Urinary Elimination Flashcards
(36 cards)
Most common urinary elimination problems
Urinary retention Urinary tract infection Urinary incontinence Urinary diversion Surgery -inability to store urine or fully empty urine
Cause of urinary elimination problems
Infection Irritable/overactive bladder Obstruction of urine flow Impaired bladder contractility Issues that impair innervation to the bladder
Postvoid residual (PVR)
Amount of urine left in the bladder after voiding, measured either by ultrasound or straight cath
Urinary retention causes
Enlarged prostate Urethral structure Bladder or urethral stones Stroke or spinal cord injuries Anesthesia or other meds Neurological impairment (MS, head injury)
S/S urinary retention
Anuria: inability to pass urine Bloating in the lower abdomen Increased frequency Urinary incontinence Increased PVR, increased volumes on bladder scan
Urinary retention complications
Urinary stasis → Urinary Tract Infection
Back from bladder → ureters → kidneys → Pyelonephritis
Irreversible kidney damage with pyelonephritis
Pyelonephritis may move to bloodstream: urosepsis
Serum lab test that measures kidney function
Creatinine
Urinary retention interventions
Privacy, toilet instead of bedpan, men stand, run water, ambulation, increase oral fluids
Bladder scan
Intermittent catheterization or “Straight cath”
S/S UTI
Foul-smelling, cloudy urine
Dysuria, frequency, urgency, incontinence
E. coli: Most common pathogen
Older adults: confusion
Lower (bladder & urethra)
Upper (Kidney infection) Pyelonephritis (fever, chills, flank pain)
Functional Incontinence
Causes outside the urinary tract
-Altered mobility, cognitive impairment, poor motivation, environmental barriers
Overflow Incontinence
Involuntary loss of urine caused by overdistended bladder often related to obstruction or poor bladder emptying due to weak/absent bladder contractions
Stress Incontinence
Small volume loss of urine with coughing, laughing, exercise, sneezing
-Weak pelvic floor muscles, childbirth trauma
Reflex Incontinence
Involuntary passage of urine at predictable intervals when pt reaches specific bladder volume
-Spinal cord damage between C1 to S2
Urge Incontinence
Involuntary passage of urine associated with strong sense of urgency related to overactive bladder
-Caused by neurological problems, bladder inflammation, bladder outlet obstruction
Interventions for urinary incontinence
Avoid caffeine Adequate hydration Pelvic floor exercises Timed voiding or scheduled toileting Barrier cream
Ureterostomy or ileal conduit
Permanent diversion created by transplanting the ureters into a closed-off portion of the intestinal ileum and bringing the other end out onto the abdominal wall forming a stoma
Nephrostomy tubes
Small tubes tunneled through the skin into renal pelvis
- Drains renal pelvis when the ureter is obstructed
- Permanent or temporary
Indications for nephrostomy tubes
When ureters are blocked due to cancer, trauma from a large kidney stone that is lodged in the ureter
Lab results indicating UTI
+ Bacteria (doesn’t necessary indicate a problem)
+ WBC (highly indicative of UTI)
+ Nitrite: with certain bacterial infections
+ Leukocyte esterase (highly indicative of UTI)
+ RBC- sometimes
Culture and sensitivity
Culture: presence of bacteria
Sensitivity: antibiotics affective for strain
Crede method (manual compression)
Hands compress bladder to assist in emptying
-should not be implemented until consult with HCP
Single-lumen catheter
Used for intermittent/straight catheterization
Double-lumen catheter
One lumen for urinary drainage and one to inflate balloon
-designed for indwelling catheters: Foley
Triple-lumen catheter
Continuous bladder irrigation or to instill medications
-One lumen drains the bladder, one used to inflate the balloon, and one delivers irrigation fluid into bladder
