Urinary Elimination Flashcards
(87 cards)
1
Q
Volume Minimum per hour
A
30 ml per hour
2
Q
What does Urine Color indicate?
A
- indicates hydration status
- impacted by meds
3
Q
Dark amber urine
A
dehydration
4
Q
Clear Urine
A
adequate hydration
5
Q
Odor
A
-Ammonia is normal smell
6
Q
Strong odor
A
Is infection
7
Q
What urine has less of a smell?
A
Dilute Urine
8
Q
Which would you Assess clarity? Fresh or unfresh urine
A
Fresh!
9
Q
Newborn and Infant
A
Urinate frequently
No bladder control
10
Q
Toddler and preschooler
A
Develop voluntary urine control
Toilet training
11
Q
School-age child and adolescent
A
Nocturnal enuresis
12
Q
Adult and older adult
A
With older age incontinence, nocturia
An older adult with confusion is a strong indicator for a urinary tract infection
13
Q
Voiding
A
Term means to urinate
14
Q
Dysuria
A
Painful urination
15
Q
Polyuria
A
Excessive urination
16
Q
Anuria
A
Severely decreased or absent urine
17
Q
Oliguria
A
decreased urination
18
Q
Urgency
A
Feeling like one is unable to delay voiding voluntarily
19
Q
Urinary Retention
A
Urine remains in the bladder after voiding
20
Q
Nocturia
A
Waking up to void at night
21
Q
Frequency
A
Voids frequently in small amounts
22
Q
Hematuria
A
Blood in the urine
23
Q
Pyuria
A
When urine contains pus
24
Q
incontinence
A
Involuntary loss of urine from the bladder
25
Any intake of fluids
Oral
Intravenous
Nasogastric or PEG tube
26
What hormone makes the body retain fluid?
ADH
27
What triggers the release of that hormone?
Increased plsama osmolarity
28
How many oz 1 ML
30
29
How can the body lose fluids?
Multiple routes
| Vomiting, diarrhea, diaphoresis, wound drainage, urine, burns, or blood loss
30
You can record fluid loss by measuring
output
31
Output should
match intake or be within 200-300 mL
32
What does it indicate if output is less?
Decreased kidney perfusion or dehydration
33
What do you use to get urine output without a catheter?
Graduate, hat, urinal, bedpan
34
How does Hypotension affect the kidneys?
Leads to poor renal perfusion
| Kidneys are unable to filtrate
35
What conditions cause decreased muscle tone?
Obesity
Multiple pregnancies
Chronic constipation
Continuous bladder drainage
36
Surgery
Volume deficit
Urinary retention from anesthesia
Need to void within 8 hours of surgery
37
What medications increase urine output
| and what medications cause retention?
Diuretics = increase urine output
| Opioids, tricyclic, antihistamines = urinary retention
38
Diet: What foods promote diuresis and what foods promote retention?
Alcohol and caffeine promote diuresis
| Salty foods promote retention
39
What position makes it difficult for a patient to use a bedpan or urinal?
Difficult to use a bedpan or urinal while laying flat
40
Cognitive/ Psychological factors
Neurologic conditions, brain tumor, stroke, confusion can all impair drinking or voiding
Heat can promote urination, cold can prevent it.
Hearing water running can promote urination
41
Obstruction
Tumor, renal stones, prostate
Kinked or clogged urinary catheter
Increases risk of urinary stasis and infection
42
Risk Factors for UTI
- female anatomy: shorter urethra and incorrect wiping
- sexual intercourse
- urinary catheter
- CAUTI
43
What is a CAUTI
Catheter-associated urinary tract infection (CAUTI)
A UTI that develops when a catheter is in place greater than 48 hours prior to the onset of infection
One of the most common healthcare-acquired infections
Increases morbidity and morality for patients
44
Education on prevention of UTIs
- Adequate water intake? flush microorganisms
- Aim to void at least every 4 hours
- Void immediately after sexual intercourse?
- flushing miccroorganisms
- Wash hands carefully with soap and water
45
S/s of UTI
```
Fever
Flank pain
Dysuria
Frequency
Urgency
Pyuria
Hematuria
```
46
Timed Voiding
Timed voiding
Used for cognitive or physical impairment
Void on a fixed schedule
Urge urinary incontinence
47
Habit retraining
- Schedule bathroom trips around when incontinence episodes occur
- Functional and total urinary incontinence
48
Prompted Voiding
- Take time to check to see if there is a need to void
| - Functional and total urinary incontinence
49
Bladder training
- schedule voiding times with a narrow range of 2 hours
- Eventually widen range to 4 hours
- Urge and reflex incontinence
50
Urinary Diversion
- Surgical procedure to alter the pathway of urine elimination
- commonly performed after the removal of the bladder (cystectomy)
- Two types: Ileal conduit and neobladder
51
What happens if a patient doesn't void after surgery?
- Use a bladder scanner to check bladder for urine
52
Urine specimen types: Random
-Can be poured from nonsterile container into cup
53
Urine specimen types: Clean-catch
- sterile cup or bedpan
| - seek specimen without microorganisms
54
Urine specimen types: 24 hour
- Specific measurement of kidney's excretion of substances
| - Educate all personnel and family about need to keep all urine for the 24 hour period
55
Urine specimen types: Catheter
- In and out to obtain specimen at a specific time
| - Indwelling, can collect from a port near the top of catheter (not from drainage bag)
56
Urine Tests: Reagent Strips
-Detect substances an their amounts such as pH, glucose, protein, ketones
57
Urine Tests: Urine culture and sensitivity
- Determine microorganism that causes UTI
| - Determine correct antibiotic to use
58
Urinalysis Color
```
Normal: Light yellow- amber
Almost colorless: increase fluid intake
Dark color: decrease fluid intake
Red, pink , dark brown: rbcs in urine
Pink, Orange, Dark-brown, Blue-green: medications or foods
```
59
Urinalysis Turbidity
Normal: Clear
Hazy, Cloudy, Smoky: urine specimen allowed to stand at room temp
RBCs, WBCs, bacteria, mucus threads: mucosal irritation
60
Urinalysis pH
Normal: 6
Range: 4.6-8
<6: Diet high in meat or some fruits, metabolic acidosis( DM, starvation), respiratory acidosis (emphysema).
>6: Diet high in vegetables and citrus fruits, UTIs, metabolic alkalosis (hyperventilation)
61
Specific Gravity
Range: 1.015-1.025
<1.015: increased fluid intake, diuretic therapy, diabetes insipidus, renal diseases
>1.025: decreased fluid intake, increase fluid loss (vomiting, diarrhea, fever), ADH secretion (trauma, stress).
62
Protein
Normal: None-trace
| -Protein is present in severe stress, renal disease, preeclampsia
63
Glucose
Normal: None
| -Present in DM
64
Ketones
Normal: None
| Present in DM, Ketoacidosis, Starvation
65
Microscopic Exam
RBCs: Normal 0-30 abnormal: >30 UTI, bleeding, urinary tract trauma, anticoagulant therapy
WBCs: 0-5 abnormal: > UTI
Bacteria/ yeast: None-few abnormal: few- contamination from perineal skin
Casts: None-occasional abnormal: many- possible renal diseases
66
BUN Test
Urea is normally excreted
| Impaired kidneys are unable to excrete urea leading to an increased BUN
67
Creatinine
Creatinine is a waste product excreted by the kidneys
Increased creatinine indicates renal impairment
More sensitive indicator than BUN for renal impairment
68
Creatinine Clearance
Need creatinine level from urine and blood
Need the amount of urine developed in 24 hours
Estimates the kidneys glomerular filtration ability
69
Glomerular Filtration Rate
Best indicator of kidney function
Requires multiple data
Age, race, gender, serum creatinine
70
External Catheter Method:
External or condom catheter
Other noninvasive form is PrimaFit
71
External Catheter Indications
Indications for use:
Sphincter damage
Spinal cord injury
Impaired skin integrity in areas where incontinence occurs
72
Urinary Catheterization
Inserting a small tube through the urethra to the bladder to promote urine drainage
73
Intermittent or Straight
In-and-out catheter, temporary for a single voiding session or specimen collection
74
Indwelling
Inserted and kept in place by inflating a balloon
Connected to a drainage bag
A securement device is used on the thigh
75
What techniques is important in placement of all catheters!
Sterile technique is paramount
76
Indications for catheterization
Critically or acutely ill patients that need accurate intake and output measurements
Urinary retention that persists despite multiple intermittent or straight catheter attempts
Management of urinary incontinence with a stage III or IV pressure ulcer on the trunk
77
Catheter types and sizing
Catheters are sized using the French system
The higher the number the larger the lumen
Average range is 12-22 (16 most common)
78
Catheter Tube
Straight or intermittent
79
Catheter tube with bend created in it
Coude catheter: good when patient has prostate problems
80
Catheter tube with one port and balloon
Indwelling
81
Catheter tube with 2 ports and balloon
Bladder irrigation
82
DO NOT __________ the drainage bag from catheter
disconnect
83
How often should you empty drainage bag
every 8 hours
84
Why do we empty drainage bag
to prevent the development of microorganisms
85
Always keep drainage at what level?
Below the bladder
86
When to wash hands?
before and after handling catheter and wear clean gloves
87
Catheter care tips
Clean patient’s perineal area and catheter after any bowel movement
Clean at least once a shift if no bowel movement present
Use soap and water for cleaning
