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Nursing Fundamentals II > Urinary System > Flashcards

Flashcards in Urinary System Deck (171):
1

urinary system consists of....

two kidneys, two ureters, the urinary bladder, and the urethra

2

length of male urethra

3-5 inches

3

length of female urethra

2-3 inches

4

why is it hard to put in a cath for a male?

prostrate gland

5

coude

specially designed catheter to help get past prostrate; prostrate disease cancer

6

metal guide

need dr or someone from anesthia; not used too often; may bleed in urine for one to two days after; helps to get cath around prostrate gland; more invasive; used in males to get past prostrate gland

7

what is the role of kidneys?

produce urine

8

urine consists of...

95% water and 5% nitrogenous waste products of protein

9

what makes up nitrogenous waste of urine?

urea, uric acid, and creatinine

10

secondary functions of kidney

Erythropoietin (makes red blood cell) production, renin production, and the activation of Vitamin D3

11

Erythropoietin is produced and released in response to...

decreased oxygen in kidney blood supply which triggers RBC production in bone marrow

12

Unhealthy kidneys will have reduced erythropoietin production which in turn can make you...

anemic

13

role of vitamin D

promotes absorption of Ca in GI tract and regulate Ca balance

14

role of renin

- assists in blood pressure control
- anytime the kidneys sense a drop in fluid volume and blood pressure
-

15

excess electrolytes eliminated in the urine which include

Na, Ca, K, and phosphates.

16

why do you look at med doses when there is kidney dysfunction?

metabolism of medicine could be altered; may need to change dose

17

other functions of kidneys

- Assist the body to regulate blood volume by excreting or conserving water; ADH in endocrine system.
- Regulation of electrolyte balance.
- Regulation of the acid-base balance.
- Regulates the same components in tissue fluid.

18

where is urine produced?

kidney

19

how is the urine moved from kidney to bladder?

moved by virtue of peristalsis thru the ureters into the urinary bladder

20

how full is the bladder when it sends a signal to the spinal cord and brain to empty the bladder?

- 250-300cc’s is a general amount
- Some may have less and some may have more

21

micturition

expel urine from bladder

22

where are kidneys located?

retroperitoneal space

23

what hormone is responsible for producing RBCs?

erythropoietin

24

how does kidney assist in acid-base balance of the body?

secretes renin

25

what do you have to worry about when there is surgery on kidneys?

- always a high risk to bleed
- highly vascular in that area

26

3 parts of kidney

renal cortex, renal medulla and renal pelvis

27

renal cortex

outer most part of kidney

28

renal medula

- middle portion
- contains the collecting tubules and the renal pyramids

29

renal corpuscle

- glomerulus
- bowman's capsule

30

glomerulus

a ball-like network of capillaries formed from an arteriole within the Bowman's capsule

31

Bowman's capsule

surrounds the glomerulus

32

where does Lasix start to work?

loop of henle

33

where do diuretics work?

ascending/descending loop tubule

34

Bowman's capsule is attached to...

a long looped and coiled structure called the renal tubule

35

where does the blood go from the capillary network that is formed around the tubules?

collected by the venules

36

most of the contents except for large molecules and large blood cells are...

forced out of the blood from the capillaries of the glomerulus and into the Bowmans capsule

37

glomerular filtrate

matter that is filtered out of blood

38

what type of pressure does the capillary system have?

high pressure

39

what is in the matter that is filtered out of the blood?

water, electrolytes, various toxic substances, and other waste products

40

how much blood is processed by the kidneys?

400 quarts each day

41

GFR

changes with age; how well kidneys take on blood and how well it gets rid of unwanted parts and excrete

42

GFR produces...

about 2 quarts of waste products and extra water as urine

43

tubular reabsorption

During the process of filtration some of the necessary elements are reabsorbed and returned to circulation

44

what happens to the filtrate that is not reabsorbed?

is now urine and continues to travel thru the tubules

45

where does the urine go once it leaves the tubules?

to the collecting ducts and into the pelvis of the kidney and then to the rest of the urinary system

46

normal output of urine

1000-2000ml in 24 hours

47

average output of urine

1500 mL in 24 hours

48

minimum output of urine

30 mL per hour; need this much to have healthy kidney function

49

should urine be clear?

yes

50

what is the color range of urine?

pale yellow to amber or straw colored

51

what color of urine do you want?

pale yellow

52

what urine color is more dilute?

lighter color

53

what urine color is more concentrated?

darker color

54

urine screen

dip sticks; color shows what is wrong with them

55

who might use a urine screen

Camp counselor and emergency room

56

can the urine screen test check for ketones?

yes

57

can the urine screen test check for glucose?

yes

58

what does cloudy urine indicate?

presence of pus, red blood cells, or bacteria

59

dark red in urine indicates..

bleeding in the area of the kidney and high in ureter

60

bright red in urine indicates...

bleeding in the lower urinary tract/bladder and urethra

61

Interstitial cystitis

infection in walls of bladder; strands appear in urine

62

dark yellow urine...

may indicate the presence of bilirubin

63

brown looking urine...

Rhubarb and liver/gallbladder disease

64

beets make urine look...

bloody

65

pyridium makes urine look....

blaze orange; used to treat pain, dysuria and spasms

66

mandelamine makes urine look...

dark brown; made from sterile horse urine

67

foul smelling urine indicates...

infection

68

sweet smelling urine indicates...

glucose

69

should freshly collected urine be sweet or foul smelling?

no

70

Normal pH of urine

4.6 to 8.0 with an average of 6

71

The pH of urine indicates...

- the acid-base balance
- under 6 are more acidic; higher more alkaline

72

what does an alkaline measure in urine indicate?

- possible infection or bacteria
- high intake of citrus fruits or vegetables

73

what does acidic urine indicate?

- starvation
- dehydration
- diet high in meat/cranberries
- Atkins diet

74

should protein be positive or negative?

negative

75

why test urine for protein?

indicates renal function

76

how often are pregnant women checked for protein?

every visit

77

Normal specific gravity

- 1.010 to 1.025
- determine the ability of the kidney to concentrate and excrete urine
- hydration level of the patient

78

Normal specific gravity test allows you to...

correct fluid volume, get to better balance and help to decide on correct flow of iv

79

Nitrites

- should be negative
- if present would indicate possible infection

80

Ketones

should be negative

81

what are ketones?

end products of fatty acid breakdown

82

situation you might find ketones

- diabetic or special diets
- extreme athletes (should go away within a week)

83

crystals present in urine indicate...

- renal stone formation
- additional test to look for kidney stones

84

what are casts in urine?

- clumps of materials or cells that are abnormal in urine
- structures that form around other particles

85

each cast indicates...

a different problem

86

when are casts sometimes found in urine?

after exercise

87

Hyaline casts indicate...

- protein problems
- Atkin's diet

88

Granular casts indicate...

- some type of nephrotic syndrome
- problem with kidneys
- 85% loss of nephrons

89

Epithelial casts indicate...

possible glomerulonephritis

90

Waxy casts indicate...

chronic renal disease or renal failure

91

WBC

- more than 5 indicate infection
- Culture and sensitivity will be done

92

RBC

- more than two could indicate kidney disease, trauma, or tumor
- Blood in the urine can also indicate infection

93

BUN

- 8-20 mg/dl
- Reflective of age - higher with age
- Less hydrated - higher it will be
- not foolproof to diagnose kidney disease

94

Creatinine

- 0.5-1.1mg/dl
- True kidney disease for anything above 1.1
- Reliable test for diagnosis of kidney disease

95

Cystoscopy

- Scope to see what is going on in bladder (infection, tumor, polyps)
- Can do biopsy as they are looking
- Direct visualization of bladder

96

complications of cystoscopy

- change in vital signs
- stronger bleeding
- some blood in urine after procedure

97

Cystometry

- check to see when they feel the urge to go
- irrigate bladder
- should get urge at 250-300 mL
- don't put in more than 1000 mL

98

who would you perform a cystometry on?

- people with some degree of incontinence
- neuromuscular disease (ALS, multiple sclerosis)
- don’t feel the urge to urinate

99

how do you treat someone who doesn't have the urge to urinate?

- kegel exercise
- meds
- suprapubic cath

100

IVP

- check for allergy to dye
- x-ray to see the flow of the dye
- look for abnormalities
- drink water after test

101

Ultrasound

- look at kidney and pelvis

102

kidney biopsy

- highly vascular
- look for signs of bleeding

103

What is the urination pattern?

- Number of times, ask targeted questions
- Would you say you urinate 10 times per day?

104

Is there any sense of urinary retention after urination?

- Men over 50 yrs start to feel like they always have urine left
- Postpartum women or surgical intervention

105

how much urine can you take at a time?

- max is 1000 mL
- take too much could affect blood pressure

106

Does the client have complaints of excessively dry skin or pruritus?

- Not able to clear waste products
- Urea starts to come to the skin

107

Uremic frost

end stage renal disease; waste product comes to surface of skin; bile and ureic salts

108

should you be able to palpate the bladder?

- not usually
- usually about 400-500 mL before you can feel it

109

how much urine does a newborn produce?

15 to 60 ml of urine per kilogram per day

110

how do you measure urine output for newborn?

Weigh diaper before you put it on and when you take it off

111

how do newborns concentrate urine?

poorly

112

how many times does a newborn void in the first 24 hours?

25 times

113

how many times do infants void in 24 hours?

8 - 10 times

114

what do you ask parent when infant is experiencing nausea or vomiting and not feeling well?

how many wet diapers

115

when is toilet training done?

18-24 months

116

Enuresis

daytime wet

117

Nocturnal enuresis

nighttime wet

118

what age should you be concerned if child is not toilet trained?

6 yrs

119

reasons for difficulty in toilet training

- cognitive delays
- bad tonsils

120

geriatric considerations

- Decline in filtration rate
- Decreased capacity

121

Anuria

without urine, less than 100 mL in 24 hours

122

Oliguria

less than 300 - 400 mL in 24 hours

123

Polyuria

excessive urination

124

Dysuria

painful urination

125

Urgency

the feel to go

126

Frequency

how often

127

Nephrotoxic

tylenol beyond healing doses

128

Pyridium

dysuria, spasm, turn urine bright orange

129

Diuretics

Thiazides, Potassium-Sparing

130

Meds that can cause urinary retention:

antihistamines, tricyclic antidepressants, MAO inhibitors, antispasmodics, Parkinson drugs, and Beta blockers

131

Med to treat urinary retention

Urecholine

132

Meds that are nephrotoxic

Gentamycin/Garamycin (ototoxic), Amphotericin B, aspirin, and Motrin, Tylenol

133

Infection/inflammation

- Symptoms can be kind of the same
- Dysuria, burning, low grade temp
- No WBC or bacteria in inflammation
- Treat both with antibiotics

134

Renal calculi

- Stones
- Miserable
- Need a lot of fluid
- Pain better when stones are passed

135

BPH

- Benign prostatic hyperplasia
- Men
- May need to remove part of prostrate
- Prostrate - look for growth and nodules
- PSA - if elevated check to cancer, 0-4 i
- Cath males over 50, use coude cath

136

cardiac disease

decreased blood flow to kidneys

137

kidney output ok

profuse adequate 30 mL/hr

138

Urinary Incontinence

he uncontrolled loss of urine from the bladder. Incontinence has many causes some of which might be a result of a urinary tract problem, a neurological problem, and some medications as well as others

139

Stress incontinence

the most common type of incontinence and women are more likely a ffected. There is leakage of urine when the person does anything that strains the abdomen such as coughing, sneezing, laughing, jogging, dancing, and lifting.

140

treatment of stress incontinence

bladder retraining, medications such as estrogens, surgery, and teaching of Kegel exercises

141

Atrophic vaginitis

painful intercourse, slight bleeding after intercourse, irritation,

142

treat atrophic vaginitis

- estrogen, vaginal is less risky than oral
- don't use estrogen if risk of breast cancer

143

Urge incontinence

Occurs when a person is unable to suppress the sudden urge to urinate. Sometimes urine may leak without warning. Often an irritated bladder is the cause stemming from infection or concentrated urine.

144

treatment of urge incontinence

Suprapubic cath as last resort

145

Total incontinence

no urine can be retained in the bladder. The cause of this is usually neurological and can be treated with a Foley catheter. Treatment might also include urinary diversion or suprapubic catheter.

146

who can have total incontinence?

- people with delayed cognitive ability
- Neurologic - paraplegic, quadriplegic

147

treatment of total incontinence

- Use incontinent products
- Urinary diversion products

148

Nocturnal enuresis

- during sleeping
- not unusual up to the age of 6-8.
- typically the client will be checked to rule out infection by ordering a urinalysis and urine culture.

149

treatment for nocturnal enuresis if no infection

limiting fluids, awakening the child, setting alarms, and etc

150

possible causes of nocturnal enuresis include

pinworms, constipation, diabetes, sickle cell anemia, sexual abuse, stress, and sleep disorders

151

meds to treat nocturnal enuresis

- Ditropan (adults)
- DDAVP (diabetes insipidus, urinate less often, nasal spray)
- Tofranil (low dose antidepressant)

152

Urinary Retention

Urinary retention is when a person has the urge to void but cannot empty the bladder. When urinary retention is present it creates urinary stasis and increases the risk of infection.

153

causes of urinary retention

Stress, obstruction by calculi, tumor, infection, interference of the urinary sphincter during a surgical procedure, side effect of medications, and perineal trauma as in childbirth.

154

symptoms of urinary retention

Discomfort, anxiety, frequency of urination which can result in small frequent amounts, incontinence, may occur, can palpate the distended bladder over the pelvis.

155

treatment of urinary retention

Urinary analgesics such as Pyridium, antispasmodics, catheter, or surgery if an obstruction is present. Urecholine is also used to treat urinary retention. Doctor may order to measure residual volumes which should be less than 50 ml.

156

Voided specimen

implies that a hat in toilet; not good (better than nothing)

157

Midstream clean catch

- Wash genital area; start urine stream; put cup midway through; take cup out and finish
- Best specimen short of cath

158

Mini-cath

- females only
- sterile procedure
- one way to get sterile specimen

159

condom cath

- Urine specimen for a male who is incontinent
- Works for younger males but not so much for older men
- Connect to leg or drainage bag
- Good for quadriplegic or paraplegic who don't like to be wet

160

Straight cath

One lumen - straight; go in, get urine and come out; not meant to stay in; used mostly with men

161

U-bag (peds)

- attach to genitalia (labia or penis)
- put diaper back on and wait for them to go

162

Sterile collection - foley

- Just put Foley on - very first urine in bag can be taken from bag
- Foley has been on for awhile - clamp on cath, come back in 15 minutes, bring syringe (needless), let clamp go and aspirate into syringe

163

24 hour urine collection

- Know type and let lab know so that you get the appropriate container (some may have preservatives)
- Void at a specific time; start collecting after that for the next 24 hours
- Refrigerate or bucket of ice to keep it cool

164

Foley cath - two lumen

- meant to stay in
- one lumen for urine
- one lumen for water to inflate balloon
- 5, 10, & 30 cc balloon

165

Foley cath - three lumen

- meant to stay in
- one lumen for urine
- one lumen for water to inflate balloon
- one lumen to irrigate
- 5, 10, & 30 cc balloon

166

what do you do when you irrigate a bladder?

keep track of how much solution you use so you can subtract from output

167

Water intoxication

irrigation drifts into vascular system; had alert patient and a while later they have a change of personality; behavior changes, etc.; Call dr because now you may have an electrolyte imbalance

168

Urometer

accurately measures amount of urine, attached to collection bag of Foley cath

169

Strainer

strain all urine; look for kidney stones; should have dr orders but can do because of std practice

170

Urostomy bag

remove bladder; ureters are places in small intestine and surgical opening in pelvis; plate area attached into bag (kock pouch)

171

caths are measured in ....

- French
- 12-16 french is average size