37 Urinary Elimination Flashcards
male vs female urinary tract
- male urethra functions for excretion + reproduction
- male urethra has 3 parts (prostatic, membraneous, + cavernous)
- male length is 5.5-6.2inches
- female length is 1.5-2.5 in
detrusor muscle
3 layered bladder muscle
innervation of bladder muscle
auto ns-innervates
sym ns-inhibit bladder + motor impulse to internal sphincter
para ns-motor impulse to bladder + inhibit internal sphincter
symp ns on bladder
- inhibits bladder
- motors internal sphincter
- causes detrusor muscle to relax + expand and sphincter to constrict
- hold more urine
parasym ns on bladder
- motors bladder
- inhibits internal sphincter
- causes detrusor muscle to constrict + internal sphincter to relax
- for voiding
stretch receptors
in bladder wall
-when pressure becomes sufficient to stim nerves, the person feels the desire to empty
external sphincter is under ____ control
voluntary control
person feels a desire to void when the bladder fills to….
150-250mL
urination process
1 voiding is initiated 2 detrusor muscle contracts 3 internal sphincter relax 4 urine enters posterior urethra 5 perineum + external sphincter relax 6 abs contract slightly, diaphragm lowers 7 urination occurs
incontinence
involuntary loss of urine that causes a problem
retention
urine is produced NORMALLY but is NOT excreted completely
enuresis
continued incontinence of urine past the age of toilet training
nocturia
awakening at night to urinate
-may be due to diminished ability of the kidney to concentrate urine
urge incontinence
involuntary loss of urine that OCCURS SOON AFTER FEELING AN URGENT NEED TO VOID
anuria
24 hr urine output is less than 50mL
dysuria
painful or difficult urination
frequency
increased incidence of voiding
glycosuria
presence of glucose in the urine
oliguria
24 hr urine output is less than 400mL
polyuria
aka diuresis
-excessive output of urine
proteinuria
protein in urine
pyuria
pus in urine
urgency
strong desire to void
urinary incontinence
involuntary loss of urine
continence
patients who have self-control over urination
UTI
2nd most common type of infection in the body
Women are especially vulnerable bc of shorter urethra + close proximity of vagina and rectum
E. coli is the most common causal microbe
UTI analysis
Clean-catch or sterile specimen findings:
- 100,000 organisms/mL (lower counts may be considered positive if s+s are present)
- RBC + nitrate may also be present
Post-void residual
amount of urine remaining in bladder immediately after voiding
- PVR of less than 50mL indicates adequate bladder emptying
- More than 100mL means the bladder is not emptying correctly
Stress Incontinence
involuntary loss of urine R/T an increase in intra-abdominal pressure
-Commonly occurs when coughing, sneezing, laughing, or other physical activities
Transient Incontinence
appears suddenly + last for 6 months or less
-Usually caused by treatable factors like confusion secondary to acute illness, infection, or result of medical treatment (diuretics or IV administration)
Overflow Incontinence aka chronic retention of urine
Involuntary loss of urine associated w overdistention and overflow of bladder
- Bladder fills then dribbling occurs
- The signal to empty bladder may be underactive or absent
Functional Incontinence
urine loss caused by inability to reach the toilet bc of environmental barriers, physical limitations, loss of memory, or disorientation
Reflex Incontinence
experience emptying of the bladder without the sensation of the need to void
-May be r/t spinal cord injury
Total Incontinence
continuous + unpredictable loss of urine due to anatomic abnormality
-Resulting from surgery, trauma, or physical malformation
Nursing diagnosis for fluid overload or decreased fluid intake
Impaired urinary elimination
- R/T
- –Sensory motor impairment
- –UTI
- –Anatomic obstruction
Anatomy of main urinary structure + flow of urine
nephrons> pelvis of kidneys> ureters> urinary bladder
Obtaining a clean-catch or midstream urine specimen
Wear gloves> clean the area w soap and water> the patient voids and discards a small amount of urine (30mL)> Continues voiding in a sterile specimen container to collect urine (10mL)> Stops voiding into container> Remove container and continues voiding> Discard the last amount of urine in the bladder
clean-catch midstream urine is considered a ____ specimen
sterile
What is likely to lead to hyponatremia?
Frequent nasogastric tube irrigation with water
HYPERcalcemia and HYPERmagnesemia cause
decreased neuromuscular excitability
A patient has a positive Chvostek sign. The nurse interprets this as a sign of
neuromuscular excitability
-can be caused by HYPOcalcemia, HYPOmagnesemia
