January 21 - Nursing Care and the Urinary System Flashcards
Oliguria Anuria Hematuria Proteinuria Dysuria Polyuria
Oliguria-dec urine output
Anuria-no urine output
Hematuria-blood in the urine
Proteinuria- abnormal quantities of protein in the urine
Dysuria- painful urination
Polyuria-large amount of urine output
Assessment of Urine
- what do you look for
- normals of urinalysis 4
Colour, clarity Odour Urinalysis : -pH (4.8 – 8) -Specific gravity – 1.005 to 1.030 -Glucose, ketone, blood, protein -Leukocyte esterase, nitrates, wbcs
Urine Output normals
- adult urine output
- Avg adult bladder capacity
- how much mL to urge to urinate, discomfort lvl
- Normal urine output adult mL/hour
Adult urine output: 1500 mL/day
Average adult bladder capacity 600-1000 mL
200-250 urge to urinate; 400-600 discomfort
Normal urine output adult 30 to 60 mL/hour *report < 30ml/2hr.
How often do you empty urine bag
How full before you empty
When do you empty the big bag- every shift (8 or 12 hours)
Empty at about 40% full
What is urinary retention
What is dehydration
What helps?
Urinary retention- its in their bladder and they’re not peeing it out, urine is being produced
Dehydration- isn’t producing urine
Things to help- push fluids, mobilizing, pt education, running water, sit in a bath tub and pee, warm water, regular toileting, call bells, aesthetics
What is a bladder scanner
Whats it for
when do you use it
Ultrasound beside
Can use this to tell if they are dehydrated or urinary incontinent
Use this with post void residuals- can see how much is left in the bladder (greater than 150-200 requires some intervention) this is when there is urine left in the bladder after the pt has voided
What is an intermittent catheter/ indwelling (short term / long term)
When would you use
In and out used for
Tieman’s (Coude) Catheter has what at the end of its indwelling cath
Intermittent (irregular) retaining urine, after surgery and want them to pee, have a spinal cord injury and self catheterize
Indwelling catheter (short/ long term)- critically ill pt, sepsis, trauma- want to monitor the urine output every hour, post-op (depending on where the surgery was may need to keep the bladder empty to allow it to heal), terminal illness, late stag cancers
In and out- may also be used for medication into the bladder or for prostate surgery
The curl on the end is suppose to allow to get past the prostate
Remember what when giving catheter 4
A physician’s order is required for urethral catheterization removal
this is a sterile procedure
Gather all supplies, bring extra gloves and catheter, flashlight, lubricant, extra catheter for female catheterization
Bed at working height, position patient
Choice of catheter Kinds Material types Caution Size for adults and children Urological procedures Bulb Sizes
Straight (intermittent) vs. indwelling
Plastic (in and out), rubber, silicone or Teflon coated
Caution: allergy to rubber or latex
Size: #14-16 adult, #8 to10 for children
Urological procedures #20 -24
Bulb size: 3, 5, 10 or 30 mL SW
Cleaning Pubic areas
Male and females
Man - Man- clean from the urethra meatus down to the glands
Vagina - clean top to bottom, starting with
Balloon Inflation steps
Tape: non allergenic
We stop when we get urine back and then we go another 2.5cm and then we inflate the balloon
If you are on the edge still, deflate wait go further
Urine Tests 4
Methods of collection 3
Urine Tests: Urinalysis Urine culture (C & S) Timed urine e.g. 24 hour Dipstick (e.g. protein, glucose, pH)
Methods of Collection:
Clean voided: clean catch or midstream
Indwelling catheter
Suprapubic
Sterile Specimen Collection: where do you take it
Want to take a specimen from the bladder not from the catheter bag because then it is contaminated
Emptying Urine Bags
Safety Glasses
Don’t attach it to side sails
Perineal Care with Urinary Catheter
Perform after inserting catheter
Open/Closed Catheter Irrigation
Closed is better, no organisms
Catheter Removal
- is it sterile
- -what kind of syringe
DONT GO 6-8 HOURS WITHOUT VOIDING AFTER REMOVAL
no
The size of the balloon
UTI (Second most common bacterial disease)
-What are defense mechanisms to maintain sterility
What increases risk and its factors
What is community acquired
Classification and symptoms of uti Upper and lower tract and CAUTI
What is urethritis pyelonephritis
What is cystitis
Complete emptying of bladder Ureterovesical junction competence (where the urethral attaches to the bladder) Peristaltic activity Acidic pH High urea concentration
Alteration in defence mechanisms increases risk of UTI Predisposing factors: Factors increasing urinary stasis Foreign bodies Anatomical factors Compromised immune system Functional Disorders Other: catheter
Community acquired means that the person did not get it in the hospital it was contracted while out in everyday life and in the community (E. coli/ Pseudomonas)
Upper tract: Renal parenchyma, pelvis, and ureters. Causes fever, chills, flank pain, (can lead to sepsis / urosepsis) Pyelonephritis: inflammation of renal parenchyma and collecting system
Lower tract: bladder and down (no systemic symptoms) (cystitis)
Catheter-associated UTIs (CAUTIs):
Bacterial biofilms develop on inner surface of catheter
If things aren’t flowing well or aren’t treated properly
Cystitis—Inflammation and infection of the bladder wall
Pre-existing factors causing UTI:
Vesicoureteral reflux
Dysfunction of lower urinary tract
Vesicoureteral reflux:
Backward movement of urine from lower to upper urinary tract
Dysfunction of lower urinary tract:
Obstruction from BPH
Stricture
Urinary stone
Clinical Manifestations of UTI
And for elder
Frequency Urgency Dysuria Cloudy urine, blood present Incontinence Abdominal pain, flank pain (upper) Fatigue, malaise Fever, chills Nausea, vomiting
Symptoms are often absent
Experience non-localized abdominal discomfort rather than dysuria
May have cognitive impairment
Less likely to have a fever
What is urosepsis
Leads to?
Diagnosed with:
Systemic infection from urological source
Leads to septic shock and death involving gram negative organism
Urinalysis/dipstick :
Presence of nitrites, WBCs, leukocyte esterase, blood
