Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 305 > Chapter 46: Urinary Elimination > Flashcards

Chapter 46: Urinary Elimination Flashcards

1
Q

Urinary elimination depends on the function of what organs?

A

kidneys, ureters, bladder and urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What nerves must be present for urinary elimination to occur?

A

efferent (motor) and afferent (sensory) nerves from the bladder to the spinal cord and brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When the urinary system fails to function, eventually

A

all organ systems are affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Approximately ________ of the cardiac output circulates through the kidneys each minute.

A

20-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nephron

A

functional unit of the kidney that forms urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

glomerulus

A

filters approximately 125 ml of filtrate per minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Not all of the filtrate is excreted as urine:

A

approximately 99% is resorbed into the plasma leaving 1% excreted as urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Normal urine output in an adult per day

A

1000-2000 ml/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

an output of less than 30 m/hr indicates what?

A

possible circulatory, blood volume or renal alterations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The kidneys are responsible for maintaining a normal RBC by producing

A

erythropoietin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Erythropoietin

A

functions within the bone marrow to stimulate RBC production, maturation and prolongs the life of mature RBC’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Patient with chronic kidney conditions cannot produce

A

sufficient quantities of erythropoietin therefore are prone to anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aldosterone is secreted from

A

the adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aldosterone causes

A

retention of water -> increases blood volume -> increases arterial blood pressure -> increases renal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are patients with chronic renal failure prone to developing renal bone disease?

A

they do not make a sufficient amount of active vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Renal bone disease results in

A

demineralization of bone caused by impaired calcium absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ureters

A

tubular structures that enter the urinary bladder from the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ureters enter the bladder from the

A

posterior wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes urine to enter the bladder in spurts?

A

peristaltic waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A kidney stone (renal calculus) within the ureter results in

A

strong peristaltic waves that attempt to move the stone into the bladder resulting in renal colic (causes intense flank pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The urinary bladder

A

hollow, distensible, muscular organ that stores and secretes urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The urinary bladder lies where?

A

in the pelvic cavity behind the pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Urethra

A

exits the bladder and passes out of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The urethra is lined with

A

mucous membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Glands of the urethra

A

secrete mucus into the urethral canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In a woman, the urethra is how long?

A

1.5-2” long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In men, the urethra is approximately how long?

A

8” long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Most people feel the need to void from

A

400-600 ml/urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

As the bladder stretches,

A

sensory impulses are sent to the micturition center in the sacral spinal cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What makes urination a voluntary process?

A

the fact that impulses can be ignored or acted upon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Damage to the spinal cord above the sacral region causes

A

reflex incontinence.

however, the micturition reflex pathway may remain in tact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

reflex incontinence

A

loss of voluntary control to urinate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Overflow incontinence

A

occurs when the bladder is overly full and the pressure in the bladder exceeds the sphincter pressure.
involuntary loss of urine results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Causes of overflow incontinence include:

A

head injury, spinal cord injury, diabetes and trauma to the urinary system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Factors influencing urination

A
  • urinary retention
  • urinary tract infections
  • catheter associated urinary tract infections
  • urinary incontinence
  • urinary diversions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Urinary incontinence

A

T. 46-1 p 1104-5’

involuntary leakage of urine that is sufficient to be a problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Urinary Retention can be caused by

A

post void residual

BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Types of UTI’s

A

bacteriuria
pyelonephritis
dysuria
cystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Urinary diversions include

A

ureterostomy

nephrostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Diabetes Mellitus and neuromuscular diseases cause

A

changes in nerve functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Diabetes mellitus and neuromuscular diseases causes changes in nerve functions that can lead to

A

reduced bladder tone
reduced sensation of bladder fullness
inability to inhibit bladder contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

End Stage Renal disease

A

irreversible damage to the kidney tissue marked by fluid and electrolyte imbalances, accumulation of wastes in the blood and systemic symptoms of N/V, headache, coma and convulsions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Urinary retention

A

accumulation of urine due to the inability of the bladder to empty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

With severe retention, the bladder can hold as much as

A

2000-3000 ml of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When assessing for bladder distention in a patient with urinary retention, it may be

A

extremely painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Residual Urine (post void residual)

A

inability to empty the bladder after voiding

  • straight cath or bladder scanner to dx
  • breeding ground for microorganisms
47
Q

UTI’s

A

most common health care acquired infection

48
Q

80% of UTI’s result from

A

the use of indwelling catheters (results in over 1 million UTI’s each year in US)

49
Q

Each day a catheter is in place, there is a

A

5% increase in bacteria in the urine

50
Q

Catheter associated UTI’s are associated with

A

Increased hospitalizations
Increased morbidity and mortality
Longer hospital stays
Increased hospital costs

51
Q

For UTIs, what is the most common pathogen?

A

the patient’s own colonic flora including Escherichia coli (E coli)

52
Q

What causes UTIs in women?

A

poor hand hygiene
not wiping from front to back
frequent sexual intercourse (not voiding directly after)

53
Q

Benign Prostatic Hyperplasia

A

in men makes them prone to urinary retention

54
Q

Dysuria

A

symptoms of a lower UTI

55
Q

What are symptoms of dysuria?

A

Burning during urination as urine passes over inflamed tissues
As the infection worsens (pyelonephritis), fever, chills, nausea, vomiting, and malaise develop

56
Q

Cystitis

A

infection of the bladder

57
Q

Cystitis can cause

A

Frequent sensation to void (frequency)

Concentrated urine and cloudy urine due to WBCs in urine

58
Q

Hematuria

A

blood in the urine due to irritation to the bladder and urethral mucosa

59
Q

Pyelonephritis

A

kidney infection

60
Q

Pyelonephritis symptoms

A

flank pain, tenderness, fever and chills

61
Q

Stress incontinence

A

sneeze, cough

62
Q

Urge incontinence

A

can’t get to the bathroom in time

63
Q

Over Active Bladder

A

results form sudden, involuntary contraction of the muscles of the urinary bladder resulting in the urge to urinate

64
Q

Common causes of an over active bladder are

A

diabetes, CVA, UTI, and anxiety (like test anxiety)

65
Q

Incontinence can lead to

A

impaired body image and loss of independence

psychological reasons for sexual dysfunction

66
Q

Continued incontinence poses a risk for

A

pressure ulcers and skin breakdown

67
Q

Consider environmental barriers that are risk for incontinence and falls including

A

Patients with restricted mobility
Chairs that are too low for older adults to get out of
Beds raised in the high position
Difficulty undoing buttons and zippers

68
Q

Urinary Diversion

A

temporary or permanent bypass from the bladder and urethra as the exit route for urine

69
Q

Urinary Diversion requires

A

a stoma (artificial opening) on the abdomen to drain the urine

70
Q

Urinary Diversion is used in patients who

A

have cancer, radiation or constant urinary tract infections

71
Q

Nephrostomy

A

catheter inserted directly into the renal pelvis

72
Q

Psychosocial implications of Urination

A
  • self concept: body image, self-esteem, roles and identity
  • culture: very private event, embarrassing
  • sexuality
73
Q

Incontinence is NOT

A

NOT a normal part of aging

74
Q

Noninvasive alternatives to catheterization includes

A

Voiding schedule
Use ultrasound to assess urinary retention as opposed to straight catheterization
Use standards of care
Collaboration with specialists

75
Q

When assessing a patient, assess for

A

Skin and mucosal membranes: urethral meatus
Bladder for distention
Skin turgor
Oral mucosa (gather data about hydration)
Lab values for kidney function and electrolyte imbalances
Women with vaginal infections often have associated UTIs
Assess the quality of the urine
Measure I&O

76
Q

When measuring I&O’s, report

A
  • extreme increases or decreases in urine volume.

- an hourly output of <30ml/hr for 2 consecutive hours is cause for concern

77
Q

What are factors that influences urination?

A 
Age
Environmental Factors:
Medication History:
Psychological Factors:
Muscle Tone:
Fluid Balance:
Current Surgical or Diagnostic Procedures:
Presence of Disease Conditions:
78
Q

Nocturia

A

awakening to void one or more times a night

79
Q

Polyuria

A

excessive output of urine

80
Q

Oliguria

A

decreased output despite normal intake

81
Q

Oliguria may be due to

A

increased loss from vomiting, diarrhea or perspiration OR kidney disease

82
Q

Anuria

A

no urine is produced. kidney disease

83
Q

Diuresis

A

promotion of increased urination through means such as caffeine, alcohol (inhibits ADH), or the body’s compensatory systems (3-4th day post operative, for example).

84
Q

Characteristics of urine

A

color, clarity, odor

85
Q

Color of urine

A

Pale straw color to amber.

Document any abnormal color and/or sediment esp. if the cause is unknown

86
Q

Clarity of urine

A

urine should be transparent (see through)

Document cloudy or foamy (high protein concentration) urine-may be a result of WBCs and bacteria

87
Q

Odor of urine

A

Document any odor that is not characteristic.
Sweet/fruity
Ammonia smell
Certain medications and foods can also cause a distinctive odor (asparagus, amoxicillin)

88
Q

Strong ammonia odors of urine are usually from

A

stagnant urine-incontinence.

89
Q

Sweet/fruity of urine is usually occurs from

A

acetone as a byproduct of incomplete fat metabolism (starvation, diabetes)

90
Q

Common Urine Tests

A

urinalysis, specific gravity, and urine culture

91
Q

urinalysis

A

clean catch or catheterized

92
Q

specific gravity

A

the weight or degree of concentration of a substance compared with an equal volume of water.

93
Q

urine culture

A

sterile or clean voided sample

sent to the laboratory to determine which specific antibiotics are effective (sensitivity)

94
Q

Common Diagnostic Urine Tests

A
  • Radiographs (KUB, plain film)
  • Intravenous Pyelogram (IVP)
  • Ultrasound
  • Invasive Procedures
  • Endoscopy
  • Cystoscopy
95
Q

Many medications directly or indirectly contribute to

A

urinary dysfunction leading to urinary retention or incontinence

96
Q

Meds that directly or indirectly contribute to urinary dysfunction

A 
Antipsychotics
Antidepressants
Alpha adrenergic agonists (clonidine) 
Calcium channel blockers (Cardizem, Norvasc, verapamil)
Sedative hypnotics
Opioid analgesics
ACE inhibitors (captopril, Vasotec, Altace) 
Antihistamines (Benadryl)
97
Q

Factors Related to Aging

A

Prostate Enlargement in men
Changes in the urethral mucosa associated with the loss of estrogen  susceptibility to UTIs
The ability of the kidney to concentrate urine declines
Nocturia
Urinary Frequency: decreased bladder capacity causing more frequent urination
Possible muscle wasting due to immobility
Muscle damage due to childbirth
Being overweight
Over consumption of caffeine or alcohol

98
Q

Nursing Diagnosis

A 
Functional Urinary Incontinence
Stress Urinary Incontinence
Urge Urinary Incontinence
Risk For Infection
Toileting Self-care Deficit
99
Q

Example of short term goals for urination

A

After surgery the patient should have normal voiding with complete bladder emptying within 24 hours

100
Q

Example of long term goals for urination

A

The patient with stress incontinence may need weeks of pelvic floor (Kegel) exercises.

101
Q

Possible interventions

A
  • teach self-care/hygiene activities
  • place the patient in normal positions of urination if possible
  • using the sound of running water to promote relaxation to help the patient void
  • maintain measures to prevent infection
  • keep environment safe
  • understand side effects of patient medications
102
Q

Teaching self-care/hygiene activities include

A

Increasing/maintaining an adequate fluid intake (2200-2700ml/day)
Include fluids high in acid such as cranberry or apple juice
Hand hygiene
The normal sterility of the urinary tract
Proper perineal care esp. after urination and defecation

103
Q

What are normal position of urination for men and women?

A

men: standing
women: sitting up right

104
Q

keeping the environment safe

A

make a clear path to the bathroom and call light in reach to avoid falls

105
Q

Understanding the side effects of your patient medications includes checking if they cause

A

constipation, dry mouth, skin irritation and urinary retention

106
Q

A ___________________ is not best practice for incontinence.

A

indwelling catheter (foley catheter)

107
Q

Proper care and handling of a patient with a foley catheter includes

A
  • keeping bag below the level of patients waist
  • keeping the tubing free from kinks and “dependent loops”
  • perform perineal care and catheter care at least 3 times a day AND as needed
  • use institutions securement devices (Stat-loc) to prevent the catheter tubing from sliding in and out of the urethral meatus
  • encourage adequate fluid intake to prevent stagnation of urine in the bladder and keeps the catheter tubing free from sediment
  • maintain a closed urinary drainage system
108
Q

Removal of an indwelling catheter

A

assess the patient’s urinary function:
note the first voiding
keep an accurate I&O for 24

109
Q

You should assess for bladder distension in a patient that has an indwelling catheter if

A

4 hours have elapsed without voiding OR if the patient is experiencing discomfort

110
Q

If patient is unable to void, the nurse should

A
  • use an ultrasound if available
  • it may be necessary to either straight cath the patient or even replace the foley catheter if the patient is unable to void
111
Q

Bladder Training includes

A
  • Kegel Exercises
  • initiating a toileting schedule
  • avoid an overfilled bladder which increases the risk of incontinence
  • minimizing caffeine and alcohol
  • take a prescribed diuretic med early in the morning
  • maintain a healthy weight
112
Q

Kegel Exercises

A

pelvic floor exercises

113
Q

Evaluate compliance with

A
  • dietary restrictions
  • pelvic muscle exercises
  • effectiveness of antibiotic treatment
114
Q

Add tables from slide

A

….

NURS 305 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions