Ch 43. Urinary Elimination Flashcards
How much urine does the glomularis filter per min/day?
filters 125 ml/min making 1-2L/day
Less than 30ml/hr sign something is wrong
A patient with a long-standing history of diabetes mellitus is voicing concerns about kidney disease. The patient asks the nurse where urine is formed in the kidney. What is the nurse’s response?
glomerlus
Act of urination
• Sensory nerves from the bladder carry signals to the brainstem when the bladder is full.
• Forebrain activity controls voluntary micturition.
• Afferent signals result in simultaneous contraction of the bladder and relaxation of the sphincter.
• This reflex is the last to develop by kids
Strong urge to pee at 500ml.
Felt urge to pee at 250-300mL
Bladder spasms at over 500mL
Factors influencing urination Psychological factors: Sociocultural factors: Fluid balance: Diagnostic examination Surgical procedures: Pathological conditions: Medications: diuretics
Psychological Factors – anxiety/stress
Sociocultural Factors – culture, gender, religious practice (remote communities may not have access to incontinence products)
Fluid Balance – caffine/alcohol (increases diherisis [uring formaiton]. Alcohol decreases ADH. ADH helps body obtain water)
Diagnostic Examination – procedures can cause damage to urethra. Can cause infections
Surgical Procedures – anastasis blocks need to urinate. NB that their able to void post surgery. POUR (post operative uniary retention)
**Pathological conditions – neurological disease, renal disease
***Medications – diarehits increase urine output (prevent water reabsortoin).
Urinary retention key signs
not voiding for hours bladder distention restlessness diaphoresis (sweating) abdominal discomfort
Servere situations the bladder may hold a liter or more.
When might a health care provider suspect that a patient is experiencing urinary retention?
Them not empying their bladder would cause them to need to urinate many times an hour. They’re always feeling the urge to go.
Aging and urination
Adult: void 1500 to 1600 milliliters of urine a day. Ideally void 500mL/4hrs.
Kidney function will decline with age. Measured by EGFR (estimated glomerular filtration rate).
- Health = filter 125m;/min
- 80yrs old = filter 60 to 70ml/min
- End stage renal failure or end stage CKD chronic kidney disease = filer >14ml/min.
Health history
Pattern of urination
Symptoms of urinary alterations
Factors affecting urination
-characteristics of the urine
-person’s perception of urinary alteration
-impact on their self concept and how it is impacting their life
-review laboratory and diagnostic test data
Characteristics of urine? 3
Color: pale straw colored to Amber.
Clarity, is it transparent? Is it clear? Is it cloudy? Is it purulent?
Odor, it will be present. And the more concentrated is, the stronger it is as well as when it’s cloudy, it can smell foul. Really pale urine doesn’t usually have as much of a smell. sweet smelling urine is seen with diabetes or starvation
Intake and output (quantity) of urine
An output of less than 30 milliliters for more than 30 hours can cause concern or if there is an unexplained or new polyuria
Interventions: how to help someone pee
- maintain a regular pattern of urinary elimination, as this can actually retrain the bladder, and it helps to manage the urinary retention
- turning on running water
- female in squatting postion, male standing
- stroking the inncer thigh stimulation maturation reflex
- pour warm water over perineum
Resons for catherter:
- surgery, management of wounds
- enlarged prostates block the urethra and make it necessary to have a catheter.
Use of a urinary catheter requires a prescriber’s order.
Incontinence alone is not a reason to insert a urinary catheter.
Prevent catheter associated UTI’s (CAUTI’s)
- use aseptic technique
- secure catheter
- maintain closed drainage system/unobstructed flow
- urine bag below bladder
- no loops in tubing
- don’t let bag drag on floor/touch floor
- empty bag when half full
- Provide perineal care twice a day and with bowel movements.
Irrigation of catheter con
irrigation can wash sediment back into bladder.
triple lumen catheter needs irrigation.
Restorative care Lifestyle modification
Pelvic floor exercises help with preventing stress incontinence and countering overactive bladders. it may take 12 to 16 weeks for one to notice the results from pelvic floor muscle exercises.
Bladder training is used to gradually increase the time between voids and to decrease frequency
Prompted voiding may be referred to as a toileting routine and is a frequent strategy to decrease false increased use of bladder muscles and promote independence
Intermittent catherderization may be performed every 6-8hrs
Medications are prescribed for an overactive bladder or enlarged prostate in men
