Chapter 46: Urinary Elimination Flashcards
(114 cards)
1
Q
Urinary elimination depends on the function of what organs?
A
kidneys, ureters, bladder and urethra
2
Q
What nerves must be present for urinary elimination to occur?
A
efferent (motor) and afferent (sensory) nerves from the bladder to the spinal cord and brain
3
Q
When the urinary system fails to function, eventually
A
all organ systems are affected
4
Q
Approximately ________ of the cardiac output circulates through the kidneys each minute.
A
20-25%
5
Q
Nephron
A
functional unit of the kidney that forms urine
6
Q
glomerulus
A
filters approximately 125 ml of filtrate per minute
7
Q
Not all of the filtrate is excreted as urine:
A
approximately 99% is resorbed into the plasma leaving 1% excreted as urine
8
Q
Normal urine output in an adult per day
A
1000-2000 ml/day
9
Q
an output of less than 30 m/hr indicates what?
A
possible circulatory, blood volume or renal alterations
10
Q
The kidneys are responsible for maintaining a normal RBC by producing
A
erythropoietin
11
Q
Erythropoietin
A
functions within the bone marrow to stimulate RBC production, maturation and prolongs the life of mature RBC’s
12
Q
Patient with chronic kidney conditions cannot produce
A
sufficient quantities of erythropoietin therefore are prone to anemia
13
Q
Aldosterone is secreted from
A
the adrenal cortex
14
Q
Aldosterone causes
A
retention of water -> increases blood volume -> increases arterial blood pressure -> increases renal blood flow
15
Q
Why are patients with chronic renal failure prone to developing renal bone disease?
A
they do not make a sufficient amount of active vitamin D
16
Q
Renal bone disease results in
A
demineralization of bone caused by impaired calcium absorption
17
Q
ureters
A
tubular structures that enter the urinary bladder from the kidneys
18
Q
ureters enter the bladder from the
A
posterior wall
19
Q
What causes urine to enter the bladder in spurts?
A
peristaltic waves
20
Q
A kidney stone (renal calculus) within the ureter results in
A
strong peristaltic waves that attempt to move the stone into the bladder resulting in renal colic (causes intense flank pain)
21
Q
The urinary bladder
A
hollow, distensible, muscular organ that stores and secretes urine.
22
Q
The urinary bladder lies where?
A
in the pelvic cavity behind the pubic symphysis
23
Q
Urethra
A
exits the bladder and passes out of the body
24
Q
The urethra is lined with
A
mucous membranes
25
Glands of the urethra
secrete mucus into the urethral canal
26
In a woman, the urethra is how long?
1.5-2" long
27
In men, the urethra is approximately how long?
8" long
28
Most people feel the need to void from
400-600 ml/urine
29
As the bladder stretches,
sensory impulses are sent to the micturition center in the sacral spinal cord.
30
What makes urination a voluntary process?
the fact that impulses can be ignored or acted upon
31
Damage to the spinal cord above the sacral region causes
reflex incontinence.
| however, the micturition reflex pathway may remain in tact.
32
reflex incontinence
loss of voluntary control to urinate.
33
Overflow incontinence
occurs when the bladder is overly full and the pressure in the bladder exceeds the sphincter pressure.
involuntary loss of urine results
34
Causes of overflow incontinence include:
head injury, spinal cord injury, diabetes and trauma to the urinary system
35
Factors influencing urination
- urinary retention
- urinary tract infections
- catheter associated urinary tract infections
- urinary incontinence
- urinary diversions
36
Urinary incontinence
T. 46-1 p 1104-5'
| involuntary leakage of urine that is sufficient to be a problem
37
Urinary Retention can be caused by
post void residual
| BPH
38
Types of UTI's
bacteriuria
pyelonephritis
dysuria
cystitis
39
Urinary diversions include
ureterostomy
| nephrostomy
40
Diabetes Mellitus and neuromuscular diseases cause
changes in nerve functions
41
Diabetes mellitus and neuromuscular diseases causes changes in nerve functions that can lead to
reduced bladder tone
reduced sensation of bladder fullness
inability to inhibit bladder contractions
42
End Stage Renal disease
irreversible damage to the kidney tissue marked by fluid and electrolyte imbalances, accumulation of wastes in the blood and systemic symptoms of N/V, headache, coma and convulsions
43
Urinary retention
accumulation of urine due to the inability of the bladder to empty
44
With severe retention, the bladder can hold as much as
2000-3000 ml of urine
45
When assessing for bladder distention in a patient with urinary retention, it may be
extremely painful
46
Residual Urine (post void residual)
inability to empty the bladder after voiding
- straight cath or bladder scanner to dx
- breeding ground for microorganisms
47
UTI's
most common health care acquired infection
48
80% of UTI's result from
the use of indwelling catheters (results in over 1 million UTI's each year in US)
49
Each day a catheter is in place, there is a
5% increase in bacteria in the urine
50
Catheter associated UTI's are associated with
Increased hospitalizations
Increased morbidity and mortality
Longer hospital stays
Increased hospital costs
51
For UTIs, what is the most common pathogen?
the patient's own colonic flora including Escherichia coli (E coli)
52
What causes UTIs in women?
poor hand hygiene
not wiping from front to back
frequent sexual intercourse (not voiding directly after)
53
Benign Prostatic Hyperplasia
in men makes them prone to urinary retention
54
Dysuria
symptoms of a lower UTI
55
What are symptoms of dysuria?
Burning during urination as urine passes over inflamed tissues
As the infection worsens (pyelonephritis), fever, chills, nausea, vomiting, and malaise develop
56
Cystitis
infection of the bladder
57
Cystitis can cause
Frequent sensation to void (frequency)
| Concentrated urine and cloudy urine due to WBCs in urine
58
Hematuria
blood in the urine due to irritation to the bladder and urethral mucosa
59
Pyelonephritis
kidney infection
60
Pyelonephritis symptoms
flank pain, tenderness, fever and chills
61
Stress incontinence
sneeze, cough
62
Urge incontinence
can't get to the bathroom in time
63
Over Active Bladder
results form sudden, involuntary contraction of the muscles of the urinary bladder resulting in the urge to urinate
64
Common causes of an over active bladder are
diabetes, CVA, UTI, and anxiety (like test anxiety)
65
Incontinence can lead to
impaired body image and loss of independence
| psychological reasons for sexual dysfunction
66
Continued incontinence poses a risk for
pressure ulcers and skin breakdown
67
Consider environmental barriers that are risk for incontinence and falls including
Patients with restricted mobility
Chairs that are too low for older adults to get out of
Beds raised in the high position
Difficulty undoing buttons and zippers
68
Urinary Diversion
temporary or permanent bypass from the bladder and urethra as the exit route for urine
69
Urinary Diversion requires
a stoma (artificial opening) on the abdomen to drain the urine
70
Urinary Diversion is used in patients who
have cancer, radiation or constant urinary tract infections
71
Nephrostomy
catheter inserted directly into the renal pelvis
72
Psychosocial implications of Urination
- self concept: body image, self-esteem, roles and identity
- culture: very private event, embarrassing
- sexuality
73
Incontinence is NOT
NOT a normal part of aging
74
Noninvasive alternatives to catheterization includes
Voiding schedule
Use ultrasound to assess urinary retention as opposed to straight catheterization
Use standards of care
Collaboration with specialists
75
When assessing a patient, assess for
Skin and mucosal membranes: urethral meatus
Bladder for distention
Skin turgor
Oral mucosa (gather data about hydration)
Lab values for kidney function and electrolyte imbalances
Women with vaginal infections often have associated UTIs
Assess the quality of the urine
Measure I&O
76
When measuring I&O's, report
- extreme increases or decreases in urine volume.
| - an hourly output of <30ml/hr for 2 consecutive hours is cause for concern
77
What are factors that influences urination?
```
Age
Environmental Factors:
Medication History:
Psychological Factors:
Muscle Tone:
Fluid Balance:
Current Surgical or Diagnostic Procedures:
Presence of Disease Conditions:
```
78
Nocturia
awakening to void one or more times a night
79
Polyuria
excessive output of urine
80
Oliguria
decreased output despite normal intake
81
Oliguria may be due to
increased loss from vomiting, diarrhea or perspiration OR kidney disease
82
Anuria
no urine is produced. kidney disease
83
Diuresis
promotion of increased urination through means such as caffeine, alcohol (inhibits ADH), or the body's compensatory systems (3-4th day post operative, for example).
84
Characteristics of urine
color, clarity, odor
85
Color of urine
Pale straw color to amber.
| Document any abnormal color and/or sediment esp. if the cause is unknown
86
Clarity of urine
urine should be transparent (see through)
| Document cloudy or foamy (high protein concentration) urine-may be a result of WBCs and bacteria
87
Odor of urine
Document any odor that is not characteristic.
Sweet/fruity
Ammonia smell
Certain medications and foods can also cause a distinctive odor (asparagus, amoxicillin)
88
Strong ammonia odors of urine are usually from
stagnant urine-incontinence.
89
Sweet/fruity of urine is usually occurs from
acetone as a byproduct of incomplete fat metabolism (starvation, diabetes)
90
Common Urine Tests
urinalysis, specific gravity, and urine culture
91
urinalysis
clean catch or catheterized
92
specific gravity
the weight or degree of concentration of a substance compared with an equal volume of water.
93
urine culture
sterile or clean voided sample
| sent to the laboratory to determine which specific antibiotics are effective (sensitivity)
94
Common Diagnostic Urine Tests
- Radiographs (KUB, plain film)
- Intravenous Pyelogram (IVP)
- Ultrasound
- Invasive Procedures
- Endoscopy
- Cystoscopy
95
Many medications directly or indirectly contribute to
urinary dysfunction leading to urinary retention or incontinence
96
Meds that directly or indirectly contribute to urinary dysfunction
```
Antipsychotics
Antidepressants
Alpha adrenergic agonists (clonidine)
Calcium channel blockers (Cardizem, Norvasc, verapamil)
Sedative hypnotics
Opioid analgesics
ACE inhibitors (captopril, Vasotec, Altace)
Antihistamines (Benadryl)
```
97
Factors Related to Aging
Prostate Enlargement in men
Changes in the urethral mucosa associated with the loss of estrogen susceptibility to UTIs
The ability of the kidney to concentrate urine declines
Nocturia
Urinary Frequency: decreased bladder capacity causing more frequent urination
Possible muscle wasting due to immobility
Muscle damage due to childbirth
Being overweight
Over consumption of caffeine or alcohol
98
Nursing Diagnosis
```
Functional Urinary Incontinence
Stress Urinary Incontinence
Urge Urinary Incontinence
Risk For Infection
Toileting Self-care Deficit
```
99
Example of short term goals for urination
After surgery the patient should have normal voiding with complete bladder emptying within 24 hours
100
Example of long term goals for urination
The patient with stress incontinence may need weeks of pelvic floor (Kegel) exercises.
101
Possible interventions
- teach self-care/hygiene activities
- place the patient in normal positions of urination if possible
- using the sound of running water to promote relaxation to help the patient void
- maintain measures to prevent infection
- keep environment safe
- understand side effects of patient medications
102
Teaching self-care/hygiene activities include
Increasing/maintaining an adequate fluid intake (2200-2700ml/day)
Include fluids high in acid such as cranberry or apple juice
Hand hygiene
The normal sterility of the urinary tract
Proper perineal care esp. after urination and defecation
103
What are normal position of urination for men and women?
men: standing
women: sitting up right
104
keeping the environment safe
make a clear path to the bathroom and call light in reach to avoid falls
105
Understanding the side effects of your patient medications includes checking if they cause
constipation, dry mouth, skin irritation and urinary retention
106
A ___________________ is not best practice for incontinence.
indwelling catheter (foley catheter)
107
Proper care and handling of a patient with a foley catheter includes
- keeping bag below the level of patients waist
- keeping the tubing free from kinks and "dependent loops"
- perform perineal care and catheter care at least 3 times a day AND as needed
- use institutions securement devices (Stat-loc) to prevent the catheter tubing from sliding in and out of the urethral meatus
- encourage adequate fluid intake to prevent stagnation of urine in the bladder and keeps the catheter tubing free from sediment
- maintain a closed urinary drainage system
108
Removal of an indwelling catheter
assess the patient's urinary function:
note the first voiding
keep an accurate I&O for 24
109
You should assess for bladder distension in a patient that has an indwelling catheter if
4 hours have elapsed without voiding OR if the patient is experiencing discomfort
110
If patient is unable to void, the nurse should
- use an ultrasound if available
- it may be necessary to either straight cath the patient or even replace the foley catheter if the patient is unable to void
111
Bladder Training includes
- Kegel Exercises
- initiating a toileting schedule
- avoid an overfilled bladder which increases the risk of incontinence
- minimizing caffeine and alcohol
- take a prescribed diuretic med early in the morning
- maintain a healthy weight
112
Kegel Exercises
pelvic floor exercises
113
Evaluate compliance with
- dietary restrictions
- pelvic muscle exercises
- effectiveness of antibiotic treatment
114
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