- presence of indwelling catheter - urinary retention - urinary or fecal incontinence - poor perineal hygiene - females - frequent sexual intercourse - uncircumcised patients - any instrumentation of urinary tract

- costly -> no reimbursement - major risk of development with presence of indwelling catheter, increased risk with length of time - can be reasonably prevented - focus on early recognition and prompt treatment

- professional - assess understanding and expectations of treatment - meds - medical/surgical hx - assess ability to perform necessary behaviors associated with voiding - normal bowel and urinary elimination patterns - sleep/activity/nutrition - cultural preferences

- normal amount with each void - frequency and times of voiding - hx of recent changes

Urinary Elimination Flashcards by Kathleen Samuel

Micturition

complex process involving bladder, urinary sphincters, and CNS

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Voiding

bladder contraction and urethral sphincter and pelvic floor muscles

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CNS + voiding

impulses from the brain respond or ignore the urge
- when brain responds, CNS send message and external sphincter relaxes and bladder empties

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Factors influencing urinary elimination

growth and development
sociocultural factors
fluid intake
psychological factors
personal habits
pathological conditions
surgical procedures
diagnostic examinations

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Urinary changes in older adults: decreased

amount of nephrons (impaired kidney function, increased chronic kidney disease, HTN)
bladder muscle tone
bladder capacity
time btw initial desire to void and urgent need to void

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Urinary changes in older adults: increased

bladder irritability
bladder contractions during bladder filling
risk of urinary incontinence

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Urinary retention s/s

restlessness, diaphoresis, anxiety, tenderness, pain

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Urinary retention

inability to partially or completely empty the bladder, can be acute or chronic

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Post-void residual

PVR
straight cath someone or bladder scan

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Overflow incontinence problem =

urinary retention

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Bladder scan

independent nursing intervention

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UTI

most common is e-coli

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Risk factors for UTI

presence of indwelling catheter
urinary retention
urinary or fecal incontinence
poor perineal hygiene
females
frequent sexual intercourse
uncircumcised patients
any instrumentation of urinary tract

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Lower UTI

frequency, incontinence, burning with urination, dysuria, suprapubic tenderness, foul smelling cloudy urine

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Upper UTI

flank tenderness

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CAUTI

costly -> no reimbursement
major risk of development with presence of indwelling catheter, increased risk with length of time
can be reasonably prevented
focus on early recognition and prompt treatment

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Urinary incontinence

involuntary loss of urine
often multifactorial

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Stress incontinence

usually from effort or exertion, usually women, after childbirth, with laughing/coughing/etc.

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Urgency incontinence

typically older adults, overactive bladder, can be idiopathic, pt has urge to pee but can’t get to bathroom

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Overflow incontinence

poor bladder emptying, males with BPH, obstruction, leakage

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Functional incontinence

can’t get to bathroom
- older adults = need cane, trouble walking, etc

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Incontinence risk factors

more common in women and elderly
obesity
multiple pregnancies or vaginal births
neurological disorders: Parkinson’s, CVA, spinal cord injury, MS
medications: diuretics, opioids, anticholinergics, CCB, sedatives/hypnotics
confusion/dementia
immobility
depression

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Assessment

professional
assess understanding and expectations of treatment
meds
medical/surgical hx
assess ability to perform necessary behaviors associated with voiding
normal bowel and urinary elimination patterns
sleep/activity/nutrition
cultural preferences

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Pattern of urination

normal amount with each void
frequency and times of voiding
hx of recent changes

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Oliguria

low urine output

CVA tenderness

costovertebral angle

Assessment of urine

color, clarity, odor

I&O

- evaluates bladder emptying - renal function - fluid and electrolyte balance - can be a HCP order or nursing judgement

Normal urine output

30ml/hr concerned if <30/hr for greater than 2 hrs

If patient awake...

and hasn't voided in 6 hours

Abnormal color

hematuria color changes

Normal color

pale straw to amber

Normal clarity

transparent

Urine that sits

can get cloudy

Thick and cloudy

bacteria and WBCs - early morning voids can look this way since it sat all night

Abnormal odor

offensive - may indicate UTI some foods may change odor Fruity -> acetone

Urine testing

send as soon as you receive, unless it is a timed test - know if you need a preservative or not

4.6-8.0 alkaline = loss of acid acidotic = urine that sits for hours, sleep

Protein

up to 8mg/100ml - abnormal is sensitive indicator of kidney function

Glucose

+ = DM

Ketones

abnormal = DM, dehydration, starvation, excessive aspiring ingestion

Specific gravity

1.005-1.030 high = reflects concentrated, dehydration low = overhydration

RBC

normal = up to 2 abnormal = damage to glomeruli, trauma, catheter trauma

WBC

normal = 0-4 abnormal = inflammation or infection

Bacteria

possible UTI

Leukocyte esterase

possible UTI

Casts

indicate renal disease

Crystals

indicate increased risk of renal calculi

Culture and sensitivity

send to lab within 30 minutes, prelim report should be available within 24hrs

C+S importance

- obtained to determine presence of pathogenic bacteria - should obtain before abx admin - important to test the sensitivity of any growing bacteria to various abx - culture only done if UA suggests it

Adequate fluid intake

2300 mls/day - if no heart disease, has good renal function - helps flush solutes to limit bladder irritability

Nocturia

stop drinking about 2 hrs before bedtime

Crede method

pushing need HCP order

Single lumen catheter

intermittent, i+o catheter

Indwelling catheter

foley, balloon

3 lumen/3 way catheter

bladder irrigation

Coude tip

curved, BPH pts

Suprapubic

placed in the bladder through the abdominal wall - sutured in place - used when blockage of urethra or when indwelling catheter causes irritation

Nephrostomy

procedure where a thin, flexible tube (nephrostomy tube or catheter) is inserted directly into a kidney through the skin, allowing urine to drain into a bag outside the body

Catheter emptying

empty when 1/2 full

Castile wipes

PRN and q-shift and before placement

CHG wipes

q-day and before placement

Post foley

6-8 hrs without voiding, scan should be able to void within 6-8 hrs post removal

First voids

can be uncomfortable - might need to I+O cath to start

Ureterostomy

a surgical procedure where one or both ureters are detached from the bladder and brought out to the surface of the abdomen through a surgically created opening called a stoma

Urinary Elimination Flashcards

(65 cards)