E4 Urinary Elimination Flashcards
Bacteremia
Bacteria in the bloodstream
Bacteriuria
Bacteria in urine
Cystitis
an infection of the bladder that almost always follows (is secondary to) bacterial infection in the urine
Dysuria
pain and/or burning when urinating
Hematuria
Blood in urine
Micturition
the action of urinating
Nephrostomy
a procedure to drain urine from your kidney using a catheter (tube)
Pelvic floor muscle training
Begin by emptying your bladder. · Tighten the pelvic floor muscles and hold for a count of 10. · Relax the muscles completely for a count of 10.
Proteninuria
elevated protein in the urine
Pyelonephritis
a bacterial infection causing inflammation of the kidneys
Ureterostomy
a surgery that redirects your ureters, the tubes that carry pee from your kidneys to your bladder, to carry your pee to a new, surgical opening in your skin instead.
Voiding
Bladder contraction
Urethral sphincter relaxes
Pelvic floor muscles relax
Factors influencing urinary elimination
-Growth & development
-Sociocultural factors
-Psychological factors
-Personal habits
-Fluid intake
-Pathological conditions
-Surgical procedures
-Diagnostic examinations
Decreased urinary changes in older adults
-Decreased amount of nephrons
-Decreased bladder muscle tone
-Decreased bladder capacity
-Decreased time between initial desire to void and urgent need to void
Increased urinary changes in older adults
-Increased bladder irritability
-Increased bladder contractions during bladder filling
-Increased risk of urinary incontinence
Common urinary elimination problems
-Urinary retention
-UTI
-Urinary incontinence
Urinary retention
-Inability to partially or completely empty the bladder
-Can be acute or chronic
-Diagnose with Post-Void residual (PVR)
Bladder scanning is a ________ nursing action
independent
What is the most common type of UTI?
E.Coli
What does a upper vs lower UTI?
Upper: kidney infection
Lower: bladder or urethra infection
UTI risk factors
-Presence of indwelling catheter
-Any instrumentation of urinary tract
-Urinary retention
-Urinary or fecal incontinence
-Poor perineal hygiene
-Females
-Frequent sexual intercourse
-Uncircumcised patients
Older adults UTI symptoms
-Confusion
-Decreased functional status
-Delirium
-Increased falls
-Fever
Upper UTI symptoms
Flank tenderness
Lower UTI symptoms
-Burning
-Pain w/ urination
-Irritated bladder
-Urgency
-Frequency
-Incontinence
-Maybe superpubic tenderness
-Foul smell
-Cloudy urine
How to prevent CAUTI
-Good hand hygiene
-Correct way to get sample from foley
-Secured properly
-Sterile insertion
-Castile wipes
-CHG wipes
Overflow urinary incontinence
-Poor bladder emptying
-Bladder obstruction
-Males w/ BPH
Stress urinary incontinence
-Usually from effort or exertion
-laughing, coughing, sneezing
-Injury to sphincter
-Childbirth
Urgency urinary incontinence
-Older adults
-Idiopathic
-Really gotta go
Functional
-Inability to get to bathroom
-Older adults with assistive devices
-Broke leg need assistance
Incontinence risk factors
-More common in women & elderly
-Obesity
-Multiple pregnancies/ vaginal births
-Neurological disorders: Parkinson’s, CVA, Spinal cord injury, MS
-Medication therapy
-Confusion
-Dementia
-Immobility
-Depression
What Medications are risk factors for incontinence?
-Diuretics
-Opioids
-Anticholinergics
-Calcium channel blockers
-Sedatives
-Hypnotics
Assessing someone with urinary issues
- Assess understanding and expectations of treatment
- Be professional
- Assess ability to perform necessary behaviors associated with voiding
- Culture or personal considerations
- Past medical hx
- Medication use
- Normal bowel and urine patterns
- Sleep, activity, nutrition
Hesitancy
difficulty starting the stream of urine or keeping it flowing, or your flow may stop before your bladder is empty
Polyuria
Excessive urination volume- occurs when you urinate more than normal.
Oliguria
urinary output less than 400 ml per day or less than 20 ml per hour
Nocturia
Frequent nighttime urination
Might assess ____ for kidney infection/ tenderness
Costovertebral Angle (CVA)
Normal urine output and concerning urine output
N: output >30mls/hr
C: output <30mls/hr for 2 hours
The first of the day is more
concentrated
Urine that sits becomes more
cloudy & stinky
What does Thick and Cloudy urine mean?
Bacteria and WBCs
What does normal urine smell like?
-Ammonia
-Odorless
How do you get a urine sample from someone with a catheter?
Clamp catheter and get it up close to insertion site
Normal urine pH
4.6-8.0
Alkaline: loss of acid
Acidotic: urine that sits for hours
Specific gravity normal range
1.005-1.030
High: dehydrated
Low: Overhydrated
Culture & Sensitivity
-Obtained to determine presence of pathogenic bacteria
-Obtain before antibiotic administration
-Only done if urinalysis suggest infection
-Send to lab within 3o mins
-Preliminary report should be available within 24 hrs
-Sterile specimen cup
Why would you take abdominal x-ray: Kidney Urether Bladder(KUB)
-Determines size, shape, symmetry, location of structures of the urinary tract
-Detect and measure urinary calculi (kidney stones)
-Don’t have to be NPO
Patient education for urinary elimination
-Promote selfcare practices
-Maintain normal routine
-Promote healthy nutrition and fluid intake
-Avoid constipation & smoking
-Strengthen pelvic floor muscles
-Men be vigilant about your prostate health (routine check ups)
-Report any changes in urinary tract
How much fluid should you consume in a day?
2300mls/day if renal function is ok, no heart disease & no need for fluid restriction
-helps flush solutes to limit bladder irritability
If fluid needs to be increased:
- Schedule times to drink
- Identify fluid preferences
- High fluid foods (fruits)
- Stop drinking 2 hours before bedtime
Urinary retention Nursing care
-Assess & monitor urine output
-Assess for bladder distention
-Assist pt to normal position for urination
-Run water or flush commoade
-Apply cold compress to abdomen
-Encourage double voiding
-If bladder does not empty fully, try around the clock voiding
-Crede method is not recommended
-Intermittent catheterization or catheterization
What is the crede method
exerting manual pressure on the abdomen at location of bladder
What are things that can be done to prevent infection?
-Follow hospital protocol
-Assess for s/s of infection
-Perform perineal hygiene
-Void at regular intervals
-Adequate fluid intake
-Female considerations (wipe front to back)
1st line therapy Incontinence care
-Be respectful of pts feeling
-Pelvic floor muscle training
-Lifestyle changes
-Bladder retraining
-Toileting schedule
-Intermittent catherization
-Meticulous skin care
-Absorbent pads & catheters
2nd line therapy incontinence care
-Electrical stimulation
-Meds: anticholinergics
-Bulking material injections
-Botox
-Nerve stimulation
-Surgery: Sling, bladder neck suspension, prolapse surgery, artificial urinary sphincter
Do’s of meticulous skin care
-Identify & treat early
-Use skin risk assessment tools
-Use appropriate skin barrier products
-Ensure hydration
-Consult WOCN if needed
Don’ts of meticulous skin care
-Don’t use traditional soap & water
-Don’t double pad the bed
-Don’t leave soiled pads
What type of catheter is used for an enlarged prostate?
Coude tip
Suprapubic catheter
-Placed in bladder through abdominal wall
-Sutured in place
-Used when blockage of urethra or when indwelling catheter causes irritation
-Long term cath
Empty drainage bag when it is _____ full
half
Nursing catheter care
-Peri care
-Catheter care
-Secure catheter to prevent movement or pulling
-Ensure no kinks
-Keep below bladder
-Do not allow bag to touch floor
-Maintain closed drainage system
-Accurate monitoring og output
-Timely removal
Peri care, CHG, and Castille wipes can be delegated to
nursing assistant or patient but job of nurse to ensure it gets done
How soon should a pt void post removal?
6-8 hours
What should you educate pt on post removal?
First urine may cause discomfort
Catheter must be removed ______ after order written
4 hours
If you bladder scan and volume <400 mLs then
ensure adequate hydration and rescan in 2 hours
If you bladder scan and volume >400 mLs then
perform in and out cath
