Chapter 27 - urinary elimination (Week 6 Quiz) Flashcards Preview

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Flashcards in Chapter 27 - urinary elimination (Week 6 Quiz) Deck (70):

Identify the major structures of the urinary system.

Answer: The urinary system comprises the following major structures:

● Two kidneys

● Two ureters

● Bladder

● Urethra


What are the functions of the kidneys?

Answer: Kidneys have the following functions: Primary functions ● The kidneys filter metabolic wastes, toxins, excess ions, and water from the bloodstream and excrete them as urine. ● The kidneys also help to regulate blood volume, blood pressure, electrolyte levels, and acid–base balance by selectively reabsorbing water and other substances. Secondary functions ● Produce erythropoietin ● Secrete the enzyme rennin ● Activate vitamin D3 (calcitriol)


What are the functions of the kidneys?

Answer: Kidneys have the following functions: Primary functions ● The kidneys filter metabolic wastes, toxins, excess ions, and water from the bloodstream and excrete them as urine. ● The kidneys also help to regulate blood volume, blood pressure, electrolyte levels, and acid–base balance by selectively reabsorbing water and other substances. Secondary functions ● Produce erythropoietin (which produces red blood cells) ● Secrete the enzyme rennin ● Activate vitamin D3 (calcitriol)


Nephron is basic strutctural and functional unit of the kidney. Each nephron consists of

1. bowmans capsule, enclosing a gloerulus 2. a series of filtrating tubules 3. collecting duct


●   Briefly describe how urine is formed.




Urine is formed by filtration, reabsorption and secretion.

Urine is formed in the nephrons.


  1. The renal arteries bring blood to the kidneys and into the glomeruli.
  2. Blood pressure forces plasma, dissolved substances, and small proteins out of the porous glomeruli into the Bowman’s capsule to form a liquid called filtrate.

Tubular Reabsorption

  1. The filtrate moves from Bowman’s capsule into the tubular network of the nephrons where 99% of the fluid is reabsorbed.
  2. About 1% of filtrate returns, as urine, to the collecting tubule, which transports it into the ureters.

WAter and sodium are reabsorbed in distal/collecting tubules when ADH and aldosterone are secreted.


What is the glomerular filtration rate?

Amount of filtrate formed by kidney per minute


What does ADH do?

when the amt of fluid inthe body decreases, ADH is secreted, causing the distal and collecting tubules to reabsorb more water into the blood


 What role do the ureters, bladder, and urethra play in urinary elimination?


The structures of the urinary system have the following roles:

●   The ureters transport urine from the kidneys to the bladder.

●   The bladder stores urine until it is excreted.

●   The urethra transports urine from the urinary bladder to the body exterior.


T or F: you cannot palpate an empty bladder.

True. But a full or distended bladder extends upward to form a pear shape tha you can feel in the surprpubic region.


How much urine can a bladder hold?

200-450 ml of urine (Legaspi says nurses = 650mL)


What are the events leading to urinary elimination?

•Filling of bladder à 200–450 mL (50-200mL in children) of urine stimulates urge to void
•Activation of stretch receptors in bladder wall
•Signaling to the voiding reflex center
•Contraction of detrusor muscle (internal sphincter relaxes - involuntary)
Conscious relaxation of external urethral sphincter


T or F: voiding and control of urination requires only a functioning bladder and urethra.

False. Brain, spinal cord, and nerves of bladder and urethra must also be in tact and functioning.


   Identify at least three methods for determining whether hydration is adequate and urine output is within normal limits. 




Methods for determining if hydration is adequate and urination is normal include the following:

●   The person voids 1,500 mL in a 24-hour period in five to six voids.

●   An infant has 8–10 wet diapers per day.

●   For most adults, pale to clear urine indicates adequate hydration.


___ _____ is ma measure of dissolved solutes in a solution. The normal range for uring is 1.002 to 1.028. 

Specific Gravity


can be measured with reagent or refractometer




What factors effect urinary elimination?

p. 650+

  • Developmental factors:
    • Infants - do not have voluntary control (15-60mL per KG per day) 
    • Toilet training cannot occur until child can communicate urge to go and control external urethra
    • Older adults - aging leads to decreased renal blood flow which leads to decline in glomerular filtration. Bladder loses elasticity. Renal mass decreases with age.
    • Pregnancy - can weaken pelvic muscles (Kegels!)
  • Personal, Sociocultural, Environmental 
    • anxiety
    • lack of time (nurses)
    • lack of privacy
    • loss of dignity (due to hospitalization)
    • cultural - may need same sex assistance and hold it for a family member to come help
  • Nutrition – strawberries, oranges, etc can irritate the bladder. Caffeine, and chocolate give diuretic effect. High salt diet = less urination; alcohol blocks ADH and increases urine output
  • Hydration/Activity level
  • Medications - we learned in Pharm this past week
  • Surgery and anesthesia - structual changes due to surgery, anesthesia decreases BP therefore decreases urinary output.
  • Pathological conditions -
    • §Bladder/kidney infections/UTI
    • §Kidney stones
    • §Hypertrophy of the prostate (male)
    • §Mobility problems
    • §Decreased blood flow through glomeruli
    • §Neurological conditions
    • §Communication problems
    • §Alteration in cognition
    • TURP - transurethral resection of the prostate


T or F: Children should be punished for bed wetting.

False! Enuresis is normal in children, esp when childe is intensely involved in a game, test or other absorbing activity. Such events should be accepted ad not punished (p.650)


You will need a nursing history to determine what is normal for a patient. During the interview, help the patient to feel at ease. DUring the physical assessment, you should cover:

examination of the kidneys, bladder, urethra, skin and are surrounding genitals.


 What common medications increase the amount of urine voided?


Diuretics increase urine output.


What types of medications are associated with urinary retention?


Medications with anticholinergic effects may lead to urinary retention.


What types of conditions or surgeries are associated with a high incidence of altered urination?


Patients with surgeries or pathology involving the genitourinary tract have a high incidence of altered urination


 What should you discuss with your client when performing a nursing history focused on urinary elimination?


The following items should be part of a nursing history focused on urinary elimination:

●   Normal urination pattern

●   Appearance of urine

●   Changes in urination habits or urine appearance

●   History of urination problems

●   Use of urination aids

●   Lifestyle questions

●   Presence of urinary diversions, if any


What are the key elements of a physical assessment for a client with urination problems?


Physical assessment for urinary elimination includes examination of the kidneys, bladder, urethra, and skin surrounding the genitals.

●   Kidneys. Examine the kidneys by assessing for costovertebral angle tenderness (CVAT).

●   Bladder. Assess the bladder with inspection, palpation, and percussion.

●    Begin the assessment by observing for swelling of the lower abdomen. Lightly palpate the lower abdomen to define the bladder margin. Observe the patient’s response to palpation, noting any signs of tenderness or discomfort.

●    Next, percuss the area. A distended bladder that has risen into the abdomen produces a dull sound, as opposed to the normal tympanic sound of intestinal air.

●    Correlate the findings with data about the client’s fluid intake and voiding.

●   Urethra. Assess the urethra by inspecting the urethral orifice. Look for erythema, discharge, swelling, or odor. These are all signs of infection, trauma, or inflammation.

●   Perineal area. Inspect the skin in the perineal area for signs of breakdown or irritation.


If you give a person 8 oz of ice, what would you chart?

4 oz 


Ice counts as half


Of course if they ask for mL you have to multiply by 30.


P.654 discusses obtaining urine samples for studies

  • Freshly voided
  • Clean Catch
  • Sterile - never disconnect the catheter from the drainage tube to obtain a sample. Interrupting system creates a portal of entry for pathogens, thereby increasing the risk of contamination (p654) *safety 
  • 24-hour
  • Bed Side dipstick test


●   Explain how to collect a clean-catch urine specimen.

To collect a clean-catch specimen, the client must cleanse the genitalia before voiding and collect the sample in midstream. For detailed instructions, refer to Procedure 27-1 in Volume 2.


T or F: when performing a 24 hour urince collection, you start by including the first urine of the day.

False. You begin the 24 hour period at the first void but you do not collect it. Discard the first void of the cycle.


What is anuria?

absence of urine


Box 27-3 p.655

Covers terms associated with urination.


Too many too include.


What is enuresis? Dysuria?



enuresis - involuntray loss of urine

dysuria - painful or difficult urination (Dys sucks)


You are caring for a patient on a hospital unit from 0700 to 1200. Based on the following information, calculate the I&O and comment on your findings.

Receiving IV fluid at 125 mL/hr

0800 breakfast—4 oz juice, toast, scrambled eggs, 8 oz coffee

0930—3 oz water

0700 to 1200—wound drainage: 360 mL

0700 to 1200—urine output per indwelling catheter: 180 mL


●   Intake. The patient’s fluid intake is 1075 mL in 5 hours; this includes IV fluid and oral fluid.

●   Output. The patient’s fluid output is 540 mL in 5 hours; this includes urine and wound drainage.

●   Comments. There is a +535 mL balance, although the urine output is low at an average of 36 mL/hr.


BUN (blood urea nitrogen) and creatinine levels are commonly measured to assess...

renal function, and hydration


normal range:

5-18 mL/dL kids

8-21 mL/dL 14-adult*

10-31  mL/dL  age 90



What does a high BUN test mean? Low?

High: (Remeber HIGH = Higher risk that something is wrong with kidneys)

  • renal failure
  • impaired renal perfusion
  • kidney infection/inflammation
  • kidney obstruction
  • dehydration
  • excessive protein intake (reason we have to ask about nutrition!)
  • use of TPN

Low: (Remember low as in low amount of absorption or protein)

  • inadequate protein
  • malabsorption
  • liver disease


A UTI is usually caused by what bacteria?

E. Coli


An infection limited to the urethra is called ______.


______ occurs when bacteria travel up the urethrra into the bladder, causing a bladder infection. If not treated, it can lead to _______.



pyelonephritis (infection of kidneys)



Anyone who has an indwelling catheter is at risk because...

  1. Failing to maintain closed drainage system increases ris for infection by allowing bacteria to enter the catheter ; provides pathway for bacterial infection
  2. The catheter irriates the mucosal lining of the urethra which then creates portal of entry; longer it is left in the higher the risk of UTI
  3. Urine collection bag is a reservoir for microorganisms



Why are diabetic people at high risk for UTI?

Glucose in urine provides nutrients for bacteria to multiply


How do we treat UTI?



Urinary _____ is an inability to empty thebladder completely. Urinary _____ is a lack of voluntary control over urination.

retention; incontinence


What are some causes of urinary retention?

obstruction, inflammation & swelling, neurological problems, medications, anxiety.


Urinary incontinence is associated with ...

  • Skin impairment
  • obesity
  • UTIs
  • self rated poor health
  • reduced mobility
  • depression
  • increased caregiver burden.


T or F: incontinence is a normal change amongst aging populations.

False. It may be common but it is not a normal change. In fact, this is why many elderly do not seek treatment.


In men, it is most likely related to BPH or prostectomy


What are the various types of incontinence?

  • Urge - involuntary loss of larger amts of urine. Referred to as overactive bladder
  • stress - involuntary loss of small amounts with increased intra-abdominal pressure.
  • mixed - urge + stress
  • overflow - related to distended bladder
  • functional - untimely loss of urine; can't get to a toilet in time.
  • transient incontinence - short term that is expected to resolve
  • unconscious - person does not realize the bladder is full and has no urge to void.

Enuresis is also considered incontinence - involuntary urination after 5-6 years old (primary - if training was never achieved; secondary - if primary was achieved but then lost). nocturnal enuresis is bedwetting


How do we treat urinary incontinence?

Less invasive treatments to be tried first:

timed voiding and kegel exercises are first option; also reduction of caffeine intake. Weight loss if obese.

If first line of treatment does not work:

  • medication - topical estrogen, anticholinergic drugs
  • devices - 
  • sacral nerve stimulation - 
  • surgery - bladder suspension, prostate resection*


*Resection is the surgical removal of part or all of a damaged organ or structure


How can we promote normal urination?

  • Provide privacy ― curtains, doors
  • Assist with positioning:
    • men can use urinal in bed but if prefer standing help them to bedside commode or bathroom
    • women usually prefer seated upright position
    • If pt bed ridden and use urinal or bedpan, put in semi fowler's position.
  • Facilitate toileting routines ― identify client’s pattern
  • Promote adeuqate fluids/nutrition
  • Assist with hygiene:
    • Urine irritates the skin, keep dry
    • Assist w/ usual cleansing routine (pour warm soapy water over genitals while seated on toilet; rinse)
    • Offer method of hand cleansing for patient


Read p.662 red self care box on bottom left

Teaching to prevent UTI


How can we manage urinary retention?

  1. Urinary Catheterization:
  • Introduction of a sterile tube into the bladder
  • Straight catheter
  • In dwelling catheter: Foley
  • Suprapubic catheter

2. cholinergic meds (urecholine)

3. Crede's maneuver (manual pressure on bladder)

4. Apply heat to the lower abdomen to relax muscles.

5. Run water nearby or put pt's hand in it.

6. Pour water over the perinuem or assist pt to warm sitz bath.



Look at different Types of Urinary Catheter Pg 663


What is the benefit to catheterization?

Protects skin from moisture (maceration) 

obtain sterile sample

prevent bladder overdistention

empty bladder prior to your procedure

measure the amount of urine left after bladder emptied 

p.662 - slide 13-16



What is the reason we don't use the catheter unless absolutely necessary?

An indwelling catheter is the most common cause of nosocomial infections. Be sure to use strict sterile technique. Catheters must be well lubricated to protect the mucose of the urethra




The female client states to the nurse, “I’m so distressed. It seems like every time I laugh hard, I wet myself.” The nurse knows that this condition is known as

  a.  stress incontinence

  b.  urge incontinence

  c.  functional incontinence

  d.  unconscious incontinence

  Stress incontinence results from increased pressure within the abdominal cavity.


Four nurses are inserting catheters in their clients. Which nurse’s statement, related to this intervention, is incorrect?

  I am inserting this catheter to

    a.  empty your bladder prior to your procedure

  b.  treat your problem of leaking urine

  c.  obtain a sterile urine specimen

  d.  measure the amount of urine left after you emptied your   bladder

Correct answer:    B

  Insertion of a urinary catheter is not a “treatment” for incontinence.


What is the purpose of intermitten self-catheterization?

Patients with spinal cord injuries or neuro disorders use this method to drain the bladder and lmit risk of infection. Decreased risk of infection compared to indwelling catheter.




A _____ catheter is a single lumen tube that is inserted for immediate drainage of the bladder. After bladder is emptied it is removed. 

straight catheter


Less likely to become infected like indwelling; can use clean for straight vs sterile technique for indwelling.


An _____ catheter is also known as a foley. It is used for continuous drainage of the bladder.



Describe the difference between a catheter used for straight catheterization and one used for ongoing drainage.




The catheters have the following differences:

●   A straight catheter has a single lumen and is inserted for brief periods for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure post-void residual volume, or to relieve temporary bladder distention).

●   An indwelling catheter (Foley or retention catheter) is used for continuous bladder drainage and may have two or three lumens. The first lumen drains urine, the second lumen is used to inflate the balloon that holds the catheter in place, and a third lumen may be used for bladder irrigation.


 Why is intermittent catheterization preferred for patients who must be catheterized over lengthy periods of time?


For patients who must be catheterized over lengthy periods of time, intermittent catheterization is preferred because it carries a substantially lower risk of infection than an indwelling catheter.


 What are the steps for catheterization?



  1. Verify the order
  2. Gather appropriate supplies
  3. Explain the procedure to the patient
  4. Answer any questions the patient may have
  5. Provide privacy
  6. Have pt lie in dorsal recumbent position if possible (if not use side lying)


When caring for a client with an indwelling catheter you notice sandy particles around the urethral meatus. What should you do?


Sandy particles are signs of encrustation and indicate the catheter should be replaced. Provide perineal care to the patient and obtain an order for replacement of the catheter from the primary care provider.



After removing an indwelling catheter, you must follow up with the patient. Edem of the urethra, muscle tone loss may occur. If an indwelling was left in for several weeks, and the bladder was able to drain continuously it will not stretch like noraml. What is a method of bladder retraining to deal with that?

One method is to begin clamping the catheter for certain periods of time (1-4 hours) to allow the bladder to fill, then releasing the clamp to empty. This should stimulate the bladder muscle and improve tone.


T or F: If a pt had short term catheterization, it's best to remove the catheter late night.

True. Studies have shown that if the patient holds the urine in th bladder for a longer period (overnight) leading to larger volume for the first void after catheter is discontinued and they end up discharged sooner without recatheterization.


How often should the urine collection bag be emptied?


Empty the urine collection bag at least every 8 hours, or more often if it is full, to make it more convenient for the patient to ambulate.


How do we manage urinary incontinence?

  • Perineal skin care - urine ic acidic; in contact with skin becomes alkaline and causes dermatitis/excoriation
  • Behavioral interventions:
    • Lifestyle modification - diet changes, increased fluid intake, quit smoking, avoid cafeeine, prevent constiopation, low impact exercise.
    • Bladder training - goal is to enable the pt to hold increasing volumes of urine in bladder and increase intervals between voidings.
    • Scheduled voiding - similar to bladder training. Adjust time.
    • Pelvic Floor Muscle Rehab (PFMR) - kegel exercise
    • Vaginal weight training - not proven to be better than kegel alone
    • Biofeedback - electrodes on perineum give feedback on contraction
    • supportive intervention - promotes self care; if using;
  • anti-inconinence devices - 
  • pharmacological/surgical interventions
  • managing enuresis


Why should we use the term brief and NOT diaper for anyone older than a toddler?

Brief gives the patient dignity. We do not want to damage our patients self esteem. That would be the opposite of promoting normal urination


When inserting an indwelling urinary catheter in a male patient, the nurse cleanses the penis with an antiseptic wash. Which step should she take next?

1) Gently insert the tip of the prefilled syringe into the urethra to instill the lubricant.
2) Ask the patient to bear down as though trying to void.
3) Slowly insert the end of the catheter into the urinary meatus.
4) Insert the catheter about 7 to 9 inches (17 to 22.5 cm) or until urine flows.



1) Gently insert the tip of the prefilled syringe into the urethra to instill the lubricant.



The steps of the procedure for inserting an indwelling urinary catheter are as follows. The nurse should gently insert the tip of the prefilled syringe into the urethra and instill the lubricant. Then the nurse should ask the patient to bear down as though trying to void, as she slowly inserts the end of the catheter into the meatus. She should continue to insert the catheter about 7 to 9 inches (17 to 22.5 cm) or until urine flows. When urine appears, she should advance the catheter 1 to 2 inches (2.5 to 5 cm) more. She should hold the catheter securely with her dominant hand while the urine flows. After urine flows, she should stabilize the catheter's position in the urethra and use the other hand to pick up the saline-filled syringe and inflate the catheter balloon.


The nurse is obtaining the history of a newly admitted patient. Which element in the patient's history places the patient at risk for urinary tract infection?

1) Hypertension
2) Hypothyroidism
3) Diabetes mellitus
4) Hormonal contraceptive use


3) Diabetes mellitus



Diabetes mellitus places the patient at risk for urinary tract infection because glucose in the urine provides a medium favorable for bacterial growth. Hypertension, hypothyroidism, and hormonal contraceptive use are not directly related to an increased risk for urinary tract infection.


A patient who underwent surgery for removal of a pituitary tumor develops a condition in which the kidneys are unable to conserve water and the quantity of urine voided increases. Which urine specific gravity would the nurse expect to find in the patient with this disorder?

1) 1.001
2) 1.010
3) 1.025
4) 1.030


1) 1.001

(Remeber that urine that is closer to clear is 1.000; so if you are peeing more a lot, typically it will run clear and be dilute)



The patient with diabetes insipidus would have a low specific gravity, such as 1.001. This indicates dilute urine that results from poor concentrating ability of the kidneys. Normal urine specific gravity ranges from 1.010 to 1.025. A specific gravity of 1.030 indicates concentrated urine or deficient fluid volume (dehydration).


Which blood level is commonly tested to help assess kidney function?

1) Hemoglobin
2) Potassium
3) Sodium
4) Creatinine


4) Creatinine



The nurse would examine laboratory results for blood urea nitrogen and creatinine to assess kidney function. Hemoglobin, potassium, and sodium levels can be affected by kidney disease, but they do not directly assess kidney function.


A patient is admitted with pyelonephritis. Which anatomic structure is affected by this disorder?

1) Kidneys
2) Bladder
3) Urethra
4) Prostate gland


1) Kidneys



Pyelonephritis is an infection of the kidneys. Cystitis is an infection involving the bladder. An infection of the urethra is known as urethritis. Prostatitis is an infection involving the prostate gland.


The parent of a 7-year-old son brings the child to the pediatric care provider to discuss her child's nighttime bedwetting. She reports he has never achieved consistent dryness at night. What is the nurse's best response to the mother's concern?

1) "We'll start medication right away to control it."
2) "Family history is not associated with bedwetting."
3) "We will look for a urinary tract infection."
4) "Wait it out. Your son will likely outgrow it."


4) "Wait it out. Your son will likely outgrow it."



Based on the history, the nurse understands the condition is nocturnal enuresis because the child has not yet achieved dryness at night at an age where continence would be expected. Nocturnal en uresis is most common among boys. Ninety-five percent of children outgrow it by age 10. Nighttime bedwetting runs in families. So if one parent was a bedwetter, then the chances the child will also have trouble with achieving continence at night will be likely. Pharmacologic intervention can be useful for older children, particularly when the child is not sleeping at home. However, prior to age 8 or 10, medication is not indicated.


The nurse is teaching an older female patient how to manage stress incontinence at home. She instructs her to contract her pelvic floor muscles for at least 10 seconds followed by a brief period of relaxation. What is this intervention called?

1) Prompted voiding
2) Crede technique
3) Valsalva maneuver
4) Kegel exercises


4) Kegel exercises



Kegel exercises strengthen the pelvic floor muscles that support the uterus, bladder, and bowel. Doing Kegel exercises regularly can reduce urinary incontinence. These exercises involve tightening and relaxing the muscles around the vaginal area. Prompted voiding is a part of a bladder training program where the person learns to void based on a schedule, rather than empty the bladder. The Crede technique is applying manual pressure with your hands to the top portion of the bladder to initiate a urine flow. The Valsalva is the maneuver in which a person tries to exhale forcibly with a closed glottis (the windpipe) so that no air exits through the mouth or nose, for example, in strenuous coughing, straining during a bowel movement, or lifting a heavy weight.


There is a 24-hour urine collection in process for a client. The NAP inadvertently empties one specimen into the toilet instead of the collection “hat.”  The nurse should

  a.  Continue with the collection of urine until the 24-hour time  period is finished.

  b.  Make a note to the lab to inform them that one specimen was   missed during the collection.

  c.  Begin filling a new collection container and take both   containers to the lab at the end of the collection period.

  d.  Dispose of the urine already collected and begin an entirely new   24-hour collection.

Correct answer:   D

  Once one specimen is “missed” during a 24-hour urine collection, the results of the lab test will be inaccurate and the collection must be restarted.