184 unit 3 Flashcards
Urination aka micturition aka voiding
The nerve centers for urination are situated in the brain and spinal cord. largely an involuntary reflex act, but control can be learned. The voluntary control of urination develops as higher nerve centers develop after infancy. Until that time, voiding is purely a reflex. Stretch receptors in the bladder are stimulated as the urine collects. The person feels a desire to void, usually when the bladder fills about 150 to 250 mL in adult. When urination is initiated, the detrusor muscle contracts, the internal sphincter relaxes, and urine enters the posterior urethra. The muscles of the perineum and the external sphincter relax, the muscle of the abdominal wall contracts slightly, the diaphragm lowers, and urination occurs.
Dysuria
Difficulty in voiding; may or may not be associated with pain
Polyuria
Excessive output of urine (diuresis)
Oliguria
Scanty or greatly diminished amount of urine voided in a given time; 24 hour urineoutput is 100 to 400mL
Anuria
Technically no urine voided; 24-hour urine output is less than 100mL
Nocturia
Excessive urination during the night
Pyuria
Pus in the urine; urine appears cloudy
Diuretics
also called water pills, are medications designed to increase the amount of water and salt expelled from the body as urine.
Retention
Inability to void although urine is produced by the kidneys & enters the bladder;excessive storage of urine in the bladder
Micturition
Process of emptying the bladder; urination; voiding
Incontinence
Involuntary loss of urine
Hesitancy
when you have trouble starting to pee. hesitate
Hematuria
the presence of blood in urine.
Glycosuria
Presence of sugar in the urine
Cystitis
an inflammation of the bladder, the cause of cystitis is a urinary tract infection (UTI).
Nursing process: Assessment
Nursing Process: Assessment Urinary Status History & Physical Voiding Patterns Problems with Voiding Duration Severity Precipitating factors Self-care behaviors Correlate with procedures or diagnostic exams
Physical AssessmenT
Kidneys - normally not palpable. Asses for how often they goo Urinary bladder – ask last time they voided before palpating. Observe lower abdominalwall, noting any swelling, and palpate for tenderness, note smoothness and roundness andheight above the symphysis pubis. Asses if they can hold the urineo Urethral meatus or orifice – Easier in males than females. Inspect for any signs ofinflammation, discharge, or foul odor. Place female patients in the dorsal recumbentposition with the inner labia retracted for good visualization of the meatus. If the male pt. isuncircumcised, retract the foreskin to visualize the meatus.o Skin (integumentary) – rash, lesions. Problems with urinary functioning may result indisturbances in hydration and excretion of body wastes, asses the skin for color, texture, andturgor. Asses the integrity of the skin in the perineal area. Problems with incontinence mayresult in severe excoriation (abrasion of the epidermis). o Urine – asses for color, odor, clarity and the presence of sediment. Note any abnormalities.Check for abnormal constituents such as protein, blood, glucose, ketone bodies and bacteria
promote normal urination
Interventions to support normal voiding habits, fluid intake, strengthening ofmuscle toneo Stimulating urination and resolving urinary retentiono Assisting with toileting
maintain patient normal voiding pattern
Scheduleo Assist the pt. to void when they feel the need to do soo Privacyo Positiono Hygiene
type of patients are at risk for urinary tract infections (UTIs)
Women because the female urethra is shorter and in closer proximity to the vaginaand rectumo Sexually active women because during intercourse, perineal bacteria can migrateinto the urethra and bladdero Women who use diaphragms for contraception because decreases the amount ofnormally protective flora o Postmenopausal women, urinary stasis is common at this age providing an optimalenvironment for bacteria to multiply, and decrease estrogen contributes to loss ofprotective vaginal florao Patient with indwelling urinary cathetero People with diabetes mellituso Older adults. Also enlargement of the prostate in older men can contribute to thedevelopment of UTIs
Urinary Incontinence
Use of Absorbent Products When absorbent products are not use properly can cause skin breakdown and increaserisk for a UTI Long term use is not recommended until the following factors have been considered anddiscussed with a health care provider: Functional disability of the patient Type and severity of incontinence Gender Availability of caregivers Failure with previous treatment programs Patient preference Nursing Care of the Incontinent Patient Hospital Policy & Procedures Physical Assessment Palpate the pt.’s abdomen for a distended bladder, masses or tenderness
Types of Urinary Incontinence
Transient – appears suddenly and lasts for 6 months or less. Caused by treatable factorssuch as confusion secondary to acute illness, infection and as a result of medicaltreatment such as the use of diuretic or IV fluids Stress—involuntary loss of urine related to an increase in intra-abdominal pressure.Occurs during coughing, sneezing, laughing, or other physical activities, childbirth,menopause, obesity or straining from chronic constipation can also result in urine loss Urge—involuntary loss of urine that occurs soon after feeling an urgent need to void Mixed—urine loss with features of two or more types of incontinence Overflow— or chronic retention of urine, voluntary loss of urine associated with overdistention and overflow of bladder, may be due to a secondary effect of some drugs, fecalimpaction or neurologic conditions Functional—urine loss caused by the inability to reach the toilet because ofenvironmental barriers, physical limitations, loss of memory or disorientation Reflex—emptying of the bladder without sensation of need to void. Spinal cord injuriescan lead to this type Total—continuous, unpredictable loss of urine resulting from surgery, trauma or physicalmalformation
Urine retention
catheterized can be use to relieve urinary retention. Retention is often temporary and is common after surgery involving the lower abdomen, pelvis, bladder, or urethra, especially if ambulation is delayed, fluid intake is minimal, or epidural analgesia is used for pain control. Mechanical obstruction, such as swelling at the meatus, which can occur after childbirth, or an enlarged prostate in men, may can retention.
Factors affecting Micturition
Effects of aging - Inability of the kidneys to concentrate the urine may result in Nocturia Increased frequency Urine retention & stasis > UTI Decrease voluntary control affected by physical problems and the inability to reach atoilet in time
Factors affecting Micturition
Fluid & food intake - Dehydrated > kidneys reabsorb fluids, the urine produced is more concentratedand decreased in amount Fluid overload > kidneys excrete a large quantity of dilute urine Alcohol produces a diuretic effect > increase urine production Foods and beverages with high sodium content cause sodium and waterreabsorption and retention > decrease urine formation Foods such as asparagus, and onions may affect the odor of the urine Beets affect the color of the urine > red
Factors affecting Micturition
Psychological variable-Some people who experience stress void smaller amounts of urine at more frequentintervals. Stress can also interfere with the ability to relax the muscles and sphincter, and theperson may have the urge to void but it becomes difficult
Factors affecting Micturition
Activity & muscle tone-Exercise > increase urine production and elimination Immobility > poor urinary control and urinary stasis Indwelling urinary catheters, childbearing, muscle atrophy due to a decreasedestrogen levels as seen with menopause, and damage to muscles from trauma >decrease muscle tone and decrease urinary production
Factors affecting Micturition
Pathologic conditions - Multiple sclerosis Hematuria Congenital urinary tract abnormalities Polycystic kidney disease UTI Urinary calculi HTN Diabetes mellitus (high blood glucose levels) > increase urine output Gout Connective tissue disorder Acute Renal Failure is a sudden decline in kidney function and may be caused byconditions such as severe dehydration, anaphylactic shock, pyelonephritis, andureteral obstruction. Chronic Renal Failure is developed over the years and is caused by conditions such asdiabetes, HTN, and glomerulonephritis. Disease that reduce physical activity or lead to generalized weakness, such asarthritis, Parkinson’s disease, and degenerative joint disease, may interfere withtoileting. Cognitive deficits and certain psychiatric problems can interfere with a person’sability or desire to control urination volume. Fever and diaphoresis (profuse perspiration) result in body fluid conservation by thekidneys > decrease urine production, and highly concentrated
Congestive heart failure may lead to fluid retention and decreased urine output. Medication Sedatives and tranquilizers may diminish awareness of the need to void. Diuretics > Usually to treat HTN. Prevent reabsorption of water and certainelectrolytes in tubules. Increase urine production and dilute urine.*Somebody under taking diuretics, you have to check for electrolytes such as Na, K, Cl Cholinergic medications > stimulate contraction of detrusor muscle, producingurination Analgesics and tranquilizers—suppress CNS, diminish effectiveness of neural reflex Nephrotoxic > medication capable of causing kidney damage. Highest concern
Medications affecting urine color
Anticoagulants: hematuria > blood in the urine. Pink or red color Diuretics: pale yellow urine Pyridium: Orange to orange-red urine; UTI Elavil (antidepressant) or B-complex vitamins: green or blue green urine Levodopa, and antiparkison drug, and injectable iron compounds: brown or black urine
signs and sym of uti
A strong, persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Urine that appears cloudy
Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
Strong-smelling urine
Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
Urine Specimen
o Urinalysiso Urine culture (C&S)o Specific Gravityo Clean-catch or midstream specimenso Sterile specimens from indwelling cathetero 24-hour urine specimen Initiate a collection at a specific time Discard and then collect all urine voided for the next 24 hours At the end of the 24 hrs. ask the pt. to void, and add this urine to the previouslycollected urine, and send to the lab May be together or separate
urinalysis
test of the urine. 10ml
clean catch/ midstream specimen
patient voids and discards a small amount of urine; continues voiding in a sterile specimen container to collect the urine; stops voiding into container; removes container and continues voiding; then discards the last amount of urine in bladder. the first small amount of urine void help to flush away any organism near the meatus because finding may be inaccurate.
sterile specimen
from an indwelling catheter. or catheterizing pt bladder.
24hr urine specimen
Initiate a collection at a specific time Discard and then collect all urine voided for the next 24 hours At the end of the 24 hrs. ask the pt. to void, and add this urine to the previouslycollected urine, and send to the lab May be together or separate
U.O.P
URINARY OUTPUT
H.N.V
HAVE NOT VOIDED
UTI
URINARY TRACT INFECTION
U/A
URINALYSIS
C&S
CULTURE AND SENSITIVITY
CVA TENDERNESS
lower back pain associated with kidney infection.
CHF
congestive heart failure
IDDM
insulin dependent diabetes mellitus
Indwelling urethral catheter:
catheter that remains in place for continuous urine drainage. Foley catheter Designed so that it does not slip out of the bladder (balloon inflation inside bladder) Used for gradual decompression of an over distended bladder
indication for indwelling catheter
Acute urinary retention: e.g., due to medication (anesthesia, opioids, paralytics), or nerve injury
Acute bladder outlet obstruction: e.g., due to severe prostate enlargement, blood clots, or urethral compression
Need for accurate measurements of urinary output in the critically ill
To assist in healing of open sacral or perineal wounds in incontinent patients
To improve comfort for end of life, if needed
Patient requires strict prolonged immobilization (e.g., potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fracture)
Selected peri-operative needs:
Urologic surgery or other surgery on contiguous (adjacent) structures of the genitourinary tract
Anticipated prolonged duration of surgery (Note: catheters placed for this reason should be removed in PACU)
Large volume infusions or diuretics anticipated during surgery
Need for intraoperative monitoring of urinary output
External condom catheter
soft, pliable sheath made of silicone material applied externally to penis. For when voluntary control of urination is not possible this is an alternative to anindwelling catheter. Most are self-adhesive & connected to drainage tubing & collection bag.
external condom indication
an internal catheter can’t or shouldn’t be used (due to issues such as urinary tract infections, bladder spasms, or bladder stones).
tap water
500-1000, 15min,
normal saline
500-1000, 15min
soap
500-1000, 10-15min,
hypertonic
70-130, 5-10min,
oil
120-200, 30min
physical finding urinary problems
▸vital signs, assessing specifically for fever, tachypnea, and tachycardia
▸CVA tenderness on palpation or percussion
▸suprapubic tenderness or flank pain or tenderness during deep abdominal palpation
▸urine abnormalities (cloudiness, sediment, foul odor, presence of blood)
▸hydration status (skin turgor, fluid intake, urine output)
▸changes in mental status, especially in the elderly.
