Chapter 41 Flashcards
(125 cards)
1
Q
What is the importance of regular urinary elimination?
A
Regular elimination of liquid waste products is essential for healthy living.
2
Q
What factors influence personal urinary elimination habits?
A
Social, cultural, and physical requirements, including privacy and emotional needs.
3
Q
How much urine do healthy adults eliminate daily?
A
Healthy adults eliminate approximately 1400 mL of urine each day.
4
Q
What organs are involved in the urinary system?
A
The kidneys, ureters, urinary bladder, and urethra.
5
Q
What is the role of the kidneys in urine formation?
A
The kidneys filter liquid waste from the blood, balance electrolytes, regulate blood volume and pressure, and maintain acid-base balance.
6
Q
What are nephrons?
A
Nephrons are the tiny filtering units of the kidney responsible for urine formation.
7
Q
What processes are involved in urine formation?
A
Filtration, reabsorption, and tubular secretion.
8
Q
What is the function of the ureters?
A
Ureters carry urine from the kidneys to the bladder.
9
Q
What is the role of the bladder?
A
The bladder stores urine and contracts to empty it through the urethra.
10
Q
What is micturition?
A
Micturition is the process of urination.
11
Q
What are the normal characteristics of urine?
A
Urine is typically sterile, containing fluids, salts, and waste products, but free of bacteria, viruses, and fungi.
12
Q
What is anuria?
A
Anuria is the failure of the kidneys to produce or excrete urine.
13
Q
What is oliguria?
A
Oliguria is defined as reduced urine volume, less than 500 mL/day in adults.
14
Q
What is polyuria?
A
Polyuria is excessive urine production, defined as more than 2500 mL per day.
15
Q
What is nocturia?
A
Nocturia is excessive urination at night, disrupting sleep.
16
Q
What is dysuria?
A
Dysuria is painful urination that may result from various medical conditions.
17
Q
What is hematuria?
A
Hematuria is the abnormal presence of red blood cells in urine.
18
Q
What is urinary incontinence?
A
Urinary incontinence is the inability to control the passage of urine.
19
Q
What are the types of urinary incontinence?
A
Types include stress incontinence, urge incontinence, mixed incontinence, functional incontinence, and overflow incontinence.
20
Q
At what age are children considered not incontinent?
A
Children are not considered incontinent until after toilet training is well established, typically around the age of 5 years.
21
Q
What are common causes of acute urinary incontinence?
A
Common causes include extended bed rest, medications, increased urine volume, mental confusion, pregnancy, prostate infection or inflammation, stool impaction, and UTIs.
22
Q
What conditions may lead to chronic urinary incontinence?
A
Chronic urinary incontinence may be related to bladder cancer, bladder spasms, depression, enlarged prostate, neurologic conditions, pelvic prolapse, pelvic floor muscle damage, spinal injuries, or weakness of the bladder sphincter.
23
Q
What is urinary retention?
A
Urinary retention is the inability of the bladder to empty, caused by obstruction or neurologic disorders.
24
Q
What symptoms indicate chronic urinary retention?
A
Symptoms include difficulty starting urine flow, weak urine flow, and mild constant discomfort.
25
What is acute urinary retention?
Acute urinary retention is a medical emergency where the patient is unable to urinate despite a full bladder.
26
What factors contribute to urinary retention?
Factors include vaginal childbirth, infections, diabetes, stroke, heavy metal poisoning, pelvic injury, prostate enlargement, surgery, bladder stones, and certain medications.
27
What psychosocial factors affect urinary elimination?
Psychosocial factors include privacy issues, embarrassment, and anxiety related to changes in elimination patterns.
28
How does food and fluid intake affect urination?
Changes in eating or drinking patterns can disrupt normal urination, with dehydration leading to diminished output.
29
What role does muscle tone play in urination?
Muscle tone affects the bladder's ability to contract and expand, influencing urinary control.
30
How can surgical procedures affect urination?
Surgical and diagnostic procedures may alter urine formation, concentration, and passage due to tissue swelling or anesthesia.
31
What are urinary tract infections (UTIs)?
UTIs are infections caused by bacteria, often Escherichia coli, invading the urethra and multiplying.
32
Who is more vulnerable to UTIs?
Females are more vulnerable due to a shorter urethra and its proximity to bacteria sources.
33
What is a urinary diversion?
A urinary diversion is a surgical procedure performed when bladder function is impaired, which may be temporary or permanent.
34
What are the types of urinary diversions?
Types include cutaneous urinary diversion and continent diversions, such as Kock pouch and orthotopic neobladder.
35
What is the normal urinary output for adults?
Normal urinary output is approximately 0.5 to 1.5 mL/kg/hr.
36
What tests evaluate urinary function?
Common tests include blood urea nitrogen (BUN), serum creatinine levels, urinalysis, and urine culture.
37
What does elevated BUN indicate?
Elevated BUN levels may indicate dehydration, kidney disease, or conditions affecting blood flow.
38
What does creatinine measure?
Creatinine measures kidney function and is produced at a steady rate, unaffected by diet or physical activity.
39
What can elevate BUN levels?
Medications may elevate BUN levels.
40
What causes low BUN values?
Low BUN values may be caused by a low-protein diet, malnutrition, liver damage, or excessive liquid intake.
41
Is pretest preparation required for BUN tests?
No pretest preparation is required.
42
Which medications may affect BUN test results?
Certain antibiotics, corticosteroids, and diuretics may affect test results.
43
How is creatinine processed in the body?
Creatinine is filtered from the blood by the kidneys and eliminated in urine.
44
What affects creatinine levels?
Creatinine levels are not affected by diet or normal physical activities.
45
What indicates kidney damage in terms of creatinine?
Decreased urinary creatinine but increased serum levels indicate kidney damage.
46
How do muscle mass and creatinine levels relate?
The amount of creatinine in the blood is directly related to muscle mass; levels are generally higher in men than in women.
47
What are normal serum creatinine values for women?
Normal serum creatinine values for women are 0.5 to 1.1 mg/dL.
48
What are normal serum creatinine values for men?
Normal serum creatinine values for men are 0.6 to 1.3 mg/dL.
49
How are BUN and serum creatinine related?
BUN and serum creatinine are viewed in relationship to each other.
50
What does a sudden rise in BUN-to-creatinine ratio indicate?
Sudden rises in BUN-to-creatinine ratios occur in acute kidney injury associated with shock, dehydration, or severe gastrointestinal bleeding.
51
What conditions show low BUN-to-creatinine ratios?
Low BUN-to-creatinine ratios are seen in patients on low-protein diets or those with severe muscle injury, cirrhosis, or SIADH.
52
What is urinalysis?
Urinalysis is an assessment of urine at a single point in time, used as a screening tool for UTI, kidney disease, and other conditions.
53
How are urinalysis samples collected?
Samples can be collected by having the patient void in a specimen cup or through catheterization.
54
What volume of urine is required for urinalysis testing?
Only small samples of urine (10–15 mL) are required for urinalysis testing.
55
What does specific gravity in urinalysis monitor?
Specific gravity monitors the balance of water and solutes in urine.
56
What is the normal specific gravity range for adults?
Normal specific gravity in adults is 1.005 to 1.030.
57
How does fluid intake affect specific gravity?
Large volumes of water produce dilute urine with low specific gravity; dehydration results in high specific gravity.
58
What does urine pH reflect?
Urine pH reflects the acidity or alkalinity of the urine.
59
What is the average pH of urine?
Urine normally has an average pH of 6.
60
What does a urine pH of 4 indicate?
A urine pH of 4 is very acidic.
61
What does a urine pH of 7 indicate?
A urine pH of 7 is neutral.
62
What does a urine pH of 9 indicate?
A urine pH of 9 is very alkaline.
63
How does urine pH relate to kidney function?
Urine pH is useful in determining the kidneys’ response to acid-base imbalances.
64
What does the presence of protein in urine indicate?
Protein in urine may be associated with fever, vigorous exercise, pregnancy, and kidney disease.
65
What normally prevents protein from entering urine?
Protein molecules are generally too large to escape from the glomerulus capillaries into filtrate.
66
What does glucose in urine indicate?
Glucose in urine may indicate kidney damage or disease.
67
What is the significance of ketones in urine?
The presence of ketones (ketonuria) indicates that fat has broken down for energy.
68
What may large amounts of ketones in urine indicate?
Large amounts of ketones may indicate diabetic ketoacidosis.
69
What does microscopic analysis of urine involve?
Microscopic analysis involves spinning urine in a centrifuge and checking sediment for cells, casts, plugs, or crystals.
70
What does the presence of crystals in urine indicate?
The presence of crystals may indicate that stones are present.
71
What is checked if a UTI is suspected?
Urine may be checked for nitrates and leukocyte esterase levels.
72
What does a positive leukocyte esterase test indicate?
Elevated leukocyte esterase levels indicate the presence of a UTI.
73
What is the purpose of urine culture and sensitivity testing?
It is performed for the diagnosis of a UTI.
74
What is a 24-hour urine collection used for?
It is used to determine the amount of creatinine cleared through the kidneys and to measure levels of various substances.
75
What factors can interfere with a 24-hour urine collection?
Factors include failure to include some output, continuing collection beyond 24 hours, spilling the specimen, and previous ingestion of certain foods or medications.
76
What is required before starting a 24-hour urine collection?
No preparation is required, but the first morning void is discarded.
77
What is an ultrasound assessment used for?
It assesses the size, shape, and location of the kidneys and monitors blood flow.
78
What conditions may interfere with ultrasound results?
Severe obesity, recent barium studies, and excessive intestinal gas may interfere.
79
What is a KUB study?
A kidney, ureter, and bladder (KUB) study is a diagnostic x-ray used to investigate gastrointestinal conditions and detect kidney stones.
80
What is an intravenous pyelogram (IVP)?
An IVP is an x-ray study of the kidneys, bladder, ureters, and urethra using contrast material.
81
What are contraindications for IVPs?
Contraindications include pregnancy, severe kidney disease, metformin use, and iodine allergy.
82
What is computed tomography (CT) used for?
CT is used to diagnose kidney stones, bladder stones, or urinary tract blockage.
83
What is cystoscopy?
Cystoscopy is an examination of the bladder and urethra through a cystoscope.
84
What may cystoscopy be used to diagnose?
It may be used to determine the cause of hematuria, dysuria, incontinence, and other urinary issues.
85
What nursing diagnoses are associated with urinary elimination?
Nursing diagnoses include Impaired Urination, Urinary Retention, and Impaired Self-Toileting.
86
What are some short-term goals for urinary elimination?
Examples include resolution of UTI symptoms within 5 days and spontaneous bladder emptying within 12 hours post-surgery.
87
What are long-term goals associated with urinary elimination?
Examples include reporting no UTIs in 12 months and demonstrating safe toileting tasks within 9 months.
88
What is the focus of the implementation phase in nursing?
The focus is on interventions that assist the patient in achieving goals related to urinary elimination.
89
What is crucial for maintaining urinary tract health?
Patient education is crucial for maintaining urinary tract health.
90
What should be assessed before a patient's discharge?
The home should be assessed for accessibility of toileting facilities and associated safety issues.
91
What is necessary before a patient's discharge regarding incontinence?
Preparations for the patient’s return home must be made, including assessing the home for accessibility of toileting facilities and safety issues.
92
What common factors can alter a patient's urinary elimination pattern in a healthcare facility?
Bed rest, medication use, prescribed medical therapies, and privacy issues can alter the patient’s pattern.
93
What should be done to promote elimination for patients using a bedpan?
Ensure privacy, allow adequate time for the patient to void, and encourage a normal position on the bedpan.
94
Why might a bedpan need to be warmed before use?
A cold bedpan can cause contraction of the perineal muscles, inhibiting voiding.
95
What is a bedside commode?
A chair with a toilet seat top that has a container underneath to collect urine or stool for patients unable to ambulate to the bathroom.
96
When is a bedside commode appropriate for use?
It is appropriate for patients who are weak, unsteady, at risk for falling, or become short of breath when ambulating.
97
What should be done to maintain privacy for patients using a bedside commode?
Pull the privacy curtain and avoid disruptions.
98
What is the purpose of a toileting schedule?
To assist the patient with urinary elimination by encouraging regular voiding intervals.
99
What is the recommended daily fluid intake to maintain normal micturition?
A normal daily intake of 1500 to 2000 mL of fluids is usually adequate.
100
What should be monitored in hospitalized patients regarding fluid?
Both fluid intake and output (I&O) should be monitored and recorded.
101
What constitutes fluid intake?
Fluid intake includes all food and oral fluids, as well as tube feedings and intravenous fluids.
102
How should output be measured?
By collecting fluid and drainage from various receptacles and measuring in milliliters.
103
What are Kegel exercises used for?
To help keep the female pelvic floor toned and reduce the risk of incontinence.
104
What are some key prevention strategies for urinary tract infections (UTIs)?
Encourage cotton-lined underwear, adequate hydration, urination when the urge is felt, and proper perineal hygiene.
105
What is urinary catheterization?
The introduction of a catheter into the patient’s urethra to reach the bladder.
106
What are the types of catheters used for urethral catheterization?
Straight, Foley, triple-lumen, and coudé catheters.
107
What is the primary cause of catheter-associated urinary tract infections (CAUTIs)?
Approximately 80% of UTIs are the result of catheterization.
108
What is routine catheter care?
Cleansing the urethral meatus once or twice daily and ensuring catheter bags are kept below the bladder level.
109
What is the benefit of cleansing with chlorhexidine before urinary catheter insertion?
Cleansing with chlorhexidine may reduce the incidence of catheter-associated urinary tract infections (CAUTIs).
## Footnote
(Mitchell, B., Curryer, C., Holliday, E., et al., 2021)
110
What should be done to prevent backflow in urinary catheter systems?
Catheter bags should be consistently kept below the level of the bladder.
111
What type of urinary catheterization system should be used to reduce risk of interruption?
Preconnected closed-drainage urinary catheterization systems should be used.
112
Is routine irrigation of indwelling catheters recommended for UTI prevention?
No, routine irrigation of the indwelling catheter is not recommended for UTI prevention.
113
When should catheters be changed?
Catheters should be changed if debris or encrustation is noted.
114
What is a suprapubic catheter?
A suprapubic catheter is surgically placed through the abdominal wall for patients with urethral catheterization contraindications or failures.
115
What is the recommended care for patients with suprapubic catheters?
Patients should drink plenty of fluids, cleanse the catheter site daily, and avoid creams or lotions around the site.
116
What are external female catheters designed to do?
External female catheters are designed to reduce CAUTIs in women by attaching around the genital area and draining into a collection bag.
117
What types of external male catheters are available?
External male catheters include specialty styles that fit over the head of the penis and common condom catheters.
118
What are some risks associated with condom catheters?
Risks include skin necrosis, penile strangulation, urethrocutaneous fistulas, dermatitis, skin erosion, pain, and localized infection.
119
What should be done before and after catheter care?
Hand hygiene should be performed before and after catheter care.
120
Why is perineal care important for patients with urinary elimination issues?
Frequent perineal care helps prevent skin breakdown, ulceration, and infection due to urine irritation.
121
What should be avoided in perineal care?
Harsh soaps, bubble baths, powder, or sprays should be avoided as they can irritate the urethra.
122
What special care is needed for patients with urinary diversions?
Special procedures are required to maintain skin integrity and prevent infection, and patients should be encouraged to manage their own care.
123
How should urine specimens be collected?
Specimens may be collected by having the patient void into a specimen cup or using the clean-catch method for culture and sensitivity testing.
124
How are patient goals evaluated?
Patient goals are evaluated as met, partially met, or unmet, and interventions are assessed for effectiveness.
125
What is a primary concern in urinary elimination care?
Preventing kidney disease, UTIs, and secondary complications such as skin breakdown related to incontinence is a primary concern.
