184 unit 3

Question 1

Urination aka micturition aka voiding

Answer 1

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.

Question 2

Dysuria

Answer 2

Difficulty in voiding; may or may not be associated with pain

Question 3

Polyuria

Answer 3

Excessive output of urine (diuresis)

Question 4

Oliguria

Answer 4

Scanty or greatly diminished amount of urine voided in a given time; 24 hour urineoutput is 100 to 400mL

Question 5

Anuria

Answer 5

Technically no urine voided; 24-hour urine output is less than 100mL

Question 6

Nocturia

Answer 6

Excessive urination during the night

Question 7

Pyuria

Answer 7

Pus in the urine; urine appears cloudy

Question 8

Diuretics

Answer 8

also called water pills, are medications designed to increase the amount of water and salt expelled from the body as urine.

Question 9

Retention

Answer 9

Inability to void although urine is produced by the kidneys & enters the bladder;excessive storage of urine in the bladder

Question 10

Micturition

Answer 10

Process of emptying the bladder; urination; voiding

Question 11

Incontinence

Answer 11

Involuntary loss of urine

Question 12

Hesitancy

Answer 12

when you have trouble starting to pee. hesitate

Question 13

Hematuria

Answer 13

the presence of blood in urine.

Question 14

Glycosuria

Answer 14

Presence of sugar in the urine

Question 15

Cystitis

Answer 15

an inflammation of the bladder, the cause of cystitis is a urinary tract infection (UTI).

Question 16

Nursing process: Assessment

Answer 16

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

Question 17

Physical AssessmenT

Answer 17

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

Question 18

promote normal urination

Answer 18

Interventions to support normal voiding habits, fluid intake, strengthening ofmuscle toneo Stimulating urination and resolving urinary retentiono Assisting with toileting

Question 19

maintain patient normal voiding pattern

Answer 19

Scheduleo Assist the pt. to void when they feel the need to do soo Privacyo Positiono Hygiene

Question 20

type of patients are at risk for urinary tract infections (UTIs)

Answer 20

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

Question 21

Urinary Incontinence

Answer 21

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

Question 22

Types of Urinary Incontinence

Answer 22

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

Question 23

Urine retention

Answer 23

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.

Question 24

Factors affecting Micturition

Answer 24

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

Question 25

Factors affecting Micturition

Answer 25

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

Question 26

Factors affecting Micturition

Answer 26

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

Question 27

Factors affecting Micturition

Answer 27

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

Question 28

Factors affecting Micturition

Answer 28

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

Question 29

Medications affecting urine color

Answer 29

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

Question 30

signs and sym of uti

Answer 30

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

Question 31

Urine Specimen

Answer 31

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

Question 32

urinalysis

Answer 32

test of the urine. 10ml

Question 33

clean catch/ midstream specimen

Answer 33

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.

Question 34

sterile specimen

Answer 34

from an indwelling catheter. or catheterizing pt bladder.

Question 35

24hr urine specimen

Answer 35

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

Question 36

U.O.P

Answer 36

URINARY OUTPUT

Question 37

H.N.V

Answer 37

HAVE NOT VOIDED

Question 38

UTI

Answer 38

URINARY TRACT INFECTION

Question 39

U/A

Answer 39

URINALYSIS

Question 40

C&S

Answer 40

CULTURE AND SENSITIVITY

Question 41

CVA TENDERNESS

Answer 41

lower back pain associated with kidney infection.

Question 42

CHF

Answer 42

congestive heart failure

Question 43

IDDM

Answer 43

insulin dependent diabetes mellitus

Question 44

Indwelling urethral catheter:

Answer 44

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

Question 45

indication for indwelling catheter

Answer 45

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

Question 46

External condom catheter

Answer 46

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.

Question 47

external condom indication

Answer 47

an internal catheter can’t or shouldn’t be used (due to issues such as urinary tract infections, bladder spasms, or bladder stones).

Question 48

tap water

Answer 48

500-1000, 15min,

Question 49

normal saline

Answer 49

500-1000, 15min

Question 50

soap

Answer 50

500-1000, 10-15min,

Question 51

hypertonic

Answer 51

70-130, 5-10min,

Question 52

oil

Answer 52

120-200, 30min

Question 53

physical finding urinary problems

Answer 53

▸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.