Urinary Elimination Flashcards by Hannah Mcnece

Primary functions of kidneys

filter metabolic wastes, toxins, excess ions, and water from the bloodstream and excrete them as urine.

regulate blood volume, blood pressure, electrolyte levels, and acid–base balance by selectively reabsorbing water and other substances.

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Secondary function of kidneys

Produce erythropoietin
Secrete the enzyme rennin
Activate vitamin D3 (calcitriol)

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Urine is formed in the

nephrons

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transport urine from the kidneys to the bladder.

ureters

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stores urine until it is excreted.

bladder

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transports urine from the urinary

bladder to the body exterior.

urethra

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What quantity of urine in the bladder will stimulate the urge to void?

Approximately 200–450 mL of urine in adults

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Identify at least three indications for determining whether hydration is adequate and urine output is within normal limits.

The person voids 1,500 mL in a 24-hour period in five to six voids.
• An infant has 8–10 wet diapers per day.
• For most adults, pale to clear urine indicates adequate hydration.

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What common medications increase the amount of urine voided?

Diuretics increase urine output.

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What types of medications are associated with urinary retention?

Medications with anticholinergic effects may lead to urinary retention.

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A ________catheter has a single lumen and is inserted for ______ periods for immediate drainage of the bladder

straight

brief

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An _________ catheter (Foley or retention catheter) is used for _______bladder drainage and may have two or three lumens

indwelling

continuous

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Why is intermittent catheterization preferred for patients who must be catheterized over lengthy periods of time?

carries a substantially lower risk of infection than an indwelling catheter.

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sandy particles around the urethral meatus of an indwelling catheter are signs of

encrustation and indicate the catheter should be replaced

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How often should the urine collection bag be emptied?

Empty the urine collection bag at least every 8 hours, or more often if it is full, to make it more convenient for the patient to ambulate.

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Labs - BUN

10 to 20

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Labs - Creatinine

0.4 - 1.5

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Important for 24 hour urine collection:

Collect first voiding and discard
Record time
Collect all urine for next 24 hours
Keep container on ice
Complete test by collecting next morning’s first void
Compare I&amp;O to amount in container

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means blood can be seen in the urine

gross hermaturia

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means blood can be only be seen with a microscope

microscopic hermaturia

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Labs - Specific gravity

1.002 - 1.030

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13% of Americans have a problem with

overactive bladder

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Self catheterization is a _________ (clean/sterile) procedure?

CLEAN

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Big risk factor for bladder cancer

smoking

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s/s of bladder cancer

``` blood in urine frequency urgency maybe none until advanced then - dysuria, abd pain, pain in bone ```

Empty stomas when

1/2 - 2/3 full or sooner

occasional involuntary passage of urine

Enuresis

The size and functioning of the kidneys begin to decrease at about age

urination also called _______ and ______

voiding and micturition

The kidneys produce about _________ of urine per hour, or_______mL per day

50 to 60 ml or 1500

measure of dissolved solutes in a solution

Specific gravity

The normal specific gravity range for urine is

1.002 to 1.030.

Older adult Changes in Urinary:

lose ability to dilute and concentrate urine reduction in renal blood flow & filtration reduced bladder capacity - frequency/urgency/nocturia

Caffeine acts as a _____ and ______ urine production

diuretic and increases

alcohol impairs the release of _________ hormone (ADH), resulting in__________ production of urine.

antidiuretic | increased

a diet high in salt causes water________ and _______urine production.

retention and decreases

Risk factors for UTI

Sexually active women (short urethra) Menopausal women (estrogen) pregnant women Diabetes (glucose in urine)

most common microorganism for UTI

Escherichia coli (E coli)

Interventions for UTI

``` lots of water showers instead of baths don't hold it in cranberry juice - (doesn't allow organism to stick) wipe from front to back ```

Which blood studies are commonly used to to assess renal function and hydration?

Blood urea nitrogen (BUN) and creatinine levels

Normal BUN

8–20 mg/dL

Normal creatinine

0.5–1.1 mg/dL

Direct visualization of the urethra, bladder, and ureteral orifices by insertion of a scope.

Cystoscopy

Done to determine whether a muscle or nerve problem is causing problems with how well the bladder holds or releases urine. A catheter is inserted into the bladder and a pressure probe into the rectum.

Cystometry

uses intravenous radiopaque contrast medium to visualize the kidneys, ureters, bladder, and renal pelvis. It evaluates renal function by analyzing flow of contrast over time.

Intravenous Pyelogram (IVP

uses radiopaque contrast medium to visualize the renal collecting system. Contrast media is injected via a ureteral catheter inserted through a cystoscope.

retrograde pyelogram

Causes of urinary retention

``` obstruction enlarged prostrate spinal cord injuries medications/anesthesia removal of catheter ```

The client must cleanse the genitalia before voiding and collect the sample in midstream because the initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum. A midstream sample is free of these contaminants

clean catch specimen

Obtain this specimen by inserting a catheter into the bladder or by withdrawing a sample from an indwelling catheter. Do not take the specimen from the collection bag because that urine may be several hours old.

Sterile urine specimen

``` Urinalysis WNL Color odor ph specific gravity glucose ketone protein ```

``` A freshly voided sample is pale yellow to deep amber. Fresh urine has a scent. 5.0-9.0, with an average of 6.0 1.002–1.030 Negative Negative < 20 mg/day ```

Blood in the urine.

Hematuria

Gross hermaturia

can be seen in the urine

The absence of urine, or urine output of less than 100 mL in 24 hours

Anuria

Painful or difficult urination

Dysuria

Involuntary loss of urine.

Enuresis

Urine output of less than 400 mL in 24 hours.

Oliguria

Excessive urination.

Polyuria

Credé’s maneuver

manual pressure over the bladder

Presence of __________ indicates impaired carbohydrate metabolism (e.g., diabetes, fever, fasting, high-protein diets, starvation, vomiting, or the post-anesthesia period)

ketones

is a single-lumen tube that is inserted for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure PVR volume, or to relieve temporary bladder distention). After the bladder is empty or the sample obtained, the catheter is removed and the patient resumes voiding independently.

Straight catheter

also known as a Foley or retention catheter, is used for continuous bladder drainage (e.g., when the bladder must be kept empty or when continuous urine measurement is needed). It is usually a double-lumen tube: one lumen is used for urine drainage, and the second lumen is used to inflate a balloon near the tip of the catheter.

indwelling catheter

used when the patient requires intermittent or continuous bladder irrigation. The inflated balloon holds the catheter in place at the neck of the bladder. The balloon is sized according to the volume of fluid used to inflate it. For most patients you will use a 5-mL balloon; and for achieving hemostasis after a prostatectomy, a 30-mL balloon

triple lumen catheter

is used for continuous urine drainage when the urethra must be bypassed (e.g., after gynecological surgery or where there is prostatic obstruction). It is inserted through an incision above the symphysis pubis

suprapubic cathete

CBI is ____ _____ _____ and monitoring ____ & ____ is important

continuous bladder irrigation | I&O

is a surgically created opening for elimination of urine

urinary diversion, or urostomy

Is the most common type of urinary diversion because it is the simplest to perform surgically and eliminates the need for ______ ________

ileal conduit | intermittent catheterization

is used to treat bladder and urethral pain, burning, increased urination, and increased urge to urinate. This medication turns the urine a deep orange-red color and is classified as an

Pyridium | Analgesic

Medication for incontinence

oxybutynin (Ditropan)

Medication for retention

Bethanechol (Urecholine)

Medication for dribbling/overflow (think men/prostrate)

Tamulosin (Flomax)

Urinary Elimination Flashcards

(70 cards)