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nursing 20030 > interventions for urinary elimination > Flashcards

interventions for urinary elimination Flashcards

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1
Q

name the structures of the urinary system

A
  • kidneys/ureters
  • bladder
  • urethra
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2
Q

describe the urethra

A
  • 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
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3
Q

describe the kidneys

A
  • 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)
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4
Q

describe nephrons

A
  • 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
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5
Q

describe the urinary bladder

A
  • 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)
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6
Q

what are the functions of the urinary system

A
  • filtration of blood
  • micturition/voiding
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7
Q

describe micturition and voiding

A
  • 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
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8
Q

describe the assessment of history of urinary elimination

A
  • changes in urination? (color, frequency, amount)
  • pain or discomfort? (during voiding or in back/flanks)
  • previous history of urinary problems? (UTIs, kidney stones, incontinence)
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9
Q

describe objective data in assessment of urinary elimination

A
  • volume of urine (measured intake and output)
  • characteristics of urine (color, clarity, odor)
  • diagnostic test results
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10
Q

what are some aspects of further investigation into abnormal findings regarding urinary elimination

A
  • 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
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11
Q

how does fluid intake impact urinary elimination

A

affects kidney function and urine production

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12
Q

how do dietary habits impact urinary elimination

A

can contribute to kidney stone formation

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13
Q

how does pregnancy impact urinary elimination

A

–change in hormones suppresses antidiuretic hormone - increased urination

  • increase in blood volume → more work for kidneys → increased urination
  • baby pressing on bladder
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14
Q

name some different causes of urinary obstruction

A

renal calculi, edema, tumor, or enlarged prostate in men

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15
Q

what are some common medications that may increase urine output

A
  • diuretics → prevent reabsorption of water → increased output
  • cholinergics → stimulate contraction of detrusor muscle
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16
Q

how do analgesics effect urinary elmination

A
  • acts on the CNS and supresses it
  • causes diminished output
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17
Q

what are some nursing diagnosis to consider r/t urinary elimination

A
  • urinary incontinence
  • risks for infections
  • toileting: self care deficit
  • impaired urinary elimination
  • urinary retention
  • disturbed body image
  • pain
  • impaired skin integrity
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18
Q

define dysuria

A

painful or difficult urination

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19
Q

define polyuria

A

producing abnormally large volumes of urine

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20
Q

define oliguria

A

producing inadequate amounts of urine

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21
Q

define anuria

A

producing less than 50ml/day of urine

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22
Q

define urgency

A

strong need to urinate

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23
Q

define frequency

A

feeling the need to urinate more often

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24
Q

define nocturia

A

needing to void more frequently during the night

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25
Q

define hematuria

A
  • blood in urine
  • may be microscopic or gross
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26
Q

define pyuria

A

pus in the urine

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27
Q

define urinary retention

A

producing urine but not able to void

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28
Q

define enuresis

A

bed wetting

29
Q

define urinary incontinence

A

involuntary loss of control of urinary elimination

30
Q

define stress incontinence

A
  • most frequently experienced
  • inability to prevent escape of small amount of urine with increased abdominal stress (coughing, sneezing, or laughing)
31
Q

describe urge incontinence

A

sudden/strong urge to empty bladder, involuntary

32
Q

define functional incontinence

A
  • not a problem with bladder/nervous system/muscles
  • cant get to bathroom soon enough (physical limitations)
33
Q

define total incontinence

A
  • involuntary and unpredictable
  • can be continuous
  • no control
34
Q

describe kegals

A
  • helps improve pelvic floor function
  • contract muscles that stop the flow of urine
35
Q

describe urinary diversion

A
  • 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
36
Q

what types of diagnostic tests can be done for assessing urine

A
  • laboratory analysis of urine
  • bloodwork
  • radiologic tests
37
Q

what types of laboratory analysis are done to assess urine

A
  • 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
38
Q

what blood work is used to assess urine

A

-BUN (Blood Urea Nitrogen)

-creatinine

-increase in these levels indicate that kidneys are not functioning properly

39
Q

what radiologic tests are done to assess urine

A
  • 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
40
Q

is urinalysis clean or sterile?

A

clean

41
Q

is C&S clean or sterile?

A

sterile

42
Q

describe sterile samples

A
  • clean catch/midtstream
  • catheterized sample → intermittent catheter (straight from bladder to cup) or using previously placed foley catheter (sterilize and use sampling port)
43
Q

describe 24 hour urine collection

A
  • 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
44
Q

what are some indications for urinary catheterization

A
  • 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
45
Q

name different types of urinary catheters

A
  • external catheter
  • straight catheter
  • indwelling catheter
  • suprapubic
46
Q

describe an external catheter

A
  • male (condom/texas)
  • female (wick)
  • less risk of UTI
  • requires maintenance and education and must be replaced frequently
47
Q

describe a straight or intermittent catheter

A
  • uses sterile technique
  • used to collect sample or relieve urinary retention
48
Q

describe an indwelling or foley catheter

A
  • sterile technique is used
  • inserted and balloon is inflated
  • connected to bag and drains by gravity
49
Q

describe suprapubic catheter

A
  • surgically inserted through abdomen
  • permanent
  • causes less trauma and is less invasive
  • increased comfort and decreased urinary tract infections
50
Q

catheter size is measured in units of…

A
  • french
  • in adults 14-18 french are normal sizes
  • select the smallest functional size
51
Q

describe a coude catheter

A
  • curved tip
  • easier insertion for men with enlarged prostates
  • generally used for men over the age of 50
52
Q

describe a continuous irrigation catheter

A
  • has different branches where urine comes out and irrigation fluid is sent into the bladder to clean it out
53
Q

what are some nursing considerations for urinary catheterization

A
  • 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
54
Q

what position should you place a female pt in for urinary catheterization

A

dorsal recumbent (preferred) or sidelying

55
Q

what position should you place a male pt in for urinary catheterization

A
  • lying flat
  • hold penis perpendicular to abdomen
56
Q

when performing surgical asepsis/sterile technique you should always start with the assumption that

A

an object is not sterile

57
Q

sterile items must always include:

A
  • intact and undamaged packaging
  • expiration or use by date
  • “STERILE”
58
Q

opened but unused sterile items are considered…

A

unsterile

59
Q

sterile objects may only touch…

A

sterile objects

60
Q

nonsterile objects may only touch

A

nonsterile objects

61
Q

when creating a sterile field…

A
  • 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
62
Q

describe the use of antiseptic swabs on female patients prior to urinary catheterization

A
  • 3 swabs
  • move from top to bottom
  • 1 over labia minora
  • 1 over other side
  • 1 right down the middle over urethra
63
Q

describe the use of antiseptic swabs on male patients prior to urinary catheterization

A
  • 3 swabs
  • start at urethral meatus and make concentric circles outward with each swab
64
Q

describe the preventions of skin irritation with urinary elimination

A
  • keeping skin clean and dry
  • using breathable underpads
  • barrier creams
65
Q

describe the preventions of falls with urinary elimination

A
  • targeted toileting/anticipating needs
  • education
66
Q

describe the preventions of UTIs/CAUTI with urinary elimination

A
  • 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
67
Q

describe the preventions of hematuria with urinary elimination

A
  • minimize catheterization
  • use smallest functional catheter
  • gentle insertion technique
  • secure indwelling catheters
  • secure drainage tubing to prevent pulling
68
Q

what term describe a condition in which 24 hour urine output is less than 50 ml?

a. dysuria
b. glycosuria
c. pyuria
d. anuria

A

d. anuria

nursing 20030 (31 decks)

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