1. Spell and define the key terms 2. List and describe the disorders of the. the urinary system and the male reproductive

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CHAPTER 34 Urology Learning Outcomes Cognitive Domain 1. Spell and define the key terms 2. List and describe the disorders of the urinary system and the male reproductive system 3.

1 CHAPTER 34 Urology Learning Outcomes Cognitive Domain 1. Spell and define the key terms 2. List and describe the disorders of the urinary system and the male reproductive system 3. Describe and explain the purpose of various diagnostic procedures associated with the urinary system 4. Discuss the role of the medical assistant in diagnosing and treating disorders of the urinary system and the male reproductive system 5. Identify common pathologies related to each body system 6. Describe implications for treatment related to pathology Psychomotor Domain 1. Perform a female urinary catheterization (Procedure 34-1) 2. Perform a male urinary catheterization (Procedure 34-2) 3. Instruct a male patient on the testicular self-examination (Procedure 34-3) 4. Assist physician with patient care 5. Prepare a patient for procedures and/or treatments 6. Practice standard precautions 7. Document patient care 8. Document patient education 9. Practice within the standard of care for a medical assistant Affective Domain 1. Apply critical thinking skills in performing patient assessment and care 2. Use language/verbal skills that enable patients understanding 3. Demonstrate empathy in communicating with patients, family, and staff 4. Use appropriate body language and other nonverbal skills in communicating with patients, family, and staff 5. Demonstrate awareness of the territorial boundaries of the person with whom you are communicating 6. Demonstrate sensitivity appropriate to the message being delivered 7. Demonstrate recognition of the patient s level of understanding in communications 8. Recognize and protect personal boundaries in communicating with others 9. Demonstrate respect for individual diversity, incorporating awareness of one s own biases in areas including gender, race, religion, age, and economic status 10. Apply active listening skills 11. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting 629

2 630 PART III The Clinical Medical Assistant ABHES Competencies 1. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system 2. Comply with federal, state, and local health laws and regulations 3. Communicate on the recipient s level of comprehension 4. Serve as a liaison between the physician and others 5. Show empathy and impartiality when dealing with patients 6. Document accurately

3 CHAPTER 34 Urology 631 Name: Date: Grade: COG MULTIPLE CHOICE Circle the letter preceding the correct answer. 1. Cystoscopy is: a. an inflammation of the urinary bladder. b. the direct visualization of the bladder and urethra. c. a procedure used to help patients pass calculi. d. the treatment used for men with an inguinal hernia. e. the use of a small camera inserted into the rectum. 2. Which of the following might contribute to psychogenic impotence? a. Disease in any other body system b. Injury to pelvic organs c. Medication d. Exhaustion e. Cardiovascular problems 3. Before scheduling a patient for an IVP or a retrograde pyelogram, you must check for a(n): a. protein allergy. b. lubricant allergy. c. iodine allergy. d. rubber allergy. e. latex allergy. 4. A procedure that cleanses the blood of waste products and excess fluid is: a. oliguria. b. lithotripsy. c. proteinuria. d. cystoscopy. e. dialysis. 5. Young girls are prone to urethritis because they: a. forget to practice good hand-washing technique. b. have a short urethra. c. don t take enough baths. d. urinate too frequently. e. wipe from front to back. 6. Which of the following instructions would be helpful for a patient trying to pass a stone? a. Eat a large amount of fiber. b. Get plenty of bed rest and relaxation. c. Drink lots of water. d. Go to the hospital when the stone passes. e. Do not consume anything until the stone has passed. 7. Orchiopexy is surgery to correct: a. undescended testes. b. enlarged prostate. c. inguinal hernia. d. impotence. e. hydrocele. 8. One common urinary disorder in females is: a. benign prostatic hyperplasia. b. nocturia. c. hydrocele. d. cryptorchidism. e. urinary tract infection. Scenario for questions 9 and 10: An elderly patient comes in for a routine checkup, and the physician discovers his prostate gland is very enlarged. 9. What is a blood test you can run to look for prostate cancer? a. PSA test b. Proteinuria c. Snellen test d. Digital rectal exam e. Dialysis

4 632 PART III The Clinical Medical Assistant 10. A urinary condition that might indicate an enlarged prostate gland is: a. proteinuria. b. oliguria. c. nocturia. d. hematuria. e. pyuria. 11. Seventy-five percent of men with prostate cancer are over age: a. 15 years. b. 30 years. c. 34 years. d. 50 years. e. 75 years. 12. What kind of juice is recommended to patients to acidify urine? a. Tomato juice b. Orange juice c. Grape juice d. Cranberry juice e. Grapefruit juice 13. A patient should be given a catheter when: a. the patient suffers from nocturia. b. the patient has a urinary tract infection. c. the patient s urine has high PSA levels. d. the patient has calculi. e. the patient has dysuria. 14. Which of the following instruments is used to view the bladder and urethra? a. Catheter b. Cystoscope c. Dialysis machine d. Ultrasound e. Pyelogram 15. Which of the following patients is most likely to develop a urinary tract infection? a. A young boy who frequently urinates b. A teenaged girl who takes bubble baths c. An elderly woman who only wears loose-fitting dresses d. An adult woman who showers immediately after sexual intercourse e. A middle-aged man who does not wash his hands very often 16. Which of the following is the initial step in catheterization of a patient? a. Wash your hands. b. Open the catheterization kit. c. Put on sterile gloves. d. Use antiseptic swabs to clean area. e. Assist patient to assume position. 17. What is a symptom of hydronephrosis? a. Proteinuria b. Chills c. Swollen prostate d. Back pain e. High PSA levels 18. Which of the following is true for catheterizing both men and women? a. Tray may be placed on patient s lap for easy access to tools. b. Patient s position is on his or her back, legs apart. c. Catheter is inserted 5 inches. d. Nondominant hand is contaminated. e. Coudé catheter may be used.

5 CHAPTER 34 Urology Which of the following is a cause of organic impotence? a. Exhaustion b. Anxiety c. Depression d. Stress e. Endocrine imbalance 20. Ultrasonography can be used to treat which of the following? a. Renal failure b. Hydronephrosis c. Calculi d. Urinary tract infection e. Inguinal hernia COG MATCHING Grade: Place the letter preceding the defi nition on the line next to the term. Key Terms Definitions 21. anuria 22. blood urea nitrogen 23. catheterization 24. cystoscopy 25. dialysis 26. dysuria 27. enuresis 28. hematuria 29. impotence 30. incontinence 31. intravenous pyelogram (IVP) 32. lithotripsy 33. nephrostomy 34. nocturia 35. oliguria 36. prostate-specific antigen 37. proteinuria a. an inability to achieve or maintain an erection b. painful or difficult urination c. crushing a stone with sound waves d. the removal of waste in blood not filtered by kidneys by passing fluid through a semipermeable barrier that allows normal electrolytes to remain, either with a machine with circulatory access or by passing a balanced fluid through the peritoneal cavity e. excessive urination at night f. a blood test to determine the amount of nitrogen in blood or urea, a waste product normally excreted in urine g. of psychological origin h. a normal protein produced by the prostate that usually elevates in the presence of prostate cancer i. the density of a liquid, such as urine, compared with water j. radiography using contrast medium to evaluate kidney function k. direct visualization of the urinary bladder through a cystoscope inserted through the urethra l. an examination of the physical, chemical, and microscopic properties of urine m. failure of kidneys to produce urine n. blood in the urine o. the presence of large quantities of protein in the urine; usually a sign of renal dysfunction p. scant urine production q. the urge to urinate occurring more often than is required for normal bladder elimination r. a surgical opening to the outside of the body from the ureter to facilitate drainage of urine from an obstructed kidney

6 634 PART III The Clinical Medical Assistant 38. psychogenic 39. pyuria 40. retrograde pyelogram 41. specific gravity 42. ureterostomy 43. urinalysis s. pus in the urine t. bed wetting u. the placement of a catheter in the kidney pelvis to drain urine from an obstructed kidney v. the inability to control elimination of urine, feces, or both w. a procedure for introducing a flexible tube into the body x. an x-ray of the urinary tract using contrast medium injected through the bladder and ureters; useful in diagnosing obstructions 44. urinary frequency COG SHORT ANSWER Grade: 45. What is the difference between hemodialysis and peritoneal dialysis? 46. What are calculi? 47. List five microorganisms that may cause epididymitis. a. b. c. d. e.

7 CHAPTER 34 Urology What are the symptoms of a possible tumor in the urinary system? 49. Are stones more likely to form when urine is alkaline or acidic? 50. Why is a woman more likely to have cystitis than a man? 51. Why are infections in the male urinary tract likely to spread to the reproductive system? 52. What are the three characteristics of the prostate that the physician is checking when performing a digital rectal examination?

8 636 PART III The Clinical Medical Assistant 53. An older adult male patient with prostatic hypertrophy must be given a catheter in order to obtain a urine sample. What is the best type of catheter to use, and why? 54. List three suggestions to help patients avoid urinary tract infections. 55. What is the difference between an intravenous pyelogram and a retrograde pyelogram? What might the medical assistant be responsible for with regards to the physician order for an intravenous pyelogram and retrograde pyelogram? COG TRUE OR FALSE? Grade: Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement. 56. Orchiopexy refers to either one or both undescended testes. 57. A nephrologist is a physician who specializes in the physical characteristics of the urinary system. 58. No other form of birth control is needed after a man receives a vasectomy. 59. Your office is obligated to notify a patient if a procedure or medication is still in clinical trials, but likely to be approved.

9 CHAPTER 34 Urology 637 COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: 1. A middle-aged patient in good shape comes in complaining of some pain in his groin. The physician suspects he might have an inguinal hernia. What is the procedure to diagnosis this, and how is it corrected? 2. An older adult patient has been diagnosed with renal failure and will need to undergo dialysis. However, he is not sure if hemodialysis or peritoneal dialysis would be better for his lifestyle. What information can you tell him about the two different processes, including the advantages and disadvantages of each? 3. The physician asks you to give information to one of the patients about passing small calculi. What would you tell the patient about calculi, and what suggestions would you give to help the patient pass the stones? 4. A man in his early 20s has come in for his physical, and the physician has instructed you to teach him about testicular disease. You will also need to teach him how to perform a self-examination. However, the man is shy and embarrassed about the procedure. What can you say to him to help him overcome his discomfort?

10 638 PART III The Clinical Medical Assistant 5. An older adult woman has chronic renal failure, and the physician decides that she will need a catheter for peritoneal dialysis. The woman is upset that she needs this, because she believes that it will limit her movement and ability to participate in activities she likes. What can you tell her about catheters and how her lifestyle will change that might put her more at ease?

11 CHAPTER 34 Urology 639 PSY PROCEDURE 34-1 Perform a Female Urinary Catheterization Name: Date: Time: Grade: EQUIPMENT/SUPPLIES: Straight catheterization tray that includes a #14 or #16 French catheter, a sterile tray, sterile gloves, antiseptic, a specimen cup with a lid, lubricant, and a sterile drape; an examination light; an anatomically correct female torso model for performing the catheterization; a biohazard container STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.) KEY : 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted PROCEDURE STEPS SELF PARTNER INSTRUCTOR 1. Wash your hands. 2. Identify the patient. a. Explain the procedure and have the patient disrobe from the waist down. b. Provide adequate gowning and draping materials. 3. Place the patient in the dorsal recumbent or lithotomy position. a. Drape carefully to prevent unnecessary exposure. b. Open the tray and place it between the patient s legs. c. Adjust examination light to allow adequate visualization of the perineum. 4. Remove the sterile glove package and put on the sterile gloves. 5. Remove sterile drape and place it under the patient s buttocks. 6. Open the antiseptic swabs and place them upright inside the catheter tray. 7. Open the lubricant and squeeze a generous amount onto the tip of the catheter. 8. Remove the sterile urine specimen cup and lid and place them to the side of the tray. 9. Using your nondominant hand, carefully expose the urinary meatus. 10. Using your sterile dominant hand, use antiseptic swabs to cleanse the urinary meatus by starting at the top and moving the swab down each side of the urinary meatus and down the middle, using a new swab for each side and the middle. Do not contaminate the glove on this hand.

12 640 PART III The Clinical Medical Assistant 11. Pick up the catheter with the sterile, dominant hand and: a. Carefully insert the lubricated tip into the urinary meatus approximately 3 inches. b. Leave the other end of the catheter in the tray. 12. Once the urine begins to flow into the catheter tray, hold the catheter in position with your nondominant hand. 13. Use your dominant hand to direct the flow of urine into the specimen cup. 14. Remove catheter when urine flow slows or stops or 1,000 ml has been obtained. 15. Wipe the perineum carefully with the drape that was placed under the buttocks. 16. Dispose of urine appropriately and discard supplies in a biohazard container. a. Label the specimen container and complete the necessary laboratory requisition. b. Process the specimen according to the guidelines of the laboratory. 17. Remove your gloves and wash your hands. 18. Instruct patient to dress and give any follow-up information. 19. Document the procedure in the patient s medical record. CALCULATION Total Possible Points: Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = % PASS FAIL COMMENTS: Student s signature Date Partner s signature Date Instructor s signature Date

13 CHAPTER 34 Urology 641 PSY PROCEDURE 34-2 Perform a Male Urinary Catheterization Name: Date: Time: Grade: EQUIPMENT/SUPPLIES: Straight catheterization tray that includes a #14 or #16 French catheter, a sterile tray, sterile gloves, antiseptic, a specimen cup with a lid, lubricant, and a sterile drape; an examination light; an anatomically correct male torso model for performing the catheterization; a biohazard container STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.) KEY : 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted PROCEDURE STEPS SELF PARTNER INSTRUCTOR 1. Wash your hands. 2. Identify the patient. a. Explain the procedure and have the patient disrobe from the waist down. b. Provide adequate gowning and draping materials. 3. Place the patient in the supine position. a. Drape carefully to prevent unnecessary exposure. b. Open the tray and place it to the side or on the patient s thighs. c. Adjust examination light to allow adequate visualization of the perineum. 4. Remove the sterile glove package and put on the sterile gloves. 5. Carefully remove the sterile drape and place it under the glans penis. 6. Open the antiseptic swabs and place them upright inside the catheter tray. 7. Open lubricant and squeeze a generous amount onto the tip of the catheter. 8. Remove sterile urine specimen cup and lid and place them to the side of the tray. 9. Using your nondominant hand, pick up the penis to expose the urinary meatus. 10. Using your sterile dominant hand, use antiseptic swabs to cleanse the urinary meatus by starting at the top and moving the swab around each side of the urinary meatus and down the middle, using a new swab for each side and the middle. Do not contaminate the glove on this hand.

14 642 PART III The Clinical Medical Assistant 11. Using your sterile dominant hand, pick up the catheter. a. Carefully insert the lubricated tip into the meatus approximately 4 to 6 inches. b. The other end of the catheter should be left in the tray. 12. Once the urine begins to flow into the catheter tray, hold the catheter in position. 13. Use your dominant hand to direct the flow of urine into the specimen cup. 14. Remove the catheter when urine flow slows or stops or 1,000 ml has been obtained. 15. Wipe the glans penis carefully with the drape that was placed under the buttocks. 16. Dispose of urine appropriately and discard supplies in a biohazard container. 17. Label the specimen container and complete the necessary laboratory requisition. 18. Process specimen according to the guidelines of the laboratory. 19. Remove your gloves and wash your hands. 20. Instruct patient to dress and give any follow-up information. 21. Document the procedure in the patient s medical record. CALCULATION Total Possible Points: Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = % PASS FAIL COMMENTS: Student s signature Partner s signature Instructor s signature Date Date Date

15 CHAPTER 34 Urology 643 PSY PROCEDURE 34-3 Instruct a Male Patient on the Self-Testicular Examination Name: Date: Time: Grade: EQUIPMENT/SUPPLIES: A patient instruction sheet if available; a testicular examination model or pictures STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.) KEY : 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted PROCEDURE STEPS SELF PARTNER INSTRUCTOR 1. Wash your hands. 2. Identify the patient and explain the procedure. 3. Using the testicular model or pictures, explain the procedure. a. Tell the patient to examine each testicle by gently rolling between the fingers and the thumb with both hands. b. Check for lumps or thickenings. 4. Explain that the epididymis is located on top of each testicle. a. Palpate to avoid incorrectly identifying it as an abnormal growth or lump. b. Instruct patient to report abnormal lumps or thickenings to the physician. 5. Allow the patient to ask questions related to the testicular self-examination. 6. Document the procedure in the patient s medical record. CALCULATION Total Possible Points: Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = % PASS FAIL COMMENTS: Student s signature Partner s signature Instructor s signature Date Date Date

LESSON ASSIGNMENT. Urinary System Diseases/Disorders. After completing this lesson, you should be able to:

LESSON ASSIGNMENT. Urinary System Diseases/Disorders. After completing this lesson, you should be able to: LESSON ASSIGNMENT LESSON 4 Urinary System Diseases/Disorders LESSON ASSIGNMENT Paragraphs 4-1 through 4-8. LESSON OBJECTIVES After completing this lesson, you should be able to: 4-1. Identify the purposes