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NSG 3313 Exam 1 Study Guide Summer 2024 Chapter 10- Fluid and Electrolyte: Abby Electrolyte imbalances- ranges, causes, manifestations, treatments, nursing considerations o Sodium: hyponatremia and hypernatremia (SODIUM=NEURO): normal level 1...

NSG 3313 Exam 1 Study Guide Summer 2024 Chapter 10- Fluid and Electrolyte: Abby Electrolyte imbalances- ranges, causes, manifestations, treatments, nursing considerations o Sodium: hyponatremia and hypernatremia (SODIUM=NEURO): normal level 135-145 ▪ Hyponatremia Serum level less then 135 mEq/L Acute: results of fluid overload Chronic: Seen outside of hospital setting Exercise associated ▪ Causes Imbalance of water, losses by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, certain medications, SIADH ▪ Clinical Manifestations: Poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abdominal cramping, neurological changed ▪ Nurse considerations. Treatment Treat underlying condition Sodium replacement Water restriction Medication Assessment I&O, daily weight, lab values, CNS changes Encourage dietary sodium Monitor fluid intake Effects of medications ▪ Hypernatremia Serum sodium greater than 145 mEq/L Occurs with normal fluid volume, FVD,FVE ▪ Causes Fluid deprivation, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions ▪ Clinical manifestations Thirst, elevated temperature, flushed skin, restlessness, irritable, increased BP, edema ▪ Serum osmolality greater than 300 ▪ Increased urine specific gravity and osmolality ▪ Nurse management/treatment Gradual lowering of serum sodium level vis infusion of hypotonic electrolyte solution Diuretics Assessment of abnormal loss of water and low water intake Assess for OTC sources of sodium Monitor CNS changes o Potassium: hypokalemia and hyperkalemia (POTASSIUM =CARDIAC): normal level 3.5-4.5 Hypokalemia o Below-normal serum level o Less than 3.5 mEq/L ▪ Causes GI losses, medications, prolonged intestinal suctioning, recent ileostomy, tumor of the intestine, alterations of acid-base balance, poor dietary intake, hyperaldosteronism ▪ Clinical Manifestations:  ECG changes, dysrhythmias, dilute urine, excessive thirst, fatigue, anorexia, muscle weakness, decreased bowel motility, parethesia ▪ Nurse management/treatment Potassium replacement: increased dietary potassium, oral potassium supplements or IV potassium for severe deficit Monitor ECG for changes Monitor ABGS Monitor patient receiving digitalis for toxicity Monitor early signs and symptoms Administer IV potassium only after adequate urine output has been established ▪ Hyperkalemia Serum potassium greater than 5.0mEq/L Seldom occurs in patients with normal renal function Increased risk in older adults Cardiac arrest is frequently associated ▪ Causes Impaired renal function, rapid administration of potassium, hypoaldosteronism medications, tissue trauma, acidosis ▪ Clinical Manifestations: Cardiac changes and dysrhythmias, muscle weakness, parethesias, anxiety, GI manifestations ▪ Nurse management/treatment Monitor ECG, heart rate, BP, assess labs, monitor I&O o Calcium: hypocalcemia and hypercalcemia ▪ Hypocalemia Serum levels less than 8.6 mg/dL must be considered in conjunction with serum albumin level Serum calcium level controlled by parathyroid hormone and calcitonin ▪ Causes: Hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis transfusion of citrated blood, kidney injury, medications ▪ Clinical manifestations: Tetany, circumoral numbness, paresthesia, hyperactive DTRs, Trousseau sign, Chvostek sign, seizures, respiratory symptoms of dyspnea, laryngospasm, abnormal clotting, anxiety Ionized calcium levels ▪ Nurse Management/treatment IV of calcium gluconate for emergent situation (monitor for risk of extravasation) Seizure precautions Oral calcium and vitamin D supplements Exercise to decrease bone calcium loss Patient teaching related to diet and medications ▪ Hypercalcemia Serum level greater than 10.4 mg/dL Mild and moderate hypercalcemia usually asymptomatic Crisis has high mortality ▪ Causes Malignancy and hyperparathyroidism, bone loss related to immobility, diuretics ▪ Clinical Manifestations Polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias ▪ Nurse management/treatment Treat underlying cause (cancer)  Administer IV fluids, furosemide, phosphates, calcitonin, bisphosphonates Increase mobility Encourage fluids Dietary teaching, fiber for constipation Ensure safety o Magnesium: hypomagnesemia and hypermagnesemia ▪ Hypomagnesemia Serum level less than 1.8 mg/dL Associated with hypokalemia and hypocalcemia ▪ Causes Alcoholism, GI losses, eternal or parenteral feeding deficient in magnesium, medication, rapid administration of citrated blood ▪ Clinical Manifestations Chvostek and Trousseau signs, apathy, depressed mood, psychosis, neuromuscular irritability, ataxia, insomnia, confusion, muscle weakness, tremors, ECG changes and dysrhythmias Ionized serum magnesium level ▪ Nurse Management/treatment Magnesium sulfate IV is administered with a infusion pump, monitor vital signs and urine output Calcium gluconate or hypocalcemia tetany or hypermagnesemia Oral magnesium Monitor of dysphagia Seizure precaution Dietary teaching (green, leafy vegetables, beans, lentils, almonds, peanut butter) ▪ Hypermagnesemia Serum level greater than 2.6 mg/dL Rare electrolyte abnormality because kidneys efficiently excrete magnesium Falsely elevated levels with a hemolyzed blood samples Low BP, HR,RR,REFLEXES ▪ Causes Kidney injury, diabetic ketoacidosis, excessive administration of magnesium, extensive soft tissue injury ▪ Clinical Manifestation Hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes. Dysrhythmias and cardiac arrest ▪ Nurse Management/treatment IV calcium gluconate Ventilatory support for respiratory depression Hemodialysis Administration of loop diuretics, sodium chloride, LR Avoid medications containing magnesium Patient teaching regarding magnesium-containing OTC medications Observe for DTRs and changes in LOC IV Fluids- nursing considerations -Assess before administration, selection and preparation of IV fluids, administration techniques, patient monitoring and assessment, patient education and safety. Fluid losses/gains o Gains: Oral intake such as drinking fluids and eating food. IV fluids medical administration. o Loss: Urinary loss, sweating, respiratory loss, fecal loss. Fluid volume deficit/dehydration- causes, manifestations, treatments  o Hypovolemia o May occur alone or in combination with other imbalances o Loss of extracellular fluid exceeds intake ratio of water ▪ Electrolytes lost in same proportion as they exist in normal body fluids o Dehydration ▪ Not the same as FVD ▪ Loss of water alone, with increased serum sodium levels o Causes of FVD ▪ Abnormal fluid loss ▪ Decreased intake ▪ Thirds-space fluid shifts ▪ Diabetes insipidus ▪ Adrenal insufficiency, hemorrhage o Manifestations: chart 10-4 pg 234 ▪ Weight loss, tented, dry skin, increased pulse and respiratory rate, cool skin, flat neck veins, oliguria, lethargy, decreased skin turgor, concentrated urine, thirst, confusion ▪ Can develop rapidly, severity depends of loss ▪ Vomiting, diarrhea, sweating, GI suctioning, nausea, lack of access fluids, ascites o Treatment: ▪ Oral route preferred ▪ IV for acute or severe losses ▪ Types of solutions: isotonic, hypotonic, hypertonic, colloid o Nurse management: ▪ I&O at least every 8 hours ▪ Skin and tongue turgor, mucosa, urine output, mental status ▪ Daily weight ▪ Measures to minimize fluid loss ▪ Watch vital signs closely Fluid volume excess- causes, manifestations, treatments o Hypervolemia o Expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exists in the ECF o Secondary to an increase in the total-body sodium content o Causes: ▪ Due to fluid overload or diminished homeostasis mechanisms ▪ Heart failure, kidney injury, cirrhosis of liver ▪ Contributing factors: consumptions of excessive amounts of salt or other sodium salts ▪ Excessive administration of sodium containing fluids o Clinical Manifestations ▪ Edema ▪ Distended neck veins ▪ Crackles ▪ BUN ▪ HCT decrease ▪ Respiratory rate increases ▪ Low BP ▪ Bounding pulse and cough ▪ Increase urine output o Treatment ▪ Diuretics ▪ Dialysis ▪ Dietary restrictions (educate patients) o Nursing Management ▪ I&O and daily weight, assess lungs, edema and other symptoms  ▪ Monitor responses to medications ▪ Promote adherence to fluid restrictions ▪ Monitor, avoid sources of excessive sodium ▪ Promote rest Acid base imbalances- - ranges, causes, manifestations, treatments, nursing considerations o Metabolic Acidosis ▪ Low pH less than 7.35 ▪ Increased hydrogen concentration ▪ Low plasma bicarbonate less than 22 mEq/L ▪ Normal anion gap is 8 to 12 mEq/L ▪ With acidosis, hyperkalemia may occur as potassium shifts out of cell ▪ Serum calcium levels may be low with chronic metabolic acidosis Causes o Salicylate poisoning, renal failure, propylene glycol toxicity, diabetic ketoacidosis, starvation Clinical Manifestations o Headache, confusion, drowsiness, increased respiratory rate and depth, decreased blood pressure, decreased cardiac output, dysrhythmias, shock if decrease is slow, patient may be asymptomatic until bicarbonate is 15 mEq/L Nurse management o Correct underlying problem, correct metabolic imbalance o Bicarbonate may be administered o Monitor potassium levels o Hemodialysis o Peritoneal dialysis o Metabolic Alkalosis ▪ High ph. greater than 7.45 ▪ High bicarbonate greater than 26 mEq/L ▪ Hypokalemia will produce alkalosis o Causes ▪ Most commonly due to vomiting or gastric suction, may also be due to medications, especially long-term diuretic use, hyperaldosteronism, Cushing’s syndrome, and hypokalemia will produce alkalosis o Clinical Manifestations ▪ Symptoms related to decreased calcium, respiratory depression, tachycardia, symptoms of hypokalemia including tingling of the toes, fingers, dizziness and tetany, ECG changes, decreased GI motility ▪ Urine chloride levels o Nurse management ▪ Correct the underlying acid-base disorder ▪ Restore fluid volume with sodium chloride solutions ▪ Monitor I&O and ECG and neurologic changes o Respiratory Acidosis ▪ Low pH less than 7.35 ▪ PaCO2 greater than 42 mm Hg ▪ Always due to respiratory problem with inadequate ventilation, resulting in elevated plasma levels of CO2 o Causes: ▪ Pulmonary edema, overdose, atelectasis, pneumothorax, severe obesity, pneumonia, COPD, muscular dystrophy, multiple sclerosis, myasthenia gravis o Clinical Manifestations: ▪ With chronic respiratory acidosis, body may be asymptomatic. With acute respiratory acidosis may see sudden increased pulse, respiratory rate, and BP, mental changes, feeling of fullness in head, and increased conjunctival vessels  o Nurse Management ▪ Improve ventilation ▪ Bronchodilators, antibiotics, anticoagulants ▪ Pulmonary physiotherapy ▪ Adequate hydration ▪ Mechanical ventilation if necessary ▪ Monitor respiratory status, I&O o Respiratory Alkalosis ▪ pH greater than 7.45 ▪ PaCO2 less than 35 o Causes: ▪ Extreme anxiety, panic disorder, hypoxemia, salicylate intoxication, gram-negative sepsis, inappropriate ventilator settings o Clinical Manifestations ▪ Lightheadedness, inability to concentrate, numbness and tingling in extremities, tachycardia, and ventricular and atrial arrhythmias o Nurse Management ▪ Treat underlying condition ▪ Antianxiety agent ▪ Have patient breathe into bag ▪ Monitor anxiety and respiratory status ▪ Educate patient on techniques to decrease anxiety Geriatric considerations o At risk for fluid deficit and excess Compensatory mechanisms for acid base balance Respiratory- lungs, alkalosis: hyperventilation acidosis: hypoventilation Metabolic- kidneys alkalosis: acidosis: Uncompensated pH not normal “driver” is abnormal while other is normal. It’s not helping. pH – 7.15 CO2 – 52 HCO3 23 Partially Compensated pH not normal, “driver” abnormal, “compensator” abnormal…trying to help but only helping partially. pH – 7.28 CO2 – 52 HCO3 – 27 Fully Compensated pH is normal…both others are abnormal…one’s the “driver”, the other is the compensator…and it worked, completely pH – 7.36 CO2 – 48 HCO3 - 30 Chapter 48- Kidney Disorders: Abby Acute kidney injury o Rapid loss of renal function due to damage to the kidneys o Prerenal ▪ Sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kindeys from severe injury or illness o Intrarenal ▪ Direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply o Postrenal ▪ Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury o Common causes ▪ Heart failure, low blood volume, nephrotoxic drugs, inflammation and vasculitis o Labs ▪ Urinalysis, BUN, Creatinine o Phases Chronic kidney disease o Prolonged acute inflammation  o Can be subtle systemic manifestations o Five stages based on GFR o Risk Factors: Diabetes and hypertension (most common) o Educate patient about smoking and diet (low sodium) Glomerulonephritis o Repeated acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage o Renal sufficiency or failure, asymptomatic for years as glomerular damage increases before signs and symptoms develop o Abnormal laboratory test results: urine with fixed gravity, casts, proteinuria, electrolyte imbalances, and hypoalbuminemia o Medical management determined by symptoms o Nurse management ▪ Assessment, potential fluid and electrolyte imbalances, cardiac status, neurologic status, emotional support, education in self-care o Clinical manifestations ▪ Kidneys are reduced to as little as one fifth their normal kidney size ▪ Symptoms can vary, hypertension, elevated BUN and serum creatinine levels as well as proteinuria ▪ Loss of weight, strength, increasing irritability, nocturia, headache, dizziness Polycystic kidney disease o Genetic disorder- most common inherited cause of kidney failure o May have cysts in other organs o Family history o No cure, supportive treatment o Genetic counseling o Clinical Manifestations ▪ Loss of renal function and increasing size of the kidneys as the cysts grow ESKD o End stage kidney disease o Diet?  o Hemodialysis o Used when patient is acutely ill until kidneys resume function and for long-term replacement therapy in CKD and ESKD o Hold medications? o Objective is to extract toxic nitrogenous substances from the blood and to remove excess fluid ▪ Diffusion, osmosis, ultrafiltration o Vascular access ▪ Arteriovenous fistula ▪ Arteriovenous graft Peritoneal dialysis o Goals to remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balances o Perironeal membrane serves as semipermeable ▪ Ultrafiltration ▪ Peritoneal catheter o Acute intermittent, continuous ambulatory, continuous cyclic o Complications: peritonitis, leakage, bleeding Chapter 47- Urinary Function: Cass Normal urine findings Abnormal urine findings Urinary function changes with aging Bladder/Renal US Creatinine clearance BUN and creatinine Normal urine findings- 150mg/day of protein: primarily albumin and Tamm-Horsfall protein Normal range of urine specific gravity is 100.5 to 1.025. Normal urine osmolality is 200 to 800 mOsm/kg. 24 hour sample, normal value is 300 to 900 mOsm/kg Color- yellow (light/pale and clarity/turbidity- Clear pH- 4.5-8 Abnormal urine findings- Hematuria – RBCs in the urine, Dysuria – painful/ difficulty urination, Proteinuria- protein in the urine, Ketones, Nitrates – UTI, protein- damage to the glomerular, WBC- inflammation/ infection Urine color: Colorless- pale yellow: Diluted urine from diuretics, alcohol, diabetes insipidus, chronic kidney disease, glycosuria Yellow to milky white: Pyuria (Pus in your pee), Infection Pink to red: RBCs in urine, medications, and bladder or prostate surgery Orange to Amber: Dehydration, fever, bile, excess bilirubin or carotene, and medications Brown to Black: Old blood, Urobilinogen (body breaks down red blood cells, producing bilirubin), melanin, or medications Urinary function changes with aging- Older adults susceptible to kidney injury R/T renal structural and functional changes: Decreased mobility Sclerosis of the glomerulus and renal vasculature Decreased blood flow Decreased GFR 35-40 years of age Decreased renal reserve Altered tubal function and acid–base balance Men can’t get rid of salt easy – more susceptible to kidney injury Incomplete emptying of the bladder, leading to UTIs and urosepsis (life threatening UTI- spreads to kidneys and becomes sepsis) Bladder/Renal US – Noninvasive method/ May indicate urinary frequency, inability to void after removal of an indwelling urinary cath, measuring post void residual, inability to void postoperatively, or assessment of the need for cath during the initial stages of an intermittent catheterization training program. Portable battery-operated devices Scan head is placed on the patient’s abdomen and directed toward bladder. Creatinine clearance – a good measure of a GFR, the amount of plasma filtered through the glomeruli per unit of time. To calculate- a 24 hour urine specimen is collected. Formula for creatine clearance is (Volume of urine [mL/min] X Urine creatinine [mL/dL]) / Serum creatinine (mg/dL) BUN and creatinine – Get blood draw. Patients that had high protein intake potentially will have a high BUN. Creatinine level- Measures effectiveness of renal function. End product of muscle energy metabolism. In normal function, the level of creatinine, which is regulated and excreted by the kidney, remains constant in the body. High creatinine levels indicate kidney dysfunction. BUN: Index to renal function. Urea is the nitrogenous end product of protein metabolism. Test values are affected by protein intake, tissues breakdown, and fluid volume changes. BUN does not always indicate kidney issues. Can have normal kidney function. *Always look at BUN with Creatinine ratio/ Can have BUN of 30 but normal GFR and Creatinine. This means BUN was caused by protein intake. BUN to Creatinine- Evaluates hydration status. An elevated ratio is seen in hypovolemia, a normal ratio with an elevated BUN and creatinine indicates intrinsic kidney disease. Normal Values: Creatinine= 0.7 - 1.3mg/dL BUN= 7-20 mg/dL BUN: Creatinine Ratio = 10-20:1 GFR =60-100 mL/min Creatinine: endogenous waste product of muscle energy metabolism How well the kidney is functioning Chapter 49- Urinary Disorders: Blanca Renal Calculi UTI Bladder training Urinary retention Urinary incontinence Indwelling catheter care Diuretic types- when to use which Renal Calculi (Kidney stones) -Clinical Manifestations: Signs and symptoms of kidney stones can include severe pain, nausea, vomiting, fever, chills and blood in your urine. -Nursing Considerations: Patient education, Pain Management, fluid management, nutritional guidance and monitoring assessments. -Complications: Obstruction of urinary tract, infection, renal damage, recurrence of stones, CKD, hematuria, pain and discomfort, impaired quality of life. UTI : -Common Causes: Urinary tract infections (UTIs) are commonly caused by bacteria entering the urinary tract and multiplying in the bladder. The most frequent causative agents are: 1. **Escherichia coli (E. coli)**: This bacterium is the most common cause of UTIs, accounting for about 80-90% of cases. E. coli is typically found in the gastrointestinal tract and can spread to the urinary tract through improper wiping, sexual activity, or other means. 2. **Staphylococcus saprophyticus**: This bacterium is another common cause, particularly in young sexually active women. 3. **Other bacteria**: Less commonly, UTIs can be caused by bacteria such as Klebsiella, Proteus, Enterococcus, and Pseudomonas. Other factors that can contribute to UTIs include: - **Sexual activity**: Especially in women, sexual intercourse can introduce bacteria into the urinary tract. - **Poor personal hygiene**: Improper wiping after using the toilet, particularly in women (wiping from back to front), can lead to bacterial entry into the urinary tract. - **Use of spermicides and certain contraceptives**: These products can alter the bacterial balance in the genital area, increasing the risk of UTIs. - **Menopause**: Changes in estrogen levels can make women more susceptible to UTIs. - **Urinary tract abnormalities**: Structural issues in the urinary tract, such as kidney stones or urinary catheters, can increase the likelihood of bacterial infection. - **Suppressed immune system**: Conditions such as diabetes, HIV/AIDS, or certain medications that suppress the immune system can increase susceptibility to infections, including UTIs. -Patients at high risk: Women, sexually active women, pregnant women, elderly individuals, post menopausal women, patients with urinary retention. -Clinical Manifestations: -Patient Education/Prevention techniques 1. **Hygiene Practices**: - **Proper wiping technique**: Always wipe from front to back after using the toilet to prevent bacteria from entering the urethra. - **Genital hygiene**: Keep the genital area clean and dry, especially before and after sexual intercourse. 2. **Fluid Intake**: - **Stay hydrated**: Drink plenty of water throughout the day to help flush bacteria out of the urinary tract. 3. **Urination Habits**: - **Urinate frequently**: Avoid holding urine for long periods, as this can allow bacteria to multiply in the bladder. 4. **Clothing and Contraception**: - **Cotton underwear**: Wear cotton underwear and avoid tight-fitting clothing to keep the genital area dry and ventilated. - **Contraception**: Consider using alternative methods if spermicide-coated condoms or diaphragms are associated with recurrent UTIs. 5. **Sexual Activity**: - **Urinate after intercourse**: Encourage patients, especially women, to urinate shortly after sexual activity to help flush out bacteria. - **Hygiene before and after**: Ensure good genital hygiene before and after intercourse. 6. **Medical Conditions**: - **Manage underlying conditions**: Control diabetes effectively and seek appropriate treatment for conditions affecting the urinary tract. 7. **Avoid Irritants**: - **Limit irritants**: Reduce consumption of bladder irritants such as caffeine, alcohol, and spicy foods, which can exacerbate symptoms. 8. **Cranberry Products**: - **Consider cranberry**: Discuss the potential benefits of cranberry juice or supplements, though evidence is mixed on their effectiveness. 9. **Medical Follow-up**: - **Prompt treatment**: Encourage patients to seek medical attention promptly if they suspect a UTI, as early treatment can prevent complications. 10. **Awareness of Symptoms**: - **Recognize symptoms**: Educate patients about common UTI symptoms, including frequent or urgent urination, burning sensation during urination, cloudy or foul-smelling urine, and pelvic pain. By providing comprehensive education on these preventive measures, healthcare providers can empower patients to take proactive steps in reducing their risk of UTIs and managing their urinary health effectively. Bladder training -Patient Education: Understanding Bladder Function: Anatomy: Explain the basic anatomy and function of the bladder and urinary system. Urination Process: Describe how urine is stored in the bladder and expelled through the urethra. Normal Frequency: Educate on normal urinary frequency and volume based on age and individual factors. Indications for Bladder Training:  Conditions: Discuss conditions where bladder training can be beneficial, such as urge incontinence, overactive bladder, or nocturia (nighttime urination). Goals: Explain the goals of bladder training, which include improving bladder control, reducing urgency, and extending the time between bathroom visits. -Uses: Urinary incontinence patient the goals are to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. It also can diminish leakage and the sense of urgency associated with the problem. (Post void residual) Urinary retention: (the inability to empty the bladder completely during attempts to void) -Causes: Obstruction, neurological conditions , medications and weak bladder muscles. -Complications: bladder distention, increased risk for UTI, hydronephrosis (kidney swelling) -Nursing Interventions: Assess and Monitor urine output, bladder palpation to assess distention, insert a urinary catheter, and educate patient about urinary elimination. Urinary incontinence: (unplanned, involuntary, or uncontrolled loss of urine from the bladder) -Causes: Urinary incontinence (UI) can have various causes, and its important to identify the specific cause to determine the appropriate treatment. The primary causes of urinary incontinence include: 1. **Muscle Weakness and Pelvic Floor Dysfunction**: - **Pelvic floor muscles**: Weakness or damage to the muscles that support the bladder and control urination can lead to stress incontinence (leakage with physical exertion, sneezing, coughing) or urge incontinence (sudden, intense urge to urinate). - **Sphincter muscles**: Weakness in the muscles that normally keep the bladder closed can cause urinary leakage. 2. **Nerve Damage**: - **Nerve conditions**: Diseases such as diabetes, multiple sclerosis, stroke, or spinal cord injury can interfere with nerve signals to the bladder and result in overactive bladder or overflow incontinence. - **Nerve injury during childbirth**: Damage to pelvic nerves during childbirth can lead to UI later in life. 3. **Medications**: - Certain medications, such as diuretics ("water pills"), sedatives, muscle relaxants, and some antidepressants, can contribute to UI by increasing urine production or affecting bladder control. 4. **Age-related Changes**: - Aging can weaken muscles, including those in the bladder and urethra, leading to UI. Menopause-related estrogen decline can also contribute to UI in women. 5. **Obstruction or Blockage**: - Conditions that obstruct urine flow, such as an enlarged prostate in men, constipation, urinary stones, or tumors, can cause overflow incontinence where the bladder doesn't empty properly. 6. **Infection**: - Urinary tract infections (UTIs) can cause temporary UI due to irritation and inflammation of the bladder. 7. **Other Health Conditions**: - Chronic coughing (e.g., due to smoking or conditions like COPD) can weaken pelvic floor muscles and contribute to stress incontinence. - Obesity and excess weight can increase pressure on the bladder and contribute to UI. - Conditions affecting mobility or cognitive function, such as Parkinson's disease or dementia, can also impact bladder control. 8. **Genetic Predisposition**: - There may be a genetic component that predisposes some individuals to develop urinary incontinence. -Nursing Interventions: -patient education Indwelling catheter care: continuous bladder irrigation -ONLY use when medically necessary** -Nursing Interventions: Empty bag every 8 hours, Use a strict sterile technique, secure the catheter to prevent movement, frequently inspect urine color, odor, and consistency, perform daily perineal care with soap and water, maintain a closed system, follow the manufacturer's instructions when using the catheter port to obtain urine specimens, and discontinue use as soon as feasible. Diuretic types- when to use which -How would we treat patients? -Spironolactone:(potassium-sparing) For patients with hypertension, heart failure, edema, Primary Hyperaldosteronism, ascites, and hypokalemia prevention. -Furosemide: (loop diuretic) Used when the removal of excess fluid and electrolytes from the body is necessary -Hydrochlorothiazide: is a thiazide diuretic commonly used in clinical practice for various medical conditions where the removal of excess fluid and electrolytes from the body is beneficial. -Lasix: Lasix, also known as furosemide, is a loop diuretic commonly used in clinical practice for various medical conditions where the removal of excess fluid and electrolytes from the body is necessary. Chapter 53- Male Reproductive Disorders: Tiff BPH Testicular torsion TURP management Phimosis Priapism Erectile dysfunction PDE5 considerations and education Testicular cancer Continuous bladder irrigation Epididymitis BPH – Benign Prostate Hyperplasia (enlarged prostate) Manifestations: Urinary obstruction, urinary retention, and urinary tract infections Develops over a period of time; changes in urinary tract slow and insidious Symptoms depend on severity: dysuria, hesitancy, sensation of incomplete bladder emptying Management of BPH: Medical treatment Alpha-adrenergic blockers (finasteride and tamsulosin(Flomax) Note that if patient is taking these med and they go for their annual PSA level, and it is normal, that doesn’t mean they do not have prostate cancer, these meds can falsely decrease their PSA level and they need those digital rectal exams in combination with medication. Measures to reduce pain and spasms Catheter for acute condition; unable to void Surgical treatment Minimal invasive therapy Surgical resection TURP Testicular torsion Surgical emergency requiring immediate diagnosis to avoid loss of the testicle. Torsion of the testis is rotation of the testis, which twists the blood vessels in the spermatic cord and therefore impedes the arterial and venous supply to the testicle and surrounding structures in the scrotum. Manifestations: sudden pain in the testicle developing over 1-2 hours, nausea, lightheadedness, and swelling of the scrotum may develop. Physical exam: testicular tenderness, elevated testis, thickened spermatic cord and swollen, painful scrotum. If the torsion cannot be reduced manually, surgery to untwist the spermatic cord and anchor both testes in their correct position to prevent recurrence should occur within 6 hours of the onset of symptoms in order to save the testis. After 6 hours of impaired blood supply, the risk of loss of the testicle increases. TURP management What is it? Transurethral Resection of the prostate. It is completed through an endoscope where they go in and remove the prostate gland in small pieces. The pro decreases the chances of transurethral resection because they are doing small pieces at a time. Complication that you are watching for with it? o Transurethral resection syndrome- rare but potentially life threatening complication that can occur after TURP. It’s caused by the body absorbing too much of the electrolyte-free irrigation fluids used to wash the surgery area (continuous bladder irrigation), which can lead to low sodium in the blood, known as hyponatremia. o Hypervolemia- fluid overloaded, low sodium o If this happens we should expect a change in the solution or a decrease in the irrigation rate , or stop the irrigation all together Repeat procedures overtime when tissue regrows can lead to strictures from that scar tissue developing where we keep going in and cutting tissue away. Phimosis- narrowing of the foreskin due to infection Clinical manifestations: inflammation, edema, constriction because of poor hygiene, secretions called smegma What it’s caused from: - uncircumcised patient with poor hygiene Treatment: first thing, steroid cream, if severe enough-circumcision Priapism Clinical manifestations: persistently abnormally long erection without stimuli. What do we commonly see this with? We usually see this with PDE5’s and injected vasoactive agents in patients with ED Erectile dysfunction – inability to achieve or maintain an erection Most common is a vascular issue, which is a blood flow issue. Most common causes: Psychogenic causes: anxiety, fatigue, depression, absence of desire Organic causes: vascular, endocrine, hematologic, and neurologic disorders; trauma; alcohol; medications; and drug abuse (especially opiates, because they decrease testosterone) Medications associated with erectile dysfunction Low testosterone levels can also cause ED (neurological conditions that can cause testosterone levels to drop such as pituitary adenoma) PDE-5 considerations and education Contraindications for sildalafil patients or any of the PDE-5’s: nitrate use, CAD patients, Caution with retinopathy How to take them: Take at least an hour prior to sexual intercourse, it usually lasts about an hour to 2 hours. When they shouldn’t be used/contraindications: nitrate use (example: if a patient has coronary artery disease and they’re on nitroglycerin they cannot have sildalafil side effects: headache, flushing, dyspepsia PDE-5’s cause a release of nitrous oxide into vasculature and that’s going to result in an increase of blood flow to the area. Major risk associated with PDE5’s and nitrate use is priapism. Which is prolonged erection, if they have an persistent abnormal erection, its an emergency, but the key is if its persistently abnormally long without stimuli and still maintaining an erection. They will need medical treatment for this. Testicular cancer What we are going to do to prevent that? Monthly testicular self-exam (TSE) and annual testicular exam, DRE’s (digital rectal exam), PSA levels Patient population that we most commonly see that with? Men ages 15 to 40 years Most common clinical manifestations: painless lump or mass in the testes Continuous bladder irrigation -indicated for post-op prostatectomy  -hooked up to 3 way foley- one port-irrigation solution (norma saline); one port- drainage going to foley bag (drainage is typically light red, possible blood clots. -goal is to keep bladder flushing to decrease the risk of cloth forming. -left for about 1-2 days(it is temporary) -multiple bags spiked at once due to not wanting it to run dry -set rate based up on the color/consistency of fluid in drainage bag, also patient comfort level. -we want consistent red color and medium amount of clots Complication: Perforation- severe pain due to hyperinflation Obstruction- blood clots -> overfilling bladder-> perforation -I&O: should see more output than intake, should never me more input than output. Triple lumen catheter- continuous flow in, continuous flow out. Watching urinary output to make sure it is continuously going if your doing a continuous bladder irrigation. Take total output and deduct how much you have infused. TURP Management: monitor for fluid over load, low sodium. Listen to lung sounds and heart sounds to evaluate for fluid overload. Epididymitis- infection of the epididymis due to recent surgery, STD, indwelling catheter Clinical manifestations: fever, chills, testicular enlargement, frequency of urination Nursing care considerations: bed rest, scrotal elevation, ice, consider STI’s, antibiotics, jock strap (support)