interventions for urinary elimination Flashcards
name the structures of the urinary system
- kidneys/ureters
- bladder
- urethra
describe the urethra
- terminal ending of the urinary system that connects bladder to the outside
- shorter on females than males, makes females more susceptible to UTIs
- male’s also function sexually
describe the kidneys
- help to maintain the composition and volume of bodily fluids, particularly the blood
- filter and excrete blood constitutes not needed and retain the solutions or solutes that are needed
- help to concentrate and excrete waste product (urine)
describe nephrons
- functional unit of kidney
- where filtration occurs
- remove the end products of metabolism and help regulate fluid and electrolyte balance
- urine is then transported from kidney, through ureter, and to the bladder
describe the urinary bladder
- smooth muscle sack that is innervated by the ANS
- reservoir for urine
- composed of three layers called the detrusor muscle, internal sphincter, and external sphincter (guards opening between urinary bladder and urethra)
what are the functions of the urinary system
- filtration of blood
- micturition/voiding
describe micturition and voiding
- elimination of waste products
- when bladder senses that there is sufficient amount of urine → detrusor muscle contracts → causes internal sphincter to relax → small amount of urine will empty into urethra and causes muscles of the perineum and external sphincter to relax → abdominal wall will contract very slightly → diaphragm will lower and bladder is emptied
describe the assessment of history of urinary elimination
- changes in urination? (color, frequency, amount)
- pain or discomfort? (during voiding or in back/flanks)
- previous history of urinary problems? (UTIs, kidney stones, incontinence)
describe objective data in assessment of urinary elimination
- volume of urine (measured intake and output)
- characteristics of urine (color, clarity, odor)
- diagnostic test results
what are some aspects of further investigation into abnormal findings regarding urinary elimination
- fluid intake/other fluid losses
- dietary habits
- mobility/ability to assume a functional position to urinate
- anxiety/embarrassment
- cognitive dysfunction
- neurologic injury
- pregnancy
- infection
- urinary obstruction
- medication history
how does fluid intake impact urinary elimination
affects kidney function and urine production
how do dietary habits impact urinary elimination
can contribute to kidney stone formation
how does pregnancy impact urinary elimination
–change in hormones suppresses antidiuretic hormone - increased urination
- increase in blood volume → more work for kidneys → increased urination
- baby pressing on bladder
name some different causes of urinary obstruction
renal calculi, edema, tumor, or enlarged prostate in men
what are some common medications that may increase urine output
- diuretics → prevent reabsorption of water → increased output
- cholinergics → stimulate contraction of detrusor muscle
how do analgesics effect urinary elmination
- acts on the CNS and supresses it
- causes diminished output
what are some nursing diagnosis to consider r/t urinary elimination
- urinary incontinence
- risks for infections
- toileting: self care deficit
- impaired urinary elimination
- urinary retention
- disturbed body image
- pain
- impaired skin integrity
define dysuria
painful or difficult urination
define polyuria
producing abnormally large volumes of urine
define oliguria
producing inadequate amounts of urine
define anuria
producing less than 50ml/day of urine
define urgency
strong need to urinate
define frequency
feeling the need to urinate more often
define nocturia
needing to void more frequently during the night
define hematuria
- blood in urine
- may be microscopic or gross
define pyuria
pus in the urine
define urinary retention
producing urine but not able to void
define enuresis
bed wetting
define urinary incontinence
involuntary loss of control of urinary elimination
define stress incontinence
- most frequently experienced
- inability to prevent escape of small amount of urine with increased abdominal stress (coughing, sneezing, or laughing)
describe urge incontinence
sudden/strong urge to empty bladder, involuntary
define functional incontinence
- not a problem with bladder/nervous system/muscles
- cant get to bathroom soon enough (physical limitations)
define total incontinence
- involuntary and unpredictable
- can be continuous
- no control
describe kegals
- helps improve pelvic floor function
- contract muscles that stop the flow of urine
describe urinary diversion
- surgical procedure when there is damage to the urinary system
- reroute from ureter to new passage way for urine to drain outside the body via stoma to urine collection device
what types of diagnostic tests can be done for assessing urine
- laboratory analysis of urine
- bloodwork
- radiologic tests
what types of laboratory analysis are done to assess urine
- urinalysis (looking at urine in lab)
- specific gravity → measure levels of solutes in urine (higher = more concentrated and lower = less concentrated)
- culture and sensitivity (C&S) → look for fungus that grows
- 24 hour urine collection
what blood work is used to assess urine
-BUN (Blood Urea Nitrogen)
-creatinine
-increase in these levels indicate that kidneys are not functioning properly
what radiologic tests are done to assess urine
- bladder scan/bladder ultrasound → noninvasive test, shows how much fluid is in the bladder
- intravenous pyelogram (IVP) → injected with dye and find narrowing or blockage in vascular system of kidneys
- cystoscopy → use of flexible camera up urethra to look at lining or inside of bladder
- urodynamic studies → any procedure that examines structure and function of the bladder, sphincter, or urethra
is urinalysis clean or sterile?
clean
is C&S clean or sterile?
sterile
describe sterile samples
- clean catch/midtstream
- catheterized sample → intermittent catheter (straight from bladder to cup) or using previously placed foley catheter (sterilize and use sampling port)
describe 24 hour urine collection
- discard first void
- collect all urine produced for 24 hours
- avoid contamination with stool
- keep collection container on ice or refrigerated
- at the end of the 24 hour period have client empty the bladder and add that void to the container before sending to the lab
what are some indications for urinary catheterization
- urinary retention
- prevention of further skin damage or wound contamination
- essential need for accurate output measurements (surgery, trauma, certain medical conditions)
- comfort during end of life care
name different types of urinary catheters
- external catheter
- straight catheter
- indwelling catheter
- suprapubic
describe an external catheter
- male (condom/texas)
- female (wick)
- less risk of UTI
- requires maintenance and education and must be replaced frequently
describe a straight or intermittent catheter
- uses sterile technique
- used to collect sample or relieve urinary retention
describe an indwelling or foley catheter
- sterile technique is used
- inserted and balloon is inflated
- connected to bag and drains by gravity
describe suprapubic catheter
- surgically inserted through abdomen
- permanent
- causes less trauma and is less invasive
- increased comfort and decreased urinary tract infections
catheter size is measured in units of…
- french
- in adults 14-18 french are normal sizes
- select the smallest functional size
describe a coude catheter
- curved tip
- easier insertion for men with enlarged prostates
- generally used for men over the age of 50
describe a continuous irrigation catheter
- has different branches where urine comes out and irrigation fluid is sent into the bladder to clean it out
what are some nursing considerations for urinary catheterization
- explain procedure steps and rationale for procedure
- provide privacy (close curtains and shut doors)
- position patient and drape appropriately
- perform routine perineal care prior to starting procedure
what position should you place a female pt in for urinary catheterization
dorsal recumbent (preferred) or sidelying
what position should you place a male pt in for urinary catheterization
- lying flat
- hold penis perpendicular to abdomen
when performing surgical asepsis/sterile technique you should always start with the assumption that
an object is not sterile
sterile items must always include:
- intact and undamaged packaging
- expiration or use by date
- “STERILE”
opened but unused sterile items are considered…
unsterile
sterile objects may only touch…
sterile objects
nonsterile objects may only touch
nonsterile objects
when creating a sterile field…
- minimize air movement (masks needed, fans off, minimal talking)
- sanitize the work surface and allow to dry
- always face the sterile field
- keep sterile field above your waist
- sterile items must be kept within the 1 inch nonsterile margin on field
- do not reach across the sterile field
describe the use of antiseptic swabs on female patients prior to urinary catheterization
- 3 swabs
- move from top to bottom
- 1 over labia minora
- 1 over other side
- 1 right down the middle over urethra
describe the use of antiseptic swabs on male patients prior to urinary catheterization
- 3 swabs
- start at urethral meatus and make concentric circles outward with each swab
describe the preventions of skin irritation with urinary elimination
- keeping skin clean and dry
- using breathable underpads
- barrier creams
describe the preventions of falls with urinary elimination
- targeted toileting/anticipating needs
- education
describe the preventions of UTIs/CAUTI with urinary elimination
- minimize use of indwelling catheters
- use strict sterile technique for insertion
- secure indwelling catheters to prevent infection
- pericare daily and after each episode of incontinence (routine cleaning products and gentle technique)
- appropriate management of drainage tubing and bag (prevent tubing obstruction)
- empty drainage bags every 8 hours
describe the preventions of hematuria with urinary elimination
- minimize catheterization
- use smallest functional catheter
- gentle insertion technique
- secure indwelling catheters
- secure drainage tubing to prevent pulling
what term describe a condition in which 24 hour urine output is less than 50 ml?
a. dysuria
b. glycosuria
c. pyuria
d. anuria
d. anuria
