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UNJ October 04 Getting Ready for Certification: Urinary Tract Inflammation And Diseases Mary M. Linn ave you ever wondered why the TV game 2. What is the most common organism in elderly show Jeopardy has been so successful over patients with acute prostatitis? these many years? It is a show that simply a. Eschererichia coli. has questions and answers encompassing b. Proteus mirabilis. Hmany different fields of knowledge. As viewers c. Beta-hemolytic Streptococcus. watch the program, it seems that all try to answer d. Klebsiella the questions. It is fun and satisfying to know the correct response. As a viewer, there is no money 3. Mr. Clark is a 45-year-old man who complains of awarded, but the process of recalling facts, dates, severe left-sided scrotal pain that has been grad- and data is fulfilling. It is a fact that we all enjoy ually increasing over the last 3 days. He also knowing the answer. complains of dysuria and generalized left-sided Increasing knowledge in urology is also certain- scrotal swelling. Mr. Clark most likely has: ly rewarding. Not only does the practitioner gain a. Testicular cancer. that satisfaction of confidence in knowledge, but the b. Epididymitis. patient is better served by a trained caretaker. By c. Sperm granuloma. studying to become a certified advanced practice d. Balanitis. nurse, certified urological nurse, or certified associ- ate, the field of information increases immeasurably. 4. Mr. Morse has a history of benign prostatic The Certification Board of Urologic Nurses and hypertrophy with the associated lower urinary Associates (CBUNA) encourages you to challenge tract symptoms of urgency, frequency, and yourself to broaden your knowledge of urology. You incomplete emptying. He is seen in the clinic will find that it is fun to know the answers. due to a urinary tract infection and prostatitis. To learn more about the certification process, The nurse should instruct Mr. Morse to avoid simply go to www.suna.org and click on “Become which of these classes of medications? Certified.” a. Alpha-adrenergics. b. Cholinergics. 1. Mrs. Jones is a 56-year-old female who is having c. Urinary analgesics. recurrent urinary tract infections (UTIs). She is d. LH-RH analogues. concerned that infections recur even though she is following recommendations from the physi- 5. A patient has unexplained fever, hematuria, and cian. To reassure the patient, the nurse explains pyruia. However, repeated urine culture and that the infections may continue due to which of sensitivity testing results are negative for bacte- the following: ria. What should the nurse suspect? a. Previous hysterectomy. a. Candidiasis. b. High serum calcium. b. Chancroid. c. Adherence of bacterial cells to the lining of c. Human papillomavirus. the urinary tract. d. Genitourinary tuberculosis. d. Presence of lactobacillus within the peri- urethral area. Answers 1. C — Bacterial adherence to cells lining the uri- nary tract correlates with infection. Women with UTIs have a higher adherence of bacteria to their cells compared to women who have never had an infection. Answers A and B are not cor- rect as previous hysterectomy and calcium lev- Mary M. Linn, BSN, CURN, is the Nursing Supervisor, Dominion Urological Consultants, Fairfax, VA. els do not directly cause recurrent UTIs. Answer 412 UROLOGIC NURSING / October 2004 / Volume 24 Number 5 D is incorrect since the presence of lactobacillus Answer A is incorrect because candidiasis is a within the periurethral area is actually a defense yeast fungal infection. The normal flora of the against uropathogenic bacteria (Tanagho & urinary tract usually suppresses yeast infection. McAninch, 2004, p. 204). Chancroid refers to soft chancre. This is com- 2. A — Escherichia coli (E. coli) is the most com- monly seen in tropical countries and causes mon causative organism. Acute prostatitis ulcerative lesions that appear on the male as results from infection ascending from the ure- penile lesions. The female often complains of thra or reflux of infected urine from the bladder painful urination, defecation, or dyspareunia. in the prostatic ducts. Answers B, C, and D, are Answer C is incorrect because human papillo- incorrect because Protein mirabilis, Beta- mavirus are called genital warts and are sexual- hemolytic Streptococcus, and Klebsiella are ly transmissible. The lesions are soft papules pathogens less frequently found as the causative found on the penis in males and the labia, vulva, organism (Tanagho & McAninch, 2004, p. 218). or cervix in females (Karlowicz, 1995, p. 167). • 3. B — Epididymitis. Patients with epididymitis present with severe scrotal pain and scrotal References enlargement. The swelling is due to the inflam- Karlowicz, K.A. (Ed.) (1995). Urologic nursing: Principles and practice. Philadelphia: W.B. Saunders. mation of the epididymis. Symptoms associated Tanagho, E.A., & McAninch, J.W. (Eds.). (2004). Smith’s general with urinary tract infection, such as urethritis, urology (16 ed). Norwalk, CT: Appleton & Lange. cystitis, or prostatitis, may be present prior to the scrotal swelling. Answer A is incorrect because testicular cancer is usually painless with a gradual enlargement of the testis. The mass is usually firm and nontender. For answer C, a sperm granuloma is a round mass which is caused by granulomatous inflammation after extravasation of sperm from the tubules. This commonly occurs following vasectomy. Balanitis is inflammation of the glans penis (Tanagho & McAninch, 2004, pp. 221, 389). 4. A — Alpha-adrenergics. These medications such as ephedrine sulfate, imipramine, phenyl- propanolamine hydrochloride, and pseu- doephedrine exaggerate alpha response in the bladder neck and urethra to increase bladder outlet resistance. Since this patient has some degree of bladder outlet obstruction, increased resistance to the urinary flow could result in uri- nary retention. For answer B, cholinergic med- ications use a certain type of chemical to a send signal to muscle fibers. Within the bladder mus- cle fibers, cholinergic response would signal muscle contraction. These drugs contract the bladder, which would result in complete emp- tying. For answer C, urinary analgesic medica- tions, such as Pyridium® and Urogesic®, are used to relieve pain, burning, and discomfort of the urinary tract. Answer D is incorrect because LH-RH agonists are medications that are used to control the growth and spread of prostate can- cer. These medications cause the testosterone level to drop to castrate level; therefore, growth of prostate cells and prostate cancer cells is slowed to very low levels (Karlowicz, 1995, p. 391). 5. D — Genitourinary tuberculosis. Classic signs of genitourinary tuberculosis usually include hematuria, fever, and sterile pyuria. The patient may also have symptoms of a urinary tract infec- tion. In later stages, there may be symptoms of weight loss, fatigue, and anorexia. Recurrent UTIs that do not respond to antibiotic therapy should cause the nurse to suspect tuberculosis. UROLOGIC NURSING / October 2004 / Volume 24 Number 5 413.
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