Chapters 46 & 41 Flashcards
What is urinary elimination?
The processes involved in the formation, storage, and excretion of urine.
What are the key importance of urinary elimination in nursing practice?
- Preventing complications such as UTIs
- Maintaining patient comfort, dignity, and quality of life
- Using effective assessment, intervention, and education strategies
What are the main structures involved in the urinary system?
- Kidneys
- Ureters
- Bladder
- Urethra
What are the functions of the kidneys?
- Filter blood to remove waste and excess water
- Maintain electrolyte balance
- Regulate acid-base status
- Secrete hormones such as erythropoietin and renin
What is the functional unit of the kidney?
Nephron
What is the role of the ureters?
Muscular tubes that propel urine from the kidneys to the bladder via peristaltic waves.
What is the function of the bladder?
A hollow, distensible, muscular organ that stores urine.
What happens during micturition?
The detrusor muscle of the bladder contracts and the urethra relaxes.
How long is the male urethra compared to the female urethra?
Male: approximately 8 inches; Female: 1.5–2 inches.
What is glomerular filtration?
The process where blood plasma is filtered through the glomeruli, producing about 125 mL/min of filtrate.
What factors affect the glomerular filtration rate?
- Blood pressure
- Capillary permeability
What percentage of filtrate is reabsorbed in the renal tubules?
Approximately 99%
What is the role of Antidiuretic Hormone (ADH)?
Increases water reabsorption, raising urine concentration.
What does aldosterone do?
Promotes sodium (and thus water) reabsorption, affecting blood volume and pressure.
What subjective data should be collected during a urinary elimination assessment?
- Voiding patterns
- Symptom inquiry
- Medication and fluid intake history
What are some signs to look for during a physical examination of urinary elimination?
- Bladder distention or tenderness
- Perineal skin for irritation or breakdown
What is a bladder scan used for?
A noninvasive measurement of postvoid residual volume.
What does urinalysis examine?
- Urine color
- Clarity
- pH
- Specific gravity
- Presence of protein, glucose, bacteria, or casts
What does an abnormal specific gravity indicate?
Possible dehydration or renal pathology.
What are the aseptic techniques for preventing UTIs?
- Use sterile technique during catheter insertion
- Proper specimen collection
What are some strategies for managing urinary retention?
- Assess for bladder distention
- Use bladder scans or straight catheterization
- Assist patients to a proper voiding position
What types of urinary incontinence are there?
- Stress incontinence
- Urge incontinence
- Overflow incontinence
What are some management strategies for urinary incontinence?
- Pelvic floor (Kegel) exercises
- Scheduled voiding
- Environmental modifications
What is the proper procedure for indwelling catheter insertion?
Cleanse the urethral meatus using circular strokes with each cotton swab used only once.
What should be documented when removing a catheter?
Time of removal and monitoring for urinary function recovery.
What constitutes normal urinary patterns?
Normal urine output, color, odor, and consistency.
True or False: Phenazopyridine can turn urine orange.
True
What is the expected outcome for a patient with postoperative urinary retention?
Successful restoration of normal voiding patterns without complications.
What is the significance of accurate assessment in urinary elimination?
To identify issues such as retention, incontinence, or infection.
What are some nursing interventions for urinary elimination?
- Catheter care
- Patient education
- Environmental modifications
What strategies are essential for preventing UTIs and skin breakdown?
Particularly important for vulnerable populations like the elderly or postoperative patients.
What is the process of urination?
The process of urination involves the following steps:
* Filtration of blood in the kidneys
* Formation of urine in the renal tubules
* Storage of urine in the bladder
* Expulsion of urine through the urethra.
What factors commonly influence urinary elimination?
Factors that influence urinary elimination include:
* Fluid intake
* Medications
* Age
* Gender
* Neurological function
* Physical activity.
Compare and contrast normal and abnormal urine characteristics.
Normal urine characteristics include:
* Clear or pale yellow color
* Mild odor
* Specific gravity of 1.005 to 1.030.
Abnormal urine characteristics may include:
* Dark color
* Strong odor
* Presence of blood or protein.
What are the nursing implications of common diagnostic tests of the urinary system?
Nursing implications include:
* Preparing the patient for tests
* Monitoring vital signs
* Ensuring hydration
* Educating the patient about the procedure.
Discuss nursing measures to promote normal micturition.
Nursing measures to promote normal micturition include:
* Encouraging regular toilet habits
* Providing privacy
* Assisting with positioning
* Ensuring adequate fluid intake.
Discuss nursing measures to reduce urinary tract infection.
Nursing measures to reduce urinary tract infection include:
* Encouraging hydration
* Promoting proper hygiene
* Urging timely urination
* Avoiding irritants like caffeine.
Fill in the blank: The _______ is responsible for the storage of urine.
[bladder]
What is urination (micturition)?
The process of emptying the bladder
Involves the coordinated function of the kidneys, ureters, bladder, and urethra.
What is the role of the kidneys in urination?
Filter blood, producing urine that travels through the ureters to the bladder.
What triggers the urge to urinate?
Stretch receptors in the bladder when it reaches a volume of 200–400 mL.
How does the brain regulate urination?
Signals the external urethral sphincter to relax while the detrusor muscle contracts.
List factors that commonly influence urinary elimination.
- Age
- Fluid intake
- Medications
- Medical conditions
- Psychological factors
- Activity level
- Pregnancy
What is urinary retention?
Inability to completely empty the bladder.
What are the types of urinary incontinence?
- Stress incontinence
- Urge incontinence
- Overflow incontinence
- Functional incontinence
What is nocturia?
Frequent urination at night.
What is dysuria?
Painful urination.
What is polyuria?
Excessive urination.
What is oliguria?
Decreased urine output.
What are the characteristics of normal urine?
- Color: Pale yellow to amber
- Clarity: Clear
- Odor: Mild
- pH: 4.5–8
- Specific gravity: 1.005–1.030
What indicates abnormal urine clarity?
Cloudy urine, often indicating infection or proteinuria.
What does dark or bloody urine indicate?
Hematuria, which can be due to infection, trauma, or kidney stones.
What does foul-smelling urine suggest?
Urinary tract infection (UTI).
What does sweet or fruity odor in urine indicate?
Diabetes due to ketones in urine.
What does foamy urine indicate?
Excess protein, often related to kidney disease.
What is the purpose of urinalysis?
Detects infection, kidney disease, or metabolic disorders.
What does urine culture identify?
Bacteria in urinary tract infections (UTIs).
What is the significance of a 24-hour urine collection?
Measures kidney function.
What does a bladder scan measure?
Post-void residual urine.
What is cystoscopy?
Endoscopic examination of the bladder.
What do blood tests like BUN, Creatinine, and GFR evaluate?
Kidney function.
List nursing measures to promote normal micturition.
- Encourage adequate fluid intake
- Promote a regular voiding schedule
- Assist with mobility issues
- Teach pelvic floor exercises
- Provide privacy and relaxation techniques
- Use absorbent products if needed
What are nursing measures to reduce urinary tract infections (UTIs)?
- Encourage proper perineal hygiene
- Promote adequate hydration
- Encourage regular urination
- Avoid catheterization when possible
- Educate patients about irritating substances
- Suggest wearing cotton underwear
What are comorbidities that affect the kidneys?
Comorbidities include:
- Hypertension
- Acute Injury
- Rhabdomyolysis
- Autoimmune diseases like lupus
What are common urinary elimination problems?
Common problems include:
- Urinary retention
- Stress incontinence
- Urinary incontinence
- Polyuria (excessive urination)
- Oliguria (little urination)
- Nocturia (urination at night)
What considerations should be taken into account for urinary issues?
Considerations include:
- Infection control
- Growth & development
- Psychosocial implications
- Health literacy
- Patterns of urination (odor, clarity, symptoms)
- Cultural considerations
- Laboratory tests (BUN, GFR)
- Physical assessment (kidney, bladder, perineal)
What are the goals in planning for urinary issues?
Goals include:
- Promoting normal urination
- Maintaining elimination habits
- Adequate fluid intake
- Complete bladder emptying
- Preventing infection
- Warm baths/showers
What are the types of catheterization in acute care?
Types include:
- Intermittent catheterization
- Suprapubic catheterization (permanent)
- External catheters
What are the sizes for catheters in males and females?
Catheter sizes:
- Female: 12-14 Fr
- Male: 14-18 Fr
What is the purpose of bladder retraining?
Bladder retraining aims to restore normal bladder function and maintain continence.
What is the normal pH range for urine?
4.6-8.0
pH level indicates acid-base balance. Acid pH helps protect against bacterial growth.
What does the presence of protein in urine indicate?
Very sensitive indicator of kidney function
Damage to the glomerular membrane allows larger molecules such as protein to seep through.
Under what condition might glucose appear in urine?
Poorly controlled diabetes
Inability of tubules to resorb high serum glucose concentrations (> 180 mg/100 mL).
What causes ketones to be present in urine?
Breakdown of fatty acids
Occurs with poor control of type 1 diabetes, dehydration, starvation, or excessive aspirin ingestion.
What is the normal range for specific gravity in urine?
1.005-1.030
Measures concentration of particles in urine.
What does high specific gravity indicate?
Concentrated urine
Elevated by dehydration, reduced renal blood flow, and increased ADH secretion.
What does low specific gravity indicate?
Diluted urine
Reduced by overhydration, early renal disease, and inadequate ADH secretion.
What is the normal range for red blood cells (RBCs) in urine?
Up to 2
Elevated numbers indicate inflammation or infection.
What is the normal range for white blood cells (WBCs) in urine?
0-4 per low-power field
Elevated levels may indicate infection.
What does the presence of bacteria in urine indicate?
Infection or colonization
If the patient shows no symptoms, it may indicate colonization.
What are casts in urine, and what do they indicate?
Cylindrical bodies not normally present
Their presence indicates renal disease.
What do crystals in urine indicate?
Increased risk for renal calculi
Patients with high uric acid levels may develop uric acid crystals.
True or False: Protein is normally present in urine.
False
Protein presence is a sensitive indicator of kidney function.
Fill in the blank: The presence of _______ in urine can indicate renal disease.
casts
Casts take on the shape of objects within the renal tubule.
What complication is associated with suctioning in a patient with a head injury?
Increased intracranial pressure
Suctioning increases intracranial pressure even when provided in the appropriate time interval.
What should be performed before suctioning to reduce the risk of intracranial pressure?
Hyperventilation
Hyperventilation helps in minimizing the risk of increased intracranial pressure.
What are the risks of too-frequent suctioning in patients?
- Hypoxemia
- Hypotension
- Arrhythmias
- Possible trauma to the mucosa of the lungs
Frequent suctioning can lead to multiple complications that affect patient safety.
True or False: Suctioning can lead to arrhythmias in patients.
True
Arrhythmias are one of the potential complications associated with suctioning.
Fill in the blank: Suctioning increases _______ even when provided in the appropriate time interval.
intracranial pressure
This is a crucial consideration for nursing care in patients with head injuries.
Which condition involves collapsed alveoli that prevent the normal exchange of oxygen and carbon dioxide?
Atelectasis
Atelectasis is a pulmonary condition leading to a collapse of the alveoli.
What condition impairs the efficient transfer of oxygen and carbon dioxide across the lung?
Acute pulmonary embolism
Acute pulmonary embolism causes decreased arterial PO2 and an increase in the alveolar-arterial oxygen tension gradient.
What structural abnormality alters the ability of the lungs to distend?
Kyphosis
Kyphosis results in increased intra-alveolar pressure but does not cause collapsed alveoli.
True or False: A myocardial infarction may lead to collapsed alveoli.
False
A myocardial infarction may affect pulmonary circulation and result in dyspnea but does not cause collapsed alveoli.
Fill in the blank: __________ is a pulmonary condition that leads to a collapse of the alveoli.
Atelectasis
Atelectasis prevents normal gas exchange.
What are the most common gas exchange abnormalities in acute pulmonary embolism?
Decreased arterial PO2 and increased alveolar-arterial oxygen tension gradient
These abnormalities impair oxygen and carbon dioxide transfer.
What does kyphosis affect in the lungs?
Compliance
Kyphosis alters lung distension ability, affecting compliance.
What symptom may result from myocardial infarction affecting pulmonary circulation?
Dyspnea
Myocardial infarction can lead to difficulty in breathing.
What is a cause of transient urinary incontinence?
Fecal impaction
Transient incontinence is caused by medical conditions that are treatable and reversible.
What type of incontinence can be caused by idiopathic bladder overactivity?
Urge urinary incontinence
This means the cause of this type of incontinence is unknown.
What condition can cause functional incontinence?
Cognitive impairment
Cognitive impairment affects the ability to manage urinary function.
True or False: Overactive bladder can be associated with neurologic problems.
True
Urge urinary incontinence can also be related to a strong sense of urgency.
Fill in the blank: Urge urinary incontinence can be associated with a strong sense of urgency related to an overactive bladder caused by _______.
neurologic problems
Which patient is most likely to exhibit symptoms such as dysuria, urgency, frequency, and nocturia?
A patient with a urinary tract infection.
Dysuria, urgency, frequency, and nocturia are symptoms that may be exhibited by patients with urinary tract infections.
What symptoms may a patient with kidney failure experience?
Oliguria.
A patient with kidney failure may experience oliguria.
What symptoms may patients receiving diuretic therapy exhibit?
Polyuria.
Patients receiving diuretic therapy may exhibit polyuria.
What symptoms may patients with uncontrolled diabetes mellitus exhibit?
Polyuria.
Patients with uncontrolled diabetes mellitus may exhibit polyuria.
What substance in urine indicates a possible abnormality?
Glucose, 2+
A normal urinalysis should not be positive for glucose due to complete reabsorption.
What is the acceptable level of protein in urine?
Under 8 mg/100 mL
The presence of protein at 6 mg/100 mL is within normal limits.
What is the acceptable range for red blood cells in urine?
0 to 2
The presence of 2 red blood cells is considered acceptable.
What is the acceptable white blood cell count in urine?
0 to 4
A white blood cell count of 4 is within normal limits.
True or False: The presence of glucose in urine typically indicates a normal finding.
False
Glucose should not be present in urine under normal circumstances.
What underlying factor may lead to the presence of urinary ketone bodies?
Starvation, Dehydration, Uncontrolled diabetes mellitus
Ketones are produced when the body uses fat for energy, particularly when carbohydrates are inadequate.
Does epilepsy lead to the presence of ketone bodies in urine?
False
Epilepsy affects the nervous system and is not associated with ketonuria.
Does hyperthyroidism lead to the presence of ketone bodies in urine?
False
Hyperthyroidism affects the endocrine system and does not cause ketonuria.
What condition is associated with the body breaking down fatty acids for energy?
Uncontrolled diabetes mellitus
In uncontrolled diabetes, the body cannot utilize glucose effectively, leading to fat breakdown.
Fill in the blank: Ketones are produced as a by-product when the body uses ______ for energy production.
fat
This process occurs particularly when carbohydrate intake is low.
Which of the following can lead to ketonuria? (Select all that apply) - Epilepsy, Starvation, Dehydration, Hyperthyroidism, Uncontrolled diabetes mellitus
Starvation, Dehydration, Uncontrolled diabetes mellitus
Only these conditions are associated with the presence of ketone bodies in urine.
What is urinary incontinence?
Characterized by any involuntary loss of urine
Urinary incontinence can manifest in various forms, including urge and stress incontinence.
Which types of urinary incontinence are common?
Urge incontinence and stress incontinence
These are the two most prevalent forms of urinary incontinence.
True or False: Mixed incontinence is a combination of stress and functional incontinence.
False
Mixed incontinence is actually a combination of stress and urge incontinence.
Is urinary incontinence common in older adults?
Yes
Urinary incontinence is frequently observed in the older adult population.
Fill in the blank: Mixed incontinence is a combination of stress and _______.
[urge]
This distinction is important for accurate diagnosis and treatment.
What condition is suspected with increased blood pressure, tachycardia, dizziness, decreased level of consciousness, and the need to sit in a high Fowler’s position?
Hypoxia
Hypoxia is characterized by clinical signs such as apprehension, restlessness, and behavioral changes.
What are some clinical signs and symptoms of hypoxia?
- Apprehension
- Restlessness
- Inability to concentrate
- Decreased level of consciousness
- Dizziness
- Behavioral changes
Hypoxia may also lead to fatigue and agitation.
What vital sign changes are associated with hypoxia?
- Increased pulse rate
- Increased rate and depth of respiration
These changes reflect the body’s response to insufficient oxygen.
What does hyperlipidemia refer to?
Elevated levels of fat/triglycerides in the blood
Hyperlipidemia can cause xanthelasma but not the signs presented in the patient.
What is the effect of hypovolemia on blood pressure?
Causes blood pressure to decrease
Hypovolemia is typically associated with shock or severe dehydration.
What symptoms are associated with hyperventilation?
- Rapid respirations
- Sighing breaths
- Numbness and tingling of hands/feet
Hyperventilation does not present the signs in the scenario provided.
What immediate action should the nurse take for a patient with COPD receiving oxygen therapy and showing high carbon dioxide levels?
Remove the mask
The simple face mask is contraindicated for patients with carbon dioxide retention.
Why is the simple face mask contraindicated for patients with carbon dioxide retention?
It delivers 6 L/min or more of oxygen, preventing PaO2 from falling
This prevents stimulation of peripheral receptors that trigger breathing.
What flow rate of oxygen is typically delivered by a simple face mask?
6 L/min or more
This rate is too high for patients with COPD to avoid carbon dioxide retention.
What is the appropriate oxygen delivery method for a patient with COPD who retains carbon dioxide?
Use a nasal cannula
A nasal cannula allows safe delivery of lower rates of oxygen without rebreathing exhaled carbon dioxide.
What are the risks of reapplying a simple face mask on a patient with high carbon dioxide levels?
Continued carbon dioxide retention
This could worsen the patient’s condition.
What oxygen concentration does a nonrebreather mask typically deliver?
60% to 90% oxygen
Nonrebreather masks are contraindicated for COPD patients due to high oxygen levels.
What flow rate does a nonrebreather mask require?
10 to 15 L/min
This high flow rate can be harmful for patients with COPD.
True or False: Covering the patient’s mouth and nose with a simple face mask is safe for patients with COPD.
False
It allows for continued carbon dioxide retention.
