CBUNA CURN cheat sheet

Kidney sits retroperitoneally at T12–L3; right kidney lies lower than left because of the liver; adult kidney is roughly 11–12 cm long, 5–7 cm wide, 2.5–3 cm thick.

Nephron order: glomerulus → proximal convoluted tubule → loop of Henle → distal convoluted tubule → collecting duct; the loop of Henle establishes the medullary osmotic gradient for concentration.

Normal GFR ≈ 125 mL/min (≈180 L/day filtered); urine output ≈ 1–2 mL/kg/h in adults, with <0.5 mL/kg/h for 2 consecutive hours meeting a common oliguria definition.

Ureter is 25–30 cm long with three anatomic narrowing points (ureteropelvic junction, crossing of iliac vessels, ureterovesical junction) where stones lodge.

Bladder capacity is 400–600 mL with first desire to void near 150–250 mL; detrusor contraction is parasympathetic (S2–S4, pelvic nerve), while sympathetic (T10–L2, hypogastric) relaxes the detrusor and contracts the internal sphincter.

Micturition: pontine storage center keeps the external urethral sphincter (pudendal nerve, S2–S4) contracted until voluntary relaxation triggers coordinated detrusor contraction and sphincter relaxation.

Male urethra is ~20 cm in four parts (prostatic, membranous, bulbous, pendulous); female urethra is ~4 cm, which explains higher female risk of ascending infection.

ADH (vasopressin) increases collecting-duct water permeability via aquaporin-2; aldosterone increases sodium reabsorption and potassium secretion in the distal tubule.

Terminology: dysuria = painful voiding; hematuria = blood in urine; pneumaturia = gas in urine (suggests fistula); enuresis = involuntary nocturnal voiding; retention = inability to empty.

Focused urologic history: onset/duration of symptoms, voiding pattern and volumes, stream force, straining, terminal dribbling, nocturia episodes, fluid and caffeine intake, and current medications.

AUA Symptom Index (IPSS) scores 7 items 0–5; total 0–7 mild, 8–19 moderate, 20–35 severe - document the numeric score, not just a descriptor.

Bladder diary: record time and volume of each void, leakage episodes, pad use, and fluid intake for at least 3 consecutive days; it is the primary tool for frequency, urgency, and nocturia.

Urinary retention assessment: palpable suprapubic dullness, post-void residual by bladder scan (often >300–400 mL significant), and acute retention presents with suprapubic pain and inability to void.

Pain assessment uses 0–10 numeric rating scale; renal colic classically is severe, colicky flank pain radiating to the groin with restlessness, versus the constant pain of pyelonephritis.

Documentation must be objective and timed: intake/output totals, urine color/clarity/odor, catheter type and French size, drainage bag volume, and condition at shift handoff.

SBAR (Situation, Background, Assessment, Recommendation) frames escalation for fever with an indwelling catheter or sudden anuria.

Communication barriers: use trained medical interpreters for limited-English patients, teach-back to verify understanding, and avoid jargon; hearing or cognitive impairment requires shorter, repeated, written instructions.

Abnormal findings to report immediately: gross hematuria with clots, urine output <0.5 mL/kg/h, new fever >38 °C with an indwelling device, and testicular pain of sudden onset (torsion is time-critical).

CAUTI prevention bundle: avoid unnecessary catheters, use aseptic insertion technique, maintain a closed drainage system, keep the bag below bladder level, and review need daily.

Hand hygiene is the single most effective intervention; perform before and after any catheter or stoma contact, and use gloves plus hand hygiene for all device manipulation.

Aseptic insertion: perineal cleansing with antiseptic solution, sterile gloves and drape, single-use lubricant, and securing the catheter to prevent traction on the urethra.

Do not routinely irrigate or change indwelling catheters on a fixed schedule; remove as soon as no longer indicated and consider external or intermittent alternatives.

Catheter specimen collection: clamp the tubing below the sampling port for 15–30 minutes, disinfect the port, aspirate with a sterile syringe; never sample from the drainage bag.

Drainage bag must not touch the floor; empty when two-thirds full, using a separate container per patient, and prevent backflow by keeping the bag below the bladder.

Routine urine cultures are not indicated for asymptomatic bacteriuria except in pregnancy or before urologic instrumentation; treat only symptomatic infection.

Meatal care with routine antiseptics is not recommended; daily hygiene with soap and water during bathing is sufficient and reduces mucosal irritation.

Signs of CAUTI: new fever, suprapubic or flank pain, rigors, change in urine character, and leukocytosis without another source; remove the catheter when feasible and culture before antibiotics.

Urinalysis: pH 4.5–8.0, specific gravity 1.005–1.030; nitrite positive and leukocyte esterase positive suggest bacterial infection; >3 RBC/hpf is microscopic hematuria.

Urine culture: clean-catch midstream specimen; ≥100,000 CFU/mL is classic significant bacteriuria, though lower counts can be significant with symptoms or catheter specimens.

Renal function: BUN 7–20 mg/dL, creatinine 0.6–1.2 mg/dL; calculate eGFR (CKD-EPI) for staging chronic kidney disease.

PSA is a prostate-specific, not cancer-specific marker; levels can rise with BPH, prostatitis, ejaculation, or instrumentation, so avoid ejaculation and vigorous prostate manipulation before draw.

Cystoscopy: flexible or rigid scope through the urethra; assess for hematuria, stricture, and bladder tumors; post-procedure burning and mild hematuria are expected.

Urodynamic testing measures filling pressure, detrusor activity, compliance, and flow; it identifies detrusor overactivity, obstruction, and stress incontinence.

24-hour urine collection for stone risk: keep refrigerated or on ice, discard the first void, include the final void at exactly 24 hours, and record total volume.

Before contrast imaging (CT urography, IVP) screen for iodine allergy, metformin use, and renal impairment (eGFR threshold often 30 mL/min/1.73 m²).

Post-procedure priorities: monitor for bleeding, urine retention, and signs of sepsis; ensure adequate hydration after contrast and after stone procedures.

BPH: lower urinary tract symptoms from transition-zone enlargement; treat with alpha-blockers for rapid symptom relief, 5-alpha-reductase inhibitors for large glands, and combination therapy for progression risk.

Acute urinary retention is a urologic emergency: relieve with catheterization, monitor for post-obstructive diuresis (>200 mL/h for 2 hours), and evaluate for reversible causes.

Urinary tract stones: calcium oxalate most common; <10 mm may pass spontaneously, larger or infected obstructing stones need urgent decompression (stent or nephrostomy).

Renal colic first-line imaging is non-contrast CT; ultrasound is preferred in pregnancy and children to avoid radiation.

Bladder cancer: painless gross hematuria is the classic presentation; urothelial carcinoma is most common; smoking and occupational aromatic amine exposure are major risks.

Renal cell carcinoma: triad of hematuria, flank pain, and palpable mass is late-stage; many are incidental on imaging; paraneoplastic findings include hypercalcemia and polycythemia.

Prostate cancer: screen with PSA and digital rectal exam; Gleason/Grade Group determines risk; treatment options include active surveillance, surgery, radiation, and hormonal therapy.

Testicular cancer: painless firm mass in a young man; radical inguinal orchiectomy is diagnostic and therapeutic; tumor markers are AFP, beta-hCG, and LDH.

Fournier gangrene is a necrotizing fasciitis of the perineum - a surgical emergency with broad-spectrum antibiotics and debridement; suspect with disproportionate pain, crepitus, and sepsis.

Ileal conduit is the most common non-continent diversion: urine drains continuously into an external pouch; the stoma is typically right lower quadrant, spouted, and beefy red.

Continent cutaneous reservoir (Indiana pouch) requires self-catheterization every 4–6 hours; capacity typically 400–500 mL and must be emptied on schedule to prevent leakage and infection.

Orthotopic neobladder uses a detrusor voiding pattern with relaxation and Valsalva; patients need pelvic floor training and may require intermittent catheterization for incomplete emptying.

Healthy stoma: rose to red, moist, protrudes 1–2 cm; pale, dusky, or black tissue indicates ischemia and must be reported immediately.

Stoma appliance change every 3–7 days; empty pouch when one-third to one-half full; skin barrier should be cut to stoma size, not oversized.

Peristomal skin breakdown is most often caused by leakage, ill-fitting appliances, or candidiasis; measure stoma and refit rather than adding more paste.

Ostomy output: ileal conduit urine output is continuous; dehydration risk rises with high output, so monitor intake, output, and signs of hypovolemia.

Continence care: timed voiding, bladder training, pelvic floor muscle exercises, and containment products are first-line behavioral strategies; pessaries support pelvic organ prolapse.

Stoma education includes pouch selection, skin care, odor control, dietary considerations, and psychosocial adjustment; refer to an ostomy nurse for fitting and support groups.

Alpha-blockers (tamsulosin, doxazosin) relax prostatic smooth muscle; counsel on orthostatic hypotension and take at bedtime; tamsulosin is more prostate-selective.

5-alpha-reductase inhibitors (finasteride, dutasteride) shrink prostate volume over 3–6 months and lower PSA by roughly 50% at 6 months - document this before interpreting future PSA.

Anticholinergics (oxybutynin, tolterodine) treat overactive bladder; antimuscarinic effects include dry mouth, constipation, and confusion in older adults; mirabegron (beta-3 agonist) avoids these but raises blood pressure.

PDE5 inhibitors (sildenafil, tadalafil) are contraindicated with nitrates; warn about hypotension and priapism lasting >4 hours, which is an emergency.

BCG intravesical therapy for bladder cancer: instill via catheter, retain 1–2 hours, then void; rotate patient positions every 15 minutes; handle urine with bleach for 6 hours.

Intravesical chemotherapy (mitomycin C, gemcitabine) follows similar instillation protocols; use personal protective equipment and follow hazardous-drug handling.

Continuous bladder irrigation after TURP: titrate rate to keep urine light pink; if clots or dark red output occur, increase irrigation and manually irrigate with a catheter-tip syringe.

Antibiotic prophylaxis is not routine for every catheter; use for urologic procedures with mucosal trauma, and tailor to local resistance and culture results.

Urinary analgesics: phenazopyridine relieves dysuria but turns urine orange and stains clothing; it is a dye, not an antibiotic, and should not mask infection.

Teach-back is the standard method to confirm understanding: ask the patient to explain or demonstrate the skill in their own words.

Intermittent self-catheterization: wash hands, lubricate the catheter, insert gently until urine flows, drain fully, and remove slowly; teach frequency of every 4–6 hours or as prescribed.

Pelvic floor muscle training: identify the correct muscles by stopping urine midstream, then perform 8–12 contractions three times daily; avoid breath-holding and abdominal straining.

Fluid guidance: aim for 1.5–2 L/day unless fluid-restricted; reduce caffeine, alcohol, and carbonated drinks that irritate the bladder; limit evening fluids for nocturia.

Constipation management supports continence: adequate fiber, hydration, and regular toileting reduce bladder pressure and leakage.

Psychosocial screening: ask about embarrassment, sexual function, social isolation, and depression; validate feelings and refer to counseling, support groups, or a sex therapist.

Sexuality after urologic surgery: discuss erectile dysfunction, orgasm changes, and fertility preservation before treatment, not only afterward.

Stoma acceptance follows a grief-like adjustment; involve family, connect with peer mentors, and plan for return to work and leisure activities.

Self-monitoring: teach patients to track voiding, leakage, and catheter output, and to report fever, flank pain, inability to catheterize, or blood clots.

Scope of practice is defined by state nurse practice acts, licensure, employer policy, and certification; the CURN credential demonstrates specialty knowledge but does not expand legal scope.

Delegation requires the right task, circumstances, person, direction/communication, and supervision; catheter insertion is typically a licensed-nurse task, not delegated to unlicensed assistive personnel.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, voluntariness, and documentation; the nurse verifies and witnesses, and the provider obtains consent.

Confidentiality is governed by HIPAA and professional codes; share only minimum necessary information and use secure channels for urologic records.

Advocacy: raise concerns through the chain of command when a patient's safety or preferences are at risk, and document the concern and response.

Ethical principles in urology: autonomy (treatment refusal, advance directives), beneficence, nonmaleficence, justice (access to care), and veracity.

Mandatory reporting includes suspected abuse, neglect, and certain communicable diseases; follow state law and institutional policy.

Professional boundaries: avoid dual relationships and social media contact with patients; maintain objectivity and document objectively.

Evidence-based practice: appraise guidelines (AUA, EAU), participate in quality improvement, and use current evidence over tradition in catheter and stoma care.