Elimination - Urination Flashcards
Why are women more from to UTI compared to men?
Female urethra is shorter, 1.5-2’’, making it more prone to UTI, where as male urethra 5.5-6 ¼’’
Generally describe the physiology/act of urination
1. Bladder volume increases
2. Stretch receptors triggered
3. Transmits impulse to spinal cord
4. Internal sphincter relaxes, urge to void
- If appropriate place and time, external urethral sphincter muscle relaxes and urination takes place
- If time, place inappropriate, then reflex subsides until stimulated again
T/F: Intake must not equal output
False, intake = output
Know the quantity of mL that you should be intaking and outputting.
In regards to intake, how make mL comes from:
- Drinks
- Water in food
- Metabolism byproduct
In regards to ouput, how make mL comes from:
- Urine
- Lungs
- Skin
- Sweat
- Feces
Intake - 2500 mL
- Drinks = 1500
- Water in food = 750
- Metabolism by product = 250
Output - 2500 mL
- Urine = 1500
- Lungs = 400
- Skin = 400
- Sweat = 100
- Feces = 100
How many cups of water is needed? How many mL?
8-10 cups (8 ounces) per day = 2000-3000 mL
Tenting is a sign of _________
dehydration
What type of patient problems will need I&O (Hint: 3)
Know disease examples of each
Disease states causing fluid RETENTION
- Renal failure
- Cardiac failure
- Liver failure
Disease states causing fluid LOSS
- Diarrhea
- Vomitting
- Hemorrhaging
Post-Operative Patients
- x
What are the components to be included when measuring a patient’s fluid intake and output? List all applicable items (Hint: 3 intake, 3 output)
Intake:
- Oral fluids (including water, jello, popsicles, ice cream)
- IV fluids
- Irrigations
Output:
- Urine
- Emesis (vomit)
- Drainage (from surgical sites, wounds, etc.)
What does GFR stand for? What does it indicate?
- GFR: glomerular filtration rate
- indicates how well kidneys functioning
What is a healthy GFR number?
If someone has kidney disease, would their GFR number be higher or lower?
- Healthy GFR - 120
- Kidney disease = ↓GFR
What are 2 major conditions that contribute to decrease kidney function?
- Diabetes
- HTN
What stage does hemodialysis get started?
How long does dialysis take?
- Stage 3b
- Dialysis can take up 4-5 hours
- Be done 3x/week
T/F: Peritoneal dialysis has to be done at a kidney care center
False, peritoneal dialysis can be done by the patient at home
What is the normal amount of urinary output? (in mL/hr)
60-120mL/hour
Oliguria
What are the causes of oliguria? (Hint: 3 causes)
decrease urine output; 24-hour urine output of less than 30mL/hr OR 400 mL/24 hours
- Lack of fluid intake
- Vomitting/Diarrhea (abnormal losses)
- Impaired blood flow to the kidneys
Anuria
absence of urine; 24-hour urine ouput is less than 50mL
Compare Acute Renal Failure (ARF) and Chronic Renal Failure (CRF) in terms of predisposing factors
Acute (ARF)
- Nephrotic drugs
- Severe dehydration
Chronic (CRF)
- Diabetes
- HTN
What is the normal range for specific gravity?
If the number is higher/lower than the normal range, what will the urine look like/what does it indicate about a persons fluid status?
- Specific gravity: 1.015-1.025
- ↑specific gravity = concentrated urine
- ↓specific gravity = dilute urine
Factors Affecting Urination - Developmental Considerations
What are common urinary changes and challenges that occur in elderly patients? (Select all that apply.)
- Increased urine concentration, resulting in higher specific gravity.
- Diminished urine concentration, resulting in lower specific gravity.
- Decreased bladder tone.
- Decreased bladder contractility.
- Muscle weakness interfering with reaching the toilet in time.
- Decreased use of medications that affect urinary function.
- Increased medication use with side effects that may impact urinary function.
Correct Answers
2. Diminished urine concentration, resulting in lower specific gravity
3. Decreased bladder tone
4. Decreased bladder contractility
5. Muscle weakness interfering with reaching the toilet in time
7. Increased medication use with side effects that may impact urinary function
Incorrect Answers:
1. Increased urine concentration, resulting in higher specific gravity.
6. Decreased use of medications that affect urinary function.
Factors Affecting Urination - Food and Fluid
What type of effect does alcohol have on urine production?
How does sodium affect urine production?
Alcohol
- Diuretic effect -> increase urine production
Sodium Content
- Increase H2O reabsorption -> decrease urine production (more water retained by the body)
Factors Affecting Urination - Activity
Describe the effects immobility has on the urinary system
Immobility
- Funtional incontinence: urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation
- Poor muscle tone
Factors Affecting Urination - Psychological
What are 2 psychological factors that can affect urination?
- Embarassment
- Stress
Factors Affecting Urination - Medicaiton
How can medication affect urine? (Hint: color)
Can cause color changes in urine (brown)
Factors Affecting Urination - Medical Status
How do pathologic conditons and post op effects of anesthesia affect urine output?
Pathologic Conditions
- Most cuase fluid retention and decreased urine output
Post Op Effects of Anesthesia
- Usually cause fluid retention
Factors Affecting Urination - Personal Habits
How can wiping back to front affect the urinary system?
- May cause UTI, leading to painful urination and lower abdominal pain when urinating
-> Encourage patient to drink cranberry juice
Factors Affecting Urination - Other factors
How can diagnositc exams affect urination?(Hint: Cytoscopy)
-
Cytoscopy: scope in the bladder
-> Cause dysuria (painful/difficult urination)
What 5 things do you inspect/palpate when performing a (bladder) physical exam on a patient.
- Kidney percussion (back): elicits pain if infection exists
- Bladder palpation–between the symphysis pubis and the umbilicus–check for distention
- Urethral meatus- external opening of urethra
- Skin: for color, clarity, odor, sediment
- Prostate: If enlarged -> indicate urinary retention
What are 3 abnormal characteristics of urine? Be able to describe each (if applicable)
-
High or low specific gravity
-> ↑specific gravity = concentrated urine
-> ↓specific gravity = dilute urine -
Blood, protein, glucose, nitrates, WBCs in urine
-> Blood = pink/red color
-> Protein = ↓pH urine (acidic)
-> Nitrates = suggest infection
-> WBC = suggest infection - Change in color from yellow, not due to meds or food
Functional incontinence
normal bladder function, but inability to reach the toilet due to environmental barriers, physical limitations, loss of memory, or disorientation
Stress incontinence
involuntary loss of urine due to weak pelvic floor muscles and/or deficient urethral spincter (initiated by laughing, coughing, etc)
Urinary Retention
What condition will show an enlarged prostate, indicating urinary retention?
- urine produced noramlly, but not excreted completely from the bladder
- BENIGN PROSTATIC HYPERTROPHY - enlarged prostate
How do they symtoms of UTI differ from a patient who is younger and a patient who is older?
Younger
- high grade fever
- dysuria
Older
- confusion
Pyelonephritis
(is a type of UTI) infection of upper urinary tract, involving kidney and ureters
Most urine tests will undergo a culture and sensitivity test. What is this test used to determine? What do they do?
Culture and sensitivity
- Determine type of bacteria and antibiotic to use
- Send to lab -> grow specimens -> take 3 days
Clean-catch Technique
specimen of urine is collected during midstream voiding to minimize bacterial contamination from adjacent anatomic areas
What are the steps involved in collecting a clean catch urine sample? (Select all that apply.)
- Instruct the patient to clean the genital area with soap and water before collecting the sample.
- Use a non-sterile specimen container for collection.
- Have the patient begin voiding into the toilet, pause, then continue into the sterile specimen container.
- Ensure the patient completely empties their bladder into the specimen container.
- Avoid any toilet paper from getting into the specimen container.
- Wear gloves while handling the specimen to maintain sterility.
Correct Answers:
1. Instruct the patient to clean the genital area with soap and water before collecting the sample.
3. Have the patient begin voiding into the toilet, pause, then continue into the sterile specimen container.
5. Avoid any toilet paper from getting into the specimen container.
6. Wear gloves while handling the specimen to maintain sterility.
Incorrect Answers:
2. Use a non-sterile specimen container for collection.
4. Ensure the patient completely empties their bladder into the specimen container
If collecting a sterile urine specimen through a needless port, what is the MOST important thing that you should do?
Clean the access port with an antiseptic swab (1 minute?) before attaching syringe
What does a complete urinalysis (UA) typically evaluate? (Select all that apply.)
- The concentration of urine as indicated by specific gravity.
- The presence of glucose, protein, and other substances using a dipstick test.
- Blood glucose levels.
- The growth of bacteria or pathogens and their sensitivity to antibiotics through culture & sensitivity testing.
- Kidney stone composition.
- pH and presence of blood in the urine using a dipstick test.
Correct Answers:
1. The concentration of urine as indicated by specific gravity.
2. The presence of glucose, protein, and other substances using a dipstick test.
4. The growth of bacteria or pathogens and their sensitivity to antibiotics through culture & sensitivity testing.
6. pH and presence of blood in the urine using a dipstick test.
Incorrect Answers:
3. Blood glucose levels
5. Kidney stone composition.
Match each urinary tract diagnostic test with its primary purpose.
Tests:
- KUB/Flat Plate
- Intravenous Pyelogram (IVP)
- CT scan
- Renal Ultrasound
- Cystoscopy
- Renal Biopsy
- Angiogram
Purposes:
A. Uses X-rays to create detailed images of the urinary tract, including the kidneys, ureters, and bladder.
B. A simple X-ray of the abdomen that visualizes the kidneys, ureters, and bladder without the use of contrast.
C. Involves the injection of a dye into a vein followed by X-rays to view the kidneys and ureters.
D. Uses sound waves to produce images of the kidneys and can help detect cysts, tumors, and obstructions.
E. Involves taking a small sample of kidney tissue for microscopic examination to diagnose kidney diseases.
F. Involves inserting a scope through the urethra into the bladder to visually inspect the interior surfaces of the bladder and urethra.
G. A catheter is inserted through the femoral artery and threaded to the renal arteries where dye is injected to visualize renal blood flow.
Correct Matches:
B - KUB/Flat Plate
C - Intravenous Pyelogram (IVP)
A - CT scan
D - Renal Ultrasound
F - Cystoscopy
E - Renal Biopsy
G - Angiogram
Nurse Jess is instructed to initiate a 24-hour urine collection for Mrs. Allen, who is being tested for suspected metabolic abnormalities. She starts the collection process by instructing Mrs. Allen to void into the collection container. She places the container on the counter in Mrs. Allen’s room without any ice and proceeds with other duties. Nurse Jess does not post any signs in Mrs. Allen’s room or bathroom to indicate that a 24-hour urine collection is in progress. At the end of the collection period, she submits the collected urine for analysis.
Identify all the mistakes Nurse Jess made during the 24-hour urine collection process. (Hint: 4 mistakes)
Mistake #1: She should have instructed Mrs. Allen to discard the first urine specimen to ensure the test results reflect only the urine produced during the 24-hour period following the first void.
Mistake #2: She should have placed the urine collection container on ice to preserve the integrity of substances in the urine that are prone to degradation.
Mistake #3: She failed to post signs, which are critical for informing all involved (both staff and the patient) to prevent accidental disposal of collected samples and ensure all urine is saved.
Mistake #4: She did not clearly communicate to Mrs. Allen the need to collect every urine sample after the initial discarded void, which is crucial for the accuracy of the test.
Post-void Residual (PVR)
amount of urine remaining in bladder immediatley after voiding
(PVR of >100 mL is an indication the bladder is not emptying correctly)
Reflex (nerve injury) Incontinence
What types of injuries/conditions may you see this type of incontinence in?
- occurs when pt experience emptying of the bladder without the sensation of the need to void, as a result of damage to the nerves that normally signal the brain that the bladder is filling
- Spinal cord injury
- Multiple sclerosis
Overflow Incontinence
involuntary loss of urine associated with overdistention and overflow of the bladder
Urge Incontinence
involuntary loss of urine that occurs soon after feeling an urgent need to void
What type of incontinence is due to weak pelvic muscles and can be precipitated by sneezing?
Stress incontinence
Blockage of the urethra due to BPH (benign prostatic hypertrophy) causes urinary _______.
retention
Kegal exercises exercise the _________ muscles. You should perform this exercise ______ - ________ times a day for ________- _________ weeks. You will want to squeeze and hold the muscle for ______ seconds. For females vaginal _________are recommended.
pubococcygeal
30-80x/day for 6-8 weeks
Hold 10 seconds
Vaginal weights recommended
A nurse is using various techniques to help a patient initiate urination. Which of the following methods are commonly used to simulate micturition? (Select all that apply.)
- Instructing the patient to assume their normal position for urination.
- Playing the sound of running water to stimulate the urge to urinate.
- Stroking the inner thigh to trigger the reflex.
- Placing the patient’s hands in cold water.
- Pouring warm water over the perineum to encourage urination.
Correct Answers:
1. Instructing the patient to assume their normal position for urination.
2. Playing the sound of running water to stimulate the urge to urinate.
3. Stroking the inner thigh to trigger the reflex.
5. Pouring warm water over the perineum to encourage urination.
Select all patient groups that are at an increased risk for developing urinary tract infections (UTIs). (Select all that apply.)
- Sexually active women
- Men with prostate hypertrophy
- Women who use diaphragms for contraception
- Young, healthy males
- Postmenopausal women
- Individuals with indwelling urinary catheters
- Individuals with diabetes mellitus
- Older adults with diabetes
- Individuals frequently using public swimming pools
1. Sexually active women
2. Men with prostate hypertrophy (technically she didnt mention it in the slides, but they are at risk for UTI)
3. Women who use diaphragms for contraception
5. Postmenopausal women
6. Individuals with indwelling urinary catheters
7. Individuals with diabetes mellitus
8. Older adults with diabetes
Which of the following are effective measures for preventing urinary tract infections? (Select all that apply.)
- Practicing good hygiene.
- Wiping from back to front after using the restroom (for females).
- Maintaining a high fluid intake, specifically around 2000 mL per day.
- Consuming cranberry juice to help acidify the urine.
- Voiding and washing the genital area immediately after sexual intercourse.
- Wearing synthetic underwear.
- Wearing cotton underwear.
- Limiting fluid intake to prevent frequent urination
Correct Answers
1. Practicing good hygiene.
3. Maintaining a high fluid intake, specifically around 2000 mL per day.
4. Consuming cranberry juice to help acidify the urine.
5. Voiding and washing the genital area immediately after sexual intercourse.
7. Wearing cotton underwear.
Select all the valid reasons for catheterization. (Select all that apply.)
- Relieving urinary retention.
- Obtaining a sterile urine specimen.
- Obtaining a urine specimen when usual methods can’t be used.
- Emptying the bladder before, during, or after surgery.
- Monitoring urine output in critically ill patients.
- Increasing comfort for terminally ill patients.
- Administering intravenous fluids.
- Managing urinary incontinence for convenience.
1. Relieving urinary retention.
2. Obtaining a sterile urine specimen.
3. Obtaining a urine specimen when usual methods can’t be used.
4. Emptying the bladder before, during, or after surgery.
5. Monitoring urine output in critically ill patients.
6. Increasing comfort for terminally ill patients.
What are essential aspects of Foley catheter care?(Select all that apply.)
- Protect catheter tubing when getting the patient out of bed (OOB).
- Clean the catheter and perineum area when bathing the patient.
- Empty the drainage bag only when it is completely full.
- Keep the drainage bag below the level of the bladder and off the floor.
- Secure the catheter to the patient’s arm to limit movement.
- Secure the catheter to the thigh to prevent trauma and displacement.
- Store the drainage bag on the bed beside the patient.
1. Protect catheter tubing when getting the patient out of bed (OOB).
2. Clean the catheter and perineum area when bathing the patient.
4. Keep the drainage bag below the level of the bladder and off the floor.
6. Secure the catheter to the thigh to prevent trauma and displacement.
T/F: A foley catheter must be above the bladder at all times
False, must be below the bladder at all times
