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Getting Ready for Certification: Obstructive Uropathy, Pediatric And Congenital Anomalies, And Incontinence.

The American Board of Nursing Specialties and the American Nurses Credentialing Center suggest that specialty nursing certifications enrich the nursing care, promote improved healthcare outcomes, and validate professional achievements of the clinician in the specialty field. The Certification Board for Urologic Nurses and Associates (CBUNA) is committed to assisting the urologic healthcare worker to achieve this certification.

When preparing to study for the certification examination, it is important to develop a study plan, have an outline to follow, and establish a realistic timeframe. With each topic, as you begin to study, consider the anatomy of the condition, causes, diagnostic tools, treatment options, and outcomes/follow ups.

Obstructive Uropathy

Obstructive uropathy is a major section on the certification examination at all levels. Kidney stones, major types, signs and symptoms, the diagnostic evaluation, and treatment options are important for all levels of clinicians taking the certification examination.

Associate-Level Question

Factors associated with struvite renal stone formation include:

a. Poor fluid intake.

b. Certain kinds of urinary infection.

c. Medical conditions, such as hyperparathyroidism and gout.

d. Consuming too much dairy.

Rationale: "B" is the correct answer. Struvite renal stones form in the presence of urea-splitting bacterial organisms.

Resource

Flagg, L., & Joiner, C.M. (2017). Urinary stone disease. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologic nursing (1st ed., p. 392). Pitman, NJ: Society of Urologic Nurses and Associates.

RN-Level Question

A 34-year-old female patient is added to the office schedule for "passing a kidney stone." A CT performed 2 days ago showed a 6 mm left midureteral stone. You check vital signs and note BP 180/92, pulse 90, respirations 14, temperature 101.1. Her urine is positive for hemoglobin, nitrite, and leukocytes. The patient is pacing the room, groaning, appears pale. Which clinical finding suggests the greatest urgency?

a. Blood pressure 180/92.

b. Hemoglobin positive urine.

c. Nitrite positive urine and temperature 101.1.

d. Patient appears to be in a high level of discomfort.

Rationale: The correct answer is "C." An obstructing stone with a urinary tract infection is life-threatening.

Resource

Flagg, L., & Joiner, C.M. (2017). Urinary stone disease. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologie nursing (1st ed., pp. 393, 400). Pitman, NJ: Society of Urologic Nurses and Associates.

Advanced Practice-Level Question

A 52-year-old obese male comes to your clinic after being seen in the ER following an MVA. CT incidentally revealed bilateral renal stones. You review his medical history and medication list. Which of the following is unlikely to impact formation of renal stones in this patient?

a. The use of lisinopril 10 mg/day for hypertension.

b. Use of allopurinol 300 mg/day for gout.

c. Chronic diarrhea.

d. Poorly controlled diabetes with a urine pH of 5.0.

Rationale: The correct answer is "A." Allopurinol reduces uric acid in the urine and protects against calcium oxalate and uric acid stones. Diarrhea leads to low urine volumes associated with stones. The acidosis associated with diabetes creates an environment conducive to formation of uric acid stones.

Resources

American Urological Association (AUA). (2014). Medical management of kidney stones. Retrieved from http://www.auanet. org/guidelines/medical-management-of-kidney-stones(2014)#x2869

Flagg, L., & Joiner, C.M. (2017). Urinary stone disease. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologic nursing (1st ed., p. 396). Pitman, NJ: Society of Urologic Nurses and Associates.

Pediatric and Congenital Anomalies

While pediatric and congenital anomalies represent only a small portion of the certification examination, these topics are vitally important because these conditions follow patients into adulthood.

Associate-Level Question

Characteristics of renal agenesis include:

a. Duplicated ureters.

b. Ectopic ureters.

c. Horseshoe kidney.

d. Solitary kidney.

Rationale: "D" is the correct answer. Renal agenesis is defined as congenital absence of one or both kidneys.

Resource

Ribbeck, M.R. (2017). Congenital anomalies and malformations of the upper urinary tract. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologic nursing (1st ed., p. 49). Pitman, NJ: Society of Urologic Nurses and Associates.

RN-Level Question

The mother of a 5-year-old boy is asking the RN questions about her child's recent diagnosis of unilateral renal agenesis. Which of these answers is incorrect?

a. The life expectancy of a child with unilateral renal agenesis is normal.

b. The life expectancy of a child with renal agenesis is late adolescence because of the reproductive anomalies that alter hormonal changes resulting in severe co-morbid conditions.

c. Unilateral renal agenesis is associated with other urologic anomalies in the contralateral kidney.

d. Approximately 10% to 15% of males diagnosed with unilateral renal agenesis will also have reproductive anomalies.

Rationale: "B" is the correct answer. Children with unilateral renal agenesis do have a normal life expectancy. The contralateral kidney may present with vesicourethral reflux (VUR), uretero pelvic junction obstruction (UPJ) and ureterovesical junction obstruction (UVJ).

Resource

Ribbeck, M.R. (2017). Congenital anomalies and malformations of the upper urinary tract. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologic nursing (1st ed., p. 49). Pitman, NJ: Society of Urologic Nurses and Associates.

Advanced Practice-Level Question

The nurse practitioner is doing the physical examination on this 5-year-old boy with unilateral renal agenesis. She may expect to find on her examination:

a. The inability to palpate the vas deferens.

b. Small/absent testes.

c. Large, flattened and low set ears.

d. Parrot beak nose.

Rationale: "A" is the correct answer. Answers B, C, and D are all physical characteristics seen in children diagnosed with Potter's syndrome (bilateral renal agenesis).

Resource

Ribbeck, M.R. (2017). Congenital anomalies and malformations of the upper urinary tract. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologic nursing (1st ed., pp. 49-51). Pitman, NJ: Society of Urologic Nurses and Associates.

Incontinence

Incontinence is a major topic on each level of the examination. Understanding medications used to treat this condition is an important component.

Associate-Level Question

Which medication is not used to treat overactive bladder syndrome (OAB)?

a. Oxybutynin (Ditropan[R]).

b. Trospium (Sanctura[R]).

c. Solifenacin (Vesicare[R]).

d. Bethanechol (Urecholine[R]).

Rationale: "D" is the correct answer. Answers A, B, and C are all medications used to treat overactive bladder. Bethanechol is a cholinergic agent used to treat urinary retention related to bladder atony.

Resources

American Urological Association (AUA). (2014). Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: AUA/SUFU guideline. Retrieved from http:// www.auanet.org/guidelines/overactive-bladder-(oab)(aua/sufu-guideline-2012-amended-2014) Ellsworth, P., & Kirshenbaum, E. (2010). Update on the pharmacologic management of overactive bladder: the present and the future. Urologic Nursing, 30(1), 29-38. Lee, M., & Rozette, N.A. (2016). Guide to urologic medications (pp. 2-5, 16-20). Pitman, NJ: Society of Urologic Nurses and Associates.

RN-Level Question

Mrs. Brown, a 54-year-old post-menopausal female, presents with overactive bladder symptoms. Guidelines on overactive bladder from the American Urological Association (AUA) recommend which classification of medication as second-line therapy?

a. Antimuscarinics.

b. Cholinergics.

c. Alpha-1 adrenergic agonists.

d. Alpha-1 adrenergic antagonists.

Rationale: "A" is the correct answer. Anticholinergic, antimuscarinic drugs relax the bladder muscle and reduce bladder spasms (oxybutynin). Cholinergic agents exhibit the actions of the neurotransmitter acetylcholine. They will cause increased muscle contraction, increased urgency, and potential for incontinence (bethanechol). Alpha-1 adrenergic agonists help improve the contractability of the internal urethral sphincter and increase the urethral resistance. These medications are used for stress incontinence (pseudoephrine). Alpha-1 adrenergic antagonists are used to improve the urine flow in older men by relaxing the muscles in the bladder neck and prostatic smooth muscles (terazosin Hcl [Hytrin[R]]).

Resources

American Urological Association (AUA). (2014). Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: AUA/SUFU guideline. Retrieved from http:// www.auanet.org/guidelines/overactive-bladder-(oab)(aua/sufu-guideline-2012-amended-2014)

Ellsworth, P., & Kirshenbaum, E. (2010). Update on the pharmacologic management of overactive bladder: the present and the future. Urologic Nursing, 30(1), 29-38.

Lee, M., & Rozette, N.A. (2016). Guide to urologic medications (pp. 2-5, 16-20). Pitman, nJ: Society of Urologic Nurses and Associates.

Advanced Practice-Level Question

A 24-year-old male with a recent spinal cord injury is seen by the NP in the inpatient rehab center. He has symptoms of frequency, urgency, urge incontinence, and nocturia. The urodynamic study indicates the most likely classification of his overactive bladder to be:

a. Idiopathic.

b. Neurogenic.

c. Myogenic.

d. Somatic.

Rationale: The correct answer is "B." The new term for "neurogenic bladder" is neurogenic lower urinary tract dysfunction. Idiopathic OAB is poorly defined and refers to the inability to attach any one particular cause to the dysfunction. Myogenic classification includes partial denervation of the bladder commonly associated with bladder outlet obstruction and increased intravesical pressures. The term is used to refer to a neurologic cause for an abnormal innervation and function of the bladder and sphincter typically by spina bifida, spinal cord injury, multiple sclerosis, or Parkinson's disease. There is no such classification called somatic.

Resources

Alley, M. (2017). Congenital anomalies and malformations of the lower urinary tract. In D.K. Newman, J.F. Wyman, & V.W. Welch (Eds.), Core curriculum for urologic nursing (1st ed., p. 89). Pitman, NJ: Society of Urologic Nurses and Associates.

Ellsworth, P., & Kirshenbaum, E. (2010). Update on the pharmacologic management of overactive bladder: the present and the future. Urologic Nursing, 30(1), 29-38. McAninch, J.W., & Lue, T.F. (2012). Smith and Tanagho's general urology (18th ed., pp. 442-457). New York, NY: McGraw-Hill Education.

Key Words: Obstructive, uropathy, pediatric, congenital anomalies, incontinence, kidney stones, renal genesis, overactive bladder, urinary urgency.

doi: 10.7257/1053-816X.2018.38.1.42

Katherine E. Marchese, ANP-BC, CUNP, CWOCN, is a Urology Nurse Practitioner, Department of Urology, Rush University Medical Center, Chicago, IL; and President, the Certification Board for Urologic Nurses and Associates.

Christy B. Krieg, MSN, CUNP, is a Family Nurse Practitioner, Department of Urology, Indiana University Health, Indianapolis, IN.
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Title Annotation:Professional Enhancement
Author:Marchese, Katherine E.; Krieg, Christy B.
Publication:Urologic Nursing
Article Type:Report
Date:Jan 1, 2018
Words:1652
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