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Foundations > Test #4 > Flashcards

Test #4 Flashcards

1
Q

kidneys

A
  • remove waste from the blood to form urine
  • glomerulus is the working portion of the kidneys
  • produces erythropoietin: substance that forms red blood cells
  • fluid and electrolyte balance
  • blood pressure control: RAASTA system, urination – low bp = low urine and filtration
  • potassium affects heart muscle
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2
Q

ureters

A
  • transport urine from the kidneys to the bladder
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3
Q

bladder

A
  • reservoir for urine until the urge to urinate develops

- detrusor muscle

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4
Q

urethra

A
  • urine travels from the bladder and exits through the urethral meatus
  • shorter in women
  • women have increased UTIs
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5
Q

toilet training

A
  • toddlers can feel a full bladder between 12-18 months
  • USA trains between 2 and 3 years
  • other countries start training from infancy
  • kidneys start working after 3 months inutero
  • after birth void within 24 hours
  • 6-8 wet diapers a day is normal
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6
Q

Urinary System

A
  1. filtration
  2. reabsorption
  3. secretion
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7
Q

Physiology of Urination

A
  • micturation: pee/void
  • normal voiding involves contraction of detrusor and relaxation of urethral sphincter
  • brain structures that influence bladder emptying = cerebral cortex, thalamus, hypothalamus, brain stem
    1. detrusor muscle stretches and opens the bladder neck
    2. spinal cord is alerted to full bladder
    3. spinal cord send contraction signal
  • adults: 250-400ml = full bladder
  • 600ml is distended and overfull
  • child - 150-200 ml
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8
Q

Factors that influence urination

A
  • prerenal: decreased blood flow to and through the kidneys due to cardiac issues
  • renal: disease conditions of the renal tissue
  • postrenal: obstruction in the lower urinary tract = tumors, kidney stones, enlarged prostate, BPH (Hesitancy, bladder inflammation)
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9
Q

Diseases/Conditions that Influence Urination

A
  • diabetes: increased thirst, increased urination, nerve and perfusion changes
  • MS: nerve changes, neurogenic bladder issues
  • BPH: benign prostate hyperplasia (bad cells) causes retention
  • cognitive disorders: alzheimer’s disease, sensation
  • eng stage renal disease: waste buildup, Fluid and electrolyte inbalance (Uremic syndrome). kidney dialysis, transplant list
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10
Q

other factors that influence urination

A
  • sociocultural factors: privacy, how many bathrooms someone has
  • psychological factors: anxiety (can’t go or go too much), stress releases ADH which retains water
  • fluid balance
  • surgical procedures: should void within 8 hours of procedure
  • medications: narcotics, anesthesia decrease urination
  • diagnostic examination: get a CDC within 24 hours of taking out a catheter
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11
Q

urine colors

A
  • palpate pubic bones an feel if tight it is a full bladder
  • vitamin b = bright green
  • anticoagulants = pink
  • pyridium = bright orange
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12
Q

UTIs

A

lower: urethra and bladder
upper: ureters and kidneys

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13
Q

nocturia

A

nighttime urination

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14
Q

polyuria

A

excessive urination, 2500-3k ml a day

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15
Q

oliguria

A

small amounts of urine, less than 500ml a day

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16
Q

dysuria

A

painful urination

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17
Q

anuria

A

no urination, less than 100mls a day

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18
Q

diuresis

A

increased or excessive production of urine

  • diuretics cause it
  • lasix with potassium so that the heart doesnt loose its important potassium
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19
Q

cystitis

A

bladder infection

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20
Q

hematuria

A

bloody urine

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21
Q

pylonephritis

A

kidney infection

22
Q

incontinence

A

no control of urination

23
Q

nocturnal enuresis

A

wet the bed

- worry at age 6 or 7 if still wetting the bed

24
Q

pyuria

A

pus in urine

- UTI, STD

25
Q

Urinary Retention

A
  • accumulation of urine due to inability to empty bladder
  • bladder unable to respond to the micturation reflex
  • possible causes: urethral obstruction – surgical trauma, child birth, alterations in sensory innervation, anxiety, side effects of mediactions
26
Q

Urinary Tract Infections

A
  • most common health care associated infection
  • due to: Foley catheterization is leading cause of UTI and sepsis, surgical manipulation
  • 75-95% are due to e.coli from GI tract
  • stasis: urine sits and bladder gets infected
  • any condition resulting in urinary retention (BPH, swelling/trauma to urethra or kinked, obstructed or clamped catheter)
27
Q

Urinary Incontinence

A
  • involuntary urination
  • causes: aging, 50% of all long term care residents suffer from incontinence
  • complications = skin breakdown
28
Q

Urinary Diversion

A
  • alter urine path surgically
  • divert ureters to abdominal stoma
  • causes: cancer of the bladder, trauma, radiation, chronic cystitis, nephrostomy
29
Q

Urostomy

A
  • no bladder
  • stoma
  • ureters are connected to ilium and urine leaves the body through stoma
30
Q

Nephrostomy

A
  • urine goes directly from kidney into bag inside of body

- permanent

31
Q

dialysis

A
  • can be short or long term
  • *peritoneal dialysis: sterile solution goes into abdomen and waste drains out
  • blood pressure is really important
  • indirect; uses osmosis and diffusion
  • peritoneium is used as semi-permeable membrane
  • sterile solution instilled into peritoneum by gravity, left fot a time, drained out
  • *Hemodialysis: mechanical filtering of blood via membrane
  • blood exits and returns via A/V fisula, CVL
  • 2-4 hours, 3 days a week
32
Q

kidney diagnostic tests

A
  • creatinine clearance: measures rate kidney clears creatinine from blood
  • BUN (blood urea nitrogen): tests for kidney damange
  • Creatinine: more sensitive to renal failure, waste product of skeletal muscle breakdown, normal = 8-25 mg/100ml
33
Q

Kidney Transplant

A
  • used in end stage renal disease
  • only “cure” that can bring normal kidney function
  • living or cadaver donor organ
  • piggyback into abdoment
  • requires immunosuppresant medication; much easier to get sick
  • family donation common
  • surgery may be more challenging for donor
34
Q

Normal urine

A
  • *NORMAL
  • appearance: clear
  • color: staw yellow to light amber
  • Odor: slight amonia
  • PH: 4.6-7.8
  • Protein: 0mg/dl
  • Specific gravity: 1.010-1.035
  • leukocytes: negative
  • Nitrites: negative
  • ketones: negative
  • crystals: negative
  • glucose: negative
  • RBC: negative
  • WBC: negative
35
Q

Abnormal Urine

A

**ABNORMAL
- increased urine PH: respiratory or metabolic alkalosis, gastric suction, vomiting, UTI
- Decreased urine PH: metabolic acidosis, diabetes, diarrhea, respiratory acidosis
- increase protein: diabetes, chronic heart failure, preeclampsia, glomerulonephritis, polycystic disease, lupus, heavy-metal poisioning, bladder tumor
- increased specific gravity: concentrated urine, dehydration, glycosuria, proteinuria, fever, vomiting, diarrhea
- decreased specific gravity: diluted, overhydration, renal failure, hypothermia, pyelonephritis, heart failure
- increased RBCs: glomerulonephritis, acute tubular necrosis, cystitis, traumatic bladder catheterization
increased WBCs: bacterial infection in the urinary tract, glomerulonephritis, acute pyelonephritis, lupus

36
Q

psychosocial considerations

A
  • put up head of bed
  • gender differences: males stand, females sit
  • cultural differences: privacy, position (squat, sit, stand), gender congruity
  • women 2x more likely to develope incontinence due to decreased hormone levels and weak muscles (kagels)
37
Q

common urinary alterations

A
  • urgency
  • frequency
  • hesitancy
  • retention
  • dribbling
  • incontinence
  • residual urine (urine left in bladder after urination)
38
Q

Diagnostic Exams of the Urinary System

A
  • testing the urine
    1. chemical reagent strip (dip stick)
    2. bedside urinalysis (PH, glucose, blood, ketones, protein)
    3. Sterile specimen: straight catheter, aspirate from indwelling catheter, same procedure from urinary diversion
    4. timed specimen to be sent to lab: 24 hour urine for UUN (urine urea nitrogen)
39
Q

urine culture and sensitivity

A

tells you within 24-48 hours what bacteria is in the urine and which antibiotic will work

40
Q

obtaining a urine specimen

A
  • random: doesn’t have to be sterile. bedpan or urinal
  • clean catch (midstream): sterile, keep lid clean too
  • sterile: from a catheter
  • timed collection: 24 hour urine collection. dump first urine at start then collect for 24 hours and keep on ice
41
Q

Obtaining sterile specimen from exising urinary catheter

A
  • clamp catheter for 30 minutes prior to aspiration to allow fresh urine to father in tubing
  • disinfect access port
  • using syringe (10-15ml) and large bore needle, access collection port and withdraw 5-10ml urine, label, double bag and send to lab
42
Q

non-invasive examination of the bladder and kidneys

A
  1. A KUB: an X-RAY of the kidneys, ureters and bladder.
    - It is pronounced by the initials, not pronounced like the word “Cub”.
    - It is just to see them- no prep, you can eat before it too.
    - determines size, shape, location and symmetry of kidneys and bladder
  2. CT scan: Shows more detail about the structures. This can tell whether there is a tumor, or obstruction (stones). We do a bowel prep before. The CT scan can be done with or without contrast, so before the patient goes for it we have to make sure that they are not allergic to contrast dye, or iodine that is injected during the procedure.
  3. IVP: intravenous pyelogram
    - Dye is injected to check for hematuria, retention, dysuria. Afterwards we want to encourage the patient to drink fluids to flush the dye from the system. We do a bowel prep before it and also make sure that the person is not allergic to iodine and/or shellfish.
  4. Ultrasound of the bladder: identify gross renal structures and structural abnormalities, no prep required, simple, can be done on nursing unit
43
Q

Invasive Examination of the Kidneys and Bladder

A
  1. cystoscopy: the insertion of a tube into the bladder for direct visualization.
    - They can take biopsies and remove stones.
    - Done using conscious sedation means that the nurse has IV medication that we push so that the patient is sort of sleepy, but can respond if we talk to him: he is not completely out and there is no airway placed for him. The medication is used so that the patient will not remember anything that happened during the procedure, so that any pain felt will not be remembered.
    - There is a pain medication given also. Usually versed/fentanyl. (Don’t worry about remembering the meds, but I want you to know what “conscious sedation” means.
44
Q

catheter insertion

A
  • requires a provider’s order
  • explain procedure to patient
  • personal hygeine twice a day
  • catheter care per protocol
  • msust be removed promptly RN or MD decision
45
Q

Reasons for foley insertion

A
  • you can instill chemo drugs into the bladder with a foley
  • increased comfort for terminal patients
  • management of incontinence (protection of skin)
  • measurement of urine in critical patients
  • pre/post op bladder drainage
  • ## urinary retention
46
Q

suprapubic catheters

A
  • This is a catheter that is inserted by a doctor with either local or general anesthesia that is placed through the skin into the bladder.
  • It attaches to a bag outside the skin. It is held in place by sutures.
  • There is a slightly less chance of getting a UTI with a suprapubic catheter rather than a Foley catheter. (The foley catheter or straight catheter is very close to the anus, and can easily be contaminated.)
  • used for parapalegics, quadrapalegics, and comatose patients
  • slightly less chance for infection over the long term
47
Q

condom catheters

A
  • for male patients only
  • There is less chance of infection because nothing is going up into the urethra.
  • It is truly like a condom, and you roll it on like you would a condom. When it is rolled up onto the shaft of the penis, it can be a little sticky up by the pelvis, and try not to get the patient’s pubic hair stuck.
  • We need to remove these daily to clean and assess the penis, make sure there is no skin breakdown. The downside of these is they easily come off. There are sizes: Small, Med., Large, X-L. Just guestimate.
48
Q

TURP

A
  • This stands for Trans-Urethral Resection of the Prostate.
  • This procedure causes some blood to be in the urine. The problem is that we don’t want the blood to clot and occlude the catheter. So we use a 3 way catheter.
  • This catheter has 3 lumens. It has the same two that the foley catheter has, the urine tube and the lumen for the balloon to be blown up through, but it has another lumen for drainage of a sterile solution to be hung ( like a big 3 liter IV bag).
  • It is sterile solution and it just continually drains into the the bladder and sort of washes out the blood that is in there. The nurse keeps the solution running through as fast or slow as she needs it to keep the blood so that it will not make clots. The urine looks cherry red at first, so the nurse runs the solution in at a pretty fast rate. As the color of the urine starts to turn less red, then pink, then finally back to the pale yellow color, the nurse can slow down how fast the solution is running into the bladder. When there is no more blood in the urine, the irrigation is done. This irrigation takes several hours at least.
49
Q

closed catheter irrigation

A
  • three lumens: irrigant, drainage, balloon

- calculating urine output

50
Q

Intake and Output

A

Intake, when added up for each shift, and then compiled for the 24 hours, is everything we put into the patient in liquid form: Both PO and IV.

51
Q

nursing interventions to promote normal urination

A
  • perineal care/hygeine
  • catheter care
  • toilet training
  • fluid intake
52
Q

Ongoing research and practice

A

These are some interesting things that are being studied. Alternatives to indwelling catheters would be great!! Best practices on things like decreasing risks of UTI’s with foleys: for one thing, taking out all post-op foley’s within 24 hours post-op.

Foundations (8 decks)

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