MED SURG EXAM 4 GU / REPRO ( CH 36, 37, 41, 42, 43) - 3/30/22
UA Results x2 (page 726)
● first-morning specimens:
➔ best & most preferred
➔ concentrated
➔ contain abnormal constituents (if present)
➔ specimen should be examined within 1 hour of collection or kept refrigerated
● urine standing at room temperature longer than 2 hours:
➔ more bacteria present
➔ change in pH
➔ hemolysis of RBCs
● a random urine specimen collected for cytology:
➔ should not be a first-morning specimen (changes in epithelial cells occur in urine
held overnight)
● normal UA result ranges:
➔ color: light yellow to deep amber (as per textbook)
➔ appearance: clear
➔ odor: aromatic
➔ pH: 4.5 → 8.0
➔ specific gravity: 1.005 → 1.030
➔ protein: less than 20mg/dL
➢ for 24 hour urine: 30 → 150mg/dL
➔ RBCs/WBCs: less than 5/hpf
➔ casts: none to rare hyaline
★ The nurse is reviewing the urinalysis of a patient. Which of the following are
abnormal findings to report to the health care provider? Select all that apply.
A. Blood 7/hpf
B. Glucose none
C. Protein 4 mg/dL
D. White blood cells 11/hpf
E. Nitrites positive
F. pH 9.0
Prostate Cancer (page 860, 907, 909)
● dependant on testosterone to grow
● begins: in the posterior or lateral part of the gland
● spreads by one of three routes:
1. (local invasion) → bladder → seminal vesicles → peritoneum
2. (lymph system) → pelvic nodes → supraclavicular nodes
3. (vascular system) → bone → lung → liver
● risk factors:
➔ men 65+
➔ family hx
Amanda Ludwig
, ➔ elevated testosterone
➔ high fat diet
➔ occupational exposures (hydrocarbons, fire smoke)
● S/S:
➔ abdominal pain
➔ anemia
➔ back pain
➔ bone pain (hip)
➔ fatigue
➔ hematuria
➔ urinary obstruction
➔ urinary retention
➔ weakness
➔ weight loss
● complications:
➔ bladder/kidney infection
➔ bone fractures
➔ depression
➔ difficulty urinating
➔ erectile dysfunction
➔ pain
➔ weight loss
tests:
➔ PSA (less than 4ng/mL)
➔ PAP (less than 3ng/mL)
➔ acid phosphatase
➔ alkaline phosphatase
➔ serum calcium
➔ physical examination
➔ ultrasound
➔ biopsy
● therapeutic measures:
➔ Lupron
➔ Zoladex
➔ Casodex
➔ TURP
➔ radical prostatectomy
➔ brachytherapy
➔ sipuleucel-T (provenge)
➔ bilateral orchiectomy
Acute Renal Failure → Oliguric Phase (page 756, 757)
● less than 400 mL of urine is produced in 24 hours
● phase can last from up to 2 weeks to several months
Amanda Ludwig
, ● renal function recovery decreases the longer this phase lasts
● fluid is retained
● electrolytes become imbalanced
● waste products are not excreted as urine output decreases
● increased:
➔ potassium
➔ phosphate
● decreased:
➔ sodium
➔ calcium
● abnormal:
➔ RBCs
➔ WBCs
➔ platelets
● neurologic effects:
➔ confusion
➔ seizures
➔ coma
● metabolic acidosis during this phase (due to reduced hydrogen ion excretion)
Renal Calculi x2 (page 744, 745)
● stones that begin in the kidney → can travel to the urinary tract
● crystals start to form:
➔ urine is too concentrated with minerals and salts resulting in high levels of:
➢ calcium oxalate
➢ phosphorus
➢ uric acid
➔ substances such as citrate that inhibit stone formation are low
● four types of calculi:
1. calcium: with oxalate or phosphate
2. cystine: rare, hereditary (also found in foods)
3. struvite: rare, large, fast-growing stone found in alkaline urine caused by bacteria
in chronic UTIs
4. uric acid
● possible causes:
➔ family hx of stones
➔ inadequate consumption of fluids
➔ warm climate
➔ hyperthyroidism
➔ diet high in sodium, sugar or protein
➔ obesity
➔ UTI
● S/S:
➔ severe, wavelike pain from obstructed urine flow
Amanda Ludwig
UA Results x2 (page 726)
● first-morning specimens:
➔ best & most preferred
➔ concentrated
➔ contain abnormal constituents (if present)
➔ specimen should be examined within 1 hour of collection or kept refrigerated
● urine standing at room temperature longer than 2 hours:
➔ more bacteria present
➔ change in pH
➔ hemolysis of RBCs
● a random urine specimen collected for cytology:
➔ should not be a first-morning specimen (changes in epithelial cells occur in urine
held overnight)
● normal UA result ranges:
➔ color: light yellow to deep amber (as per textbook)
➔ appearance: clear
➔ odor: aromatic
➔ pH: 4.5 → 8.0
➔ specific gravity: 1.005 → 1.030
➔ protein: less than 20mg/dL
➢ for 24 hour urine: 30 → 150mg/dL
➔ RBCs/WBCs: less than 5/hpf
➔ casts: none to rare hyaline
★ The nurse is reviewing the urinalysis of a patient. Which of the following are
abnormal findings to report to the health care provider? Select all that apply.
A. Blood 7/hpf
B. Glucose none
C. Protein 4 mg/dL
D. White blood cells 11/hpf
E. Nitrites positive
F. pH 9.0
Prostate Cancer (page 860, 907, 909)
● dependant on testosterone to grow
● begins: in the posterior or lateral part of the gland
● spreads by one of three routes:
1. (local invasion) → bladder → seminal vesicles → peritoneum
2. (lymph system) → pelvic nodes → supraclavicular nodes
3. (vascular system) → bone → lung → liver
● risk factors:
➔ men 65+
➔ family hx
Amanda Ludwig
, ➔ elevated testosterone
➔ high fat diet
➔ occupational exposures (hydrocarbons, fire smoke)
● S/S:
➔ abdominal pain
➔ anemia
➔ back pain
➔ bone pain (hip)
➔ fatigue
➔ hematuria
➔ urinary obstruction
➔ urinary retention
➔ weakness
➔ weight loss
● complications:
➔ bladder/kidney infection
➔ bone fractures
➔ depression
➔ difficulty urinating
➔ erectile dysfunction
➔ pain
➔ weight loss
tests:
➔ PSA (less than 4ng/mL)
➔ PAP (less than 3ng/mL)
➔ acid phosphatase
➔ alkaline phosphatase
➔ serum calcium
➔ physical examination
➔ ultrasound
➔ biopsy
● therapeutic measures:
➔ Lupron
➔ Zoladex
➔ Casodex
➔ TURP
➔ radical prostatectomy
➔ brachytherapy
➔ sipuleucel-T (provenge)
➔ bilateral orchiectomy
Acute Renal Failure → Oliguric Phase (page 756, 757)
● less than 400 mL of urine is produced in 24 hours
● phase can last from up to 2 weeks to several months
Amanda Ludwig
, ● renal function recovery decreases the longer this phase lasts
● fluid is retained
● electrolytes become imbalanced
● waste products are not excreted as urine output decreases
● increased:
➔ potassium
➔ phosphate
● decreased:
➔ sodium
➔ calcium
● abnormal:
➔ RBCs
➔ WBCs
➔ platelets
● neurologic effects:
➔ confusion
➔ seizures
➔ coma
● metabolic acidosis during this phase (due to reduced hydrogen ion excretion)
Renal Calculi x2 (page 744, 745)
● stones that begin in the kidney → can travel to the urinary tract
● crystals start to form:
➔ urine is too concentrated with minerals and salts resulting in high levels of:
➢ calcium oxalate
➢ phosphorus
➢ uric acid
➔ substances such as citrate that inhibit stone formation are low
● four types of calculi:
1. calcium: with oxalate or phosphate
2. cystine: rare, hereditary (also found in foods)
3. struvite: rare, large, fast-growing stone found in alkaline urine caused by bacteria
in chronic UTIs
4. uric acid
● possible causes:
➔ family hx of stones
➔ inadequate consumption of fluids
➔ warm climate
➔ hyperthyroidism
➔ diet high in sodium, sugar or protein
➔ obesity
➔ UTI
● S/S:
➔ severe, wavelike pain from obstructed urine flow
Amanda Ludwig
