Ch.45 Urinary Elimination Flashcards
Table 45–3 routine urinalysis normal values
Ph:
4.6-8.0
Protein :
None or up to 8mg/100ml
If present signifies renal disease , damaged glomeruli
Glucose:
None
Present iin person with diabetes >180mg/100ml
Tubules unable to reabsorb high quantity of glucose
If intake is copious May be observed in a healthy person
Ketones :
None
Poorly controlled diabetes leads to breakdown of fatty acids
May also show in dehydration , starvation, or excessive aspirin use
Blood:
Intact erythrocytes ,hemoglobin, or myoglobin is present
May also be from menstruation
Specific gravity: the amount of particles in the urine
1.00532-1.030
Table-45-1 common types of urinary alterations
Urgency: feeling the need to avoid immediately causes are full bladder irritation of infection overactive bladder psychological stress
Dysuria: painful or difficult urination causes : bladder inflammation Trauma Sphincter inflammation
Frequency : voiding at frequent intervals less than two hours Fluid increased Inflammation Pregnancy Diuretic therapy
Hesitancy : Hard to start urinating Anxiety Edema Prostate enlargement
Polyuria
voiding large amounts of urine
Fluid increased
DIABETES
Oliguria Reduced urine output less than 400ml per 24hrs Dehydration Renal failure Uti Heart failure Increased ADH
Nocturia Voiding at night interrupting sleep Fluid intake before bed alcohol water Renal disease Aging process Prostate enlargement
Dribbling
A bit of leakage of urine
Stress incontinence - during laughing ,coughing, or lifting
Incontinence The inability to hold urine Loss of pelvic muscle tone Fecal impaction Neurological impairment Over active bladder
Hematuria Blood in the urine Globular disease Kidney or bladder infection Kidney stones Trauma Bleeding disorders
Retention Holding in urine Urethral obstructing Prostate enlargement Decreased sensory activity Effect after anesthesia Medication side effects
Residual urine The urine that is left after you urinate Inflammation or irritation of bladder Infection Trauma Inflammation of urethra
How does protein and up in urine
Protein is found in the urine if there is damage to glomeruli or tumbles allows it to enter urine
Why will there be glucose found in urine?
A persons with diabetes mellitus
high glucose levels
The tubules unable to absorb the high glucose concentration greater then 180 mg
Why will keytones appear in urine
Ketonuria
Ketone are found In the urine if the patient is :
dehydrated
Starvation
excessive usage of aspirin
Poorly controlled diabetes leads to the break down of fatty acids
Why will blood be present in urine
That it will be present if patient has UTI kidney disease bleeding from the urinary tract Consider menstruation timeframe
Explain the characteristic of high and low specific gravity and causes
High->concentrated
Low->diluted
High specific gravity can be seen in
dehydration
reduced renal bloodflow and
increase ADH
reduced specific gravity seen
over hydration
early renal disease
inadequate ADH secretion
Casts
Cylindrical bodies Hyaline Wbcs Rbs Granular and epithelial cells that are found when there is a renal alteration
Crystals
If present, resulted from food metabolism,
If excess , will form to be renal stone – uric acids , calcium phosphate
Table 45–4 diagnostic examinations
Abdominal roentgenogram:
Plain film of bladder ,kidneys ,ureter
Why is it used? Used to determine the size Shape Symmetry Location Of the kidneys
Ct scan
Detailed images
To view if there may any obstructions or Tumors
How should the nurse prepare a patient for this examination ?
Bowel cleaning
Make sure to ask for allergies!! Shellfish
- iodine is used for the medium contast
Explain the procedure and help patient into comfortable position
Explain that the patient must stay still
IVP -intravenous pyelogram
To view the collecting ducts Renal pelvis Outline of the ureters Bladder Urethra
Injected IV iodine
How can the nurse prepare the patient for his type of examination?
Bowel cleaning
Must be kept on clear liquids prior to examination
ALLERGIES-remember giving iodine
Fluid intake to flush out dye
Observe for allergy symptoms
Ultrasound renal
High frequency is used to identify kidney for Any abnormalities
No bowel cleaning necessary
Ultrasound Bladder
Helps identify any abnormalities In the bladder or LUT
Can also help see the amount of urine in The bladder
Encourage patient to drink fluid for better view of bladder
UROFLOWMETRY
Measures the flow rate of urine
Determines bladder muscular function
Explains why incontinence may be occurring
Endoscopy -cystoscopy
Direct view of the urethra and bladder
Invasive procedure
Specimen can directly collected
How does the nurse prepare the patient for this type of examination ?
Signed consents Bowl cleaning Asses vital signs after exam Assess urine Monitor I&O Encourage fluids Watch out for complications
Arteriogram angiography
Can see into renal arteries and branchings to identify any obstructions or narrowing
Catheter is placed into femoral artery and introduced up to the renal arteries
Radiopaque Contrast is entered through femoral artery catheter
X-ray films are taken rapidly
How can the nurse prepare the patient for this examination ?
Signed consents ALLERGIES monitor vitals signs after Bed rest Catheter site Care Monitor neurocirculatory function
Table 45–5 urinary incontinence and treatment options
Functional :
The passage of urine by the fault of external factors
Ex . Inability to get to the toilet
Sensory cognitive and mobility issues
How can the nurse help a patient with this condition?
Change clothes due to spoiling
Schedule toilet times
Chug pads under patient
Stress incontinence
Occurs due to increase abdominal pressure and no bladder contraction can be caused by Laughing Coughing Lifting
How can the nurse help a patient with this type of condition?
Pelvic floor exercise program (kegal)
Surgery by surgeons
Biofeedback (controlling by physiological aspects)
Electrical stimulation
Chug pad under patient
Urge incontinence
Expelling of urine right after having the feeling of wanting to urinate
Urgency to void
Frequency
Bladder spasm
Contraction
How can be nurse help? Antimuscarinic agents Biofeedback Bladder retraining ( timed toileting,bladder diary,goal to void every 3-4 hours ) Kegel exercises Lifestyle modifications Absorbent pads
Overflow Incontinence
Loss of urine without having the urge to void Caused by Spinal cord dysfunction Loss of cerebral awareness Reflux impairment
Symptoms
Reflex emptying when certain volume reached
How can the nurse help?
Intermittent catheterization
Condom catheter
CREDE’s method- compressing the bladder wall which relaxes the sphincter and promotes total emptying of bladder
Hyperactive /over active bladder
Associated with frequency and Nocturia
Desire to urinate that is difficult to ignore or put off
How can he nurse help this patient? Kegel exercises Fluid intake Limit carbonated and caffeinated beverages Bladder training Biofeedback
