-day intervals ❖ Dysmenorrhea: painful menstruation o Patho and etiology  ▪ Primary dysmenorrhea: not pathological; caused by action of endogenous prostaglandins ▪ Secondary dysmenorrhea: caused by reproductive tract disorder o Dx ▪ Hormonal tests o Therapeutic measures ▪ Aspirin or NSAIDs (inhibit prostaglandin synthesis) ▪ Hormonal adjustment ▪ D&C o Nursing Care and education ▪ Warm heating pad ▪ Knee to chest position (if related to uterine retroversion) ❖ Endometriosis: endometrial tissue on outside of uterus o Patho and etiology ▪ Retrograde menstruation: backward leakage of blood and tissue into fallopian tubes and pelvic cavity o S/S ▪ Scar tissue development ▪ Pain ▪ Swelling ▪ Abdominal organ damage ▪ Infertility o Therapeutic measures ▪ Surgical interventions ▪ Reduction of estrogen and prevention of ovulation ▪ Analgesics o Nursing care and education ▪ Heat application ❖ Menopause: permanent cessation of menses due to decreased estrogen o Patho and etiology ▪ Natural with aging ▪ Perimenopause: gradual decline in hormone production before permanent end of cessation ▪ Increased risk for heart disease and osteoporosis o S/S ▪ Erratic menses ▪ Atrophy of urogenital tissue ▪ Decreased natural lubrication  ▪ PH shifts toward alkalinity ▪ Vasomotor instability- hot flashes and night sweats o Therapeutic measures ▪ Hormone replacement therapy (HRT) or menopausal hormone therapy (MHT) ▪ Phytoestrogens (benefits of estrogen replacement without HRT)- soy, tofu, flax seeds, black cohosh o Complications ▪ Any bleedings (always investigate) o Nursing care and education ▪ Dress in layers (helps with hot flashes) ▪ Water soluble lube ▪ Decrease intake of caffeine, sugar, and alcohol ▪ May still be fertile until complete cessation even after several months of amenorrhea ❖ Irritations and inflammations of Vagina and Vulva: outbalanced pH levels o Patho ▪ Vaginosis: overgrowth ▪ Vaginitis: inflammation o Etiology ▪ Poor nutrition ▪ Douching ▪ Inconsistent blood sugars ▪ Stress ▪ Pregnancy ▪ Sitting still for long periods ▪ Restrictive clothing ▪ Antibiotic treatment ▪ Frequent and persistent yeast infections (possible sign of HIV) o S/S ▪ Itching and burning ▪ Redness ▪ Foul odor ▪ Discharge o Dx ▪ Pelvic exam ▪ PH and culture o Therapeutic  ▪ Antibiotics- clindamycin (Cleocin) ▪ Antifungals- “azoles” ▪ Antiprotozoals- metronidazole (Flagyl) o Nursing care and education ▪ Allow privacy and ensure confidentiality ▪ Educate about self-administration Douche form-lay down for best administration (vagina slopes backwards) Wear pads if pt walks or sits after administration (to prevent staining of clothing) ❖ Toxic Shock Syndrome: o Patho & Etiology: ▪ Primarily associated with superabsorbent tampon use during menstruation but can also occur with nasal packing. ▪ It is a severe systemic infection with strains of Staphylococcus Aureus that produces an epidermal toxin. ▪ The effect on the liver, kidneys, and circulatory system makes TSS a life-threatening condition. o S/S: ▪ Sudden high fever ▪ Sore throat ▪ Headache ▪ Dizziness ▪ Confusion ▪ Redness of the palms and soles of the feet ▪ Rash ▪ Blisters & Petechiae followed by peeling of the skin ▪ Dyspareunia: pain with intercourse o Prevention: ▪ Rotate using tampons and pads ▪ Change tampons every 4 hours ▪ Proper hand hygiene ▪ NOT using tampons or female barrier contraceptives in the first 12 weeks after giving birth. o Nursing care & Patient education: ▪ Educate patients on signs and symptoms and to come in early if any speculation of TSS.  ▪ Some defects can be treated with surgeries by endoscopy or by surgical incision. ❖ Disorders related to development of genital organs o Patho and etiology ▪ Agenesis: never developed ▪ Hypoplasia: underdeveloped ▪ Imperforate: expected openings don’t exist o S/S ▪ Dysmenorrhea ▪ Dyspareunia (pain with intercourse) ▪ Infertility ▪ Repeated spontaneous abortions (miscarriages) ▪ Preterm labor o Dx ▪ Ultrasonography (USN) ▪ Hysterosalpingography (HSG) ▪ CT and MRI o Therapeutic measures ▪ Surgery ❖ Displacement disorders o Cystocele: bladder sages into vaginal space due to inadequate support ▪ Pelvic pressure and stress incontinence may be noticed ▪ Tx: Kegels, anterior colporrhaphy (surgery), resuspending bladder o Rectocele: rectum sags into vagina due to inadequate support ▪ Pelvic pressure, fecal incontinence, constipation, hemorrhoids can be noticed ▪ Tx: Kegels, maintain bowel regularity, high fiber diet, posterior colporrhaphy ❖ Uterine position disorders o Types ▪ Anteversion: uterus lies too far forward ▪ Retroversion: uterus lies too far backward ▪ Anteflexion: upper portion of uterus bends forward ▪ Retroflexion: upper portion of uterus bends backward o S/S ▪ Painful menstruation and intercourse ▪ Infertility ▪ Repeated spontaneous abortion  o Therapeutic measures ▪ Pessary (corrects positional problems) ▪ Surgery ❖ Uterine Prolapse o Patho ▪ Uterus sags into vagina o S/S ▪ Back pain ▪ Pelvic pain ▪ Pain with intercourse ▪ Urinary incontinence ▪ Constipation ▪ Development of hemorrhoids o Complications ▪ Compromised circulation and tissue necrosis o Therapeutic measures ▪ Surgical resuspension ▪ Kegels ▪ Pessary ▪ Hysterectomy ❖ Fertility Disorders o Therapeutic measures ▪ IVF o Nursing Care & Education for patients undergoing Fertility testing: ▪ An understanding and nurturing attitude is VERY important because infertility can cause low self-esteem and relationship problems. ▪ People that have been undergoing long term fertility can easily become discouraged with the process, expenses, especially if it has been ineffective. ▪ Educate patients to keep a precise record of body temperatures, ovulation cycles, and menstrual cycles because hormonal changes cause all these changes. ▪ Assess pulses and blood pressures, and a thorough assessment for checkups and procedures such as endometrial biopsy. ▪ For an endometrial biopsy a pregnancy test should be done before procedure, pain medication should be om hand. *For an endometrial Biopsy have a Vasovagal reaction kit containing epinephrine or atropine, a tourniquet and a syringe according to HCPs choice ❖ Fibroid tumors (also called “leiomyoma”); benign o Patho ▪ Benign tumor made of endometrial cells implanted in uterine walls ▪ No exact cause ▪ May be related to hormones and hereditary o S/S ▪ Fertility issues ▪ Urinary frequency ▪ Constipation ▪ Tissue necrosis o Dx ▪ Abdominal or transvaginal ultrasound ▪ Blood testing ▪ MRI o Therapeutic measures ▪ Hormone suppression ▪ Fibroid embolization ▪ Myomectomy (preserves fertility) ▪ Hysterectomy ❖ Polyps: benign growths; teardrop shape attached to a stalk o S/S- bleeding after sec and in between menses o No known cause; may be related to estrogen o Tx- removal ❖ Reproductive system cysts: hypertrophy of corpus luteum after ovulation; benign o Patho- incomplete ovulation o Tx- may shrink spontaneously, laparotomy if they are excessive in size, heat to area can decrease pain and discomfort ❖ Polycystic ovarian syndrome (PCOS): complex endocrine disorder with no cause; benign o S/S- infertility, obesity, menstrual disturbances, masculinization (hair growth) o Increased risk for DM, HTN, CAD, depression, endometrial cancer o Dx- blood tests, pelvic exam, transvaginal ultrasound o Tx- blood pressure meds, lipid control meds, oral hypoglycemic agents ❖ Bartholin cysts: benign cysts on each side of vaginal opening o If cysts become infected, they can be very painful o Pain with sex  o Tx- sitz baths, incision and drainage, antibiotics, marsupialization (permanent opening to facilitate drainage) ❖ Dermoid cysts: also called a “teratoma cyst”; benign; some may be malignant o Tx- laparoscopy or laparotomy, hormone adjustment o Dx- biopsy o Nursing care- reassurance ❖ Vulvar Cancer: not common; malignant o S/S- persistent itching of vulva, white or red patches, rough areas, skin ulcers, wartlike growths o RF- human papillomavirus, changes of genitalia, immunosuppression, smoking o Dx- pelvic exam, biopsies o Tx- chemo, radiation, surgery ❖ Cervical cancer: cervical dysplasia; malignant o RF- HPV, multiple sex partners, 3 or more pregnancies, smoking, obesity, immunosuppression, chlamydia, gonorrhea, syphilis, HIV/AIDS o S/S- spotting, serosanguineous discharge o Dx- pap smears, self-checks, colposcopy o Tx- cryotherapy (freezing), laser therapy, surgery o Prevention- HPV vaccine ❖ Endometrial cancer: malignant; most common type of uterine cancer o Due to relative estrogen excess from obesity, perimenopausal period, hormone replacement, never being pregnant, older age o S/S- abrupt change in bleeding patterns o Dx- endometrial biopsy, transvaginal ultrasound o Tx- depends on metastasis; hysterectomy, chemo and radiation ❖ Ovarian cancer: malignant; insidious killer o RF- early menarche, family history, older age o S/S- weight loss, urinary frequency, pelvic pain, bloating, constipation, early satiety o Dx- bimanual exam o Tx- laparoscopy or laparotomy, estrogen-blocking therapy can reduce stimulation of cancer cells, radiation and chemo Chapter 43: Male Genitourinary Disorders Chapter 44: Sexually Transmitted Infections