Chapter 46 Flashcards
The last step in the removal & elimination of excess water and by-product of body metabolism
Urinary elimination
Protein in urine
Proteinuria
Blood in urine
hematuria
Normal range of urine production
1-2 L a day
Factors that influence the production of urine
fluid intake and temperature
Stimulates red blood cell production
erythropoietin
renin function
convert angiotensinogen into angiotensin ii
what does angiotensin ii cause
vasoconstriction
Patients with kidney impairment can have these medical problems
anemia, hypertension, and electrolyte balance
Areas of the brain involved in bladder control
cerebral cortex, thalamus, hypothalamus, and brainstem
Psychosocial conditions influencing urination
Social expectation (school, recesses, work breaks)
physiological factors influencing urination
Anxiety & stress (increase) and depression (decrease)
Medications affecting urination. Patients hold on to water
Diuretics (increase)
Urinary retention
The inability to partially or completely empty the bladder
Postvoid residual (PVR)
amount of urine left in the bladder after voiding and is measured by ultrasound or straight catheterization.
Most common cause of UTI
Escherichia coli
Cystitis symptoms
Urgency, frequency, incontinence, suprapubic tenderness, and foul-smelling cloudy urine.
sign of UTI in older adult
delirium
UTI in upper urinary tract
pyelonephritis
symptoms: fever, chills, diaphoresis, and flank pain
Urinary diversions
when patients have had the bladder removed b/c of cancer or bladder dysfunction, and the urine is diverted to the outside of the body through an opening of the abdominal wall called a stoma.
Two types of urinary diversions
Continent urinary diversion: distal part of the ilium and proximal part of the colon
orthotopic neobladder: uses an ileal pouch to replace the bladder.
6 month old infant who weighs 13-15lbs will excrete how much urine a day
400-500 ml a day
Best position to examine the female genitalia
dorsal recumbent position to provide full exposure to the genitalia
retracted foreskins can cause dangerous swelling called
Paraphimosis
Assessment of I&O is a way you assess
bladder emptying, renal function, and fluid and electrolyte balance
although I&O is often a written order, it can also be….
placed by the nursing judgement
Output measurement includes
Urine, vomitus, gastric drainage tubes, and wound drains
A change in urine can be an indicator of
fluid imbalance, kidney dysfunction, decreased blood volume.
if urinary output falls below 30 mL/hr, the nurse should do what first
assess for signs of blood loss and notify the health care provider.
How long should a nurse wait to evaluate for urinary retention if a client has had fluid and is not voiding urin
3-6 hr
Normal urine color
Pale straw color to amber, depending on its concentration
Patients taking diuretics urine will look
diluted in color while medication is active.
Bleeding from kidneys causes urine to look
dark red
Bleeding from the bladder or urethra causes urine to look
bright red
Urine will look bright orange if a patient is taking
Phenazopyridine
What foods cause red urine
Beets, rhubarb and blackberries
patients with liver disease could have what color urine
Dark amber, as a result of high concentrations of bilirubin.
Clarity of urine should be
transparent
Renal disease causes urine to appear (consistency)
cloudy because of protein concentration. Could also look thick because of bacteria and white blood cells
Foods that change the odor of urine
asparagus and garlic
proper label for all specimen collections
PT name, date, time, and type of collection
To obtain urine that is fresh and up to policy, what must the patient do
PT must double void
second voided specimen is the one sent to the laboratory
A patient with normal renal function who does not have heart disease or alterations requiring fluid restrictions should have an output of
30 ML/kg of weight or 0.5 ounces/lb/day
Indwelling
remains in place over a period of time
Intermittent
one-time cathertization for bladder emptying
Indwelling catheterization can last as little or as long as?
2 weeks to more than a month
Difference in catheters
- number of catheter lumens
- the presence of a balloon to keep the catheter in place
- the shape of the catheter
- a closed drainage system
Single-lumen catheters are used for
intermittent/straight catheterization
Double-lumen catheters are used for
indwelling catheters
one lumen for the urinary drainage and one used to inflate the balloon to keep the catheter in place.
Triple-lumen catheters
continuous bladder irrigation or when it is necessary to instill medication into the bladder.
A health care provider chooses a catheter based on
- latex allergy
- history of catheter encrustation
- anatomical factors
- susceptibility to infection
indwelling catheters are made of
latex or silicone (good for patients who require a lot of changes, due to encrustation
Intermittent/straight catheters are made of
rubber or polyvinyl chloride
Most common adult size of indwelling catheter
14-16 Fr
Infant indwelling catheter size
5-6 Fr
Children indwelling catheter size
8-10 Fr
young girls indwelling catheter size
12Fr
Indwelling catheter balloon sizes
3mL (children)
10 mL (adult)
30 mL
Why should the drainage system never be separated?
It can introduce the system to pathogens
When a patient ambulates, it is important to
carry the bag below the level of the patients bladder, and use a leg bag if necessary.
The only drainage bag that does not need to be kept dependent to the bladder is a
Specially designed drainage bag (belly bag)
Patients should receive catheter care how often?
Every 8 hours
What can an overfull drainage bag do?
create tension and pulling on the catheter, resulting in trauma to the urethra and/or urinary meatus.
In the presence of no urine drainage, what should the nurse assess first?
Check to make sure there are no kinks or obvious occlusions of the drainage tubing or catheter.
How long should all patients have their voiding monitored after catheter removal?
For at least 24-48 hours
Symptoms requiring intervention after a catheter has been removed and the first few urinary voids are complete
- Abdominal pain & distention
- A sensation of incomplete emptying
- Incontinence
- Constant dribbling of urine
- Voiding in very small amounts
What catheter increases the risk of a UTI
Indwelling catheter
After catheter is removed, how many days until symptoms of infection develop?
2-3 or more
What are the 2 alternatives to urethral catheters
Suprapubic catheterization & External catheter (condom catheter)
Suprapubic catheter is
A urinary drainage tube inserted surgically into the bladder through the abdominal wall above the symphysis pubis.
How does a suprapubic catheter stay in place
- sutured to the skin
- secured with adhesive material
- retained in the bladder with a fluid-filled balloon
External catheter is
A condom-like sheath that fits over the penis, providing a safe noninvasive way to contain urine.
Medications to treat urgency, frequency, nocturia and urgency UI
Antimuscarinics
- derifenacin
- oxybutynin
- solifenacin
- fesoterodine
- tolterodine
- tropsium
Adverse effects of antimuscarinics
dry mouth, constipation and blurred vision
Common irritants that increase symptoms of frequency, urgency, and incontinence
artificial sweeteners, spicy food, citrus products, and caffeine.
Pelvic floor muscle training
kegels
Factors influencing urination
growth and development, sociocultural factors, psychological factors, personal factors, personal habits, fluid intake, pathological conditions, surgical procedures, medications, diagnostic examinations
