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Nursing Technologies > 6.3 Urinary Elimination > Flashcards

6.3 Urinary Elimination Flashcards

1
Q

Urination

A
  • Also called voiding or micturition
  • Consists of Kidneys, Ureters, Bladder, and Urethra
  • Most people void 3-4 times a day
  • More frequent urine can mean infection or laxity in pelvic muscle
  • Retention can be due to blockage from prostate enlargement for men or pelvic musculature prolapse for women, bladder cancer, and medication.
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2
Q

Urinary Incontinence Types

A

Overflow - Overdistension and overflow of bladder

Functional - Factors outside of urinary tract

Reflex - Emptying bladder without sensation of need to void

Total - Continuous, unpredictable loss of urine

Stress - Involuntary loss of urine related to increased pressure in abdomen from sneezing, laughing or coughing

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3
Q

Urinary Incontinence Types

A

Transient - Appears suddenly and lasts 6 months or less

Mixed - Urine loss from 2 or more types of incontinence

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4
Q

Factors affecting Micturition (urination)

A

Children - (2-5) Toilet Training and Enuresis (involuntary)

Elderly - Decreased muscle tone and strength, nocturia (wake up at night with need to urinate), medications increasing urine production

Food/Fluid Intake - Dehydration/food causing urine production

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5
Q

Factors Affecting Micturition (cont)

A

Psychological - Stress from not having privacy (bedpan) or voiding in unfamiliar place

Pathological - Acute Kidney Injury (AKI), UTI, Urinary Calculi (stones), Chronic Kidney Disease (CKD), Hypertension, Diabetes mellitus.

  • Medications
  • Congenital urinary tract abnormalities (present at birth)
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6
Q

Caring for patients with UTI

A
  • Sexually active women more at risk for UTI
    (Bacteria likely to flow from vagina to urethra)
  • Urinating after sex helps flush bacteria
  • Spermicidal jelly can change protective bacterial flora in vagina.
  • Post Menopausal women have urinary stasis, decreased vaginal flora, and pelvic floor musculature laxity.
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7
Q

Caring for Patients with UTI

A
  • People with catheters are at risk of bacteria entering up tube.
  • CAUTI is most common Hospital Acquired Infection
  • Diabetes Mellitus more at risk
  • Men with enlarged prostates are at risk
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8
Q

Medication affect on Urine

A

Anticoagulants - Hematuria (blood in urine) resulting in pink/red color

Diuretics - Prevents reabsorption of water and certain electrolytes causing lighter urine color

Cholinergic Medication - Stimulates contractions of detrusor muscle, producing urination

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9
Q

Medication affect on Urine

A

Analgesics/Tranquilizers - Suppress CNS, diminished neural reflex

Phenazopyridine (pyridium) - OTC pain reliever that causes orange or red color of urine

B-Complex Vitamins - Changes urine to blue/green

Levodopa (L-Dopa) - Changes urine brown or black

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10
Q

Kidney Assessment of Urinary Function

A
  • Palpation of kidneys preformed by advanced health care practitioner as part of a more detailed assessment
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11
Q

Urinary Bladderm

A
  • Palpate and Percuss or use bedside scanner
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12
Q

Urethral Orifice

A
  • Inspect signs of infection, discharge or color
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13
Q

Skin

A
  • Inspect color, texture, turgor and excretion of wastes
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14
Q

Urine

A

Assess color, odor, clarity, sediment (matter that settles at the bottom)

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15
Q

Measuring Urine Output

A
  • Void into bedpan, urinal, or specimen container
  • Urometers attached to catheters are the most accurate way to assess urine output
  • Wear gloves and pour urine into measuring device such as calibrated container to measure urine output.
  • Read at eye level on a flat surface
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16
Q

Normal Urine

A
  • Pale yellow, straw, or amber in color
  • Clear and translucent without exudate, pus, or sediment
  • Free of malodorous odor
  • Ammonia odor means bacterial action
  • Minimum of 30mL an hour
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17
Q

Urinalysis

A
  • Collected in Cup and Measured with Dipstick
  • Measures Infection/Dehydration
  • Menstrual flow can alter results as blood is a component
  • Process/refrigerate specimen within an hour of collection
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18
Q

Urine Cultures

A
  • Collected in sterile container to grow bacteria and determine pathogen
  • If there is pain when urinating (sensitivity) antibiotics are placed in petri dish to determine which ones kill the pathogen
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19
Q

24 hour urine

A
  • Used to diagnose kidney disease by evaluating creatine and protein
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20
Q

Clean-Catch/Midstream Specimens

A
  • Used for urinalysis or sterile specimens
  • Collected in sterile specimen
  • Wipe urinary meatus first
    (front to back females) (tip of penis for men)
  • Clean further, urinate into toilet first then begin collection of specimen
21
Q

Clean-Catch/Midstream Specimen

A

Step 1 - Hand Hygiene
Step 2 - Get 3 cleaning wipes
Step 3 - Open and set wipes on paper towel
Step 4 - Wipe downward and use wipe only once
Step 5 - Keep labia spread during urination
Step 6 - Open cup (do not touch rim or inside)
Wipe 1 - Spread labia with 2 fingers and wipe downward urethra
Wipe 2 - Wipe downward from urethra
Wipe 3 - Wipe downward from urethra
Urinate while still holding labia open until cup is half full.

22
Q

Sterile Specimens from catheter

A
  • Collected directly into a cup using intermittent (red cap) catheter. Collected from a port
23
Q

Urine Specimen from Urinary Diversion (Urostomy)

A
  • Clean urine specimen drained from urinary bag
  • Insert catheter 2-3 cm into stoma
  • If no catheter clean stoma and allow it to drain into a cup
24
Q

24 Hour Urine Specimen

A
  • Discard first void and then collect into special container that is refrigerator.
25
Q

Specimen from Infants and Children

A
  • Collection bag adhered to skin surrounding perineum or penis
  • Port at bottom of the bag can aspirate contents in the bag
26
Q

Patient Goals

A
  • Produce sufficient quantity of urine to maintain fluid, electrolyte, and acid-base balance
  • Empty bladder completely at regular intervals without discomfort
  • Provide care for urinary diversion and know when to notify physician
  • Develop plan to modify factors contributing to current or future urinary problems
  • Correct unhealthy urinary factors
27
Q

Promoting Normal Urination

A
  • Develop schedule based on patients normal void habits
  • Allow patient to have comfortable position and privacy
    (Males - Upright Position)
  • Provide perineal hygiene
  • Promote fluid intake (8-10 ounces) to flush bacteria
  • Strengthen pelvic floor improves control of urination and incontinence
    (Kegel exercises,
28
Q

Assisting with Toilet

A
  • Assist in walking, keeping balance, cleaning, and flushing
29
Q

Bedside Commode

A
  • Used when patient can get out of bed but not walk to bathroom
  • Document patient tolerance of activity and ability to use
  • Record intake and output
  • Document unusual urine/stool characteristics
  • Alterations in patients skin
30
Q

Bedpan

A
  • Raise head of bed when possible to provide comfort. Used for when patients cannot move.
31
Q

Assessments before using Bedpan

A
  • Assess unusual elimination habits
  • Determine why patient needs bedpan
  • Access degree of limitation and ability to help with activity
  • Assess health issues that contraindicate certain patient actions
  • Check devices that can interfere with bedpan
  • Assess characteristics of urine and patients skin
  • Position bedpan to prevent muscle strain/discomfort, elevate head to 30-45 degrees, wear gloves
  • For patients who are immobile you can roll them onto bedpan
32
Q

Urinal

A
  • Patient voids using urinal with assistance
  • Patient maintains continence
  • Patient demonstrates how to use urinal
  • Patient maintains skin integrity
33
Q

Catheters

A
  • Inserting tube through urinary meatus into bladder
  • Should be used with sterile technique
  • Used to relieve urinary retention, obtain sterile specimen when patient cannot void, allow voiding of patient with prolonged immobilization, obtain accurate urinary output for critically ill patients
34
Q

Intermittent Catheter

A
  • Single lumen to empty bladder then removed

- “No Touch” kits to decrease infection

35
Q

Indwelling Catheter (Foley Catheter)

A
  • Double/Triple lumen catheter
  • 1 lumen for emptying bladder
  • 1 lumen leading to balloon with saline solution to stay in bladder after insertion
  • 1 Lumen to irrigate bladder if necessary
36
Q

French Diameters

A
  • Refers to diameter of a catheter
37
Q

Insertion of Urinary Catheter for Females

A
  • Setup Sterile Field
  • Insert 2-3 inches more after you see urine
  • After in place, inflate balloon with sterile water
  • Make sure bag is below urethra
  • When removing, remove sterile water from balloon and pull catheter out
38
Q

Insertion of Male Catheter

A
  • Cleaning in and out in circular motion
  • ## Insert catheter all the way to Y port (Longer urethra)
39
Q

Suprapubic Catheter

A
  • Surgically inserted through abdominal wall into bladder
  • Used for long term drainage when there is a blockage of bladder not allowing catheter to be inserted into urethra.
  • Care includes skin care around insertion site, care of drainage tube and drainage bag
40
Q

External Urinary Sheath Catheter

A
  • Condom Catheter
  • Allow 1-2 inches between tip of penis and catheter.
  • Vigilant skin care to avoid excoriation.
  • Sheath should be removed daily to wash penis
  • Inspect skin for urination
  • Do not retract foreskin for non circumcised patients
41
Q

External Female Catheter

A

Purewick - Non-invasive device for women that collects urine via suction in a container
- 40mmHg suction

42
Q

Absorbent Products

A
  • Pads, undergarments, diapers, can help mild incontinence.
  • Be aware of skin breakdown if wet pad stays on too long
  • Care needed if stool collects
43
Q

Catheter Care

A
  • Sterile technique and cleaning perineal area with soap and water during insertion
  • Continued care to prevent CAUTI
  • Clean ports with alcohol before using
  • Urine drained into calibrated container to measure output
  • Note color/clarity/odor of urine
  • Redness/irritation (infection) report immediately
  • Use appropriate PPE and make sure spout of catheter does not touch side of containers being drained into
  • Secure catheter to leg with band or adhesive to prevent pulling
  • Place drainage bag low on bed frame
  • Drainage bag must be lower than patients bladder
44
Q

Safety with Catheter

A
  • Follow medical/surgical asepsis
  • Identify risks of latex allergies (use non-latex catheter)
  • Allergies to povidone-iodine (betadine). Provide alternatives such as chlorhexidine
45
Q

Catheter irrigation/instillation

A
  • Natural irrigation through increased fluid intake is preferred.
  • Catheter irrigation used to rinse sediment, blood clots, or debris. Also used to infuse medications that act directly on bladder
  • Routine intermittent irrigation of long term catheters are not recommended due to risk of infection
  • Closed system irrigation via triple lumen catheter is suggested to prevent obstruction and maintain closed system.
46
Q

Dialysis

A
  • Remove fluid/waste from body in patient with kidney failure
47
Q

Peritoneal Dialysis

A
  • Catheter inserted through abdominal wall into peritoneal cavity to allow dialysate to be infused and drained.
  • Exit care is important for patient care
  • Dialysis catheter dressing is changed using aseptic techniques without trauma to site or patient.
  • Dressing should be dry, clean and intact without signs of inflammation or infection
48
Q

Hemodialysis Access

A
  • Requires access to patients vascular system
  • Insertion of catheter into vein or arteriovenous fistula/graft.
  • Cared for in the same manner as central venous access device

Nursing Technologies (17 decks)

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