C9- Elimination Urinary System Flashcards
Anuria
24 hour urine output is less than 50mL
Dysuria
Painful or difficult urination
Frequency: urinary problems definition
Increased incidence of voiding
Glycosuria
Presence of sugar in the urine
Hematuria
Blood in the urine
Nocturia
Awakening at night to urinate
Oliguria
Scanty or greatly diminished amount of urine voided in a given time
24hr output is less than 400mL
Polyuria
Excessive output of urine
Proteinuria
Protein in the urine, indication of kidney disease
Pyuria
Pus in the urine
Urine appears cloudy
Urgency
Strong desire to void
Urinary incontinence
Involuntary loss of urine
Stress incontinence
Increase Intra-abdominal pressure
-sneeze, cough, laugh, physical activity
-pregnancy, menopause, obesity, chronic constipation
Urge incontinence
Gotta go!! Frequent urge
-loss of urine before reaching toilet
-cause:
-infection
-loss of bladder tone d/t catheter
Overflow incontinence
Overdistention and overflow of bladder
-signal to empty may be absent
-bladder fills, dribbling occurs
-Causes:
-2nd to drugs
-fecal impactions
-neuro problems
Reflex Incontinence
Bladder empties without sensation of need to void
Causes:
-spinal cord injury
Functional incontinence
Loss of urine d/t inability to reach bathroom
-environmental barriers
-physical limitations
-loss of memory
-disorientation
Total Incontinence
Continuous, unpredictable loss of urine
Causes:
-surgery
-trauma
-anatomical abnormality
Normal Urine volume
Average output= 1500-3000mL/day
SHOULD BE EQUIVALENT TO INTAKE
Normal Urine appearance/turbidity
Clear or translucent
Cloudiness is abnormal- d/t cells or particulate
Normal Urine color
Pale yellow
Abnormal=
-straw colored
-amber colored
-depends on the concentration
Normal urine odor
Aromatic
Ammonia odor is due to bacterial action
pH of normal urine
Range of 4.6-8.0. = NORMALLY AROUND 6
Acidic urine blocks bacterial growth and caluli
Specific gravity of normal urine
Normal range is 1.015-1.025
Normal protein levels in urine
Negative or trace amounts
Positive = renal disease
Normal glucose in urine
Negative
If positive = diabetes mellitus DM
Normal ketones in urine
Negative
Ketonuria= diabetic Kerosins or starvation
Specific gravity test
Compares the density of urine to the density of water
The higher the number = the more dehydrated
Dark amber urine cause
Dehydration
Brown urine cause
Liver/gallbladder disease
Red-brown urine cause
Blood in urine
Orange, green, blue urine cause
Medications, dyes
> 3000mL abnormal urine output cause
Diuretics
Diabetes
High fluid intake
<400mL urine output cause
Kidney dysfunction
Excessive fluid loss
Low fluid intake
Urinalysis (UA) Tests:
Color, odor, RBC’s/WBC’s, pH, glucose, ketones, protein, nitrates, bacteria
BUN (blood urea nitrogen) normal range
7-20 mg/dL
Serum Creatinine normal range
0.8-1.4 mg/dL
Elevation indicates renal insufficiency
Physical assessment for urinary complications
Weigh client
-best indicator of fluid status
Assess I & O
Vital signs
Assess mucous membrane moisture
Assess skin turgor
Bladder assessment
Order of nursing physical assessment (nursing)
Inspection
-abdomen (note distention if any)
Palpating
-tenderness distention, height of bladder
-urinary retention
Bedside bladder scanner
-ultrasound image of bladder
-urine volume present
(PVR of <50mL= normal bladder emptying)
(PVR of >100mL = not emptying correctly)
Inspection urinary nursing assessment
Abdomen
Urinary meatus and genitalia
-inflammation, discharge, tissue integrity
Perineum and scrotum
-skin integrity
-edema
-Prolapse of bladder or uterus
-loss of pelvic muscle tone
-incomplete emptying of bladder
Palpation urinary nursing assessment
Tenderness
Distention
Height of bladder
(Urinary retention)
Bedside bladder scanner nursing assessment
Ultrasound image of bladder
-urine volume present
Assess postvoid residual
-PVR of <50mL= normal bladder emptying
-PVR of >100mL= abnormal bladder emptying (not emptying completely)
Promoting Normal Urination
Maintain /develop voiding habits
Promote fluid intake
Strengthen muscle tone
-pelvic floor muscle training
Stimulate urination
-prevent retention
Assist with toileting
Continence/bladder training
Timed voiding based on log
Set ties
Voiding every 2hrs
Assist with toileting
Kegel exercises
Stress incontinence
Strengthen pelvic floor muscles
Crede’s maneuver
Overflow incontinence
During voiding:
-lean forward
-apply light pressure over bladder to complete emptying
Cutaneous triggering
Reflex incontinence
lightly stroke pubic or thigh skin
Delayed urination
Urge incontinence
when urge occurs, hold 5mins before voiding
gradually lengthen time
eventually 3-4hrs
Anticolinergics
Relax smooth muscle of bladder
Decrease bladder muscle contraction
May increase capacity and decrease urge
Cutaneous ureterostomy
Ureters directed through abdominal wall and attached to opening in skin
Usually permanent
Ileal conduit
Ureters drain from stoma
created from intestine
Ostomy bag
continuously draining urine
Continent rivalry diversion CUD
Ureters diverted into a segment of ileum and cecum
uses section of intestine to create internal reservoir that holds urine
Catheterizable stoma
needs to be done at regular intervals