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NUR350 > Urinary Elimination Care Skills > Flashcards

Urinary Elimination Care Skills Flashcards

(38 cards)

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1
Q

Micturition

A

The process of emptying the bladder

Normal adult voiding:
1500-1600ml/day OR 30ml/hr

Desire to urinate when:
250-300ml in adult
50-100ml in child

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2
Q

Kidney

A

Empties urine into bladder intermittently

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3
Q

Micturition Process

A
  1. Stretch receptors in bladder
  2. Impulses sent to spinal cord
  3. Signals travel to pontine micturition centre in brainstem
  4. Signals sent back down resulting in relaxation of internal sphincter and contract of detrusor muscle
  5. Conscious relaxation of external urethral sphincter
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4
Q

Factors influencing urinary elimination

A
  • physiological (anxiety, stress)
  • sociocultural (squatting v sitting)
  • fluid balance (oral intake, caffeine, alcohol
  • surgical/diagnostic (general anaesthetic)
  • pathological conditions
  • medications (diuretics)
  • environment (comfort)
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5
Q

Promote Urinary Elimination

A

a. promote fluid intake: 1500-2000ml daily
b. void q 3-4 hours
c. encourage BM
d. avoid substances that irritate bladder (caffeine, alcohol, greasy or spicy good, tobacco)
e. stimulate voiding reflex
f. complete bladder emptying
g. prevent infection (perineal hygiene)

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6
Q

Urinary Assessment

A

a. Health history (voiding patterns, changes, risk factors that affect voiding)
b. Physical assessment
- fluid balance (skin condition, diaphoresis, mucous membrane)
- abdominal assessment (including kidney)
- perineum assessment
c. Urine assessment
- characteristics (colour, odour, clarity)
- intake and output
- urine testing and specimen collection

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7
Q

Intake includes

A

IV fluids, dietary fluids, blood products

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8
Q

Output includes

A

Urine, diarrhea, emesis, diaphoresis, drainage

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9
Q

Output can be measured by..

A

a. graduated cylinder
b. urometer
c. urine hat

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10
Q

Incontinence

A

Involuntary loss of urine

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11
Q

Urgency

A

Sudden and compelling urge to void that cannot be postponed

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12
Q

Dysuria

A

painful or difficult urination

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13
Q

Frequency

A

voiding more than 8 times in a 24 hour period

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14
Q

Hesitancy

A

difficult initiating urination

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15
Q

Polyuria

A

large increased amount of urine

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16
Q

Oliguria

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A

decreased amount of urine

- less than 400ml in 24 hours

17
Q

Nocturia

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A

getting up at night to void

18
Q

Dribbling

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A

Leakage despite voluntary control

19
Q

Hematuria

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A

presence of blood in urine

20
Q

Elevated post-void residual urine

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A

urine retained in bladder

50ml remaining is normal but more than 100ml is not

21
Q

Urinary Incontinence

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A

a. can be transient
b. urgency
c. stress incontinence (laughing, sneezing, coughing)
d. mixed (features of stress and urgency)
e. chronic retention (bladder unable to empty completely)
- enlarged prostate, fecal impaction, spinal cord injuries
f. multifactorial

22
Q

Urinary retention

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A

Marked accumulation of urine in the bladder as a result of inability to empty bladder

23
Q

Urinary tract infection

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A

Infection of lower urinary tract leading to cystitis, urethritis and prostatitis

Risk factors:

  • sexual activity
  • pregnancy
  • low levels of vaginal estrogen
  • incomplete bladder emptying
  • decreased immunity

Symptoms:

  • dysuria
  • fever
  • frequency, urgency
  • hematuria
  • nausea, vomiting
  • urine concentrated and cloudy (foul smell)
24
Q

Urinary diversions

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A

bypass bladder and urethra (permanent or temporary)

a. ureterostomy
ureters to abdominal surface
b. ileal loop
ureters attach to segment of ileum
c. nephrostomy
drainage tube directly into renal pelvis
25
Signs and symptoms of Urinary Retention
- feelings of pressure and discomfort - restlessness, diaphoresis - distended bladder - dull over supra-pubic area - absence of urine output - small frequency voiding or dribbling
26
Complication of urinary retention
Prolonged retention can lead to: - stagnation/stasis (alkaline, hospitable to bacteria) - greater risk of UTI - kidney infection
27
Bladder scanner
ultrasound technology using high-frequency sound waves to detect urine volume in bladder
28
Managing urinary retention
a. treat the cause - change medications - prostate surgery b. intermittent catheter
29
Urinary catheterization
Introduction of a catheter through the urethra into the urinary bladder a. Intermittent - insert for 5-10 mins or just long enough to empty the bladder b. indwelling - retained for longer using small balloon that keeps catheter in place
30
Urinary catheterization lengths
Peds: 8-10 French Vagina: 10-12 French (5-7.5 cm) Penis: 12-16 French (22 cm) *clean urethra meatus with chlorhexidine
31
Intermittent catheterization
Inserted for 5-10 mins or just long enough to empty bladder Indications: - bladder distention - sterile urine specimen - assess post void residual - urethral strictures - management for patients with SCI, neuromuscular degeneration, incompetent bladder
32
Indwelling catheterization
Retained for longer using small balloon that keeps catheter in place ``` Indications: (short term) - surgical procedures - continuous measurement - bladder irrigation - prolonged immobilization due to trauma - acute retention/obstruction - end of life (long term) - chronic retention - pressure injury - intractable incontinence ```
33
Urinary catheter types
a. straight catheter (intermittent) b. indwelling retention catheter (one for drainage, one for balloon inflation) c. triple lumen catheter (one for drainage, balloon, and irrigation * Closed bladder irrigation d. coude catheter (curved tip, helpful for enlarged prostate) e. suprapubic catheterization - surgically placed through abdo wall above symphysis pubis - urethral trauma f. condom catheter (elastic tape) - change q1day - nocturia
34
Catheter Care
a. perineal care (BID, post BM, prn) - soap and water, dirty to clean b. catheter care (TID, post BM) - urethral meatus followed by catheter c. promote fluid intake d. collection devices - never raise higher than bladder - don't clip on bed rail or drag on floor
35
CAUTI prevention
- hand hygiene - strict aseptic technique - maintain closed system - prevent pooling of urine in tubing - avoid kinks - don't let bag drag on floor - empty bag at least q8hr (or half full) - remove asap
36
Preventing UTI
a. promote good personal hygiene b. showers not baths c. daily intake of 1500-200ml d. practice frequent voiding every 2-4 hr
37
Urine Testing (Specimen collection)
a. routine (routine and microscopic) b. midstream urine specimen (c and s) c. catheter specimen (c and s) d. timed specimen (collection over given time) e. urine dip (chemical reagent strips)
38
Renal Replacement
Dialysis - cleaning blood, renal failure that can no longer be treated with medication or diet modification alone a. peritoneal dialysis (indirect using osmosis and diffusion) b. hemodialysis (machine using semi-permeable filtering membrane) Kidney transplant

NUR350 (27 decks)

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