MVU NURS620 EXAM 3 QUESTIONS AND
CORRECT DETAILED ANSWERS
Chronic pelvic pain definition
Non-cyclic pain of 6 or more months duration that is localized to the pelvis and is of
sufficient severity to cause functional disability
Chronic pelvic pain diffentials
endometriosis, interstitial cystitis, irritable bowel syndrome
interstitial cystitis (IC)
•Chronic inflammatory condition of the bladder clinically characterized by irritable voiding
symptoms or urgency and frequency, in the absence of objective evidence of another disease
•IC related CPP is worsened by intercourse and perimenstrual status
•90% of IC occurs in females
•Symptoms
•Pathogenesis: dysfunction of GAG layer
•Lab: diagnosis of exclusion
•Tests: GYN, U/S, IVP, Cystoscopy
•PUF Symptom Scale (>5, IC likely)
•Intravesical Potassium Sensitivity Test
Management of interstitial cystits
,•Oral Pentosan polysulfate sodium: 100mg TID or 200mg BID
•Course duration: 2-4 months minimum
•Intravesical DMSO bladder instillation
•Bladder training (reduce eliminations)
• Hydrodistension of bladder, low acid diet, laser, NSAIDS, antidepressants, muscle relaxants
Male UTI
•Less common due to length of urethra- rule out with PSA for prostatitis
•Clinical presentation
-Dysuria
-Urgency/ frequency
-Cloudy urine
•Differential diagnosis
•UA/C+S
•Treat 10 to 14 days
•Consider IVP or cystoscopy
phylonephritis**
Clinical presentation: chills, fever, flank pain, CVA tenderness, urinary symptoms may
accompany
•Urine culture required***
•Hospitalization or close monitoring- if symptoms persist after 48 hours of abx treatment time
to hospitalize
•Treat for 7 -14 days with Septra DS or Cipro (?)
•Follow-up urine culture
Who is at greater risk for pyelonephritis
,Those with GU abnormalities, geriatric and pregnant patients
Hematuria
•Pathogenesis: prerenal, renal, post renal, false, benign
•Clinical presentation
-Color of the urine
-Concurrent symptoms?
•History
-Medications & dietary history- are they taking aspirin or lots of NSAIDS
-Menstrual history
•Differential diagnosis
-UTI / pyelonephritis
-Cancers
-BPH
Hematuria Exam and testing
•Physical exam
-Abdominal exam - tenderness, masses, CVA tenderness, pelvic / prostate exam
•Diagnostic tests
-Urinalysis, C&S
-ANA (rhumatoid process), CMP, CBC,
-IVP, cystoscopy- need for recurrent (refer for urology)
management - hematuria
-Antibiotic therapy if bacterial infection found
-Refer for further evaluation - urology or nephrology
, Urinary Incontinence
•Involuntary loss of urine sufficient to be a social or hygienic problem
•Affects 20 million people in the US •Costs more than $16 billion per
year
•Leads to social isolation, depression, skin problems, UTIs, and falls
•Significantly underreported
HPI for urinary incontinence
•Have you had any accidents?
•Do you check out the location of the bathroom wherever you go?
•How often do you experience leakage of urine?
•How much do you lose each time?
Risk Factors for Incontinence: DIAPPERS
•Delirium and dementia
•Infections
•Atrophic vaginitis
•Psychological: depression
•Pharmacological: diuretics, nicotine, caffeine
•Endocrine: DM, hypercalcemia, hyperthyroid
•Restricted mobility
•Stool in rectal vault
Types of incontinence
"OUTS"
Overflow incontinence (loss when specific volume reached)
Urge incontinence (loss from contraction that follows strong, sudden need)
Total incontinence (complete loss of urinary control, as from a nonfunctioning urethral
CORRECT DETAILED ANSWERS
Chronic pelvic pain definition
Non-cyclic pain of 6 or more months duration that is localized to the pelvis and is of
sufficient severity to cause functional disability
Chronic pelvic pain diffentials
endometriosis, interstitial cystitis, irritable bowel syndrome
interstitial cystitis (IC)
•Chronic inflammatory condition of the bladder clinically characterized by irritable voiding
symptoms or urgency and frequency, in the absence of objective evidence of another disease
•IC related CPP is worsened by intercourse and perimenstrual status
•90% of IC occurs in females
•Symptoms
•Pathogenesis: dysfunction of GAG layer
•Lab: diagnosis of exclusion
•Tests: GYN, U/S, IVP, Cystoscopy
•PUF Symptom Scale (>5, IC likely)
•Intravesical Potassium Sensitivity Test
Management of interstitial cystits
,•Oral Pentosan polysulfate sodium: 100mg TID or 200mg BID
•Course duration: 2-4 months minimum
•Intravesical DMSO bladder instillation
•Bladder training (reduce eliminations)
• Hydrodistension of bladder, low acid diet, laser, NSAIDS, antidepressants, muscle relaxants
Male UTI
•Less common due to length of urethra- rule out with PSA for prostatitis
•Clinical presentation
-Dysuria
-Urgency/ frequency
-Cloudy urine
•Differential diagnosis
•UA/C+S
•Treat 10 to 14 days
•Consider IVP or cystoscopy
phylonephritis**
Clinical presentation: chills, fever, flank pain, CVA tenderness, urinary symptoms may
accompany
•Urine culture required***
•Hospitalization or close monitoring- if symptoms persist after 48 hours of abx treatment time
to hospitalize
•Treat for 7 -14 days with Septra DS or Cipro (?)
•Follow-up urine culture
Who is at greater risk for pyelonephritis
,Those with GU abnormalities, geriatric and pregnant patients
Hematuria
•Pathogenesis: prerenal, renal, post renal, false, benign
•Clinical presentation
-Color of the urine
-Concurrent symptoms?
•History
-Medications & dietary history- are they taking aspirin or lots of NSAIDS
-Menstrual history
•Differential diagnosis
-UTI / pyelonephritis
-Cancers
-BPH
Hematuria Exam and testing
•Physical exam
-Abdominal exam - tenderness, masses, CVA tenderness, pelvic / prostate exam
•Diagnostic tests
-Urinalysis, C&S
-ANA (rhumatoid process), CMP, CBC,
-IVP, cystoscopy- need for recurrent (refer for urology)
management - hematuria
-Antibiotic therapy if bacterial infection found
-Refer for further evaluation - urology or nephrology
, Urinary Incontinence
•Involuntary loss of urine sufficient to be a social or hygienic problem
•Affects 20 million people in the US •Costs more than $16 billion per
year
•Leads to social isolation, depression, skin problems, UTIs, and falls
•Significantly underreported
HPI for urinary incontinence
•Have you had any accidents?
•Do you check out the location of the bathroom wherever you go?
•How often do you experience leakage of urine?
•How much do you lose each time?
Risk Factors for Incontinence: DIAPPERS
•Delirium and dementia
•Infections
•Atrophic vaginitis
•Psychological: depression
•Pharmacological: diuretics, nicotine, caffeine
•Endocrine: DM, hypercalcemia, hyperthyroid
•Restricted mobility
•Stool in rectal vault
Types of incontinence
"OUTS"
Overflow incontinence (loss when specific volume reached)
Urge incontinence (loss from contraction that follows strong, sudden need)
Total incontinence (complete loss of urinary control, as from a nonfunctioning urethral
