HAII Quiz: CH 25

Cloudy urine

UTI, kidney stones

Blue urine

medication side effect (amitriptyline, indocin)foods: asparagusdye after prostate surgery

Dark gray urine

urine contains melanin, melanuria

Tea urine

liver disease, especially with pale stools, jaundicemyoglobinuriasome medications or food dyesblood in urine

Pink urine

with mensessome foods like beets, berries, food dyessome laxativeskidney stonesUTI

Red urine

blood in urinenephritis, cystitscancer (prostate, bladder)following prostate surgery

Orange urine

Medication side effect: Rifampin for meningitis, Pyridium, Warfarin (Coumadin)Some foods, food dyes, laxativesDehydrationJaundice (bilirubinemia)

Amber urine

gold or concentrated with dehydrationsome laxativesfood or supplements with b complex vitamins

Yellow urine

natural yellow is urochrome excretion, a pigment in bloodbright neon yellow with vitamin supplements

Pale yellow urine

clear, watery with excess liquidsacute viral hepatitis, cirrhosis

Aging adult

No definite end to fertilityAround 40 years, production of sperm begins to decr, although it continues into 80-90sTestosterone production declines after age 30 but continues very gradually so resulting physical changes are not evident until later in life- pubic hair decr, penis size decr- due to decr tone of dartos muscle, scrotal contents hang lower, rugae decr, scrotum becomes pendulous- testes decr in size and are less firm to palpation- incr connective tissue is present in tubules, so these become thickened and produce less sperm

Culture and genetics: circumsion

During pregnancy or immediate neonatal period, parents may ask whether or not to circumcise male infantReligious and cultural as well as medical indication- AAP health benefits outweigh risksLowers risk for certain STIs such as HPV, herpes simplex virus, genital ulcer disease in men and decr risk for bacterial vaginosis and trichomoniasis in femalesReduced risk for contracting HIV infection through heterosexual contact

Culture and genetics: kidney disease

Two main causes of ESRD: hypertension & diabetesPrevalence of diabetes & hypertension is higher in some racial groups: African Americans, American Indians & Hispanics are more likely to be affectedContributing factors such as low socioeconomic status lead to poor health outcomes by limiting access to care and/or diagnosis/treatment being delayed

Culture and genetics: bladder cancer

4th most common cancer in men with ethnic differencesSmoking is the most common risk factor along with occupational exposure to chemicalsAssess for painless hematuria.

Testicular self-examination (TSE)

Encourage self-care by teaching every male from 13 to 14 years old through adulthood how to examine his own testiclesOverall incidence of testicular cancer is still rare, but testicular cancer most commonly occurs in young men age 15 to 35 Early detection of cancer enhanced if male is familiar with his normal consistencyPoints to include during health teaching are:T - timing, once a monthS - shower, warm water relaxes scrotal sacE - examine, check for and report changes immediately

Assessment of urinary function

Observe urine colorNote pH and specific gravity (pH 4.5-8) (1.0003)Serum analysis of kidney function correlated w/ creatinine level which is relatively stable (end product of muscle metabolism) (normal level .7-1.5)BUN measures urea which can vary based on several factors (end product of protein metabolism) (10-20, above 20 may indicate dehydration)

Urethritis (Urethral Discharge and Dysuria)

Infection of urethra causes painful, burning urination or pruritusMeatus edges are reddened, everted, and swollen w/ purulent dischargeUrine is cloudy w/ discharge and mucus shredsCause determined by urine screen:-- gonococcal urethritis has thick, profuse, yellow/gray-brown discharge-- nongonococcal urethritis may have similar discharge but often has scanty, mucoid dischargeOf these, about 40% are caused by chlamydia

Renal calculi

Renal stones from calcium oxalate or uric acid form in kidney tubules and then migrate and become urgent when they pass into ureter, become lodged, obstruct urine flow, causing hydronephrosis..Abrupt severe flank pain w/ radiation to the groin or abdomen, N/V, restlessness, gross or microscopic hematuria

Acute urinary retention and urinary tract infection

Inability to pass urine w/ bladder distention and lower abdominal painCommon in older men due to bladder outlet obstruct of BPHThis can cause UTI, from stasis and turbulent flowIncr among men ages >60Presents w/ dysuria, frequency, urgency, nocturia, suprapubic pain, occasionally gross hematuria, possible fevertx w/ antibiotics and address underlying problem

Urethral stricture

Pinpoint, constricted opening at meatus or inside along urethra. Occurs congenitally or secondary to urethral injury. Gradual decrease in force and caliber of urine stream is most common symptom. Shaft feels indurated along ventral aspect at site of stricture.

Aging woman

Females hormonal milieu decr rapidly in contrast w/ slow decline in aging male- menopause: cessation of menses- uterus shrinks in size and decr myometrium- uterus droops as sacral ligaments relax and pelvic musculature weakens---- sometimes it may protrude, or prolapse, into vagina- ovaries atrophy to 1-2cm and are not palpable after menopause- cervix shrinks, looks paler, thick, glistening epithelium- vagina becomes shorter, narrower, and less elastic b/c of incr connective tissue--- atrophy of tissues w/ incr alkalinity

Cervical cancer

Racial/geographic disparity- black women have higher cervical cancer incidence rates and lower relative survival rates than white women- factors leading to this occurrence: stage of diagnosis, access to care, patient refusal, inappropriate physician recommendation, poorer health and presence of comorbidities

HPV vaccine

For all boys and girls starting at 11 and 12 years of age

Female circumsion

Infibulation or female genital mutilation - invasive surgical procedure (removal partial or total of the clitoris) usually performed on girls before puberty (social custom)- practiced w/ in Aboriginal, Christian, and Muslim families who have emigrated to US from western and Southern Asia, Middle East, and large areas of Africa

Pap smear

Screens for cervical cancer, but not for endometrial or ovarian cancerDo not obtain during woman's menses or if a heavy infectious discharge presentInstruct the woman not to douche, have vaginal intercourse, or put anything into vagina 24hrs before collectingObtain a pap smear before other specimens so you will not disrupt or remove cells