interventions for urinary elimination

Question 1

name the structures of the urinary system

Answer 1

• kidneys/ureters
• bladder
• urethra

Question 2

describe the urethra

Answer 2

• terminal ending of the urinary system that connects bladder to the outside
• shorter on females than males, makes females more susceptible to UTIs
• male’s also function sexually

Question 3

describe the kidneys

Answer 3

• help to maintain the composition and volume of bodily fluids, particularly the blood
• filter and excrete blood constitutes not needed and retain the solutions or solutes that are needed
• help to concentrate and excrete waste product (urine)

Question 4

describe nephrons

Answer 4

• functional unit of kidney
• where filtration occurs
• remove the end products of metabolism and help regulate fluid and electrolyte balance
• urine is then transported from kidney, through ureter, and to the bladder

Question 5

describe the urinary bladder

Answer 5

• smooth muscle sack that is innervated by the ANS
• reservoir for urine
• composed of three layers called the detrusor muscle, internal sphincter, and external sphincter (guards opening between urinary bladder and urethra)

Question 6

what are the functions of the urinary system

Answer 6

• filtration of blood
• micturition/voiding

Question 7

describe micturition and voiding

Answer 7

• elimination of waste products
• when bladder senses that there is sufficient amount of urine → detrusor muscle contracts → causes internal sphincter to relax → small amount of urine will empty into urethra and causes muscles of the perineum and external sphincter to relax → abdominal wall will contract very slightly → diaphragm will lower and bladder is emptied

Question 8

describe the assessment of history of urinary elimination

Answer 8

• changes in urination? (color, frequency, amount)
• pain or discomfort? (during voiding or in back/flanks)
• previous history of urinary problems? (UTIs, kidney stones, incontinence)

Question 9

describe objective data in assessment of urinary elimination

Answer 9

• volume of urine (measured intake and output)
• characteristics of urine (color, clarity, odor)
• diagnostic test results

Question 10

what are some aspects of further investigation into abnormal findings regarding urinary elimination

Answer 10

• fluid intake/other fluid losses
• dietary habits
• mobility/ability to assume a functional position to urinate
• anxiety/embarrassment
• cognitive dysfunction
• neurologic injury
• pregnancy
• infection
• urinary obstruction
• medication history

Question 11

how does fluid intake impact urinary elimination

Answer 11

affects kidney function and urine production

Question 12

how do dietary habits impact urinary elimination

Answer 12

can contribute to kidney stone formation

Question 13

how does pregnancy impact urinary elimination

Answer 13

–change in hormones suppresses antidiuretic hormone - increased urination

• increase in blood volume → more work for kidneys → increased urination
• baby pressing on bladder

Question 14

name some different causes of urinary obstruction

Answer 14

renal calculi, edema, tumor, or enlarged prostate in men

Question 15

what are some common medications that may increase urine output

Answer 15

• diuretics → prevent reabsorption of water → increased output
• cholinergics → stimulate contraction of detrusor muscle

Question 16

how do analgesics effect urinary elmination

Answer 16

• acts on the CNS and supresses it
• causes diminished output

Question 17

what are some nursing diagnosis to consider r/t urinary elimination

Answer 17

• urinary incontinence
• risks for infections
• toileting: self care deficit
• impaired urinary elimination
• urinary retention
• disturbed body image
• pain
• impaired skin integrity

Question 18

define dysuria

Answer 18

painful or difficult urination

Question 19

define polyuria

Answer 19

producing abnormally large volumes of urine

Question 20

define oliguria

Answer 20

producing inadequate amounts of urine

Question 21

define anuria

Answer 21

producing less than 50ml/day of urine

Question 22

define urgency

Answer 22

strong need to urinate

Question 23

define frequency

Answer 23

feeling the need to urinate more often

Question 24

define nocturia

Answer 24

needing to void more frequently during the night

Question 25

define hematuria

Answer 25

- blood in urine - may be microscopic or gross

Question 26

define pyuria

Answer 26

pus in the urine

Question 27

define urinary retention

Answer 27

producing urine but not able to void

Question 28

define enuresis

Answer 28

bed wetting

Question 29

define urinary incontinence

Answer 29

involuntary loss of control of urinary elimination

Question 30

define stress incontinence

Answer 30

- most frequently experienced - inability to prevent escape of small amount of urine with increased abdominal stress (coughing, sneezing, or laughing)

Question 31

describe urge incontinence

Answer 31

sudden/strong urge to empty bladder, involuntary

Question 32

define functional incontinence

Answer 32

- not a problem with bladder/nervous system/muscles - cant get to bathroom soon enough (physical limitations)

Question 33

define total incontinence

Answer 33

- involuntary and unpredictable - can be continuous - no control

Question 34

describe kegals

Answer 34

- helps improve pelvic floor function - contract muscles that stop the flow of urine

Question 35

describe urinary diversion

Answer 35

- surgical procedure when there is damage to the urinary system - reroute from ureter to new passage way for urine to drain outside the body via stoma to urine collection device

Question 36

what types of diagnostic tests can be done for assessing urine

Answer 36

- laboratory analysis of urine - bloodwork - radiologic tests

Question 37

what types of laboratory analysis are done to assess urine

Answer 37

- **urinalysis** (looking at urine in lab) - **specific gravity** → measure levels of solutes in urine (higher = more concentrated and lower = less concentrated) - **culture and sensitivity (C&S) →** look for fungus that grows - **24 hour urine collection**

Question 38

what blood work is used to assess urine

Answer 38

**-BUN (Blood Urea Nitrogen)** **-creatinine** -increase in these levels indicate that kidneys are not functioning properly

Question 39

what radiologic tests are done to assess urine

Answer 39

- **bladder scan/bladder ultrasound** → noninvasive test, shows how much fluid is in the bladder - **intravenous pyelogram (IVP)** → injected with dye and find narrowing or blockage in vascular system of kidneys - **cystoscopy** → use of flexible camera up urethra to look at lining or inside of bladder - **urodynamic studies** → any procedure that examines structure and function of the bladder, sphincter, or urethra

Question 40

is urinalysis clean or sterile?

Answer 40

clean

Question 41

is C&S clean or sterile?

Answer 41

sterile

Question 42

describe sterile samples

Answer 42

- clean catch/midtstream - catheterized sample → intermittent catheter (straight from bladder to cup) or using previously placed foley catheter (sterilize and use sampling port)

Question 43

describe 24 hour urine collection

Answer 43

- discard first void - collect all urine produced for 24 hours - avoid contamination with stool - keep collection container on ice or refrigerated - at the end of the 24 hour period have client empty the bladder and add that void to the container before sending to the lab

Question 44

what are some indications for urinary catheterization

Answer 44

- urinary retention - prevention of further skin damage or wound contamination - essential need for accurate output measurements (surgery, trauma, certain medical conditions) - comfort during end of life care

Question 45

name different types of urinary catheters

Answer 45

- external catheter - straight catheter - indwelling catheter - suprapubic

Question 46

describe an external catheter

Answer 46

- male (condom/texas) - female (wick) - less risk of UTI - requires maintenance and education and must be replaced frequently

Question 47

describe a straight or intermittent catheter

Answer 47

- uses sterile technique - used to collect sample or relieve urinary retention

Question 48

describe an indwelling or foley catheter

Answer 48

- sterile technique is used - inserted and balloon is inflated - connected to bag and drains by gravity

Question 49

describe suprapubic catheter

Answer 49

- surgically inserted through abdomen - permanent - causes less trauma and is less invasive - increased comfort and decreased urinary tract infections

Question 50

catheter size is measured in units of…

Answer 50

- french - in adults 14-18 french are normal sizes - select the smallest functional size

Question 51

describe a coude catheter

Answer 51

- curved tip - easier insertion for men with enlarged prostates - generally used for men over the age of 50

Question 52

describe a continuous irrigation catheter

Answer 52

* has different branches where urine comes out and irrigation fluid is sent into the bladder to clean it out

Question 53

what are some nursing considerations for urinary catheterization

Answer 53

- explain procedure steps and rationale for procedure - provide privacy (close curtains and shut doors) - position patient and drape appropriately - perform routine perineal care prior to starting procedure

Question 54

what position should you place a female pt in for urinary catheterization

Answer 54

dorsal recumbent (preferred) or sidelying

Question 55

what position should you place a male pt in for urinary catheterization

Answer 55

- lying flat - hold penis perpendicular to abdomen

Question 56

when performing surgical asepsis/sterile technique you should always start with the assumption that

Answer 56

an object is not sterile

Question 57

sterile items must always include:

Answer 57

- intact and undamaged packaging - expiration or use by date - "STERILE"

Question 58

opened but unused sterile items are considered…

Answer 58

unsterile

Question 59

sterile objects may only touch…

Answer 59

sterile objects

Question 60

nonsterile objects may only touch

Answer 60

nonsterile objects

Question 61

when creating a sterile field…

Answer 61

- minimize air movement (masks needed, fans off, minimal talking) - sanitize the work surface and allow to dry - always face the sterile field - keep sterile field above your waist - sterile items must be kept within the 1 inch nonsterile margin on field - do not reach across the sterile field

Question 62

describe the use of antiseptic swabs on female patients prior to urinary catheterization

Answer 62

- 3 swabs - move from top to bottom - 1 over labia minora - 1 over other side - 1 right down the middle over urethra

Question 63

describe the use of antiseptic swabs on male patients prior to urinary catheterization

Answer 63

- 3 swabs - start at urethral meatus and make concentric circles outward with each swab

Question 64

describe the preventions of skin irritation with urinary elimination

Answer 64

- keeping skin clean and dry - using breathable underpads - barrier creams

Question 65

describe the preventions of falls with urinary elimination

Answer 65

- targeted toileting/anticipating needs - education

Question 66

describe the preventions of UTIs/CAUTI with urinary elimination

Answer 66

- minimize use of indwelling catheters - use strict sterile technique for insertion - secure indwelling catheters to prevent infection - pericare daily and after each episode of incontinence (routine cleaning products and gentle technique) - appropriate management of drainage tubing and bag (prevent tubing obstruction) - empty drainage bags every 8 hours

Question 67

describe the preventions of hematuria with urinary elimination

Answer 67

- minimize catheterization - use smallest functional catheter - gentle insertion technique - secure indwelling catheters - secure drainage tubing to prevent pulling

Question 68

what term describe a condition in which 24 hour urine output is less than 50 ml? a. dysuria b. glycosuria c. pyuria d. anuria

Answer 68

d. anuria