Genitourinary and Fluid Balance Flashcards
(24 cards)
What are the functions of the kidney:
- regulates water volume, concentration of solutes in water, blood pH, and production of erythropoietin
- filters blood stream
- removing toxins and waste
- returning necessary components back to blood
What does the urinary system consist of:
- ureters
- bladder
- urethra
- Kidneys
Micturition VS. Urination
Micturition: the physiologic process of eliminating urine
Urination: the act of expelling urine from the body
What is Hematuria?
- blood in urine - can be microscopic (not visible to the naked eye) or macroscopic (visible to the naked eye)
What is Dysuria?
- painful urination (subjective symptom)
What is Fluid Volume?
- Can be a deficit status (dehydration) or overload (retaining fluid)
- Patient should be in a fluid balance (input = output)
What is the purpose of diuretic medications?
- help the body increase urination output (ie. Used when a patient is retaining fluid)
What is an Expected Urine Output?
- Amount of urine a healthy individual produces each hour = 0.5mL/Kg/hour
- Ex. Clients weighs 82kg - 22 Kg x 0.5mL/Kg/hr = 41 mL/hour
What are the 4 Factors that affect Micturition?
1) Disease/Disability
2) Pelvic Floor/ Muscle Tone
3) Psychologic Factors
4) Medications
How is urine output affected by disease/dsiability?
- Infection
- Disease of the kidneys (can lead to decreased secretion, filtration, or reabsorption)
- Continence/retention factors
- Immobility
- Neurological Changes
How is urine output affected by Pelvic Floor/Muscle Tone?
- Pregnancy and childbirth
- Chronic constipation/straining
- Heavy lifting
- Obesity
- these factors can weaken pelvic muscles (which provide voluntary control of when we urinate)
- A weak pelvic floor can lead to involuntary loss of urine (ex. Peeing when coughing or sneezing)
How is urine output affected by Psychologic Factors?
- Lack of privacy
- Aversion to public restrooms
- Anxiety
How is urine output affected by Medication?
- some medications can increase urine output or cause urinary retention
What are the 3 steps in taking a Focused History of the Genitourinary tract?
- Specific Questions
○ What are your normal urinary patterns and habits?
○ Frequency, urgency, dysuria?
○ Associated symptoms?
○ Functional impact? - Background Information
○ Family history
○ Past medical history
○ Medications - Anatomical Variations
○ Any anatomical changes along upper and lower urinary tract can change urinary habits
Physical Examination
What affects urine colour?
- Urine colour varies based on how much fluid is in your body and how much filtering your kidney is doing
- Urine gets its yellow colour from urobilin/urochrome - compound excreted by kidneys
- The more water you drink, the more clear your pee is - because you are diluting the other substances that are being excreted
What different colours of pee mean?
Darker shade of yellow (honey) - not consuming enough water
Yellow or Orange
- Some medications can turn pee colour
- ie. Phenazopyridine - treatment for painful UTIs
- ie. Sulfasalazine - treatment for colitis
Dark brown
- Can be a result of eating rhubarb, aloe, or fava beens
- can be a sign of severe dehydration
- Can indicate rhabdomyolysis: dangerous condition in which muscles break down (Other symptoms - muscle cramps, severe pains, feeling weak or tired after exercise)
- Poor liver function can result in extra bilirubin (extra component of bile) in urine
- if you have a history of melanoma - brown urine can be a sign that this cancer is progressing
Urine is pink/red tint
- Could be a result of eating rhubarb, blueberries, or beets
- Medications (ie. Rifampin) causes red pee
- Could be a tint of blood in urine (resulting from UTI or infection)
Blue/green urine
- Usually not an issue
- could be a result of something you ate
- Asparagus can make pee green
- Medications - muscle relaxers and heartburn reducers
- Fungus/yeast
- Pseudomonas
- Other signs of infections: burning, odor, pain, fever
- Could be a sign of familial hypocalciuric hypercalcemia - genetic disorder
Clear VS. Cloudy Urine
Clear Urine
Clarity: The urinary system is sterile - there should be no sediment, mucous, or visible blood floating in a urine sample
- Normal urine is clear, or see through.
Cloudy Urine
- Odor: Urine may smell strong if a patient is dehydrated but it should never have a foul smell associated to it.
- Volume: the amount of urine will depend on the situation
What is Fluid Balance?
Fluid Balance - describes the balance of the input and output of fluids in the body to allow metabolic processes to function correctly.
- Balance is maintained through intake (food and water), and output (urine, feces, and insensible losses)
What is Considered ‘Intake’?
- All fluids are taken orally (gelatins, ice creams, soups)
- Feeding tubes
- IV fluids
- Blood products
Intake should = output + 500mL to cover insensible losses
What is Considered ‘Output’?
- Urine
- Vomit (emesis)
- Diarrhea
- Gastric suction
- Drainage from tubes or drains
- Insensible losses
What is Considered ‘Insensible Fluid Loss’?
- Fluid loss that can not be measured:
- Sweat
- Moisture excreted from lungs (ie. talking, breathing)
- Fluid lost via solid bowel movements
- Metabolic processes (ie. Fevers)
What are the Signs of Fluid Overload?
- Difficulty breathing
- Crackles on auscultation of lungs
- Pitting edema of lower legs/ankles
- Fatigue
- Bloodwork shown
- Hypertension
What are Signs of Fluid Deficit?
- Impaired cognitive function
- Headaches
- Fatigue
- Dry skin and mucous membranes
- Hypotension, tachycardia, weakened pulse
- Oliguria
- Pediatric population: lack of tears, sunken fontanelles
- Higher concentration of electrolytes, increased creatine level
