Chapter 45 Urinary Elimination Flashcards
Kidneys:
remove wastes from the blood to form urine
Ureters:
transport urine from the kidneys to the bladder
Bladder:
holds urine until the urge to urinate develops
Urethra:
urine leaves the body through it
Efferent:
leaves
Afferent:
arrives
Urine should be released in a catheter how many mL/hr?
30 mL/hr
Nephron in kidneys:
functional unit that forms urine
Proteinuria:
presence of large proteins in the urine
-sign of glomerular injury
The normal adult urine output average:
1200-1500 mL/day
Eythropoietin:
Within bone marrow to stimulate RBC production and maturation and prolongs the life of mature RBCs
Renin:
released from juxtaglomerular cells
functions as a enzyme to convert angiotensinogen into angiotensin I
Kidneys affect:
calcium and phosphate regulation
Kidney functions:
Production of erythropoietin
Production of renin, prostagiandin E2, and prostacyclin affect BP
Voiding
Bladder contraction + Urethral sphincter and pelvic floor muscle relaxation
Act of Urination
- Stretching of bladder wall signals the micturition center in the sacral spinal cord.
- Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control.
- When a person is ready to void, the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract, and the bladder empties.
Renal calculus:
obstruction within a ureter
-kidney stones
An adult normally voids every
2-4 hours
Reflex Incontinence:
damage to the spinal cord above the sacral region
Overflow incontinence:
when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine
Factors influencing urination:
- Disease conditions
- Medications and medical procedures
- Socioeconomic factors (need for privacy)
- Psychological factors (anxiety, stress, privacy)
- Fluid balance
Uremic syndrome:
increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome
Renal replacement therapies:
treatment such as dialysis or organ transplantation
Peritoneal dialysis:
an indirect method of cleaning the blood of waste products using osmosis and diffusion
Sociocultural factors:
- North Americans: bathrooms are private
- European cultures: accept communal toilet facilities
Nocturia:
awakening to void one or more times at night
Polyuria:
an excessive output of urine
Oliguria:
a urine output that is decreased despite normal intake
Anuria:
no urine is produced
Diuresis:
coffee, tea, cocoa, and cola drinks that contain caffeine promote urine formation
Fever:
excessive perspiration loss from fever decreases urine amount
Amitriptyline causes a
green or blue discoloration
Disease conditions affecting urination:
- Prerenal, renal, postrenal classification
- Conditions of the lower urinary tract
- Diabetes mellitus and neuromuscular diseases such as multiple sclerosis
- Benign prostatic hyperplasia
- Cognitive impairments (e.g., Alzheimer’s)
- Diseases that slow or hinder physical activity
- Conditions that make it difficult to reach and use toilet facilities
- End-stage renal disease, uremic syndrome
Medical Interventions- Surgical procedures:
- Restriction of fluid intake lowers urine output.
- Stress causes fluid retention
Medical Interventions - Medications:
- Some cause urinary retention and/or overflow incontinence.
- Some cause urgency and incontinence.
- Some change the color of urine
Medical Interventions- Diagnostic examinations
- Restriction of fluid intake lowers urine output.
- Direct visualization causes localized trauma and edema; patients may have difficulty voiding.
Urinary retention:
An accumulation of urine due to the inability of the bladder to empty
Urinary tract infection
Results from catheterization or procedure
Urinary incontinence
Involuntary leakage of urine
Urinary diversion
Diversion of urine to external source
Older Adults - Promote:
- Provide frequent opportunities to void. Older adults have a smaller bladder capacity than younger adults.
- Encourage older adults to empty the bladder completely before and after meals and at bedtime.
- Encourage patients to increase fluid intake to at least six to eight glasses a day unless medically contraindicated
A health care provider may suspect that an older patient is experiencing urinary retention when the patient has
Small amounts of urine voided 2 to 3 times per hour.
Nursing Knowledge Base:
- Infection control and hygiene
- Growth and development
- Muscle tone
- Psychosocial considerations
- Cultural considerations
Urine Collection in Children:
-Difficult
-Preschool children and toddlers have difficulty voiding on request.
Ex. running water, hat, bag
A young girl is having problems urinating postoperatively. You remember that children may have trouble voiding
In the presence of a person other than their parents
Physical Assessment:
- Gather nursing history for the patient’s urination pattern and symptoms, and factors affecting urination.
- Conduct physical assessment of the patient’s body systems potentially affected by urinary change.
- Assess characteristics of urine.
- Assess the patient’s perception of urinary problems as it affects self-concept and sexuality.
- Gather relevant laboratory and diagnostic test data.
Skin and mucosal membranes:
Assess hydration.
Kidneys
Flank pain may occur with infection or inflammation.
Bladder
Distended bladder rises above symphysis pubis
Urethral meatus
Observe for discharge, inflammation, and lesions.
Assessment of Urine:
- Intake and output
- Color, clarity, odor
- Urine testing (specimen collection)
Color of urine:
Pale-straw to amber color
Clarity of urine:
Transparent unless pathology is present
Odor of urine
Ammonia in nature
Urine tests and diagnostic examinations:
Urinalysis Specific gravity Culture Noninvasive procedures Invasive procedures
Stimulating micturition reflex:
- Maintaining elimination habits
- Maintaining adequate fluid intake
- Promoting complete bladder emptying
- Preventing infection
Catheterization:
- Insertion
- Closed drainage systems
- Care
- Peri hygiene
- Fluid intake
Catheter is what kind of environment?
Sterile
Restorative care:
- Strengthening pelvic floor muscles
- Bladder retraining
- Habit training
- Self-catheterization
- Maintenance of skin integrity
- Promotion of comfort
Safety Guidelines:
Follow principles of surgical and medical asepsis as indicated when performing catheterizations, handling urine specimens, or helping patients with their toileting needs.
Identify patients at risk for latex allergy (i.e., patients with history of hay fever; asthma; and allergies to certain foods such as bananas, grapes, apricots, kiwi fruit, and hazelnuts).
Identify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.
The nurse directs NAP to:
- Adjust for any special needs or adaptations
- Provide personal hygiene
- Report any urine changes
- Explain procedures
Intake:
Oral liquids, enteral feedings, parenterally
Output:
Urine, diarrhea, vomitus, gastric suction and drainage from surgical tubes
Monitoring Intake and Output:
- Educate patient and family
- Delegation to NAP
- Record and report any changes in I&O
Intermittent catheterization is used when
evaluating the residual urine following urination. The investigation requires measurement of urine remaining in the bladder after voiding. Intermittent catheterization prevents the risk of infection.
Long-term catheterization is done in clients with
urinary retention. It may also be done for clients with recurrent episodes of urinary infections, skin breakdown, and terminal illness.
Short-term catheterization is required for
obstructive conditions, surgical repair of bladder and urethra, prevention of urethral obstruction, and bladder irrigation.
