Elimination (Urinary) Flashcards
Urinary elimination depends on the effective functioning of the upper urinary tract’s ___________ and the lower urinary tract’s urinary ________.
kidneys and ureters; bladder, urethra, and pelvic floor
The paired kidneys are situated on either side of the _________, behind the ________.
spinal column; peritoneal cavity
T/F: The left kidney is slightly lower than the right due to the position of the liver.
F - right kidney is lower
They are the primary regulators of fluid and acid–base balance in the body.
Kidneys
The functional units of the kidneys, the _______, filter the blood and remove metabolic wastes.
nephrons
T/F: In the average adult 1,200 mL of blood, or about 21% of the cardiac output, passes through the kidneys every minute.
T
Each kidney contains approximately 1 million nephrons. Each nephron has a _______, a tuft of capillaries surrounded by Bowman’s capsule.
glomerulus
Which of the following statements is/are true:
- The endothelium of glomerular capillaries is porous, allowing fluid and solutes to readily move across this membrane into the capsule.
- Plasma proteins and blood cells are too large to cross the membrane normally.
- Glomerular filtrate is similar in composition to plasma, made up of water, electrolytes, glucose, amino acids, and metabolic wastes.
All of the above
Which of the following is/are true?
- From Bowman’s capsule the filtrate moves into the tubule of the nephron.
- In the distal convoluted tubule, most of the water and electrolytes are reabsorbed.
- Solutes such as glucose are reabsorbed in the loop of Henle.
- Other substances are secreted into the filtrate in the same area, resulting in concentrated urine.
- In the proximal convoluted tubule, additional water and sodium are reabsorbed under the control of hormones such as antidiuretic hormone (ADH) and aldosterone.
2nd and 5th are false - proximal; distal
Which of the following is/are true?
- This controlled reabsorption allows regulation of fluid and electrolyte balance in the body.
- When fluid intake is low or the concentration of solutes in the blood is high, ADH is released from the posterior pituitary, more water is reabsorbed in the distal tubule, and less urine is excreted.
- By contrast, when fluid intake is high or the blood solute concentration is low, ADH is suppressed.
-Without ADH, the distal tubule becomes impermeable to water, and more urine is excreted.
-When aldosterone is released from the adrenal cortex, sodium and water are reabsorbed in greater quantities, increasing the blood volume and decreasing urinary output.
All of the above
Once the urine is formed in the kidneys, it moves through the collecting ducts into the calyces of the renal pelvis and from there into the _______.
ureters
T/F:
1st Statement: The upper end of each ureter is funnel-shaped as it enters the kidney.
2nd Statement: The lower ends of the ureters enter the bladder at the posterior corners of the floor of the bladder
Both T
At the junction between the ureter and the bladder, a flaplike fold of mucous membrane acts as a valve to prevent _________ of urine up the ureters.
reflux
The ________ (vesicle) is a hollow, muscular organ that serves as a reservoir for urine and as the organ of excretion. When empty, it lies behind the symphysis pubis.
urinary bladder
In men, the bladder lies in front of the _______ and above the prostate gland. In women, it lies in front of the ________.
rectum; uterus and vagina
The wall of the bladder is made up of four layers:
(1) an inner mucous layer;
(2) a connective tissue layer;
(3) three layers of smooth muscle fibers, some of which extend lengthwise, some obliquely, and some more or less circularly;
(4) an outer serous layer.
The smooth muscle layers are collectively called the _______. It allows the bladder to expand as it fills with urine, and to contract to release urine to the outside of the body during voiding.
detrusor muscle
The ________ at the base of the bladder is a triangular area marked by the ureter openings at the posterior corners and the opening of the urethra at the anterior inferior corner.
trigone
T/F
1st Statement: The bladder is capable of considerable distention because of rugae (folds) in the mucous membrane lining and because of the elasticity of its walls.
2nd Statement: When full, the dome of the bladder may extend above the symphysis pubis; in extreme situations, it may extend as high as the umbilicus. Normal bladder capacity is between 300 and 600 mL of urine.
Both T
The urethra extends from the bladder to the _______ (opening).
urinary meatus
In the adult woman, the urethra lies directly behind the _______, anterior to the vagina, and is between 3 and 4 cm (1.5 in.) long
symphysis pubis
T/F: In women, the urethra serves only as a passageway for the elimination of urine.
T
The urinary meatus is located between the _______, in front of the vagina, and below the clitoris.
labia minora
T/F:
1st Statement: The male urethra is approximately 20 cm (8 in.) long and serves as a passageway for urine only.
2nd Statement: The meatus is located at the proximal end of the penis
Both F - serves as a passageway for semen too; distal
In both men and women, the urethra has a _________ that is continuous with the bladder and the ureters.
mucous membrane lining
T/F:
1st Statement: An infection of the urethra can extend through the urinary tract to the kidneys.
2nd Statement: Men are particularly prone to urinary tract infections (UTIs) because of their short urethra and the proximity of the urinary meatus to the anus.
1st T 2nd F - Women
The vagina, urethra, and rectum pass through the _________, which consists of sheets of muscles and ligaments that provide support to the viscera of the pelvis.
pelvic floor
These muscles and ligaments extend from the symphysis pubis to the coccyx forming a ________.
sling
T/F: Specific sphincter muscles contribute to the continence mechanism.
T
The __________ situated in the proximal urethra and the bladder neck is composed of smooth muscle under involuntary control. It provides active tension designed to close the urethral lumen.
internal sphincter muscle
The _________ is composed of skeletal muscle under voluntary control, allowing the individual to choose when urine is eliminated.
external sphincter muscle
________, _________, and _______ all refer to the process of emptying the urinary bladder.
micturition, voiding, and urination
Urine collects in the bladder until pressure stimulates special sensory nerve endings in the bladder wall called ________.
stretch receptors
You urinate when:
T/F:
1st Statement: This occurs when the adult bladder contains between 250 and 450 mL of urine.
2nd Statement: In children, a considerably smaller volume, 50 to 200 mL, stimulates these nerves.
Both T
Identify the statements that is/are true:
- The stretch receptors transmit impulses to the spinal cord, specifically to the voiding reflex center located at the level of the second to fourth sacral vertebrae, causing the internal sphincter to relax and stimulating the urge to void.
- If the time and place are appropriate for urination, the conscious portion of the brain relaxes the external urethral sphincter muscle and urination takes place.
- If the time and place are inappropriate, the micturition reflex usually subsides until the bladder becomes more filled and the reflex is stimulated again.
All of the above
Voluntary control of urination is possible only if the nerves supplying the bladder and urethra, the neural tracts of the cord and brain, and the motor area of the cerebrum are all “_______”.
intact
T/F: The individual must be able to sense that the bladder is full.
T
Injury to any of these parts of the nervous system—for example, by a ________ or ______ above the level of the sacral region—results in intermittent involuntary emptying of the bladder.
cerebral hemorrhage or spinal cord injury
T/F: Older adults whose cognition is IMPROVED may not be aware of the need to urinate or able to respond to this urge by seeking toilet facilities.
F - poor
T/F:
1st Statement: Urine output varies according to fluid intake but gradually increases to 250 to 500 mL a day during the first year.
2nd Statement: An infant may urinate as often as 20 times a day.
Both T
The urine of the neonate is colorless and odorless and has a specific gravity of _________. This is due to?
1.008; newborns and infants have immature kidneys, they are unable to concentrate urine very effectively.
T/F: Infants are born with urinary control.
F - without
T/F:
1st Statement: Infants will develop urinary control between the ages of 2 and 5 years.
2nd Statement: Control during the night-time normally precedes daytime control.
1st T 2nd F - control during the daytime normally precedes night-time control.
T/F:
1st Statement: The preschooler is able to take responsibility for independent toileting.
2nd Statement: Parents need to realize that accidents do occur and the child should be punished or disciplined for this.
1st T 2nd F - Shouldn’t be punished or disciplined
T/F: Girls should be taught to wipe from back to front to prevent contamination of the urinary tract by feces.
F - front to back
The child’s elimination system reaches maturity during this period. The kidneys double in size between ages 5 and 10 years. During this period, the child urinates six to eight times a day.
School-Age Children
Is defined as the involuntary passing of urine when control should be established (about 5 years of age), which can be a problem for some school-age children.
Enuresis
_________, or bed-wetting, is the involuntary passing of urine during sleep. It has many causes but basically, it occurs because the client fails to awaken when the bladder empties.
Nocturnal enuresis
T/F: Bed-wetting should not be considered a problem until after the age of 8.
F - age of 6
T/F:
1st Statement: Nocturnal enuresis may be referred to as primary when the child has never achieved night-time urinary control.
2nd Statement: The incidence of nocturnal enuresis declines as the child matures.
Both T
_________ is that which appears after the child has achieved dryness for a period of 6 consecutive months. It is often related to another problem such as constipation, stress, or illness, and may resolve when the cause is eliminated.
Secondary enuresis
The excretory function of the kidney diminishes with ________, but usually not significantly below normal levels unless a disease process intervenes.
Ex. Blood flow can be reduced by arteriosclerosis, impairing renal function.
age
T/F: With age, the number of functioning nephrons decreases to some degree, impairing the kidney’s filtering abilities.
T
Choose the statements that is/are true:
- Conditions that alter normal fluid intake and output, such as having influenza or having surgery, can compromise the kidney’s ability to filter, maintain acid–base balance, and maintain electrolyte balance in older adults.
- It also takes a much LESSER time for these processes to return to normal functioning.
- The decrease in kidney function also places the older adult at higher risk for toxicity from medications if excretion rates are longer.
1st and 3rd T 2nd F - longer
The more noticeable changes with age are those related to the _______.
bladder
T/F:
1st Statement: Complaints of urinary urgency and urinary frequency are common.
2nd Statement: In men, these changes are often due to an enlarged prostate gland, and in women, they may be due to weakened muscles supporting the bladder or weakness of the urethral sphincter.
Both T
T/F: The capacity of the bladder and its ability to completely empty doesn’t diminish with age.
F - it diminishes with age
This explains the need for older adults to arise during the night to void and the retention of residual urine, predisposing the older adult to bladder infections.
nocturnal frequency
For many people, a set of conditions helps stimulate the ________. These conditions include privacy, normal position, sufficient time, and, occasionally, running water.
micturition reflex
Circumstances that do not allow for the client’s accustomed conditions may produce anxiety and muscle tension. As a result, the person is unable to relax abdominal and perineal muscles and the external urethral sphincter; thus, ______ is inhibited.
voiding
People also may voluntarily suppress urination because of perceived time pressures; for example, nurses often ignore the urge to void until they are able to take a break. This behavior can increase the risk of _______.
UTIs
T/F: The healthy body maintains a balance between the amount of fluid ingested and the amount of fluid eliminated.
T
T/F: When the amount of fluid intake increases, therefore, the output normally increases.
T
Choose the following that increase fluid output:
- Alcohol
- Fluids that contain caffeine.
- Food and fluids high in sodium
1st and 2nd statement only - alcohol increase fluid output by inhibiting the production of antidiuretic hormone; fluids that contain caffeine (e.g., coffee, tea, and cola drinks) also increase urine production; food and fluids high in sodium can cause fluid retention because water is retained to maintain the normal concentration of electrolytes.
T/F: Some foods and fluids can change the color of urine. For example, beets can cause urine to appear red; foods containing carotene can cause the urine to appear yellower than usual.
T
Many medications, particularly those affecting the __________, interfere with the normal urination process and may cause retention.
autonomic nervous system
It increases urine formation by preventing the re-absorption of water and electrolytes from the tubules of the kidney into the bloodstream.
Ex. chlorothiazide and furosemide
Diuretics
T/F: Good muscle tone is important to maintain the stretch and contractility of the detrusor muscle so the bladder can fill adequately and empty completely.
T
Clients who require a _________ for a long period may have poor bladder muscle tone because continuous drainage of urine prevents the bladder from filling and emptying normally.
retention catheter
________ also contributes to the ability to store and empty urine.
Pelvic muscle tone
Diseases of the kidneys may affect the ability of the _______ to produce urine.
nephrons
Abnormal amounts of protein or blood cells may be present in the urine, or the kidneys may virtually stop producing urine altogether, a condition known as ________.
renal failure.
T/F: Heart and circulatory disorders such as heart failure, shock, or hypertension can affect blood flow to the kidneys, interfering with urine production.
T
If abnormal amounts of fluid are lost through another route (e.g., vomiting or high fever), the kidneys _______ water and urinary output falls.
retain
A ________ (calculus) may obstruct a ureter, blocking urine flow from the kidney to the bladder.
urinary stone
Hypertrophy of the ________, a common condition affecting older men, may obstruct the urethra, impairing urination and bladder emptying.
prostate gland
The urethra may swell following a _______, and surgical procedures on any part of the urinary tract may result in some _________; as a result, the urine may be red or pink-tinged for a time.
cystoscopy; postoperative bleeding
Spinal anesthetics can affect the passage of urine because they decrease the client’s awareness of the need to ________.
void
Surgery on structures adjacent to the urinary tract can also affect voiding because of swelling in the _________.
lower abdomen
Although people’s patterns of urination are highly individual, most people void about _________ a day.
five to six times
T/F: People usually void when they first awaken in the morning, before they go to bed, and around mealtimes.
T
________ (or diuresis) refers to the production of abnormally large amounts of urine by the kidneys, often several liters more than the client’s usual daily output.
Polyuria
Polyuria can follow excessive fluid intake, a condition known as ________, or may be associated with diseases such as diabetes mellitus, diabetes insipidus, and chronic nephritis.
polydipsia
T/F: Polyuria can cause excessive fluid loss, leading to intense thirst, dehydration, and weight loss.
T
T/F: The terms oliguria and anuria are used to describe increased urinary output.
F - decreased
________ is low urine output, usually less than 500 mL a day or 30 mL an hour for an adult.
Oliguria
________ is low urine output, usually less than 500 mL a day or 30 mL an hour for an adult.
Oliguria
Although oliguria may occur because of abnormal fluid losses or a lack of fluid intake, it often indicates impaired blood flow to the ______ or impending ________ and should be promptly reported to the primary care provider.
kidneys; renal failure
T/F: Restoring renal blood flow and urinary output promptly can prevent renal failure and its complications.
T
________ refers to a lack of urine production.
Anuria
Should the kidneys become unable to adequately function, some mechanism of filtering the blood is necessary to prevent illness and death. This filtering is done through the use of _______, a technique by which fluids and molecules pass through a semi-permeable membrane according to the rules of osmosis.
renal dialysis
What are the two most common methods of dialysis?
hemodialysis and peritoneal dialysis
In _______, the client’s blood flows through vascular catheters, passes by the dialysis solution in an external machine, and then returns to the client.
hemodialysis
In ________, the dialysis solution is instilled into the abdominal cavity through a catheter, allowed to rest there while the fluid and molecules exchange, and then removed through the catheter.
peritoneal dialysis
T/F: Both hemodialysis and peritoneal dialysis must be performed at frequent intervals until the client’s kidneys can resume the filtering function.
T
_______,________,_______, and ______ often are manifestations of underlying conditions such as a UTI.
Frequency, nocturia, urgency, and dysuria
_______,_______,_______, and _____ may be either a manifestation or the primary problem affecting urinary elimination.
Enuresis, incontinence, retention, and neurogenic bladder
_______ is voiding at frequent intervals, that is, more than four to six times per day.
Urinary frequency
Which of the following may cause Urinary frequency:
- An increased intake of fluid
- Conditions such as UTI, stress, and pregnancy
All of the above
_______ is voiding two or more times at night. Like frequency, it is usually expressed in terms of the number of times the person gets out of bed to void.
Nocturia
_________ is the sudden, strong desire to void. There may or may not be a great deal of urine in the bladder, but the person feels a need to void immediately.
Urgency
Which of the following may cause Urgency?
- psychological stress
- irritation of the trigone and urethra.
- poor external sphincter control
- unstable bladder contractions.
All of the above
T/F: Urgency is a normal finding.
F
_______ means voiding that is either painful or difficult.
Dysuria
Choose the things Dysuria can accompany.
- a stricture (decrease in caliber) of the urethra
- urinary infections
- injury to the bladder and urethra.
- polyuria
1st-3rd statements only
T/F:
1st Statement: Often clients will say they have to push to void or that burning accompanies or follows voiding.
2nd Statement: The burning may be described as severe, like a hot poker, or more subdued, like a sunburn.
Both T
Often, ________ (a delay and difficulty in initiating voiding) is associated with dysuria.
urinary hesitancy
_______ is involuntary urination in children beyond the age when voluntary bladder control is normally acquired, usually 4 or 5 years of age.
Enuresis
T/F: Nocturnal enuresis often is irregular in occurrence and affects girls more often than boys.
F - it affects boys more
T/F: Diurnal (daytime) enuresis may be persistent and pathologic in origin. It affects men and boys more frequently.
F - women and girls
T/F: Urinary incontinence (UI), or involuntary leakage of urine or loss of bladder control, is a health symptom, not a disease.
T
UI is only normal in infants.
T
Occurs because of weak pelvic floor muscles and/or urethral hypermobility, causing urine leakage with such activities as laughing, coughing, sneezing, or any body movement that puts pressure on the bladder.
Stress urinary incontinence (SUI)
Facts that make a person more likely to experience SUI includes (select all that applies):
- for women, shorter urethras
- for women, the trauma to the pelvic floor associated with childbirth
- changes related to menopause
- for men, SUI may result after a prostatectomy
All of the above
T/F: SUI is not related to emotional stress but is “caused by increased pressure or ‘stress’ on the bladder as well as anatomical changes to the urethra, and pelvic floor muscle weakness”
T
This type of incontinence is described as an urgent need to void and the inability to stop micturition (passage of urine). The urine leakage can range from a few drops to soaking of undergarments. It is a major symptom of an overactive bladder
Urge Urinary Incontinence
Diagnosed when symptoms of both stress UI and urgency UI are present. It is very common among middle-aged and older women (Scemons, 2013). Treatment is usually based on which type of UI is the most bothersome to the client.
Mixed Urinary Incontinence
This is “continuous involuntary leakage or dribbling of urine that occurs with incomplete bladder emptying”.
Overflow incontinence
T/F: It can be seen in men with an enlarged prostate and clients with a neurologic disorder (e.g., multiple sclerosis, Parkinson’s disease, spinal cord injury).
T
An impaired neurologic function can interfere with the normal mechanisms of urine elimination, resulting in a _________.
neurogenic bladder
T/F:
1st Statement: The client with a neurogenic bladder does not perceive bladder fullness and is therefore unable to control the urinary sphincters.
2nd Statement: The bladder may become flaccid and distended or spastic, with frequent involuntary urination.
Both T
When emptying of the bladder is impaired, urine accumulates and the bladder becomes overdistended, a condition known as ___________.
urinary retention
Overdistention of the bladder causes poor __________ of the detrusor muscle, further impairing urination.
contractility
Common causes of urinary retention include prostatic __________ (enlargement), surgery, and some medications
hypertrophy
T/F:
1st Statement: Chronic urinary retention is the most common complication in the first 2 to 4 hours postoperatively.
2nd Statement: Acute urinary retention can include paraplegia, quadriplegia, multiple sclerosis, and urethral or perineal trauma
Both F - Acute; Chronic
Choose all that is included in Assessment:
- Nursing history
- Physical assessment of the genitourinary system, hydration status, and examination of the urine
- Relating the data obtained to the results of any diagnostic tests and procedures.
- Bowel pattern
1st to 3rd only
In nursing history, the nurse determines the client’s (choose all that apply):
- normal voiding pattern and frequency
- appearance of the urine and any recent changes
- any past or current problems with urination
- the presence of an ostomy, and factors influencing the elimination pattern.
All of the above
Complete physical assessment of the urinary tract usually includes:
- percussion of the kidneys to detect areas of tenderness.
- palpation and percussion of the bladder are also performed.
- if the client’s history or current problems indicate a need for it, the urethral meatus of both male and female clients is inspected for swelling, discharge, and inflammation.
- SpO2 Concentration
1st to 3rd statements only
Problems with urination can affect the elimination of wastes from the body, it is important for the nurse to assess the:
- skin for color
- adventitious breath sounds
- texture and tissue turgor as well as the presence of edema
1st and 3rd only
T/F: If incontinence, dribbling, or dysuria is noted in the history, the skin of the perineum should be inspected for irritation because contact with urine can excoriate the skin.
T
Choose the statements that is/are true:
- normal urine consists of 96% water and 4% solutes
- organic solutes include urea, ammonia, creatinine, and uric acid.
- creatine is the chief organic solute
- inorganic solutes include sodium, chloride, potassium, sulfate, magnesium, and phosphorus.
- sodium chloride is the most abundant inorganic salt.
- variations in color can occur.
1st, 2nd, 4th, 5th, and 6th only; Urea
T/F: Normally, the kidneys produce urine at a rate of approximately 60 mL/h or about 1,500 mL/day.
T
_______ is affected by many factors, including fluid intake, body fluid losses through other routes such as perspiration and breathing or diarrhea, and the cardiovascular and renal status of the individual.
Urine output
T/F: Urine outputs below 50 mL/h may indicate low blood volume or kidney malfunction and must be reported.
F - 30 mL
What’s the normal amount for urine output?
1,200–1,500 mL
What’s the abnormal amount for urine output?
Under 1,200 mL or A large amount over intake
T/F:
1st Statement: Urinary output normally is approximately equal to fluid intake.
2nd Statement: Output of less than 30 mL/h may indicate increased blood flow to the kidneys and should be immediately reported.
1st T 2nd F - decreased
What is the normal color and clarity of the urine?
Straw, amber or Transparent
What is the abnormal color or clarity of the urine?
- Dark amber
- Cloudy
- Dark orange
- Red or dark brown Mucous plugs
- viscid, thick
Select the following that is/are true about urine’s color and clarity:
- concentrated urine is darker in color
- dilute urine may appear almost clear, or very pale yellow.
- some foods and drugs may color urine.
- red blood cells in the urine (hematuria) may be evident as pink, bright red, or rusty brown urine.
- menstrual bleeding can also color urine but should not be confused with hematuria.
- white blood cells, bacteria, pus, or contaminants such as prostatic fluid, sperm, or vaginal drainage may cause cloudy urine.
All of the above
What should be the odor of urine?
faint aromatic
What should not be the odor of urine?
offensive
Select the following that is/are true about urine:
- some foods (e.g., asparagus) cause a musty odor
- infected urine can have a fetid odor
- urine that is colored yellow to orange should have an orange-y odor
- urine high in glucose has a sweet odor.
1st, 2nd, and 4th
What is the normal sterility of urine?
No microorganism present
T/F:
1st Statement: Urine in the bladder is unsterile.
2nd Statement: Urine specimens may be contaminated by bacteria from the perineum during collection.
1st F 2nd T - urine in the bladder is sterile
What is the normal pH of urine?
4.5–8
What is the abnormal pH of urine?
Over 8 Under 4.5
Select the following that is/are true about urine:
- freshly voided urine is normally somewhat acidic
- alkaline urine may indicate a state of alkalosis, UTI, or a diet high in fruits and vegetables.
- more acidic urine (low pH) is found in starvation, with diarrhea, or with a diet high in protein foods or cranberries.
All of the above
What is the normal specific gravity of urine?
1.010–1.025
T/F: Concentrated urine has a higher specific gravity; diluted urine has a lower specific gravity.
T
Is glucose should be present in urine?
No
T/F: Glucose in the urine indicates high blood glucose levels (greater than 180 mg/dL) and may be indicative of undiagnosed or uncontrolled diabetes mellitus.
T
Is ketone bodies should be present in urine?
No
________, the end product of the breakdown of fatty acids, are not normally present in urine. They may be present in the urine of clients who have uncontrolled diabetes mellitus, who are in a state of starvation, or who have ingested excessive amounts of aspirin.
Ketones
Is blood should be present in urine?
No.
________ may be present in the urine of clients who have UTI, kidney disease, or bleeding from the urinary tract.
Blood
Is the urine remaining in the bladder following voiding and is normally 50 to 100 mL.
Postvoid residual (PVR)
Manifestations of urine retention may include:
frequent voiding of small amounts (e.g., less than 100 mL in an adult), urinary stasis, and UTI.
_______ is measured to assess the amount of retained urine after voiding and determine the need for interventions (e.g., medications to promote detrusor muscle contraction).
PVR
To measure PVR, the nurse _______ or ________ the client after voiding.
catheterizes; bladder scans
T/F:
1st Statement: The amount of urine voided and the amount obtained by catheterization or bladder scan are measured and recorded.
2nd Statement: An indwelling catheter may be inserted if the PVR exceeds a specified amount.
Both T
Blood levels of two metabolically produced substances, ________, are routinely used to evaluate renal function.
urea and creatinine
T/F: The kidneys through filtration and tubular secretion normally eliminate both urea and creatinine.
T
Urea, the end product of protein metabolism, is measured as __________.
blood urea nitrogen (BUN)
Creatinine is produced in relatively constant quantities by the _________.
muscles
The _________ uses 24-hour urine and serum creatinine levels to determine the glomerular filtration rate, a sensitive indicator of renal function.
creatinine clearance test
NANDA International includes two general diagnostic labels for urinary elimination:
Impaired Urinary Elimination and Readiness for Enhanced Urinary Elimination
Diagnosis that includes dysfunction in urine elimination
Impaired Urinary Elimination
Diagnosis that includes a pattern of urinary functions for meeting eliminatory needs, which can be strengthened.
Readiness for Enhanced Urinary Elimination
The more specific NANDA International nursing diagnoses related to urinary elimination include the following:
- Functional Urinary Incontinence
- Overflow Urinary Incontinence
- Reflex Urinary Incontinence
- Stress Urinary Incontinence
- Urge Urinary Incontinence
- Risk for Urge Urinary Incontinence
- Urinary Retention
Inability of usually continent person to reach toilet in time to avoid unintentional loss of urine
Functional Urinary Incontinence
Involuntary loss of urine associated with overdistention of the bladder
Overflow Urinary Incontinence
Involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached.
Reflex Urinary Incontinence
Sudden leakage of urine with activities that increase intra-abdominal pressure
Stress Urinary Incontinence
Involuntary passage of urine occurring soon after a strong sense of urgency to void
Urge Urinary Incontinence
Vulnerable to involuntary passage of urine occurring soon after a strong sensation or urgency to void, which may compromise health
Risk for Urge Urinary Incontinence
If the client has urinary retention or undergoes an invasive procedure such as catheterization or cystoscopic examination.
Risk for Infection
If the client is incontinent. Incontinence can be physically and emotionally distressing to clients because it is considered socially unacceptable. Often the client is embarrassed about dribbling or having an accident and may restrict normal activities for this reason.
Situational Low Self-Esteem or Social Isolation
If the client is incontinent. Bed linens and clothes saturated with urine irritate and macerate the skin. Prolonged skin dampness leads to dermatitis (inflammation of the skin) and subsequent formation of dermal ulcers.
Risk for Impaired Skin Integrity
If the client has functional incontinence.
Toileting Self-Care Deficit
If the client has impaired urinary function associated with a disease
process.
Risk for Deficient Fluid Volume or Excess Fluid Volume
If the client has a urinary diversion ostomy.
Disturbed Body Image
If the client requires self-care skills to manage (e.g., a new urinary diversion ostomy).
Deficient Knowledge
If the client is incontinent and being cared for by a family member for extended periods.
Risk for Caregiver Role Strain
If the client is incontinent.
Risk for Social Isolation
Examples of overall goals for clients with urinary elimination problems may include the following (select the ones that apply):
- Maintain or restore a normal voiding pattern.
- Regain normal urine output.
- Prevent associated risks such as infection, skin breakdown, fluid and electrolyte imbalance, and lowered self-esteem.
- Perform toileting activities independently with or without assistive devices.
- Contain urine with the appropriate device, catheter, ostomy appliance, or absorbent product.
T/F: To provide for continuity of care, the nurse needs to consider the client’s needs for teaching and assistance with care in the home.
T
T/F: Discharge planning includes assessment of the client and family’s resources and abilities for self-care, available financial resources, and the need for referrals and home health services.
T
Increasing fluid intake increases urine production, which in turn stimulates the ________. A normal daily intake averaging 1,500 mL of measurable fluids is adequate for most adult clients.
micturition reflex
Many clients have increased ________, necessitating a higher daily fluid intake. For example, clients who are perspiring excessively (have diaphoresis) or who are experiencing abnormal fluid losses through vomiting, gastric suction, diarrhea, or wound drainage require fluid to replace these losses in addition to their normal daily intake requirements.
fluid requirements
Clients who are at risk for UTI or urinary calculi (stones) should consume 2,000 to 3,000 mL of fluid daily. _________ and frequent urination reduce the risk of UTI as well as stone formation.
Dilute urine
T/F:
1st Statement: Increased fluid intake are encouraged for some clients such as people with kidney failure or heart failure.
2nd Statement: For these clients, a fluid restriction may be necessary to prevent fluid overload and edema.
1st F 2nd T - may be contraindicated
T/F: Prescribed medical therapies often interfere with a client’s normal voiding habits. When a client’s urinary elimination pattern is adequate, the nurse helps the client adhere to normal voiding habits as much as possible.
T
T/F: Clients who are weakened by a disease process or impaired physically may require assistance with toileting.
T
Most UTIs are caused by bacteria common to the intestinal environment (e.g., _________).
Escherichia coli
T/F: UI is a normal part of aging and often is treatable.
F - not normal part of aging
Independent nursing interventions for clients with UI include:
(a) a behavior-oriented continence training program that may consist of bladder retraining, habit training, and pelvic floor muscle exercises; (b) meticulous skin care;
(c) for males, application of an external drainage device (condom-type catheter device).
Which requires that the client postpone voiding, resist or inhibit the sensation of urgency, and void according to a timetable rather than according to the urge to void.
Bladder retraining
Select the statements that is/are of Bladder Retraining:
- The goals are to gradually lengthen the intervals between urination to correct the client’s frequent urination, to stabilize the bladder, and to diminish urgency.
- This form of training may be used for clients who have bladder instability and urge incontinence.
- Delayed voiding provides larger voided volumes and longer intervals between voiding.
- Initially, voiding may be encouraged every 2 to 3 hours except during sleep and then every 4 to 6 hours.
All of the above
A vital component of bladder training is inhibiting the urge-to-void sensation. To do this, the nurse instructs the client to practice deep, slow ______ until the urge diminishes or disappears.
breathing
Also referred to as scheduled toileting, attempts to keep clients dry by having them void at regular intervals, such as every 2 to 4 hours. The goal is to keep the client dry and is a common therapy for frail older clients and those who are bedridden or have Alzheimer’s disease
Habit training
Pelvic floor muscle (PFM), or _______, exercises help to strengthen pelvic floor muscles and can reduce or eliminate episodes of incontinence.
Kegel
The client can identify the perineal muscles by tightening the ________ as if to control the passing of gas or to hold a bowel movement.
anal sphincter
bonus
bonus
When the exercise is properly performed, contraction of the muscles of the buttocks and thighs is ________. PFM can be performed anytime, anywhere, sitting or standing.
avoided
If these actions are unsuccessful, the primary care provider may order a _________ such as bethanechol chloride (Urecholine) to stimulate bladder contraction and facilitate voiding.
cholinergic drug
Clients who have a _______ bladder (weak, soft, and lax bladder muscles) may use manual pressure on the bladder to promote bladder emptying.
flaccid
The method that uses manual pressure on the bladder to promote bladder emptying.
Credé’s maneuver
T/F: Credé’s maneuver is advised without a primary care provider or nurse practitioner’s order and is used only for clients who have lost and are not expected to regain voluntary bladder control.
F - it is not advised
When all measures fail to initiate voiding, ________ may be necessary to empty the bladder completely. An ________ may be inserted until the underlying cause is treated.
urinary catheterization; indwelling Foley catheter
Alternatively, _________ (every 3 to 4 hours) may be performed because the risk of UTI may be less than with an indwelling catheter.
intermittent straight catheterization
________ is the introduction of a catheter into the urinary bladder. This is usually performed only when absolutely necessary, because the danger exists of introducing microorganisms into the bladder.
Urinary catheterization
A _________ is a “urinary tract infection that occurs while an indwelling catheter is in place or within 48 hours of its removal”
catheter-associated urinary tract infection (CAUTI)
Another hazard is ________ with urethral catheterization, particularly in the male client, whose urethra is longer and more tortuous.
trauma
T/F:
1st Statement: It is not important to insert a catheter along the normal contour of the urethra.
2nd Statement: Damage to the urethra can occur if the catheter is forced through strictures or at an incorrect angle.
1st F 2nd T - it is important
In males, the urethra is normally _______, but it can be straightened by elevating the penis to a position perpendicular to the body.
curved
T/F: Catheters are commonly made of rubber or plastics although they may be made from latex, silicone, or polyvinyl chloride (PVC).
T
They are sized by the diameter of the lumen using the ________. the larger the number, the larger the lumen.
French (Fr) scale
Either ________, inserted to drain the bladder and then immediately removed, or ________, which remain in the bladder to drain urine, may be used.
straight catheters; retention catheters
The _________ is a single-lumen tube with a small eye or opening about 1.25 cm (0.5 in.) from the insertion tip
straight catheter
The ________ is a double-lumen catheter. The outside end of this two-way retention catheter is bifurcated; that is, it has two openings, one to drain the urine, the other to inflate the balloon
retention, or Foley catheter
The _______ lumen drains urine from the bladder and the second _______ lumen is used to inflate the balloon near the tip of the catheter to hold the catheter in place within the bladder.
larger; smaller
A variation of the indwelling catheter is the ________, which has a curved tip. This is sometimes used for men who have a hypertrophied prostate because its tip is somewhat stiffer than a regular catheter and thus it can be better controlled during insertion, and passage is often less traumatic.
coudé (elbowed) catheter
Clients who require continuous or intermittent bladder irrigation may have a three-way Foley catheter. The three-way catheter has a ______ through which sterile irrigating fluid can flow into the bladder. The fluid then exits the bladder through the drainage lumen, along with the urine.
third lumen
The _______ of the retention catheter balloon is indicated on the catheter along with the diameter, for example, “#16 Fr—5 mL balloon.”
size
The purpose of the _______ is to secure the catheter in the bladder.
catheter balloon
T/F: Pre-testing of silicone balloons in particular is not recommended because the silicone can form a cuff or crease at the balloon area that can cause trauma to the urethra during catheter insertion.
T
T/F: It is important to follow the manufacturer’s instructions for the proper volume to use for balloon inflation. Improperly inflated catheter balloons may cause drainage and deflation difficulties.
T
Retention catheters are usually connected to a closed gravity drainage system. This system consists of:
the catheter, drainage tubing, and a collecting bag for the urine.
T/F: A closed system cannot be opened anywhere along the system, from catheter to collecting bag.
T
Some health facilities, however, may use an open system, which consists of:
separate packages for the catheter and the drainage tubing and collecting bag.
T/F:
1st Statement: The open system requires the nurse to be especially vigilant to ensure sterile technique is maintained when connecting the catheter and drainage tubing.
2nd Statement: The open system is preferred because it reduces the risk of microorganisms entering the system and infecting the urinary tract.
1st T 2nd F - closed
T/F: Nursing care of the client with an indwelling catheter and continuous drainage is largely directed toward preventing infection of the urinary tract and encouraging urinary flow through the drainage system.
T
The client with a retention catheter should drink up to 3,000 mL/day if permitted.
T/F:
- Large amounts of fluid ensure a large urine output, which keeps the bladder flushed out and decreases the likelihood of urinary stasis and subsequent infection.
- Small volumes of urine also minimize the risk of sediment or other particles obstructing the drainage tubing.
1st T 2nd F - large volumes
__________ the urine of clients with a retention catheter may reduce the risk of UTI and calculus formation. Foods such as eggs, cheese, meat and poultry, whole grains, cranberries, plums and prunes, and tomatoes tend to increase the acidity of urine. Conversely, most fruits and vegetables, legumes, and milk and milk products result in alkaline urine.
Acidifying
T/F: No special cleaning other than routine hygienic care is necessary for clients with retention catheters, nor is special meatal care recommended.
T
T/F: Routine changing of catheter and tubing is not recommended.
T
Collection of sediment in the catheter or tubing and impaired urine drainage are _______ for changing the catheter and drainage system. When this occurs the catheter and drainage system are removed and discarded, and a new sterile catheter with a closed drainage system is inserted using an aseptic technique.
indicators
T/F:
- If the catheter has been in place for a short time (e.g., 48 to 72 hours), the client usually has little difficulty regaining normal urinary elimination patterns.
- Swelling of the urethra, however, may initially interfere with voiding, so the nurse should regularly assess the client for urinary retention until voiding is re-established.
Both T
Clients who have had a retention catheter for a prolonged period may require bladder retraining to regain bladder ________.
muscle tone
A few days before removal, the catheter may be _________ for specified periods of time (e.g., 2 to 4 hours), then released to allow the bladder to empty.
clamped
_______ is performed by many clients who have some form of neurogenic bladder dysfunction such as that caused by spinal cord injury and multiple sclerosis.
Clean intermittent self-catheterization (CISC)
The procedure for self-catheterization is similar to that used by the nurse to catheterize a client. Essential steps are outlined in the accompanying Client Teaching. Because the procedure requires physical and mental preparation, client assessment is important. The client should have:
- Sufficient manual dexterity to manipulate a catheter
- Sufficient mental ability
- Motivation and acceptance of the procedure
- For women, reasonable agility to access the urethra
- Bladder capacity greater than 100 mL.
T/F:
- Before teaching CISC, the nurse should establish the client’s voiding patterns, the volume voided, fluid intake, and residual amounts.
- CISC is easier for males to learn because of the visibility of the urinary meatus. Females need to learn initially with the aid of a mirror but eventually should perform the procedure by using only the sense of touch.
Both T
An irrigation is a flushing or washing-out with a specified solution. It is carried out on a primary care provider’s order, usually to wash out the bladder and sometimes to apply a medication to the bladder lining.
Bladder Irrigation
Catheter irrigations may also be performed to maintain or restore the patency of a catheter, for ex- ample, to remove pus or blood clots blocking the catheter. _______________ is used.
Sterile technique
The ________ is the preferred technique for catheter or bladder irrigation because it is associated with a lower risk of UTI.
Closed method
T/F:
- Closed catheter irrigations may be either continuous or intermittent.
- This method is most often used for clients who have had genitourinary surgery.
Both T
The _______ helps prevent blood clots from occluding the catheter. A _______, or triple lumen, catheter is generally used for closed irrigations. The irrigating solution flows into the bladder through the irrigation port of the catheter and out through the urinary drainage lumen of the catheter.
continuous irrigation; three-way
Occasionally open irrigation may be necessary to restore catheter patency. The risk of injecting microorganisms into the urinary tract is greater with open irrigations because the connection between the indwelling catheter and the drainage tubing is ________.
broken
T/F:
- The open method of catheter or bladder irrigation is performed with double-lumen indwelling catheters.
- It may be necessary for clients who develop blood clots and mucous fragments that occlude the catheter or when it is undesirable to change the catheter.
Both T
A ________ is inserted surgically through the abdominal wall above the symphysis pubis into the urinary bladder.
suprapubic catheter
A _________ is the surgical rerouting of urine from the kidneys to a site other than the bladder. Clients with bladder cancer often need a urinary diversion when the bladder must be removed or bypassed.
urinary diversion
With incontinent diversions clients have no control over the passage of urine and require the use of an _________ to contain the urine.
external ostomy appliance
T/F: Urinary diversions may or may not involve the removal of the bladder (cystectomy). Examples of incontinent diversions include ureterostomy, nephrostomy, vesicostomy, and ileal conduits.
T
A ________ is when one or both of the ureters may be brought directly to the side of the abdomen to form small stomas. This procedure, however, has some disadvantages in that the stomas provide direct access for microorganisms from the skin to the kidneys, the small stomas are difficult to fit with an appliance to collect the urine, and they may narrow, impairing urine drainage.
ureterostomy
A __________ diverts urine from the kidney via a catheter inserted into the renal pelvis to a nephrostomy tube and bag.
nephrostomy
A ________ may be formed when the bladder is left intact but voiding through the ure- thra is not possible (e.g., due to an obstruction or a neurogenic blad- der). The ureters remain connected to the bladder, and the bladder wall is surgically attached to an opening in the skin below the navel, forming an opening (stoma) for urinary drainage.
vesicostomy
The most common incontinent urinary diversion is the __________. In this procedure, a segment of the ileum is removed and the intestinal ends are reattached. One end of the portion removed is closed with sutures to create a pouch, and the other end is brought out through the abdominal wall to create a stoma.
ileal conduit or ileal loop
T/F:
- The ureters are implanted into the ileal pouch. The ileal stoma is more readily fitted with an appliance than ureterostomies because of its larger size.
- The mucous membrane lining of the ileum also provides some protection from ascending infection. Urine drains continuously from the ileal pouch.
Both T
The Kock (pronounced “coke”) pouch, or continent ileal bladder conduit, also uses a portion of the _________ to form a reservoir for urine
ileum
A continent diversion with a ________ involves replacing a diseased or damaged bladder with a piece of ileum and colon that is located in the same location as the bladder that was removed. As a result, a pouch or new bladder is created.
neobladder
