Ch 46 potter urinary elimination Flashcards
1
Q
function of the kidneys, ureters, bladder, and urethra
A
urinary elimination depends
2
Q
filter waste products of metabolism from the blood
A
kidneys
3
Q
transport urine from the kidneys to the bladder
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ureters
4
Q
holds urine until the volume in the bladder triggers a sensation of urge,
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bladder
5
Q
occurs when the brain gives the bladder permission to empty, the bladder contracts, the urinary sphincter relaxes, and urine leaves the body through the urethra.
A
Micturition
6
Q
lie retroperitoneal on either side of the vertebral column behind the peritoneum and against the deep muscles of the back.
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kidneys
7
Q
left kidney is higher than the right because of the
A
anatomical position of the liver (kidney difference)
8
Q
, the functional unit of the kidneys, remove waste products from the blood and play a major role in the regulation of fluid and electrolyte balance.
A
Nephrons
9
Q
Each nephron contains a cluster of capillaries called the
A
glomerulus
10
Q
water, glucose, amino acids, urea, uric acid, creatinine, and major electrolytes. Large proteins and blood cells do not normally filter through the glomerulus.
A
glomerulus filters
11
Q
protein (proteinuria) or blood (hematuria) is found in the urine,
A
glomerular injury is suspected.
12
Q
Approximately 99% is resorbed into the plasma by the proximal convoluted tubule of the nephron, the loop of Henle, and the distal tubule. The remaining 1% is excreted as urine.
A
not all glomerular filtrate is excreted as urine
13
Q
that the delicate balance of fluid and electrolytes is maintained.
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resorption process
14
Q
is 1 to 2 L/day
A
normal range of urine production
15
Q
such as fluid intake and body temperature
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factors can influence the production of urine
16
Q
cannot voluntarily control voiding until 18 to 24 months
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Children voiding development
17
Q
may experience a decrease in bladder capacity, increased bladder irritability, and an increased frequency of bladder contractions during bladder filling.
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Older adults bladder
18
Q
increased risk for urinary incontinence because of chronic illnesses and factors that interfere with mobility, cognition, and manual dexterity.
-ability to hold urine between the initial desire to void and an urgent need to void decreases.
A
Older adults bladder
19
Q
can decrease the desire for urinary continence.
A
Depression impact on bladder
20
Q
fluids, electrolytes, and solutes are balanced, increased fluid intake
A
increases urine production.
21
Q
decreases the release of antidiuretic hormones, thus increasing urine production.
A
Alcohol impact on bladder
22
Q
Arthritis, Parkinson’s disease, dementia, and chronic pain
A
syndromes can interfere with timely access to a toilet.
23
Q
Diabetes mellitus, multiple sclerosis, and stroke can
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conditions alter bladder contractility and the ability to sense bladder filling
24
Q
can cause the loss of urine control because of bladder overactivity and impaired coordination between the contracting bladder and urinary sphincter
A
Spinal cord injury or intervertebral disk disease (above S1)
25
(e.g., benign prostatic hyperplasia [BPH]) can cause obstruction of the bladder outlet, causing urinary retention.
Prostatic enlargement
26
—1.one is mechanical obstruction of the lower urinary tract;
-2other is altered neural control of the bladder and detrusor mechanism, most commonly due to analgesic drugs
Urinary retention in the postoperative period has 2 main causes
27
(e.g., phenazopyridine-orange, riboflavin–intense yellow)
Some drugs change the color of urine
28
is a way to evaluate bladder emptying, renal function, and fluid and electrolyte balance
Assessment of I&O
29
need to include all oral liquids and semiliquids, enteral feedings, and any parenteral fluids
Intake measurements
30
includes not only urine but any fluid that leaves the body that can be measured such as vomitus, gastric drainage tubes, and wound drains.
Output measurement
31
is a key indicator of kidney and bladder function.
Urinary output
32
of fluid imbalance, kidney dysfunction, or decreased blood volume
change of urine volume can be a significant indicator
33
, the nurse should immediately assess for signs of blood loss and notify the health care provider
urinary output falls below 30 mL/hr (for more than 2 consecutive hours)
34
not voided for longer than 3 to 6 hours and have had fluid intake recorded should be evaluated for urinary retention.
bladder dysfunction
35
receptacles with volume-measurement markings.
Urine volume is measured using
36
from a pale straw to amber
Normal urine ranges in color
37
Bleeding from the kidneys or ureters usually causes
urine to become dark red
38
bleeding from the bladder or urethra usually causes
bright red urine.
39
Hematuria and blood clots are a common cause of
urinary catheter blockage.
40
is the result of high concentrations of bilirubin (urobilinogen) in patients with liver disease.
Dark amber urine
41
, freshly voided urine appears cloudy because of protein concentration.
renal disease
42
as a result of bacteria and white blood cells.
Urine may also appear thick and cloudy
43
helps protect against bacterial growth
Acid pH
44
(4.6 to 8.0)
pH of normal urine range
45
(up to 8 mg/100 mL)
Protein normal urine range
46
Patients with dehydration, starvation, or excessive aspirin ingestion also
have ketonuria. (abnormal in urine)
47
(1.005 to 1.030)
Specific gravity normal range
48
(0-4 per low-power field)
WBCs normal range
49
Crystals indicate increased risk for the development of
renal calculi (stone).
50
Detect and measure the size of urinary calculi
Abdominal roentgenogram (Noninvasive Procedures)test urinary tract
51
- Identify anatomical abnormalities, renal tumors and cysts, calculi, and obstruction of the ureters
Computed tomography of abdomen and pelvis (CT)
52
Detect and measure urinary calculi, tumors, hematuria, obstruction of the urinary tract
Intravenous pyelogram (IVP)
53
Detect and measure urinary calculi, tumors, hematuria, obstruction of the urinary tract
Ultrasound:
| Renal bladder
54
Microscopic hematuria, detect bladder tumors and obstruction of the bladder outlet and urethra
Cystoscopy (invasive)
55
pelvic muscle exercises
Kegel exercises
56
is the placement of a tube through the urethra into the bladder to drain urine
Urinary catheterization
57
(one-time catheterization for bladder emptying)
intermittent (Urinary catheterization )
58
(remains in place over a period of time).
| - short term (2 weeks or less) or long term (more than 1 month)
indwelling(Urinary catheterization )
59
when ultrasound or a bladder scanner is unavailable or as a way to manage chronic urinary retention.
Intermittent catheterization is used to measure PVR
60
is related to the number of catheter lumens, the presence of a balloon to keep the indwelling catheter in place, the shape of the catheter, and a closed drainage system.
difference among urinary catheters
61
are used for intermittent/straight catheterization
Single-lumen catheters
62
, designed for indwelling catheters, provide one lumen for urinary drainage while a second lumen is used to inflate a balloon that keeps the catheter in place
Double-lumen catheters
63
are used for continuous bladder irrigation (CBI) or when it becomes necessary to instill medications into the bladder
Triple-lumen catheters
64
have a larger internal diameter and may be helpful in patients who require frequent catheter changes as a result of encrustation.
silicone catheters
65
are made of latex or silicone.
Indwelling catheters
66
with special coatings reduce urethral irritation
Latex catheters
67
are made of rubber (softer and more flexible) or polyvinyl chloride (PVC)
- bladder does not empty, patients or caregivers learn to intermittently catheterize.
Intermittent/straight catheters
68
This catheter has a curvature at the end that helps it maneuver through the prostatic urethra in the presence of a large prostate.
Coudé-tip catheter.
69
This catheter has a curvature at the end that helps it maneuver through the prostatic urethra in the presence of a large prostate.
Coudé-tip catheter.
70
is based on the French (Fr) scale, which reflects the internal diameter of the catheter.
size of a urinary catheter
71
is based on the French (Fr) scale, which reflects the internal diameter of the catheter.
size of a urinary catheter
72
appropriate catheter use, proper insertion and maintenance techniques, quality improvement programs, ongoing surveillance for CAUTI, and related causative factors
Measures to reduce CAUTI are organized into five areas:
73
are used to instill medication into the bladder.
Bladder instillations
74
provides intermittent or continuous irrigation of a urinary catheter without disrupting the sterile connection between the catheter and the drainage system
Closed catheter irrigation
75
is an example of a continuous infusion of a sterile solution into the bladder, usually using a three-way irrigation closed system with a triple-lumen catheter.
-used following genitourinary surgery to keep the bladder clear and free of blood clots or sediment.
CBI
76
should record the time and amount of each voiding, including any incontinence.
bladder diary
77
is a soft, pliable condom-like sheath that fits over the penis, providing a safe and noninvasive way to contain urine.
-mainly made up of silicone
external catheter, also called a condom catheter or penile sheath,
78
is suitable for incontinent patients who have complete and spontaneous bladder emptying
- less risk for UTI than indwelling catheters;
- excellent option for the male with UI.
condom-type external catheter
79
, wash penis with warm, soapy water and gently roll sheath and adhesive off penile shaft
- Inspect penis with condom catheter in place within 15 to 30 minutes after application
to remove condom (external catheter)
80
must wear a pouch to collect the effluent (drainage)
- pouch should be changed every 4 to 6 days
- Each pouch may be connected to a bedside drainage bag for use at night.
Immediately after surgery the patient with an incontinent urinary diversion
81
, wash penis with warm, soapy water and gently roll sheath and adhesive off penile shaft
to remove condom (external catheter)
82
must wear a pouch to collect the effluent (drainage)
Immediately after surgery the patient with an incontinent urinary diversion
83
, gently cleanse the skin surrounding the stoma with warm tap water using a washcloth and pat dry. Do not use soap because it can leave a residue on the skin.
changing a pouch
84
do not have to wear an external pouch.
| -if there's residue in continent urinary diversions 4 to 6 times a day for the rest of their lives
continent urinary diversions
85
is an essential resource when selecting the right appliance so that the pouch fits snugly against the surface of the skin around the stoma, preventing damaging leakage of urine
specialty ostomy nurse
86
do not have to wear an external pouch.
continent urinary diversions
87
are used to treat urinary urgency.
- most common adverse effects of antimuscarinics are dry mouth, constipation, and blurred vision
- change in mental status in older adults
antimuscarinics (e.g., oxybutynin and trospium)// medication
88
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is in a class of medications called beta-3 adrenergic agonists. It relaxes the bladder muscles to prevent urgent, or uncontrolled, urination
--monitor BP- can increase
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mirabegron//medication
89
are used to treat urinary urgency.
antimuscarinics (e.g., oxybutynin and trospium)// medication
90
is in a class of medications called beta-3 adrenergic agonists. It relaxes the bladder muscles to prevent urgent, or uncontrolled, urination
mirabegron//medication
91
is in a class of medications called beta-3 adrenergic agonists. It relaxes the bladder muscles to prevent urgent, or uncontrolled, urination
mirabegron//medication
92
is sometimes treated with bethanechol,
medication for Urinary retention called
93
men with outlet obstruction caused by an enlarged prostate are treated with agents that relax the smooth muscle of the prostatic urethra
tamsulosin and silodosin
94
are considered first-line treatment for stress, urge, and mixed incontinence
-include pelvic floor muscle training (PFMT), bladder retraining, and a variety of toileting schedules
behavioral therapy
95
with antibiotics
UTIs are treated
96
Patients with painful urination are sometimes prescribed urinary analgesics that act on the urethral and bladder mucosa
-urine will be orange
(e.g., phenazopyridine).
97
and is based on therapy first developed by obstetrician gynecologist Dr. Arnold Kegel in the 1940
Kegel exercises (aka pelvic floor muscle training )
98
patients to avoid common irritants such as artificial sweeteners, spicy foods, citrus products, and especially caffeine
stuff irritate bladder functioning
99
to elevate the feet for a minimum of a few hours in the afternoon to help diminish nighttime voiding frequency.
patients with edema (techniques to help diminish void frequency)
100
and is based on therapy first developed by obstetrician gynecologist Dr. Arnold Kegel in the 1940
Kegel exercises (aka pelvic floor muscle training )
101
is a behavioral therapy designed to help patients control bothersome urinary urgency and frequency.
- Only highly motivated and cognitively intact patients are candidates for this therapy
- urge to void becomes less severe or subsides, only then should the patient start his or her trip to the bathroom
Bladder retraining
102
Patients are taught to inhibit the urge to void by taking slow, deep breaths to relax, performing five to six quick, strong pelvic muscle exercises (flicks) in quick succession, followed by distracting attention from bladder sensations.
ways to inhibit URGE to void (Bladder retraining)
103
involves intensive instruction augmented by computerized measurement of muscle activity that is displayed on a monitor. The visual feedback helps the patient learn to contract the muscles correctly.
Biofeedback (alternative for kegel exercsie)
104
is a program of toileting designed for patients with mild or moderate cognitive impairment.
- Patients are toileted based on their usual voiding pattern
- give positive feedback for dryness, prompt the patient to toilet, and reward the patient for desired behavior.
Prompted voiding
105
Patients are taught to inhibit the urge to void by taking slow, deep breaths to relax, performing five to six quick, strong pelvic muscle exercises (flicks) in quick succession, followed by distracting attention from bladder sensations.
ways to inhibit URGE to void
106
presents as inflammation of the skin and can also cause blistering and swelling to the affected area
-multifaceted condition
Incontinence-associated dermatitis (IAD)
107
don’ts include only using traditional soap and water for cleaning, double padding the bed, leaving soiled pads in contact with the skin, and assuming incontinence is inevitable
Incontinence-associated dermatitis (IAD) (dont do)
108
Some patients experience chronic inability to completely empty the bladder as a result of neuromuscular damage related to multiple sclerosis, diabetes, spinal cord injury, and urinary retention caused by
outlet obstruction.
109
presents as inflammation of the skin and can also cause blistering and swelling to the affected area
Incontinence-associated dermatitis (IAD)
110
don’ts include only using traditional soap and water for cleaning, double padding the bed, leaving soiled pads 1176in contact with the skin, and assuming incontinence is inevitable
Incontinence-associated dermatitis (IAD) (dont do)
111
(i.e., patient history of hay fever; asthma; and allergies to certain foods such as bananas, grapes, apricots, kiwifruit, and hazelnuts).
at risk for latex allergy
112
. Provide alternatives such as chlorhexidine.
if allergic to povidone-iodine use..
113
3 mL for culture or 20 mL for routine urinalysis.
amount of volume for withdrawal for culture testing
114
(determined by colony count of more than 10,000 organisms per milliliter).
Urine culture reveals bacterial growth
115
(on back with knees flexed)
dorsal recumbent position (position female for exposure catheter)
116
is inflammation of the bladder; associated symptoms include hematuria, foul-smelling cloudy urine, and urgency/frequency (lower urinary tract)
Cystitis
117
is a common symptom of a lower urinary tract infection (bladder). Flank pain, fever, and chills are all signs of pyelonephritis (upper urinary tract).
Dysuria//pyelonephritis
118
may indicate occlusion of catheter
decrease in urine output indicate
119
is inflammation of the bladder; associated symptoms include hematuria, foul-smelling cloudy urine, and urgency/frequency
Cystitis
120
is a common symptom of a lower urinary tract infection (bladder). Flank pain, fever, and chills are all signs of pyelonephritis (upper urinary tract).
Dysuria
121
kidney function and damage to the glomerular membrane such as in glomerulonephritis.
Protein indicates
122
early renal disease, and inadequate antidiuretic hormone secretion reduce specific gravity
Overhydration// reduce specific gravity
123
Abnormal blood sugars would be seen in someone with ketones in the urine or a patient with diabetes.
ketones/ abnormal blood sugar
124
is associated with renal disease or damage and some medications
Increased blood pressure//renal disease
125
, early renal disease, and inadequate antidiuretic hormone secretion reduce specific gravity
Overhydration// reduce specific gravity
126
Assess for delayed hypersensitivity to the contrast media.//allergic reaction, ex fever, rash, difficulty breathing
intravenous pyelography
