CH 10: Urinary Elimination Flashcards

1
Q

age related changes related to urinary elimination

A

Hypertrophy of the bladder muscle and thickening on the bladder _ urinary frequency & reduced storage capacity
Changes in cortical control micturition _ nocturia
Insufficient neurological control of bladder emptying and weak bladder muscles _ retention _ UTI
Decreased tubular function _ concentrated urine
Decreased kidney filtration _ decreased ability to eliminate drugs _ toxicity
Increase in renal threshold for glucose _ no glycosuria with hyperglycemia
Urgency, nocturia, frequency, retention _ embarrassment

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2
Q

urinary health promotion

A

diet
avoid catheters
enhance voiding
frequent toileting/schedule
if embarrassed, used a comfortable, nonjudgemental tone

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3
Q

nocturia can cause:
use:

A

accidents/falls when walking to the bathroom

nightlights and remove hazards

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4
Q

diet for urinary health promotion

A

fluid intake (reduce at bedtime)
Vitamin C, cranberries, prunes, plums, eggs, cheese, yogurt, fish, grains

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5
Q

ways to enhance voiding

A

voiding upright
massage bladder
run water and rock back and forth

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6
Q

UTI in older adults

A

most common infection of older adults
prevalence increases with age

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7
Q

causes of UTIs

A

poor hygiene
prostate issues
catheterization
dehydration
DM
neurogenic bladders
debilitation

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8
Q

early s/s of UTI

A

burning
urgency
fever
delirium
possibly asymptomatic from lack of temp change

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9
Q

late s/s of UTI

A

retention
incontinence
hematuria

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10
Q

severe UTIs can lead to:

A

septicemia/urosepsis (occurring more frequently in older adults)

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11
Q

treatment for UTIs

A

-establish urinary drainage and control infection
-monitor I&O
-fluids (except…)
-monitor for s/s of complications
-Vit C (raises acidity of urine)

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12
Q

prevention of UTIs

A

Promote daily cranberry juice (but can be a bladder irritant when UTI is present)
Avoid catheters, consider alternatives, & question rationale
Convenience for staff, NO-NO!

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13
Q

urinary incontinence in older adults

A
  • Common and bothersome; often goes unreported
  • NOT A NORMAL PART OF AGING
  • Can be transient (acute) or established (chronic)
  • Various types
  • Assess for factors that cause incontinence
  • Can be embarrassing to discuss
  • Do’s and Don’ts
  • Interventions for urination, skin, and falls
  • Staff training
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14
Q

interventions for urinary incontinence

A

(depend on the type)
* Kegel Exercises
* Bladder retraining program
* Monitor I&O; assess for wetness every 2 hours
* Proper hygiene
* Avoid bladder irritants (caffeine, alcohol, citrus/fruits, tomatoes, spicy foods, artificial sweeteners)
* Easily accessible bathroom
* Increase fluids except when contraindicated
* Crede’s method
* Avoid indwelling catheters
* Provide meticulous urinary cath care when in use
* Use of containment devices
* Modify environment
* Interventions to protect skin and prevent falls

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15
Q

stress incontinence

A

due to increased abdominal pressure under stress (weak pelvic floor muscles)

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16
Q

functional incontinence

A

cannot get to the bathroom in time which causes incontinence

17
Q

urge incontinence

A

due to involuntary contraction of the bladder muscles

18
Q

overflow incontinence

A

due to blockage of the urethra

19
Q

neurogenic incontinence

A

due to disturbed function of the nervous system

20
Q

common causes of transient incontinence (DIAPPERS)

A

Delirium
Infection
Atrophic Urethritis
Pharmaceuticals
Psychologic
Excess urine output
Restricted Mobility
Stool Impaction

21
Q

contributing factors to urinary incontinence

A

-UTI
-Severe constipation
-Drugs
-Hyperglycemia
-Hypercalcemia
-Restricted mobility
-Acute confusion

22
Q

If pt is still incontinent after finding contributing factors of urinary incontinence

A

-establish pattern of urinary loss (diary)
-Measure residual urine volume (by ultrasound)
-Assess for vaginal prolapse and atrophic vaginitis (women)
-assess prostate by rectal examination (men)

23
Q

help for urge incontinence

A

bladder retraining
antimuscarinic drugs

24
Q

help for stress incontinence

A

pelvic floor muscle training
surgical intervention if unsuccessful

25
Q

help for overflow incontinence

A

residual volume >100mL
surgical relief of obstruction
intermittent catheterization if no obstruction

26
Q

risk factors for bladder cancer

A

chronic bladder irritation
exposure to dyes
cigarette smoking

27
Q

s/s of bladder cancer

A

painless hematuria
frequency
dysuria

28
Q

tx of bladder cancer

A

surgery, radiation
chemo
immunotherapy

29
Q

renal calculi for older adults results from:

A

immobilization
infection
changes in pH and concentration
chronic diarrhea
dehydration
elimination of uric acid
hypercalcemia

30
Q

s/s of renal calculi

A

pain
hematuria
s/s of UTI

31
Q

symptoms with glomerulonephritis

A

subtle and nonspecific

32
Q

careful use of what medications with glomerulonephritis

A

dig
diuretics
antihypertensives on
kidney/kidney excretion

33
Q

what is glomerulonephritis

A

inflammation and damage to the filtering part of the kidneys (glomerulus)